Multiple Sclerosis
Conditions
Brief summary
This study will assess the efficacy, safety, and tolerability of ACT-128800 in patients with relapsing-remitting multiple sclerosis.
Interventions
ACT-128800 (Dose 1) administered orally once daily
Matching placebo administered orally once daily
ACT-128800 (Dose 2) administered orally once daily
ACT-128800 (Dose 3) administered orally once daily
Sponsors
Study design
Eligibility
Inclusion criteria
* Adult males and females * Diagnosis of RRMS as defined by the revised (2005) McDonald Diagnostic Criteria for Multiple Sclerosis (MS). * Signed inform consent prior to initiation of any study-mandated procedure.
Exclusion criteria
* A diagnosis of MS categorized as primary progressive or secondary progressive or progressive relapsing. * Patients currently treated for an autoimmune disorder other than MS. * Contraindications for MRI. * Ongoing bacterial, viral, or fungal infection. * History or presence of malignancy. Additional inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative Number of New T1 Gadolinium-Enhancing (Gd+) Lesions on Magnetic Resonance Imaging (MRI) Scan From Week 12 to Week 24 | From Week 12 to 24 | Cumulative Number of new T1 gadolinium-enhancing (Gd+) lesions per year on magnetic resonance imaging (MRI) scan from Week 12 to Week 24 were reported. Negative binomial (NB) regression analysis on Per protocol analysis set and imputation was applied for the missing data. Here, MS signifies multiple sclerosis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Annualized Confirmed Relapse Rate | Up to 24 weeks | Relapse: occurrence of acute episode of one or more new symptoms or worsened symptoms of Multiple Sclerosis (MS), not associated with fever/infection and lasting 24 hours after stable 30 days period. Confirmed relapse: increase from baseline at least 0.5 point Expanded Disability Status Scale (EDSS) score or increase of one point in one, two or three Functional Systems (FS), excluding bowel/bladder and cerebral/mental FS. EDSS and FS scores are based on neurological examination for assessing its impairment in MS. Among eight FS, seven are ordinal clinical rating scales ranging from 0-5 or 6 with higher scale indicating overall functional impairment assessing Visual, Brain Stem, Pyramidal, Cerebellar, Sensory, Bowel/Bladder and Cerebral functions. Rating individual FS scores is used to rate EDSS with information concerning gait and use of assistance. EDSS is ordinal clinical scale ranges 0 (normal neurological examination) to 10(death due to MS) |
| Number of Participants With First Confirmed Relapse as Assessed by Kaplan-Meier Estimate From Baseline to Week 24 | Baseline to Week 24 | Relapse: occurrence of acute episode of one or more new symptoms or worsened symptoms of MS, not associated with fever/infection and lasting 24 hours after stable 30 days period. Confirmed relapse: increase from baseline at least 0.5 point Expanded Disability Status Scale (EDSS) score or increase of one point in one, two or three Functional Systems (FS), excluding bowel/bladder and cerebral/mental FS. EDSS and FS scores are based on neurological examination for assessing its impairment in MS. Among eight FS, seven are ordinal clinical rating scales ranging from 0-5 or 6 with higher scale indicating overall functional impairment assessing Visual, Brain Stem, Pyramidal, Cerebellar, Sensory, Bowel/Bladder and Cerebral functions. Rating individual FS scores is used to rate EDSS with information concerning gait and use of assistance. EDSS is ordinal clinical scale ranges 0 (normal neurological examination) to 10(death due to MS). Kaplan-Meier estimate used for Outcome Measure analysis. |
Countries
Australia, Austria, Belgium, Bulgaria, Canada, Czechia, Finland, France, Germany, Hungary, Israel, Italy, Netherlands, Poland, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Ponesimod 40 mg Participants received ponesimod capsules once daily as per up-titration schedule with an initial dose of 10 milligram (mg) ponesimod on Days 1 to 7 followed by first up-titration dose of 20 mg ponesimod on Days 8 to 14 and lastly received 40 mg ponesimod as second up-titration dose on Day 15 to Week 24. | 119 |
| Ponesimod 20 mg Participants received ponesimod capsules once daily as per up-titration schedule with an initial dose of 10 mg ponesimod on Days 1 to 7 followed by 20 mg ponesimod on Day 8 to Week 24. | 116 |
| Ponesimod 10 mg Participants received ponesimod capsules once daily as per up-titration schedule with a dose of 10 mg ponesimod on Day 1 to Week 24. | 108 |
| Placebo Participants received the ponesimod matching placebo tablets once daily for up to Week 24 as per up-titration schedule. | 121 |
