Relapsing Forms of Multiple Sclerosis (RMS) Study of Bruton's Tyrosine Kinase (BTK) Inhibitor Tolebrutinib (SAR442168) (GEMINI 2)

NCT ID: NCT04410991

Last Updated: 2025-07-02

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

899 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-06-11

Study Completion Date

2024-07-16

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 pharmacodynamics (PD) of SAR442168

Detailed Description

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Study duration varied per participant in this event driven trial with a treatment duration of approximately 18 to 36 months. Participants completing the study were offered to participate in a long term safety study.

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

Dose 1 of oral SAR442168 daily + 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

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

Group Type ACTIVE_COMPARATOR

Teriflunomide HMR1726

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 HMR1726

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) and agrees not to donate eggs (ova, oocytes) for the purpose of reproduction during the study and for the same period of time.

* 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 multiplesclerosis (PPMS) according to the 2017 revision of the McDonald diagnostic criteria or with nonrelapsing secondary progressive multiplesclerosis (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, hepatitis B or C, 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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North Central Neurology Associates, PC-Site Number:8400009

Cullman, Alabama, United States

Site Status

Center for Neurology and Spine-Site Number:8400089

Phoenix, Arizona, United States

Site Status

Arcadia Neurology Center-Site Number:8400070

Arcadia, California, United States

Site Status

Multiple Sclerosis Center of California-Site Number:8400135

Newport Beach, California, United States

Site Status

Harbor UCLA-Site Number:8400088

Torrance, California, United States

Site Status

Mountain Neurological Research Center, Inc.-Site Number:8400128

Basalt, Colorado, United States

Site Status

Advanced Neurosciences Research-Site Number:8400025

Fort Collins, Colorado, United States

Site Status

South Florida Neurology Associates-Site Number:8400029

Boca Raton, Florida, United States

Site Status

University of Florida Health-Site Number:8400159

Gainesville, Florida, United States

Site Status

Neurology Associates, PA-Site Number:8400004

Maitland, Florida, United States

Site Status

University of Miami-Site Number:8400063

Miami, Florida, United States

Site Status

Infinity Clinical Research-Site Number:8400008

Sunrise, 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

Prairie Education and Research Cooperative-Site Number:8400071

Springfield, Illinois, United States

Site Status

Fort Wayne Neurological Center-Site Number:8400039

Fort Wayne, Indiana, United States

Site Status

CHI Saint Joseph Medical Group Neurology-Site Number:8400110

Lexington, Kentucky, United States

Site Status

University of Kentucky-Site Number:8400106

Lexington, Kentucky, United States

Site Status

Norton Neurology MS Services-Site Number:8400127

Louisville, Kentucky, United States

Site Status

The NeuroMedical Center-Site Number:8400057

Baton Rouge, Louisiana, United States

Site Status

International Neurorehabilitation Institute-Site Number:8400034

Lutherville-Timonium, Maryland, United States

Site Status

Wayne State University-Site Number:8400046

Detroit, Michigan, United States

Site Status

Minneapolis Clinic of Neurology-Site Number:8400051

Minneapolis, Minnesota, United States

Site Status

Saint Luke's Hospital-Site Number:8400153

Kansas City, Missouri, United States

Site Status

West Omaha Family Physicians-Site Number:8400139

Omaha, Nebraska, United States

Site Status

University Of Nebraska-Site Number:8400129

Omaha, Nebraska, United States

Site Status

Hackensack University Hospital-Site Number:8400047

Hackensack, New Jersey, United States

Site Status

University of New Mexico-Site Number:8400032

Albuquerque, New Mexico, United States

Site Status

South Shore Neurologic Associates-Site Number:8400100

Patchogue, New York, United States

Site Status

Novant Health Multiple Sclerosis Care Center - South Park-Site Number:8400120

Charlotte, North Carolina, United States

Site Status

Meridian Clinical Research, LLC-Site Number:8400005

Raleigh, North Carolina, United States

Site Status

Sanford Brain & Spine Center-Site Number:8400126

Fargo, North Dakota, United States

Site Status

Dayton Center for Neurological Disorders-Site Number:8400081

Centerville, Ohio, United States

Site Status

Jefferson Neurology Associates-Site Number:8400016

Philadelphia, Pennsylvania, United States

Site Status

Premier Neurology-Site Number:8400069

Greer, South Carolina, United States

Site Status

Advanced Neuroscience Center-Site Number:8400035

Franklin, Tennessee, United States

Site Status

Sibyl Wray, MD, Neurology, PC-Site Number:8400007

Knoxville, Tennessee, United States

Site Status

Mt Olympus Medical Research-Site Number:8400163

Katy, Texas, United States

Site Status

Neurology Center of San Antonio-Site Number:8400036

San Antonio, Texas, United States

Site Status

Texas Institute for Neuroogical Disorders-Sherman-Site Number:8400151

Sherman, Texas, United States

Site Status

Neurological Associates-Site Number:8400097

Richmond, Virginia, United States

Site Status

Wheaton Franciscan Healthcare-Site Number:8400022

Milwaukee, Wisconsin, United States

Site Status

Investigational Site Number :0320004

CABA, Buenos Aires, Argentina

Site Status

Investigational Site Number :0320002

Capital Federal, Buenos Aires, Argentina

Site Status

Investigational Site Number :0320001

CABA, Buenos Aires F.D., Argentina

Site Status

Investigational Site Number :0320003

Rosario, Santa Fe Province, Argentina

Site Status

Investigational Site Number :0320005

San Miguel de Tucumán, , Argentina

Site Status

Investigational Site Number :0560005

Bruges, , Belgium

Site Status

Investigational Site Number :0560004

Ghent, , Belgium

Site Status

Investigational Site Number :0560002

Mons, , Belgium

Site Status

Investigational Site Number :0560001

Overpelt, , Belgium

Site Status

Investigational Site Number :0760001

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Investigational Site Number :0760002

