Low-dose (7.5 mg) oral methotrexate for chronic progressive multiple sclerosis. Design of a randomized, placebo-controlled trial with sample size benefits from a composite outcome variable including preliminary data on toxicity.
OBJECTIVE
To present a detailed description of (1) the study design of this ongoing trial, (2) advantages of using a composite outcome variable instead of multiple individual outcome measures, (3) treatment group characteristics at baseline, and (4) observed short-term methotrexate (MTX) toxicity.


METHODS
Randomized, double-masked, placebo-controlled intervention study.


METHODS
Referral-based outpatient multidisciplinary multiple sclerosis (MS) clinic.


METHODS
Participation offered to all clinically definite chronic progressive multiple sclerosis (CPMS) patients attending clinic ages 21 to 60, disease duration > 1 year, Expanded Disability Status Scale (EDSS) score 3.0 to 6.5 (ambulatory with moderate disability). Patients first stratified by EDSS 3.0 to 5.5 and 6.0 to 6.5, then randomized to MTX or placebo treatment.


METHODS
Weekly oral low-dose (7.5 mg) MTX or identical-appearing placebo for 2 years followed by a 1-year observation period.


METHODS
Sample size calculations undertaken prior to enrolling patients based upon a composite outcome variable consisting of designated change in any of the following functional measures: (1) EDSS, (2) Ambulation Index (AI), (3) Box and Block Test (BBT), and (4) 9-Hole Peg Test (9HPT).


RESULTS
(1) Treatment group characteristics were comparable at baseline, (2) no patient has been withdrawn for adverse effects or lost to follow-up, (3) no significant short-term MTX toxicity has been observed.


CONCLUSIONS
(1) The use of a composite outcome measure in the design of MS clinical trials is a promising alternative to multiple individual outcome measures that are relatively insensitive to detecting clinical change, (2) low-dose oral weekly MTX does not appear to be associated with significant short-term toxicity in CPMS. Conclusions regarding therapeutic efficacy of MTX in MS must await completion of this clinical trial.
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, OH 44195-5244.
D E
DE
Goodkin
R A
RA
Rudick
S
S
VanderBrug Medendorp
T
T
Greene
K M
KM
Schwetz
J
J
Fischer
M M
MM
Daughtry
J
J
Ross
C
C
Van Dyke
D000328:Adult; D002490:Central Nervous System / Q000187:drug effects; D002908:Chronic Disease; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D012107:Research Design
D008727:Methotrexate