| Total | 464 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Administrative reason | 1 | 2 | 3 | 0 |
| Overall Study | Lost to Follow-up | 1 | 0 | 1 | 0 |
| Overall Study | Withdrawal by Subject | 4 | 7 | 5 | 5 |
Baseline characteristics
| Characteristic | Ponesimod 40 mg | Ponesimod 10 mg | Ponesimod 20 mg | Placebo | Total |
|---|---|---|---|---|---|
| Age, Continuous Age ( years ) | 36.5 years STANDARD_DEVIATION 8.52 | 36.9 years STANDARD_DEVIATION 9.24 | 35.3 years STANDARD_DEVIATION 8.52 | 36.6 years STANDARD_DEVIATION 8.58 | 36.3 years STANDARD_DEVIATION 8.7 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 117 Participants | 108 Participants | 116 Participants | 121 Participants | 462 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 2 Participants | 2 Participants | 6 Participants | 12 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) White | 114 Participants | 105 Participants | 114 Participants | 114 Participants | 447 Participants |
| Region of Enrollment Australia | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Region of Enrollment Austria | 2 Participants | 2 Participants | 2 Participants | 3 Participants | 9 Participants |
| Region of Enrollment Belgium | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants |
| Region of Enrollment Bulgaria | 5 Participants | 5 Participants | 4 Participants | 5 Participants | 19 Participants |
| Region of Enrollment Canada | 3 Participants | 4 Participants | 3 Participants | 3 Participants | 13 Participants |
| Region of Enrollment Czech Republic | 14 Participants | 12 Participants | 14 Participants | 12 Participants | 52 Participants |
| Region of Enrollment Finland | 6 Participants | 4 Participants | 4 Participants | 6 Participants | 20 Participants |
| Region of Enrollment France | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 4 Participants |
| Region of Enrollment Germany | 1 Participants | 1 Participants | 2 Participants | 2 Participants | 6 Participants |
| Region of Enrollment Hungary | 7 Participants | 2 Participants | 7 Participants | 3 Participants | 19 Participants |
| Region of Enrollment Israel | 3 Participants | 1 Participants | 2 Participants | 3 Participants | 9 Participants |
| Region of Enrollment Italy | 8 Participants | 6 Participants | 7 Participants | 7 Participants | 28 Participants |
| Region of Enrollment Netherlands | 1 Participants | 2 Participants | 1 Participants | 2 Participants | 6 Participants |
| Region of Enrollment Poland | 7 Participants | 10 Participants | 8 Participants | 12 Participants | 37 Participants |
| Region of Enrollment Romania | 1 Participants | 3 Participants | 2 Participants | 3 Participants | 9 Participants |
| Region of Enrollment Russia | 9 Participants | 8 Participants | 9 Participants | 7 Participants | 33 Participants |
| Region of Enrollment Serbia | 10 Participants | 11 Participants | 10 Participants | 11 Participants | 42 Participants |
| Region of Enrollment Spain | 4 Participants | 3 Participants | 2 Participants | 4 Participants | 13 Participants |
| Region of Enrollment Sweden | 5 Participants | 4 Participants | 6 Participants | 6 Participants | 21 Participants |
| Region of Enrollment Switzerland | 0 Participants | 2 Participants | 2 Participants | 1 Participants | 5 Participants |
| Region of Enrollment Ukraine | 5 Participants | 5 Participants | 6 Participants | 7 Participants | 23 Participants |
| Region of Enrollment United Kingdom | 5 Participants | 4 Participants | 5 Participants | 4 Participants | 18 Participants |
| Region of Enrollment United States | 20 Participants | 18 Participants | 18 Participants | 19 Participants | 75 Participants |
| Sex: Female, Male Gender Female | 79 Participants | 71 Participants | 78 Participants | 85 Participants | 313 Participants |
| Sex: Female, Male Gender Male | 40 Participants | 37 Participants | 38 Participants | 36 Participants | 151 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 119 | 0 / 114 | 0 / 108 | 0 / 121 |
| other Total, other adverse events | 83 / 119 | 73 / 114 | 69 / 108 | 77 / 121 |
| serious Total, serious adverse events | 3 / 119 | 7 / 114 | 7 / 108 | 5 / 121 |
Outcome results
Cumulative Number of New T1 Gadolinium-Enhancing (Gd+) Lesions on Magnetic Resonance Imaging (MRI) Scan From Week 12 to Week 24
Cumulative Number of new T1 gadolinium-enhancing (Gd+) lesions per year on magnetic resonance imaging (MRI) scan from Week 12 to Week 24 were reported. Negative binomial (NB) regression analysis on Per protocol analysis set and imputation was applied for the missing data. Here, MS signifies multiple sclerosis.
