E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Relapsing Multiple Sclerosis |
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E.1.1.1 | Medical condition in easily understood language |
Multiple sclerosis (MS) is a long-term disease that attacks the central nervous system, affecting the brain, spinal cord, and optic nerves. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10048393 |
E.1.2 | Term | Multiple sclerosis relapse |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10080700 |
E.1.2 | Term | Relapsing multiple sclerosis |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
• To evaluate the efficacy of fenebrutinib compared with placebo on the
total number of new gadolinium enhancing T1 magnetic resonance
imaging (MRI) lesions |
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E.2.2 | Secondary objectives of the trial |
• To evaluate the effect of fenebrutinib on MRI lesions
• To evaluate the safety of fenebrutinib compared with placebo
• To characterize the fenebrutinib pharmacokinetics (PK) profile |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Participants who are aged 18 to 55 years inclusive at the time of signing Informed Consent Form
• A diagnosis of relapsing MS (RMS) in accordance with the revised 2017 McDonald Criteria and one of the following:
o At least two documented clinical relapses within the last 2 years or one documented clinical relapse within 12 months of screening (but not within the 30 days prior to screening)
o Documented evidence of the presence of at least one T1 Gd+ lesion on MRI in the 6 months prior to randomization (may include the screening MRI)
• Expanded Disability Status Scale (EDSS) at screening from 0 to 5.5 points
• For women of childbearing potential: participants who agree to remain abstinent (refrain from heterosexual intercourse) or use contraception, and agreement to refrain from donating eggs during the treatment period and for 28 days after the final dose of fenebrutinib
• For men: participants who agree to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agree to refrain from donating sperm during the treatment period and for 28 days after the final dose of fenebrutinib to avoid exposing the embryo |
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E.4 | Principal exclusion criteria |
•Disease duration of >10 years from the onset of symptoms and an EDSS score at screening <2.0
•A diagnosis of primary progressive MS or non-active secondary progressive MS
•Any known or suspected active infection at screening or baseline, or any major episode of infection requiring hospitalization or treatment with IV anti-microbials within 8 weeks prior to or during screening or treatment with oral anti-microbials within 2 weeks prior to or during screening
•History of progressive multifocal leukoencephalopathy (PML)
•History of cancer
•Basal or squamous cell carcinoma of the skin that has been excised and is considered cured and in situ carcinoma of the cervix treated with apparent success by curative therapy >1 year prior to screening is not exclusionary
•Presence of other neurological disorders
•Evidence of clinically significant psychiatric, pulmonary, renal, hepatic, metabolic, gastrointestinal (GI), or cardiovascular disease, or endocrine disease that, in the investigator’s opinion, would preclude patient participation
•Presence of the New York Heart Association Class III and Class IV criteria for congestive heart failure
•Screening 12-lead ECG that demonstrates clinically relevant abnormalities that may affect patient safety or interpretation of study results
•Current treatment with medications that are well known to prolong the QT interval at doses that have a clinically meaningful effect on QT, as determined by the investigator
•History of ventricular dysrhythmias or risk factors for ventricular dysrhythmias
•Participants undergoing dialysis or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m^2
•Any of the following laboratory results: ALT or AST >2*upper limit of normal (ULN); Total bilirubin greater than 1.5*ULN; Hemoglobin <9.5 grams/deciliter; White blood cell count <2000 cells/mm^3 (µL); Platelet count <100*10^9/L; Absolute neutrophil count <=1500 cells/mm^3 (µL); IgG<500 mg/dL
•Any concomitant disease that may require chronic treatment with systemic corticosteroids or immunosuppressants during the course of the 12-week double-blind study period
•History of alcohol or other drug abuse within 12 months prior to screening
•Positive screening tests for active, latent, or inadequately treated hepatitis B
•Positive screening tests for hepatitis C
•Evidence of active or latent or inadequately treated infection with tuberculosis
•Abnormalities in hepatic synthetic function tests judged by the investigator to be clinically significant
•History of hospitalization or transfusion for a GI bleed
•Known bleeding diathesis
•Any condition possibly affecting oral drug absorption
•History of or currently active primary or secondary (non−drug-related) immunodeficiency
•Inability to complete an MRI scan or contraindication to Gd administration
•Any previous history of organ transplantation
•Any previous treatment with bone marrow transplantation or hematopoietic stem cell transplantation
•Adrenocorticotropic hormone or systemic corticosteroid therapy within 4 weeks prior to screening or during the screening period
•Receiving an unstable dosing regimen of proton pump inhibitors or H2-receptor antagonist during the screening phase and/or no plan to remain at a stable dose for the duration of study treatment
•Treatment with IVIg or plasmapheresis within 12 weeks prior to randomization
•Sensitivity or intolerance to any ingredient (including excipients) of fenebrutinib
•Receipt of a live-attenuated vaccine within 6 weeks prior to randomization
•Need for systemic anticoagulation (oral or injectable) or anti-platelet agent other than nonsteroidal anti-inflammatory drugs, aspirin, and other salicylates
•Previous treatment with fenebrutinib or another Brutons tyrosine kinase (BTK) inhibitor for any indication
•Treatment with strong CYP3A4 inhibitors, strong or moderate CYP3A4 inducers, within 7 days or 5 drug-elimination half-lives (whichever is longer) prior to randomization
•Treatment with CYP3A4 substrates with a narrow therapeutic window within 7 days or 5 drug-elimination half-lives (whichever is longer) prior to randomization
•Previous use of anti-CD20 therapies, unless the last infusion was more than 2 years prior to screening and B-cell count is normal at screening
•Previous use of fingolimod, siponimod, ozanimod, or ponesimod within 6 weeks of randomization
•Previous use of natalizumab within 6 months of randomization
•Previous treatment with azathioprine, mycophenolate mofetil, or methotrexate within 12 weeks of randomization
•Previous use of teriflunomide, unless plasma concentrations < 0.02 mg/L
•Any previous treatment with cladribine, mitoxantrone, daclizumab, alemtuzumab, or cyclophosphamide
•Treatment with dimethyl fumarate or monomethyl fumarate within 4 weeks of randomization
•Treatment with any investigational agent within 5 half-lives of randomization
•Previous treatment with any other immunomodulatory or immunosuppressive medication |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Total number of new gadolinium-enhancing T1 lesions observed on MRI scans of the brain at Weeks 4, 8, and 12 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
1.Total number of new or enlarging T2-weighted lesions observed on brain MRI at Weeks 4, 8, and 12
2.Proportion of participants free from any new gadolinium-enhancing T1 lesions and new or enlarging T2-weighted lesions observed on brain MRI at Weeks 4, 8, and 12
3.Incidence and severity of adverse events
4.Change from baseline in vital signs
5.Change from baseline in targeted clinical laboratory test results
6.Proportion of participants with suicidal ideation or behavior, as assessed by Columbia-Suicide Severity Rating Scale
7.Plasma concentration of fenebrutinib at specified timepoints |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-2. At Weeks 4, 8, and 12
3. From the start of treatment until 28 days after the final dose of study treatment
4-5. Double blind period: Baseline (Day -28 to Day -1) to Week 12; Open label period: Baseline (Week 0) to Week 96
6. Double blind period: At Baseline (Day -28 to Day -1), Weeks 4, 8 and 12; Open label period: Baseline (Week 0), Weeks 12, 24, 48, 76 and 96
7. At Days 1, 29, 57, 85, at early discontinuation visit
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 17 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Egypt |
Japan |
Kenya |
Morocco |
Serbia |
Croatia |
Czechia |
Norway |
Slovakia |
Slovenia |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 4 |