Efficacy and safety study comparing SAR442168 to placebo in participants with nonrelapsing secondary progressive multiple sclerosis

Phase 3

Recruiting

• Conditions: Multiple sclerosis,

• Registration Number: CTRI/2020/11/029092
• Lead Sponsor: Sanofi Healthcare India Private Limited

Brief Summary

SAR442168 is expected to reduce MS relapse rate, disability progression, and underlying central nervous system (CNS) damage through its dual action on adaptive immunity in the periphery and innate immunity and the inflammation process in the CNS. The results from the Phase 2b trial (DRI15928) demonstrated a dose–response relationship for SAR442168 as evidenced by a reduction in the number of new Gd-enhancing T1-hyperintense brain lesions detected by brain MRI after 12 weeks of treatment. There was an 85% relative reduction in lesions at 12 weeks in the 60 mg dose group as compared with placebo. This was obtained from the negative binomial regression model adjusted for baseline Gd-enhancing T1-hyperintense lesion activity SPMS occurs in more than 50% of patients with relapsing remitting multiple sclerosis (RRMS) within 15 to 20 years. Chronic disability accumulation remains a significant unmet need for people living with MS. Individuals with progressive disease, including SPMS, need therapies to reduce the accumulation of disability. With several drugs approved for active secondary progressive disease, there is still no treatment available for NRSPMS. Evidence of inflammation and presence of activated T and B cells in the brain have been confirmed in primary progressive (PPMS) and SPMS, especially in the early stages.4 Inflammatory activity in RMS has been attenuated to different degrees with a variety of immunomodulatory therapies; however, historically these therapies have shown very little effect on disease activity in people with progressive MS despite the evidence for inflammatory activity. This may relate to conditions in the CNS, especially the integrity of the blood brain barrier (BBB), but also to the potency and mechanism of action of the agents. There is still a significant unmet need for therapies that target neuroinflammation in the CNS with a goal of halting long-term disability and neurodegeneration in all diagnostic categories of MS (i.e. RMS as well as progressive forms of the disease, PPMS and SPMS). 5 Even the most recent high-efficacy disease-modifying therapies act mainly on adaptive immunity in the periphery with only modest or temporary ability to slow neuroinflammatory and neurodegenerative processes and stop disease progression. 6,7 Therefore, development of MS treatments with new modes of action is of interest.

Detailed Description

Not available

Study Timeline

• Study Start: 2020-11-30
• Last Update Posted: 2023-08-28

Recruitment & Eligibility

• Status: Open to Recruitment
• Sex: All
• Target Recruitment: 1290

Inclusion Criteria

• Participants are eligible to be included in the study only if all of the following criteria apply: Age I 01.
• The participant must be 18 to 60 years of age, inclusive, at the time of signing the informed consent.
• Type of participant and disease characteristics: I 02.
• The participant must have been diagnosed with RRMS according to the 2017 revision of the McDonald diagnostic criteria (16).
• The participant must have a current diagnosis of SPMS in accordance with the clinical course criteria (11) revised in 2013 (10) and endorsed by an Adjudication Committee.
• The participant must have documented evidence of disability progression observed during the 12 months before screening.
• Eligibility will be analyzed by an Adjudication Committee (to evaluate source data for disability confirmation; details see Section 10.1.5.3).
• Absence of clinical relapses for at least 24 months.
• The participant must have an EDSS score at screening from 3.0 to 6.5 points, inclusive.
• The participant must have, at screening, disease duration from the onset of MS symptoms of: <20 years in participants with EDSS scores at screening >5.0; OR <10 years in participants with EDSS scores at screening ≤5.0 Weight I 05.
• Not applicable.
• Male and /or Female Contraceptive use should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
• A) Male participants Not applicable B) Female participants A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies: Is not a WOCBP OR Is a WOCBP and agrees to use an acceptable contraceptive method as described in Appendix 4 of protocol during the intervention period.
• A WOCBP must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) (Appendix 2 [Section 10.2] of protocol) before the first dose of study intervention.
• If a urine test cannot be confirmed as negative (eg, an ambiguous result), a serum pregnancy test is required.
• In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
• The Investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy, if allowed by local regulations See Section 10.8 of protocol for country-specific contraception requirements.
• Informed Consent I 10.
• The participant is capable of giving signed informed consent as described in Appendix 1 of the protocol which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
• In countries where the legal age of majority is above 18 years, a specific ICF must also be signed by the participant’s legally authorized representative (Appendix 1, Section 10.1.3 of the protocol).

