A Study Comparing the Effectiveness and Safety of Teriflunomide and Interferon Beta-1a in Patients With Relapsing Multiple Sclerosis (TENERE)

• ClinicalTrials.gov Identifier: NCT00883337
• Recruitment Status: Completed
• First Posted: April 17, 2009
• Results First Posted: November 6, 2012
• Last Update Posted: June 13, 2016
• Sponsor: Sanofi
• Information provided by (Responsible Party): Sanofi

Tracking Information

• First Submitted Date: April 16, 2009
• First Posted Date: April 17, 2009
• Results First Submitted Date: October 3, 2012
• Results First Posted Date: November 6, 2012
• Last Update Posted Date: June 13, 2016
• Study Start Date: April 2009
• Actual Primary Completion Date: September 2011 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: May 4, 2016)

• Core Treatment Period: Overview of Failures [ Time Frame: Core treatment period between 48 and 118 weeks depending on when the participant was enrolled ]
  Failure was defined as the first occurence of confirmed relapse or permanent treatment discontinuation (for any cause) which ever came first. If no events occurred, the participant was considered free of failure. 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.
• Core Treatment Period: Time to Failure: Kaplan-Meier Estimates of the Rate of Failure at Timepoints [ Time Frame: Core treatment period between 48 and 118 weeks depending on when the participant was enrolled ]
  Probability of disability progression at 24, 48 and 96 weeks was estimated using Kaplan-Meier method on the time to failure defined as the time from randomization to failure. Participants free of failure were censored at the date of last treatment. Kaplan-Meier method consists in computing probabilities of non occurrence of event at any observed time of event and multiplying successive probabilities for time ≤t by any earlier computed probabilities to estimate the probability of being event-free for the amount of time t. Probability of event at time t is 1 minus the probability of being event-free for the amount of time t.

• Original Primary Outcome Measures (submitted: April 16, 2009): Time to failure, defined as the first occurrence of relapse or permanent study treatment discontinuation for any cause whichever comes first [ Time Frame: up to about 68 weeks ]

Current Secondary Outcome Measures (submitted: May 4, 2016)

• Core Treatment Period: Annualized Relapse Rate [ARR] - Poisson Regression Estimates [ Time Frame: Core treatment period between 48 and 118 weeks depending on when the participant was enrolled ]
  ARR is obtained from the total number of confirmed relapses that occured during the treatment period divided by the sum of the treatment durations. 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: Change From Baseline in Fatigue Impact Scale (FIS) Total Score [ Time Frame: Baseline (before randomization) and 48 weeks ]
  FIS is a subject-reported scale that qualifies the impact of fatigue on daily life in patients with MS. It consists of 40 statements that measure fatigue in three areas; physical, cognitive, and social. FIS total score ranges from 0 (no problem) to 160 (extreme problem). Least-square means were estimated using a Mixed-effect model with repeated measures [MMRM] on FIS total score data (treatment group, region of enrollment, baseline EDSS stratum, visit, treatment-by-visit interaction, baseline value, and baseline-by-visit interaction as factors).
• Core Treatment Period: Treatment Satisfaction Questionnaire for Medication [TSQM] Scores [ Time Frame: 48 weeks ]
  TSQM version 1.4 is an instrument to assess patients' satisfaction with medication. It consists of 13 questions that cover three dimensions (effectiveness, side effects and convenience) plus a global satisfaction question. Four scores ranging from 0 to 100 (extremely satisfied) are obtained. Least-square means were estimated using a Mixed-effect model with repeated measures [MMRM] on TSQM score data (treatment group, region of enrollment, baseline EDSS stratum, visit, treatment-by-visit interaction as factors).
• Core Treatment Period: Overview of Adverse Events [AE] [ Time Frame: from first study drug intake up to 112 days after last intake in the core treatment period or up to first intake in the extension treatment period, whichever occurred first ]
  AE are any unfavorable and unintended sign, symptom, syndrome, or illness observed by the investigator or reported by the participant during the study.
• Extension Treatment Period: Overview of AEs [ Time Frame: From first intake of study drug in extension treatment period up to 28 days after the last intake in the extension treatment period ]
  AEs were any unfavourable and unintended sign, symptom, syndrome, or illness observed by the investigator or reported by the participant during the study.
• Extension Treatment Period: ARR Poisson Regression Estimates [ Time Frame: Extension treatment period (Maximum: 197 weeks) ]
  ARR was obtained from the total number of confirmed relapses that occurred during the treatment period divided by the sum of the standardized treatment durations.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 enrolment and baseline EDSS stratum as covariates).

• Original Secondary Outcome Measures (submitted: April 16, 2009): Annualized relapse rate, defined as number of relapses per patient-year [ Time Frame: up to about 68 weeks ]
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: A Study Comparing the Effectiveness and Safety of Teriflunomide and Interferon Beta-1a in Patients With Relapsing Multiple Sclerosis
• Official Title: A Multi-center, Randomized, Parallel-group, Rater-blinded Study Comparing the Effectiveness and Safety of Teriflunomide and Interferon Beta-1a in Patients With Relapsing Multiple Sclerosis Plus a Long Term Extension Period

Brief Summary

Primary objective was to assess the effectiveness evaluated by the time to failure of two doses of teriflunomide in comparison to interferon beta-1a in participants with relapsing Multiple Sclerosis [MS].

