Relapsing Multiple Sclerosis
Conditions
Brief summary
A study to evaluate the efficacy and safety of fenebrutinib on disability progression and relapse rate in adult participants with RMS. Eligible participants will be randomized in a 1:1 ratio to receive either fenebrutinib or teriflunomide. At the end of the double-blind treatment (DBT) phase (after disclosure of the DBT results), the Sponsor will determine whether or not to initiate the open-label extension (OLE) phase of the study.
Interventions
DRUGFenebrutinib
Participants will receive fenebrutinib.
DRUGTeriflunomide
Participants will receive teriflunomide.
DRUGPlacebo
Participants will receive teriflunomide-matching placebo or fenebrutinib-matching placebo.
Sponsors
Hoffmann-La Roche
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Masking description
Sponsor will also be blinded.
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Expanded Disability Status Scale (EDSS) score of 0 - 5.5 at screening * A diagnosis of RMS in accordance with the revised 2017 McDonald Criteria * Ability to complete the 9-hole Peg Test (9-HPT) for each hand in \< 240 seconds * Ability to perform the Timed 25-foot Walk Test (T25FWT) in \< 150 seconds * For female participants of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and refrain from donating eggs * For male participants: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and refrain from donating sperm OLE Inclusion Criteria: * Completed the DBT phase of the study (remaining on study treatment; no other disease-modifying therapy (DMT) administered) and who, in the opinion of the investigator, may benefit from treatment with fenebrutinib * Participants randomized to the teriflunomide treatment arm during the DBT phase must undergo the accelerated teriflunomide elimination procedure (ATEP) prior to the first administration of open-label fenebrutinib * For female participants of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and refrain from donating eggs * For male participants: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and refrain from donating sperm
Exclusion criteria
* Disease duration of \> 10 years from the onset of symptoms and an EDSS score at screening \< 2.0 * Female participants who are pregnant or breastfeeding, or intending to become pregnant * Male participants who intend to father a child during the study * A diagnosis of primary progressive multiple sclerosis (PPMS) or non-active secondary progressive multiple sclerosis (SPMS) * Any known or suspected active infection at screening, including but not limited to a positive screening tests for hepatitis B (HBV) and hepatitis C (HCV), an active or latent or inadequately treated infection with tuberculosis (TB), a confirmed or suspected progressive multifocal leukoencephalopathy (PML) * History of cancer including hematologic malignancy and solid tumors within 10 years of screening * Known presence of other neurological disorders, that could interfere with the diagnosis of MS or assessments of efficacy or safety during the study and clinically significant cardiovascular, psychiatric, pulmonary, renal, hepatic, endocrine, metabolic or gastrointestinal (GI) disease * Rare hereditary problems of galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption * Hypoproteinemia * Acute liver disease * Chronic liver disease unless considered stable for \> 6 months * Presence of cirrhosis (Child-Pugh Class A, B, or C) or Gilbert's syndrome * Participants with significantly impaired bone marrow function or significant anemia, leukopenia, neutropenia or thrombocytopenia * Any concomitant disease that may require chronic treatment with systemic corticosteroids or immunosuppressants during the course of the study * History of alcohol or other drug abuse within 12 months prior to screening * History of or currently active primary or secondary (non-drug-related) immunodeficiency, including known history of human immunodeficiency virus (HIV) infection * Inability to complete an MRI scan * Adrenocorticotropic hormone or systemic corticosteroid therapy within 4 weeks prior to screening (inhaled and topical corticosteroids are allowed) * Receipt of a live-attenuated vaccine within 6 weeks prior to randomization * Any previous treatment with immunomodulatory or immunosuppressive medication without an appropriate washout period OLE
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Annualized Relapse Rate (ARR) | Minimum of 96 weeks |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Onset of Composite 12-week Confirmed Disability Progression (cCDP12) | Minimum of 96 weeks | — |
| Time to Onset of Composite 24-week Confirmed Disability Progression (cCDP24) | Minimum of 96 weeks | — |
| Time to Onset of 12-week Confirmed Disability Progression (CDP12) | Minimum of 96 weeks | — |
| Time to Onset of 24-week Confirmed Disability Progression (CDP24) | Minimum of 96 weeks | — |
| Total Number of T1 Gadolinium-enhancing (Gd+) Lesions, New and/or Enlarging T2-weighted Lesions, as Detected by Magnetic Resonance Imaging (MRI) | Baseline, Weeks 12, 24, 48 and 96 | — |
| Percentage Change in Total Brain Volume From Week 24, as Assessed by MRI | From Week 24 to Week 96 | — |
| Change in Participant-reported Physical Impacts of Multiple Sclerosis (MS), Measured by the Multiple Sclerosis, Impact Scale (29-Item), Version 2 (MSIS-29 v2) Physical Scale | Baseline, Weeks 12, 24, 36, 48, 60, 72, 84 and 96 | The MSIS-29 v2 is a 29-item participant-reported measure of the physical and psychological impacts of MS. Participants are asked to rate how much their functioning and well-being have been impacted over the past 14 days on a 4-point scale, ranging from "Not at all" (1) to "Extremely" (4). The physical score is the sum of items 1-20, which is then transformed to a 0-100 scale. The psychological score is the sum of items 21-29, transformed to a 0-100 scale. Higher scores indicate a greater impact of MS. |
| Time to Onset of 12-week Confirmed 4-point Worsening in Symbol Digit Modality Test (SDMT) Score | Minimum of 96 weeks | The SDMT is used for detecting the presence of cognitive impairment and changes in cognitive functioning over time and in response to treatment. The SDMT is a brief, easy-to-administer test, involving a simple substitution task. Using a reference key, the examinee has 90 seconds to pair specific numbers with given geometric figures. Responses will be collected only orally, and the administration time is approximately 5 minutes. The number of correct responses in 90 seconds will be considered the SDMT score. A decrease by 4 points on the SDMT score from baseline represents a clinically meaningful change in cognitive processing. The SDMT score ranges from 0 to 110. The higher the results, the better processing speed/working memory. |
| Change From Baseline to Week 48 in the Concentration of Blood Neurofilament Light Chain (NfL) | Up to 48 weeks | — |
| Percentage of Participants With Adverse Events (AEs) | Up to 4.5 years | — |
| Plasma Concentrations of Fenebrutinib at Specified Timepoints | Up to 4.5 years | — |
| Time to Onset of Composite 12-week Confirmed Progression Independent of Relapse Activity (cPIRA12) | Minimum of 96 weeks | — |
Countries
Austria, Brazil, Bulgaria, Canada, Denmark, France, Greece, Guatemala, India, Italy, Mexico, Poland, Russia, South Korea, Turkey (Türkiye), United Kingdom, United States
Contacts
STUDY_DIRECTORClinical Trials
Hoffmann-La Roche
Outcome results
None listed