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Study to Assess the Efficacy and Safety of Ublituximab in Participants With Relapsing Forms of Multiple Sclerosis (RMS) ( ULTIMATE 1 )

Phase III: UbLiTuximab In Multiple Sclerosis Treatment Effects (ULTIMATE I STUDY)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03277261
Acronym
ULTIMATE 1
Enrollment
549
Registered
2017-09-11
Start date
2017-09-19
Completion date
2020-11-06
Last updated
2021-12-06

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Relapsing Multiple Sclerosis (RMS)

Brief summary

This study determines the Annualized Relapse Rate (ARR) in participants with RMS after 96 weeks (approximately 2 years) treatment with intravenous (IV) infusion of ublituximab/oral placebo compared to 14 mg oral teriflunomide/IV placebo.

Interventions

BIOLOGICALUblituximab

Administered as an IV infusion.

DRUGTeriflunomide

Film-coated tablets administered orally.

DRUGOral Placebo

Administered orally.

DRUGIV Placebo

Administered as an IV infusion.

Sponsors

TG Therapeutics, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Masking description

Double-blinded, active-controlled study

Intervention model description

Randomized, multi-center, double-blinded, active-controlled study

Eligibility

Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No

Inclusion criteria

* 18-55 age * Diagnosis of RMS (McDonald criteria 2010) * Active disease * Expanded disability status scale (EDSS) 0-5.5 (inclusive) at screening

Exclusion criteria

* Treatment with prior Anti-cluster of differentiate 20 (CD20) or other B cell directed treatment * Treatment with the following therapies at any time prior to randomization: alemtuzumab, natalizumab, teriflunomide, leflunomide and stem cell transplantation * Diagnosed with Primary Progressive MS (PPMS) * Pregnant or nursing

Design outcomes

Primary

MeasureTime frameDescription
Annualized Relapse Rate (ARR)Up to 96 weeksARR is defined as the number of Independent Relapse Adjudication Panel (IRAP)-confirmed relapses per participant year. The estimate of ARR for a treatment group is the total number of relapses for participants in the respective treatment group divided by the sum of treatment duration for participants in that specific treatment group.

Secondary

MeasureTime frameDescription
Total Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per ParticipantWeeks 24, 48, and 96The total number of NELs were calculated as the sum of the individual number of lesions at Weeks 24, 48, and 96, divided by the total number of MRI scans of the brain.
Time to Confirmed Disability Progression (CDP) for at Least 12 WeeksUp to Week 9612-week CDP is defined as an increase in EDSS at least 1 point higher than the baseline EDSS if the baseline EDSS is ≤5.5 or at least 0.5 higher than the baseline EDSS if the baseline EDSS is \>5.5. The EDSS is based on a standard neurological examination, (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, and cerebral) and ambulation function system assessments. The EDSS disability scale ranges in 0.5-point steps from 0 (normal) to 10 (death) where higher scores indicate disability. The time to onset of 12-week CDP is the time to progression to the EDSS change defined above.
Percentage of Participants With No Evidence of Disease Activity (NEDA)Week 24 up to Week 96A participant with NEDA is defined as a participant without relapses confirmed by the IRAP, without MRI activities (no T1 Gd+ lesions and no new/enlarging T2 lesions), and no 12-week CDP. Any evidence of disease activity from Week 24 to Week 96 was counted as not reaching NEDA. Any evidence of disease activity before Week 24 was not counted.
Total Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per ParticipantWeeks 12, 24, 48, and 96The total number of Gd-enhancing T1-lesions were calculated as the sum of the individual number of lesions at Weeks 12, 24, 48, and 96, divided by the total number of MRI scans of the brain.
Percent Change From Baseline in Brain VolumeBaseline up to Week 96
Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs)From the first dose of study drug through the end of the study (up to approximately 116 weeks)An adverse event (AE) is any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporarily associated with the use of a medicinal product, whether or not considered related to the medicinal product. A Serious AE is defined as any untoward medical occurrence that: results in death, is immediately life-threatening, requires in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, and/or causes a congenital anomaly/birth defect. A TEAE is an AE that starts or worsens after receiving study drug.
Percentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)Baseline up to Week 96The SDMT involves a simple substitution task using a reference key, the examinee has 90 seconds to pair specific numbers with given geometric figures. Responses are done verbally. The administration time is approximately 5 minutes. The total SDMT score for each visit ranging from 0-110 is defined as the total number of correct answers reported in the case report form (CRF), where high scores indicate better outcome. Impaired SDMT is defined as a decrease from baseline of at least 4 points at any post-baseline assessment up to the Week 96 visit.

