title: Avonex Combination Trial in relapsing--remitting MS: rationale, design and baseline data.
abstract: OBJECTIVE
  To review the rationale, design and baseline data of the Avonex Combination Trial (ACT), an investigator-run study of intramuscular interferon beta-1a (IM IFNbeta-1a) combined with methotrexate (MTX) and/or IV methylprednisolone (IVMP) in relapsing-remitting multiple sclerosis (RRMS) patients with continued disease activity on IM IFNbeta-1a monotherapy.
  
  
  METHODS
  Eligibility criteria included RRMS, Expanded Disability Status Scale score 0-5.5, and >or=1 relapse or gadolinium-enhancing MRI lesion in the prior year while on IM IFNbeta-1a monotherapy. Subjects continued IFNbeta-1a 30 mcg IM weekly and were randomized in a 2 x 2 factorial design to adjunctive weekly placebo or MTX 20 mg PO, with or without IVMP 1,000 mg/day for three days every other month. ACT was industry-supported, and collaboratively designed and governed by an Investigator Steering Committee with independent Advisory and Data Safety Monitoring Committees. Study operations, MRI analysis and aggregated data were managed by the Cleveland Clinic MS Academic Coordinating Center.
  
  
  RESULTS
  In total 313 subjects were enrolled with clinical and MRI characteristics typical of RRMS. Most subjects (86.9%) qualified with a clinical relapse, with or without an enhancing MRI lesion, in the preceding year. At baseline, 21.4% had enhancing lesions, and 5.1% had anti-IFNbeta neutralizing antibodies. ACT's management and operational structures functioned well.
  
  
  CONCLUSIONS
  This study provides an innovative model for academic-industry collaborative MS research and will enhance understanding of the utility of combination therapy for RRMS patients with continued disease activity on an established first-line treatment.
authors.affiliation: Mellen Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. cohenj@ccf.org
authors.forename: J A
authors.initials: JA
authors.lastname: Cohen
authors.forename: P A
authors.initials: PA
authors.lastname: Calabresi
authors.forename: S
authors.initials: S
authors.lastname: Chakraborty
authors.forename: K R
authors.initials: KR
authors.lastname: Edwards
authors.forename: T
authors.initials: T
authors.lastname: Eickenhorst
authors.forename: W L
authors.initials: WL
authors.lastname: Felton
authors.forename: E
authors.initials: E
authors.lastname: Fisher
authors.forename: R J
authors.initials: RJ
authors.lastname: Fox
authors.forename: A D
authors.initials: AD
authors.lastname: Goodman
authors.forename: C
authors.initials: C
authors.lastname: Hara-Cleaver
authors.forename: G J
authors.initials: GJ
authors.lastname: Hutton
authors.forename: P B
authors.initials: PB
authors.lastname: Imrey
authors.forename: D M
authors.initials: DM
authors.lastname: Ivancic
authors.forename: B F
authors.initials: BF
authors.lastname: Mandell
authors.forename: J E
authors.initials: JE
authors.lastname: Perryman
authors.forename: T F
authors.initials: TF
authors.lastname: Scott
authors.forename: T T
authors.initials: TT
authors.lastname: Skaramagas
authors.forename: H
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003299:Cooperative Behavior; D003627:Data Interpretation, Statistical; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000473:pathology; D018579:Patient Selection; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016899:Interferon-beta; D008775:Methylprednisolone; D000068556:Interferon beta-1a; D008727:Methotrexate