Curitiba, , Brazil

Site Status

Investigational Site Number :0760007

São Paulo, , Brazil

Site Status

Investigational Site Number :1240002

Edmonton, Alberta, Canada

Site Status

Investigational Site Number : 1240012

Hamilton, Ontario, Canada

Site Status

Investigational Site Number :1240014

London, Ontario, Canada

Site Status

Investigational Site Number :1240005

Greenfield Park, Quebec, Canada

Site Status

Investigational Site Number :1240006

Gatineau, , Canada

Site Status

Investigational Site Number :1240021

Québec, , Canada

Site Status

Investigational Site Number :1520002

Santiago, Reg Metropolitana de Santiago, Chile

Site Status

Investigational Site Number :1520005

Santiago, Reg Metropolitana de Santiago, Chile

Site Status

Investigational Site Number :1520001

Santiago, Reg Metropolitana de Santiago, Chile

Site Status

Investigational Site Number :1520003

Santiago, Reg Metropolitana de Santiago, Chile

Site Status

Investigational Site Number :1520006

Concepción, , Chile

Site Status

Investigational Site Number :1520004

Valdivia, , Chile

Site Status

Investigational Site Number :1910001

Zagreb, , Croatia

Site Status

Investigational Site Number :1910002

Zagreb, , Croatia

Site Status

Investigational Site Number :1910003

Zagreb, , Croatia

Site Status

Investigational Site Number :2030002

Brno, , Czechia

Site Status

Investigational Site Number :2030011

Hradec Králové, , Czechia

Site Status

Investigational Site Number :2030001

Jihlava, , Czechia

Site Status

Investigational Site Number :2030008

Prague, , Czechia

Site Status

Investigational Site Number :2030005

Praha 5 - Motol, , Czechia

Site Status

Investigational Site Number :2500019

Besançon, , France

Site Status

Investigational Site Number :2500018

Bordeaux, , France

Site Status

Investigational Site Number :2500011

Bron, , France

Site Status

Investigational Site Number :2500005

Clermont-Ferrand, , France

Site Status

Investigational Site Number :2500006

Montpellier, , France

Site Status

Investigational Site Number :2500010

Nantes, , France

Site Status

Investigational Site Number :2500002

Nice, , France

Site Status

Investigational Site Number :2500017

Nîmes, , France

Site Status

Investigational Site Number :2500007

Paris, , France

Site Status

Investigational Site Number :2500004

Poissy, , France

Site Status

Investigational Site Number :2500003

Rennes, , France

Site Status

Investigational Site Number :2500001

Strasbourg, , France

Site Status

Investigational Site Number :2760005

Bayreuth, , Germany

Site Status

Investigational Site Number :2760015

Berlin, , Germany

Site Status

Investigational Site Number :2760014

Berlin, , Germany

Site Status

Investigational Site Number :2760020

Bochum, , Germany

Site Status

Investigational Site Number :2760012

Essen, , Germany

Site Status

Investigational Site Number :2760003

Würzburg, , Germany

Site Status

Investigational Site Number :3000001

Athens, , Greece

Site Status

Investigational Site Number :3000006

Athens, , Greece

Site Status

Investigational Site Number :3000002

Athens, , Greece

Site Status

Investigational Site Number :3000007

Athens, , Greece

Site Status

Investigational Site Number :3000009

Athens, , Greece

Site Status

Investigational Site Number :3000004

Larissa, , Greece

Site Status

Investigational Site Number :3000003

Thessaloniki, , Greece

Site Status

Investigational Site Number :3480105

Budapest, , Hungary

Site Status