Countries

United States

Participant flow

Recruitment details

A total of 549 participants were enrolled across investigative sites in Belarus, Spain, the United Kingdom, Georgia, Poland, Russia, Serbia, Ukraine, and the United States from 19 September 2017 to 6 November 2020.

Pre-assignment details

A total of 646 participants were screened and of those, 549 were enrolled and randomized to receive either ublituximab/oral placebo or teriflunomide/IV placebo.

Participants by arm

ArmCount
Ublituximab + Oral Placebo
Participants were administered ublituximab 150 mg, IV infusion over 4 h on Day 1 followed by 450 mg over 1 h on Days 15, 168, 336 and 504 (Week 72) along with the oral placebo QD from Day 1 up to the last day of Week 95.
274
Teriflunomide + IV Placebo
Participants were administered teriflunomide 14 mg tablet, orally, QD from Day 1 up to the last day of Week 95 along with the placebo IV infusion on Days 1, 15, 168, 336 and 504 (Week 72).
275
Total549

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event171
Overall StudyInvestigator / Sponsor Decision42
Overall StudyLack of Efficacy22
Overall StudyLost to Follow-up22
Overall StudyOther-Alternative Treatment/Unspecified Reasons11
Overall StudyParticipant Withdrawal of Consent615
Overall StudyPregnancy20

Baseline characteristics

CharacteristicUblituximab + Oral PlaceboTeriflunomide + IV PlaceboTotal
Age, Continuous36.3 years
STANDARD_DEVIATION 8.48
37.0 years
STANDARD_DEVIATION 9.62
36.7 years
STANDARD_DEVIATION 9.07
Ethnicity (NIH/OMB)
Hispanic or Latino
7 Participants2 Participants9 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
263 Participants267 Participants530 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
4 Participants6 Participants10 Participants
Race/Ethnicity, Customized
Race
Black or African American
6 Participants6 Participants12 Participants
Race/Ethnicity, Customized
Race
Native Hawaiian or Other Pacific Islander
1 Participants0 Participants1 Participants
Race/Ethnicity, Customized
Race
Other
0 Participants2 Participants2 Participants
Race/Ethnicity, Customized
Race
White
267 Participants267 Participants534 Participants
Sex: Female, Male
Female
167 Participants180 Participants347 Participants
Sex: Female, Male
Male
107 Participants95 Participants202 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
2 / 2740 / 275
other
Total, other adverse events
197 / 273181 / 275
serious
Total, serious adverse events
31 / 27319 / 275

Outcome results

Primary

Annualized Relapse Rate (ARR)

ARR is defined as the number of Independent Relapse Adjudication Panel (IRAP)-confirmed relapses per participant year. The estimate of ARR for a treatment group is the total number of relapses for participants in the respective treatment group divided by the sum of treatment duration for participants in that specific treatment group.

Time frame: Up to 96 weeks

Population: Modified Intention-to-Treat (mITT) population consisted of all participants in the ITT population who received at least one dose of study medication and have at least one baseline and post baseline efficacy assessment.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Ublituximab + Oral PlaceboAnnualized Relapse Rate (ARR)0.076 relapses per participant-years
Teriflunomide + IV PlaceboAnnualized Relapse Rate (ARR)0.188 relapses per participant-years
p-value: <0.000195% CI: [0.268, 0.615]Negative Binomial Model
Secondary

Percentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)

The SDMT involves a simple substitution task using a reference key, the examinee has 90 seconds to pair specific numbers with given geometric figures. Responses are done verbally. The administration time is approximately 5 minutes. The total SDMT score for each visit ranging from 0-110 is defined as the total number of correct answers reported in the case report form (CRF), where high scores indicate better outcome. Impaired SDMT is defined as a decrease from baseline of at least 4 points at any post-baseline assessment up to the Week 96 visit.

Time frame: Baseline up to Week 96

Population: mITT population consisted of all participants in the ITT population who received at least one dose of study medication and have at least one baseline and post baseline efficacy assessment.

ArmMeasureValue (NUMBER)
Ublituximab + Oral PlaceboPercentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)29.2 percentage of participants
Teriflunomide + IV PlaceboPercentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)31.8 percentage of participants
p-value: =0.466995% CI: [0.603, 1.261]Logistic Regression
Secondary

Percentage of Participants With No Evidence of Disease Activity (NEDA)

A participant with NEDA is defined as a participant without relapses confirmed by the IRAP, without MRI activities (no T1 Gd+ lesions and no new/enlarging T2 lesions), and no 12-week CDP. Any evidence of disease activity from Week 24 to Week 96 was counted as not reaching NEDA. Any evidence of disease activity before Week 24 was not counted.

Time frame: Week 24 up to Week 96

Population: mITT population consisted of all participants in the ITT population who received at least one dose of study medication and have at least one baseline and post baseline efficacy assessment.

