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Laquinimod

Phase 3

Multiple Sclerosis | Small molecule | Neurology |Teva Pharmaceutical Industries Limited|Last Updated: Jul 7, 2022

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLEDDMC
Total Trials3
Total Enrollment4,636

FDA Designations

No designations recorded

Clinical trial landscape

Laquinimod · 9 trials · 8 indications

Phase 3 3Phase 2 5Phase 1 1
NCT01707992The Efficacy, Safety, and Tolerability of Laquinimod in Participants With Relapsing Remitting Multiple Sclerosis (RRMS)Multiple Sclerosis
COMPLETED2,199 Analytics
NCT00605215BRAVO Study: Laquinimod Double-blind Placebo-controlled Study in Participants With Relapsing-Remitting Multiple Sclerosis (RRMS) With a Rater Blinded Reference Arm of Interferon β-1a (Avonex®)Multiple Sclerosis
COMPLETED1,331 Analytics
NCT00509145Safety and Efficacy of Orally Administered Laquinimod Versus Placebo for Treatment of Relapsing Remitting Multiple Sclerosis (RRMS)Multiple Sclerosis
COMPLETED1,106 Analytics
PHASE3COMPLETED
The Efficacy, Safety, and Tolerability of Laquinimod in Participants With Relapsing Remitting Multiple Sclerosis (RRMS)
Multiple SclerosisUnlock trial analytics
PHASE3COMPLETED
BRAVO Study: Laquinimod Double-blind Placebo-controlled Study in Participants With Relapsing-Remitting Multiple Sclerosis (RRMS) With a Rater Blinded Reference Arm of Interferon β-1a (Avonex®)
Multiple SclerosisUnlock trial analytics
PHASE3COMPLETED
Safety and Efficacy of Orally Administered Laquinimod Versus Placebo for Treatment of Relapsing Remitting Multiple Sclerosis (RRMS)
Multiple SclerosisUnlock trial analytics

Study Endpoints

Primary Endpoints

Placebo-Controlled Phase: Time to Confirmed Disease Progression (CDP) Confirmed After At Least 3 Months (Number of Participants With CDP After At Least 3 Months)
Baseline to Month 24

Time to CDP was defined as the time to a sustained increase in Kurtzke's Expanded Disability Status Scale (EDSS) score of at least 1 point if baseline EDSS score was less than or equal to 5.0, or at least 0.5 point if the baseline EDSS score was 5.5, over a period of at least three months. EDSS assesses disability in 8 functional systems with an overall score ranging from 0 (normal) to 10 (death due to multiple sclerosis \[MS\]). Data is presented as distribution of CDP (number of participants with CDP) sustained for 3 months.

Annualized Rate of Confirmed Relapses
Baseline up to Month 24

A relapse was defined as the appearance of new neurological abnormalities or the reappearance of previously observed neurological abnormalities; lasting at least 48 hours and immediately preceded by an improved neurological state of ≥30 days from onset of previous relapse, accompanied by observed objective neurological changes (an increase of ≥0.5 in Expanded Disability Status Scale \[EDSS\] score, or an increase of 1 grade in the score of 2 or more of the 7 Functional Systems \[FS\], or an increase of 2 grades in the score of 1 FS as compared to the previous evaluation). Total number of confirmed relapses during the treatment period was divided by the sum of number of days on study in the treatment period and then multiplied by the number of days in the year to calculate the annualized relapse rate. Annualized relapse rate was derived from a baseline-adjusted negative binomial regression.

Relapse Rate: Number of Confirmed Relapses During the Double Blind Study Period
Up to Month 24

A relapse was defined as the appearance of at least one new neurological abnormality or the reappearance of at least one previously observed neurological abnormalities lasting greater than or equal to 48 hours and immediately preceded by an improving neurological state of greater than or equal to 30 days from onset of previous relapse. An event was counted as a relapse only when the participant's symptoms were accompanied by observed objective neurological changes, consistent with one or more of the following: An increase of greater than or equal to 0.5 in the Expanded Disability Status Scale (EDSS) score as compared to previous evaluation, an increase of one grade in the actual score of greater than or equal to 2 of the 7 functional systems (FS), as compared to previous evaluation, or an increase of 2 grades in the actual score of one FS as compared to the previous evaluation.

