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Teriflunomide

Phase 3

Multiple Sclerosis | Small molecule | Immunology |Sanofi|Last Updated: Feb 6, 2025

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 Trials11
Total Enrollment4,660
FDA Designations
No designations recorded
Clinical Trials (11)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT02201108Efficacy, Safety and Pharmacokinetics of Teriflunomide in Pediatric Patients With Relapsing Forms of Multiple SclerosisPHASE3 COMPLETED 166Jul 16, 2014Jul 29, 2024Feb 6, 202557 United States, Belgium +20
NCT00751881An Efficacy Study of Teriflunomide in Participants With Relapsing Multiple SclerosisPHASE3 COMPLETED 1,169Aug 1, 2008Aug 1, 2015Jul 7, 2016193 United States, Australia +24
NCT00622700Phase III Study With Teriflunomide Versus Placebo in Patients With First Clinical Symptom of Multiple SclerosisPHASE3 COMPLETED 618Feb 1, 2008Feb 1, 2016Mar 13, 2017131 United States, Australia +19
NCT00803049Long Term Safety and Efficacy Study of Teriflunomide 7 mg or 14 mg in Patients With Relapsing-Remitting Multiple SclerosisPHASE3 COMPLETED 742Oct 1, 2006Dec 1, 2015Jan 30, 2017116 United States, Austria +19
NCT00134563Study of Teriflunomide in Reducing the Frequency of Relapses and Accumulation of Disability in Patients With Multiple SclerosisPHASE3 COMPLETED 1,088Sep 1, 2004Jul 1, 2010Jan 4, 201321 United States, Austria +19
NCT01403376Study to Investigate the Immune Response to Influenza Vaccine in Patients With Multiple Sclerosis on TeriflunomidePHASE2 COMPLETED 128Sep 1, 2011Jan 1, 2012Feb 18, 201614 Austria, Canada +3
NCT00811395Long Term Safety of Teriflunomide When Added to Interferon-Beta or Glatiramer Acetate in Patients With Multiple SclerosisPHASE2 COMPLETED 182Oct 1, 2007Apr 1, 2010Dec 31, 20127 United States, Austria +5
NCT00489489Phase II Study of Teriflunomide as Adjunctive Therapy to Interferon-beta in Subjects With Multiple SclerosisPHASE2 COMPLETED 118May 1, 2007Jun 1, 2009Nov 6, 20125 United States, Canada +3
NCT00475865Phase II Study of Teriflunomide as Adjunctive Therapy to Glatiramer Acetate in Subjects With Multiple SclerosisPHASE2 COMPLETED 123Apr 1, 2007Oct 1, 2009Nov 6, 20126 United States, Austria +4
NCT00228163Long Term Safety and Efficacy of Teriflunomide (HMR1726) in Multiple Sclerosis With RelapsesPHASE2 COMPLETED 147Jan 1, 2002Jan 1, 2015Mar 25, 201516 Canada, France
NCT01487096Safety and Efficacy of Teriflunomide (HMR1726) in Multiple Sclerosis With RelapsesPHASE2 COMPLETED 179Apr 1, 2001Mar 1, 2003Oct 4, 20122 Canada, France
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Study Endpoints
Primary Endpoints
Time to First Confirmed Clinical Relapse
Baseline up to Week 96

Time to first clinical relapse was defined as the duration (in weeks) between randomization and first confirmed clinical relapse. Clinical relapses were defined as new or recurrent neurological symptoms not associated with fever or infection, lasting at least 24 hours, and accompanied by new objective neurological findings upon neurological examination and documented by a standardized, quantified functional system score (FSSs) which included 8 items and items were rated on different scales: brain stem, cerebellar and cerebral functions rated on a scale of 0 to 5; visual, pyramidal, sensory and bowel/bladder rated on a scale of 0 to 6 and ambulation on a scale of 0 to 12, where higher score in each scale indicated worsened neurological function. Confirmed clinical relapse were reviewed and confirmed by an independent Relapse Adjudication Panel (RAP). A participant without confirmed clinical relapse, was considered as clinical relapse free until the end of Week 96.

