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M5049 low dose

Phase 3

Coronavirus Disease 2019 | Small molecule | Infectious Disease |Merck KGaA|Trials Updated: Oct 6, 2026

M5049 low dose development status

Highest phase Phase 3 (NCT07840287)
Phase scored for MKGAFPhase 2
Registered trials 6 across 2 sponsors since Nov 2021

M5049 low dose target and mechanism

ModalitySmall molecule

Also known as M5049, Enpatoran

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLEDDMC
Total Trials8
Total Enrollment1,851

FDA Designations

No designations recorded

M5049 low dose clinical trials

M5049 low dose · 8 trials · 7 indications

Phase 3 3Phase 2 3Phase 1 2
NCT07840287A Long-Term Extension (LTE) Study Of Enpatoran In Cutaneous Manifestations Of Lupus With Or Without Systemic Disease [Elowen-LTE]Systemic Lupus Erythematosus (SLE)
NOT YET_RECRUITING404 Analytics
NCT07355218A Study of Enpatoran in Participants With Cutaneous Manifestations of Lupus With or Without Systemic Disease (ELOWEN-2)Systematic Lupus Erythematosus
RECRUITING202 Analytics
NCT07332481A Study of Enpatoran in Participants With Cutaneous Manifestations of Lupus With or Without Systemic DiseaseSystemic Lupus Erythematosus (SLE)
RECRUITING202 Analytics
PHASE3NOT YET_RECRUITING
A Long-Term Extension (LTE) Study Of Enpatoran In Cutaneous Manifestations Of Lupus With Or Without Systemic Disease [Elowen-LTE]
Systemic Lupus Erythematosus (SLE)Unlock trial analytics
PHASE3RECRUITING
A Study of Enpatoran in Participants With Cutaneous Manifestations of Lupus With or Without Systemic Disease (ELOWEN-2)
Systematic Lupus ErythematosusUnlock trial analytics
PHASE3RECRUITING
A Study of Enpatoran in Participants With Cutaneous Manifestations of Lupus With or Without Systemic Disease
Systemic Lupus Erythematosus (SLE)Unlock trial analytics

Study Endpoints

Primary Endpoints

Number of Participants With Treatment Emergent adverse events (TEAEs), Serious Adverse Events (SAEs), and Adverse Events of Special Interest (AESI)
From current LTE study Day 1 to Week 120
Percentage of Participants With Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) 70 Response, Defined as >= 70 Percent (%) Decrease in CLASI-A Score From Baseline
At Week 24
Time to Recovery
Day 1 through Day 28

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.

Number of Participants With Treatment-Emergent Adverse Events (TEAEs), Adverse Events of Special Interests (AESIs), TEAEs Leading to Treatment Discontinuation and Serious TEAEs (SAEs) According to NCI-CTCAE Version 5.0
Day 1 through Day 60

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.

Number of Participants With Clinically Significant Changes From Baseline in Laboratory Parameters
Day 1 through Day 28

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.

Number of Participants With Clinically Significant Changes From Baseline in 12-Lead Electrocardiogram (ECG) Measurements
Day 1 through Day 28

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.

Part 1: Safety Profile as Assessed by Incidence of Treatment-Emergent Adverse Events (TEAEs), Serious Adverse Events (SAEs), Adverse Event of Special Interest (AESIs)
Baseline up to Week 50 (Long Term Extension Part 1)
Part 2: Safety Profile as Assessed by Incidence of Treatment-Emergent Adverse Events (TEAEs), Serious Adverse Events (SAEs), Adverse Event of Special Interest (AESIs)
Baseline up to Week 194 (LTE Part 1 and LTE Prolongation Part 2))
Cohort A: Change From Baseline in Cutaneous Lupus Erythematosus Disease Area and Severity Index-A (CLASI-A) Total Score at Week 16
Baseline, week 16

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.

Cohort B: Number of Participants With British Isles Lupus Assessment Group (BILAG)-Based Composite Lupus Assessment (BICLA) Response at Week 24
At Week 24

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.

