Relapsing Forms of Multiple Sclerosis (RMS) Study of Bruton's Tyrosine Kinase (BTK) Inhibitor Tolebrutinib (SAR442168) (GEMINI 1)

NCT ID: NCT04410978

Last Updated: 2025-07-02

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

974 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-06-30

Study Completion Date

2024-07-15

Brief Summary

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Primary Objective:

To assess efficacy of daily SAR442168 compared to a daily dose of 14 mg teriflunomide (Aubagio) measured by annualized adjudicated relapse rate (ARR) in participants with relapsing forms of MS

Secondary Objective:

To assess efficacy of SAR442168 compared to teriflunomide (Aubagio) on disability progression, MRI lesions, cognitive performance and quality of life To evaluate the safety and tolerability of daily SAR442168 To evaluate population pharmacokinetics (PK) of SAR442168 and relevant metabolites and its relationship to efficacy and safety To evaluate pharmacodynamics (PD) of SAR442168

Detailed Description

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This was an event-driven (6-month confirmed disability worsening \[CDW\]) trial with a variable treatment duration (end-of-study \[EOS\] duration: up to approximately 48 months).

Conditions

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Relapsing Multiple Sclerosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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SAR442168

60 mg oral SAR442168 + placebo to match the teriflunomide tablet once daily

Group Type EXPERIMENTAL

Tolebrutinib

Intervention Type DRUG

Pharmaceutical form: Tablet

Route of administration: Oral

Placebo to match Teriflunomide

Intervention Type DRUG

Pharmaceutical form: Tablet

Route of administration: Oral

Teriflunomide

14 mg oral teriflunomide + placebo to match the SAR442168 tablet once daily

Group Type ACTIVE_COMPARATOR

Teriflunomide

Intervention Type DRUG

Pharmaceutical form: Tablet

Route of administration: Oral

Placebo to match Tolebrutinib

Intervention Type DRUG

Pharmaceutical form: Tablet

Route of administration: Oral

Interventions

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Tolebrutinib

Pharmaceutical form: Tablet

Route of administration: Oral

Intervention Type DRUG

Teriflunomide

Pharmaceutical form: Tablet

Route of administration: Oral

Intervention Type DRUG

Placebo to match Tolebrutinib

Pharmaceutical form: Tablet

Route of administration: Oral

Intervention Type DRUG

Placebo to match Teriflunomide

Pharmaceutical form: Tablet

Route of administration: Oral

Intervention Type DRUG

Other Intervention Names

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SAR442168

Eligibility Criteria

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Inclusion Criteria

* The participant must be 18 to 55 years of age, inclusive, at the time of signing the informed consent
* The participant must have been diagnosed with RMS according to the 2017 revision of the McDonald diagnostic criteria
* The participant has an expanded disability status scale (EDSS) score ≤5.5 at the first Screening Visit
* The participant must have at least 1 of the following prior to screening:

* ≥1 documented relapse within the previous year OR
* ≥2 documented relapses within the previous 2 years, OR
* ≥1 documented Gd enhancing lesion on an MRI scan within the previous year
* Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies
* Male participants are eligible to participate if they agree to the following during the intervention period and until accelerated elimination procedure:

* Refrain from donating sperm

Plus either:

* Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent OR
* Must agree to use contraception/barrier as detailed below:

Agree to use a male condom and should also be advised of the benefit for a female partner to use a highly effective method of contraception as a condom may break or leak when having sexual intercourse with a woman of childbearing potential (WOCBP) who is not currently pregnant

* A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions apply:

* Is not a WOCBP OR
* Is a WOCBP and agrees to use a contraceptive method that is highly effective (with a failure rate of \<1% per year), preferably with low user dependency, during the intervention period and until accelerated elimination procedure is completed (or for at least 10 days after the last dose of SAR442168, if the case was unblinded)
* A WOCBP must have a negative highly sensitive pregnancy test at screening and within 24hours before the first dose of study intervention.
* If a urine test cannot be confirmed as negative (eg, an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
* The Investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
* The participant must have given written informed consent prior to undertaking any study related procedure. This includes consent to comply with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. In countries where the legal age of maturity is greater than 18 years, a specific ICF for such legally minor participants must also be signed by the participant's legally authorized representative