Core Treatment Period: Annualized Relapse Rate (ARR): Poisson Regression Estimate
Core treatment period between 48 - 152 weeks depending on time of enrollment

ARR is obtained from the total number of confirmed relapses that occurred during the treatment period divided by the sum of treatment durations. Each episode of relapse - appearance, or worsening of a clinical symptom that was stable for at least 30 days, that persisted for a minimum of 24 hours in the absence of fever - was to be confirmed by an increase in Expanded Disability Status Scale (EDSS) score or Functional System scores. To account for the different treatment durations among participants, a Poisson regression model with robust error variance was used (total number of confirmed relapses as response variable; log-transformed treatment duration as "offset" variable; treatment group, region of enrollment and baseline EDSS stratum as covariates).

Core Treatment Period: Time to Conversion to Clinically Definite Multiple Sclerosis (CDMS)
Up to a maximum of 108 weeks depending on time of enrollment

Conversion to CDMS was defined by the occurrence of a relapse, which was defined as a new neurological abnormality separated by at least 30 days from onset of a preceding clinical event, presented for at least 24 hours and occurred in the absence of fever or known infection. Percent probability of conversion at 24, 48, and 108 weeks was estimated using Kaplan-Meier method.

Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs)
Baseline (LTS6050) up to 28 days after last dose of study drug up to 450 weeks

Adverse event (AE) was defined as any untoward medical occurrence in a participant who received investigational medicinal product (IMP) without regard to possibility of causal relationship with this treatment. TEAEs: AEs that developed or worsened or became serious during on-treatment period which was defined as the period from the time of first dose of study drug (in LTS6050) up to 4 weeks (28 days) after last dose of study drug. Serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of the following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. Any TEAE included both serious and non-serious AEs.

Annualized Relapse Rate [ARR]: Poisson Regression Estimates
108 weeks

ARR is obtained from the total number of confirmed relapses that occured during the treatment period divided by the sum of the treatment durations. Each episode of relapse - appearance, or worsening of a clinical symptom that was stable for at least 30 days, that persisted for a minimum of 24 hours in the absence of fever - was to be confirmed by an increase in EDSS score or Functional System scores. To account for the different treatment durations among participants, a Poisson regression model with robust error variance was used (total number of confirmed relapses as response variable; log-transformed treatment duration as "offset" variable; treatment group, region of enrollment and baseline EDSS stratum as covariates).

Percentage of Participants With Antibody Titer ≥40 at 28 Days Post Vaccination
28 days post vaccination

For each viral strain (H1N1, H3N2, and B), the antibody titer, level of antibodies in blood sample when exposed to antigen, was calculated as the mean of two replicates. If the titer was below or above the limit of detection, the threshold value was used. The percentage of participants achieving a titer of 40 or more, as well as the 90% confidence interval (CI) using normal approximation were calculated for each strain and treatment group.

Overview of Adverse Events [AE]
from first study drug intake in PDY6045/PDY6046 study up to 112 days after last intake in initial study or in the extension study, whichever occured last (64 weeks max)

AE are any unfavorable and unintended sign, symptom, syndrome, or illness observed by the investigator or reported by the participant during the study.

Overview of AE With Potential Risk of Occurence
from first study drug intake in PDY6045/PDY6046 study up to 112 days after last intake in initial study or in the extension study, whichever occured last (64 weeks max)

AE with potential risk of occurrence were defined as follows: * Hepatic disorders; * Immune effects, mainly effects on bone marrow and infection; * Pancreatic disorders; * Malignancy; * Skin disorders, mainly hair loss and hair thinning; * Pulmonary disorders; * Hypertension; * Peripheral neuropathy; * Psychiatric disorders; * Hypersensitivity.

