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Sarilumab

Phase 3

Rheumatoid Arthritis | Small molecule | Immunology |Sanofi|Last Updated: Mar 28, 2022

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindPLACEBO_CONTROLLEDDMCBiomarker
Total Trials4
Total Enrollment2,681
FDA Designations
No designations recorded
Clinical Trials (4)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT02373202A Study Assessing the Safety and Efficacy of Sarilumab Added to Non-MTX DMARDs or as Monotherapy in Japanese Patients With Active Rheumatoid Arthritis (SARIL-RA-HARUKA)PHASE3 COMPLETED 91Feb 1, 2015Nov 1, 2016Jan 30, 201840 Japan
NCT02332590Efficacy and Safety of Sarilumab and Adalimumab Monotherapy in Patients With Rheumatoid Arthritis (SARIL-RA-MONARCH)PHASE3 COMPLETED 369Jan 28, 2015Dec 29, 2020Mar 28, 202286 United States, Chile +13
NCT01709578To Evaluate The Effect Of SAR153191 (REGN88) Added To Other RA Drugs In Patients With RA Who Are Not Responding To Or Intolerant Of Anti-TNF Therapy (SARIL-RA-TARGET)PHASE3 COMPLETED 546Oct 1, 2012Mar 1, 2015Aug 8, 2017196 United States, Argentina +28
NCT01061736Evaluation of Sarilumab (SAR153191/REGN88) on Top of Methotrexate in Rheumatoid Arthritis PatientsPHASE2 COMPLETED 1,675Mar 1, 2010Oct 1, 2013Jun 28, 2017262 United States, Argentina +34
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Study Endpoints
Primary Endpoints
Number of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)
Baseline up to Week 58

Adverse event (AE) was defined as any untoward medical occurrence in a participant who received IMP and did not necessary have to had a causal relationship with treatment. All AEs that occurred from the first dose of the IMP administration up to 6 weeks after last dose of treatment (up to Week 58) were considered as TEAEs. SAEs were AEs resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly or a medically important event. TEAEs included both SAEs and non-SAEs.

Number of Participants With Potentially Clinically Significant Vital Signs Abnormalities
Baseline up to Week 58

Criteria for potentially clinically significant vital sign abnormalities: * Systolic blood pressure (SBP) supine: \<=95 mmHg and decrease from baseline (DFB) \>=20 mmHg; \>=160 mmHg and increase from baseline (IFB) \>=20 mmHg * Diastolic blood pressure (DBP) supine: \<=45 mmHg and DFB \>=10 mmHg; \>=110 mmHg and IFB ≥10 mmHg * SBP (Orthostatic): \<=-20 mmHg * DBP (Orthostatic): \<=-10 mmHg * Heart rate (HR) supine: \<=50 beats per minute (bpm) and DFB \>=20 bpm; \>=120 bpm and IFB \>=20 bpm * Weight: \>=5% DFB; \>=5% IFB

Number of Participants With Potentially Clinically Significant Electrocardiogram (ECG) Abnormalities
Baseline up to Week 58

Criteria for potentially clinically significant ECG abnormalities: * PR Interval: \>200 milliseconds (ms); \>200 ms and IFB \>=25%; \>220 ms; \>220 ms and IFB \>=25%; \>240 ms; \>240 ms and IFB \>=25% * QRS Interval: \>110 ms; \>110 ms and IFB \>=25%; \>120 ms; \>120 ms and IFB \>=25% * QT Interval: \>500 ms * QTc Bazett (QTc B): \>450 ms; \>480 ms; \>500 ms; IFB \>30 and \<=60 ms, IFB \>60 ms * QTc Fridericia (QTc F): \>450 ms; \>480 ms; \>500 ms; IFB \>30 and \<=60 ms; IFB \>60 ms

Number of Participants With Potentially Clinically Significant Laboratory Abnormalities: Hematological Parameters
Baseline up to Week 58

