Daclizumab high-yield process in relapsing-remitting multiple sclerosis (SELECT): a randomised, double-blind, placebo-controlled trial.

Abstract

BACKGROUND:

Daclizumab, a humanised monoclonal antibody, modulates interleukin-2 signalling by blocking the α subunit (CD25) of the interleukin-2 receptor. We assessed whether daclizumab high-yield process (HYP) would be effective when given as monotherapy for a 1 year treatment period in patients with relapsing-remitting multiple sclerosis.

METHODS:

We did a randomised, double-blind, placebo-controlled trial at 76 centres in the Czech Republic, Germany, Hungary, India, Poland, Russia, Ukraine, Turkey, and the UK between Feb 15, 2008, and May 14, 2010. Patients aged 18-55 years with relapsing-remitting multiple sclerosis were randomly assigned (1:1:1), via a central interactive voice response system, to subcutaneous injections of daclizumab HYP 150 mg or 300 mg, or placebo, every 4 weeks for 52 weeks. Patients and study personnel were masked to treatment assignment, except for the site pharmacist who prepared the study drug for injection, but had no interaction with the patient. The primary endpoint was annualised relapse rate. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00390221.

FINDINGS:

204 patients were assigned to receive placebo, 208 to daclizumab HYP 150 mg, and 209 to daclizumab HYP 300 mg, of whom 188 (92%), 192 (92%), and 197 (94%), respectively, completed follow-up to week 52. The annualised relapse rate was lower for patients given daclizumab HYP 150 mg (0·21, 95% CI 0·16-0·29; 54% reduction, 95% CI 33-68%; p<0·0001) or 300 mg (0·23, 0·17-0·31, 50% reduction, 28-65%; p=0·00015) than for those given placebo (0·46, 0·37-0·57). More patients were relapse free in the daclizumab HYP 150 mg (81%) and 300 mg (80%) groups than in the placebo group (64%; p<0·0001 in the 150 mg group and p=0·0003 in the 300 mg group). 12 (6%) patients in the placebo group, 15 (7%) of those in the daclizumab 150 mg group, and 19 (9%) in the 300 mg group had serious adverse events excluding multiple sclerosis relapse. One patient given daclizumab HYP 150 mg who was recovering from a serious rash died because of local complication of a psoas abscess.

INTERPRETATION:

Subcutaneous daclizumab HYP administered every 4 weeks led to clinically important effects on multiple sclerosis disease activity during 1 year of treatment. Our findings support the potential for daclizumab HYP to offer an additional treatment option for relapsing-remitting disease.

FUNDING:

Biogen Idec and AbbVie Biotherapeutics Inc.

• Authors: Ralf Gold, Gavin Giovannoni, Krzysztof Selmaj, Eva Havrdova, Xavier Montalban, Ernst-Wilhelm Radue, Dusan Stefoski, Randy Robinson, Katherine Riester, Jitesh Rana, Jacob Elkins, Gilmore O'Neill, SELECT study investigators
• Journal: Lancet (London, England) (Lancet) Vol. 381 Issue 9884 Pg. 2167-75 (Jun 22 2013) ISSN: 1474-547X [Electronic] England
• PMID: 23562009 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Humanized
• Immunoglobulin G
• daclizumab HYP
• Daclizumab

Topics

• Adolescent
• Adult
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects)
• Daclizumab
• Dose-Response Relationship, Drug
• Double-Blind Method
• Drug Administration Schedule
• Europe
• Female
• Follow-Up Studies
• Humans
• Immunoglobulin G (administration & dosage, adverse effects)
• Injections, Subcutaneous
• Male
• Middle Aged
• Multiple Sclerosis, Relapsing-Remitting (diagnosis, drug therapy)
• Quality of Life
• Reference Values
• Risk Assessment
• Time Factors
• Treatment Outcome
• Young Adult