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CompletedNCT03277248ULTIMATE IIUpdated Dec 6, 2021Results posted

Study to Assess the Efficacy and Safety of Ublituximab in Participants With Relapsing Forms of Multiple Sclerosis (RMS)

A Phase 3 interventional study of Ublituximab and Teriflunomide in Relapsing Multiple Sclerosis (RMS), sponsored by TG Therapeutics, Inc.. Completed at 13 sites in United States. Open to participants aged 18 Years to 55 Years. Per ClinicalTrials.gov, last updated 2021-12-06.

Sponsored by TG Therapeutics, Inc. · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
545
Allocation
Randomized
Ages
18 Years to 55 Years
Sex
All
01

Study summary

This study determines the Annualized Relapse Rate (ARR) in participants with RMS after 96 weeks (approximately 2 years) treatment with intravenous (IV) infusion of ublituximab/oral placebo compared to 14 mg oral teriflunomide/IV placebo.

02

Conditions studied

  • Relapsing Multiple Sclerosis (RMS)
03

Who can participate

Ages eligible
18 Years to 55 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Diagnosis of relapsing multiple sclerosis (RMS) (McDonald Criteria 2010)
  • Active disease
  • Expanded disability status scale (EDSS) 0 - 5.5 (inclusive) at screening

Exclusion criteria

Exclusion Criteria:

  • Treatment with prior Anti-cluster of differentiate 20 (CD20) or other B cell directed treatment
  • Treatment with the following therapies at any time prior to randomization: alemtuzumab, natalizumab, teriflunomide, leflunomide and Stem cell transplantation
  • Diagnosed with primary progressive multiple sclerosis (PPMS)
  • Pregnant or nursing
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
545 participants (actual)

Study arms

  • Experimental
    Ublituximab + Oral Placebo

    Participants received ublituximab intravenous (IV) infusion, 150 milligrams (mg) over 4 hours (h) on Day 1 followed by 450 mg over 1 h on Days 15, 168, 336 and 504 (Week 72) along with the oral placebo tablet, once daily (QD) from Day 1 up to the last day of Week 95.

    Biological: Ublituximab · Drug: Oral Placebo

  • Active comparator
    Teriflunomide + IV Placebo

    Participants received teriflunomide 14 mg tablet, orally, QD from Day 1 up to the last day of Week 95 along with the placebo IV infusion on Days 1, 15, 168, 336 and 504 (Week 72).

    Drug: Teriflunomide · Drug: IV Placebo

Interventions

  • BiologicalUblituximab

    Administered as an IV infusion.

    Also known as: TG-1101

  • DrugTeriflunomide

    Film coated tablets administered orally.

  • DrugOral Placebo

    Administered orally.

  • DrugIV Placebo

    Administered as an IV Infusion.

05

What researchers measure

Primary outcomes

  1. Annualized Relapse Rate (ARR)

    ARR is defined as the number of Independent Relapse Adjudication Committee (IRAP)-confirmed relapses per participant year. The estimate of ARR for a treatment group is the total number of relapses for participants in the respective treatment group divided by the sum of treatment duration for participants in that specific treatment group.

    Time frame: Up to 96 weeks

Secondary outcomes

  1. Total Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant

    The total number of Gd-enhancing T1-lesions were calculated as the sum of the individual number of lesions at Weeks 12, 24, 48, and 96, divided by the total number of MRI scans of the brain.

    Time frame: Weeks 12, 24, 48, and 96

  2. Total Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant

    The total number of NELs were calculated as the sum of the individual number of lesions at Weeks 24, 48, and 96, divided by the total number of MRI scans of the brain.

    Time frame: Weeks 24, 48, and 96

  3. Time to Confirmed Disability Progression (CDP) for at Least 12 Weeks

    12-week CDP is defined as an increase in EDSS at least 1 point higher than the baseline EDSS if the baseline EDSS is ≤5.5 or at least 0.5 higher than the baseline EDSS if the baseline EDSS is \>5.5. The EDSS is based on a standard neurological examination, (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, and cerebral) and ambulation function system assessments. The EDSS disability scale ranges in 0.5-point steps from 0 (normal) to 10 (death) where higher scores indicate disability. The time to onset of 12-week CDP is the time to progression to the EDSS change defined above.

    Time frame: Up to Week 96

  4. Percentage of Participants With No Evidence of Disease Activity (NEDA)

    A participant with NEDA is defined as a participant without relapses confirmed by the IRAP, without MRI activities (no T1 Gd+ lesions and no new/enlarging T2 lesions), and no 12-week CDP. Any evidence of disease activity from Week 24 to Week 96 was counted as not reaching NEDA. Any evidence of disease activity before Week 24 was not counted.