Exclusion Criteria

* The participant has been diagnosed with primary progressive multiple sclerosis (PPMS) according to the 2017 revision of the McDonald diagnostic criteria or with nonrelapsing secondary progressive multiple sclerosis (SPMS)
* The participant has a history of infection or may be at risk for infection including but not limited to: HIV, transplantation, live attenuated vaccines, progressive multifocal leukoencephalopathy, tuberculosis, any persistent chronic or active recurring infection
* Clinically significant laboratory abnormalities (including evidence of liver injury) or electrocardiogram abnormalities at Screening.
* The participant has conditions or situations that would adversely affect participation in this study, including but not limited to:

* A short life expectancy due to pre-existing health condition(s) as determined by their treating neurologist
* Medical condition(s) or concomitant disease(s) making them nonevaluable for the primary efficacy endpoint or that would adversely affect participation in this study, as judged by the Investigator
* A requirement for concomitant treatment that could bias the primary evaluation
* The participant has a history of or currently has concomitant medical or clinical conditions that would adversely affect participation in this study
* At screening, the participant is positive for hepatitis B surface antigen and/or hepatitis B core antibody and/or is positive for hepatitis C antibody
* The participant has any of the following:

* A bleeding disorder or known platelet dysfunction at any time prior to the screening visit
* A platelet count \<150 000/μL at the screening visit
* The participant has a lymphocyte count below the lower limit of normal (LLN) at the screening visit
* The presence of psychiatric disturbance or substance abuse
* Prior/concomitant therapy
* The participant is receiving potent and moderate inducers of cytochrome P450 (CYP) 3A or potent inhibitors of CYP2C8 hepatic enzymes
* The participant is receiving anticoagulant/antiplatelet therapies

The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.
Minimum Eligible Age

18 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sanofi

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Clinical Sciences & Operations

Role: STUDY_DIRECTOR

Sanofi

Locations

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University of Alabama MS Center-Site Number:8400013

