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Not yet recruitingNCT06663189TWINSUpdated Jan 3, 2025

Disease Modifying Therapies Withdrawal in Inactive Relapsing-remitting Multiple Sclerosis Patients Aged 55 and Over (TWINS : Therapies Withdrawal IN Relapsing Multiple Sclerosis)

A Phase 3 interventional study of treatment withdrawal and Usual DMT continuation in Relapsing-remitting Multiple Sclerosis (RRMS), sponsored by University Hospital, Strasbourg, France. Not yet recruiting at 22 sites in France. Open to participants aged 55 Years and older. Per ClinicalTrials.gov, last updated 2025-01-03.

Sponsored by University Hospital, Strasbourg, France · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
200
Allocation
Randomized
Ages
55 Years and older
Sex
All
01

Study summary

Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) characterized by loss of motor and sensory function, that results from immune-mediated inflammation, demyelination and subsequent axonal damage. It is the most common cause of neurological disability in young adults, involving a long-term therapeutic follow-up. 85% of the patients are diagnosed with Relapsing-Remitting form of MS (RRMS). This form is characterized by clearly defined acute or subacute neurological symptoms (relapses) followed by periods of partial to complete recovery.

Disease-modifying therapies (DMT) used to treat RRMS are immunomodulatory or suppressor molecules which have proven efficacy in limiting disease activity (decreasing relapse rate and delaying time to disease progression).

However, the long-term safety of DMT is uncertain, as there is an increased risk of developing adverse events or infections (sometimes severe) such as observed in the last pandemic of COVID-19 (higher risk of infection), highlighting the need to reassess the benefit/risk ratio of maintaining immunomodulatory or suppressive therapy in the MS population. In elderly patients with comorbidity, this risk is further increased. To date, few studies on the discontinuation of treatment in elderly RRMS patients have been conducted. However, those available demonstrate that there was no difference in relapse rates between patients who continued or discontinued treatment. These results are consistent with immunosenescence studies in RRMS that suggested a negative correlation between relapse rate/inflammatory processes and age. On the contrary, there is evidence indicating a positive correlation between age and the number of infections.

In addition, in the current context in France, it is important to take into account the medico-social cost associated with long-term treatments. In France, the average estimated annual cost per patient is 12,000€, more than half of which is attributed to medications.Furthermore, with age progression, an inversion of the benefit/cost assessment has been observed in treated patients.

Considering these medical and medico-social factors, it is reasonable to question the value of continuing treatment in stable patients with RRMS over 55 years.

This is a randomized, controlled, multicentric, open-label, parallel groups, 1:1 ratio non-inferiority clinical trial, comparing (1) a group that will stop treatment, to (2) a group that will continue treatment, over the course of 2 years, to determine the survival rate without MS activity defined clinically or by imaging.

The patients in both arms will be followed over 2 years after randomization. 5 visits will be performed for all patients: inclusion/randomization visit (M0) and 4 follow-up visits every 6 months (M6, M12, M18, and M24). An additional phone call at M3 is planned.

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Conditions studied

  • Relapsing-remitting Multiple Sclerosis (RRMS)
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In context

Multiple Sclerosis

3,460 studies on the registry are indexed under Multiple Sclerosis; 661 are open to participants now.

This study's planned enrollment of 200 is above the median of 50 across 2,342 interventional studies indexed under Multiple Sclerosis.

Browse Multiple Sclerosis studies →

Lead sponsor

University Hospital, Strasbourg, France is the lead sponsor of 966 studies on the registry; 342 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
55 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Patient (male or female) aged 55 and over
  2. RRMS diagnosis according to revised McDonald 2017 criteria
  3. First MS symptom >5 years ago. If the date is unknown, RRMS diagnosis >5 years ago
  4. Stable disease in the last 5 years according to the revised Lublin and Reingold classification characterized by :

    Stable T2 lesions documented by MRI performed at least 5 years prior to inclusion versus MRI performed within 6 months prior to the inclusion visit, AND Stable EDSS documented at least 5 years prior to inclusion versus EDSS documented within 6 months prior to inclusion visit, according to the investigator's judgment, AND The absence of relapses within 5 years prior to the inclusion visit

