Effect of peginterferon beta-1a on MRI measures and achieving no evidence of disease activity: results from a randomized controlled trial in relapsing-remitting multiple sclerosis

Abstract

Background: Subcutaneous peginterferon beta-1a provided clinical benefits at Year 1 (placebo-controlled period) of the 2-Year Phase 3 ADVANCE study in relapsing-remitting multiple sclerosis (RRMS). Here we report the effect of peginterferon beta-1a on brain magnetic resonance imaging (MRI) lesions, and no evidence of disease activity (NEDA; absence of clinical [relapses and 12-week confirmed disability progression] and MRI [gadolinium-enhancing, and new or newly-enlarging T2 hyperintense lesions] disease activity) during Year 1.

Methods: RRMS patients (18-65 years; Expanded Disability Status Scale score ≤5) were randomized to double-blind placebo or peginterferon beta-1a 125 μg every 2 or 4 weeks. Sensitivity analyses of last observation carried forward and composite disease activity (using minimal MRI allowance definitions) were conducted.

Results: 1512 patients were randomized and dosed (placebo n = 500; peginterferon beta-1a every 2 [n = 512] or 4 [n = 500] weeks). Every 2 week dosing significantly reduced, versus placebo and every 4 week dosing, the number of new or newly-enlarging T2 hyperintense lesions at Weeks 24 (by 61% and 51%, respectively) and 48 (secondary endpoint; by 67% and 54%, respectively); all p < 0.0001. Every 2 week dosing also provided significant reductions versus placebo and every 4 week dosing in the number of new T1 hypointense, gadolinium-enhancing, and new active (gadolinium-enhancing plus non-enhancing new T2) lesions (all p < 0.0001), as well as the volume of T2 and T1 lesions (p < 0.05) at Weeks 24 and 48. Significantly more patients dosed every 2 weeks had NEDA versus placebo and every 4 weeks (all p < 0.01) from baseline to Week 48 (33.9% versus 15.1% and 21.5%, respectively [odds ratios, ORs: 2.89 and 1.87]), from baseline to Week 24 (41.0% versus 21.9% and 30.7%, [ORs: 2.47 and 1.57]) and from Week 24 to Week 48 (60.2% versus 28.9% and 36.6%, [ORs: 3.71 and 2.62]). Consistent results were seen when allowing for minimal MRI activity.

Conclusion: During Year 1 of ADVANCE, significantly more RRMS patients receiving peginterferon beta-1a every 2 weeks had NEDA, and early and sustained improvements in all MRI endpoints, versus placebo and every 4 week dosing. NEDA sensitivity analyses align with switch strategies in clinical practice settings and provide insight into future responders/non-responders.

Trial registration: ClinicalTrials.gov: NCT00906399.

Figure 1

Lesion numbers at Weeks 24 and 48. A) New or newly-enlarging T2 lesions ^aBased on negative binomial regression analysis, adjusted baseline T2 lesion number. The data for 48 weeks has been published previously [10]. CI = confidence interval. B) New T1 hypointense lesions compared to baseline ^bBased on mean number of new lesions only and p value based on multiple logit regression, adjusted for baseline number of T1 lesions. The data for 48 weeks has been published previously [10]. SE = standard error. C) Gd+ lesions ^cBased on mean number of lesions only and p value based on multiple logit regression, adjusted for baseline number of Gd+ lesions. Gd+ = gadolinium-enhancing; SE = standard error.

Figure 2

NEDA proportions. A) Baseline to Week 48. B). Baseline to Week 24. C). Weeks 24–48. ORs are shown with 95% confidence intervals in parentheses. ^aDefined as absence of both clinical (no relapses and no onset of 12-week confirmed disability progression over the interval) and MRI (no gadolinium-enhancing lesions and no new or newly-enlarging T2 hyperintense lesions) disease activity; data from patients with complete MRI results during the time interval were used for analysis of MRI disease activity. NEDA = No evidence of disease activity; MRI = magnetic resonance imaging; OR = odds ratio.