Phase III Study With Teriflunomide Versus Placebo in Patients With First Clinical Symptom of Multiple Sclerosis (TOPIC)

• ClinicalTrials.gov Identifier: NCT00622700
• Recruitment Status: Completed
• First Posted: February 25, 2008
• Results First Posted: December 19, 2014
• Last Update Posted: March 13, 2017
• Sponsor: Sanofi
• Information provided by (Responsible Party): Sanofi

• Study Type: Interventional
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Double (Participant, Investigator); Primary Purpose: Treatment
• Condition: Multiple Sclerosis
• Interventions: Drug: Teriflunomide; Drug: Placebo
• Enrollment: 618

Participant Flow

Recruitment Details	A total of 846 participants were screened, of which 618 randomized in core treatment period. Out of 618, 423 entered in extension treatment period. End date of core treatment period was 17 December 2012 (maximum treatment duration: 120 weeks). End date of extension treatment period was 05 February 2016 (maximum treatment duration: 283 weeks).
Pre-assignment Details	Participants were randomized in 1:1:1 ratio to teriflunomide 7 mg,14 mg or placebo in core treatment period. Those completing core period, given opportunity to enter long-term extension period (participants originally given placebo re-randomized [1:1]to teriflunomide 7 mg/14 mg; those originally given 7 mg,14 mg continued with the same fixed dose).

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg	Placebo/ Teriflunomide 7 mg	Teriflunomide 7 mg/7 mg	Placebo/Teriflunomide 14 mg	Teriflunomide 14 mg/14 mg
Arm/Group Description	Core treatment period: Placebo matched to teriflunomide tablet once daily orally.	Core treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Teriflunomide 14 mg tablet once daily orally.	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Teriflunomide 7 mg tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.	Core treatment period: Teriflunomide 14 mg tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.
Period Title: Core Treatment Period
Started	197	205	216	0	0	0	0
Treated	197	203	214	0	0	0	0
Completed	141	150	163	0	0	0	0
Not Completed	56	55	53	0	0	0	0
Reason Not Completed
Randomized but Not Treated	0	2	2	0	0	0	0
Adverse Event	18	25	18	0	0	0	0
Lack of Efficacy	19	6	12	0	0	0	0
Lost to Follow-up	1	1	1	0	0	0	0
Death	1	0	0	0	0	0	0
Progressive Disease	3	1	0	0	0	0	0
Withdrawal by Subject	12	18	15	0	0	0	0
Other than specified above	2	2	5	0	0	0	0
Period Title: Extension Treatment Period
Started	0 [1]	0	0	64 [2]	142 [3]	67 [2]	150 [4]
Completed	0	0	0	43	103	50	120
Not Completed	0	0	0	21	39	17	30
Reason Not Completed
Adverse Event	0	0	0	5	9	6	8
Lack of Efficacy	0	0	0	2	8	1	9
Protocol Violation	0	0	0	0	0	2	0
Lost to Follow-up	0	0	0	0	1	0	0
Progressive Disease	0	0	0	1	2	0	2
Withdrawal by Subject	0	0	0	11	16	6	10
Missing	0	0	0	2	3	1	0
Other than specified above	0	0	0	0	0	1	1
[1] Participants were re-randomized in a 1:1 ratio to either teriflunomide 7 mg or 14 mg treatment arm.; [2] 10 participants completed core treatment period but did not enter in extension treatment period.; [3] 8 participants completed core treatment period but did not enter in extension treatment period.; [4] 13 participants completed core treatment period but did not enter in extension treatment period.

Baseline Characteristics

Arm/Group Title		Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg	Total
Arm/Group Description		Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.	Total of all reporting groups
Overall Number of Baseline Participants		197	205	216	618
Baseline Analysis Population Description		Randomized population: all randomized participants according to the treatment group to which they were assigned in the core treatment period.
Age, Continuous; Mean (Standard Deviation); Unit of measure: Years
	Number Analyzed	197 participants	205 participants	216 participants	618 participants
		32.0 (8.4)	31.6 (9.0)	32.8 (8.1)	32.7 (8.9)
Sex: Female, Male; Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	197 participants	205 participants	216 participants	618 participants
	Female	135 68.5%	130 63.4%	154 71.3%	419 67.8%
	Male	62 31.5%	75 36.6%	62 28.7%	199 32.2%
Region; Measure Type: Number; Unit of measure: Participants	Number Analyzed	197 participants	205 participants	216 participants	618 participants
Eastern Europe		94	96	101	291
Western Europe		76	74	74	224
Americas and Australia		27	35	41	103
Expanded Disability Status Scale (EDSS) Score [1]; Mean (Standard Deviation); Unit of measure: Units on a scale
	Number Analyzed	197 participants	205 participants	216 participants	618 participants
		1.71 (1.00)	1.50 (1.02)	1.80 (0.97)	1.67 (1.00)
		[1] Measure Description: EDSS is an ordinal scale in half-point increments that qualifies disability in participants with MS. It consists of 8 ordinal rating scales assessing seven functional systems (visual, brainstem, pyramidal, cerebellar, sensory, bowel/bladder and cerebral) as well as ambulation. EDSS total score ranges from 0 (normal neurological examination) to 10 (death due to MS).

