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A Study of Efficacy and Safety of M2951 in Participants With Relapsing Multiple Sclerosis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02975349
Recruitment Status : Active, not recruiting
First Posted : November 29, 2016
Results First Posted : February 5, 2021
Last Update Posted : May 27, 2021
Sponsor:
Collaborator:
Merck KGaA, Darmstadt, Germany
Information provided by (Responsible Party):
EMD Serono ( EMD Serono Research & Development Institute, Inc. )

Study Description
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Brief Summary:
The aim of this protocol is to find out about the safety and effectiveness of M2951 in participants with relapsing multiple sclerosis. Participants were placed into 1 of 3 groups to receive M2951, placebo or tecfidera for 24 weeks. After 24 weeks, the participants on placebo were given M2951.

Condition or disease Intervention/treatment Phase
Relapsing-remitting Multiple Sclerosis Drug: Evobrutinib Drug: Placebo Drug: Tecfidera Phase 2

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 267 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Double-Blind, Placebo-Controlled Phase II Study of M2951 With a Parallel, Open-Label, Active Control Group (Tecfidera), in Patients With Relapsing Multiple Sclerosis to Evaluate Efficacy, Safety, Tolerability, Pharmacokinetics, and Biological Activity.
Actual Study Start Date : March 7, 2017
Actual Primary Completion Date : January 24, 2018
Estimated Study Completion Date : February 15, 2025

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Placebo then Evobrutinib 25 mg QD
Participants who received placebo matched to Evobrutinib tablet orally for 24 weeks in active treatment period 1 received Evobrutinib 25 milligram (mg) orally, once daily (QD) in blinded extension (BE) period from week 25 to week 48.
 Drug: Placebo
Placebo were administered for 24 weeks

Drug: Evobrutinib
Following Placebo for 24 weeks, participants received Evobrutinib 25 milligram (mg) orally, once daily (QD) from Week 24 to 48 weeks.
Other Name: M2951
Experimental: Evobrutinib 25 mg QD
Participants received Evobrutinib 25 mg orally, QD up to Week 48 in active treatment period 1 and BE period.
 Drug: Evobrutinib
Participants received Evobrutinib 25 mg orally, once daily (QD) up to Week 48
Other Name: M2951
Experimental: Evobrutinib 75 mg QD
Participants received Evobrutinib 75 mg orally, QD up to Week 48 in active treatment period 1 and BE period.
 Drug: Evobrutinib
Participants received Evobrutinib 75 mg orally, QD up to Week 48
Other Name: M2951
Experimental: Evobrutinib 75 mg BID
Participants received Evobrutinib 75 mg orally, twice daily (BID) up to Week 48 in active treatment period 1 and BE period.
 Drug: Evobrutinib
Participants received Evobrutinib 75 milligrams (mg) orally, twice daily (BID) up to Week 48
Other Name: M2951
Active Comparator: Tecfidera
Participants received Tecfidera 120 mg twice daily (BID) for first 7 days followed by 240 mg orally, BID up to Week 48 in active treatment period 1 and BE period.
 Drug: Tecfidera
Tecfidera; 120 mg hard capsule BID for 7 days then 240 mg hard capsule BID for duration of treatment (48 weeks).
Placebo Comparator: Placebo
Participants received placebo matched to Evobrutinib tablet orally for 24 weeks in active treatment period 1.
 Drug: Placebo
Placebo were administered for 24 weeks


Outcome Measures
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Primary Outcome Measures :
  1. Total Number of Gadolinium-Enhancing T1 Lesions [ Time Frame: Week 12 to Week 24 ]
    Analysis of T1-Gadolinium enhancing lesions was done using magnetic resonance imaging (MRI) scans. As per planned analysis, Tecfidera treatment group was not included in inferential analysis.


Secondary Outcome Measures :
  1. Annualized Relapse Rate (ARR) at Week 24 [ Time Frame: Week 24 ]
    A qualifying relapse is defined as new, worsening or recurrent neurological symptoms attributed to Multiple Sclerosis (MS) that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days. As per planned analysis, Tecfidera treatment group was not included in inferential analysis.

  2. Qualified Relapse-Free Status at Week 24 [ Time Frame: Week 24 ]
    A qualifying relapse is defined as new, worsening or recurrent neurological symptoms attributed to Multiple Sclerosis (MS) that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days. Percentage of participants with qualified relapse-free status at week 24 were reported. As per planned analysis, Tecfidera treatment group was not included in inferential analysis.

