Multiple Sclerosis
Conditions
Brief summary
This study is an extension to the study AC-058B201 and will investigate the long-term safety, tolerability and efficacy of ponesimod in patients with relapsing-remitting multiple sclerosis.
Interventions
Ponesimod 10 mg oral use
Ponesimod 20 mg oral use
Ponesimod 40 mg oral use
Sponsors
Study design
Eligibility
Inclusion criteria
1. Patients who completed study treatment at their regular Week 24 (End of treatment) visit within the core study AC-058B201. 2. Signed informed consent for participating in the extension study.
Exclusion criteria
1\. Any clinically relevant medical or surgical condition, which, in the opinion of the investigator, would put the patient at risk by participating in the extension study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Annualized Relapse Rate (ARR) of Confirmed Relapses | From ponesimod start date up to the end of Analysis Period (AP) 3. The actual time varied for each participant and could be up to 13.3 years | ARR is defined as the number of confirmed relapses per year. A relapse is defined as the occurrence of an acute episode of one or more new symptoms, or worsening of existing symptoms of multiple sclerosis (MS), not associated with fever or infection, and lasting for at least 24 hours after a stable period of at least 30 days. A confirmed relapse is a relapse accompanied by an increase from the previous clinically stable assessment (that is, performed at least 30 days after the onset of any previous relapse) of at least 0.5 point in the Expanded Disability Status Scale (EDSS) score, or one point in the score for at least one of the Functional System (FS) scores, excluding the bowel and bladder, and mental FS. EDSS is ordinal clinical scale ranges 0 (normal neurological examination) to 10 (death due to MS). |
| Time to First Confirmed Relapse | From ponesimod start date up to the end of Analysis Period (AP) 3. The actual time varied for each participant and could be up to 13.3 years | Time to first confirmed relapse was reported. A relapse is defined as the occurrence of an acute episode of one or more new symptoms, or worsening of existing symptoms of multiple sclerosis (MS), not associated with fever or infection, and lasting for at least 24 hours after a stable period of at least 30 days. A confirmed relapse is a relapse accompanied by an increase from the previous clinically stable assessment (that is, performed at least 30 days after the onset of any previous relapse) of at least 0.5 point in the Expanded Disability Status Scale (EDSS) score, or one point in the score for at least one of the Functional System (FS) scores, excluding the bowel and bladder, and mental FS. EDSS is ordinal clinical scale ranges from 0 (normal neurological examination) to 10 (death due to MS). |
| Time to 24 Weeks Confirmed Disability Progression | From ponesimod baseline up to the end of Analysis Period (AP) 3. The actual time varied for each participant and could be up to 13.3 years | Time to 24 weeks confirmed disability progression (accumulation) was reported. Disability progression is defined as an increase of at least 1 point in the EDSS score if baseline EDSS was between 1 and 5.0, an increase of at least 1.5 points if baseline EDSS was 0, or an increase of at least 0.5 points if the baseline EDSS was equal or greater than 5.5. A 24-week confirmed disability progression is defined as a 24-week sustained increase from baseline in the EDSS scores, that is, every EDSS score (scheduled or unscheduled, with or without relapse) within a 24-week duration after the first progression should meet the progression criteria as specified above. EDSS is ordinal clinical scale ranges from 0 (normal neurological examination) to 10 (death due to MS). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With at Least One Treatment-emergent Serious Adverse Events (SAEs) | From ponesimod start date up to the end of study treatment + 15 Days. The actual time of observation varied for each participant and could be up to 12.97 years + 15 days | Number of participants with at least one treatment-emergent SAEs were reported. An adverse event (AE) is any untoward medical occurrence in a participant participating in a clinical study that does not necessarily have a causal relationship with the pharmaceutical/biological agent under study. An SAE is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalisation; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly/birth defect; suspected transmission of any infectious agent via a medicinal product or medically important. Treatment-emergent SAEs were those SAEs that occurred at or after the initial administration of ponesimod up to 15 days (inclusive) after last administration of ponesimod as study drug. |
Countries
Austria, Bulgaria, Canada, Czechia, Finland, France, Germany, Hungary, Israel, Netherlands, Poland, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine, United Kingdom, United States
Participant flow
Recruitment details
Participants who were enrolled in the core study (NCT01006265) entered this extension study. As planned, combined analysis (core plus extension study) was done for efficacy and safety (435 participants).
Pre-assignment details
Data reported in each arm are based on first dose received during treatment period (TP) 1.
