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NCT01185821

Long-term Safety, Tolerability and Efficacy of BAF312 Given Orally in Patients With Relapsing-remitting Multiple Sclerosis

Completed Phase 2 Results posted Last updated 27 March 2018
What this trial tests

Phase 2 trial testing BAF312 in Relapsing Remitting Multiple Sclerosis in 185 participants. Completed in 10 October 2016.

Timeline
30 August 2010
Primary endpoint
10 October 2016
10 October 2016

Quick facts

Lead sponsorNovartis Pharmaceuticals
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingquadruple
Primary purposetreatment
Enrollment185
Start date30 August 2010
Primary completion10 October 2016
Estimated completion10 October 2016
Sites46 locations across Italy, Finland, Russia, Germany, Hungary, Norway, Poland, Canada

Drugs / interventions tested

Conditions studied

Sponsor

Novartis Pharmaceuticals — full company profile →

Who can join

Adults 18 to 56, any sex, with Relapsing Remitting Multiple Sclerosis. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Total Number of Adverse Events During Evaluation of Long Term Safety and Tolerability of BAF312A in Extension Study. Primary · Baseline up to approximately 5 years

Refer to adverse events for complete listing of serious adverse events and other adverse events. Adverse events of interest were presented in separate tables. There were no reports of macular edema.

Serious adverse events
GroupValue95% CI
BAF312 10 mg/2 mg4
BAF312 2 mg/2 mg7
BAF312 1.25 mg/2 mg6
BAF312 .5 mg/2 mg6
BAF312 .25 mg/2 mg8
Other adverse events
GroupValue95% CI
BAF312 10 mg/2 mg30
BAF312 2 mg/2 mg26
BAF312 1.25 mg/2 mg42
BAF312 .5 mg/2 mg29
BAF312 .25 mg/2 mg42
Number of Participants With Cardiac Conduction Abnormalities During the Titration Phase of the Study (Without Washout) Primary · Baseline Extension up to day 10

Number of patients with abnormal ECG conduction findings during dose-blinded titration at any visit post-dose, by type of abnormality and treatment (Extension Set). Number analyzed represent participants who had ECG results. Washout was defined as not being on treatment drug between Core and Extension for \>7 days. Abbreviation: Con=conduction, IVCD=intraventricular conduction defect , WPW=Wolff-Parkinson-White syndrome

Conduction-Prolonged QTc
GroupValue95% CI
BAF312 10 mg/2 mg5
BAF312 2 mg/2 mg2
BAF312 1.25 mg/2 mg5
BAF312 .5 mg/2 mg2
BAF312 .25 mg/2 mg4
Conduction - IVCD
GroupValue95% CI
BAF312 10 mg/2 mg3
BAF312 2 mg/2 mg8
BAF312 1.25 mg/2 mg1
BAF312 .5 mg/2 mg3
BAF312 .25 mg/2 mg0
Conduction - AV Mobitz I
GroupValue95% CI
BAF312 10 mg/2 mg1
BAF312 2 mg/2 mg0
BAF312 1.25 mg/2 mg0
BAF312 .5 mg/2 mg0
BAF312 .25 mg/2 mg0
Con:1st degree AV block
GroupValue95% CI
BAF312 10 mg/2 mg0
BAF312 2 mg/2 mg1
BAF312 1.25 mg/2 mg1
BAF312 .5 mg/2 mg1
BAF312 .25 mg/2 mg1
Conduction - WPW
GroupValue95% CI
BAF312 10 mg/2 mg0
BAF312 2 mg/2 mg0
BAF312 1.25 mg/2 mg0
BAF312 .5 mg/2 mg1
BAF312 .25 mg/2 mg0
Number of Participants With Cardiac Conduction-IVCD Abnormality During the Titration Phase of the Study (With Washout) Primary · Baseline Extension up to day 10

Number of patients with abnormal ECG conduction findings during dose-blinded titration at any visit post-dose, by type of abnormality and treatment (Extension Set). Number analyzed represent participants who had ECG results. Washout was defined as not being on treatment drug between Core and Extension for \>7 days. Abbreviations: washout = WO, Con=conduction

GroupValue95% CI
BAF312 .25 mg/2 mg4
Number of Participants With Changes in Blood Pressure for Overall Extension Study. (Extension Analysis Set) Primary · Baseline Extension up to approximately 5 years

Sitting blood pressure was measured in triplicate. The categories of notably low and high values and changes are presented for systolic (SBP) and diastolic (DBP). Multiple occurrences for a patient are counted as one occurrence in this table.

