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
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.
Exclusion Criteria:
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
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
Administered as an IV infusion.
Also known as: TG-1101
Film coated tablets administered orally.
Administered orally.
Administered as an IV Infusion.
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
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
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
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
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
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
Percent Change From Baseline in Brain Volume
Time frame: Baseline to Week 96
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)
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.
| Milestone | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Started | 272 | 273 |
| Completed | 254 | 239 |
| Not completed | 18 | 34 |
| Withdrew: Adverse event | 3 | 1 |
| Withdrew: Subject withdrawal of consent | 6 | 23 |
| Withdrew: Investigator/sponsor decision | 2 | 2 |
| Withdrew: Pregnancy | 4 | 1 |
| Withdrew: Lost to follow-up | 0 | 2 |
| Withdrew: Lack of efficacy | 0 | 2 |
| Withdrew: Other-alternative treatment//covid-19 related/unspecified reasons | 3 | 3 |
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.
| relapses per participant-years | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Annualized Relapse Rate (ARR) | 0.091 (0.049 to 0.169) | 0.178 (0.109 to 0.291) |
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.
| lesions per scan per participant | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Total Number of Gadolinium (Gd)-Enhancing T1-Lesions Per Magnetic Resonance Imaging (MRI) Scan Per Participant | 0.009 (0.004 to 0.017) | 0.250 (0.162 to 0.385) |
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.
| lesions per scan per participant | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Total Number of New and Enlarging T2 Hyperintense Lesions (NELs) Per MRI Scan Per Participant | 0.282 (0.200 to 0.397) | 2.831 (2.128 to 3.767) |
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.
| weeks | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Time to Confirmed Disability Progression (CDP) for at Least 12 Weeks | NA (NA to NA) | NA (NA to NA) |
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.
| percentage of participants | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Percentage of Participants With No Evidence of Disease Activity (NEDA) | 43.0 | 11.4 |
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.
| percentage of participants | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Percentage of Participants With Impaired Symbol Digit Modalities Test (SDMT) | 29.0 | 31.6 |
| percent change | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Percent Change From Baseline in Brain Volume | -0.194 (-0.225 to -0.164) | -0.176 (-0.207 to -0.146) |
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.
| percentage of participants | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| TEAEs | 92.3 | 93.8 |
| TESAEs | 10.3 | 7.7 |
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.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Ublituximab + Oral Placebo | 1/272 (0.4%) | 28/272 (10.3%) | 234/272 (86%) |
| Teriflunomide + IV Placebo | 0/273 (0%) | 21/273 (7.7%) | 233/273 (85.3%) |
| Event | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| Acute sinusitisInfections and infestations | 3/272 | 0/273 |
| COVID-19 pneumoniaInfections and infestations | 2/272 | 1/273 |
| PneumoniaInfections and infestations | 2/272 | 2/273 |
| Pyelonephritis acuteInfections and infestations | 0/272 | 2/273 |
| EpilepsyNervous system disorders | 0/272 | 2/273 |
| Bone marrow toxicityBlood and lymphatic system disorders | 1/272 | 0/273 |
| Febrile neutropeniaBlood and lymphatic system disorders | 1/272 | 0/273 |
| GlaucomaEye disorders | 1/272 | 0/273 |
| Abdominal herniaGastrointestinal disorders | 1/272 | 0/273 |
| Decreased activityGeneral disorders | 1/272 | 0/273 |
| Event | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo |
|---|---|---|
| HeadacheNervous system disorders | 103/272 | 87/273 |
| NasopharyngitisInfections and infestations | 67/272 | 54/273 |
| AlopeciaSkin and subcutaneous tissue disorders | 13/272 | 48/273 |
| Back painMusculoskeletal and connective tissue disorders | 35/272 | 23/273 |
| PyrexiaGeneral disorders | 34/272 | 14/273 |
| DiarrhoeaGastrointestinal disorders | 25/272 | 32/273 |
| Respiratory tract infectionInfections and infestations | 30/272 | 28/273 |
| NauseaGastrointestinal disorders | 29/272 | 28/273 |
| Abdominal painGastrointestinal disorders | 28/272 | 12/273 |
| Influenza like illnessGeneral disorders | 28/272 | 7/273 |
Intention-to-treat (ITT) population consisted of all randomized participants.
| Age, Continuous(years) | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo | Total |
|---|---|---|---|
| Mean | 34.5 ± 8.76 | 36.2 ± 8.97 | 35.3 ± 8.90 |
| Sex: Female, Male(Participants) | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo | Total |
|---|---|---|---|
| Female | 178 | 176 | 354 |
| Male | 94 | 97 | 191 |
| Race/Ethnicity, Customized(Participants) | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo | Total |
|---|---|---|---|
| Black or African American | 2 | 3 | 5 |
| White | 269 | 269 | 538 |
| Other | 1 | 1 | 2 |
| Race/Ethnicity, Customized(Participants) | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo | Total |
|---|---|---|---|
| Hispanic or Latino | 6 | 3 | 9 |
| Not Hispanic or Latino | 262 | 263 | 525 |
| Not Reported | 2 | 2 | 4 |
| Unknown | 2 | 5 | 7 |
| Region of Enrollment(participants) | Ublituximab + Oral Placebo | Teriflunomide + IV Placebo | Total |
|---|---|---|---|
| Belarus | 29 | 35 | 64 |
| Spain | 6 | 2 | 8 |
| United Kingdom | 4 | 1 | 5 |
| Croatia | 25 | 24 | 49 |
| Poland | 39 | 38 | 77 |
| Russia | 78 | 85 | 163 |
| Ukraine | 74 | 69 | 143 |
| United States | 17 | 19 | 36 |
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Plan to share: Undecided — Data will be shared after study completion via publication.
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TG Therapeutics, Inc.