Investigational Site Number :3480102

Budapest, , Hungary

Site Status

Investigational Site Number :3480106

Kaposvár, , Hungary

Site Status

Investigational Site Number :3480103

Tatabánya, , Hungary

Site Status

Investigational Site Number :3560005

Chandigarh, , India

Site Status

Investigational Site Number :3560007

Gurgaon, , India

Site Status

Investigational Site Number :3560008

Gurgaon, , India

Site Status

Investigational Site Number :3560002

New Delhi, , India

Site Status

Investigational Site Number :3560004

Thiruvananthapuram, , India

Site Status

Investigational Site Number :3760002

Ashkelon, , Israel

Site Status

Investigational Site Number :3760003

Haifa, , Israel

Site Status

Investigational Site Number :3760006

Rehovot, , Israel

Site Status

Investigational Site Number :3760004

Safed, , Israel

Site Status

Investigational Site Number :3760001

Tel Litwinsky, , Israel

Site Status

Investigational Site Number :4280002

Riga, , Latvia

Site Status

Investigational Site Number :4280003

Riga, , Latvia

Site Status

Investigational Site Number :5280001

Amsterdam, , Netherlands

Site Status

Investigational Site Number :5780002

Namsos, , Norway

Site Status

Investigational Site Number :5780001

Oslo, , Norway

Site Status

Investigational Site Number :6200001

Braga, , Portugal

Site Status

Investigational Site Number :6200005

Coimbra, , Portugal

Site Status

Investigational Site Number :6200011

Lisbon, , Portugal

Site Status

Investigational Site Number :6200006

Lisbon, , Portugal

Site Status

Investigational Site Number :6200002

Matosinhos Municipality, , Portugal

Site Status

Investigational Site Number :6200010

Porto, , Portugal

Site Status

Investigational Site Number :6200004

Santa Maria da Feira, , Portugal

Site Status

San Juan MS Center-Site Number:8400015

Guaynabo, , Puerto Rico

Site Status

Investigational Site Number :6430006

Barnaul, , Russia

Site Status

Investigational Site Number :6430013

Bryansk, , Russia

Site Status

Investigational Site Number :6430001

Kazan', , Russia

Site Status

Investigational Site Number :6430010

Kirov, , Russia

Site Status

Investigational Site Number :6430007

Moscow, , Russia

Site Status

Investigational Site Number :6430005

Moscow, , Russia

Site Status

Investigational Site Number :6430003

Novosibirsk, , Russia

Site Status

Investigational Site Number :6430014

Saint Petersburg, , Russia

Site Status

Investigational Site Number :6430004

Saint Petersburg, , Russia

Site Status

Investigational Site Number :6430002

Saint Petersburg, , Russia

Site Status

Investigational Site Number :6430011

Saransk, , Russia

Site Status

Investigational Site Number :6430012

Yekaterinburg, , Russia

Site Status

Investigational Site Number :6880001

Belgrade, , Serbia

Site Status

Investigational Site Number :6880003

Belgrade, , Serbia

Site Status

Investigational Site Number :6880006

Belgrade, , Serbia

Site Status

Investigational Site Number :6880002

Kragujevac, , Serbia

Site Status

Investigational Site Number :6880004

Niš, , Serbia

Site Status

Investigational Site Number :6880005

Novi Sad, , Serbia

Site Status

Investigational Site Number :7030001

Bratislava, , Slovakia

Site Status

Investigational Site Number :7030002

Martin, , Slovakia

Site Status

Investigational Site Number :7030004

Nitra, , Slovakia

Site Status

Investigational Site Number :4100001

Goyang-si, Gyeonggi-do, South Korea

Site Status

