Dose-finding Study for SAR442168 in Relapsing Multiple Sclerosis

A Phase 2b Dose-finding Study for SAR442168, a Bruton's Tyrosine Kinase Inhibitor, in Participants With Relapsing Multiple Sclerosis

Primary Objective:

To determine the dose-response relationship for SAR442168 to reduce the number of new active brain lesions.

Secondary Objectives:

• To evaluate efficacy of SAR442168 on disease activity as assessed by imaging measures.
• To evaluate the safety and tolerability of SAR442168.

Study Overview

• Status: Completed
• Conditions: Relapsing Multiple Sclerosis
• Intervention / Treatment: Drug: SAR442168; Drug: Placebo; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI)

Detailed Description

The total study duration was 24 weeks which included a screening period of 4 weeks, a treatment period of 16 weeks, and a follow-up period of up to 4 weeks. Participants who completed the Week 16 visit were proposed to be enrolled in a long-term extension safety and efficacy study to assess safety, tolerability and efficacy of SAR442168.

• Study Type: Interventional
• Enrollment (Actual): 130
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Gatineau, Canada, J8Y 1W2
    • Investigational Site Number 1240002
  • Greenfield Park, Canada, J4V 2J2
    • Investigational Site Number 1240001
  • Vancouver, Canada, V6T 2B5
    • Investigational Site Number 1240003
• Czechia
  • Brno, Czechia, 62500
    • Investigational Site Number 2030007
  • Hradec Kralove, Czechia, 50005
    • Investigational Site Number 2030004
  • Jihlava, Czechia, 58633
    • Investigational Site Number 2030003
  • Ostrava - Poruba, Czechia, 70852
    • Investigational Site Number 2030005
  • Pardubice, Czechia, 53203
    • Investigational Site Number 2030006
  • Praha 2, Czechia, 12808
    • Investigational Site Number 2030001
  • Praha 5 - Motol, Czechia, 15006
    • Investigational Site Number 2030002
• Estonia
  • Tallinn, Estonia, 11315
    • Investigational Site Number 2330001
• France
  • Nancy Cedex, France, 54035
    • Investigational Site Number 2500004
  • Nantes Cedex 1, France, 44093
    • Investigational Site Number 2500001
  • Strasbourg Cedex, France, 67098
    • Investigational Site Number 2500002
  • Toulouse Cedex 9, France, 31059
    • Investigational Site Number 2500003
• Netherlands
  • Amsterdam, Netherlands, 1081 HV
    • Investigational Site Number 5280001
  • Sittard-Geleen, Netherlands, 6162 BG
    • Investigational Site Number 5280002
• Russian Federation
  • Kazan, Russian Federation, 420021
    • Investigational Site Number 6430006
  • Moscow, Russian Federation, 125367
    • Investigational Site Number 6430003
  • Moscow, Russian Federation, 127015
    • Investigational Site Number 6430002
  • Saint-Petersburg, Russian Federation, 197110
    • Investigational Site Number 6430001
  • St-Petersburg, Russian Federation, 194044
    • Investigational Site Number 6430005
  • St-Petersburg, Russian Federation, 197022
    • Investigational Site Number 6430004
  • Tyumen, Russian Federation, 625000
    • Investigational Site Number 6430007
• Slovakia
  • Bratislava, Slovakia, 82606
    • Investigational Site Number 7030001
  • Martin, Slovakia, 03659
    • Investigational Site Number 7030002
• Spain
  • Barakaldo, Spain, 48903
    • Investigational Site Number 7240006
  • Barcelona, Spain, 08035
    • Investigational Site Number 7240002
  • Madrid, Spain, 28007
    • Investigational Site Number 7240001
  • Murcia, Spain, 30120
    • Investigational Site Number 7240004
  • Salt, Spain, 17190
    • Investigational Site Number 7240005
  • Sevilla, Spain, 41071
    • Investigational Site Number 7240003
• Ukraine
  • Chernivtsi, Ukraine, 58018
    • Investigational Site Number 8040002
  • Dnipro, Ukraine, 49005
    • Investigational Site Number 8040005
  • Lviv, Ukraine, 79010
    • Investigational Site Number 8040001
  • Lviv, Ukraine, 79013
    • Investigational Site Number 8040006
  • Odesa, Ukraine, 65025
    • Investigational Site Number 8040009
  • Vinnytsya, Ukraine, 21005
    • Investigational Site Number 8040003
  • Zhytomyr, Ukraine, 10002
    • Investigational Site Number 8040007
• United States
  • Alabama
    • Cullman, Alabama, United States, 35058
      • Investigational Site Number 8400005
  • Florida
    • Maitland, Florida, United States, 32761
      • Investigational Site Number 8400002
    • Sunrise, Florida, United States, 33351
      • Investigational Site Number 8400004
    • Tampa, Florida, United States, 33612
      • Investigational Site Number 8400009
  • Georgia
    • Savannah, Georgia, United States, 31406
      • Investigational Site Number 8400007
  • Illinois
    • Northbrook, Illinois, United States, 60062
      • Investigational Site Number 8400001
  • Ohio
    • Dayton, Ohio, United States, 45417
      • Investigational Site Number 8400008
    • Westerville, Ohio, United States, 43081
      • Investigational Site Number 8400006
  • Tennessee
    • Knoxville, Tennessee, United States, 37922
      • Investigational Site Number 8400003