SBP Low: ≤ 90
GroupValue95% CI
BAF312 10 mg/2 mg1
BAF312 2 mg/2 mg3
BAF312 1.25 mg/2 mg2
BAF312 .5 mg/2 mg1
BAF312 .25 mg/2 mg1
SBP ≥ 20 decrease from baseline
GroupValue95% CI
BAF312 10 mg/2 mg8
BAF312 2 mg/2 mg10
BAF312 1.25 mg/2 mg4
BAF312 .5 mg/2 mg6
BAF312 .25 mg/2 mg10
SBP High: ≥ 160
GroupValue95% CI
BAF312 10 mg/2 mg1
BAF312 2 mg/2 mg1
BAF312 1.25 mg/2 mg1
BAF312 .5 mg/2 mg3
BAF312 .25 mg/2 mg3
SBP ≥ 20 increase from baseline
GroupValue95% CI
BAF312 10 mg/2 mg9
BAF312 2 mg/2 mg8
BAF312 1.25 mg/2 mg12
BAF312 .5 mg/2 mg13
BAF312 .25 mg/2 mg18
DBP Low: ≤ 50
GroupValue95% CI
BAF312 10 mg/2 mg1
BAF312 2 mg/2 mg0
BAF312 1.25 mg/2 mg1
BAF312 .5 mg/2 mg0
BAF312 .25 mg/2 mg1
DBP ≥ 15 decrease from baseline
GroupValue95% CI
BAF312 10 mg/2 mg14
BAF312 2 mg/2 mg8
BAF312 1.25 mg/2 mg10
BAF312 .5 mg/2 mg10
BAF312 .25 mg/2 mg10
DBP High: ≥ 100
GroupValue95% CI
BAF312 10 mg/2 mg4
BAF312 2 mg/2 mg7
BAF312 1.25 mg/2 mg4
BAF312 .5 mg/2 mg4
BAF312 .25 mg/2 mg4
DBP ≥ 15 increase from baseline
GroupValue95% CI
BAF312 10 mg/2 mg9
BAF312 2 mg/2 mg13
BAF312 1.25 mg/2 mg13
BAF312 .5 mg/2 mg11
BAF312 .25 mg/2 mg17
Number of Participants With Viral Infections of Interest Greater or Equal to 5% in Any Dose Group (Extension Set) Primary · Baseline Extension up to approximately 5 years

Most infections were clinical diagnoses and were not confirmed by microbiology / virologic investigations. A patient with multiple occurrences of an infection for a preferred term is counted only once in each specific category. Events identified as infections by the Investigator and defined as an AE with onset on or after the first dose of Extension Study drug up to and including 30 days after the date of the last dose

Oral herpes
GroupValue95% CI
BAF312 10 mg/2 mg5
BAF312 2 mg/2 mg0
BAF312 1.25 mg/2 mg4
BAF312 .5 mg/2 mg2
BAF312 .25 mg/2 mg4
Herpes zoster
GroupValue95% CI
BAF312 10 mg/2 mg5
BAF312 2 mg/2 mg0
BAF312 1.25 mg/2 mg3
BAF312 .5 mg/2 mg2
BAF312 .25 mg/2 mg0
Influenza
GroupValue95% CI
BAF312 10 mg/2 mg3
BAF312 2 mg/2 mg4
BAF312 1.25 mg/2 mg3
BAF312 .5 mg/2 mg6
BAF312 .25 mg/2 mg6
Number of Participants With Dermatologic Alterations - Basal Cell Carcinoma (Extension Set) Primary · Baseline Extension up to approximately 5 years
GroupValue95% CI
BAF312 10 mg/2 mg1
BAF312 2 mg/2 mg0
BAF312 1.25 mg/2 mg1
BAF312 .5 mg/2 mg0
BAF312 .25 mg/2 mg1
Number of Relapses in One Year - Annualized Relapse Rates for Overall Extension Study (ARR) (Extension Set) Secondary · Baseline extension up to approximately 5 years

Group level ARR (raw) is calculated as the total number of relapses for all the patients in the treatment group divided by the total number of days on study for all patients in the group and multiplied by 365.25 to obtain the annual rate. Model estimates are based on a negative binomial regression model, adjusted for treatment group, age, baseline EDSS, baseline number of Gd-enhanced T1 lesions and number of relapses in previous 2 years as covariates, with log(time on study in years) as the offset variable, using the log link.