  5. Treated with a Moderate Efficacy Therapy (MET) for at least 5 consecutive years (IFN-β, glatiramer acetate, dimethyl fumarate, teriflunomide, diroximel fumarate); switching from one first-line treatment to another is accepted if the reason for the change is related to personal convenience or intolerance to the first treatment.
  6. Patient with affiliation to a social security regimen
  7. Patient able to understand the objectives and risks associated with the research and to give informed consent to the study
  8. Patient willing and able to comply with study procedures for the duration of the study

Exclusion criteria

Exclusion Criteria:

  1. Primary progressive or secondary progressive with or without relapse as defined by the revised Lublin and Reingold classification
  2. Previous or ongoing treatment with a High Efficacy therapy (HET), with the exception of induction therapy (mitoxantrone, stem cell transplantation, alemtuzumab) provided that the last administration took place at least 10 years prior to inclusion.
  3. Contraindication to MRI (claustrophobia, weight ≥ 140 kg, pacemaker, cochlear implants, foreign body in eye, intracranial vascular clips, surgery in the 6 weeks prior to the beginning of the study, coronary stent implanted in the 8 weeks prior to the beginning of the study,...).

    NB : Gadolinium contraindication will not prevent recruitment of the patient; in this case MRI will be carried out without contrast product injection

  4. History of neurological disease affecting the central nervous system: hereditary degenerative CNS disease, degenerative cognitive disease, systemic autoimmune disease, sarcoidosis, Lyme disease...
  5. Chronic disease which requires chronic treatment with corticoids or immunosuppressors
  6. Uncontrolled cardiac, renal or hepatic disease
  7. Patient participating in another interventional trial (drug or a medical device) or patient who are still within an exclusion period
  8. Patient wishing to discontinue background therapy, whether or not they are experiencing adverse effects.
  9. Patient not considering discontinuing background therapy, whether or not they are experiencing adverse effects.
  10. Pregnant or breastfeeding woman
  11. Patient with difficulty to read or understand French,
  12. Patient subject to a legal protection measure
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Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
200 participants (estimated)

Study arms

  • Experimental
    Experimental

    Treatment withdrawal; patients will stop their Disease Modifying Treatment (DMT)

    Drug: treatment withdrawal · Other: MRI · Behavioral: Quality of Life questionnaires · Other: Disability evaluation tests

  • Active comparator
    Control arm

    Patients will continue their DMT as per routine pratice

    Drug: Usual DMT continuation · Other: MRI · Behavioral: Quality of Life questionnaires · Other: Disability evaluation tests

Interventions

  • Drugtreatment withdrawal

    Patients will STOP their DMT

  • DrugUsual DMT continuation

    Patients will continue their DMT during the trial as usual : Interferon-β (IFN-β), glatiramer acetate, dimethyl fumarate, teriflunomide or diroximel fumarate

  • OtherMRI

    Cerebral+spinal cord enhanced MRI (M0) Cerebral enhanced MRI (M6, Relapse early visit) Unenhanced cerebral MRI (M12, M18, M24, Relapse distant visit

  • BehavioralQuality of Life questionnaires

    EQ-5D5L: EuroQol-5-Dimension 5 levels Burden of Treatment Questionnaire (BTQ self-administered questionnaires) Hospital Anxiety and Depression (HAD) questionnaire

  • OtherDisability evaluation tests

    EDSS: Expanded Disability Status Scale 25Foot/Walk 9-HPT:Nine Hole Peg Test

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What researchers measure

Primary outcomes

  1. Time to first clinical and/or radiological disease activity during a period of 2 years.

    A clinical activity (relapse) is defined by the occurrence of new or worsening of neurological symptoms linked to MS. Relapses must meet the following criteria: * Symptoms must last at least 24 hours, without other clinical factors leading to confusion (fever, infection, lesion, drug adverse events) * Must be followed by improvement or resolution of the neurological state within 30 days * New symptoms or worsening of neurological state must be accompanied by an objective neurologic state aggravation * The neurological symptom must be linked to the modified FSS (pyramidal, cerebellar, brainstem, sphincter, mental, sensory or visual functions) A radiological activity is defined if MRI shows either: * at least 3 new or enlarged T2 ≥ 3 mm on the same exam or * at least 3 cumulative new or enlarged T2 lesions ≥ 3 mm during follow up or * one enhanced gadolinium lesion compared to the previous MRI.