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:

• Participant must be 18 to 55 years of age, inclusive, at the time of signing the informed consent.
• Participant was diagnosed with relapsing multiple sclerosis (RMS) according to the 2017 revision of the McDonald diagnostic criteria.
• Participant must had at least 1 documented relapse within the previous year, OR greater than or equal to (>=) 2 documented relapses within the previous 2 years, OR >=1 active Gadolinium (Gd) enhancing brain lesion on an MRI scan in the past 6 months and prior to screening.
• A female participant must had used a double contraception method including a highly effective method of birth control from inclusion and up to 2 months after the last study dose, except if she had undergone sterilization at least 3 months earlier or was postmenopausal. Menopause was defined as being amenorrheic for >=12 months with serum follicle-stimulating hormone (FSH) level greater than (>) 30 International Units per liters.
• Male participants, whose partners were of childbearing potential (including breastfeeding women), must had accepted to use, during sexual intercourse, a double contraceptive method according to the following algorithm: (condom) plus (intrauterine device or hormonal contraceptive) from inclusion up to 3 months after the last dose.
• Male participants whose partners were pregnant must had used, during sexual intercourse, a condom from inclusion up to 3 months after the last dose.
• Male participants had agreed not to donate sperm from the inclusion up to 3 months after the last dose.
• Participant had given written informed consent prior to undertaking any study-related procedure.

Exclusion criteria:

• The participant had been diagnosed with primary progressive multiple sclerosis according to the 2017 revision of the McDonald diagnostic criteria or with non relapsing secondary progressive multiple sclerosis.
• Requirement for concomitant treatment that could bias the primary evaluation.
• Contraindication for MRI.
• Contraindications to use MRI Gd contrast-enhancing preparations.
• History of infection with the human immunodeficiency virus (HIV).
• History of active or latent tuberculosis.
• Any other active infections that would adversely affect participation or investigational medicinal product administration in this study, as judged by the Investigator.
• Presence of any screening laboratory or electrocardiogram values outside normal limits that were considered in the Investigator's judgment to be clinically significant.
• Presence of liver injury.
• At screening, the participant was positive for hepatitis B surface antigen and/or hepatitis B core antibody and/or was positive for hepatitis C antibody.
• Bleeding disorder or known platelet dysfunction at any time prior to screening visit.
• Participant had received any live (attenuated) vaccine (including but not limited to varicella zoster, oral polio, and nasal influenza) within 2 months before first treatment visit.
• Participant was receiving strong inducers or inhibitors of cytochrome P450 3A (CYP3A) or CYP2C8 hepatic enzymes.
• Participant was receiving anticoagulant/antiplatelet therapies.
• Participant had taken other investigational drugs within 3 months or 5 half lives, whichever was longer, before screening visit.
• Participant had an Expanded Disability Status Scale score >5.5 at first screening visit.
• Participant had a relapse in the 30 days prior to randomization.
• Participant was pregnant or a breastfeeding woman.
• History or presence of significant other concomitant illness.
• The participant had received medications/treatments for multiple sclerosis within a specified time frame.