Percent Brain Volume Change (PBVC) From Baseline to Week 48 Using a Repeated Measures ANCOVA Model
Baseline (at least 14 days but not more than 6 weeks prior to Day 1), Weeks 24, 48 and including early termination visits

Brain atrophy (BA) was measured using magnetic resonance imaging (MRI) scans of the brain. BA was analyzed using baseline-adjusted repeated measures analysis of covariance (ANCOVA- SAS® PROC MIXED) in which 1 contrast was constructed in order to compare between laquinimod 0.6 mg and placebo. The statistical model was a repeated measures analysis of covariance with treatment group, week, treatment group by week interaction, normalized brain volume at baseline, natural logarithm of T2 lesion volume at baseline, and country as fixed effects. Only on-treatment observations (include all the assessments done up to one month after the last dose of the study drug) were included. Values are adjusted means. The cancelled laquinimod 1.5 mg treatment arm was not included in the repeated measures ANCOVA model analysis. However PBVC by visit data are offered in outcome #2.

Percent Brain Volume Change (PBVC) From Baseline to Weeks 24 and 48
Baseline (at least 14 days but not more than 6 weeks prior to Day 1), Weeks 24, 48

Brain atrophy (BA) was measured using magnetic resonance imaging (MRI) scans of the brain. Early termination scans of participants who discontinued the study after week 36 are considered scans at week 48.

Change From Baseline in UHDRS-TMS at Week 52
Baseline, Week 52

UHDRS is a research tool developed by Huntington Disease (HD) Study Group to provide a uniform assessment of the clinical features and course of HD. Components of the full UHDRS assess motor function, cognition, behaviour, functional abilities, independence scale and total functional capacities. Motor function assessment includes TMS and Total Functional Capacity (TFC) score. The UHDRS TMS assesses all the motor features of HD and includes maximal chorea, maximal dystonia, ocular pursuit, saccade initiation and velocity, dysarthria, tongue protrusion, finger tapping, hand pronation and supination, luria, rigidity, bradykinesia, gait, tandem walking, and retropulsion pull test. Each of these was rated on a scale of 0 (normal motor function) to 4 (severely impaired motor function). TMS score is a sum of individual scores ranging from 0 (normal motor function) to 124 (severely impaired motor function). Lower TMS scores indicate better motor function.

Number of Participants With Adverse Events (AEs)
Baseline up to Week 16

An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Serious adverse event (SAE) was an AE 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. AEs included both SAEs and non-serious AEs. A summary of other non-serious AEs and all SAEs, regardless of causality is located in the 'Reported AE section'.

Percent Change From Baseline in Swollen Joint Count at Week 12
Baseline, Week 12

The number of swollen joints was used to assess lupus arthritis activity. Joint swelling was defined as soft tissue swelling that was detectable along the joint margins. 66 joints were examined for swelling. These joints include the temporomandibular (n = 2), sternoclavicular (n =2), acromioclavicular (n = 2), shoulder (n = 2), elbow (n = 2), wrist (n = 2), metacarpophalageal (n= 10), interphalangeal of thumb (n = 2), distal interphalangeal (n = 8), proximal interphalangeal (n =8), knee (n = 2), ankle mortise (n = 2), ankle tarsus (n = 2), metatarsophalangeal (n = 10), interphalangeal of great toe (n = 2), and proximal/distal interphalangeal of the toes (n = 8).

