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Masitinib treatment in patients with progressive multiple sclerosis: a randomized pilot study.
Vermersch P., Benrabah R., Schmidt N., Zéphir H., Clavelou P., Vongsouthi C., Dubreuil P., Moussy A., Hermine O.
BMC Neurology 12, 1 (2012) 36 - http://www.hal.inserm.fr/inserm-00740070
 (22691628) 
Masitinib treatment in patients with progressive multiple sclerosis: a randomized pilot study.
Patrick Vermersch () 1, Rabah Benrabah2, Nicolas Schmidt3, Hélène Zéphir1, Pierre Clavelou4, Cyrille Vongsouthi5, Patrice Dubreuil6, 7, Alain Moussy6, Olivier Hermine () 6, 8
1 :  Laboratoire d'Immunologie
Université Lille II - Droit et santé – Faculté de Médecine – Institut de Médecine Prédictive et de Recherche Thérapeutique (IMPRT) : IFR14 – EA 2686
Pôle Recherche - 1, place de Verdun 59045 Lille Cédex
France
2 :  Private Practice
Private practice
31 rue Letellier, Paris
France
3 :  Private Practice
Private practice
Rueil-Malmaison
France
4 :  Service de Neurologie
CHU Clermont-Ferrand – CHU Gabriel-Montpied – Université d'Auvergne - Clermont-Ferrand I
58, Bd Montalembert 63003 Clermont-Ferrand Cedex 1
France
5 :  Private Practice
Private practice
Montpellier
France
6 :  AB Science
AB Science Headquarter
3 avenue George V 75008 Paris
France
7 :  CRCM - Centre de recherche en cancérologie de Marseille
http://crcm.marseille.inserm.fr/
INSERM : U891 – Université de la Méditerranée - Aix-Marseille II
27, Bd Leï Roure - 13009 Marseille
France
8 :  Service d'hématologie adulte
Centre de référence des mastocytoses – CNRS : UMR8147 – Hôpital Necker - Enfants Malades – Université Paris V - Paris Descartes
149 - 161 rue de Sèvres 75743 Paris
France
ABSTRACT: BACKGROUND: Treatment options for patients suffering from progressive forms of multiple sclerosis (MS) remain inadequate. Mast cells actively participate in the pathogenesis of MS, in part because they release large amounts of various mediators that sustain the inflammatory network. Masitinib, a selective oral tyrosine kinase inhibitor, effectively inhibits the survival, migration and activity of mast cells. This exploratory study assessed the safety and clinical benefit of masitinib in the treatment of primary progressive MS (PPMS) or relapse-free secondary progressive MS (rfSPMS). METHODS: Multicenter, randomized, placebo-controlled, proof-of-concept trial. Masitinib was administered orally at 3 to 6 mg/kg/day for at least 12 months, with dose adjustment permitted in event of insufficient response with no toxicity. The primary response endpoint was the change relative to baseline in the multiple sclerosis functional composite score (MSFC). Clinical response was defined as an increase in MSFC score relative to baseline of > 100%. RESULTS: Thirty-five patients were randomized to receive masitinib (N = 27) or placebo (N = 8). Masitinib was relatively well tolerated with the most common adverse events being asthenia, rash, nausea, edema, and diarrhea. The overall frequency of adverse events was similar to the placebo group, however, a higher incidence of severe and serious events was associated with masitinib treatment. Masitinib appeared to have a positive effect on MS-related impairment for PPMS and rfSPMS patients, as evidenced by an improvement in MSFC scores relative to baseline, compared with a worsening MSFC score in patients receiving placebo; +103% +/- 189 versus -60% +/- 190 at month-12, respectively. This positive albeit non-statistically significant response was observed as early as month-3 and sustained through to month-18, with similar trends seen in the PPMS and rfSPMS subpopulations. A total of 7/17 (41%) assessable masitinib patients reported clinical response following 12 months of treatment (according to the modified intent-to-treat population, observed cases) compared with none in the placebo group. The Expanded Disability Status Scale remained stable for both treatment groups. CONCLUSION: These data suggest that masitinib is of therapeutic benefit to PPMS and rfSPMS patients and could therefore represent an innovative avenue of treatment for this disease. This exploratory trial provides evidence that may support a larger placebo-controlled investigation.
Sciences du Vivant/Neurosciences/Neurobiologie
Sciences du Vivant/Neurosciences
Anglais
1471-2377

Articles dans des revues avec comité de lecture
10.1186/1471-2377-12-36
BMC Neurology (BMC Neurol)
Publisher BioMed Central
ISSN 1471-2377 
internationale
12/06/2012
12/06/2012
12
1
36

Multiple sclerosis – Primary progressive multiple sclerosis – Secondary progressive multiple sclerosis – Tyrosine kinase inhibitor – Masitinib – Mast cells
This work was partially financed by INSERM (Institut National de la Santé et de la Recherche Médicale), la Ligue Nationale Contre le Cancer (équipe labellisée PD) and ANR-MRAR (Agence Nationale pour la Recherche, grant Maladies Rares - PD and OH) and INCA (Institut National du Cancer, grant Translationnel - PD and OH).
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