Efficacy and Safety of Remibrutinib Compared to Teriflunomide in Participants With Relapsing Multiple Sclerosis

Brief Summary
To compare the efficacy and safety of remibrutinib versus teriflunomide in patients with relapsing multiple sclerosis (RMS)
Brief Title
Efficacy and Safety of Remibrutinib Compared to Teriflunomide in Participants With Relapsing Multiple Sclerosis (RMS)
Detailed Description
The study CLOU064C12301 consists of an initial Core Part (CP) (maximum duration per participant of up to 30 months), followed by an Extension Part (EP, of up to 5 years duration) for eligible participants.

The Core Part is a randomized, double-blind, double-dummy, active comparator-controlled, fixed-dose, parallel-group, multi-center study in approximately 800 participants with relapsing multiple sclerosis (RMS).

The Extension Part is an open-label, single-arm, fixed-dose design in which eligible participants are treated with remibrutinib for up to 5 years.

A second study of identical design (CLOU064C12302) will be conducted simultaneously. Both studies will be conducted globally and data from the two studies will be pooled for some of the endpoints.
Central Contacts
Central Contact Role
Contact
Central Contact Phone
1-888-669-6682
Central Contact Email
novartis.email@novartis.com
Central Contact Role
Contact
Central Contact Phone
+41613241111
Completion Date
Completion Date Type
Estimated
Conditions
Relapsing Multiple Sclerosis
Eligibility Criteria
Inclusion Criteria:

* 18 to 55 years of age
* Diagnosis of RMS according to the 2017 McDonald diagnostic criteria
* At least: 1 documented relapse within the previous year. OR 2 documented relapses within the previous 2 years, OR 1 active Gadolinium (Gd)-enhancing lesion in the 12 months.
* EDSS score of 0 to 5.5 (inclusive)
* Neurologically stable within 1 month

Exclusion Criteria:

* Diagnosis of primary progressive multiple sclerosis (PPMS)
* Disease duration of more than 10 years in participants with EDSS score of 2 or less at screening
* History of clinically significant CNS disease other than MS
* Ongoing substance abuse (drug or alcohol)
* History of malignancy of any organ system (other than complete resection of localized basal cell carcinoma of the skin or in situ cervical cancer),
* Participants with history of confirmed Progressive Multifocal Leukoencephalopathy (PML) or Neurological symptoms consistent with PML
* suicidal ideation or behavior
* Evidence of clinically significant cardiovascular, neurological, psychiatric, pulmonary , renal, hepatic, endocrine, metabolic, hematological disorders or gastrointestinal disease that can interfere with interpretation of the study results or protocol adherence
* Participants who have had a splenectomy
* Active clinically significant systemic bacterial, viral, parasitic or fungal infections
* Positive results for syphilis or tuberculosis testing
* Uncontrolled disease states, such as asthma, or inflammatory bowel disease, where flares are commonly treated with oral or parenteral corticosteroids
* Active, chronic disease of the immune system (including stable disease treated with immune therapy (e.g. Leflunomide, Methotrexate)) other than MS (e.g. rheumatoid arthritis, systemic lupus erythematosus, etc.) with the exception of well-controlled diabetes or thyroid disorder.
* Participants with a known immunodeficiency syndrome (AIDS, hereditary immune deficiency, drug induced immune deficiency), or tested positive for HIV antibody
* History or current treatment for hepatic disease including but not limited to acute or chronic hepatitis, cirrhosis (including all Child-Pugh classes) or hepatic failure or any chronic liver or biliary disease.
* History of severe renal disease or creatinine level
* Participants at risk of developing or having reactivation of hepatitis
* Hematology parameters at screening:

* Hemoglobin: \< 10 g/dl (\<100g/L)
* Platelets: \< 100000/mm3 (\<100 x 109/L)
* Absolute lymphocyte count \< 800/mm3 (\<0.8 x 109/L)
* White blood cells: \<3 000/mm3 (\<3.0 x 109/L)
* Neutrophils: \< 1 500/mm3 (\<1.5 x 109/L)
* B-cell count \< 50% lower limit of normal (LLN) or total IgG \& total IgM \< LLN (only required for participants who had a history of receiving B-cell therapies, such as rituximab, ocrelizumab or ofatumumab, prior to screening)
* History or current diagnosis of significant ECG abnormalities
* Resting QTcF ≥450 msec (male) or ≥460 msec (female) at pre-treatment as per central ECG reading at screening visit
* Use of other investigational drugs
* Requirement for anticoagulant medication or use of dual anti-platelet therapy Significant bleeding risk or coagulation disorders,
* History of gastrointestinal bleeding
* Major surgery within 8 weeks prior to screening
* History of hypersensitivity to any of the study drugs or excipients
* Pregnant or nursing (lactating) female participants, prior to randomization
* Women of childbearing potential not using highly effective contraception
* Sexually active males not agreeing to use condom
* Have received any live or live-attenuated vaccines within 6 weeks of randomization or requirement to receive these vaccinations during study
* Use of strong CYP3A4 inhibitors or use of moderate or strong CYP3A4 inducers within two weeks prior to randomization