Liver Function: Number of Participants With Potentially Clinically Significant Abnormalities [PCSA]
from first study drug intake in PDY6045/PDY6046 study up to 112 days after last intake in initial study or in the extension study, whichever occured last (64 weeks max)

PCSA values are abnormal values considered medically important by the Sponsor according to predefined criteria based on literature review. Hepatic parameters thresholds were defined as follows: * Alanine Aminotransferase \[ALT\] \>3, 5, 10 or 20 Upper Normal Limit \[ULN\]; * Aspartate aminotransferase \[AST\] \>3, 5, 10 or 20 ULN; * Alkaline Phosphatase \>1.5 ULN; * Total Bilirubin \[TB\] \>1.5 or 2 ULN; * ALT \>3 ULN and TB \>2 ULN;

Overview of AE With Potential Risk of Occurrence
from first study drug intake up to 112 days after last intake or up to the first intake in the extension study LTS6047, whichever occured first (40 weeks max)

AE with potential risk of occurrence were defined as follows: * Hepatic disorders; * Immune effects, mainly effects on bone marrow and infection; * Pancreatic disorders; * Malignancy; * Skin disorders, mainly Hair loss and Hair thinning; * Pulmonary disorders; * Hypertension; * Peripheral neuropathy; * Psychiatric disorders; * Hypersensitivity.

Liver Function: Number of Participants With Potentially Clinically Significant Abnormalities (PCSA)
from first study drug intake up to 112 days after last intake or up to the first intake in the extension study LTS6047, whichever occured first (40 weeks max)

PCSA values are abnormal values considered medically important by the Sponsor according to predefined criteria based on literature review. Hepatic parameters thresholds were defined as follows: * Alanine Aminotransferase \[ALT\] \>3, 5, 10 or 20 Upper Normal Limit \[ULN\]; * Aspartate aminotransferase \[AST\] \>3, 5, 10 or 20 ULN; * Alkaline Phosphatase \>1.5 ULN; * Total Bilirubin \[TB\] \>1.5 or 2 ULN; * ALT \>3 ULN and TB \>2 ULN;

Overview of Adverse Events (AE]
from first study drug intake up to 112 days after last intake or up to the first intake in the extension study LTS6047, whichever occured first (40 weeks max)

AE are any unfavorable and unintended sign, symptom, syndrome, or illness observed by the investigator or reported by the participant during the study.

Number of patients with adverse events
Up to a maximum of 532 weeks (4 weeks after last treatment intake) or until teriflunomide is commercially available in the country where patient lives
MRI assessment: number of unique active lesions per scan (T2/proton density and gadolinium-enhanced T1 scan analysis)
36 weeks

The number of unique active lesions per scan was calculated by dividing the sum of unique newly active lesions and unique persistently active lesions observed on treatment by the number of scans performed on treatment. Unique newly active lesions were all unique T1 and T2 lesions identified, one or more times, in a scan but not in the previous scan and, that had not been classified as unique newly active in any previous scan. Unique persistently active lesions were all unique T1 and T2 lesions identified, one or more times, in a scan and also in the previous scan.