GroupValue95% CI
BAF312 10 mg/2 mg0.180.11 – 0.31
BAF312 2 mg/2 mg0.150.08 – 0.26
BAF312 1.25 mg/2 mg0.160.10 – 0.26
BAF312 .5 mg/2 mg0.190.11 – 0.33
BAF312 .25 mg/2 mg0.220.14 – 0.35
Percentage of Participants Free of Magnetic Resonance Imaging (MRI) Identified Disease Activity at Any Scan During Extension Study (Extension Set) Secondary · Baseline Extension up to approximately 5 years

Free of MRI disease activity is defined as free of Gadolinium enhanced T1 lesions at any scan; free of new or enlarging T2 lesions at any scan: free of both gadolinium enhanced T1 lesions and new or enlarging T2 lesions at any scan. Number of patients analyzed = patients with at least one MRI scan during the specified time period. New lesions at a specific visit are assessed relative to the previous scheduled visit scan. No imputation of missing scans is performed. As a result missing scans can lead to an overestimation of the proportion of patients free of a specific MRI activity.

Free of Gd-enhanced T1 lesions at any scan
GroupValue95% CI
BAF312 10 mg/2 mg58.1
BAF312 2 mg/2 mg57.7
BAF312 1.25 mg/2 mg58.1
BAF312 .5 mg/2 mg44.8
BAF312 .25 mg/2 mg66.0
Free of new/enlarging T2 lesions at any scan
GroupValue95% CI
BAF312 10 mg/2 mg32.3
BAF312 2 mg/2 mg42.3
BAF312 1.25 mg/2 mg46.5
BAF312 .5 mg/2 mg20.7
BAF312 .25 mg/2 mg40.4
Free of Gd-enhanced T1 and new enlarged T2 lesions
GroupValue95% CI
BAF312 10 mg/2 mg32.3
BAF312 2 mg/2 mg42.3
BAF312 1.25 mg/2 mg44.2
BAF312 .5 mg/2 mg20.7
BAF312 .25 mg/2 mg40.4
Percentage of Participants Free of Confirmed Disability Progression in Extension Study (Extension Set) Secondary · Baseline Extension up to approximately 5 years

Six-month disability progression was defined relative to extension baseline EDSS score: 1.5 point increase in patients with baseline EDSS score of 0, 1.0 increase in patients with baseline EDSS score of between 0.5 to 5.0, inclusive and 0.5 increase in patients with baseline EDSS score of ≥ 5.5. The criteria for 6-month disability progression included detection of onset of progression and confirmation of progression for a period of at least 6 months.

GroupValue95% CI
BAF312 10 mg/2 mg72.356.0 – 88.7
BAF312 2 mg/2 mg82.466.6 – 98.3
BAF312 1.25 mg/2 mg84.873.5 – 96.0
BAF312 .5 mg/2 mg81.466.6 – 96.1
BAF312 .25 mg/2 mg78.665.4 – 91.9

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse Events (AEs) are collected from First Patient First Visit (FPFV)until Last Patient Last Visit (LPLV). All AEs reported in this record are from date of First Patient First Treatment until Last Patient Last Visit.. Reporting threshold: 3.999%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

BAF312 10/2 mg
Serious: 4/33 (12%)
Deaths:
BAF312 2/2 mg
Serious: 7/29 (24%)
Deaths:
BAF312 1.25/2 mg
Serious: 6/43 (14%)
Deaths:
BAF312 0.5/2 mg
Serious: 6/29 (21%)
Deaths:
BAF312 0.25/2 mg
Serious: 8/50 (16%)
Deaths:
All Patients
Serious: 31/184 (17%)
Deaths:

Serious adverse events (40 terms)