Birmingham, Alabama, United States

Site Status

University of San Francisco, Sandler Neurosciences Center-Site Number:8400137

San Francisco, California, United States

Site Status

University of Colorado-Site Number:8400012

Aurora, Colorado, United States

Site Status

Georgetown University Medical Center-Site Number:8400119

Washington D.C., District of Columbia, United States

Site Status

Beth Israel Deaconess Medical Center-Site Number:8400064

Fort Myers, Florida, United States

Site Status

Axiom Clinical Research of Florida-Site Number:8400001

Tampa, Florida, United States

Site Status

University of South Florida-Site Number:8400006

Tampa, Florida, United States

Site Status

Meridian Clinical Research-Site Number:8400003

Savannah, Georgia, United States

Site Status

Consultants In Neurology-Site Number:8400011

Northbrook, Illinois, United States

Site Status

Tufts Medical Center-Site Number:8400072

Boston, Massachusetts, United States

Site Status

Michigan Institute For Neurological Disorders-Site Number:8400058

Farmington Hills, Michigan, United States

Site Status

The Memorial Hospital-Site Number:8400033

Owosso, Michigan, United States

Site Status

Sharlin Health & Neurology-Site Number:8400093

Ozark, Missouri, United States

Site Status

Missouri Baptist Medical Center-Site Number:8400019

St Louis, Missouri, United States

Site Status

Meridian Clinical Research, LLC-Site Number:8400005

Raleigh, North Carolina, United States

Site Status

Wake Forest University Baptist Medical Center-Site Number:8400116

Winston-Salem, North Carolina, United States

Site Status

The Ohio State University Wexner Medical Center-Site Number:8400150

Columbus, Ohio, United States

Site Status

Optimed Research, LTD-Site Number:8400147

Columbus, Ohio, United States

Site Status

Columbus Neuroscience-Site Number:8400010

Westerville, Ohio, United States

Site Status

Oklahoma Medical Research Foundation-Site Number:8400018

Oklahoma City, Oklahoma, United States

Site Status

Providence Multiple Sclerosis Center-Site Number:8400020

Portland, Oregon, United States

Site Status

University of Texas Southwestern Medical Center-Site Number:8400077

Dallas, Texas, United States

Site Status

Multiple Sclerosis Center, Swedish Neuroscience Institute-Site Number:8400121

Seattle, Washington, United States

Site Status

Investigational Site Number :0400004

Linz, , Austria

Site Status

Investigational Site Number :1120005

Vitebsk, , Belarus

Site Status

Investigational Site Number :1120004

Vitebsk, , Belarus

Site Status

Investigational Site Number :1000002

Pleven, , Bulgaria

Site Status

Investigational Site Number :1000005

Plovdiv, , Bulgaria

Site Status

Investigational Site Number :1000004

Sofia, , Bulgaria

Site Status

Investigational Site Number :1000008

Sofia, , Bulgaria

Site Status

Investigational Site Number :1000001

Sofia, , Bulgaria

Site Status

Investigational Site Number :1000006

Sofia, , Bulgaria

Site Status

Investigational Site Number :1000009

Sofia, , Bulgaria

Site Status

Investigational Site Number :1240016

Vancouver, British Columbia, Canada

Site Status

Investigational Site Number :1240003

Ottawa, Ontario, Canada

Site Status

Investigational Site Number :1240013

Toronto, Ontario, Canada

Site Status

Investigational Site Number :1240006

Gatineau, Quebec, Canada

Site Status

Investigational Site Number :1560022

Baotou, , China

Site Status

Investigational Site Number :1560006

Beijing, , China

Site Status

Investigational Site Number :1560010

Beijing, , China

Site Status

Investigational Site Number :1560012

Beijing, , China

Site Status

Investigational Site Number :1560023

Beijing, , China

Site Status

Investigational Site Number :1560001

Beijing, , China

Site Status

Investigational Site Number :1560009

Beijing, , China

Site Status

Investigational Site Number :1560025

Beijing, , China

Site Status

Investigational Site Number :1560021

Beijing, , China

Site Status

Investigational Site Number :1560004

Changchun, , China

Site Status

Investigational Site Number :1560015

Changsha, , China

Site Status

Investigational Site Number :1560005

Chengdu, , China

Site Status

Investigational Site Number :1560019

Chongqing, , China

Site Status

Investigational Site Number :1560035

Fuzhou, , China

Site Status

Investigational Site Number :1560016

Guangzhou, , China

Site Status

Investigational Site Number :1560028

Guangzhou, , China

Site Status

Investigational Site Number :1560002

Guangzhou, , China

Site Status

Investigational Site Number :1560027

Hohhot, , China

Site Status

Investigational Site Number :1560044

Nanjing, , China

Site Status

Investigational Site Number :1560042

Nanjing, , China

Site Status

Investigational Site Number :1560003

Shanghai, , China

Site Status

Investigational Site Number :1560018

Shenyang, , China

Site Status

Investigational Site Number :1560014

Shijiazhuang, , China

Site Status