ArmMeasureValue (NUMBER)
Ublituximab + Oral PlaceboPercentage of Participants With No Evidence of Disease Activity (NEDA)44.6 percentage of participants
Teriflunomide + IV PlaceboPercentage of Participants With No Evidence of Disease Activity (NEDA)15.0 percentage of participants
p-value: <0.000195% CI: [3.536, 8.375]Regression, Logistic
Secondary

Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs)

An adverse event (AE) is any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporarily associated with the use of a medicinal product, whether or not considered related to the medicinal product. A Serious AE is defined as any untoward medical occurrence that: results in death, is immediately life-threatening, requires in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, and/or causes a congenital anomaly/birth defect. A TEAE is an AE that starts or worsens after receiving study drug.

Time frame: From the first dose of study drug through the end of the study (up to approximately 116 weeks)

Population: Safety population included all participants who received at least one dose of study drug (ublituximab or teriflunomide, with corresponding placebos).

ArmMeasureGroupValue (NUMBER)
Ublituximab + Oral PlaceboPercentage of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs)TEAEs86.1 percentage of participants
Ublituximab + Oral PlaceboPercentage of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs)TESAEs11.4 percentage of participants
Teriflunomide + IV PlaceboPercentage of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs)TEAEs89.1 percentage of participants
Teriflunomide + IV PlaceboPercentage of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs)TESAEs6.9 percentage of participants
Secondary

Percent Change From Baseline in Brain Volume

Time frame: Baseline up to Week 96

Population: mITT- MRI population included participants in mITT population who have baseline and post-baseline MRI efficacy assessments. Overall number of participants analyzed signifies participants who were evaluable for this outcome measure.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Ublituximab + Oral PlaceboPercent Change From Baseline in Brain Volume-0.197 percent change
Teriflunomide + IV PlaceboPercent Change From Baseline in Brain Volume-0.125 percent change
p-value: <0.000195% CI: [-0.107, -0.036]Mixed Model Repeated Measures (MMRM)
Secondary

Time to Confirmed Disability Progression (CDP) for at Least 12 Weeks

12-week CDP is defined as an increase in EDSS at least 1 point higher than the baseline EDSS if the baseline EDSS is ≤5.5 or at least 0.5 higher than the baseline EDSS if the baseline EDSS is \>5.5. The EDSS is based on a standard neurological examination, (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, and cerebral) and ambulation function system assessments. The EDSS disability scale ranges in 0.5-point steps from 0 (normal) to 10 (death) where higher scores indicate disability. The time to onset of 12-week CDP is the time to progression to the EDSS change defined above.

Time frame: Up to Week 96

Population: mITT population consisted of all participants in the ITT population who received at least one dose of study medication and have at least one baseline and post baseline efficacy assessment. As per protocol, data was summarized for the mITT Population using pooled data from participants in this study and TG1101-RMS302 \[NCT03277248\].

ArmMeasureValue (MEDIAN)
Ublituximab + Oral PlaceboTime to Confirmed Disability Progression (CDP) for at Least 12 WeeksNA weeks
Teriflunomide + IV PlaceboTime to Confirmed Disability Progression (CDP) for at Least 12 WeeksNA weeks
Secondary

Total Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant

The total number of Gd-enhancing T1-lesions were calculated as the sum of the individual number of lesions at Weeks 12, 24, 48, and 96, divided by the total number of MRI scans of the brain.

Time frame: Weeks 12, 24, 48, and 96

Population: mITT- magnetic resonance imaging (MRI) population included participants in mITT population who have baseline and post-baseline MRI efficacy assessments. Overall number of participants analyzed signifies participants who were evaluable for this outcome measure.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Ublituximab + Oral PlaceboTotal Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant0.016 lesions per scan per participant
Teriflunomide + IV PlaceboTotal Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant0.491 lesions per scan per participant
p-value: <0.000195% CI: [0.019, 0.058]Negative Binomial Model
Secondary

Total Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant

The total number of NELs were calculated as the sum of the individual number of lesions at Weeks 24, 48, and 96, divided by the total number of MRI scans of the brain.

Time frame: Weeks 24, 48, and 96

Population: mITT- MRI population included participants in mITT population who have baseline and post-baseline MRI efficacy assessments. Overall number of participants analyzed signifies participants who were evaluable for this outcome measure.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Ublituximab + Oral PlaceboTotal Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant0.213 lesions per scan per participant
Teriflunomide + IV PlaceboTotal Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant2.789 lesions per scan per participant
p-value: <0.000195% CI: [0.056, 0.104]Negative Binomial Model

Source: ClinicalTrials.gov · Data processed: May 31, 2026