  3. Change From Baseline in Expanded Disability Status Scale (EDSS) at Week 24 [ Time Frame: Baseline, Week 24 ]
    The EDSS is an ordinal clinical rating scale in half-point increments. It assesses the following eight functional systems, areas of the central nervous system that control bodily functions: Pyramidal (ability to walk), Cerebellar (coordination), Brain stem (speech and swallowing), Sensory (touch and pain), Bowel and bladder functions, Visual, Mental, Other (includes any other neurological findings due to Multiple Sclerosis [MS]). EDSS overall score ranging from 0 (normal) to 10 (death due to MS). As per planned analysis, Tecfidera treatment group was not included in inferential analysis.

  4. Number of Participants With Treatment-emergent Adverse Events (TEAEs), Serious TEAEs and TEAEs Leading to Death [ Time Frame: Baseline up to Safety Follow-up (Week 52) ]
    An adverse event (AE) was defined as any untoward medical occurrence in a participant which does not necessarily have a causal relationship with the study drug. An AE was defined as any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of study drug, whether or not considered related to the study drug or worsening of pre-existing medical condition, whether or not related to study drug. A serious adverse event (SAE) was an AE that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged inpatient hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. Treatment-emergent adverse events are defined as any adverse event with a start date on or after the date of first dose and within 28 days after the date of last dose in the study. TEAEs include both Serious TEAEs and non-serious TEAEs.

  5. Number of Participants With Clinically Significant Changes From Baseline in Vital Signs and Electrocardiograms (ECGs) [ Time Frame: Baseline up to Safety Follow-up (Week 52) ]
    Vital signs, including semi supine blood pressure, pulse rate, respiratory rate, weight, and oral temperature were assessed. ECG parameters included rhythm, ventricular rate, PR interval, QRS duration, and QT interval. Number of participants with clinically significant change from baseline in vital signs and ECG were reported. Clinical Significance was decided by the investigator.

  6. Number of Participants With Grade 3 or Higher Hematology, Biochemistry and Urinalysis Values [ Time Frame: Baseline up to Safety Follow-up (Week 52) ]
    Hematology, biochemistry, and urinalysis values were graded with National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 4.03 toxicity grades (where Grade 1 = mild, Grade 2 = moderate, Grade 3 = severe, Grade 4 = life threatening and Grade 5 = death). For the hematology and biochemistry parameters, participants with a value grade 3 or higher were reported. For the urinalysis parameters, participants with a value grade 3 or higher, or a value >= 2 upper limit of normal (ULN), or a value classified as ++ Increasing were reported.

  7. Absolute Concentrations of Immunoglobulin (Ig) Levels (Active Treatment Period) [ Time Frame: Baseline (Day 1), Weeks 4, 16, and 24 ]
    Absolute Concentrations serum levels of IgG, IgA, IgM were assessed.

  8. Absolute Concentrations of Immunoglobulin (Ig) Levels (Blinded Extension Period) [ Time Frame: Weeks 48 ]
    Absolute Concentrations serum levels of IgG, IgA, IgM were to be assessed.

  9. Change From Baseline in Immunoglobulin (Ig) Levels (Active Treatment Period) [ Time Frame: Baseline (Day 1), Weeks 4, 16, and 24 ]
    Change in the serum levels of IgG, IgA, IgM were assessed.

  10. Change From Baseline in Immunoglobulin (Ig) Levels (Blinded Extension Period) [ Time Frame: Baseline (Day 1), Week 48 ]
    Change in the serum levels of IgG, IgA, IgM were to be assessed.

  11. Absolute Numbers of B Cells (Active Treatment Period) [ Time Frame: Baseline (Day 1), Weeks 4, and 24 ]
    Absolute Numbers of B Cells are reported.

  12. Absolute Numbers of B Cells (Blinded Extension Period) [ Time Frame: Weeks 48 and 52 ]
    Absolute Numbers of B Cells to be reported.

  13. Change From Baseline in Absolute B Cells (Active Treatment Period) [ Time Frame: Baseline (Day 1), Weeks 4, and 24 ]
    Change from baseline in absolute B cells are reported.

  14. Change From Baseline in Absolute B Cells (Blinded Extension Period) [ Time Frame: Weeks 48 and 52 ]
    Change from baseline in absolute B cells to be reported.

  15. Total Number of New Gadolinium-positive (Gd+) T1 Lesions [ Time Frame: Week 12 to 24 ]
    Analysis of Gadolinium-positive T1 lesions was done using magnetic resonance imaging (MRI) scans. As per planned analysis, Tecfidera treatment group was not included in inferential analysis.

  16. Mean Per-scan Number of Gadolinium-positive (Gd+) T1 Lesions [ Time Frame: Week 12 to Week 24 ]
    Analysis of Gadolinium-positive T1 lesions was done using magnetic resonance imaging (MRI) scans. As per planned analysis, Tecfidera treatment group was not included in inferential analysis.