Investigational Site Number :1560008

Taiyuan, , China

Site Status

Investigational Site Number :1560020

Tianjin, , China

Site Status

Investigational Site Number :1560011

Wuhan, , China

Site Status

Investigational Site Number :1560017

Xi'an, , China

Site Status

Investigational Site Number :1560033

Yinchuan, , China

Site Status

Investigational Site Number :2030004

Hradec Králové, , Czechia

Site Status

Investigational Site Number :2030009

Pardubice, , Czechia

Site Status

Investigational Site Number :2030003

Teplice, , Czechia

Site Status

Investigational Site Number :2030007

Zlín, , Czechia

Site Status

Investigational Site Number :2080001

Esbjerg, , Denmark

Site Status

Investigational Site Number :2080005

Holstebro, , Denmark

Site Status

Investigational Site Number :2330001

Tallinn, , Estonia

Site Status

Investigational Site Number :2330002

Tartu, , Estonia

Site Status

Investigational Site Number :2460003

Helsinki, , Finland

Site Status

Investigational Site Number :2460001

Tampere, , Finland

Site Status

Investigational Site Number :2460002

Turku, , Finland

Site Status

Investigational Site Number :2760001

Dresden, , Germany

Site Status

Investigational Site Number :2760019

Düsseldorf, , Germany

Site Status

Investigational Site Number :2760016

Hamburg, , Germany

Site Status

Investigational Site Number :2760008

Münster, , Germany

Site Status

Investigational Site Number :2760004

Rostock, , Germany

Site Status

Investigational Site Number :2760011

Ulm, , Germany

Site Status

Investigational Site Number : 3440001

Shatin, NT, , Hong Kong

Site Status

Investigational Site Number :3800002

Pozzilli, Isernia, Italy

Site Status

Investigational Site Number :3800007

Orbassano, Torino, Italy

Site Status

Investigational Site Number :3800011

Bergamo, , Italy

Site Status

Investigational Site Number :3800015

Catania, , Italy

Site Status

Investigational Site Number :3800012

Florence, , Italy

Site Status

Investigational Site Number :3800014

Genova, , Italy

Site Status

Investigational Site Number :3800001

Milan, , Italy

Site Status

Investigational Site Number :3800010

Milan, , Italy

Site Status

Investigational Site Number :3800003

Napoli, , Italy

Site Status

Investigational Site Number :3800006

Napoli, , Italy

Site Status

Investigational Site Number :3800008

Pavia, , Italy

Site Status

Investigational Site Number :3800005

Roma, , Italy

Site Status

Investigational Site Number :3800009

Roma, , Italy

Site Status

Investigational Site Number :3800013

Roma, , Italy

Site Status

Investigational Site Number :3920016

Chiba, Chiba, Japan

Site Status

Investigational Site Number :3920008

Koriyama-shi, Fukushima, Japan

Site Status

Investigational Site Number :3920012

Tsukuba, Ibaraki, Japan

Site Status

Investigational Site Number :3920022

Morioka, Iwate, Japan

Site Status

Investigational Site Number :3920005

Niigata, Niigata, Japan

Site Status

Investigational Site Number :3920004

Moriguchi-shi, Osaka, Japan

Site Status

Investigational Site Number :3920001

Osaka, Osaka, Japan

Site Status

Investigational Site Number :3920018

Kawagoe-shi, Saitama, Japan

Site Status

Investigational Site Number :3920014

Bunkyo-ku, Tokyo, Japan

Site Status

Investigational Site Number :3920003

Kodaira-shi, Tokyo, Japan

Site Status

Investigational Site Number :3920010

Ōta-ku, Tokyo, Japan

Site Status

Investigational Site Number :3920013

Shinjuku-ku, Tokyo, Japan

Site Status

Investigational Site Number :3920009

Ube-shi, Yamaguchi, Japan

Site Status

Investigational Site Number :3920023

Sagamihara-shi, , Japan

Site Status

Investigational Site Number :4400003

Kaunas, , Lithuania

Site Status

Investigational Site Number :4400002

Klaipėda, , Lithuania

Site Status

Investigational Site Number :4400004

Šiauliai, , Lithuania

Site Status

Investigational Site Number :4400001

Vilnius, , Lithuania

Site Status

Investigational Site Number :4840002

México, , Mexico

Site Status

Investigational Site Number :4840001

México, , Mexico

Site Status

Investigational Site Number :4840003

Veracruz, , Mexico

Site Status

Investigational Site Number :6160008

Plewiska, Greater Poland Voivodeship, Poland

Site Status

Investigational Site Number :6160003

Bydgoszcz, Kuyavian-Pomeranian Voivodeship, Poland

Site Status

Investigational Site Number :6160005

Warsaw, Masovian Voivodeship, Poland

Site Status

Investigational Site Number :6160006

Warsaw, Masovian Voivodeship, Poland

Site Status

Investigational Site Number :6160009

Glogow Mlp., Podkarpackie Voivodeship, Poland

Site Status

Investigational Site Number :6160002

Katowice, Silesian Voivodeship, Poland

Site Status

Investigational Site Number :6160004

Katowice, Silesian Voivodeship, Poland

Site Status

Investigational Site Number :6160001

Lodz, , Poland

Site Status

Investigational Site Number :6420015

Brasov, , Romania

Site Status