Investigational Site Number :4100003

Seoul, Seoul-teukbyeolsi, South Korea

Site Status

Investigational Site Number :4100006

Seoul, Seoul-teukbyeolsi, South Korea

Site Status

Investigational Site Number :4100002

Seoul, Seoul-teukbyeolsi, South Korea

Site Status

Investigational Site Number :7240011

Seville, Andalusia, Spain

Site Status

Investigational Site Number :7240006

Barcelona, Barcelona [Barcelona], Spain

Site Status

Investigational Site Number :7240009

Barakaldo, Bizkaia, Spain

Site Status

Investigational Site Number :7240004

Salt, Girona [Gerona], Spain

Site Status

Investigational Site Number :7240013

Las Palmas de Gran Canaria, Las Palmas, Spain

Site Status

Investigational Site Number :7240008

A Coruña, , Spain

Site Status

Investigational Site Number :7240007

L'Hospitalet de Llobregat, , Spain

Site Status

Investigational Site Number :7240005

Lleida, , Spain

Site Status

Investigational Site Number :7240003

Madrid, , Spain

Site Status

Investigational Site Number :7240001

Madrid, , Spain

Site Status

Investigational Site Number :7240002

Madrid, , Spain

Site Status

Investigational Site Number :7240010

Málaga, , Spain

Site Status

Investigational Site Number :7240012

Pozuelo de Alarcón, , Spain

Site Status

Investigational Site Number :7560003

Aarau, , Switzerland

Site Status

Investigational Site Number :7560002

Bern, , Switzerland

Site Status

Investigational Site Number :7560004

Lugano, , Switzerland

Site Status

Investigational Site Number :7920002

Ankara, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920005

Besevler / Ankara, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920006

Istanbul, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920004

Kuttahta, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920001

Samsun, , Turkey (Türkiye)

Site Status

Investigational Site Number :7920003

Trabzon, , Turkey (Türkiye)

Site Status

Investigational Site Number :8040020

Chernihiv, , Ukraine

Site Status

Investigational Site Number :8040002

Chernivtsi, , Ukraine

Site Status

Investigational Site Number :8040019

Chernivtsi, , Ukraine

Site Status

Investigational Site Number :8040005

Dnipro, , Ukraine

Site Status

Investigational Site Number :8040022

Kharkiv, , Ukraine

Site Status

Investigational Site Number :8040018

Kharkiv, , Ukraine

Site Status

Investigational Site Number :8040007

Kyiv, , Ukraine

Site Status

Investigational Site Number :8040006

Lviv, , Ukraine

Site Status

Investigational Site Number :8040003

Vinnytsia, , Ukraine

Site Status

Investigational Site Number :8260003

Exeter, Devon, United Kingdom

Site Status

Investigational Site Number :8260016

Canterbury, Kent, United Kingdom

Site Status

Investigational Site Number :8260009

Bristol, , United Kingdom

Site Status

Countries

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United States Argentina Belgium Brazil Canada Chile Croatia Czechia France Germany Greece Hungary India Israel Latvia Netherlands Norway Portugal Puerto Rico Russia Serbia Slovakia South Korea Spain Switzerland Turkey (Türkiye) Ukraine United Kingdom

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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U1111-1238-1373

Identifier Type: REGISTRY

Identifier Source: secondary_id

2020-000644-55

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

EFC16034

Identifier Type: -

Identifier Source: org_study_id

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