Pharmacokinetic (PK) Plasma Concentrations of Enpatoran
Predose, 0.5, 1, 1.5, 2, 4, 8, 12, 24, 36, and 48 hours postdose
Part A: Cohort 1 and 2: Number of Participants with Treatment-Emergent Adverse Events (TEAEs), Serious TEAEs and Adverse Event of Special Interest (AESI), TEAEs Leading to Permanent Treatment Discontinuation and Treatment-Related TEAEs
Up to Day 102
Part A: Cohort 3 and 4; Part B: Cohort 5: Number of Participants with Treatment-Emergent Adverse Events (TEAEs), Serious TEAEs and Adverse Event of Special Interest (AESI), TEAEs Leading to Permanent Treatment Discontinuation and Treatment-Related TEAEs
Up to Day 186
Part A: Cohort 1 and 2: Number of Participants with Treatment-Emergent Adverse Events (TEAEs) Based on Severity
Up to Day 102
Part A: Cohort 3 and 4; Part B: Cohort 5: Number of Participants with Treatment-Emergent Adverse Events (TEAEs) Based on Severity
Up to Day 186
Part A: Cohort 1 and 2: Number of Participants with Clinically Significant Changes from Baseline in Laboratory Parameters, Vital Signs, Electroencephalogram (EEG) and Electrocardiogram (ECG) Findings
Up to Day 102
Part A: Cohort 3 and 4; Part B: Cohort 5: Number of Participants with Clinically Significant Changes from Baseline in Laboratory Parameters, Vital Signs, Electroencephalogram (EEG) and Electrocardiogram (ECG) Findings
Up to Day 186
Part A: Cohort 1 and 2: Number of Participants with Confirmed Signs and Symptoms of Prodromal Seizure
Up to Day 102
Part A: Cohort 3 and 4; Part B: Cohort 5: Number of Participants with Confirmed Signs and Symptoms of Prodromal Seizure
Up to Day 186
Part A: Cohort 1 and 2: Number of Participants with Suicidal Behavior and Suicidal Ideation as Assessed by Columbia-Suicide Severity Rating Scale (C-SSRS)
Up to Day 102

Secondary Endpoints

Number of Participants With Abnormalities in Laboratory Parameters (greater than or equal to [>=] Grade 3)
From current LTE study Day 1 to Week 120
Number of Participants With Abnormalities in Vital Signs
From current LTE study Day 1 to Week 120
Number of Participants With Abnormalities in Electrocardiogram (ECG) Parameter
From current LTE study Day 1 to Week 120
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Study Design & Arms

AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
EnpatoranEXPERIMENTAL -
PlaceboPLACEBO_COMPARATOR -
M5049 50 mgEXPERIMENTAL -
M5049 100 mgEXPERIMENTAL -
M5049 low dose + PlaceboEXPERIMENTALParticipants 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+ PlaceboEXPERIMENTALParticipants 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 + PlaceboEXPERIMENTALParticipants 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: PlaceboPLACEBO_COMPARATORParticipants 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 doseEXPERIMENTALParticipants 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 doseEXPERIMENTALParticipants 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 doseEXPERIMENTALParticipants 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): PlaceboPLACEBO_COMPARATORParticipants 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 doseEXPERIMENTALParticipants 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 doseEXPERIMENTALParticipants 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 doseEXPERIMENTALParticipants 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 AEXPERIMENTAL -
Part A (Cohort 2): M5049 Dose BEXPERIMENTAL -
Part A (Cohort 3): M5049 Dose CEXPERIMENTAL -
Part A (Cohort 4): M5049 Dose DEXPERIMENTAL -
Part A: PlaceboPLACEBO_COMPARATOR -
Part B (Cohort 5): M5049 Dose EEXPERIMENTAL -
Part B: PlaceboPLACEBO_COMPARATOR -

Interventions

NameTypeDescription
EnpatoranDRUGParticipants will receive a dose of Enpatoran orally for 108 weeks.
PlaceboDRUGParticipants will receive a single oral dose of a placebo matching Enpatoran tablet twice daily from Day 1 to Day 168.
Standard of care (SoC)DRUGParticipants will receive Investigator-recommended SoC.
M5049DRUGParticipants received M5049 50 milligram (mg) orally twice daily for 14 days.
M5049 low doseDRUGParticipants will receive film-coated tablets of M5049 at a low dose orally, twice a day (BID) for up to 194 weeks.
M5049 medium doseDRUGParticipants will receive film-coated tablets of M5049 at a medium dose orally, BID for up to 194 weeks.
M5049 high doseDRUGParticipants will receive film-coated tablets of M5049 at a high dose orally, BID for up to 194 weeks.
Enpatoran low doseDRUGParticipants will receive film-coated tablets of Enpatoran at a low dose orally, twice daily (BID) up to 24 weeks.
Enpatoran medium doseDRUGParticipants will receive film-coated tablets of Enpatoran at a medium dose, orally, BID up to 24 weeks.
Enpatoran high doseDRUGParticipants will receive film-coated tablets of Enpatoran at a high dose, orally, BID up to 24 weeks.
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Eligibility Criteria

