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CompletedNCT04410978GEMINI 1Updated Jul 2, 2025Results posted

Relapsing Forms of Multiple Sclerosis (RMS) Study of Bruton's Tyrosine Kinase (BTK) Inhibitor Tolebrutinib (SAR442168) (GEMINI 1)

A Phase 3 interventional study of Tolebrutinib and Teriflunomide in Relapsing Multiple Sclerosis, sponsored by Sanofi. Completed at 179 sites in 24 countries. Open to participants aged 18 Years to 55 Years. Per ClinicalTrials.gov, last updated 2025-07-02.

Sponsored by Sanofi · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
974
Allocation
Randomized
Ages
18 Years to 55 Years
Sex
All
01

Study summary

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

Read the detailed description

This was an event-driven (6-month confirmed disability worsening [CDW]) trial with a variable treatment duration (end-of-study [EOS] duration: up to approximately 48 months).

02

Conditions studied

  • Relapsing Multiple Sclerosis
03

In context

Lead sponsor

Sanofi is the lead sponsor of 1,508 studies on the registry; 90 are open to participants now.

Of its 198 completed or terminated interventional studies of FDA-regulated products, 118 (60%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

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

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

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, 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.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Investigator, Outcomes assessor)
Enrollment
974 participants (actual)

Study arms

  • Experimental
    SAR442168

    60 mg oral SAR442168 + placebo to match the teriflunomide tablet once daily

    Drug: Tolebrutinib · Drug: Placebo to match Teriflunomide

  • Active comparator
    Teriflunomide

    14 mg oral teriflunomide + placebo to match the SAR442168 tablet once daily

    Drug: Teriflunomide · Drug: Placebo to match Tolebrutinib

Interventions

  • DrugTolebrutinib

    Pharmaceutical form: Tablet Route of administration: Oral

    Also known as: SAR442168

  • DrugTeriflunomide

    Pharmaceutical form: Tablet Route of administration: Oral

  • DrugPlacebo to match Tolebrutinib

    Pharmaceutical form: Tablet Route of administration: Oral

  • DrugPlacebo to match Teriflunomide

    Pharmaceutical form: Tablet Route of administration: Oral

06

What researchers measure

Primary outcomes

  1. Annualized Relapse Rate (ARR) as Assessed by Confirmed Protocol-defined Adjudicated Relapses

    Multiple sclerosis (MS) relapse was defined as a monophasic, acute or subacute onset of new neurological symptoms or worsening of previous neurological symptoms with an objective change on neurological examination. Symptoms were attributable to MS, lasted for \>=24 hours with or without recovery, present at normal body temperature, and preceded by \>=30 days of clinical stability.

    Time frame: Baseline (Day 1) to approximately 48 months

Secondary outcomes

  1. Time to Onset of 6-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale

    The EDSS was a disability scale that assessed the following 7 functional domains: visual, brainstem, pyramidal \[motor\], cerebellar \[coordination\], sensory, cerebral, and bowel/bladder. The total EDSS score ranged from 0 (normal) to 10 (death due to MS), increasing in increments of 0.5 points. Higher scores indicated increased disability. Time to onset of 6-month CDW was defined as the time from randomization to the onset of a confirmed, sustained increase from baseline in EDSS score (of \>=1.5 points when the baseline score was 0, of \>=1.0 point when the baseline score was 0.5 to \<=5.5, of \>=0.5 points when the baseline EDSS score was \>5.5) over at least 6 months that was not attributable to another etiology.

    Time frame: Baseline (Day 1) to approximately 48 months

  2. Time to Onset of 3-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale

    The EDSS was a disability scale that assessed the following 7 functional domains: visual, brainstem, pyramidal \[motor\], cerebellar \[coordination\], sensory, cerebral, and bowel/bladder. The total EDSS score ranged from 0 (normal) to 10 (death due to MS), increasing in increments of 0.5 points. Higher scores indicated increased disability. Time to onset of 3-month CDW was defined as the time from randomization to the onset of a confirmed, sustained increase from baseline in EDSS score (of \>=1.5 points when the baseline score was 0, of \>=1.0 point when the baseline score was 0.5 to \<=5.5, of \>=0.5 points when the baseline EDSS score was \>5.5) over at least 3 months that was not attributable to another etiology.

    Time frame: Baseline (Day 1) to approximately 48 months

  3. Mean Number of New and/or Enlarging T2-Hyperintense Lesions Per Year

    Magnetic resonance imaging (MRI) of the brain was performed to identify number of new and/or enlarging T2-hyperintense lesions defined as the sum of the individual number of new and/or enlarging T2 lesions starting from baseline up to and including the EOS visit.

    Time frame: Baseline (Day 1) to approximately 48 months

  4. Mean Number of New Gadolinium-Enhancing T1-Hyperintense Lesions Per Scan

    MRI of the brain was performed to identify number of new Gd-enhancing T1-hyperintense lesions defined as the sum of the individual number of new Gd- enhancing T1-hyperintense lesions starting from baseline up to and including the EOS visit.