Outcome Measures

1. Primary Outcome

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

Outcome Measure Data

Analysis Population Description

Intent-to-treat (ITT) population included all randomized participants who had at least 1 day study medication exposure. Participants were analyzed in the treatment group to which they were randomized.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	197	203	214
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: percent probability
Percent Probability of Conversion at 24 weeks	14.3; (9.2 to 19.4)	8.7; (4.6 to 12.8)	9.0; (5.0 to 13.0)
Percent Probability of Conversion at 48 weeks	26.0; (19.2 to 32.8)	14.2; (8.9 to 19.6)	13.7; (8.6 to 18.7)
Percent Probability of Conversion at 108 weeks	35.9; (27.8 to 43.9)	27.6; (19.9 to 35.4)	24.0; (17.0 to 31.0)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Placebo, Teriflunomide 14 mg
	Comments	A step-down hierarchical testing procedure, starting with the test of teriflunomide 14 mg versus placebo was used. Time to conversion to CDMS was analyzed using the Cox proportional hazard model with treatment, region, and baseline monofocal/multifocal status as covariates.
	Type of Statistical Test	Superiority or Other
	Comments	[Not Specified]
Statistical Test of Hypothesis	P-Value	0.0087
	Comments	P value was derived using Wald chi-squared test in the Cox proportional hazard model.
	Method	Wald chi-squared
	Comments	[Not Specified]
Method of Estimation	Estimation Parameter	Hazard Ratio (HR)
	Estimated Value	0.574
	Confidence Interval	(2-Sided) 95%; 0.379 to 0.869
	Estimation Comments	[Not Specified]

Statistical Analysis 2

Statistical Analysis Overview	Comparison Group Selection	Placebo, Teriflunomide 7 mg
	Comments	A step-down hierarchical testing procedure was used. The second step was the test of teriflunomide 7 mg versus placebo for time to conversion to CDMS. Time to conversion to CDMS was analyzed using the Cox proportional hazard model with treatment, region, and baseline monofocal/multifocal status as covariates.
	Type of Statistical Test	Superiority or Other
	Comments	[Not Specified]
Statistical Test of Hypothesis	P-Value	0.0271
	Comments	P value was derived using Wald chi-squared test in the Cox proportional hazard model.
	Method	Wald chi-squared
	Comments	[Not Specified]
Method of Estimation	Estimation Parameter	Hazard Ratio (HR)
	Estimated Value	0.628
	Confidence Interval	(2-Sided) 95%; 0.416 to 0.949
	Estimation Comments	[Not Specified]

2. Secondary Outcome

Title	Core Treatment Period: Time to Conversion to Definite Multiple Sclerosis (DMS)
Description	Conversion to DMS was demonstrated by dissemination of MRI lesions in time (as per McDonald criteria) or a relapse, whichever occurs first. MRI Imaging criteria were detection of Gadolinium (Gd) enhancement at least 3 months after onset of initial clinical event, if not at site corresponding to initial event; detection of new T2 lesion if it appears at any time compared with reference scan (done at time of screening) done at least 30 days after onset of the initial clinical event. Occurrence of relapse was defined as new neurological abnormality separated by at least 30 days from onset of preceding clinical event, present for at least 24 hours and occurring in absence of fever or known infection. New clinical abnormality (neurological sign) that is consistent with participant's symptoms with increase in at least one Functional System (FS) or EDSS score compared to last EDSS assessment. Percent probability of conversion at 24, 48, and 108 weeks was estimated using Kaplan-Meier method.
Time Frame	Up to a maximum of 108 weeks depending on time of enrollment

Outcome Measure Data

Analysis Population Description

ITT population.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	197	203	214
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: percent probability
Percent Probability of Conversion at 24 weeks	58.2; (51.0 to 65.4)	45.7; (38.5 to 52.9)	46.0; (39.0 to 53.0)
Percent Probability of Conversion at 48 weeks	72.4; (65.7 to 79.1)	57.3; (49.8 to 64.7)	57.8; (50.6 to 64.9)
Percent Probability of Conversion at 108 weeks	87.0; (81.2 to 92.7)	73.3; (66.0 to 80.7)	71.5; (64.5 to 78.4)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Placebo, Teriflunomide 14 mg
	Comments	A step-down hierarchical testing procedure was used. The third step was the test of teriflunomide 14 mg versus placebo for time to conversion to DMS. This was analyzed using the Cox proportional hazard model with treatment, region, and baseline monofocal/multifocal status as covariates.
	Type of Statistical Test	Superiority or Other
	Comments	[Not Specified]
Statistical Test of Hypothesis	P-Value	0.0003
	Comments	P value was derived using Wald chi-squared test in the Cox proportional hazard model.
	Method	Wald chi-squared
	Comments	[Not Specified]
Method of Estimation	Estimation Parameter	Hazard Ratio (HR)
	Estimated Value	0.651
	Confidence Interval	(2-Sided) 95%; 0.515 to 0.822
	Estimation Comments	[Not Specified]