Investigational Site Number :6420008

Bucharest, , Romania

Site Status

Investigational Site Number :6420004

Campulung Muscel, , Romania

Site Status

Investigational Site Number :6420003

Constanța, , Romania

Site Status

Investigational Site Number :6420010

Oradea, , Romania

Site Status

Investigational Site Number :6420005

Sibiu, , Romania

Site Status

Investigational Site Number :6420001

Târgu Mureş, , Romania

Site Status

Investigational Site Number :6420002

Timișoara, , Romania

Site Status

Investigational Site Number :6430014

Krasnoyarsk, , Russia

Site Status

Investigational Site Number :6430002

Moscow, , Russia

Site Status

Investigational Site Number :6430008

Moscow, , Russia

Site Status

Investigational Site Number :6430011

Nizhny Novgorod, , Russia

Site Status

Investigational Site Number :6430003

Nizhny Novgorod, , Russia

Site Status

Investigational Site Number :6430007

Pyatigorsk, , Russia

Site Status

Investigational Site Number :6430012

Rostov-on-Don, , Russia

Site Status

Investigational Site Number :6430001

Saint Petersburg, , Russia

Site Status

Investigational Site Number :6430005

Samara, , Russia

Site Status

Investigational Site Number :6430009

Smolensk, , Russia

Site Status

Investigational Site Number :6430006

Tyumen, , Russia

Site Status

Investigational Site Number :6430004

Ufa, , Russia

Site Status

Investigational Site Number :7240003

Seville, Andalusia, Spain

Site Status

Investigational Site Number :7240009

Barcelona, Barcelona [Barcelona], Spain

Site Status

Investigational Site Number :7240008

Donostia / San Sebastian, Basque Country, Spain

Site Status

Investigational Site Number :7240001

Pozuelo de Alarcón, Madrid, Spain

Site Status

Investigational Site Number :7240004

Córdoba, , Spain

Site Status

Investigational Site Number :7240005

Málaga, , Spain

Site Status

Investigational Site Number :7240006

Murcia, , Spain

Site Status

Investigational Site Number :7240007

Valencia, , Spain

Site Status

Investigational Site Number :7520001

Gothenburg, , Sweden

Site Status

Investigational Site Number :7520002

Stockholm, , Sweden

Site Status

Investigational Site Number :1580007

Hsinchu, , Taiwan

Site Status

Investigational Site Number :1580005

Kaohsiung City, , Taiwan

Site Status

Investigational Site Number :1580003

Taichung, , Taiwan

Site Status

Investigational Site Number :1580002

Taipei, , Taiwan

Site Status

Investigational Site Number :1580006

Taoyuang, , Taiwan

Site Status

Investigational Site Number :7920005

Eskişehir, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920011

Hatay, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920002

Istanbul, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920009

Istanbul, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920007

Istanbul, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920003

Istanbul, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920008

Izmir, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920010

Izmir, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920001

Kocaeli, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920006

Mersin, , Turkey (Türkiye)

Site Status

Investigational Site Number :8040011

Ivano-Frankivsk, , Ukraine

Site Status

Investigational Site Number :8040016

Kharkiv, , Ukraine

Site Status

Investigational Site Number :8040013

Kharkiv, , Ukraine

Site Status

Investigational Site Number :8040008

Kherson, , Ukraine

Site Status

Investigational Site Number :8040014

Kyiv, , Ukraine

Site Status

Investigational Site Number :8040010

Lutsk, , Ukraine

Site Status

Investigational Site Number :8040001

Lviv, , Ukraine

Site Status

Investigational Site Number :8040009

Odesa, , Ukraine

Site Status

Countries

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United States Austria Belarus Bulgaria Canada China Czechia Denmark Estonia Finland Germany Hong Kong Italy Japan Lithuania Mexico Poland Romania Russia Spain Sweden Taiwan Turkey (Türkiye) Ukraine

References

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Oh J, Arnold DL, Cree BAC, Ionete C, Kim HJ, Sormani MP, Syed S, Chen Y, Maxwell CR, Benoit P, Turner TJ, Wallstroem E, Wiendl H; Tolebrutinib Phase 3 GEMINI 1 and 2 Trial Group. Tolebrutinib versus Teriflunomide in Relapsing Multiple Sclerosis. N Engl J Med. 2025 May 15;392(19):1893-1904. doi: 10.1056/NEJMoa2415985. Epub 2025 Apr 8.

Reference Type DERIVED
PMID: 40202623 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

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Other Identifiers

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U1111-1238-1418

Identifier Type: REGISTRY

Identifier Source: secondary_id

2020-000637-41

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

EFC16033

Identifier Type: -

Identifier Source: org_study_id

NCT04964791

Identifier Type: -

Identifier Source: nct_alias

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