  17. Total Number of New or Enlarging T2 Lesions [ Time Frame: Week 12 to Week 24 ]
    Analysis of New or Enlarging T2 lesions was done using magnetic resonance imaging (MRI) scans. As per planned analysis, Tecfidera treatment group was not included in inferential analysis.

  18. Change From Baseline in Volume of T2 Lesions at Week 24 [ Time Frame: Baseline, Week 24 ]
    Analysis of volume of T2 lesions was done using magnetic resonance imaging (MRI) scans. Tecfidera treatment group was not included in inferential analysis.

  19. Change From Baseline in Volume of Gadolinium-positive (Gd+) T1 Lesions at Week 24 [ Time Frame: Baseline, Week 24 ]
    Analysis of volume of Gd+ T1 lesions was done using magnetic resonance imaging (MRI) scans. As per planned analysis, Tecfidera treatment group was not included in inferential analysis.

  20. Number of Gadolinium-positive (Gd+) T1 Lesions at Week 48 [ Time Frame: Week 48 ]
    Analysis of Gd+ T1 lesions was done using magnetic resonance imaging (MRI) scans.

  21. Number of New Gadolinium-positive (Gd+) T1 Lesions at Week 48 [ Time Frame: Week 48 ]
    Analysis of new Gd+ T1 lesions was done using magnetic resonance imaging (MRI) scans.

  22. Annualized Relapse Rate (ARR) [ Time Frame: Week 0 to Week 48 ]
    A qualifying relapse is defined as new, worsening or recurrent neurological symptoms attributed to Multiple Sclerosis (MS) that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days.

  23. Qualified Relapse-free Status [ Time Frame: Week 25 to Week 48 ]
    A qualifying relapse is defined as new, worsening or recurrent neurological symptoms attributed to Multiple Sclerosis (MS) that last for at least 24 hours without fever or infection, or adverse reaction to prescribed medication, preceded by a stable or improving neurological status of at least 30 days. Percentage of participants with qualified relapse-free status were reported.

  24. Change From Week 24 in Expanded Disability Status Scale (EDSS) at Week 48 [ Time Frame: Week 24, Week 48 ]
    The EDSS is an ordinal clinical rating scale in half-point increments. It assesses the following eight functional systems, areas of the central nervous system that control bodily functions: Pyramidal (ability to walk), Cerebellar (coordination), Brain stem (speech and swallowing), Sensory (touch and pain), Bowel and bladder functions, Visual, Mental, Other (includes any other neurological findings due to Multiple Sclerosis [MS]). EDSS overall score ranging from 0 (normal) to 10 (death due to MS).

  25. Total Number of New or Enlarging T2 Lesions at Week 48 Relative to Week 24 [ Time Frame: Week 24 to Week 48 ]
    Analysis of New or Enlarging T2 lesions was done using magnetic resonance imaging (MRI) scans.

  26. Change From Week 24 in Volume of Gadolinium-positive (Gd+) T1 Lesions at Week 48 [ Time Frame: Week 24, Week 48 ]
    Analysis of volume of Gd+ T1 lesions was done using magnetic resonance imaging (MRI) scans.

  27. Change From Week 24 in Volume of T2 Lesions at Week 48 [ Time Frame: Week 24, Week 48 ]
    Analysis of volume of T2 lesions was done using magnetic resonance imaging (MRI) scans.


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Participants with a diagnosis of relapsing multiple sclerosis (may include participants with Secondary Progressive Multiple Sclerosis (SPMS) with superimposed relapses provided they meet the other criteria) in accordance with revised McDonald criteria for MS and Lublin and Reingold
  • Male or female aged 18 to 65 years
  • One or more documented relapses within the 2 years before Screening with either: a) One relapse which occurred within the last year prior to randomization or b) the presence of at least 1 gadolinium-positive (Gd+) T1 lesion within 6 months prior to randomization would make the patient eligible.
  • Expanded Disability Status Scale score of 0 to 6 at Baseline
  • Women of childbearing potential must use a supplementary barrier method together with a highly effective method of contraception (according to International Council for Harmonisation [ICH] guidance M3[R2]) for 4 weeks prior to randomization, throughout the trial, and for 90 days after the last dose of IMP.
  • Signed and dated informed consent (participant must be able to understand the informed consent) indicating that the participant has been informed of all the pertinent aspects of the trial prior to enrolment and will comply with the requirements of the protocol.