Statistical Analysis 2

Statistical Analysis Overview	Comparison Group Selection	Placebo, Teriflunomide 7 mg
	Comments	A step-down hierarchical testing procedure was used. The fourth step was the test of teriflunomide 7 mg versus placebo for time to conversion to DMS. This was analyzed using the Cox proportional hazard model with treatment, region, and baseline monofocal/multifocal status as covariates.
	Type of Statistical Test	Superiority or Other
	Comments	[Not Specified]
Statistical Test of Hypothesis	P-Value	0.0020
	Comments	P value was derived using Wald chi-squared test in the Cox proportional hazard model.
	Method	Wald chi-squared
	Comments	[Not Specified]
Method of Estimation	Estimation Parameter	Hazard Ratio (HR)
	Estimated Value	0.686
	Confidence Interval	(2-Sided) 95%; 0.540 to 0.871
	Estimation Comments	[Not Specified]

3. Secondary Outcome

Title	Core Treatment Period: Annualized Relapse Rate (ARR)
Description	ARR is the total number of confirmed relapses that occurred during the treatment period divided by the total number of patient-years treated. 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. ARR was assessed using Poisson regression model with robust error variance. To account for the different treatment durations among participants, a Poisson regression model with robust error variance was used (total number of confirmed relapses onset between randomization date and last dose date as the response variable, treatment, region and baseline monofocal/multifocal status as covariates, and log-transformed treatment duration as an offset variable).
Time Frame	Up to a maximum of 108 weeks depending on time of enrollment

Outcome Measure Data

Analysis Population Description

ITT population.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	197	203	214
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: relapses per patient year
	0.284; (0.214 to 0.378)	0.190; (0.139 to 0.260)	0.194; (0.143 to 0.263)

4. Secondary Outcome

Title	Core Treatment Period: Brain Magnetic Resonance Imaging (MRI) Assessment: Change From Baseline in Total Lesion Volume at Week 108
Description	The total lesion volume (burden of disease) is the total volumes of hyperintense on T2 plus hypointense on T1 as measured by MRI scan. Least-square means were estimated using a Mixed-effect model with repeated measures (MMRM) on cubic root transformed volume data with factors for treatment, baseline monofocal/multifocal status, region, visit, treatment-by-visit interaction, cubic root transformed baseline burden of disease, and baseline-by-visit interaction.
Time Frame	Baseline, Week 108

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	68	75	99
Least Squares Mean (Standard Error); Unit of Measure: milliliter
	0.053 (0.033)	0.041 (0.032)	-0.038 (0.029)

5. Secondary Outcome

Title	Core Treatment Period: Brain MRI Assessment: Number of Gadolinium Enhancing (Gd-enhancing) T1-lesions Per MRI Scan (Poisson Regression Estimates)
Description	Number of Gd-enhancing T1-lesions per scan is the total number of Gd-enhancing T1-lesions that occurred during the treatment period divided by the total number of scans performed during the treatment period. To account for the different numbers of scans performed among the participants, a Poisson regression model with robust error variance was used (total number of Gd-enhancing T1-lesions as response variable, treatment, baseline monofocal/multifocal status, region and baseline number of Gd-enhancing T1-lesions as covariates, and log-transformed number of scans as an offset variable).
Time Frame	Up to a maximum of 108 weeks depending on time of enrollment

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	109	84	74
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: lesions per scan
	0.953; (0.708 to 1.284)	0.749; (0.433 to 1.294)	0.395; (0.262 to 0.598)

6. Secondary Outcome

Title	Core Treatment Period: Brain MRI Assessment: Volume of Gadolinium Enhancing (Gd-enhancing) T1-lesions Per MRI Scan
Description	Total volume of Gd-enhancing T1-lesions per scan is the sum of the volumes of Gd-enhancing T1-lesions observed during the treatment period divided by the total number of scans performed during the treatment period. To account for the different numbers of scans performed among the participants, a Poisson regression model with robust error variance was used (total number of Gd-enhancing T1-lesions as response variable, treatment, baseline monofocal/multifocal status, region and baseline number of Gd-enhancing T1-lesions as covariates, and log-transformed number of scans as an offset variable).
Time Frame	Up to a maximum of 108 weeks depending on time of enrollment

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	109	84	74
Measure Type: Number; Unit of Measure: milliliters per scan
	0.079	0.058	0.034

7. Secondary Outcome

Title	Core Treatment Period: Brain MRI Assessment: Change From Baseline in Volume of Hypointense Post-Gadolinium T1 Lesion Component
Description	Volume of hypointense post-gadolinium T1 lesion component was measured by MRI scan. Least-square means were estimated using a Mixed-effect model with repeated measures (MMRM) on cubic root transformed volume data adjusted for baseline monofocal/multifocal status, region, visit, treatment-by-visit interaction, cubic root transformed baseline value, and baseline-by-visit interaction
Time Frame	Baseline, Week 108

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	68	75	99
Least Squares Mean (Standard Error); Unit of Measure: milliliter
	0.028 (0.018)	0.025 (0.018)	-0.033 (0.016)