Participants by arm
| Arm | Count |
|---|---|
| Ponesimod 10 Milligrams (mg) Participants with relapsing-remitting multiple sclerosis having completed their regular Week 24 treatment visit of the core study (NCT01006265) while receiving ponesimod 10 mg or placebo, entered this extension study and received ponesimod 10 mg capsules orally once daily during treatment period (TP) 1. Participants continued to receive ponesimod 10 mg tablet orally, once daily during TP2. All participants received ponesimod 20 mg tablet orally, once daily during TP3. | 115 |
| Ponesimod 20 Milligrams (mg) Participants with relapsing-remitting multiple sclerosis having completed their regular Week 24 treatment visit of the core study (NCT01006265) while receiving ponesimod 20 mg or placebo, entered this extension study and received ponesimod 20 mg capsules orally once daily during TP1. Participants continued to receive ponesimod 20 mg tablet orally, once daily during TP2 and TP3. | 121 |
| Ponesimod 40 Milligrams (mg) Participants with relapsing-remitting multiple sclerosis having completed their regular Week 24 treatment visit of the core study (NCT01006265) while receiving ponesimod 40 mg or placebo, entered this extension study and received ponesimod 40 mg capsules orally once daily during TP1. Participants were then re-randomized to receive ponesimod 10 or 20 mg tablet orally, once daily during TP2. All participants received ponesimod 20 mg tablet orally, once daily during TP3. | 117 |
| Total | 353 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 2 | 1 | 4 |
| Overall Study | Death | 0 | 1 | 0 |
| Overall Study | Lack of Efficacy | 7 | 6 | 3 |
| Overall Study | Lost to Follow-up | 2 | 5 | 4 |
| Overall Study | Other | 0 | 0 | 1 |
| Overall Study | Physician Decision | 3 | 1 | 3 |
| Overall Study | Withdrawal by Subject | 30 | 27 | 26 |
Baseline characteristics
| Characteristic | Total | Ponesimod 10 Milligrams (mg) | Ponesimod 20 Milligrams (mg) | Ponesimod 40 Milligrams (mg) |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 353 Participants | 115 Participants | 121 Participants | 117 Participants |
| Age, Continuous | 36.2 years STANDARD_DEVIATION 8.6 | 36.6 years STANDARD_DEVIATION 8.67 | 36.1 years STANDARD_DEVIATION 8.58 | 35.9 years STANDARD_DEVIATION 8.61 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 0 Participants | 0 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 351 Participants | 115 Participants | 121 Participants | 115 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 9 Participants | 3 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 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 |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) White | 340 Participants | 112 Participants | 118 Participants | 110 Participants |
| Region of Enrollment Austria | 8 Participants | 4 Participants | 2 Participants | 2 Participants |
| Region of Enrollment Bulgaria | 13 Participants | 5 Participants | 3 Participants | 5 Participants |
| Region of Enrollment Canada | 6 Participants | 2 Participants | 2 Participants | 2 Participants |
| Region of Enrollment Czech Republic | 43 Participants | 12 Participants | 17 Participants | 14 Participants |
| Region of Enrollment Finland | 16 Participants | 6 Participants | 6 Participants | 4 Participants |
| Region of Enrollment France | 3 Participants | 1 Participants | 1 Participants | 1 Participants |
| Region of Enrollment Germany | 4 Participants | 1 Participants | 1 Participants | 2 Participants |
| Region of Enrollment Hungary | 15 Participants | 2 Participants | 8 Participants | 5 Participants |
| Region of Enrollment Israel | 3 Participants | 0 Participants | 2 Participants | 1 Participants |
| Region of Enrollment Italy | 22 Participants | 8 Participants | 8 Participants | 6 Participants |
| Region of Enrollment Netherlands | 2 Participants | 0 Participants | 1 Participants | 1 Participants |
| Region of Enrollment Poland | 31 Participants | 14 Participants | 6 Participants | 11 Participants |
| Region of Enrollment Romania | 3 Participants | 1 Participants | 2 Participants | 0 Participants |
| Region of Enrollment Russia | 30 Participants | 8 Participants | 11 Participants | 11 Participants |
| Region of Enrollment Serbia | 40 Participants | 16 Participants | 13 Participants | 11 Participants |
| Region of Enrollment Spain | 9 Participants | 1 Participants | 4 Participants | 4 Participants |
| Region of Enrollment Sweden | 18 Participants | 4 Participants | 6 Participants | 8 Participants |
| Region of Enrollment Switzerland | 3 Participants | 2 Participants | 1 Participants | 0 Participants |
| Region of Enrollment Ukraine | 16 Participants | 4 Participants | 7 Participants | 5 Participants |
| Region of Enrollment United Kingdom | 14 Participants | 5 Participants | 4 Participants | 5 Participants |
| Region of Enrollment United States | 54 Participants | 19 Participants | 16 Participants | 19 Participants |
| Sex: Female, Male Female | 233 Participants | 77 Participants | 80 Participants | 76 Participants |
| Sex: Female, Male Male | 120 Participants | 38 Participants | 41 Participants | 41 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 139 | 1 / 145 | 0 / 151 |
| other Total, other adverse events | 121 / 139 | 125 / 145 | 140 / 151 |
| serious Total, serious adverse events | 32 / 139 | 35 / 145 | 25 / 151 |
Outcome results
Annualized Relapse Rate (ARR) of Confirmed Relapses
ARR is defined as the number of confirmed relapses per year. A relapse is defined as the occurrence of an acute episode of one or more new symptoms, or worsening of existing symptoms of multiple sclerosis (MS), not associated with fever or infection, and lasting for at least 24 hours after a stable period of at least 30 days. A confirmed relapse is a relapse accompanied by an increase from the previous clinically stable assessment (that is, performed at least 30 days after the onset of any previous relapse) of at least 0.5 point in the Expanded Disability Status Scale (EDSS) score, or one point in the score for at least one of the Functional System (FS) scores, excluding the bowel and bladder, and mental FS. EDSS is ordinal clinical scale ranges 0 (normal neurological examination) to 10 (death due to MS).
