A Multinational, Randomized, Double-blind, Parallel-group, Placebo-controlled Study Assessing the Safety and Tolerability

A multinational, multicenter, randomized, double-blind, parallel-group, placebo-controlled study to assess the safety, tolerability and efficacy of two daily doses of oral laquinimod (0.6mg or 1.2mg) in adjunct to glatiramer acetate (GA) or interferon-beta (IFN-B) in relapsing remitting multiple sclerosis (RRMS) subjects

Study Overview

• Status: Withdrawn
• Conditions: Relapsing Multiple Sclerosis
• Intervention / Treatment: Drug: Laquinimod 0.6; Drug: Laquinimod 1.2; Other: Glatiramer Acetate or interferon-beta+ Placebo

• Study Type: Interventional
• Phase: Phase 2

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 55 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Subjects must have a documented MS diagnosis as defined by the Revised McDonald criteria [Ann Neurol 2011: 69:292-302], with a relapsing-remitting disease course.
2. Subjects must be ambulatory with an EDSS score of 1-5.5 (inclusive) at the baseline visit.
3. Subjects must be relapse-free and in a stable neurological condition and free of corticosteroid treatment [intravenous (IV), intramuscular (IM) and/or oral] 30 days prior to screening (month -1).
4. Subjects must be treated with either Copaxone® or an IFN-B preparation (Avonex®, Betaseron®/Betaferon®, Rebif® or Extavia®), at a stable dose for at least 6 months prior to the screening visit (switching between IFN-B preparations during the 6 months prior to screening is allowed; switching between any IFN-B preparation and GA, or vice versa, is exclusionary).
5. Subjects must have had experienced at least one documented relapse in the 36 weeks prior to randomization, with an incomplete recovery of the neurological functions as compared to pre-relapse status.
6. Subjects must be between 18 and 55 years of age, inclusive.
7. Women of child-bearing potential must practice an acceptable method of birth control [acceptable methods of birth control in this study include: surgical sterilization, intrauterine devices, oral contraceptive, contraceptive patch, long-acting injectable contraceptive or double-barrier method (condom or diaphragm with spermicide)].
8. Subjects must be able to sign and date a written informed consent prior to entering the study.
9. Subjects must be willing and able to comply with the protocol requirements for the duration of the study.

Exclusion Criteria:

1. An onset of a relapse between Month -1 (Screening) and 0 (Baseline), unstable neurological condition or any treatment with corticosteroids [intravenous (IV), intramuscular (IM) and/or oral] or Adrenocorticotropic hormone.
2. Use of experimental or investigational drugs, and/or participation in drug clinical studies within the 6 months prior to Screening.
3. Use of immunosuppressive including Mitoxantrone (Novantrone®) or cytotoxic agents within 6 months prior to the screening visit.
4. Previous use of either of the following: natalizumab (Tysabri®), cladribine, laquinimod, and fingolimod (Gilenya®).
5. Previous treatment with intravenous immunoglobulin (IVIG) within 2 months prior to screening visit.
6. Systemic corticosteroid treatment of ≥30 consecutive days duration within 2 months prior to screening visit.
7. Previous total body irradiation or total lymphoid irradiation.
8. Previous stem cell treatment, autologous bone marrow transplantation or allogenic bone marrow transplantation.
9. Use of moderate/strong inhibitors of cytochrome P450 CYP3A4 within 2 weeks prior to the screening visit.
10. Use of inducers of CYP3A4 within 2 weeks prior to the screening visit.
11. Use of amiodarone within 2 years prior to screening visit.
12. Pregnancy or breastfeeding.
13. A ≥3xULN serum elevation of either alanine transaminase (ALT) or aspartate transaminase (AST) at screening.
14. Serum direct bilirubin which is ≥2x upper limit of normal (ULN) at screening.

15. Subjects with a potentially clinically significant or unstable medical or surgical condition that would preclude safe and complete study participation, as determined by medical history, physical examinations, ECG, laboratory tests or chest X-ray. Such conditions may include (but are not limited to):

    • A cardiovascular or pulmonary disorder that cannot be well-controlled by standard treatment permitted by the study protocol.
    • A gastrointestinal disorder that may affect the absorption of study medication.
    • Renal or metabolic diseases
    • Any form of acute or chronic liver disease
    • Known human immunodeficiency virus (HIV) positive status
    • A history of drug and/or alcohol abuse
    • An unstable psychiatric disorder.
    • A known history of tuberculosis.
    • Unstable psychiatric disorder
    • Any malignancies, excluding basal cell carcinoma (BCC), in the last 5 years.
16. A glomerular filtration rate less than 60 ml/min at screening visit.
17. A known history of sensitivity to gadolinium (Gd).
18. Inability to successfully undergo MRI scanning.
19. Previous endovascular treatment for Chronic Cerebrospinal Venous Insufficiency (CCSVI).
20. Known drug hypersensitivity that would preclude administration of laquinimod, such as hypersensitivity to: mannitol, meglumine or sodium stearyl fumarate.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Laquinimod 0.6; GA 20 mg/1mL or an IFN-B preparation + oral daily administration of laquinimod 0.6 mg	Drug: Laquinimod 0.6; Laquinimod 0.6 capsule
Experimental: Laquinimod 1.2; GA 20 mg/1mL or an IFN-B preparation + oral daily administration of laquinimod 1.2 mg	Drug: Laquinimod 1.2; Placebo
Experimental: GA or IFN + Placebo; GA 20 mg/1mL or an IFN-B preparation + oral daily placebo	Other: Glatiramer Acetate or interferon-beta+ Placebo; GA 20 mg/1mL or IFN-B (Avonex®, Betaseron®/Betaferon®, Rebif® or Extavia®) + oral daily placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety and efficacy	To assess the safety, tolerability and efficacy of laquinimod in RRMS	10 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tolerability	To assess the safety, tolerability and efficacy of laquinimod in RRMS as compared to placebo, subjects treated with GA or an IFN-B preparation (Avonex®, Betaseron®/Betaferon®, Rebif® or Extavia®).	10 months

Collaborators and Investigators

• Sponsor: Teva Branded Pharmaceutical Products R&D, Inc.
• Investigators: Principal Investigator: Ralf Gold, MD

Study record dates

Study Major Dates

• Study Start: March 1, 2012
• Primary Completion (Anticipated): December 1, 2013
• Study Completion (Anticipated): January 1, 2014

Study Registration Dates

• First Submitted: July 26, 2011
• First Submitted That Met QC Criteria: July 26, 2011
• First Posted (Estimate): July 27, 2011

Study Record Updates

• Last Update Posted (Estimate): August 27, 2013
• Last Update Submitted That Met QC Criteria: August 26, 2013
• Last Verified: August 1, 2013

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Physiological Effects of Drugs; Anti-Infective Agents; Antiviral Agents; Antirheumatic Agents; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Adjuvants, Immunologic; Interferons; Interferon-beta; Glatiramer Acetate; (T,G)-A-L
• Other Study ID Numbers: LAQ-MS-201