8. Secondary Outcome

Title	Core Treatment Period: Brain MRI Assessment: Change From Baseline in Volume of T2 Lesion Component
Description	Volume of T2 lesion component was measured by MRI scan. Least-square means were estimated using a Mixed-effect model with repeated measures (MMRM) on cubic root transformed volume data adjusted for baseline monofocal/multifocal status, region, visit, treatment-by-visit interaction, cubic root transformed baseline value, and baseline-by-visit interaction.
Time Frame	Baseline, Week 108

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	68	75	99
Least Squares Mean (Standard Error); Unit of Measure: milliliter
	0.052 (0.033)	0.036 (0.032)	-0.035 (0.029)

9. Secondary Outcome

Title	Core Treatment Period: Brain MRI Assessment: Percent Change From Baseline in Atrophy
Description	Atrophy was measured by MRI scan.
Time Frame	Baseline, Week 108

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	68	75	99
Mean (Standard Deviation); Unit of Measure: percent change
	-0.386 (1.326)	-0.197 (1.218)	-0.366 (1.151)

10. Secondary Outcome

Title	Core Treatment Period: Time to 12-Week Sustained Disability Progression
Description	The 12-week sustained disability progression was defined as increase from baseline of at least 1-point in EDSS score (at least 0.5-point for participants with baseline EDSS score of greater than [>] 5.5) that persisted for at least 12 weeks. Percent probability of participants free of 12-week sustained disability progression at 24, 48, and 108 weeks was estimated using Kaplan-Meier method.
Time Frame	Up to a maximum of 108 weeks depending on time of enrollment

Outcome Measure Data

Analysis Population Description

ITT population.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	197	203	214
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: percent probability
Percent Probability at 24 weeks	96.0; (93.0 to 98.9)	94.3; (90.9 to 97.8)	97.9; (95.9 to 99.9)
Percent Probability at 48 weeks	91.7; (87.3 to 96.1)	90.1; (85.4 to 94.7)	93.9; (90.2 to 97.6)
Percent Probability at 108 weeks	85.5; (79.2 to 91.8)	86.5; (80.8 to 92.1)	89.2; (84.1 to 94.3)

11. Secondary Outcome

Title	Core Treatment Period: Change From Baseline in EDSS at Week 108
Description	EDSS is an ordinal scale in half-point increments that qualifies disability in participants with MS. It consists of 8 ordinal rating scales assessing seven functional systems (visual, brainstem, pyramidal, cerebellar, sensory, bowel/bladder and cerebral) as well as ambulation. EDSS total score ranges from 0 (normal neurological examination) to 10 (death due to MS). Least-square means were estimated using a Mixed-effect model with repeated measures (MMRM) on cubic root transformed volume data adjusted for baseline monofocal/multifocal status, region, visit, treatment-by-visit interaction, baseline value and baseline-by-visit interaction
Time Frame	Baseline, Week 108

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	80	82	102
Least Squares Mean (Standard Error); Unit of Measure: units on a scale
	0.069 (0.087)	-0.191 (0.086)	-0.166 (0.080)

12. Secondary Outcome

Title	Core Treatment Period: Change From Baseline in Fatigue Impact Scale (FIS) Total Score at Week 108
Description	FIS is a participant-reported scale that qualifies the impact of fatigue on daily life in participants 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 adjusted for or baseline monofocal/multifocal status, region, visit, treatment-by-visit interaction, baseline value and baseline-by-visit interaction.
Time Frame	Baseline, Week 108

Outcome Measure Data

Analysis Population Description

ITT population, but including only participants who had post-baseline data.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	84	95	106
Least Squares Mean (Standard Error); Unit of Measure: units on a scale
	-2.537 (2.794)	-2.524 (2.710)	-1.827 (2.551)

13. Secondary Outcome

Title	Core Treatment Period: Overview of Adverse Events (AEs)
Description	AEs are any unfavorable and unintended sign, symptom, syndrome, or illness observed by the investigator or reported by the participant during the study.
Time Frame	From first study drug intake up to 112 days after last intake in the placebo-controlled period or up to first intake in the extension treatment period, whichever occurred first

Outcome Measure Data

Analysis Population Description

Safety population:all randomized participants exposed to study medication; analyzed according to drug actually received. In Placebo arm, 4 received teriflunomide 7mg & 2 received teriflunomide 14mg, hence they were included in respective teriflunomide arm. Participants who were randomized but not treated were excluded (2 in each teriflunomide arm).

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	191	207	216
Measure Type: Number; Unit of Measure: participants
Any AE	155	161	183
Any serious AE	18	18	24
Any AE leading to death	1	0	0
Any AE leading to treatment discontinuation	19	25	18

14. Secondary Outcome

Title	Extension Treatment Period: Time to Conversion to Clinically Definite Multiple Sclerosis (CDMS)
Description	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 was estimated using Kaplan-Meier method.
Time Frame	From randomization in the core period up to 390 Weeks (Extension treatment period [maximum exposure: 283 Weeks])

Outcome Measure Data

Analysis Population Description

ITT Population: all randomized participants in the extension who had at least 1 day IMP exposure. Participants were analyzed according to the treatment group allocated by the randomization in the core study followed by the re-randomized treatment group during the extension period.