Time frame: From ponesimod start date up to the end of Analysis Period (AP) 3. The actual time varied for each participant and could be up to 13.3 years
Population: Ponesimod analysis set (PAS) included all participants who received at least one dose of ponesimod at any time during the core and/or the extension study (435 participants).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Ponesimod 10 Milligrams (mg) | Annualized Relapse Rate (ARR) of Confirmed Relapses | 0.205 Confirmed relapses per year |
| Ponesimod 20 Milligrams (mg) | Annualized Relapse Rate (ARR) of Confirmed Relapses | 0.142 Confirmed relapses per year |
| Ponesimod 40 Milligrams (mg) | Annualized Relapse Rate (ARR) of Confirmed Relapses | 0.150 Confirmed relapses per year |
Time to 24 Weeks Confirmed Disability Progression
Time to 24 weeks confirmed disability progression (accumulation) was reported. Disability progression is defined as an increase of at least 1 point in the EDSS score if baseline EDSS was between 1 and 5.0, an increase of at least 1.5 points if baseline EDSS was 0, or an increase of at least 0.5 points if the baseline EDSS was equal or greater than 5.5. A 24-week confirmed disability progression is defined as a 24-week sustained increase from baseline in the EDSS scores, that is, every EDSS score (scheduled or unscheduled, with or without relapse) within a 24-week duration after the first progression should meet the progression criteria as specified above. EDSS is ordinal clinical scale ranges from 0 (normal neurological examination) to 10 (death due to MS).
Time frame: From ponesimod baseline up to the end of Analysis Period (AP) 3. The actual time varied for each participant and could be up to 13.3 years
Population: PAS included all participants who received at least one dose of ponesimod at any time during the core and/or the extension study (435 participants).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ponesimod 10 Milligrams (mg) | Time to 24 Weeks Confirmed Disability Progression | NA Weeks |
| Ponesimod 20 Milligrams (mg) | Time to 24 Weeks Confirmed Disability Progression | NA Weeks |
| Ponesimod 40 Milligrams (mg) | Time to 24 Weeks Confirmed Disability Progression | NA Weeks |
Time to First Confirmed Relapse
Time to first confirmed relapse was reported. A relapse is defined as the occurrence of an acute episode of one or more new symptoms, or worsening of existing symptoms of multiple sclerosis (MS), not associated with fever or infection, and lasting for at least 24 hours after a stable period of at least 30 days. A confirmed relapse is a relapse accompanied by an increase from the previous clinically stable assessment (that is, performed at least 30 days after the onset of any previous relapse) of at least 0.5 point in the Expanded Disability Status Scale (EDSS) score, or one point in the score for at least one of the Functional System (FS) scores, excluding the bowel and bladder, and mental FS. EDSS is ordinal clinical scale ranges from 0 (normal neurological examination) to 10 (death due to MS).
Time frame: From ponesimod start date up to the end of Analysis Period (AP) 3. The actual time varied for each participant and could be up to 13.3 years
Population: PAS included all participants who received at least one dose of ponesimod at any time during the core and/or the extension study (435 participants).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ponesimod 10 Milligrams (mg) | Time to First Confirmed Relapse | 272.3 Weeks |
| Ponesimod 20 Milligrams (mg) | Time to First Confirmed Relapse | 656.7 Weeks |
| Ponesimod 40 Milligrams (mg) | Time to First Confirmed Relapse | 431.7 Weeks |
Number of Participants With at Least One Treatment-emergent Serious Adverse Events (SAEs)
Number of participants with at least one treatment-emergent SAEs were reported. An adverse event (AE) is any untoward medical occurrence in a participant participating in a clinical study that does not necessarily have a causal relationship with the pharmaceutical/biological agent under study. An SAE is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalisation; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly/birth defect; suspected transmission of any infectious agent via a medicinal product or medically important. Treatment-emergent SAEs were those SAEs that occurred at or after the initial administration of ponesimod up to 15 days (inclusive) after last administration of ponesimod as study drug.
Time frame: From ponesimod start date up to the end of study treatment + 15 Days. The actual time of observation varied for each participant and could be up to 12.97 years + 15 days
Population: Ponesimod analysis set included all participants who received at least one dose of ponesimod at any time during the core and/or the extension study (435 participants).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ponesimod 10 Milligrams (mg) | Number of Participants With at Least One Treatment-emergent Serious Adverse Events (SAEs) | 32 Participants |
| Ponesimod 20 Milligrams (mg) | Number of Participants With at Least One Treatment-emergent Serious Adverse Events (SAEs) | 35 Participants |
| Ponesimod 40 Milligrams (mg) | Number of Participants With at Least One Treatment-emergent Serious Adverse Events (SAEs) | 25 Participants |