Percent Change From Baseline in Tender Joint Count at Week 12
Baseline, Week 12

The number of tender joints was used to assess lupus arthritis activity. Joint tenderness was defined as the presence or absence of tenderness and/or pain in a joint at rest with pressure or on passive movement of the joint and joint manipulation. 68 joints were examined for tenderness. These joints include the temporomandibular (n = 2), sternoclavicular (n =2), acromioclavicular (n = 2), shoulder (n = 2), elbow (n = 2), wrist (n = 2), metacarpophalageal (n= 10), interphalangeal of thumb (n = 2), distal interphalangeal (n = 8), proximal interphalangeal (n =8), hip (n = 2), knee (n = 2), ankle mortise (n = 2), ankle tarsus (n = 2), metatarsophalangeal (n = 10), interphalangeal of great toe (n = 2), and proximal/distal interphalangeal of the toes (n = 8).

Percent Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) at Week 24
Baseline, Week 24

Estimated Glomerular Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula.

Safety, Tolerability, Clinical Effect - proportion of subjects in clinical remission, proportion of subjects who respond to treatment.
8 weeks
AUC0-24 of EE and LNG plasma concentrations.
10 min prior to dosing and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, and 24 hours postdose

to assess the effect of once daily oral doses of laquinimod on the pharmacokinetics (PK) of ethinylestradiol (EE) and levonorgestrel (LNG)

Cmax of EE and LNG plasma concentrations.
10 min prior to dosing and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, and 24 hours postdose

to assess the effect of once daily oral doses of laquinimod on the pharmacokinetics (PK) of ethinylestradiol (EE) and levonorgestrel (LNG

Secondary Endpoints

Placebo-Controlled Phase: Percent Change From Baseline in Brain Volume at Month 15
Baseline, Month 15
Placebo-Controlled Phase: Time to First Confirmed Relapse (Number of Participants With Confirmed Relapse)
Baseline to Month 24
Placebo-Controlled Phase: Time to CDP Confirmed After At Least 6 Months (Number of Participants With CDP After At Least 6 Months)
Baseline to Month 24
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Study Design & Arms

AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Placebo-Controlled Phase: PlaceboPLACEBO_COMPARATORParticipants will receive 2 capsules of placebo (matching to laquinimod 0.6 milligrams \[mg\]) once daily orally for up to 24 months.
Placebo-Controlled Phase: Laquinimod 0.6 mgEXPERIMENTALParticipants will receive 1 capsule of laquinimod 0.6 mg and 1 capsule of matching placebo once daily orally for up to 24 months.
Placebo-Controlled Phase: Laquinimod 1.2 mgEXPERIMENTALParticipants will receive laquinimod 1.2 mg (2 capsules of laquinimod 0.6 mg each) once daily orally for up to 24 months.
Active Treatment Phase: Laquinimod 0.6 mgEXPERIMENTALParticipants who completed the placebo-controlled phase on placebo and on laquinimod 0.6 mg treatment group after 01 January 2016, will receive 1 capsule of laquinimod 0.6 mg and 1 capsule of matching placebo once daily orally for 24 months.
Active Treatment Phase: Laquinimod 1.2 mgEXPERIMENTALParticipants who completed the placebo-controlled phase on placebo and on laquinimod 1.2 mg treatment group prior to 01 January 2016, will receive laquinimod 1.2 mg (2 capsules of laquinimod 0.6 mg each) once daily orally for 24 months.
Active Treatment Phase: Off DrugNO_INTERVENTIONParticipants who were discontinued from treatment with laquinimod 1.2 mg during the placebo-controlled phase due to sponsor decision after 01 January 2016 will continue the active-treatment phase off drug for 24 months.
PlaceboPLACEBO_COMPARATORParticipants will receive 1 capsule of placebo matching to laquinimod orally once daily for 24 months.
LaquinimodEXPERIMENTALParticipants will receive 1 capsule of laquinimod 0.6 mg orally once daily for 24 months.
Avonex®ACTIVE_COMPARATORParticipants will receive an injection of Avonex® 30 micrograms (mcg) given intramuscularly (IM) once weekly for 24 months.
Laquinimod 0.6 mgEXPERIMENTAL1 capsule containing 0.6 mg laquinimod and 2 capsules containing placebo were administered orally once daily for at least 48 weeks.
Laquinimod 1.5 mgEXPERIMENTAL3 capsules containing 0.5 mg laquinimod were administered orally once daily for at least 48 weeks. However this arm was discontinued as of 01 January 2016 and no participants reached the 48 week timeframe.
Laquinimod 0.5 mgEXPERIMENTALParticipants will receive 1 capsule of laquinimod 0.5 milligrams (mg) and 2 capsules of matching placebo, orally once daily for 52 weeks.
Laquinimod 1.0 mgEXPERIMENTALParticipants will receive 2 capsule of laquinimod 0.5 mg (total 1.0 mg laquinimod) and 1 capsule of matching placebo, orally once daily for 52 weeks.
Laquinimod 1 mgEXPERIMENTALParticipants will receive 2 capsules of laquinimod 0.5 mg orally once daily for 12 weeks.