Inclusion to Extension part:

• Participants who complete the Core Part of the study on double-blind study treatment and conduct the Accelerated Elimination Procedure (AEP)

Other inclusion and exclusion criteria may apply
Inclusion Criteria
Inclusion Criteria:

* 18 to 55 years of age
* Diagnosis of RMS according to the 2017 McDonald diagnostic criteria
* At least: 1 documented relapse within the previous year. OR 2 documented relapses within the previous 2 years, OR 1 active Gadolinium (Gd)-enhancing lesion in the 12 months.
* EDSS score of 0 to 5.5 (inclusive)
* Neurologically stable within 1 month

Inclusion to Extension part:

• Participants who complete the Core Part of the study on double-blind study treatment and conduct the Accelerated Elimination Procedure (AEP)

Other inclusion and
Gender
All
Gender Based
false
Keywords
MS
RMS
RRMS
active secondary progressive multiple sclerosis SPMS
remibrutinib
LOU064
teriflunomide
adult
relapse
Expanded Disability Status Scale
T2 lesions
T1 lesions
GD- enhancing MRI
Neurofilament light chain
McDonald diagnostic criteria
Healthy Volunteers
No
Last Update Submit Date
Maximum Age
55 Years
Minimum Age
18 Years
NCT Id
NCT05147220
Org Class
Industry
Org Full Name
Novartis
Org Study Id
CLOU064C12301
Overall Status
Recruiting
Phases
Phase 3
Primary Completion Date
Primary Completion Date Type
Estimated
Official Title
A Randomized, Double-blind, Double-dummy, Parallel-group Study, Comparing the Efficacy and Safety of Remibrutinib Versus Teriflunomide in Participants With Relapsing Multiple Sclerosis, Followed by Extended Treatment With Open-label Remibrutinib
Primary Outcomes
Outcome Description
ARR is the average number of confirmed MS relapses in a year
Outcome Measure
Annualized relapse rate (ARR) of confirmed relapses [Core Part]
Outcome Time Frame
From Baseline, up to 30 months
Secondary Ids
Secondary Id
2020-005899-36
Secondary Outcomes
Outcome Description
Time to 3-month confirmed disability progression (3mCDP) is defined as an increase in Expanded Disability Status Scale (EDSS) which is sustained for at least 3 months
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Time to 3-month confirmed disability progression (3mCDP) on Expanded Disability Status Scale (EDSS) [Core Part] (pooled data)
Outcome Description
Time to 6-month confirmed disability progression (6mCDP) is defined as an increase in Expanded Disability Status Scale (EDSS) which is sustained for at least 6 months
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Time to 6-month confirmed disability progression (6mCDP) on EDSS [Core Part] (pooled data)
Outcome Description
Number of new/newly enlarged T2 lesions per year
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Annualized rate of new or enlarging T2 lesion [Core Part]
Outcome Description
Neurofilament light chain (NfL) concentration in serum
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Neurofilament light chain (Nfl) [Core Part]
Outcome Description
Average number of Gd-enhancing T1 lesions per scan
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Number of Gd-enhancing T1 lesions per MRI scan [Core Part]
Outcome Description
Percentage of participants with No Evidence of Disease Activity-3 (NEDA-3), as assessed by absence of confirmed MS relapses, 6mCDP and new/enlarging T2 lesions on MRI
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Percentage of participants with No Evidence of Disease Activity-3 (NEDA-3) [Core Part] (pooled data)
Outcome Description
Change in the Expanded Disability Status Scale (EDSS), an increase of at least 0.5 points on the EDSS (total) score, or an increase of at least 1 point on at least two functional scores (FSs), or an increase of at least 2 points on at least one FS, excluding changes involving bowel/bladder or cerebral FS, compared to the previous available rating.
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Time to first confirmed relapse [Core Part]
Outcome Description
Decrease in Expanded Disability Status Scale Score (EDSS) which is sustained for at least 6 months
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Time to 6-month confirmed disability improvement (6mCDI) on EDSS [Core Part] (pooled data)
Outcome Description
Time to 3-month confirmed disability progression (3mCDP) and 6-month confirmed disability progression (6mCDP) is defined as an increase in Expanded Disability Status Scale (EDSS) which is sustained for at least 3 months or 6 months, respectively, without an on-study relapse before or on the day of a progression event.
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Time to 3-months confirmed disability progression (3mCDP) and 6-month confirmed disability progression (6mCDP) independent of relapse activity (PIRA) [Core Part] (pooled data)
Outcome Description