Exclusion Criteria

• Participants are excluded from the study if any of the following criteria apply: Medical conditions E 01. The participant has a history of infection or may be at risk for infection: A history of T-lymphocyte or T-lymphocyte-receptor vaccination, transplantation (including solid organ, stem cell, and bone marrow transplantation) and/or antirejection therapy. E 02. The presence of psychiatric disturbance or substance abuse as evidenced by: A history of any psychiatric disease, behavioral condition, or depression requiring hospitalization within 2 years prior to the Screening Visit E 03. The following findings obtained during the screening visit considered in the Investigator’s judgment to be clinically significant: Any screening laboratory values outside normal limits. Abnormal ECG E 04. Conditions that may predispose the patient to excessive bleeding: A bleeding disorder or known platelet dysfunction at any time prior to the Screening Visit E 05. Conditions that would adversely affect participation in the study or make the primary efficacy endpoint non-evaluable: A short life expectancy due to pre-existing health condition(s) as determined by their treating neurologist Prior/concomitant therapy E 06. A requirement for concomitant treatment that could bias the primary evaluation, such as any of the following medications/treatments within the specified time frame before any randomization assessment (no wash out is required for interferon beta or glatiramer acetate treatments although use is not permitted on or after Day 1): Prior/concurrent clinical study experience E 07. The participant is receiving strong inducers or inhibitors of CYP3A or CYP2C8 hepatic enzymes as listed in Section 10.9. of the protocol. E 08. The participant is receiving anticoagulant/antiplatelet therapies; those that are not permitted to be taken concomitantly with the IMP, include the following: Acetylsalicylic acid (aspirin) Antiplatelet drugs (eg, clopidogrel) E 09. The participant has sensitivity to any of the study interventions, or components thereof, or has a drug or other allergy that, in the opinion of the Investigator, contraindicates participation in the study E 10. The participant was previously exposed to any BTK inhibitor, including SAR442168. E 11. The participant has taken other investigational drugs within 3 months or 5 half-lives, whichever is longer, before the screening visit. Diagnostic assessments E 12. The participant has a contraindication for MRI, ie, presence of pacemaker, metallic implants in high risk areas (ie, artificial heart valves, aneurysm/vessel clips), presence of metallic material (eg, shrapnel) in high risk areas, known history of allergy to any contrast medium, or history of claustrophobia that would prevent completion of all protocol scheduled MRI Other exclusions E 13. Individuals accommodated in an institution because of regulatory or legal order; prisoners or participants who are legally institutionalized. E 14. Any country-related specific regulation that would prevent the participant from entering the study. See Appendix 8 (Section 10.8) (country-specific requirements). E 15. The participant is not suitable for participation, whatever the reason, as judged by the Investigator, including medical or clinical conditions, or participants potentially at risk of noncompliance to study procedures or not able to follow the schedule of protocol assessments due to other reasons (exception: participants who are not able to complete electronic clinical outcome assessments may be given paper clinical outcome assessments to complete). E 16. Participants are employees of the clinical study site or other individuals directly involved in the conduct of the study, or immediate family members of such individuals (in conjunction with Section 1.61 of the International Council for Harmonisation [ICH].
• Good Clinical Practice [GCP] Ordinance E6). E 17. Any other situation during study implementation/course that may raise ethics considerations. E 18. Deleted in amended protocol 01 Note: a one-time retest at screening may be performed if an abnormal laboratory test value is considered temporary.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Time to onset of 6-month confirmed disability Progression (CDP) defined as follows:	6 months
- Increase of ≥1.0 point from the baseline EDSS score when the baseline score is ≤5.0, OR	6 months
- Increase of ≥0.5 point when the baseline EDSS score is 5.0	6 months

Secondary Outcome Measures

Name	Time	Method
Time to onset of sustained 20% increase in the 9-HPT for at least 3 months	Time to onset of sustained 20% increase in the T25-FW for at least 3 months

Trial Locations

Locations (9)

All India Institute of Medical Sciences (AIIMS) - The Neurosciences (N.S) Centre; 🇮🇳 West, DELHI, India

Artemis Hospital; 🇮🇳 Gurgaon, HARYANA, India

Brain Clinic Jasleen Hospital; 🇮🇳 Nagpur, MAHARASHTRA, India

Fortis Hospital, Gurgaon; 🇮🇳 Gurgaon, HARYANA, India

Justice K S Hegde Charitable Hospital, Dept. of Neurology, Mangalore; 🇮🇳 Kannada, KARNATAKA, India

NIMHANS; 🇮🇳 Bangalore, KARNATAKA, India

Nizam’s Institute of Medical Sciences; 🇮🇳 Hyderabad, TELANGANA, India

Postgraduate Institute of Medical Education and Research; 🇮🇳 Chandigarh, CHANDIGARH, India

Sir Gangaram Hospital; 🇮🇳 Central, DELHI, India

All India Institute of Medical Sciences (AIIMS) - The Neurosciences (N.S) Centre

🇮🇳West, DELHI, India

Dr M V Padma

Principal investigator

9810819167

vasanthapadma123@gmail.com