    Time frame: From Week 24 to Week 96

  5. Percentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)

    The SDMT involves a simple substitution task using a reference key, the examinee has 90 seconds to pair specific numbers with given geometric figures. Responses are done verbally. The administration time is approximately 5 minutes. The total SDMT score for each visit ranging from 0-110 is defined as the total number of correct answers reported in the case report form (CRF), where high scores indicate better outcome. Impaired SDMT is defined as a decrease of at least 4 points from baseline at any post-baseline assessment up to the Week 96 visit.

    Time frame: Baseline to Week 96

  6. Percent Change From Baseline in Brain Volume

    Time frame: Baseline to Week 96

  7. Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Treatment-Emergent Serious Adverse Events (TESAEs)

    An adverse event (AE) is any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporarily associated with the use of a medicinal product, whether or not considered related to the medicinal product. A serious AE is defined as any untoward medical occurrence that: results in death, is immediately life-threatening, requires in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, and/or causes a congenital anomaly/birth defect. TEAEs are AEs that start or worsen after receiving the study drug.

    Time frame: From the first dose of study drug through the end of the study (up to approximately 116 weeks)

06

Results

Posted Dec 6, 2021

Participant flow

A total of 545 participants were enrolled across investigative sites in Belarus, Spain, the United Kingdom, Croatia, Poland, Russia, Ukraine, and the United States from 25 August 2017 to 12 November 2020.

Participant flow — Overall Study
MilestoneUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Started272273
Completed254239
Not completed1834
Withdrew: Adverse event31
Withdrew: Subject withdrawal of consent623
Withdrew: Investigator/sponsor decision22
Withdrew: Pregnancy41
Withdrew: Lost to follow-up02
Withdrew: Lack of efficacy02
Withdrew: Other-alternative treatment//covid-19 related/unspecified reasons33

Outcome measures

PrimaryAnnualized Relapse Rate (ARR)

ARR is defined as the number of Independent Relapse Adjudication Committee (IRAP)-confirmed relapses per participant year. The estimate of ARR for a treatment group is the total number of relapses for participants in the respective treatment group divided by the sum of treatment duration for participants in that specific treatment group.

Time frame:
Up to 96 weeks
Reported as:
Least squares mean · relapses per participant-years
Annualized Relapse Rate (ARR)
relapses per participant-yearsUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Annualized Relapse Rate (ARR)0.091 (0.049 to 0.169)0.178 (0.109 to 0.291)
Statistical analysis
  • Ublituximab + Oral Placebo vs Teriflunomide + IV Placebo · Negative Binomial Model · p = 0.0022 (GEE (Generalized Estimating Equation) model for the relapse count per participant with logarithmic link function, treatment, region, and baseline Expanded Disability Status Scale (EDSS) strata as covariates and log (years of treatment) as offset.) · Rate ratio (ublituximab / teriflunomide): 0.509 · 95% CI 0.330 to 0.784
SecondaryTotal Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant

The total number of Gd-enhancing T1-lesions were calculated as the sum of the individual number of lesions at Weeks 12, 24, 48, and 96, divided by the total number of MRI scans of the brain.

Time frame:
Weeks 12, 24, 48, and 96
Reported as:
Least squares mean · lesions per scan per participant
Total Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant
lesions per scan per participantUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Total Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant0.009 (0.004 to 0.017)0.250 (0.162 to 0.385)
Statistical analysis
  • Ublituximab + Oral Placebo vs Teriflunomide + IV Placebo · Negative Binomial Model · p = <.0001 (GEE model for the relapse count per participant with logarithmic link function, treatment, region, and baseline EDSS strata as covariates and log (years of treatment) as offset.) · Rate ratio (ublituximab / teriflunomide): 0.035 · 95% CI 0.019 to 0.064
SecondaryTotal Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant

The total number of NELs were calculated as the sum of the individual number of lesions at Weeks 24, 48, and 96, divided by the total number of MRI scans of the brain.

Time frame:
Weeks 24, 48, and 96
Reported as:
Least squares mean · lesions per scan per participant
Total Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant
lesions per scan per participantUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Total Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant0.282 (0.200 to 0.397)2.831 (2.128 to 3.767)
Statistical analysis
  • Ublituximab + Oral Placebo vs Teriflunomide + IV Placebo · Negative Binomial Model · p = <.0001 (GEE model for the relapse count per participant with logarithmic link function, treatment, region, and baseline EDSS strata as covariates and log (years of treatment) as offset.) · Rate ratio (ublituximab / teriflunomide): 0.100 · 95% CI 0.073 to 0.136
SecondaryTime to Confirmed Disability Progression (CDP) for at Least 12 Weeks

12-week CDP is defined as an increase in EDSS at least 1 point higher than the baseline EDSS if the baseline EDSS is ≤5.5 or at least 0.5 higher than the baseline EDSS if the baseline EDSS is \>5.5. The EDSS is based on a standard neurological examination, (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, and cerebral) and ambulation function system assessments. The EDSS disability scale ranges in 0.5-point steps from 0 (normal) to 10 (death) where higher scores indicate disability. The time to onset of 12-week CDP is the time to progression to the EDSS change defined above.