    Time frame: Baseline (Day 1) to approximately 48 months

  5. Change From Baseline in Cognitive Function as Assessed by the Symbol Digit Modalities Test (SDMT) at EOS

    The SDMT was used to assess processing speed, divided attention, visual scanning, tracking and motor speed. It involved a simple substitution task using a reference key. The number of correct substitutions and number of items completed within a 90 second interval (maximum 110 seconds) were recorded. A decrease of 4 points from baseline on the SDMT was considered meaningful worsening. The score was the number of correctly coded items from 0-110 in 90 seconds; higher scores indicating a better outcome. Baseline was defined as the last available value prior to the first dose of study intervention.

    Time frame: Baseline (Day 1) to EOS (up to approximately 48 months)

  6. Change From Baseline in Cognitive Function as Assessed by the California Verbal Learning Test Second Edition (CVLT-II) at EOS

    The CVLT-II was a verbal learning and memory test consisting of recall and recognition of a list of 16 words. For each assessment, 5 trials were completed. Total Correct Recall Trials 1-5 was scaled to a normalized T-score metric, which had a mean of 50 and standard deviation of 10, the maximum possible score was 80 and a minimum was 0. Higher values indicated improved cognitive function. Baseline was defined as the last available value prior to the first dose of study intervention.

    Time frame: Baseline (Day 1) to EOS (up to approximately 48 months)

  7. Time to Onset of 6-Month Confirmed Disability Improvement (CDI) as Assessed by Expanded Disability Status Scale

    The EDSS was a disability scale that assessed the following 7 functional domains: visual, brainstem, pyramidal \[motor\], cerebellar \[coordination\], sensory, cerebral, and bowel/bladder. The total EDSS score ranged from 0 (normal) to 10 (death due to MS), increasing in increments of 0.5 points. Higher scores indicated increased disability. CDI was defined as a decrease of \>=1 point from baseline in the EDSS score lasting at least 6 months.

    Time frame: Baseline (Day 1) to approximately 48 months

  8. Percent Change in Brain Volume Loss at EOS Compared to Month 6

    MRI of the brain was performed at the specified timepoints to detect the changes in brain volume loss.

    Time frame: Month 6 to EOS (up to approximately 48 months)

  9. Change From Baseline in Multiple Sclerosis Quality of Life 54 (MSQoL-54) Questionnaire Score at EOS

    MSQoL-54 was standardized instrument comprising generic and MS-specific items. This 54-item instrument generated 12 subscales and 2 single-item measures (satisfaction with sexual function \[1 item\]; change in health \[1 item\]). 12 subscales were: a: physical health (10 items), b: health perceptions (5 items), c: energy (5 items), d: role limit physical (4 items), e: sexual function (4 items), f: pain (3 items), g: social function (3 items), h: health distress (4 items), i: overall quality of life (2 items), j: emotional well-being (5 items), k: role limitations emotional (3 items) and l: cognitive function (4 items). Physical and mental health composite score were calculated as weighted sum of 'a to h' and 'i to l' subscales respectively. Each composite score was transformed linearly to common 0 (worst) to 100 (best) score range; higher score indicated improved quality of life. Baseline was defined as last available value prior to first dose of study intervention.

    Time frame: Baseline (Day 1) to EOS (up to approximately 48 months)

  10. Number of Participants With Treatment-emergent Adverse Events (TEAEs), Treatment-emergent Serious Adverse Events (TESAEs), TEAEs Leading to Permanent Study Intervention Discontinuation and Treatment-emergent Adverse Events of Special Interest (AESIs)

    An AE was any untoward medical occurrence in a participant or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. SAE was any untoward medical occurrence that at any dose: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent disability/incapacity, was a congenital anomaly/birth defect or was an important medical event. An AESI was an AE (serious or nonserious) of scientific and medical concern specific to the Sponsor's product or program for which ongoing monitoring and immediate notification by the Investigator to the Sponsor was required. TEAEs were defined as AEs that developed, worsened or became serious during the TE period.

    Time frame: From first dose of study intervention (Day 1) up to the earliest of either 10 days post last dose, death or last contact; up to approximately 48 months

  11. Maximum Observed Plasma Concentration (Cmax) of Tolebrutinib and M2 Metabolite

    Blood samples were collected at specified timepoints to assess Cmax of tolebrutinib and M2 metabolite using population pharmacokinetic (PK) model.

    Time frame: 30-90 minutes post-dose at Months 6, 9, and 12 and 2.5-5 hours post-dose at Months 6 and 12

  12. Time to Maximum Observed Plasma Concentration (Tmax) of Tolebrutinib and M2 Metabolite

    Blood samples were collected at specified timepoints to assess Tmax of tolebrutinib and M2 metabolite using population PK model.

    Time frame: 30-90 minutes post-dose at Months 6, 9, and 12 and 2.5-5 hours post-dose at Months 6 and 12

  13. Area Under the Plasma Concentration-time Curve Over the Last 24-hours Dosing Interval (AUC0-24) of Tolebrutinib and M2 Metabolite

    Blood samples were collected at specified timepoints to assess AUC0-24 of tolebrutinib and M2 metabolite using population PK model.