Criteria for potentially clinically significant abnormalities: * Hemoglobin: \<=115 g/L (Male\[M\]) or \<=95 g/L (Female\[F\]); \>=185 g/L (M) or \>=165 g/L (F); DFB \>=20 g/L * Hematocrit: \<=0.37 v/v (M) or \<=0.32 v/v (F); \>=0.55 v/v (M) or \>=0.5 v/v (F) * Red blood cells (RBC): \>=6 Tera/L * Platelets: \<50 Giga/L; \>=50 and \<100 Giga/L; \>=700 Giga/L * White blood cells (WBC): \<3.0 Giga/L (Non-Black \[NB\]) or \<2.0 Giga/L (Black \[B\]); \>=16.0 Giga/L * Neutrophils: \<1.5 Giga/L (NB) or \<1.0 Giga/L (B); \<1.0 Giga/L * Lymphocytes: \<0.5 Giga/L; \>=0.5 Giga/L and \<lower limit of normal (LLN); \>4.0 Giga/L * Monocytes: \>0.7 Giga/L * Basophils: \>0.1 Giga/L * Eosinophils: \>0.5 Giga/L or \>upper limit of normal (ULN) (if ULN \>=0.5 Giga/L)

Number of Participants With Potentially Clinically Significant Laboratory Abnormalities: Metabolic Parameters
Baseline up to Week 58

Criteria for potentially clinically significant abnormalities: * Glucose: \<=3.9 mmol/L and \<LLN; \>=11.1 mmol/L (unfasted \[unfas\]) or \>=7 mmol/L (fasted \[fas\]) * Hemoglobin A1c (HbA1c): \>8% * Total cholesterol: \>=6.2 mmol/L; \>=7.74 mmol/L * LDL cholesterol: \>=4.1 mmol/L; \>=4.9 mmol/L * Triglycerides: \>=4.6 mmol/L; \>=5.6 mmol/L

Number of Participants With Potentially Clinically Significant Laboratory Abnormalities: Electrolytes
Baseline up to Week 58

Criteria for potentially clinically significant abnormalities: * Sodium: \<=129 mmol/L; \>=160 mmol/L * Potassium: \<3 mmol/L; \>=5.5 mmol/L * Chloride: \<80 mmol/L; \>115 mmol/L

Number of Participants With Potentially Clinically Significant Laboratory Abnormalities: Renal Function Parameters
Baseline up to Week 58

Criteria for potentially clinically significant abnormalities: * Creatinine: \>=150 micromol/L (adults); \>=30% change from baseline, \>=100% change from baseline * Creatinine clearance: \<15 mL/min; \>=15 to \<30 mL/min; \>=30 to \<60 mL/min; \>=60 to \<90 mL/min * Blood urea nitrogen: \>=17 mmol/L * Uric acid: \<120 micromol/L; \>408 micromol/L

Number of Participants With Potentially Clinically Significant Laboratory Abnormalities: Liver Function Parameters
Baseline up to Week 58

Criteria for potentially clinically significant abnormalities: * Alanine Aminotransferase (ALT): \>1 ULN and \<=1.5 ULN; \>1.5 ULN and \<=3 ULN; \>3 ULN and \<=5 ULN; \>5 ULN and \<=10 ULN; \>10 ULN and \<=20 ULN; \>20 ULN * Aspartate aminotransferase (AST): \>1 ULN and \<=1.5 ULN; \>1.5 ULN and \<=3 ULN; \>3 ULN and \<=5 ULN; \>5 ULN and \<=10 ULN; \>10 ULN and \<=20 ULN; \>20 ULN * Alkaline phosphatase: \>1.5 ULN * Total bilirubin (TBILI): \>1.5 ULN; \>2 ULN * Conjugated bilirubin(CBILI): \>1.5 ULN * Unconjugated bilirubin: \>1.5 ULN * ALT \>3 ULN and TBILI \>2 ULN * CBILI \>35% TBILI and TBILI \>1.5 ULN * Albumin: \<=25 g/L