    Time frame: From enrollment to the end of study visit at 24 months

07

Study locations

22 sites
  • CHU de Bordeaux-Hôpital Pellegrin
    Bordeaux, 33076, France
  • CHU de Caen-Hôpital Côte de Nacre
    Caen, 14033, France
    • Pierre BRANGER · Contact · branger-p@chu-caen.fr · (0) 2 31 06 46 17
    • Pierre BRANGER · Principal investigator
  • CHU de Clermont-Ferrand-Hôpital Gabriel Montpied
    Clermont Ferrand, 63003, France
  • Assistance Publique des Hôpitaux de Paris (APHP)-Hôpital Henri Mondor
    Créteil, 94010, France
    • Alain CREANGE, MD PhD · Contact · alain.creange@aphp.fr · 01 49 81 23 15
    • Alain CREANGE, MD PhD · Principal investigator
  • CHU de Dijon-Hôpital du Bocage
    Dijon, 21079, France
  • CH de Gonesse
    Gonesse, 95500, France
  • CHU de Grenoble Alpes
    La Tronche, 38700, France
  • Groupement des Hôpitaux de l'Institut Catholique de Lille Hôpital Saint Vincent de Paul
    Lille, 59020, France
  • CHU de Lille-Hôpital Roger Salengro
    Lille, 59037, France
    • Hélène ZEPHIR THI · Contact · h-zephir@chru-lille.fr · (0)3 20 44 68 46
    • Hélène ZEPHIR THI · Principal investigator
  • CHU de Limoges-Hôpital Dupuytren
    Limoges, 87042, France
  • Assistance Publique des Hôpitaux de Marseille (APHM)-Hôpital La Timone Adultes
    Marseille, 13005, France
  • CHU de Montpellier-Hôpital G. De Chauliac
    Montpellier, 34295, France
  • CHU de Nancy -Hôpital Central
    Nancy, 54035, France
    • Guillaume MATHEY, MD · Contact · G.MATHEY@chru-nancy.fr · 03 83 85 16 88
    • Guillaume MATHEY, MD · Principal investigator
  • CHU de Nice-Hôpital Pasteur
    Nice, 06002, France
    • Mikaël COHEN · Contact · Cohen.m@chu-nice.fr · 04 92 03 79 01
    • Mikaël COHEN · Principal investigator
  • CHU de Nîmes
    Nimes, 30029, France
  • Assistance Publique des Hôpitaux de Paris (APHP)-Hôpital Pitié-Salpêtrière
    Paris, 75013, France
  • Fondation Ophtalmologique Rothschild
    Paris, 75019, France
    • Caroline BENSA · Contact · cbensa@for.paris · (0)1 48 03 68 52
    • Caroline BENSA · Principal investigator
  • CHU de Rennes-C.H.R. Pontchaillou
    Rennes, 35033, France
  • CHU de Rouen-Hôpital Charles Nicolle
    Rouen, 76038, France
  • CHU Nantes -CIC de Neurologie
    Saint Herblain, 44 093, France
  • Les Hôpitaux Universitaires de Strasbourg
    Strasbourg, 67000, France
  • CHU de Tours
    Tours, 37044, France
    • Ines DOGHRI, MD · Contact · I.DOGHRI@chu-tours.fr · 02 47 47 37 22
    • Ines DOGHRI, MD · Principal investigator
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jan 3, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT06663189
Lead sponsor
University Hospital, Strasbourg, France
Collaborators
Ministry of Health, France
Responsible party
Sponsor
First posted
Oct 29, 2024
Start date
Jan 2025 (estimated)
Primary completion
Jan 2027 (estimated)
Completion
Jun 2029 (estimated)
Last update
Jan 3, 2025

Study contacts

Sarah HUSTACHE
Contact
dpidrci@chru-strasbourg.fr
03 3 88 11 54 15 ext. 00 33
Nicolas COLLONGUES, MD, PhD
principal investigator · University Hospital, Strasbourg, France

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is not yet recruiting, as verified in Jan 2025. You cannot join it, but the record below documents what was studied.

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