Symbol Digit Modalities Test (SDMT), an array of symbols paired with empty spaces, measures processing in speed; participants verbally match the number for each symbol as rapidly as possible. The score is the number of correctly coded items in 90 seconds. Higher scores indicate improvement. Lower scores indicate worsening
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Change from baseline in the Symbol Digit Modalities Test (SDMT) [Core Part] (pooled data)
Outcome Description
The patient walking speed to cover 25-foot distance is recorded in seconds. Longer time indicates poorer lower limb function. 20% worsening is defined as 20% increase from baseline T25FW score
Outcome Time Frame
Baseline, up to 30 months
Outcome Measure
Time to 6-month confirmed worsening by at least 20% in the Timed 25-foot walk test (T25FW) [Core Part] (pooled data)
Outcome Description
The patient's right and left arm function to peg 9 holes measured in seconds. Longer time indicates poorer upper limb function. 20% worsening is defined as 20% increase from baseline 9HPT score in at least one hand (average of two trials per hand)
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Time to 6-month confirmed worsening by at least 20% in the Timed 9-hole peg test (9HPT) (pooled data) [Core Part] (pooled data)
Outcome Description
The composite involves CDP and worsening by at least 20% in T25FW and 9HPT
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Time to composite 6-month confirmed disability Progression (CDP) [Core Part] (pooled data)
Outcome Description
Change from baseline in total T2 lesion volume.
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Change from Baseline in T2 lesion volume [Core Part]
Outcome Description
29-item, self-administered questionnaire that includes 2 domains, physical and psychological. Responses are captured on a 4-point scale ranging from "not at all" (1) to "extremely" (4), where higher scores reflect greater impact on day to day life
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Change from baseline in Multiple Sclerosis Impact Scale (MSIS-29) [Core Part]
Outcome Description
Adverse events and SAEs including clinically significant , laboratory data, vital signs, electrocardiogram (ECG), Columbia Suicide Severity Rating
Outcome Time Frame
Baseline up to 30 months
Outcome Measure
Number of participants with Adverse events and Serious adverse events(SAE) [Core Part]
Outcome Description
Blood concentrations of remibrutinib
Outcome Time Frame
Month 1, Month 6
Outcome Measure
Pharmacokinetics of remibrutinib [Core Part]
Outcome Description
Adverse events and SAEs including clinically significant, laboratory data, vital signs, electrocardiogram (ECG), Columbia Suicide Severity Rating
Outcome Time Frame
Day 1 Extension up to 5 years
Outcome Measure
Number of participants with Adverse events and Serious adverse events (SAE) [Extension Part]
Outcome Description
ARR is the average number of confirmed MS relapses in a year
Outcome Time Frame
Day 1 Extension up to 5 years
Outcome Measure
Annualized relapse rate (ARR) of confirmed relapses [Extension Part]
Outcome Description
Number of new/newly enlarged T2 lesions per year
Outcome Time Frame
Day 1 Extension up to 5 years
Outcome Measure
Annualized rate of new or enlarging T2 lesion [Extension Part]
Outcome Description
Time to 6-month confirmed disability progression (6mCDP) is defined as an increase in Expanded Disability Status Scale (EDSS) which is sustained for at least 6 months
Outcome Time Frame
Day 1 Extension up to 5 years
Outcome Measure
Time to 6-month confirmed disability progression (6mCDP) on EDSS [Extension Part]
Outcome Description
Symbol Digit Modalities Test (SDMT), an array of symbols paired with empty spaces, measures processing in speed; participants verbally match the number for each symbol as rapidly as possible. The score is the number of correctly coded items in 90 seconds. Higher scores indicate improvement. Lower scores indicate worsening
Outcome Time Frame
Day 1 Extension up to 5 years
Outcome Measure
Change from baseline in the Symbol Digit Modalities Test (SDMT) [Extension Part]
Outcome Description
Neurofilament light chain (NfL) concentration in serum
Outcome Time Frame
Day 1 Extension up to 5 years
Outcome Measure
Neurofilament light chain (NfL) [Extension Part]
Outcome Description
29-item, self-administered questionnaire that includes 2 domains, physical and psychological. Responses are captured on a 4-point scale ranging from "not at all" (1) to "extremely" (4), where higher scores reflect greater impact on day to day life
Outcome Time Frame
Day 1 Extension up to 5 years
Outcome Measure
Change from baseline in Multiple Sclerosis Impact Scale (MSIS-29) [Extension Part]
Start Date
Start Date Type
Actual
Status Verified Date
First Submit Date
First Submit QC Date
Std Ages
Adult
Maximum Age Number (converted to Years and rounded down)
55
Minimum Age Number (converted to Years and rounded down)
18
Investigators
Investigator Type
Principal Investigator
Investigator Name
Lauren Gluck
Investigator Email
lgluck@montefiore.org