Time frame:
Up to Week 96
Reported as:
Median · weeks
Time to Confirmed Disability Progression (CDP) for at Least 12 Weeks
weeksUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Time to Confirmed Disability Progression (CDP) for at Least 12 WeeksNA (NA to NA)NA (NA to NA)
SecondaryPercentage of Participants With No Evidence of Disease Activity (NEDA)

A participant with NEDA is defined as a participant without relapses confirmed by the IRAP, without MRI activities (no T1 Gd+ lesions and no new/enlarging T2 lesions), and no 12-week CDP. Any evidence of disease activity from Week 24 to Week 96 was counted as not reaching NEDA. Any evidence of disease activity before Week 24 was not counted.

Time frame:
From Week 24 to Week 96
Reported as:
Number · percentage of participants
Percentage of Participants With No Evidence of Disease Activity (NEDA)
percentage of participantsUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Percentage of Participants With No Evidence of Disease Activity (NEDA)43.011.4
Statistical analysis
  • Ublituximab + Oral Placebo vs Teriflunomide + IV Placebo · Regression, Logistic · p = <.0001 (Logistic regression model with treatment, region, baseline EDSS strata and log transformed baseline MRI lesion counts (T1-unenhancing, T2, Gd-enhancing) as covariates.) · Odds ratio (ublituximab / teriflunomide): 7.946 · 95% CI 4.917 to 12.841
SecondaryPercentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)

The SDMT involves a simple substitution task using a reference key, the examinee has 90 seconds to pair specific numbers with given geometric figures. Responses are done verbally. The administration time is approximately 5 minutes. The total SDMT score for each visit ranging from 0-110 is defined as the total number of correct answers reported in the case report form (CRF), where high scores indicate better outcome. Impaired SDMT is defined as a decrease of at least 4 points from baseline at any post-baseline assessment up to the Week 96 visit.

Time frame:
Baseline to Week 96
Reported as:
Number · percentage of participants
Percentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)
percentage of participantsUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Percentage of Participants With Impaired Symbol Digit Modalities Test (SDMT)29.031.6
Statistical analysis
  • Ublituximab + Oral Placebo vs Teriflunomide + IV Placebo · Regression, Logistic · p = 0.4290 (Logistic regression model with treatment, region, baseline EDSS strata and log transformed baseline MRI lesion counts (T1 unenhancing, T2, Gd enhancing) as covariates.) · Odds ratio (ublituximab / teriflunomide): 0.862 · 95% CI 0.596 to 1.246
SecondaryPercent Change From Baseline in Brain Volume
Time frame:
Baseline to Week 96
Reported as:
Least squares mean · percent change
Percent Change From Baseline in Brain Volume
percent changeUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Percent Change From Baseline in Brain Volume-0.194 (-0.225 to -0.164)-0.176 (-0.207 to -0.146)
Statistical analysis
  • Ublituximab + Oral Placebo vs Teriflunomide + IV Placebo · Mixed Model Repeated Measures · p = 0.3108 (Mixed model repeated measures (MMRM) model includes treatment, region, baseline EDSS strata, visit, treatment-by-visit interaction, and baseline volume (cube root transformed) as covariates and an unstructured covariance matrix.) · Least squares mean difference: -0.018 · 95% CI -0.053 to 0.017
SecondaryPercentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Treatment-Emergent Serious Adverse Events (TESAEs)

An adverse event (AE) is any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporarily associated with the use of a medicinal product, whether or not considered related to the medicinal product. A serious AE is defined as any untoward medical occurrence that: results in death, is immediately life-threatening, requires in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, and/or causes a congenital anomaly/birth defect. TEAEs are AEs that start or worsen after receiving the study drug.

Time frame:
From the first dose of study drug through the end of the study (up to approximately 116 weeks)
Reported as:
Number · percentage of participants
Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Treatment-Emergent Serious Adverse Events (TESAEs)
percentage of participantsUblituximab + Oral PlaceboTeriflunomide + IV Placebo
TEAEs92.393.8
TESAEs10.37.7

