Adherence Trial With MS LifeLines ® Services

The proposed study is a web-based, prospective, parallel group, Phase IV, 12-month study of
patients receiving support services provided by MSLL and contracted nursing services.
Following referral of patients to MSLL, consenting patients will be allocated to one of two
groups (2:1), based on their geographic area. Group A will be further randomized 1:1 to the
standard services subgroup (Group A1) or a customized services subgroup (Group A2). The
standard subgroup will receive phones calls and nurse visits at set intervals. Patients in
the custom services subgroup will have the option of selecting as many or as few of the
"standard" services they will receive after the initial injection training. Subjects will
have the option of receiving educational materials, planning tools, and reminders. Patients
allocated to Group B will receive a visit for injection training and the follow-up call and
then MSLL phone calls at set intervals. Over a period of 12 months (each month defined as a
28-day period), all subjects will receive support services (nurse visit and follow-up phone
call, etc) and complete online assessments (MSRS-R, PDSS, etc).

The primary objective of the trial is to determine the impact of two different levels of
support service, group A1 and A2, provided by MSLL within Group A, on adherence to
prescribed treatment in newly diagnosed or first-switch relapsing remitting multiple
sclerosis (RRMS) subjects.

Secondary Objective:

The secondary objectives are:

- To use a pair wise comparison to determine the impact on adherence of the two different
levels of service intervention provided by MSLL not compared in the primary objective
(Standard services subgroup of Group A (A1) to Group B and Customized service subgroup
of Group A (A2) to Group B)

- To determine the correlation of adherence with subject-reported outcomes and other
study data;

- To examine the changes from baseline in subject-reported outcomes in each service arm;

- To examine changes from baseline in risk for non-adherence in each service arm; and

- To determine rate of trial dropout between each service arm

Inclusion Criteria:

- Age 18 to 65 years at the time of informed consent signature

- Male or female

- Female subjects of child bearing potential who report they are not pregnant at
screening and agree to avoid pregnancy during study participation by using adequate
contraception, defined as two barrier methods, one barrier method with a spermicide,
intrauterine device, or use of oral female contraceptive

- Outpatient status at time of online screening

- Subjects prescribed Rebif by their treating physicians for newly diagnosed RRMS or
first-switch subjects with RRMS. Allowable prior disease-modifying drugs (DMDs) for
RRMS include Rebif, Copaxone ®, Avonex ® , Extavia ®, Betaseron ®, Gilenya™, and
Aubagio ® (with accelerated elimination), Tysabri ® and Tecfidera™

- Stable disease status without a history of hospitalization for treatment of RRMS
within 30 days prior to online screening

- Access to, and ability to use, a computer, a mouse, the internet, and an email
address. In addition, subjects in the Group A will be required to have access to a
telephone that accepts text messaging (in case randomized to the Custom subgroup)

- Subject-reported ability to complete online assignments and read English

- Electronically verified informed consent before any trial-related activities are
carried out

Exclusion Criteria:

- Any combination therapy with another DMD for Multiple Sclerosis (MS) while
participating in the trial

- Use of steroids, including adrenocorticotropic hormone (ACTH) gel, for RRMS within 30
days prior to online screening

- Score of 4 on any of the items of the MSRS-R or a score between 5 and 8, inclusive,
on the PDDS

- Hospitalization or surgical procedure within 30 days prior to online screening or
surgical intervention planned during the 12-month study period

- Pregnant or breastfeeding.

- Diagnosis of primary progressive, secondary progressive or progressive relapsing MS

- History of malignancy, with the exception of skin cancer completely excised and
considered cured;

- History of seizures or unexplained blackouts within 30 days prior to online screening

- History of hospitalization for a mental health issue within 30 days prior to online
screening

- Current illegal drug use at the time of online screening;

- Any prior participation in an interventional clinical trial for MS (except for
Aubagio ® or Tecfidera™), participation in any trial within 30 days prior to online
screening, or current participation in another clinical trial;

- Current treatment of another autoimmune disorder other than stable thyroid disease at
the time of online screening

- History of prior treatment for MS with any of the following: alemtuzumab,
cyclophosphamide, methotrexate, azathioprine, cyclosporin, intravenous immunoglobulin
(IVIg), and plasma exchange

- Other significant subject-reported disease that would exclude the subject from the
trial

- Significant renal or hepatic impairment that would compromise completion of the trial