    Time frame: 30-90 minutes post-dose at Months 6, 9, and 12 and 2.5-5 hours post-dose at Months 6 and 12

  14. Change From Baseline in Plasma Neurofilament Light Chain (NfL) and Serum Chitinase-3 Like Protein-1 (Chi3L1) Levels at EOS

    Blood samples were collected at specified timepoints to assess change from baseline in NfL and Chi3L1. Baseline was defined as the last available value prior to the first dose of study intervention.

    Time frame: Baseline (Day 1) to EOS (up to approximately 48 months)

  15. Change From Baseline in Cluster of Differentiation (CD)19+ B Cells at EOS

    Blood samples were collected at specified timepoints to assess change from baseline in CD19+ B cells. Baseline was defined as the last available value prior to the first dose of study intervention.

    Time frame: Baseline (Day 1) to EOS (up to approximately 48 months)

  16. Change From Baseline in Serum Immunoglobulin (Ig) Levels at EOS

    Blood samples were collected at specified timepoints to assess change from baseline in IgG and IgM levels. Baseline was defined as the last available value prior to the first dose of study intervention.

    Time frame: Baseline (Day 1) to EOS (up to approximately 48 months)

07

Results

Posted Jun 18, 2025

Participant flow

This study was conducted at 162 sites in 24 countries. A total of 1152 participants were screened from 30-Jun-2020 to 04-Aug-2022, of which 178 were screen failures. Screen failures were mainly due to not meeting eligibility criteria.

Participant flow — Overall Study
MilestoneTeriflunomide 14 mgTolebrutinib 60 mg
Started488486
Completed415409
Not completed7377
Withdrew: Poor compliance to protocol24
Withdrew: Withdrawal by subject6466
Withdrew: Other67
Withdrew: Missing study status10

Outcome measures

PrimaryAnnualized Relapse Rate (ARR) as Assessed by Confirmed Protocol-defined Adjudicated Relapses

Multiple sclerosis (MS) relapse was defined as a monophasic, acute or subacute onset of new neurological symptoms or worsening of previous neurological symptoms with an objective change on neurological examination. Symptoms were attributable to MS, lasted for \>=24 hours with or without recovery, present at normal body temperature, and preceded by \>=30 days of clinical stability.

Time frame:
Baseline (Day 1) to approximately 48 months
Reported as:
Number · relapses per participant year
Annualized Relapse Rate (ARR) as Assessed by Confirmed Protocol-defined Adjudicated Relapses
relapses per participant yearTeriflunomide 14 mgTolebrutinib 60 mg
Annualized Relapse Rate (ARR) as Assessed by Confirmed Protocol-defined Adjudicated Relapses0.122 (0.100 to 0.150)0.130 (0.108 to 0.156)
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · Chi-squared · p = 0.6691 (Threshold for significance at 2-sided 0.05 level.) · Relative risk: 1.061 · 95% CI 0.808 to 1.393
SecondaryTime to Onset of 6-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale

The EDSS was a disability scale that assessed the following 7 functional domains: visual, brainstem, pyramidal \[motor\], cerebellar \[coordination\], sensory, cerebral, and bowel/bladder. The total EDSS score ranged from 0 (normal) to 10 (death due to MS), increasing in increments of 0.5 points. Higher scores indicated increased disability. Time to onset of 6-month CDW was defined as the time from randomization to the onset of a confirmed, sustained increase from baseline in EDSS score (of \>=1.5 points when the baseline score was 0, of \>=1.0 point when the baseline score was 0.5 to \<=5.5, of \>=0.5 points when the baseline EDSS score was \>5.5) over at least 6 months that was not attributable to another etiology.

Time frame:
Baseline (Day 1) to approximately 48 months
Reported as:
Median · months
Time to Onset of 6-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale
monthsTeriflunomide 14 mgTolebrutinib 60 mg
Time to Onset of 6-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale17.97 (2.9 to 33.9)15.38 (2.6 to 36.8)
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · Log Rank · p = 0.4888 (Derived from log-rank test with stratification of EDSS strata (\<4, \>=4), geographic region (US, non-US).) · Hazard ratio (hr): 0.850 · 95% CI 0.565 to 1.278
SecondaryTime to Onset of 3-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale

The EDSS was a disability scale that assessed the following 7 functional domains: visual, brainstem, pyramidal \[motor\], cerebellar \[coordination\], sensory, cerebral, and bowel/bladder. The total EDSS score ranged from 0 (normal) to 10 (death due to MS), increasing in increments of 0.5 points. Higher scores indicated increased disability. Time to onset of 3-month CDW was defined as the time from randomization to the onset of a confirmed, sustained increase from baseline in EDSS score (of \>=1.5 points when the baseline score was 0, of \>=1.0 point when the baseline score was 0.5 to \<=5.5, of \>=0.5 points when the baseline EDSS score was \>5.5) over at least 3 months that was not attributable to another etiology.

Time frame:
Baseline (Day 1) to approximately 48 months
Reported as:
Median · months
Time to Onset of 3-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale
monthsTeriflunomide 14 mgTolebrutinib 60 mg
Time to Onset of 3-Month Confirmed Disability Worsening as Assessed by Expanded Disability Status Scale17.96 (2.9 to 39.3)14.93 (0.2 to 41.0)
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · Log Rank · p = 0.2991 (Derived from log-rank test with stratification of EDSS strata (\<4, \>=4), geographic region (US, non-US).) · Hazard ratio (hr): 0.819 · 95% CI 0.582 to 1.151
SecondaryMean Number of New and/or Enlarging T2-Hyperintense Lesions Per Year

Magnetic resonance imaging (MRI) of the brain was performed to identify number of new and/or enlarging T2-hyperintense lesions defined as the sum of the individual number of new and/or enlarging T2 lesions starting from baseline up to and including the EOS visit.