Age Range18 Years to 76 Years
SexALL
Healthy VolunteersNo
Study Sites2

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-...

Countries:United StatesGermanyAustraliaBrazilBulgariaCanadaChinaCzechiaIsraelItalyPolandRomaniaSouth KoreaSpainSwitzerlandTaiwanUnited KingdomFranceJapanSlovakiaPhilippinesArgentinaChileColombiaGreeceMauritiusMexicoMoldovaSerbiaSouth AfricaNorth MacedoniaUkraine
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Recent Changes (Last 90 Days)

LOWOct 6, 2026NCT07355218lastUpdatePostDate: changed
LOWOct 6, 2026NCT07332481lastUpdatePostDate: changed
LOWOct 6, 2026NCT07355218lastUpdatePostDate: changed
LOWOct 6, 2026NCT07332481lastUpdatePostDate: changed
LOWSep 25, 2026NCT07840287NEW_TRIAL: changed
LOWSep 25, 2026NCT07840287NEW_TRIAL: changed
LOWSep 15, 2026NCT07355218lastUpdatePostDate: changed
LOWSep 15, 2026NCT07355218lastUpdatePostDate: changed
LOWSep 15, 2026NCT07355218lastUpdatePostDate: changed
LOWSep 11, 2026NCT07332481lastUpdatePostDate: changed
LOWSep 11, 2026NCT07332481lastUpdatePostDate: changed
LOWAug 17, 2026NCT07355218lastUpdatePostDate: changed
LOWAug 17, 2026NCT07355218lastUpdatePostDate: changed
LOWAug 14, 2026NCT07332481lastUpdatePostDate: changed
LOWAug 14, 2026NCT07332481lastUpdatePostDate: changed
LOWJul 24, 2026NCT07332481lastUpdatePostDate: changed
LOWJul 24, 2026NCT07332481lastUpdatePostDate: changed
LOWJul 20, 2026NCT05540327lastUpdatePostDate: changed
LOWJul 20, 2026NCT05540327lastUpdatePostDate: changed
LOWJul 17, 2026NCT07355218lastUpdatePostDate: changed

Frequently asked questions about M5049 low dose

What is M5049?

M5049 is an investigational small molecule being developed by Merck KGaA. It is in Phase 2 clinical development for systemic lupus erythematosus and has also been studied in coronavirus disease 2019. It is not yet approved for any indication.

What is M5049 used for in systemic lupus erythematosus?

M5049 is being evaluated as a treatment for systemic lupus erythematosus, including cutaneous lupus erythematosus. It is in Phase 2 development and is not approved. Clinical trials have enrolled adults with these conditions to assess the drug in a placebo-controlled, double-blind setting.

Who makes M5049?

M5049 is developed by Merck KGaA, which trades under the ticker MKGAF. The company is running the clinical development program for the drug across lupus and COVID-19 indications.

What phase is M5049 in?

M5049 is in Phase 2 clinical development. One Phase 2 trial in systemic lupus erythematosus is active and not recruiting, and a Phase 2 trial in COVID-19 pneumonia has been completed. A Phase 1 study in cutaneous and systemic lupus erythematosus is also completed.

What clinical trials is M5049 in?

M5049 has been studied in three registered trials. NCT05540327 is an active Phase 2 long-term extension study in systemic lupus erythematosus. NCT04647708 is a completed Phase 1 study in cutaneous and systemic lupus erythematosus. NCT04448756 is a completed Phase 2 study in COVID-19 pneumonia.

Is M5049 the same as M5049 low dose?

Yes, M5049 low dose is an alternative name for M5049. Both refer to the same investigational small molecule developed by Merck KGaA, so searches using either name point to the same drug and clinical program.