Arm/Group Title	Placebo/Teriflunomide 7 mg	Teriflunomide 7 mg/ 7mg	Placebo/ Teriflunomide 14 mg	Teriflunomide 14 mg/14 mg
Arm/Group Description:	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.	Core treatment period: Teriflunomide 14 mg tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	64	142	67	150
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: Percent probability
Percent Probability of Conversion at 24 Weeks	4.7; (0.0 to 9.9)	3.5; (0.5 to 6.6)	13.5; (5.3 to 21.6)	4.7; (1.3 to 8.0)
Percent Probability of Conversion at 48 Weeks	12.5; (4.4 to 20.6)	9.9; (5.0 to 14.8)	21.2; (11.3 to 31.0)	8.7; (4.2 to 13.3)
Percent Probability of Conversion at 72 Weeks	15.7; (6.8 to 24.6)	17.1; (10.9 to 23.4)	24.3; (13.9 to 34.6)	14.8; (9.1 to 20.6)
Percent Probability of Conversion at 96 Weeks	18.9; (9.3 to 28.6)	23.9; (16.7 to 31.0)	27.4; (16.6 to 38.2)	16.2; (10.3 to 22.1)
Percent Probability of Conversion at 120 Weeks	22.3; (12.0 to 32.7)	27.7; (20.2 to 35.2)	32.2; (20.8 to 43.6)	18.3; (12.1 to 24.6)
Percent Probability of Conversion at 144 Weeks	22.3; (12.0 to 32.7)	29.4; (21.7 to 37.1)	33.9; (22.3 to 45.4)	22.0; (15.3 to 28.8)
Percent Probability of Conversion at 168 Weeks	22.3; (12.0 to 32.7)	32.2; (24.2 to 40.3)	33.9; (22.3 to 45.4)	22.8; (16.0 to 29.7)
Percent Probability of Conversion at 192 Weeks	22.3; (12.0 to 32.7)	37.5; (28.6 to 46.4)	35.9; (24.0 to 47.8)	24.8; (17.6 to 32.0)
Percent Probability of Conversion at 216 Weeks	25.6; (13.9 to 37.3)	38.9; (29.8 to 48.1)	39.3; (26.3 to 52.3)	24.8; (17.6 to 32.0)
Percent Probability of Conversion at 240 Weeks	29.5; (16.1 to 42.9)	40.8; (31.3 to 50.4)	39.3; (26.3 to 52.3)	26.3; (18.7 to 34.0)
Percent Probability of Conversion at 264 Weeks	29.5; (16.1 to 42.9)	43.0; (32.9 to 53.2)	39.3; (26.3 to 52.3)	26.3; (18.7 to 34.0)
Percent Probability of Conversion at 288 Weeks	29.5; (16.1 to 42.9)	43.0; (32.9 to 53.2)	39.3; (26.3 to 52.3)	26.3; (18.7 to 34.0)
Percent Probability of Conversion at 312 Weeks	29.5; (16.1 to 42.9)	43.0; (32.9 to 53.2)	49.4; (28.3 to 70.5)	26.3; (18.7 to 34.0)
Percent Probability of Conversion at 336 Weeks	29.5; (16.1 to 42.9)	48.7; (34.7 to 62.7)	49.4; (28.3 to 70.5)	26.3; (18.7 to 34.0)

15. Secondary Outcome

Title	Extension Treatment Period: Overview of Adverse Events (AEs)
Description	AEs are any unfavorable and unintended sign, symptom, syndrome, or illness observed by the investigator or reported by the participant during the study. Safety population included all randomized population who actually received at least 1 dose of the IMP in extension and analyzed according to the treatment actually received in core study followed by treatment actually received in the extension treatment period.
Time Frame	From re-randomization up to 283 Weeks

Outcome Measure Data

Analysis Population Description

Analysis was performed on Safety population. In Placebo/teriflunomide 7mg arm, 2 received 7mg in the core period; In Placebo/teriflunomide 14mg, 1 received 7mg in the core period, hence, they were included in the 7mg/7mg arm in extension period as treatment received in the core period for consistency.

Arm/Group Title	Placebo/Teriflunomide 7 mg	Teriflunomide 7 mg/ 7mg	Placebo/ Teriflunomide 14 mg	Teriflunomide 14 mg/14 mg
Arm/Group Description:	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Teriflunomide 7 mg tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.	Core treatment period: Teriflunomide 14 mg tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	62	145	66	150
Measure Type: Number; Unit of Measure: participants
Any AE	47	110	57	120
Any Serious AE	8	17	8	24
Any AE Leading to Death	0	0	0	0
Any AE leading to Permanent Discontinuation	5	8	5	7

16. Other Pre-specified Outcome

Title	Core Treatment Period: Liver Function: Number of Participants With Potentially Clinically Significant Abnormalities (PCSA)
Description	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 limit of normal(ULN);; Aspartate aminotransferase (AST) >3, 5, 10 or 20 ULN;; Alkaline Phosphatase >1.5 ULN;; Total Bilirubin (TB) >1.5, 2, or 3 ULN;; ALT >3 ULN and TB >2 ULN.
Time Frame	From first study drug intake up to 112 days after last intake in the placebo-controlled period or up to first intake in the extension treatment period, whichever occurred first

Outcome Measure Data

Analysis Population Description

Safety population as described in Outcome Measure 13. Here 'n' signifies the number of participants for the treatment group who had that parameter assessed at post-baseline.

Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg
Arm/Group Description:	Placebo matched to teriflunomide tablet once daily orally.	Teriflunomide 7 mg tablet once daily orally.	Teriflunomide 14 mg tablet once daily orally.
Overall Number of Participants Analyzed	191	207	216
Measure Type: Number; Unit of Measure: participants
ALT >3 ULN (n=190, 207, 216)	18	25	26
ALT >5 ULN (n=190, 207, 216)	12	10	11
ALT >10 ULN (n=190, 207, 216)	5	1	3
ALT >20 ULN (n=190, 207, 216)	0	0	1
AST >3 ULN (n=190, 207, 216)	9	12	10
AST >5 ULN (n=190, 207, 216)	1	4	6
AST >10 ULN (n=190, 207, 216)	1	0	1
AST >20 ULN (n=190, 207, 216)	0	0	1
Alkaline Phosphatase >1.5 ULN (n=190, 207, 216)	0	0	1
TB >1.5 ULN (n=190, 207, 216)	14	9	8
TB >2 ULN (n=190, 207, 216)	8	0	3
TB >3 ULN (n=190, 207, 216)	0	0	1
ALT >3 ULN and TB >2 ULN (n=190, 207, 216)	2	0	2

Adverse Events

Time Frame	All Adverse Events (AE) were collected from signature of the informed consent form up to the final visit (up to 390 weeks [maximum exposure in core treatment period: 120 weeks and maximum exposure in extension treatment period: 283 weeks]) regardless of seriousness or relationship to investigational product.
Adverse Event Reporting Description	Reported adverse events are treatment-emergent adverse events that is AEs that developed/worsened during the 'on treatment period' (time from first dose of study drug up to 112 days after last intake in core treatment period [or up to 1st intake in extension period, whichever occurred first] or 28 days after last intake in extension treatment period). Analysis was performed on safety population as described in Outcome Measure 15.
Arm/Group Title	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg	Placebo/Teriflunomide 7 mg	Teriflunomide 7 mg/7 mg	Placebo/Teriflunomide 14 mg	Teriflunomide 14 mg/14 mg
Arm/Group Description	Core treatment period: Placebo matched to teriflunomide tablet once daily orally.	Core treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Teriflunomide 14 mg tablet once daily orally.	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Teriflunomide 7 mg tablet once daily orally. Extension treatment period: Teriflunomide 7 mg tablet once daily orally.	Core treatment period: Placebo matched to teriflunomide tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.	Core treatment period: Teriflunomide 14 mg tablet once daily orally. Extension treatment period: Teriflunomide 14 mg tablet once daily orally.
All-Cause Mortality
	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg	Placebo/Teriflunomide 7 mg	Teriflunomide 7 mg/7 mg	Placebo/Teriflunomide 14 mg	Teriflunomide 14 mg/14 mg
	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)
Total	--/--	--/--	--/--	--/--	--/--	--/--	--/--
Serious Adverse Events
	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg	Placebo/Teriflunomide 7 mg	Teriflunomide 7 mg/7 mg	Placebo/Teriflunomide 14 mg	Teriflunomide 14 mg/14 mg
	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)
Total	18/191 (9.42%)	18/207 (8.70%)	24/216 (11.11%)	8/62 (12.90%)	17/145 (11.72%)	8/66 (12.12%)	24/150 (16.00%)
Blood and lymphatic system disorders
Iron deficiency anaemia † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	1/66 (1.52%)	0/150 (0.00%)
Lymphadenitis † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Neutropenia † 1	2/191 (1.05%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	2/145 (1.38%)	1/66 (1.52%)	0/150 (0.00%)
Cardiac disorders
Supraventricular tachycardia † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Tachycardia † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Ear and labyrinth disorders
Vertigo † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Endocrine disorders
Goitre † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	1/66 (1.52%)	0/150 (0.00%)
Eye disorders
Conjunctivitis allergic † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Gastrointestinal disorders
Chronic gastritis † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Duodenitis † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Mallory-Weiss syndrome † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Abdominal pain † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Dental cyst † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Gastroduodenal ulcer † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	1/66 (1.52%)	0/150 (0.00%)
Inguinal hernia † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Pancreatitis † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Pancreatitis acute † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Peptic ulcer † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	1/66 (1.52%)	0/150 (0.00%)
Radicular cyst † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
General disorders
Hernia † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Hepatobiliary disorders
Cholelithiasis † 1	0/191 (0.00%)	1/207 (0.48%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Cholecystitis † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Cholecystitis acute † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Hepatocellular injury † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Infections and infestations
Abdominal wall abscess † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Acute sinusitis † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	1/150 (0.67%)
Dengue fever † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Gastroenteritis † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Pneumonia † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Abdominal abscess † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Appendicitis † 1	0/191 (0.00%)	0/207 (0.00%)	2/216 (0.93%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Appendicitis perforated † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Bronchitis † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Clostridium difficile colitis † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Cystitis † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Genital infection † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Infectious mononucleosis † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Pharyngitis † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Pilonidal cyst † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Pulmonary tuberculosis † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Pyelonephritis acute † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Rectal abscess † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Sinusitis † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Injury, poisoning and procedural complications
Facial bones fracture † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Upper limb fracture † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Ankle fracture † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Craniocerebral injury † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Foot fracture † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Intentional overdose † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Ligament sprain † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Overdose † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Tibia fracture † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	2/145 (1.38%)	0/66 (0.00%)	0/150 (0.00%)
Wound dehiscence † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Investigations
Amylase increased † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	2/150 (1.33%)