DB Period: Change From Baseline in Disease Activity Score for 28 Joints - Erythrocyte Sedimentation Rate (DAS28-ESR) Score at Week 24
Baseline, Week 24

DAS28-ESR is a composite score that includes 4 variables: TJC (based on 28 joints); SJC (based on 28 joints); GH assessment by the participant assessed from the ACR and RA core set questionnaire (participant global assessment) in 100 mm VAS; Marker of inflammation assessed by ESR in mm/hr. The DAS28-ESR score provides a number indicating the current disease activity of the RA. DAS28-ESR total score ranges from 2-10. A DAS28-ESR score above 5.1 means high disease activity, DAS28-ESR score below 3.2 indicates low disease activity and DAS28-ESR score below 2.6 means disease remission. Least square (LS) mean and standard error (SE) at Week 24 were obtained using Mixed-effect model with repeated measures (MMRM) approach.

Percentage of Participants Who Achieved at Least 20% Improvement in the American College of Rheumatology (ACR20) Criteria at Week 24
Week 24

ACR responses are assessed with a composite rating scale of the American College of Rheumatology that includes 7 variables: tender joint count (TJC); swollen joint count (SJC); levels of an acute phase reactant (C-reactive Protein levels \[CRP\]); participant's assessment of pain; participant's global assessment of disease activity; physician's global assessment of disease activity; participant's assessment of physical function by (health assessment questionnaire disability index \[HAQ-DI\]). ACR20 is defined as achieving at least 20% improvement in both TJC and SJC, and at least 20% improvement in at least 3 of the 5 other assessments of the ACR.

Change From Baseline in the Health Assessment Questionnaire-Disability Index (HAQ-DI) at Week 12
Baseline, Week 12

Physical function was assessed by HAQ-DI. It consisted of at least 2 questions per category, participant reported assessment of ability to perform tasks in 8 categories of daily living activities: dress/groom; arise; eat; walk; reach; grip; hygiene; and common activities over past week rated on a 4-point scale where 0 = no difficulty; 1 = some difficulty; 2 = much difficulty; 3 = unable to do. Overall score was computed as the sum of category scores and divided by the number of categories answered, ranging from 0 to 3, where 0 = no disability and 3 = unable to do, high-dependency disability. Least-squares (LS) means and standard errors (SE) at Week 12 were obtained from a mixed-effect model with repeated measures (MMRM) with treatment, region, number of previous anti-TNFs, visit, and treatment-by-visit interaction as fixed effects and baseline HAQ-DI as a covariate.

Part A: Percentage of Participants Achieving American College of Rheumatology 20% (ACR20) Response at Week 12
Baseline to Week 12

ACR20 response was defined, based on guidelines set forth by the American College of Rheumatology (ACR), as ≥20 % improvement in tender joint count and swollen joint count as well as ≥20% improvement in at least 3 of 5 following measures: C-Reactive Protein (CRP), Participant assessment of pain; Participant's global assessment of disease activity; Physician global assessment of disease activity; and Health Assessment Question-Disability Index (HAQ-DI). Missing data imputed by Last Observation Carried Forward (LOCF).

Part B: Percentage of Participants Achieving ACR20 Response at Week 24
Baseline to Week 24

ACR20 improvement responses were determined without imputation of missing post-baseline values. In addition data collected after treatment discontinuation or rescue was set to missing. Responder status was determined if possible. With these rules, participants automatically became non-responders for all time points beyond the time point they started rescue treatment or discontinued study treatment.

Part B: Change From Baseline in Health Assessment Question Disability Index (HAQ-DI) at Week 16
Baseline, Week 16

HAQ-DI was a participant-reported questionnaire that assesses the difficulty of performing daily activities: dress/groom, arise, eat, walk, reach, grip, hygiene and common activities. Overall score range from 0=least difficulty to 3=extreme difficulty. An increase in the score indicates a worsening of physical function while a decrease in the score represents improvement. Data collected after treatment discontinuation was set to missing.