Time frame: From Week 12 to 24
Population: Per protocol analysis set included participants of mITT set (randomized participants who received at least one dose of study drug, and had at least one valid post-baseline MRI) who met the criteria for evaluable participants for the analysis of MRI data (participants with Relapsing-remitting multiple sclerosis (RRMS) received study drug until 168 days, two post-baseline MRIs b/w Week 12-24, no forbidden treatment for MS).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Ponesimod 40 mg | Cumulative Number of New T1 Gadolinium-Enhancing (Gd+) Lesions on Magnetic Resonance Imaging (MRI) Scan From Week 12 to Week 24 | 1.4 Lesions | Standard Deviation 3.24 |
| Ponesimod 20 mg | Cumulative Number of New T1 Gadolinium-Enhancing (Gd+) Lesions on Magnetic Resonance Imaging (MRI) Scan From Week 12 to Week 24 | 1.1 Lesions | Standard Deviation 1.96 |
| Ponesimod 10 mg | Cumulative Number of New T1 Gadolinium-Enhancing (Gd+) Lesions on Magnetic Resonance Imaging (MRI) Scan From Week 12 to Week 24 | 3.5 Lesions | Standard Deviation 7.27 |
| Placebo | Cumulative Number of New T1 Gadolinium-Enhancing (Gd+) Lesions on Magnetic Resonance Imaging (MRI) Scan From Week 12 to Week 24 | 6.2 Lesions | Standard Deviation 13.42 |
Annualized Confirmed Relapse Rate
Relapse: occurrence of acute episode of one or more new symptoms or worsened symptoms of Multiple Sclerosis (MS), not associated with fever/infection and lasting 24 hours after stable 30 days period. Confirmed relapse: increase from baseline at least 0.5 point Expanded Disability Status Scale (EDSS) score or increase of one point in one, two or three Functional Systems (FS), excluding bowel/bladder and cerebral/mental FS. EDSS and FS scores are based on neurological examination for assessing its impairment in MS. Among eight FS, seven are ordinal clinical rating scales ranging from 0-5 or 6 with higher scale indicating overall functional impairment assessing Visual, Brain Stem, Pyramidal, Cerebellar, Sensory, Bowel/Bladder and Cerebral functions. Rating individual FS scores is used to rate EDSS with information concerning gait and use of assistance. EDSS is ordinal clinical scale ranges 0 (normal neurological examination) to 10(death due to MS)
Time frame: Up to 24 weeks
Population: All treated analysis set included all randomized participants who received at least one dose of study drug.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Ponesimod 40 mg | Annualized Confirmed Relapse Rate | 0.224 Relapse per year | Standard Deviation 0.7834 |
| Ponesimod 20 mg | Annualized Confirmed Relapse Rate | 0.396 Relapse per year | Standard Deviation 1.0169 |
| Ponesimod 10 mg | Annualized Confirmed Relapse Rate | 0.297 Relapse per year | Standard Deviation 0.7987 |
| Placebo | Annualized Confirmed Relapse Rate | 0.601 Relapse per year | Standard Deviation 1.6626 |
Number of Participants With First Confirmed Relapse as Assessed by Kaplan-Meier Estimate From Baseline to Week 24
Relapse: occurrence of acute episode of one or more new symptoms or worsened symptoms of MS, not associated with fever/infection and lasting 24 hours after stable 30 days period. Confirmed relapse: increase from baseline at least 0.5 point Expanded Disability Status Scale (EDSS) score or increase of one point in one, two or three Functional Systems (FS), excluding bowel/bladder and cerebral/mental FS. EDSS and FS scores are based on neurological examination for assessing its impairment in MS. Among eight FS, seven are ordinal clinical rating scales ranging from 0-5 or 6 with higher scale indicating overall functional impairment assessing Visual, Brain Stem, Pyramidal, Cerebellar, Sensory, Bowel/Bladder and Cerebral functions. Rating individual FS scores is used to rate EDSS with information concerning gait and use of assistance. EDSS is ordinal clinical scale ranges 0 (normal neurological examination) to 10(death due to MS). Kaplan-Meier estimate used for Outcome Measure analysis.
Time frame: Baseline to Week 24
Population: All treated analysis set included all randomized participants who received at least one dose of study drug. Here 'N' (number of participants analyzed) included all participants who were evaluated for this outcome measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ponesimod 40 mg | Number of Participants With First Confirmed Relapse as Assessed by Kaplan-Meier Estimate From Baseline to Week 24 | 10 Participants |
| Ponesimod 20 mg | Number of Participants With First Confirmed Relapse as Assessed by Kaplan-Meier Estimate From Baseline to Week 24 | 17 Participants |
| Ponesimod 10 mg | Number of Participants With First Confirmed Relapse as Assessed by Kaplan-Meier Estimate From Baseline to Week 24 | 14 Participants |
| Placebo | Number of Participants With First Confirmed Relapse as Assessed by Kaplan-Meier Estimate From Baseline to Week 24 | 25 Participants |