Relapsing Forms of Multiple Sclerosis (RMS) Study of Bruton's Tyrosine Kinase (BTK) Inhibitor Tolebrutinib (SAR442168)

Study Overview
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Brief Summary
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Primary Objective: To assess efficacy of daily SAR442168 compared to a daily dose of 14 mg teriflunomide (Aubagio) measured by annualized adjudicated relapse rate (ARR) in participants with relapsing forms of MS Secondary Objective: To assess efficacy of SAR442168 compared to teriflunomide (Aubagio) on disability progression, MRI lesions, cognitive performance and quality of life To evaluate the safety and tolerability of daily SAR442168 To evaluate population pharmacokinetics (PK) of SAR442168 and relevant metabolites and its relationship to efficacy and safety To evaluate pharmacodynamics (PD) of SAR442168

Detailed Description
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Study duration will vary per participant in this event driven trial with a treatment duration of approximately 18 to 36 months. Participants completing the study will be offered to participate in a long term safety study.

Official Title
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A Phase 3, Randomized, Double-blind Efficacy and Safety Study Comparing SAR442168 to Teriflunomide (Aubagio®) in Participants With Relapsing Forms of Multiple Sclerosis

Conditions
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Relapsing Multiple Sclerosis

Intervention / Treatment
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* Drug: Tolebrutinib
* Drug: Teriflunomide HMR1726
* Drug: Placebo to match Tolebrutinib
* Drug: Placebo to match Teriflunomide