Secondary Endpoints
Probability of Participants Who Were Clinical Relapse Free at Weeks 24, 48, 72, 96, 120, 144, 168 and 192
Weeks 24, 48, 72, 96, 120, 144, 168 and 192
Brain Magnetic Resonance Imaging (MRI) Assessment: Number of New or Enlarged T2 Lesions Per MRI Scan
Baseline up to Week 192
Brain Magnetic Resonance Imaging Assessment: Number of T1 Gadolinium (Gd)-Enhancing T1 Lesions Per MRI Scan
Baseline up to Week 192
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Study Design & Arms
AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
PlaceboPLACEBO_COMPARATORMatching placebo tablets
TeriflunomideEXPERIMENTALTeriflunomide oral tablet, three dosages (3.5, 7 or 14 mg) to reach 14 mg adult equivalent
Teriflunomide 7 mg / 14 mgEXPERIMENTALCore treatment period: Teriflunomide 7 mg once daily. Extension treatment period: Teriflunomide 14 mg once daily.
Teriflunomide 14 mg / 14 mgEXPERIMENTALCore treatment period: Teriflunomide 14 mg once daily. Extension treatment period: Teriflunomide 14 mg once daily.
Placebo / Teriflunomide 14 mgPLACEBO_COMPARATORCore treatment period: Placebo (for teriflunomide) once daily. Extension treatment period: Teriflunomide 14 mg once daily.
Placebo/Teriflunomide 7 mg or Teriflunomide 14 mgPLACEBO_COMPARATORCore treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Re-randomized in 1:1 ratio to either teriflunomide 7 mg or 14 mg once daily orally.
Teriflunomide 7 mg/7 mgEXPERIMENTALCore treatment period: Teriflunomide 7 mg tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.
Teriflunomide 14 mg/14 mgEXPERIMENTALCore treatment period: Teriflunomide 14 mg tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.
Placebo/Teriflunomide 7 mgEXPERIMENTALParticipants who completed treatment of placebo (for teriflunomide) tablet once daily (QD) for 108 weeks in EFC6049 study, received teriflunomide tablet 7 mg QD for 288 weeks in this extension study.
Placebo/Teriflunomide 14 mgEXPERIMENTALParticipants who completed treatment of placebo (for teriflunomide) tablet QD for 108 weeks in EFC6049, study received teriflunomide 14 mg tablet QD for 288 weeks in this extension study.
Teriflunomide 7 mgEXPERIMENTALTeriflunomide 7 mg once daily for 108 weeks
Teriflunomide 14 mgEXPERIMENTALTeriflunomide 14 mg once daily for 108 weeks
IFN-β-1ACTIVE_COMPARATORInfluenza vaccine in participants treated with a stable dose of Interferon-β-1 (IFN-β-1) for at least 6 months
Placebo + IFN-βPLACEBO_COMPARATORPlacebo (for teriflunomide) once daily concomitantly with interferon-β \[IFN-β\] for 24 additional weeks
Teriflunomide 7 mg + IFN-βEXPERIMENTALTeriflunomide 7 mg once daily concomitantly with interferon-β \[IFN-β\] for 24 additional weeks
Teriflunomide 14 mg + IFN-βEXPERIMENTALTeriflunomide 14 mg once daily concomitantly with interferon-β \[IFN-β\] for 24 additional weeks
Placebo + GAPLACEBO_COMPARATORPlacebo (for teriflunomide) once daily concomitantly with glatiramer acetate \[GA\] for 24 additional weeks
Teriflunomide 7 mg + GAEXPERIMENTALTeriflunomide 7 mg once daily concomitantly with glatiramer acetate \[GA\] for 24 additional weeks
Teriflunomide 14 mg + GAEXPERIMENTALTeriflunomide 14 mg once daily concomitantly with glatiramer acetate \[GA\] for 24 additional weeks
Interventions
NameTypeDescription
TeriflunomideDRUGPharmaceutical form:film-coated tablet, Route of administration: oral
PlaceboDRUGPharmaceutical form:tablet, Route of administration: oral
Teriflunomide (HMR1726)DRUGTablet, oral administration QD.
Placebo (for teriflunomide)DRUGFilm-coated tablet Oral administration
Interferon-β-1DRUGPowder for reconstitution, of any licensed strength for either intramuscular or subcutaneous injection
Influenza vaccineBIOLOGICALInactivated, split-virion influenza vaccine 2011-2012 One administration by intramuscular or intradermal route as per product specification
Interferon-β [IFN-β]DRUGPowder for reconstitution, of any licensed strength for either intramuscular or subcutaneous injection
Glatiramer Acetate [GA]DRUGSolution in prefilled syringe for subcutaneous injection
Interferon-βDRUGPowder for reconstitution, of any licensed strength for either intramuscular or subcutaneous injection
Glatiramer Acetate (GA)DRUGSolution in prefilled syringe for subcutaneous injection
Placebo (placebo for teriflunomide)DRUGfilm-coated tablet oral administration
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Eligibility Criteria
Age Range10 Years — 17 Years
SexALL
Healthy VolunteersNo
Study Sites57

* Participants with relapsing MS were eligible. Participants who met the criteria of MS based on McDonald criteria 2010 and International Pediatric Multiple Sclerosis Study Group (IPMSSG) criteria for pediatric MS, version of 2012 and had: * at least one relapse (or attack) in the 12 months prece...

Countries:United StatesBelgiumBulgariaCanadaChinaEstoniaFranceGreeceIsraelLebanonLithuaniaMoroccoNetherlandsNorth MacedoniaPortugalRussiaSerbiaSpainTunisiaTurkey (Türkiye)UkraineUnited KingdomAustraliaAustriaBelarusChileCzechiaGermanyMexicoPhilippinesPolandRomaniaSlovakiaSwedenThailandDenmarkFinlandHungaryItalyNorwaySwitzerland
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