Secondary objectives were:

• To assess the effect of the two doses in comparison to interferon beta-1a on:

  • Frequency of relapses,
  • Fatigue,
  • Participant's satisfaction with treatment.
• To evaluate the safety and tolerability of the two doses in comparison to interferon beta-1a.

The study consisted of a core treatment period with a common end date defined as 48 weeks after randomization of the last participant, followed by an optional long-term extension treatment period until teriflunomide is commercially available in accordance with local regulations.

Detailed Description

The core treatment period per participant was variable depending on the enrollment in the study (maximum of approximatively 118 weeks). The two doses of teriflunomide were administered in double-blind fashion, whereas interferon beta-1a (Rebif®) was open-label.

The opportunity to continue with the highest dose of teriflunomide in open-label fashion was offered to the participants who successfully completed treatment in the core study.

The overall treatment period was followed by a 4-week elimination follow-up period.

• Study Type: Interventional
• Study Phase: Phase 3
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Single (Outcomes Assessor); Primary Purpose: Treatment
• Condition: Multiple Sclerosis

Intervention

• Drug: Interferon β-1a

  Sterile preservative-free solution packaged in graduated pre-filled syringes

  Subcutaneous injection

  Ascending doses from 8.8 to 44 mcg according to local standard for Rebif®

  Other Name: Rebif®
• Drug: Teriflunomide

  Film-coated tablet

  Oral administration

  Other Name: HMR1726

Study Arms

• Experimental: Teriflunomide 7 mg / 14 mg
  Teriflunomide 7 mg once daily (core treatment period) and teriflunomide 14 mg once daily (extended treatment period).
  Intervention: Drug: Teriflunomide
• Experimental: Teriflunomide 14 mg / 14 mg
  Teriflunomide 14 mg once daily (core treatment period) and teriflunomide 14 mg once daily (extension treatment period).
  Intervention: Drug: Teriflunomide
• Active Comparator: IFN-β-1a / 14 mg
  Interferon β-1a 3 times a week (core treatment period) and teriflunomide 14 mg once daily (extended treatment period).
  Interventions:

  • Drug: Interferon β-1a
  • Drug: Teriflunomide

Publications *

• Vermersch P, Czlonkowska A, Grimaldi LM, Confavreux C, Comi G, Kappos L, Olsson TP, Benamor M, Bauer D, Truffinet P, Church M, Miller AE, Wolinsky JS, Freedman MS, O'Connor P; TENERE Trial Group. Teriflunomide versus subcutaneous interferon beta-1a in patients with relapsing multiple sclerosis: a randomised, controlled phase 3 trial. Mult Scler. 2014 May;20(6):705-16. doi: 10.1177/1352458513507821. Epub 2013 Oct 14.
• Comi G, Freedman MS, Meca-Lallana JE, Vermersch P, Kim BJ, Parajeles A, Edwards KR, Gold R, Korideck H, Chavin J, Poole EM, Coyle PK. Prior treatment status: impact on the efficacy and safety of teriflunomide in multiple sclerosis. BMC Neurol. 2020 Oct 6;20(1):364. doi: 10.1186/s12883-020-01937-4.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: October 3, 2012): 324
• Original Estimated Enrollment (submitted: April 16, 2009): 300
• Actual Study Completion Date: May 2015
• Actual Primary Completion Date: September 2011 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

• Relapsing form of MS meeting McDonald's criteria for MS diagnosis and Expanded Disability Status Scale [EDSS] score ≤5.5 at screening visit.

Exclusion Criteria:

• Significantly impaired bone marrow function or, significant anemia, leukopenia or thrombocytopenia;
• Persistent significant or severe infection.
• Liver function impairment or known history of hepatitis.
• Use of adrenocorticotrophic hormone [ACTH] or systemic corticosteroids for 2 weeks prior to randomization.
• Human immunodeficiency virus [HIV] positive.
• Prior use of Rebif®, or prior or concomitant use of other interferons in the 3 months prior to randomization.
• Prior or concomitant use of cladribine, mitoxantrone, or other immunosuppressant agents such as azathioprine, cyclophosphamide, cyclosporin, methotrexate, mycophenolate, or natalizumab.
• Pregnant or breast-feeding woman.

Extension criteria:

The participants who met all the following criteria at the end of the core study period were eligible for enrolment into the open-label extension phase:

• Participants who had not discontinued treatment in the core period and who had a minimum treatment of 48 weeks and completed the EOT visit (Visit 18).
• Participants who had not met criteria for treatment withdrawal.
• An informed consent must be obtained in writing from the participant for this open-label extension phase prior to entering and prior to completion of any extension phase procedure.
• Participants who demonstrated a willingness and ability to roll over to the extension phase with the opportunity to continue treatment on 14 mg/day of teriflunomide under open-label.

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

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 18 Years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Belgium, Canada, Czech Republic, France, Germany, Greece, Hungary, Italy, Poland, Spain, Switzerland, Tunisia, United Kingdom

Administrative Information

• NCT Number: NCT00883337
• Other Study ID Numbers: EFC10891; 2008-006226-34 ( EudraCT Number )
• Has Data Monitoring Committee: Yes
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Current Responsible Party: Sanofi
• Original Responsible Party: ICD Study Director, sanofi-aventis
• Current Study Sponsor: Sanofi
• Original Study Sponsor: Same as current
• Collaborators: Not Provided

Investigators

• Study Director: Clinical Sciences & Operations; Sanofi

• PRS Account: Sanofi
• Verification Date: May 2016