Participation Criteria
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Eligibility Criteria
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Inclusion criteria : The participant must be 18 to 55 years of age, inclusive, at the time of signing the informed consent The participant must have been diagnosed with RMS according to the 2017 revision of the McDonald diagnostic criteria The participant has an expanded disability status scale (EDSS) score ≤5.5 at the first Screening Visit The participant must have at least 1 of the following prior to screening: ≥1 documented relapse within the previous year OR ≥2 documented relapses within the previous 2 years, OR ≥1 documented Gd enhancing lesion on an MRI scan within the previous year Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies Male participants are eligible to participate if they agree to the following during the intervention period and until accelerated elimination procedure: Refrain from donating sperm Plus either: Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent OR Must agree to use contraception/barrier as detailed below: Agree to use a male condom and should also be advised of the benefit for a female partner to use a highly effective method of contraception as a condom may break or leak when having sexual intercourse with a woman of childbearing potential (WOCBP) who is not currently pregnant A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions apply: Is not a WOCBP OR Is a WOCBP and agrees to use a contraceptive method that is highly effective (with a failure rate of <1% per year), preferably with low user dependency, during the intervention period and until accelerated elimination procedure is completed (or for at least 10 days after the last dose of SAR442168, if the case was unblinded) A WOCBP must have a negative highly sensitive pregnancy test at screening and within 24hours 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. The participant must have given written informed consent prior to undertaking any study related procedure. This includes consent to comply with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. In countries where the legal age of maturity is greater than 18 years, a specific ICF for such legally minor participants must also be signed by the participant's legally authorized representative Exclusion criteria: The participant has been diagnosed with primary progressive multiple sclerosis (PPMS) according to the 2017 revision of the McDonald diagnostic criteria or with nonrelapsing secondary progressive multiple sclerosis (SPMS) The participant has a history of infection or may be at risk for infection including but not limited to: HIV, transplantation, live attenuated vaccines, progressive multifocal leukoencephalopathy, tuberculosis, hepatitis B or C, any persistent chronic or active recurring infection Clinically significant laboratory abnormalities (including evidence of liver injury) or electrocardiogram abnormalities at Screening. The participant has conditions or situations that would adversely affect participation in this study, including but not limited to: A short life expectancy due to pre-existing health condition(s) as determined by their treating neurologist Medical condition(s) or concomitant disease(s) making them nonevaluable for the primary efficacy endpoint or that would adversely affect participation in this study, as judged by the Investigator A requirement for concomitant treatment that could bias the primary evaluation The participant has a history of or currently has concomitant medical or clinical conditions that would adversely affect participation in this study At screening, the participant is positive for hepatitis B surface antigen and/or hepatitis B core antibody and/or is positive for hepatitis C antibody The participant has any of the following: A bleeding disorder or known platelet dysfunction at any time prior to the screening visit A platelet count <150 000/μL at the screening visit The participant has a lymphocyte count below the lower limit of normal (LLN) at the screening visit The presence of psychiatric disturbance or substance abuse Prior/concomitant therapy The participant is receiving potent and moderate inducers of cytochrome P450 (CYP) 3A or potent inhibitors of CYP2C8 hepatic enzymes The participant is receiving anticoagulant/antiplatelet therapies The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SAR442168<br>Dose 1 of oral SAR442168 + placebo to match the teriflunomide tablet once daily | Drug: Tolebrutinib<br>* Pharmaceutical form: Tablet Route of administration: Oral<br>* Other names: SAR442168;Drug: Placebo to match Teriflunomide<br>* Pharmaceutical form: Tablet Route of administration: Oral<br>|
| Active Comparator: Teriflunomide<br>Oral 14 mg oral teriflunomide + placebo to match the SAR442168 tablet once daily | Drug: Teriflunomide HMR1726<br>* Pharmaceutical form: Tablet Route of administration: Oral<br>Drug: Placebo to match Tolebrutinib<br>* Pharmaceutical form: Tablet Route of administration: Oral<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Annualized Adjudicated Relapse Rate : Number of confirmed adjudicated protocol defined relapses | Annualized Adjudicated Relapse Rate : Number of confirmed adjudicated protocol defined relapses | Up to approximately 36 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to onset of confirmed disability worsening confirmed over at least 6 months | Time to onset of confirmed disability worsening (CDW), confirmed over at least 6 months, defined as follows: increase of ≥1.5 points from the baseline expanded disability status scale (EDSS) score when the baseline score is 0 OR increase of ≥1.0 point from the baseline EDSS score when the baseline score is 0.5 to ≤5.5 OR increase of ≥0.5 point from the baseline EDSS score when the baseline score is >5.5 - 5. | Up to approximately 36 months | 
| Time to onset of CDW, assessed by the EDSS score and confirmed over at least 3 months |  | Up to approximately 36 months | 
| Total number of new and/or enlarging T2 hyperintense lesions as detected by MRI from Month 6 through the end of study (EOS) |  | From 6 months up to approximately 36 months | 
| Total of Gd-enhancing T1 hyperintense lesions as detected by MRI from 6 months through the EOS |  | From 6 months up to approximately 36 months | 
| Change in cognitive function | Change in cognitive function from baseline to the end of study (EOS) as assessed by SDMT and by CVLT-II where available | From Baseline up to approximately 36 months | 
| Time to confirmed disability improvement | Time to confirmed disability improvement (CDI), defined as a ≥1.0 point decrease on the EDSS from the baseline EDSS score confirmed over at least 6 months | From Baseline up to approximately 36 months | 
| Percent Change in Brain volume loss (BVL) | Brain volume loss (BVL) rate as detected by brain MRI from Month 6 to the EOS | From 6 months up to approximately 36 months | 
| Change in Multiple Sclerosis Quality of Life | Change in Multiple Sclerosis Quality of Life-54 (MSQoL-54) from the baseline through the EOS | From Baseline up to approximately 36 months | 
| Number of participants with adverse events A(Es) leading to permanent study intervention discontinuation, and adverse events of special interest (AESI) |  | From screening until end of study approximately 36 months | 
| Population Pharmacokinetics - Concentration SAR442168 and relevant metabolites at 6 months | Plasma concentration of SAR442168 (population PK assessment) at 6 Months | 6 Months | 
| Population Pharmacokinetics Concentration of SAR442168 and relevant metabolites at 9 Months | Plasma concentration of SAR442168 (population PK assessment) at 9 Months | 9 Months | 
| Population Pharmacokinetics - Concentration of SAR442168 and relevant metabolites at 12 Months | Plasma concentration of SAR442168 (population PK assessment) at 12 Months | 12 Months | 
| Change in plasma NfL | Change in plasma neurofilament light chain (NfL) levels at the EOS compared to baseline | From Baseline until end of study approximately 36 months | 
| Change in lymphocyte Phenotype | Change in lymphocyte phenotype subsets in whole blood at the EOS compared to baseline in a subset of participants | From Baseline until end of study approximately 36 months | 
| Changes in plasma Immunoglobulin levels | Changes in serum immunoglobulin level at the EOS compared to baseline | From Baseline until end of study (up to 36 months) | 
| Change in CHI3L1 levels | Change in serum Chi3L1 levels at the EOS compared to baseline | From Baseline until end of study approximately 36 months |