The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

8

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cohort 1: SAR442168 5 mg Then Placebo; Participants received SAR442168 5 milligrams (mg), orally once daily for first 12 weeks then crossed over to matching placebo orally once daily for 4 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous
Experimental: Cohort 1: SAR442168 15 mg Then Placebo; Participants received SAR442168 15 mg, orally once daily for first 12 weeks then crossed over to matching placebo orally once daily for 4 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous
Experimental: Cohort 1: SAR442168 30 mg Then Placebo; Participants received SAR442168 30 mg, orally once daily for first 12 weeks then crossed over to matching placebo orally once daily for 4 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous
Experimental: Cohort 1: SAR442168 60 mg Then Placebo; Participants received SAR442168 60 mg, orally once daily for first 12 weeks then crossed over to matching placebo orally once daily for 4 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous
Experimental: Cohort 2: Placebo Then SAR442168 5 mg; Participants received placebo matching to SAR442168 tablets, orally once daily for first 4 weeks then crossed over to SAR442168 5 mg orally once daily for 12 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous
Experimental: Cohort 2: Placebo Then SAR442168 15 mg; Participants received placebo matching to SAR442168 tablets, orally once daily for first 4 weeks then crossed over to SAR442168 15 mg orally once daily for 12 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous
Experimental: Cohort 2: Placebo Then SAR442168 30 mg; Participants received placebo matching to SAR442168 tablets, orally once daily for first 4 weeks then crossed over to SAR442168 30 mg orally once daily for 12 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous
Experimental: Cohort 2: Placebo Then SAR442168 60 mg; Participants received placebo matching to SAR442168 tablets, orally once daily for first 4 weeks then crossed over to SAR442168 60 mg orally once daily for 12 weeks during the 16 weeks treatment period. To maintain the blinding, each participant was given a total of 4 tablets daily, either of SAR442168 or SAR442168 and placebo, to achieve the specified daily dose of SAR442168.	Drug: SAR442168; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Placebo; Pharmaceutical form: Film coated tablet; Route of administration: Oral; Drug: Locally approved intravenous contrast medium for contrast enhanced magnetic resonance imaging (MRI); Pharmaceutical form: Solution for injection; Route of administration: Intravenous

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of new Gd-enhancing T1 hyperintense lesions	Number of new Gd-enhancing T1 hyperintense lesions at the end of 12 weeks of SAR442168 treatment as detected by brain MRI	Week 12 for Arms 1 - 4, Week 4 and Week 16 for Arms 5 - 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of new or enlarging T2 lesions	Number of new or enlarging T2 lesions at the end of 12 weeks of SAR442168 treatment	Week 12 for Arms 1 - 4, Week 4 and Week 16 for Arms 5 - 8
Total number of Gd-enhancing T1 hyperintense lesions	Total number of Gd-enhancing T1-hyperintense lesions at the end of 12 weeks of SAR442168 treatment	Week 12 for Arms 1 - 4, Week 4 and Week 16 for Arms 5 - 8
Number of participants experiencing adverse events	Number (n) of participants experiencing an adverse event (AE)/Serious Adverse Event (SAE) or potentially clinically significant abnormalities in laboratory tests, electrocardiogram (ECG), or vital signs	From baseline to the end of study (approximately 20 weeks)
Percentage of participants experiencing adverse events	Percentage (%) of participants experiencing an adverse event (AE)/Serious Adverse Event (SAE) or potentially clinically significant abnormalities in laboratory tests, electrocardiogram (ECG), or vital signs	From baseline to the end of study (approximately 20 weeks)

Collaborators and Investigators

• Sponsor: Sanofi

Publications and helpful links

General Publications

• Reich DS, Arnold DL, Vermersch P, Bar-Or A, Fox RJ, Matta A, Turner T, Wallström E, Zhang X, Mareš M, Khabirov FA, Traboulsee A; Tolebrutinib Phase 2b Study Group. Safety and efficacy of tolebrutinib, an oral brain-penetrant BTK inhibitor, in relapsing multiple sclerosis: a phase 2b, randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2021 Sep;20(9):729-738. doi: 10.1016/S1474-4422(21)00237-4.

Study record dates

Study Major Dates

• Study Start (Actual): March 29, 2019
• Primary Completion (Actual): January 2, 2020
• Study Completion (Actual): January 2, 2020

Study Registration Dates

• First Submitted: March 1, 2019
• First Submitted That Met QC Criteria: March 23, 2019
• First Posted (Actual): March 26, 2019

Study Record Updates

• Last Update Posted (Actual): April 22, 2022
• Last Update Submitted That Met QC Criteria: April 21, 2022
• Last Verified: April 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Sclerosis
• Other Study ID Numbers: DRI15928; 2018-003927-12 (EudraCT Number); U1111-1220-0572 (Other Identifier: UTN)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No