Time frame:
Baseline (Day 1) to approximately 48 months
Reported as:
Mean · number of new and or enlarging T2lesions
Mean Number of New and/or Enlarging T2-Hyperintense Lesions Per Year
number of new and or enlarging T2lesionsTeriflunomide 14 mgTolebrutinib 60 mg
Mean Number of New and/or Enlarging T2-Hyperintense Lesions Per Year5.175 (4.447 to 6.024)5.611 (4.826 to 6.524)
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · Chi-squared · p = 0.4575 · Relative risk: 1.084 · 95% CI 0.876 to 1.342
SecondaryMean Number of New Gadolinium-Enhancing T1-Hyperintense Lesions Per Scan

MRI of the brain was performed to identify number of new Gd-enhancing T1-hyperintense lesions defined as the sum of the individual number of new Gd- enhancing T1-hyperintense lesions starting from baseline up to and including the EOS visit.

Time frame:
Baseline (Day 1) to approximately 48 months
Reported as:
Mean · number of new Gd-enhancing T1 lesions
Mean Number of New Gadolinium-Enhancing T1-Hyperintense Lesions Per Scan
number of new Gd-enhancing T1 lesionsTeriflunomide 14 mgTolebrutinib 60 mg
Mean Number of New Gadolinium-Enhancing T1-Hyperintense Lesions Per Scan0.285 (0.221 to 0.367)0.530 (0.439 to 0.641)
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · Chi-squared · p = 0.0001 · Relative risk: 1.860 · 95% CI 1.358 to 2.548
SecondaryChange From Baseline in Cognitive Function as Assessed by the Symbol Digit Modalities Test (SDMT) at EOS

The SDMT was used to assess processing speed, divided attention, visual scanning, tracking and motor speed. It involved a simple substitution task using a reference key. The number of correct substitutions and number of items completed within a 90 second interval (maximum 110 seconds) were recorded. A decrease of 4 points from baseline on the SDMT was considered meaningful worsening. The score was the number of correctly coded items from 0-110 in 90 seconds; higher scores indicating a better outcome. Baseline was defined as the last available value prior to the first dose of study intervention.

Time frame:
Baseline (Day 1) to EOS (up to approximately 48 months)
Reported as:
Least squares mean · score on a scale
Change From Baseline in Cognitive Function as Assessed by the Symbol Digit Modalities Test (SDMT) at EOS
score on a scaleTeriflunomide 14 mgTolebrutinib 60 mg
Change From Baseline in Cognitive Function as Assessed by the Symbol Digit Modalities Test (SDMT) at EOS0.329 ± 0.03180.364 ± 0.0318
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · MMRM · p = 0.4320 · Least square (ls) mean difference: 0.035 · 95% CI -0.053 to 0.124
SecondaryChange From Baseline in Cognitive Function as Assessed by the California Verbal Learning Test Second Edition (CVLT-II) at EOS

The CVLT-II was a verbal learning and memory test consisting of recall and recognition of a list of 16 words. For each assessment, 5 trials were completed. Total Correct Recall Trials 1-5 was scaled to a normalized T-score metric, which had a mean of 50 and standard deviation of 10, the maximum possible score was 80 and a minimum was 0. Higher values indicated improved cognitive function. Baseline was defined as the last available value prior to the first dose of study intervention.

Time frame:
Baseline (Day 1) to EOS (up to approximately 48 months)
Reported as:
Least squares mean · T-score
Change From Baseline in Cognitive Function as Assessed by the California Verbal Learning Test Second Edition (CVLT-II) at EOS
T-scoreTeriflunomide 14 mgTolebrutinib 60 mg
Change From Baseline in Cognitive Function as Assessed by the California Verbal Learning Test Second Edition (CVLT-II) at EOS15.827 ± 0.724117.700 ± 0.7236
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · MMRM · p = 0.0675 · Ls mean difference: 1.873 · 95% CI -0.135 to 3.880
SecondaryTime to Onset of 6-Month Confirmed Disability Improvement (CDI) as Assessed by Expanded Disability Status Scale

The EDSS was a disability scale that assessed the following 7 functional domains: visual, brainstem, pyramidal \[motor\], cerebellar \[coordination\], sensory, cerebral, and bowel/bladder. The total EDSS score ranged from 0 (normal) to 10 (death due to MS), increasing in increments of 0.5 points. Higher scores indicated increased disability. CDI was defined as a decrease of \>=1 point from baseline in the EDSS score lasting at least 6 months.

Time frame:
Baseline (Day 1) to approximately 48 months
Reported as:
Median · months
Time to Onset of 6-Month Confirmed Disability Improvement (CDI) as Assessed by Expanded Disability Status Scale
monthsTeriflunomide 14 mgTolebrutinib 60 mg
Time to Onset of 6-Month Confirmed Disability Improvement (CDI) as Assessed by Expanded Disability Status Scale12.04 (2.8 to 37.1)11.82 (2.8 to 33.0)
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · Log Rank · p = 0.3594 (Derived from log-rank test with stratification of EDSS strata (\<4, \>=4), geographic region (US, non-US).) · Hazard ratio (hr): 0.831 · 95% CI 0.554 to 1.245
SecondaryPercent Change in Brain Volume Loss at EOS Compared to Month 6

MRI of the brain was performed at the specified timepoints to detect the changes in brain volume loss.

Time frame:
Month 6 to EOS (up to approximately 48 months)
Reported as:
Least squares mean · percent change
Percent Change in Brain Volume Loss at EOS Compared to Month 6
percent changeTeriflunomide 14 mgTolebrutinib 60 mg
Percent Change in Brain Volume Loss at EOS Compared to Month 6-0.884 ± 0.0368-0.688 ± 0.0369
Statistical analysis
  • Teriflunomide 14 mg vs Tolebrutinib 60 mg · MMRM · p = 0.0002 · Ls mean difference: 0.196 · 95% CI 0.093 to 0.298
SecondaryChange From Baseline in Multiple Sclerosis Quality of Life 54 (MSQoL-54) Questionnaire Score at EOS

MSQoL-54 was standardized instrument comprising generic and MS-specific items. This 54-item instrument generated 12 subscales and 2 single-item measures (satisfaction with sexual function \[1 item\]; change in health \[1 item\]). 12 subscales were: a: physical health (10 items), b: health perceptions (5 items), c: energy (5 items), d: role limit physical (4 items), e: sexual function (4 items), f: pain (3 items), g: social function (3 items), h: health distress (4 items), i: overall quality of life (2 items), j: emotional well-being (5 items), k: role limitations emotional (3 items) and l: cognitive function (4 items). Physical and mental health composite score were calculated as weighted sum of 'a to h' and 'i to l' subscales respectively. Each composite score was transformed linearly to common 0 (worst) to 100 (best) score range; higher score indicated improved quality of life. Baseline was defined as last available value prior to first dose of study intervention.

Time frame:
Baseline (Day 1) to EOS (up to approximately 48 months)
Reported as:
Least squares mean · score on a scale
Change From Baseline in Multiple Sclerosis Quality of Life 54 (MSQoL-54) Questionnaire Score at EOS
score on a scaleTeriflunomide 14 mgTolebrutinib 60 mg
Physical health composite score-2.468 ± 0.7014-0.460 ± 0.7021
Mental health composite score-2.070 ± 0.8346-0.729 ± 0.8359
SecondaryNumber of Participants With Treatment-emergent Adverse Events (TEAEs), Treatment-emergent Serious Adverse Events (TESAEs), TEAEs Leading to Permanent Study Intervention Discontinuation and Treatment-emergent Adverse Events of Special Interest (AESIs)

An AE was any untoward medical occurrence in a participant or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. SAE was any untoward medical occurrence that at any dose: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent disability/incapacity, was a congenital anomaly/birth defect or was an important medical event. An AESI was an AE (serious or nonserious) of scientific and medical concern specific to the Sponsor's product or program for which ongoing monitoring and immediate notification by the Investigator to the Sponsor was required. TEAEs were defined as AEs that developed, worsened or became serious during the TE period.

Time frame:
From first dose of study intervention (Day 1) up to the earliest of either 10 days post last dose, death or last contact; up to approximately 48 months
Reported as:
Count of participants · Participants
Number of Participants With Treatment-emergent Adverse Events (TEAEs), Treatment-emergent Serious Adverse Events (TESAEs), TEAEs Leading to Permanent Study Intervention Discontinuation and Treatment-emergent Adverse Events of Special Interest (AESIs)
ParticipantsTeriflunomide 14 mgTolebrutinib 60 mg
TEAEs423407
TESAEs4042
TEAEs leading to permanent study intervention discontinuation2423
TEAESIs5753
SecondaryMaximum Observed Plasma Concentration (Cmax) of Tolebrutinib and M2 Metabolite

Blood samples were collected at specified timepoints to assess Cmax of tolebrutinib and M2 metabolite using population pharmacokinetic (PK) model.

Time frame:
30-90 minutes post-dose at Months 6, 9, and 12 and 2.5-5 hours post-dose at Months 6 and 12
Reported as:
Mean · nanogram/milliliter (ng/mL)
Maximum Observed Plasma Concentration (Cmax) of Tolebrutinib and M2 Metabolite
nanogram/milliliter (ng/mL)Tolebrutinib 60 mg
Tolebrutinib12.0 ± 7.75
M2 Metabolite28.3 ± 15.8
SecondaryTime to Maximum Observed Plasma Concentration (Tmax) of Tolebrutinib and M2 Metabolite

Blood samples were collected at specified timepoints to assess Tmax of tolebrutinib and M2 metabolite using population PK model.

Time frame:
30-90 minutes post-dose at Months 6, 9, and 12 and 2.5-5 hours post-dose at Months 6 and 12
Reported as:
Mean · hour (h)
Time to Maximum Observed Plasma Concentration (Tmax) of Tolebrutinib and M2 Metabolite
hour (h)Tolebrutinib 60 mg
Tolebrutinib1.28 ± 0.513
M2 Metabolite1.40 ± 0.508
SecondaryArea Under the Plasma Concentration-time Curve Over the Last 24-hours Dosing Interval (AUC0-24) of Tolebrutinib and M2 Metabolite

Blood samples were collected at specified timepoints to assess AUC0-24 of tolebrutinib and M2 metabolite using population PK model.

Time frame:
30-90 minutes post-dose at Months 6, 9, and 12 and 2.5-5 hours post-dose at Months 6 and 12
Reported as:
Mean · ng*h/mL
Area Under the Plasma Concentration-time Curve Over the Last 24-hours Dosing Interval (AUC0-24) of Tolebrutinib and M2 Metabolite
ng*h/mLTolebrutinib 60 mg
Tolebrutinib30.5 ± 18.2
M2 Metabolite76.7 ± 44.1
SecondaryChange From Baseline in Plasma Neurofilament Light Chain (NfL) and Serum Chitinase-3 Like Protein-1 (Chi3L1) Levels at EOS

Blood samples were collected at specified timepoints to assess change from baseline in NfL and Chi3L1. Baseline was defined as the last available value prior to the first dose of study intervention.

Time frame:
Baseline (Day 1) to EOS (up to approximately 48 months)
Reported as:
Median · picogram/mL
Change From Baseline in Plasma Neurofilament Light Chain (NfL) and Serum Chitinase-3 Like Protein-1 (Chi3L1) Levels at EOS
picogram/mLTeriflunomide 14 mgTolebrutinib 60 mg
NfL-1.665 (-6.100 to 0.830)-0.325 (-3.505 to 2.220)
Chi3L11017.100 (-4494.850 to 7672.450)1572.250 (-2582.000 to 6356.600)
SecondaryChange From Baseline in Cluster of Differentiation (CD)19+ B Cells at EOS

Blood samples were collected at specified timepoints to assess change from baseline in CD19+ B cells. Baseline was defined as the last available value prior to the first dose of study intervention.

Time frame:
Baseline (Day 1) to EOS (up to approximately 48 months)
Reported as:
Median · cells/microliter
Change From Baseline in Cluster of Differentiation (CD)19+ B Cells at EOS
cells/microliterTeriflunomide 14 mgTolebrutinib 60 mg
Change From Baseline in Cluster of Differentiation (CD)19+ B Cells at EOS-45.000 (-81.000 to -5.000)-60.500 (-97.500 to -28.500)
SecondaryChange From Baseline in Serum Immunoglobulin (Ig) Levels at EOS

Blood samples were collected at specified timepoints to assess change from baseline in IgG and IgM levels. Baseline was defined as the last available value prior to the first dose of study intervention.

Time frame:
Baseline (Day 1) to EOS (up to approximately 48 months)
Reported as:
Median · gram/liter
Change From Baseline in Serum Immunoglobulin (Ig) Levels at EOS
gram/literTeriflunomide 14 mgTolebrutinib 60 mg
IgG-0.660 (-1.460 to 0.150)0.235 (-0.500 to 1.020)
IgM-0.150 (-0.330 to -0.030)-0.340 (-0.520 to -0.190)

Adverse events

Collected over From first dose of study intervention (Day 1) up to the earliest of either 10 days post last dose, death or last contact; up to approximately 48 months. Deaths were collected from baseline (Day 1) up to end of follow-up, approximately 48 months.. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Teriflunomide 14 mg0/488 (0%)40/488 (8.2%)321/488 (65.8%)
Tolebrutinib 60 mg0/486 (0%)42/486 (8.6%)296/486 (60.9%)
Most frequent serious events
Showing 10 of 76
Most frequent serious events
EventTeriflunomide 14 mgTolebrutinib 60 mg
Multiple Sclerosis RelapseNervous system disorders5/4883/486
Covid-19 PneumoniaInfections and infestations2/4884/486
AppendicitisInfections and infestations0/4882/486
Uterine LeiomyomaNeoplasms benign, malignant and unspecified (incl cysts and polyps)1/4882/486
Abortion SpontaneousPregnancy, puerperium and perinatal conditions1/4882/486
SciaticaNervous system disorders2/4880/486
Nasal Septum DeviationRespiratory, thoracic and mediastinal disorders2/4880/486
Intervertebral Disc ProtrusionMusculoskeletal and connective tissue disorders2/4880/486
Covid-19Infections and infestations1/4881/486
Chronic TonsillitisInfections and infestations0/4881/486
Most frequent other events
Showing 10 of 15
Most frequent other events
EventTeriflunomide 14 mgTolebrutinib 60 mg
Covid-19Infections and infestations135/488117/486
AlopeciaSkin and subcutaneous tissue disorders73/48836/486
NasopharyngitisInfections and infestations41/48859/486
NeutropeniaBlood and lymphatic system disorders58/48814/486
HeadacheNervous system disorders44/48856/486
Upper Respiratory Tract InfectionInfections and infestations46/48846/486
Alanine Aminotransferase IncreasedInvestigations40/48823/486
DiarrhoeaGastrointestinal disorders36/48822/486
Urinary Tract InfectionInfections and infestations27/48834/486
Viral Upper Respiratory Tract InfectionInfections and infestations34/48831/486

Baseline characteristics

Analysis was performed on the randomized population.

Age, Continuous
Age, Continuous(years)Teriflunomide 14 mgTolebrutinib 60 mgTotal
Mean36.6 ± 9.436.8 ± 9.036.7 ± 9.2
Sex: Female, Male
Sex: Female, Male(Participants)Teriflunomide 14 mgTolebrutinib 60 mgTotal
Female325334659
Male163152315
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Teriflunomide 14 mgTolebrutinib 60 mgTotal
American Indian or Alaska Native369
Asian6778145
Native Hawaiian or Other Pacific Islander011
Black or African American10414
White406395801
More than one race112
Unknown or Not Reported112
08

Study locations

179 sites
  • University of Alabama MS Center-Site Number:8400013
    Birmingham, Alabama 35233, United States
  • University of San Francisco, Sandler Neurosciences Center-Site Number:8400137
    San Francisco, California 94158, United States
  • University of Colorado-Site Number:8400012
    Aurora, Colorado 80045, United States
  • Georgetown University Medical Center-Site Number:8400119
    Washington D.C., District of Columbia 20007, United States
  • Beth Israel Deaconess Medical Center-Site Number:8400064
    Fort Myers, Florida 33919, United States
  • Axiom Clinical Research of Florida-Site Number:8400001
    Tampa, Florida 33609-4052, United States
  • University of South Florida-Site Number:8400006
    Tampa, Florida 33612, United States
  • Meridian Clinical Research-Site Number:8400003
    Savannah, Georgia 31406, United States
  • Consultants In Neurology-Site Number:8400011
    Northbrook, Illinois 60062, United States
  • Tufts Medical Center-Site Number:8400072
    Boston, Massachusetts 02111, United States
  • Michigan Institute For Neurological Disorders-Site Number:8400058
    Farmington Hills, Michigan 48334, United States
  • The Memorial Hospital-Site Number:8400033
    Owosso, Michigan 48867, United States
  • Sharlin Health & Neurology-Site Number:8400093
    Ozark, Missouri 65721, United States
  • Missouri Baptist Medical Center-Site Number:8400019
    St Louis, Missouri 63131, United States
  • Meridian Clinical Research, LLC-Site Number:8400005
    Raleigh, North Carolina 27607, United States
  • Wake Forest University Baptist Medical Center-Site Number:8400116
    Winston-Salem, North Carolina 27157, United States
  • The Ohio State University Wexner Medical Center-Site Number:8400150
    Columbus, Ohio 43221, United States
  • Optimed Research, LTD-Site Number:8400147
    Columbus, Ohio 43235, United States
  • Columbus Neuroscience-Site Number:8400010
    Westerville, Ohio 40382, United States
  • Oklahoma Medical Research Foundation-Site Number:8400018
    Oklahoma City, Oklahoma 73104, United States
  • Providence Multiple Sclerosis Center-Site Number:8400020
    Portland, Oregon 97225, United States
  • University of Texas Southwestern Medical Center-Site Number:8400077
    Dallas, Texas 75390, United States
  • Multiple Sclerosis Center, Swedish Neuroscience Institute-Site Number:8400121
    Seattle, Washington 98122, United States
  • Investigational Site Number :0400004
    Linz, 4021, Austria
  • Investigational Site Number :1120005
    Vitebsk, 210009, Belarus
  • Investigational Site Number :1120004
    Vitebsk, 210037, Belarus
  • Investigational Site Number :1000002
    Pleven, 5800, Bulgaria
  • Investigational Site Number :1000005
    Plovdiv, 4000, Bulgaria
  • Investigational Site Number :1000004
    Sofia, 1113, Bulgaria
  • Investigational Site Number :1000008
    Sofia, 1407, Bulgaria
  • Investigational Site Number :1000001
    Sofia, 1431, Bulgaria
  • Investigational Site Number :1000006
    Sofia, 1431, Bulgaria
  • Investigational Site Number :1000009
    Sofia, 1680, Bulgaria
  • Investigational Site Number :1240016
    Vancouver, British Columbia V6T 2B5, Canada
  • Investigational Site Number :1240003
    Ottawa, Ontario K1H 8L6, Canada
  • Investigational Site Number :1240013
    Toronto, Ontario M5B 1W8, Canada
  • Investigational Site Number :1240006
    Gatineau, Quebec J8Y 1W2, Canada
  • Investigational Site Number :1560022
    Baotou, 014010, China
  • Investigational Site Number :1560006
    Beijing, 100034, China
  • Investigational Site Number :1560010
    Beijing, 100050, China
  • Investigational Site Number :1560012
    Beijing, 100053, China
  • Investigational Site Number :1560023
    Beijing, 100191, China
  • Investigational Site Number :1560001
    Beijing, 100730, China
  • Investigational Site Number :1560009
    Beijing, 100730, China
  • Investigational Site Number :1560025
    Beijing, 100730, China
  • Investigational Site Number :1560021
    Beijing, 100853, China
  • Investigational Site Number :1560004
    Changchun, 130021, China
  • Investigational Site Number :1560015
    Changsha, 410008, China
  • Investigational Site Number :1560005
    Chengdu, 610041, China
  • Investigational Site Number :1560019
    Chongqing, 400016, China
  • Investigational Site Number :1560035
    Fuzhou, 350005, China
  • Investigational Site Number :1560016
    Guangzhou, 510080, China
  • Investigational Site Number :1560028
    Guangzhou, 510515, China
  • Investigational Site Number :1560002
    Guangzhou, 510630, China
  • Investigational Site Number :1560027
    Hohhot, 010050, China
  • Investigational Site Number :1560044
    Nanjing, 210008, China
  • Investigational Site Number :1560042
    Nanjing, 210029, China
  • Investigational Site Number :1560003
    Shanghai, 200040, China
  • Investigational Site Number :1560018
    Shenyang, 110004, China
  • Investigational Site Number :1560014
    Shijiazhuang, 050000, China
  • Investigational Site Number :1560008
    Taiyuan, 030001, China
  • Investigational Site Number :1560020
    Tianjin, 300052, China
  • Investigational Site Number :1560011
    Wuhan, 430030, China
  • Investigational Site Number :1560017
    Xi'an, 710038, China
  • Investigational Site Number :1560033
    Yinchuan, 750004, China
  • Investigational Site Number :2030004
    Hradec Králové, 50005, Czechia
  • Investigational Site Number :2030009
    Pardubice, 53203, Czechia
  • Investigational Site Number :2030003
    Teplice, 415 29, Czechia
  • Investigational Site Number :2030007
    Zlín, 76275, Czechia
  • Investigational Site Number :2080001
    Esbjerg, 6700, Denmark
  • Investigational Site Number :2080005
    Holstebro, 7500, Denmark
  • Investigational Site Number :2330001
    Tallinn, 11315, Estonia
  • Investigational Site Number :2330002
    Tartu, 50406, Estonia
  • Investigational Site Number :2460003
    Helsinki, 00180, Finland
  • Investigational Site Number :2460001
    Tampere, 33520, Finland
  • Investigational Site Number :2460002
    Turku, 20520, Finland
  • Investigational Site Number :2760001
    Dresden, 01307, Germany
  • Investigational Site Number :2760019
    Düsseldorf, 40225, Germany
  • Investigational Site Number :2760016
    Hamburg, 22179, Germany
  • Investigational Site Number :2760008
    Münster, 48149, Germany
  • Investigational Site Number :2760004
    Rostock, 18055, Germany
  • Investigational Site Number :2760011
    Ulm, 89081, Germany
  • Investigational Site Number : 3440001
    Shatin, NT, Hong Kong
  • Investigational Site Number :3800002
    Pozzilli, Isernia 86077, Italy
  • Investigational Site Number :3800007
    Orbassano, Torino 10043, Italy
  • Investigational Site Number :3800011
    Bergamo, 24127, Italy
  • Investigational Site Number :3800015
    Catania, 95123, Italy
  • Investigational Site Number :3800012
    Florence, 50134, Italy
  • Investigational Site Number :3800014
    Genova, 16132, Italy
  • Investigational Site Number :3800001
    Milan, 20132, Italy
  • Investigational Site Number :3800010
    Milan, 20133, Italy
  • Investigational Site Number :3800003
    Naples, 80131, Italy
  • Investigational Site Number :3800006
    Naples, 80131, Italy
  • Investigational Site Number :3800008
    Pavia, 27100, Italy
  • Investigational Site Number :3800005
    Roma, 00152, Italy
  • Investigational Site Number :3800009
    Roma, 00168, Italy
  • Investigational Site Number :3800013
    Roma, 00189, Italy
  • Investigational Site Number :3920016
    Chiba, Chiba 260-8677, Japan
  • Investigational Site Number :3920008
    Koriyama-shi, Fukushima 963-8052, Japan
  • Investigational Site Number :3920012
    Tsukuba, Ibaraki 305-0005, Japan

Showing the first 100 of 179 sites across 24 countries.

09

References and documents

Publications

  • Oh J, Arnold DL, Cree BAC, Ionete C, Kim HJ, Sormani MP, Syed S, Chen Y, Maxwell CR, Benoit P, Turner TJ, Wallstroem E, Wiendl H; Tolebrutinib Phase 3 GEMINI 1 and 2 Trial Group. Tolebrutinib versus Teriflunomide in Relapsing Multiple Sclerosis. N Engl J Med. 2025 May 15;392(19):1893-1904. doi: 10.1056/NEJMoa2415985. Epub 2025 Apr 8. PubMed 40202623 ↗

Study documents

  • Study protocol · Dec 20, 2023
  • Statistical analysis plan · Jul 10, 2024

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

Individual participant data

Plan to share: Yes — Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 2, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT04410978
Lead sponsor
Sanofi
Responsible party
Sponsor
First posted
Jun 1, 2020
Start date
Jun 30, 2020
Primary completion
Jul 15, 2024
Completion
Jul 15, 2024
Results posted
Jun 18, 2025
Last update
Jul 2, 2025

Study contacts

Clinical Sciences & Operations
study director · Sanofi

Oversight

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

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