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Also known as Enpatoran low dose, M5049, M5049 low dose, M5049 medium dose, M5049 high dose
Enpatoran · 8 trials · 7 indications
Time to recovery was defined as the time from first dose (Day 1) to first occurrence of World Health Organization (WHO) 9-point ordinal scale 3 or less. The scoring is assessed with the following ordinal scale: 0. Uninfected: no clinical or virological evidence of infection; 1. Ambulatory: no limitation of activities; 2. Ambulatory: limitation of activities; 3. Hospitalized, mild disease: hospitalized, no oxygen therapy; 4. Hospitalized, mild disease: oxygen by mask or nasal prongs; 5. Hospitalized, severe disease: noninvasive ventilation or high-flow oxygen; 6. Hospitalized, severe disease: intubation and mechanical ventilation; 7. Hospitalized, severe disease: ventilation plus additional organ support for example: vasopressors or Extracorporeal membrane oxygenation (ECMO); 8. Death.
Adverse Event (AE) was defined any untoward medical occurrence in a participant administered with a study drug, which does not necessarily had a causal relationship with this treatment. Serious AE was defined AE that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial/prolonged inpatient hospitalization; congenital anomaly/birth defect. TEAEs: TEAEs was defined as events with onset date or worsening during the on treatment period. TEAEs included serious TEAEs and non-serious TEAEs.
Laboratory investigation included hematology and biochemistry. The number of participants with clinically significant changes from baseline in laboratory parameters were reported. Clinical significance was determined by the investigator.
12-lead ECG recordings included rhythm, heart rate (as measured by RR interval), PR interval, QRS duration, and QT interval. 12-lead ECG recordings were obtained after the participants have rested for at least 10 minutes in semisupine position. Clinical significance was determined by the investigator. The number of participants with clinically significant changes from baseline in 12-lead ECG findings were reported.
The CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index) was a validated instrument used to assess disease activity (CLASI-A) and damage in lupus erythematosus. The activity scale included erythema, scale/hypertrophy, active alopecia, recent hair loss, and mucous membrane disease, while the damage scale measured dyspigmentation, atrophy, and scarring. CLASI-A scores ranged from 0 to 70, with mild, moderate, and severe disease corresponding to scores of 0-9, 10-20, and 21-70, respectively. Erythema and scale/hypertrophy sub-scores were computed across 13 body areas, with maximum scores of 39 and 26, respectively. The remaining 5 points reflected contributions from active alopecia (0-3), recent hair loss (0-1), and mucous membrane involvement (0-1), completing the total CLASI-A activity score. Directionality reflected worsening with higher scores and improvement with lower scores.
BILAG-based BICLA response is defined as participants meeting all of the following criteria: 1. Improvement in baseline BILAG scores in all organ systems with moderate or severe disease activity-i.e., all grade A scores (severe disease requiring high-dose therapy) must improve to B (moderate), C (mild), or D (no activity); all grade B scores (moderate disease requiring moderate therapy) must improve to C or D; 2. No new BILAG A scores and no more than one new BILAG B score; 3. No worsening in total SLEDAI-2K score from baseline; 4. No significant deterioration (≤10%) in physician's global assessment; and 5. No treatment failure, defined as initiation of non-protocol therapy. Directionality is toward clinical improvement and disease stabilization.
| Arm | Type | Description |
|---|---|---|
| Enpatoran | EXPERIMENTAL | - |
| Placebo | PLACEBO_COMPARATOR | - |
| M5049 50 mg | EXPERIMENTAL | - |
| M5049 100 mg | EXPERIMENTAL | - |
| M5049 low dose + Placebo | EXPERIMENTAL | Participants with CLE (active SCLE and/or DLE) or SLE who received low dose of M5049 in WILLOW study will continue to receive M5049 low dose and matching placebo. |
| M5049 medium dose+ Placebo | EXPERIMENTAL | Participants with CLE (active SCLE and/or DLE) or SLE who received medium dose of M5049 in WILLOW study will continue to receive M5049 medium dose and matching placebo. |
| M5049 high dose + Placebo | EXPERIMENTAL | Participants with CLE (active SCLE and/or DLE) or SLE who received M5049 matched placebo or high dose of M5049 in WILLOW study will receive M5049 high dose . |
| Cohort A: Placebo | PLACEBO_COMPARATOR | Participants with CLE (active SCLE and/or DLE) or SLE with predominantly active lupus rash (Cutaneous Lupus Erythematosus Disease Area and Severity Index \[CLASI-A\] greater than or equal to \[\>=\] 8) will be enrolled in Cohort A to receive placebo matched to Enpatoran. |
| Cohort A: Enpatoran low dose | EXPERIMENTAL | Participants with CLE (active SCLE and/or DLE) or SLE with predominantly active lupus rash (CLASI-A \>= 8) will be enrolled in Cohort A to receive low dose of Enpatoran. |
| Cohort A: Enpatoran medium dose | EXPERIMENTAL | Participants with CLE (active SCLE and/or DLE) or SLE with predominantly active lupus rash (CLASI-A \>= 8) will be enrolled in Cohort A to receive medium dose of Enpatoran. |
| Cohort A: Enpatoran high dose | EXPERIMENTAL | Participants with CLE (active SCLE and/or DLE) or SLE with predominantly active lupus rash (CLASI-A \>= 8) will be enrolled in Cohort A to receive high dose of Enpatoran. |