Adverse events

Collected over From the first dose of study drug through the end of the study (up to approximately 116 weeks). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Ublituximab + Oral Placebo1/272 (0.4%)28/272 (10.3%)234/272 (86%)
Teriflunomide + IV Placebo0/273 (0%)21/273 (7.7%)233/273 (85.3%)
Most frequent serious events
Showing 10 of 48
Most frequent serious events
EventUblituximab + Oral PlaceboTeriflunomide + IV Placebo
Acute sinusitisInfections and infestations3/2720/273
COVID-19 pneumoniaInfections and infestations2/2721/273
PneumoniaInfections and infestations2/2722/273
Pyelonephritis acuteInfections and infestations0/2722/273
EpilepsyNervous system disorders0/2722/273
Bone marrow toxicityBlood and lymphatic system disorders1/2720/273
Febrile neutropeniaBlood and lymphatic system disorders1/2720/273
GlaucomaEye disorders1/2720/273
Abdominal herniaGastrointestinal disorders1/2720/273
Decreased activityGeneral disorders1/2720/273
Most frequent other events
Showing 10 of 39
Most frequent other events
EventUblituximab + Oral PlaceboTeriflunomide + IV Placebo
HeadacheNervous system disorders103/27287/273
NasopharyngitisInfections and infestations67/27254/273
AlopeciaSkin and subcutaneous tissue disorders13/27248/273
Back painMusculoskeletal and connective tissue disorders35/27223/273
PyrexiaGeneral disorders34/27214/273
DiarrhoeaGastrointestinal disorders25/27232/273
Respiratory tract infectionInfections and infestations30/27228/273
NauseaGastrointestinal disorders29/27228/273
Abdominal painGastrointestinal disorders28/27212/273
Influenza like illnessGeneral disorders28/2727/273

Baseline characteristics

Intention-to-treat (ITT) population consisted of all randomized participants.

Age, Continuous
Age, Continuous(years)Ublituximab + Oral PlaceboTeriflunomide + IV PlaceboTotal
Mean34.5 ± 8.7636.2 ± 8.9735.3 ± 8.90
Sex: Female, Male
Sex: Female, Male(Participants)Ublituximab + Oral PlaceboTeriflunomide + IV PlaceboTotal
Female178176354
Male9497191
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Ublituximab + Oral PlaceboTeriflunomide + IV PlaceboTotal
Black or African American235
White269269538
Other112
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Ublituximab + Oral PlaceboTeriflunomide + IV PlaceboTotal
Hispanic or Latino639
Not Hispanic or Latino262263525
Not Reported224
Unknown257
Region of Enrollment
Region of Enrollment(participants)Ublituximab + Oral PlaceboTeriflunomide + IV PlaceboTotal
Belarus293564
Spain628
United Kingdom415
Croatia252449
Poland393877
Russia7885163
Ukraine7469143
United States171936
07

Study locations

13 sites
  • TG Therapeutics RMS Investigational Trial site
    Phoenix, Arizona 58018, United States
  • TG Therapeutics RMS Investigational Trial Site
    Aurora, Colorado 80045, United States
  • TG Therapeutics RMS Investigational Trial Site
    Tampa, Florida 33612, United States
  • TG Therapeutics RMS Investigational Trial Site
    Lexington, Kentucky 40513, United States
  • TG Therapeutics RMS Investigational Trial Site
    Chesterfield, Missouri 63017, United States
  • TG Therapeutics RMS Investigational Trial Site
    Las Vegas, Nevada 89106, United States
  • TG Therapeutics RMS Investigational Trial Site
    Teaneck, New Jersey 07666, United States
  • TG Therapeutics RMS Investigational Trial Site
    Albuquerque, New Mexico 87131, United States
  • TG Therapeutics RMS Investigational Trial Site
    Patchogue, New York 11772, United States
  • TG Therapeutics RMS Investigational Trial site
    Columbus, Ohio 43221, United States
  • TG Therapeutics RMS Investigational Trial Site
    Pittsburgh, Pennsylvania 15212, United States
  • TG Therapeutics RMS Investigational Trial site
    San Antonio, Texas 78258, United States
  • TG Therapeutics RMS Investigational Trial site
    Seattle, Washington 98122, United States
08

References and documents

Publications

  • Steinman L, Fox E, Hartung HP, Alvarez E, Qian P, Wray S, Robertson D, Huang D, Selmaj K, Wynn D, Cutter G, Mok K, Hsu Y, Xu Y, Weiss MS, Bosco JA, Power SA, Lee L, Miskin HP, Cree BAC; ULTIMATE I and ULTIMATE II Investigators. Ublituximab versus Teriflunomide in Relapsing Multiple Sclerosis. N Engl J Med. 2022 Aug 25;387(8):704-714. doi: 10.1056/NEJMoa2201904. PubMed 36001711 ↗

Study documents

  • Study protocol · Sep 4, 2020
  • Statistical analysis plan · Sep 4, 2020

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Undecided — Data will be shared after study completion via publication.

09

Registry details

Key details

Study ID
NCT03277248
Lead sponsor
TG Therapeutics, Inc.
Responsible party
Sponsor
First posted
Sep 11, 2017
Start date
Aug 25, 2017
Primary completion
Aug 4, 2020
Completion
Nov 12, 2020
Results posted
Dec 6, 2021
Last update
Dec 6, 2021

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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