Interventions

NameTypeDescription
LaquinimodDRUGLaquinimod will be administered as per the dose and schedule specified in the respective arms.
PlaceboDRUGPlacebo matching to laquinimod will be administered as per the schedule specified in the respective arms.
Avonex®DRUGAvonex® will be administered per dose and schedule specified in the arm description.
Mycophenolate MofetilDRUGMycophenolate Mofetil (MMF) will be administered per dose and schedule specified in the arm description.
Prednisolone/PrednisoneDRUGPrednisolone/Prednisone will be administered per dose and schedule specified in the arm description.
MethylprednisoloneDRUGMethylprednisolone (MP) will be administered per dose and schedule specified in the arm description.
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Eligibility Criteria

Age Range18 Years to 55 Years
SexALL
Healthy VolunteersNo
Study Sites284

Inclusion Criteria: * Participants must have a confirmed and documented multiple sclerosis (MS) diagnosis as defined by the Revised McDonald criteria, with relapse onset disease or a relapsing-remitting disease course. * Participants must be ambulatory with Kurtzke's expanded disability status scal...

Countries:United StatesAustriaBelarusBelgiumBosnia and HerzegovinaBulgariaCanadaCroatiaCzechiaEstoniaFranceGeorgiaGermanyGreeceHungaryIsraelItalyLatviaMoldovaMontenegroNorth MacedoniaPolandRomaniaRussiaSerbiaSlovakiaSouth KoreaSpainUkraineUnited KingdomLithuaniaPuerto RicoSouth AfricaNetherlandsSwedenTurkey (Türkiye)Portugal
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Frequently asked questions about Laquinimod

What is Laquinimod used for?

Laquinimod is an investigational small molecule being studied for relapsing remitting multiple sclerosis, lupus nephritis, and other conditions including lupus arthritis, Crohn's disease, Huntington's disease, and primary progressive multiple sclerosis. It has been evaluated in placebo-controlled clinical trials for these indications.

Who makes Laquinimod?

Laquinimod is being developed by Teva Pharmaceutical Industries Limited, a company traded on the New York Stock Exchange under the ticker TEVA. Teva has sponsored multiple clinical trials of the drug in multiple sclerosis and lupus nephritis.

What phase is Laquinimod in?

Laquinimod has completed Phase 2 and Phase 3 clinical trials. It remains an investigational drug and is not approved for any indication. The most advanced completed trials were Phase 3 studies in relapsing remitting multiple sclerosis.

What clinical trials has Laquinimod been in?

Laquinimod has been studied in several completed trials, including NCT00509145 and NCT01707992 in relapsing remitting multiple sclerosis, NCT00605215 (the BRAVO study) comparing it to placebo with a reference arm of interferon beta-1a, and NCT01085097 in lupus nephritis. These trials were randomized, double-blind, and placebo-controlled.

How does Laquinimod work?

Laquinimod is a small molecule immunomodulator. It is thought to modulate the immune system, but its exact mechanism of action is not fully established. It has been investigated for its effects on inflammatory processes in multiple sclerosis and lupus nephritis.

Is Laquinimod the same as any other drug?

Laquinimod is a distinct investigational compound and is not known to be the same as any other marketed drug. It has been studied under the name laquinimod in clinical trials sponsored by Teva Pharmaceutical Industries.