| Cohort B (Part 1 + Part 2): Placebo | PLACEBO_COMPARATOR | Participants with active SLE who have moderate to high systemic disease activity (British Isles Lupus Assessment Group \[BILAG A/2B\]) with 1 or 2 of the following: CLASI-A \>= 8 and/or Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) \>= 6 will be enrolled in Cohort B to receive placebo matched to Enpatoran . |
| Cohort B (Part 1 + Part 2): Enpatoran high dose | EXPERIMENTAL | Participants with active SLE who have moderate to high systemic disease activity (BILAG A/2B) with 1 or 2 of the following: CLASI-A \>= 8 and/or SLEDAI \>= 6 will be enrolled in Cohort B to receive high dose of Enpatoran. |
| Cohort B (Part 2): Enpatoran low dose | EXPERIMENTAL | Participants with active SLE who have moderate to high systemic disease activity (BILAG A/2B) with 1 or 2 of the following: CLASI-A \>= 8 and/or SLEDAI \>= 6 will be enrolled in Cohort B to receive low dose of M5049. |
| Cohort B (Part 2): Enpatoran medium dose | EXPERIMENTAL | Participants with active SLE who have moderate to high systemic disease activity (BILAG A/2B) with 1 or 2 of the following: CLASI-A \>= 8 and/or SLEDAI \>= 6 will be enrolled in Cohort B to receive medium dose of Enpatoran. |
| Control Group 1 (Normal Renal Function) | EXPERIMENTAL | - |
| Group 2 (Impaired Renal Function) | EXPERIMENTAL | - |
| Part A (Cohort 1): M5049 Dose A | EXPERIMENTAL | - |
| Part A (Cohort 2): M5049 Dose B | EXPERIMENTAL | - |
| Part A (Cohort 3): M5049 Dose C | EXPERIMENTAL | - |
| Part A (Cohort 4): M5049 Dose D | EXPERIMENTAL | - |
| Part A: Placebo | PLACEBO_COMPARATOR | - |
| Part B (Cohort 5): M5049 Dose E | EXPERIMENTAL | - |
| Part B: Placebo | PLACEBO_COMPARATOR | - |
| Name | Type | Description |
|---|---|---|
| Enpatoran | DRUG | Participants will receive a dose of Enpatoran orally for 108 weeks. |
| Placebo | DRUG | Participants will receive a single oral dose of a placebo matching Enpatoran tablet twice daily from Day 1 to Day 168. |
| Standard of care (SoC) | DRUG | Participants will receive Investigator-recommended SoC. |
| M5049 | DRUG | Participants received M5049 50 milligram (mg) orally twice daily for 14 days. |
| M5049 low dose | DRUG | Participants will receive film-coated tablets of M5049 at a low dose orally, twice a day (BID) for up to 194 weeks. |
| M5049 medium dose | DRUG | Participants will receive film-coated tablets of M5049 at a medium dose orally, BID for up to 194 weeks. |
| M5049 high dose | DRUG | Participants will receive film-coated tablets of M5049 at a high dose orally, BID for up to 194 weeks. |
| Enpatoran low dose | DRUG | Participants will receive film-coated tablets of Enpatoran at a low dose orally, twice daily (BID) up to 24 weeks. |
| Enpatoran medium dose | DRUG | Participants will receive film-coated tablets of Enpatoran at a medium dose, orally, BID up to 24 weeks. |
| Enpatoran high dose | DRUG | Participants will receive film-coated tablets of Enpatoran at a high dose, orally, BID up to 24 weeks. |
Inclusion Criteria: 1. Are up to date according to local guidelines/ recommendations. Recombinant zoster vaccination is encouraged but not mandatory. 2. Are participants with active cutaneous manifestations of lupus erythematosus that have successfully completed the 24-week treatment of the Elowen-...
Enpatoran is an investigational small molecule developed by Merck KGaA for cutaneous manifestations of lupus, with or without systemic disease, and it has also been studied in renal impairment. It is being evaluated in Phase 3 lupus trials and was previously studied in a completed Phase 1 pharmacokinetics trial in participants with renal impairment.
Enpatoran is being studied for cutaneous manifestations of lupus, including systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE), with or without systemic disease. It is investigational and has not been approved for these indications. A separate completed Phase 1 trial evaluated its pharmacokinetics in renal impairment.
Enpatoran targets TLR7 and TLR8, two toll-like receptors involved in immune signaling, and acts as an antagonist of both. By blocking TLR7 and TLR8, enpatoran is designed to reduce the immune activation associated with lupus. This mechanism underlies its development in cutaneous and systemic lupus erythematosus.
Enpatoran is developed by Merck KGaA, which trades under the ticker MKGAF. The company is running the Phase 3 lupus program, including the ELOWEN-2 study and the Elowen-LTE long-term extension study, as well as the completed Phase 1 renal impairment pharmacokinetics trial.
Enpatoran is in Phase 3 development for cutaneous manifestations of lupus with or without systemic disease, and it is investigational. A Phase 1 pharmacokinetics study in renal impairment has been completed. The Phase 3 studies include ELOWEN-2 and Elowen-LTE, and enpatoran has not been approved by the FDA.
Enpatoran is being studied in Phase 3 trials NCT07355218 (ELOWEN-2) and NCT07332481, both recruiting adults with cutaneous lupus with or without systemic disease, and in the not-yet-recruiting long-term extension NCT07840287 (Elowen-LTE). The completed Phase 1 trial NCT06589713 evaluated renal impairment effects on enpatoran pharmacokinetics.
Enpatoran low dose is an alternative name used for enpatoran, so both names refer to the same investigational small molecule developed by Merck KGaA. Enpatoran is a TLR7 and TLR8 antagonist being studied in Phase 3 trials for cutaneous manifestations of lupus with or without systemic disease.