Blood creatine phosphokinase increased † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	2/150 (1.33%)
Aspartate aminotransferase increased † 1	0/191 (0.00%)	1/207 (0.48%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Lipase increased † 1	0/191 (0.00%)	1/207 (0.48%)	2/216 (0.93%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	1/150 (0.67%)
Transaminases increased † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Alanine aminotransferase increased † 1	3/191 (1.57%)	5/207 (2.42%)	4/216 (1.85%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Weight decreased † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Musculoskeletal and connective tissue disorders
Intervertebral disc protrusion † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Synovial cyst † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Intervertebral disc disorder † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Osteochondrosis † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Rheumatoid arthritis † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Cervix carcinoma † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Uterine leiomyoma † 1	2/191 (1.05%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	1/150 (0.67%)
Breast cancer † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Liposarcoma † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Meningioma † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Spinal meningioma benign † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	1/66 (1.52%)	0/150 (0.00%)
Thyroid cancer † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Nervous system disorders
Carpal tunnel syndrome † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Radicular syndrome † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Axonal neuropathy † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Loss of consciousness † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Speech disorder † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Pregnancy, puerperium and perinatal conditions
Abortion spontaneous † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Abortion threatened † 1	0/191 (0.00%)	1/207 (0.48%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Pregnancy † 1	0/191 (0.00%)	0/207 (0.00%)	2/216 (0.93%)	0/62 (0.00%)	1/145 (0.69%)	1/66 (1.52%)	0/150 (0.00%)
Psychiatric disorders
Adjustment disorder † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Completed suicide † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Depression † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Psychiatric decompensation † 1	1/191 (0.52%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Suicide attempt † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Reproductive system and breast disorders
Cervical cyst † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Endometrial hyperplasia † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Fallopian tube cyst † 1	1/191 (0.52%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Menorrhagia † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Ovarian cyst † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Testicular torsion † 1	0/191 (0.00%)	1/207 (0.48%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Uterine haemorrhage † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	1/66 (1.52%)	0/150 (0.00%)
Respiratory, thoracic and mediastinal disorders
Nasal septum deviation † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Dyspnoea † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Skin and subcutaneous tissue disorders
Diffuse alopecia † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	1/62 (1.61%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
Erythema nodosum † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	1/145 (0.69%)	0/66 (0.00%)	0/150 (0.00%)
Vascular disorders
Circulatory collapse † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Hypertension † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	1/66 (1.52%)	1/150 (0.67%)
Orthostatic hypotension † 1	0/191 (0.00%)	0/207 (0.00%)	0/216 (0.00%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	1/150 (0.67%)
Deep vein thrombosis † 1	0/191 (0.00%)	0/207 (0.00%)	1/216 (0.46%)	0/62 (0.00%)	0/145 (0.00%)	0/66 (0.00%)	0/150 (0.00%)
† Indicates events were collected by systematic assessment; 1 Term from vocabulary, MedDRA-18.1
Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events	5%
	Placebo	Teriflunomide 7 mg	Teriflunomide 14 mg	Placebo/Teriflunomide 7 mg	Teriflunomide 7 mg/7 mg	Placebo/Teriflunomide 14 mg	Teriflunomide 14 mg/14 mg
	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)	Affected / at Risk (%)
Total	117/191 (61.26%)	129/207 (62.32%)	135/216 (62.50%)	33/62 (53.23%)	66/145 (45.52%)	38/66 (57.58%)	70/150 (46.67%)
Gastrointestinal disorders
Diarrhoea † 1	12/191 (6.28%)	22/207 (10.63%)	15/216 (6.94%)	4/62 (6.45%)	9/145 (6.21%)	4/66 (6.06%)	14/150 (9.33%)
Nausea † 1	9/191 (4.71%)	11/207 (5.31%)	9/216 (4.17%)	2/62 (3.23%)	7/145 (4.83%)	1/66 (1.52%)	9/150 (6.00%)
General disorders
Fatigue † 1	14/191 (7.33%)	10/207 (4.83%)	9/216 (4.17%)	2/62 (3.23%)	3/145 (2.07%)	4/66 (6.06%)	3/150 (2.00%)
Infections and infestations
Nasopharyngitis † 1	29/191 (15.18%)	24/207 (11.59%)	35/216 (16.20%)	9/62 (14.52%)	14/145 (9.66%)	9/66 (13.64%)	15/150 (10.00%)
Bronchitis † 1	5/191 (2.62%)	9/207 (4.35%)	8/216 (3.70%)	4/62 (6.45%)	7/145 (4.83%)	2/66 (3.03%)	8/150 (5.33%)
Sinusitis † 1	9/191 (4.71%)	7/207 (3.38%)	6/216 (2.78%)	6/62 (9.68%)	4/145 (2.76%)	4/66 (6.06%)	6/150 (4.00%)
Influenza † 1	9/191 (4.71%)	8/207 (3.86%)	16/216 (7.41%)	3/62 (4.84%)	5/145 (3.45%)	5/66 (7.58%)	4/150 (2.67%)
Upper respiratory tract infection † 1	14/191 (7.33%)	23/207 (11.11%)	20/216 (9.26%)	2/62 (3.23%)	5/145 (3.45%)	2/66 (3.03%)	4/150 (2.67%)
Urinary tract infection † 1	10/191 (5.24%)	10/207 (4.83%)	20/216 (9.26%)	3/62 (4.84%)	5/145 (3.45%)	5/66 (7.58%)	4/150 (2.67%)
Investigations
Alanine aminotransferase increased † 1	28/191 (14.66%)	32/207 (15.46%)	35/216 (16.20%)	0/62 (0.00%)	5/145 (3.45%)	6/66 (9.09%)	3/150 (2.00%)
Blood creatine phosphokinase increased † 1	1/191 (0.52%)	9/207 (4.35%)	5/216 (2.31%)	4/62 (6.45%)	1/145 (0.69%)	1/66 (1.52%)	2/150 (1.33%)
Musculoskeletal and connective tissue disorders
Back pain † 1	7/191 (3.66%)	14/207 (6.76%)	8/216 (3.70%)	4/62 (6.45%)	5/145 (3.45%)	4/66 (6.06%)	10/150 (6.67%)
Arthralgia † 1	6/191 (3.14%)	13/207 (6.28%)	7/216 (3.24%)	1/62 (1.61%)	4/145 (2.76%)	2/66 (3.03%)	4/150 (2.67%)
Nervous system disorders
Headache † 1	25/191 (13.09%)	31/207 (14.98%)	30/216 (13.89%)	4/62 (6.45%)	8/145 (5.52%)	8/66 (12.12%)	6/150 (4.00%)
Dizziness † 1	7/191 (3.66%)	7/207 (3.38%)	11/216 (5.09%)	1/62 (1.61%)	4/145 (2.76%)	2/66 (3.03%)	4/150 (2.67%)
Paraesthesia † 1	9/191 (4.71%)	11/207 (5.31%)	22/216 (10.19%)	3/62 (4.84%)	1/145 (0.69%)	3/66 (4.55%)	4/150 (2.67%)
Psychiatric disorders
Depression † 1	11/191 (5.76%)	8/207 (3.86%)	8/216 (3.70%)	2/62 (3.23%)	4/145 (2.76%)	3/66 (4.55%)	1/150 (0.67%)
Respiratory, thoracic and mediastinal disorders
Oropharyngeal pain † 1	8/191 (4.19%)	11/207 (5.31%)	2/216 (0.93%)	0/62 (0.00%)	1/145 (0.69%)	2/66 (3.03%)	0/150 (0.00%)
Skin and subcutaneous tissue disorders
Alopecia † 1	15/191 (7.85%)	12/207 (5.80%)	25/216 (11.57%)	2/62 (3.23%)	3/145 (2.07%)	7/66 (10.61%)	5/150 (3.33%)
Vascular disorders
Hypertension † 1	2/191 (1.05%)	5/207 (2.42%)	12/216 (5.56%)	3/62 (4.84%)	4/145 (2.76%)	0/66 (0.00%)	5/150 (3.33%)
† Indicates events were collected by systematic assessment; 1 Term from vocabulary, MedDRA-18.1

Limitations and Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There IS an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

If no publication has occurred within 12 months of the completion of the study, the Investigator shall have the right to publish/present independently the results of the study. The Investigator shall provide the Sponsor with a copy of any such presentation/publication for comment at least 30 days before any presentation/submission for publication. If requested by the Sponsor, any presentation/submission shall be delayed up to 90 days, to allow the Sponsor to preserve its proprietary rights.

Results Point of Contact

• Name/Title: Trial Transparency Team
• Organization: Sanofi
• EMail: Contact-us@sanofi.com

Publications:

Miller AE, Wolinsky JS, Kappos L, Comi G, Freedman MS, Olsson TP, Bauer D, Benamor M, Truffinet P, O'Connor PW; TOPIC Study Group. Oral teriflunomide for patients with a first clinical episode suggestive of multiple sclerosis (TOPIC): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014 Oct;13(10):977-86. doi: 10.1016/S1474-4422(14)70191-7. Epub 2014 Sep 2.

• Responsible Party: Sanofi
• ClinicalTrials.gov Identifier: NCT00622700
• Other Study ID Numbers: EFC6260; HMR1726D-3005 ( Other Identifier: HMR ); 2006-001152-12 ( EudraCT Number )
• First Submitted: February 14, 2008
• First Posted: February 25, 2008
• Results First Submitted: November 7, 2014
• Results First Posted: December 19, 2014
• Last Update Posted: March 13, 2017