Exclusion Criteria:

  • Progressive MS
  • Disease duration > 15 years in participants with EDSS of 2 or less
  • Use of the following, as determined in the protocol ; rituximab, ocrelizumab, mitoxantrone, or lymphocyte-depleting therapies, lymphocyte trafficking blockers (eg, natalizumab, fingolimod), intravenous (IV) immunoglobulins (Ig), plasmapheresis, immunosuppressive treatments, B-interferons or glatiramer acetate, Systemic glucocorticoids, teriflunomide
  • Exposure to Tecfidera within 6 months prior to randomization
  • Any allergy, contraindication, or inability to tolerate Tecfidera
  • Treatment with dalfampridine (fampridine, Ampyra) unless on a stable dose for ≥ 30 days prior to randomization
  • Inability to comply with MRI scanning
  • Immunologic disorder other than MS, with the exception of secondary well-controlled diabetes or thyroid disorder, or any other condition requiring oral, IV, intramuscular, or intra-articular corticosteroid therapy
  • Vaccination with live or live-attenuated virus vaccine within 1 month prior to Screening
  • Severe drug allergy or history of anaphylaxis, or allergy to the IMP or any of its incipients
  • Active, clinically significant viral, bacterial, or fungal infection, or any major episode of infection requiring hospitalization or treatment with parenteral anti-infectives within 4 weeks of Screening, or completion of oral anti-infectives within 2 weeks before or during Screening, or a history of recurrent infections (ie, 3 or more of the same type of infection in a 12-month rolling period). Vaginal candidiasis, onychomycosis, and genital or oral herpes simplex virus considered by the Investigator to be sufficiently controlled would not be exclusionary.
  • History of or positive testing for human immunodeficiency virus (HIV), hepatitis C (HCV) antibody and/or polymerase chain reaction, hepatitis B surface antigen (HBsAg) (+) and/or hepatitis B core total, and/or immunoglobulin M (IgM) antibody (+) at Screening.
  • The participant: • Has a history of or current diagnosis of active tuberculosis (TB) or • Is currently undergoing treatment for latent TB infection (LTBI) or • Has an untreated LTBI or • Has a positive QuantiFERON®-TB test at Screening.
  • Indeterminate QuantiFERON®
  • Participants with current household contacts with active TB will also be excluded
  • History of splenectomy or any major surgery within 2 months prior to Screening
  • History of myocardial infarction or cerebrovascular event as per the protocol
  • History of attempted suicide within 6 months prior to Screening or a positive response to items 4 or 5 of Columbia-Suicide Severity Rating Scale (C-SSRS)
  • An episode of major depression within the last 6 months prior to Screening
  • On anticoagulation, fish oil supplements, or antiplatelet therapy other than daily aspirin for cardioprotection and treatment of Tecfidera induced flushing
  • History of cancer, except adequately treated basal cell or squamous cell carcinoma of the skin
  • Breastfeeding/lactating or pregnant women
  • Participation in any investigational drug trial within 1 month or 5 half-lives of the investigational drug, whichever is longest, prior to Screening
  • Participants currently receiving (or unable to stop using prior to receiving the first dose of IMP) medications or herbal supplements known to be potent inhibitors of cytochrome P450 3A (CYP3A)
  • History of or current alcohol or substance abuse
  • Clinically significant abnormality on electrocardiogram or screening chest X-ray
  • Clinically significant laboratory abnormality
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02975349


Locations
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Sponsors and Collaborators
EMD Serono Research & Development Institute, Inc.
Merck KGaA, Darmstadt, Germany
Investigators
Layout table for investigator information
Study Director: Medical Responsible EMD Serono Inc., a business of Merck KGaA, Darmstadt, Germany
  Study Documents (Full-Text)

Documents provided by EMD Serono ( EMD Serono Research & Development Institute, Inc. ):
Study Protocol  [PDF] May 29, 2018
Statistical Analysis Plan  [PDF] February 14, 2018

More Information
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Additional Information:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: EMD Serono Research & Development Institute, Inc.
ClinicalTrials.gov Identifier: NCT02975349    
Other Study ID Numbers: MS200527-0086
2016-001448-21 ( EudraCT Number )
First Posted: November 29, 2016    Key Record Dates
Results First Posted: February 5, 2021
Last Update Posted: May 27, 2021
Last Verified: April 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by EMD Serono ( EMD Serono Research & Development Institute, Inc. ):
M2951
Relapsing Multiple Sclerosis
Bruton's Tyrosine Kinase inhibitor
Additional relevant MeSH terms:
Layout table for MeSH terms
Multiple Sclerosis
Multiple Sclerosis, Relapsing-Remitting
Sclerosis
Pathologic Processes
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
 Autoimmune Diseases
Immune System Diseases
Dimethyl Fumarate
Dermatologic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs