A Research Study to Evaluate the Efficacy and Safety of Cenerimod in Subjects Suffering From Systemic Lupus Erythematosus

Study Overview
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Brief Summary
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The goal of this clinical trial is to see how well cenerimod is in reducing symptoms of Systemic Lupus Erythematous in adult patients with moderate to severe symptoms. The main questions it aims to answer are: How well cenerimod works on top of the treatment already being administered. How safe cenerimod is for adult patients with Systemic Lupus Erythematosus. Researchers will compare one dose of cenerimod and a placebo to see how well cenerimod works when is added to the treatment already being administered. In this research study approximately 210 participants will receive cenerimod and approximately 210 participants will receive placebo for 12 months.

Official Title
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A Phase 3, Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-group Study to Evaluate the Efficacy, Safety, and Tolerability of Cenerimod in Adult Subjects With Moderate-to-severe Systemic Lupus Erythematosus (SLE) on Top of Background Therapy

Conditions
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Lupus Erythematosus, Systemic

Intervention / Treatment
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* Drug: Cenerimod
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inclusion criteria at screening: Signed Informed Consent Form (ICF) prior to any study-mandated procedure. Diagnosis of Systemic Lupus Erythematosus (SLE) made at least 6 months prior to Screening, according to 2019 European League Against Rheumatism / American College of Rheumatology Criteria. An modified Systemic Lupus Erythematosus Disease Activity Index-2000 (mSLEDAI-2K) score ≥ 6 and clinical mSLEDAI-2K score ≥ 4 with at least 2 points for musculoskeletal or mucocutaneous manifestations (i.e., myositis, arthritis, rash, alopecia, mucosal ulcers). The mSLEDAI-2K score does not include leukopenia. British Isles Lupus Assessment Group-2004 (BILAG) Grade B in ≥ 2 organ systems or a BILAG Grade A in ≥ 1 organ system. Physician's Global Assessment (PGA) score ≥ 1.0 on a 0 to 3 Visual Analogue Scale (VAS). Currently treated with one or more of the following SLE background medications: Anti-malarials (≤ 400 mg/day hydroxychloroquine, ≤ 500 mg/day chloroquine, ≤ 100 mg/day quinacrine). Mycophenolate mofetil (≤ 2 g/day) / mycophenolic acid (≤1.44 g/day). Azathioprine (≤ 2 mg/kg/day). Methotrexate (≤ 25 mg/week). Oral Corticosteroids (OCS): if OCS is the only SLE background medication: ≥ 7.5 mg/day and ≤30 mg/day prednisone or equivalent. if OCS is not the only SLE background medication: ≤ 30 mg/day prednisone or equivalent. Belimumab (≤10 mg/kg every 4 weeks intravenously, or 200 mg/week subcutaneously (s.c.). Treatment with antimalarials, mycophenolate mofetil, mycophenolic acid, azathioprine, methotrexate or belimumab must have been started at least 90 days prior to Screening. Treatment with OCS must have been started at least 30 days prior to Screening. • For women of childbearing potential (WoCBP): Negative serum pregnancy test at Screening. Agreement to undertake monthly urine pregnancy tests from Randomization up to 6 months after study treatment discontinuation. Agreement to use a highly effective method of contraception from Screening (Visit 1) up to 6 months after study treatment discontinuation. Inclusion criteria at randomization: A clinical mSLEDAI-2K score ≥ 4 with at least 2 points for musculoskeletal or mucocutaneous manifestations (i.e., myositis, arthritis, rash, alopecia, mucosal ulcers). British Isles Lupus Assessment Group-2004 (BILAG) Grade B in 2 or more organ systems or a BILAG Grade A in 1 or more organ system. Physician's Global Assessment (PGA) score ≥ 1.0 on a 0 to 3 visual analog scale. Presence of at least one of the following items of serological evidence of active SLE or biological variables predictive of Type 1 Interferon (IFN-1) high signature (in a Screening sample as measured by central laboratory): Anti-dsDNA antibodies elevated to above normal, Complement C3 < lower limit of normal, Antinuclear Antibodies with a titer of at least 1:160, Anti-Smith antibody elevated to above normal, Platelets < 200 000/μL, Urine protein/creatinine ratio > 12.5 mg/mmol (110.5 mg/g). Currently treated with one or more of the following SLE background medications that must be stable for at least 30 days prior to Randomization (except OCS, which must be stable for at least 15 days prior to Randomization): Antimalarials (≤ 400 mg/day hydroxychloroquine, ≤ 500 mg/day chloroquine, ≤ 100 mg/day quinacrine); Mycophenolate mofetil (≤ 2 g/day) / mycophenolic acid (≤ 1.44g/day); Azathioprine (≤ 2 mg/kg/day); Methotrexate (≤ 25 mg/week); OCS: if OCS is the only SLE background medication: ≥ 7.5 mg/day and ≤ 30 mg/day prednisone or equivalent. if OCS is not the only SLE background medication: ≤ 30 mg/day prednisone or equivalent). Belimumab (≤ 10 mg/kg every 4 weeks intravenous (i.v.) or ≤ 200 mg/week s.c.). WoCBP must have a negative urine pregnancy test at Randomization. Main Exclusion Criteria: Pregnant, planning to be become pregnant up to Final Study Visit or lactating women. Severe central nervous system lupus or active severe or unstable neuropsychiatric SLE characterized by: aseptic meningitis; cerebral vasculitis; myelopathy; demyelination syndromes (ascending, transverse, acute inflammatory demyelinating polyradiculopathy); acute confusional state; impaired level of consciousness; psychosis; acute stroke or stroke syndrome; cranial neuropathy; status epilepticus; cerebellar ataxia; or mononeuritis multiplex: That would make the subject unable to fully understand the ICF; OR Where, in the opinion of the Principal Investigator, protocol-specified standard of care is insufficient and the use of a more aggressive therapeutic approach, such as adding i.v. cyclophosphamide and/or high dose i.v. pulse corticosteroid (CS) therapy or other treatments not permitted in the protocol is indicated. A diagnosis of mixed connective tissue disease or any history of overlap syndromes of SLE with psoriasis, rheumatoid arthritis, erosive arthritis, scleroderma, autoimmune hepatitis or uncontrolled autoimmune thyroid disease. History or presence of Mobitz type II or third-degree atrioventricular block, sick sinus syndrome, symptomatic bradycardia or syncope associated with cardiac disorders. Subjects who experienced myocardial infarction, unstable angina pectoris, stroke, transient ischemic attack, vascular thrombosis, decompensated heart failure requiring hospitalization, or heart failure defined by the New York Heart Association Class III/IV within 6 months prior to Screening. Resting Heart Rate < 50 bpm as measured by the 12-lead ECG at Screening or at Randomization. An elevated QT interval corrected according to Fridericia's formula (QTcF) interval of > 470 ms (females) / > 450 ms (males) at Screening or at Randomization. History or presence of severe respiratory disease or pulmonary fibrosis, based on medical history and chest X-ray (or CT scan as per local guidelines), performed at Screening or within 6 months prior to Screening. History of clinically relevant bronchial asthma or chronic obstructive pulmonary disease that has required treatment with oral or parenteral CS for more than a total of 2 weeks within the last 6 months prior to Screening. History or presence of malignancy (except for surgically excised basal or squamous cell skin or mucosal lesions, including dysplasia and carcinoma in situ), lymphoproliferative disease, or history of total lymphoid irradiation. Presence of macular edema or active uveitis detected by optical coherence tomography (OCT) during screening. History of chronic liver or biliary disease (other than Gilbert's Syndrome) or subjects with alanine aminotransferase or aspartate aminotransferase > 3 × Upper Limit of Normal (ULN) or total bilirubin > 1.5 ULN (unless in the context of known Gilbert's Syndrome). Significant hematology abnormality at screening assessment: lymphocyte count < 500 /μL (0.5 × 10^9/L); hemoglobin < 7 g/dL; white blood cell count < 2000/μL (2.0 × 10^9/L); or platelets < 25000/μL (25 × 10^9/L) at screening assessment. Treatment with the following medications within 15 days or 5 half-lives of the medication (whichever is longer) prior to Randomization: β-blockers, diltiazem, verapamil, digoxin, digitoxin, or any other antiarrhythmic or heart-rate -lowering systemic therapy. QT-prolonging drugs with known risk of torsade de pointes irrespective of indication. Treatment with the following medications within 30 days or 5 half-lives of the medication (whichever is longer) prior to Randomization: Cyclophosphamide, cyclosporine, tacrolimus, sirolimus, mizoribine, etc. Pulse methylprednisolone. Vaccination with live vaccines (including live vaccines for COVID-19). Intra-articular, intramuscular or i.v. CS within 6 weeks prior to Randomization. Treatment with the following medications within 90 days or 5 half-lives of the medication (whichever is longer) prior to Randomization: Leflunomide. i.v. immunoglobulins. Treatment with any investigational agent within 90 days or 5 half-lives of the drug (whichever is longer) prior to Randomization. Treatment with B cell-depleting biological agents, e.g., rituximab or ocrelizumab, within 12 months prior to Randomization. Treatment with anifrolumab within 12 months prior to Randomization. Treatment with any of the following medications any time prior to Screening: Alemtuzumab, Sphingosine-1-phosphate receptor modulators (e.g., fingolimod), Subjects previously randomized to cenerimod or placebo in any trial involving cenerimod.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cenerimod 4 mg<br>Participants will receive cenerimod once daily in addition to background SLE therapy. | Drug: Cenerimod<br>* Cenerimod will be supplied as film-coated tablets at the dose of 4 mg.<br>* Other names: ACT-334441;|
| Placebo Comparator: Placebo<br>Participants will receive matching placebo once daily in addition to background SLE therapy. | Drug: Placebo<br>* Matching placebo will be supplied as identical film-coated tablets formulated with the same excipients but without the active ingredient, cenerimod.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline to Month 12 in the modified Systemic Lupus Erythematosus Disease Activity Index-2000 (mSLEDAI-2K) score | This endpoint is based on the SLEDAI-2K index, modified to exclude leukopenia. All values of mSLEDAI-2K from baseline through Month 12 visits will be accounted for in the assessment of this endpoint. | Day 1 (pre-dose baseline) to Month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Response on Systemic Lupus Erythematosus Responder Index (SRI) at Month 12 | Response on SRI-4 is defined as: Reduction from baseline of at least 4 points in the mSLEDAI-2K, and No new British Isles Lupus Assessment Group-2004 (BILAG) A organ domain score and not more than one new BILAG B organ domain score compared to baseline, and No worsening from baseline in subjects' lupus disease activity, where worsening is defined as an increase ≥ 0.30 points on a 3-point Physician's Global Assessment visual analog scale, and No violation of protocol-specified medication rules detailed in the core protocol. | Day 1 (pre-dose baseline) to Month 12 | 
| Time to first confirmation of a 4-month sustained modified Systemic Lupus Erythematosus Disease Activity Index-2000 (mSLEDAI-2K) response | A response is defined as a reduction of at least 4 points from baseline. | Day 1 (pre-dose baseline) to Month 12 | 
| Time to first confirmation of a 4-month sustained response in mucocutaneous manifestations | Response is defined as: No increase in the overall mSLEDAI-2K score, and Remission (score of zero) from baseline in the mSLEDAI-2K score of mucocutaneous manifestations. | Day 1 (pre-dose baseline) to Month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Musculoskeletal and connective tissue disorders, Immune System Diseases, Autoimmune Diseases