Part B: Change From Baseline in Van Der Heijde Modified Total Sharp Score (mTSS) at Week 52
Baseline, Week 52

The Sharp method modified by D. van der Heijde involves separate scores for erosions and joint space narrowing based on radiographs to assess the degree of structural damage. Total score range from 0 (normal) to 448 (worst possible total score). An increase in total score represents progression of structural damage. Missing data were imputed by the linear extrapolation method.

Secondary Endpoints
Percentage of Participants Achieving American College of Rheumatology (ACR) 20, 50 and 70 Responses at Week 52
Week 52
Change From Baseline at Week 52 in Disease Activity Score for 28 Joints Based on C-Reactive Protein (DAS28-CRP)
Baseline, Week 52
Change From Baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI) Score at Week 52
Baseline, Week 52
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Study Design & Arms
AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Sarilumab 150 mg q2w + DMARDsEXPERIMENTALParticipants received sarilumab 150 mg, subcutaneous (SC) injection, once every two weeks (q2w) along with non-MTX DMARDs (sulfasalazine, leflunomide, bucillamine, tacrolimus, and/or mizoribine) for up to 52 weeks.
Sarilumab 200 mg q2w + DMARDsEXPERIMENTALParticipants received sarilumab 200 mg, SC injection, q2w along with non-MTX DMARDs (sulfasalazine, leflunomide, bucillamine, tacrolimus, and/or mizoribine) for up to 52 weeks.
Sarilumab 150 mg q2wEXPERIMENTALParticipants received sarilumab 150 mg, SC injection, q2w for up to 52 weeks.
Sarilumab 200 mg q2wEXPERIMENTALParticipants received sarilumab 200 mg, SC injection, q2w for up to 52 weeks.
Adalimumab 40 mg/Sarilumab 200 mgACTIVE_COMPARATORAdalimumab 40 milligrams (mg) subcutaneous (SC) injection in combination with placebo for sarilumab every 2 weeks (q2w) for 24 weeks during the double-blind (DB) period. The dosing frequency of adalimumab was adjusted to 40 mg every week (qw) dosing in case of participants with inadequate response (less than \[\<\] 20% improvement from baseline in tender joint count \[TJC\] and swollen joint count \[SJC\] for 2 consecutive visits) at or after Week 16 until Week 23. Participants who completed 24 weeks in the DB period had the option to continue in open label extension (OLE) period and received sarilumab 200 mg q2w until commercial availability of sarilumab in their country or up to a maximum of an additional 276 weeks (i.e. up to Week 300).
Sarilumab 200 mg/Sarilumab 200 mgEXPERIMENTALSarilumab 200 mg SC injection in combination with placebo for adalimumab q2w for 24 weeks during the DB period. The dosing frequency of placebo for adalimumab was adjusted to 40 mg qw dosing in case of participants with inadequate response (\<20% improvement from baseline in TJC and SJC for 2 consecutive visits) at or after Week 16 until Week 23. Participants who completed 24 weeks in the DB period had the option to continue in OLE period and received sarilumab 200 mg q2w until commercial availability of sarilumab in their country or up to a maximum of an additional 276 weeks (i.e. up to Week 300).
Placebo q2wPLACEBO_COMPARATORPlacebo matched to sarilumab once every 2 weeks (q2w) was added to one or a combination of the nonbiologic DMARD (hydroxychloroquine, methotrexate, sulfasalazine and/or Leflunomide), except for simultaneous combination use of leflunomide and methotrexate for 24 weeks.
Part A: SAR 100 mg qwEXPERIMENTALSarilumab 100 mg subcutaneous (SC) injection weekly (qw) on top of MTX for 12 weeks.
