Study Evaluating Rebif, Copaxone, and Tysabri for Active Multiple Sclerosis (SURPASS)

• Change from baseline to 48 weeks in T2 lesion volume [ Time Frame: 78 weeks ] [ Designated as safety issue: No ]
• Proportion of subjects free of disease activity [ Time Frame: 78 weeks ] [ Designated as safety issue: No ]
• Change from baseline to 48 weeks in physical impact score of multiple sclerosis impact scale (MSIS-29) [ Time Frame: 78 weeks ] [ Designated as safety issue: No ]

Protocol version 5 of this study will be conducted to continue providing study treatment in fulfillment of the commitments made in Versions 1 through 4 of the protocol.

• Drug: Natalizumab
  300 mg IV every 4 weeks
  Other Name: Tysabri
• Biological: Interferon Beta-1a
  44 mcg subcutaneous 3 times per week
  Other Name: Rebif
• Biological: Glatiramer acetate
  20 mg subcutaneous once daily
  Other Name: Copaxone

• Experimental: Natalizumab
  Intervention: Drug: Natalizumab
• Active Comparator: Interferon Beta-1a
  Intervention: Biological: Interferon Beta-1a
• Active Comparator: Glatiramer acetate
  Intervention: Biological: Glatiramer acetate

Inclusion Criteria:

1. Have a diagnosis of relapsing remitting multiple sclerosis as defined by the revised McDonald Committee criteria (Polman 2005).
2. Must have been treated with a stable regimen of either glatiramer acetate (20 mg per day SC) or interferon beta-1a (44 mcg 3 times per week) as their principal first therapy for MS for 6 to 18 months prior to randomization. (Note: prior treatment with another MS therapy of ≤30 days total duration is not exclusionary [e.g. titration to 44 mcg is allowed]).

3. Have had disease activity within 12 months prior to screening while on therapy; disease activity must be observed after a minimum of 6 months on therapy. Qualifying disease activity is defined as:

   • One or more clinical relapses OR
   • Two or more new MRI lesions (Gd+ and/or T2 hyperintense) For inclusion purposes: (a) a relapse is defined as neurologic signs and/or symptoms documented in the medical record by a neurologist and of sufficient duration to be determined by the Investigator or the Treating Physician as consistent with an MS relapse or (b) MRI activity must be verified by the central reader center.
4. Be naïve to natalizumab.
5. Be between the ages of 18 and 60, inclusive at the time of informed consent.
6. Have a documented EDSS score between 0.0 and 5.5, inclusive.

Exclusion Criteria:

1. Have a diagnosis of primary progressive, secondary progressive, or progressive relapsing MS (as defined by Lublin and Reingold, 1996). These conditions require the presence of continuous clinical disease worsening over a period of at least 3 months. Patients with these conditions may also have superimposed relapses, but are distinguished from relapsing-remitting patients by the lack of clinically stable periods or clinical improvement.
2. Have known intolerance, contraindication to, or history of non-compliance with, the use of glatiramer acetate or interferon beta-1a.
3. Have had an MS exacerbation (relapse) within 30 days prior to randomization AND/OR the patient has not stabilized from a previous relapse, in the opinion of the Investigator, prior to randomization.
4. The patient is considered by the Investigator to be immunocompromised based on medical history, physical examination, laboratory testing, or due to prior immunosuppressive or immunomodulating treatment.
5. Subjects for whom MRI is contraindicated, i.e., have pacemakers or other contraindicated implanted metal devices, have suffered or are at risk for side effects from gadolinium (Gd), or have claustrophobia that cannot be medically managed.
6. History of any clinically significant (as determined by the Investigator) cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, neurologic, dermatologic, psychiatric, renal, or other major disease that would preclude participation in a clinical trial.
7. History of malignant disease, including solid tumors and hematologic malignancies (with the exception of basal cell and squamous cell carcinomas of the skin that have been completely excised and are considered cured).
8. Known history of Human Immunodeficiency Virus (HIV).
9. Positive test result for Hepatitis C virus (test for hepatitis C virus antibody [HCV Ab]) or hepatitis B virus (test for hepatitis B surface antigen [HBsAg] and/or hepatitis B core antibody [HBcAb]).
10. History of transplantation or any anti-rejection therapy.
11. History of PML