Part A: SAR 150 mg qwEXPERIMENTALSarilumab 150 mg SC injection qw on top of MTX for 12 weeks.
Part A: SAR 100 mg q2wEXPERIMENTALSarilumab 100 mg SC injection every other week (q2w) alternating with placebo on top of MTX for 12 weeks.
Part A: SAR 150 mg q2wEXPERIMENTALSarilumab 150 mg SC injection q2w alternating with placebo on top of MTX for 12 weeks.
Part A: SAR 200 mg q2wEXPERIMENTALSarilumab 200 mg SC injection q2w alternating with placebo on top of MTX for 12 weeks.
Part A: Placebo qwPLACEBO_COMPARATORPlacebo (for sarilumab) qw on top of MTX for 12 weeks.
Part B Cohort 1: Non-selected DosesEXPERIMENTALSarilumab 100 mg qw, 150 mg qw or 100 mg q2w SC injections as in Part A on top of MTX up to dose selection. After dose selection, participants were not continued but were allowed to participate in the open-label, long-term, extension study SARIL-RA-EXTEND (LTS11210).
Part B: SAR 150 mg q2w (Cohort 1[Selected Dose]+Cohort 2)EXPERIMENTALSarilumab 150 mg SC injection q2w on top of MTX for a maximum of 52 weeks. Participants with inadequate response from Week 16 could be rescued with open-label highest dose of sarilumab.
Part B: SAR 200 mg q2w (Cohort 1[Selected Dose]+Cohort 2)EXPERIMENTALSarilumab 200 mg SC injection q2w on top of MTX for a maximum of 52 weeks. Participants with inadequate response from Week 16 could be rescued with open-label highest dose of sarilumab.
Part B: Placebo q2w (Cohort 1[Selected Dose]+Cohort 2)EXPERIMENTALPlacebo (for sarilumab) q2w on top of MTX for a maximum of 52 weeks. Participants with inadequate response from Week 16 could be rescued with open-label highest dose of sarilumab.
Interventions
NameTypeDescription
SarilumabDRUGPharmaceutical form:solution
SulfasalazineDRUGPharmaceutical form: Tablet Route of administration: Oral
LeflunomideDRUGPharmaceutical form: Tablet Route of administration: Oral
BucillamineDRUGPharmaceutical form: Tablet Route of administration: Oral
TacrolimusDRUGPharmaceutical form: Capsule Route of administration: Oral
MizoribineDRUGPharmaceutical form: Tablet Route of administration: Oral
AdalimumabDRUGPharmaceutical form: solution for injection in pre-filled syringe; Route of administration: SC
Placebo (for sarilumab)DRUGPharmaceutical form: solution for injection in pre-filled syringe; Route of administration: SC
Placebo (for adalimumab)DRUGPharmaceutical form: solution for injection in pre-filled syringe; Route of administration: SC
placeboDRUGPharmaceutical form:solution Route of administration: subcutaneous
hydroxychloroquineDRUGDispensed according to the local practice.
methotrexateDRUGDispensed according to the local practice.
Folic AcidDRUGAccording to local standard
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Eligibility Criteria
Age Range20 Years — N/A
SexALL
Healthy VolunteersNo
Study Sites40

Inclusion criteria: Diagnosis of rheumatoid arthritis (RA), according to the American College of Rheumatology/The European League Against Rheumatism (ACR/EULAR) 2010 Rheumatoid Arthritis Classification Criteria with \>=3 months disease duration. Moderately to severely active RA defined as: * At l...

Countries:JapanUnited StatesChileCzechiaGermanyHungaryIsraelPeruPolandRomaniaRussiaSouth AfricaSouth KoreaSpainUkraineUnited KingdomArgentinaAustraliaAustriaBrazilCanadaColombiaEcuadorGreeceGuatemalaItalyLithuaniaMexicoNew ZealandPortugalSlovakiaTaiwanTurkey (Türkiye)BelarusBelgiumEgyptEstoniaFinlandIndiaMalaysiaNetherlandsNorwayPhilippinesThailand
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