ReactionSystemBAF312 10/2 mgBAF312 2/2 mgBAF312 1.25/2 mgBAF312 0.5/2 mgBAF312 0.25/2 mgAll Patients
Multiple sclerosis relapseNervous system disorders
Basal cell carcinomaNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Breast cancerNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Splenic cystBlood and lymphatic system disorders
OtosclerosisEar and labyrinth disorders
GlaucomaEye disorders
Abdominal discomfortGastrointestinal disorders
GastritisGastrointestinal disorders
NauseaGastrointestinal disorders
Pancreatitis acuteGastrointestinal disorders
VomitingGastrointestinal disorders
Submandibular massGeneral disorders
Biliary dyskinesiaHepatobiliary disorders
Anaphylactic reactionImmune system disorders
Oral herpesInfections and infestations
PyelonephritisInfections and infestations
Pyelonephritis acuteInfections and infestations
Respiratory tract infectionInfections and infestations
Upper respiratory tract infectionInfections and infestations
Urinary tract infectionInfections and infestations
Ankle fractureInjury, poisoning and procedural complications
Craniocerebral injuryInjury, poisoning and procedural complications
Femur fractureInjury, poisoning and procedural complications
Tendon ruptureInjury, poisoning and procedural complications
Smear cervix abnormalInvestigations
Other adverse events (125 terms — click to expand)

ReactionSystemBAF312 10/2 mgBAF312 2/2 mgBAF312 1.25/2 mgBAF312 0.5/2 mgBAF312 0.25/2 mgAll Patients
NasopharyngitisInfections and infestations
HeadacheNervous system disorders
Upper respiratory tract infectionInfections and infestations
InfluenzaInfections and infestations
LymphopeniaBlood and lymphatic system disorders
Urinary tract infectionInfections and infestations
InsomniaPsychiatric disorders
DiarrhoeaGastrointestinal disorders
Back painMusculoskeletal and connective tissue disorders
FatigueGeneral disorders
SinusitisInfections and infestations
Melanocytic naevusNeoplasms benign, malignant and unspecified (incl cysts and polyps)
DepressionPsychiatric disorders
PharyngitisInfections and infestations
VertigoEar and labyrinth disorders
BronchitisInfections and infestations
HypertensionVascular disorders
PyrexiaGeneral disorders
Oral herpesInfections and infestations
Alanine aminotransferase increasedInvestigations
Lymphocyte count decreasedInvestigations
CoughRespiratory, thoracic and mediastinal disorders
ArthralgiaMusculoskeletal and connective tissue disorders
Gamma-glutamyltransferase increasedInvestigations
Abdominal pain upperGastrointestinal disorders
HypercholesterolaemiaMetabolism and nutrition disorders
Pain in extremityMusculoskeletal and connective tissue disorders
ToothacheGastrointestinal disorders
GastroenteritisInfections and infestations
Herpes zosterInfections and infestations
TonsillitisInfections and infestations
Skin papillomaNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
FallInjury, poisoning and procedural complications
Musculoskeletal painMusculoskeletal and connective tissue disorders
ParaesthesiaNervous system disorders
AnxietyPsychiatric disorders
NauseaGastrointestinal disorders
CystitisInfections and infestations
ContusionInjury, poisoning and procedural complications

Most-reported serious reactions: Multiple sclerosis relapse, Basal cell carcinoma, Breast cancer, Splenic cyst, Otosclerosis, Glaucoma, Abdominal discomfort, Gastritis.

Data from ClinicalTrials.gov NCT01185821 adverse events section.

Sponsor's own description

This study consisted of a two year dose blinded phase during which patients received one of five doses of siponimod (10, 2, 1.25, 0.5 or 0.25mg) following which patients were switched to open label treatment with siponimod 2mg for approximately a further 3 years. It will provide data on long term safety, tolerability and efficacy of siponimod in the RRMS patient population

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Sphingosine 1-phosphate: Lipid signaling in pathology and therapy.
    Cartier A, Hla T. · · 2019 · cited 477× · PMID 31624181 · DOI 10.1126/science.aar5551
  2. Targeting the sphingosine-1-phosphate axis in cancer, inflammation and beyond.
    Kunkel GT, Maceyka M, Milstien S, Spiegel S. · · 2013 · cited 377× · PMID 23954895 · DOI 10.1038/nrd4099
  3. Sphingosine 1-Phosphate Receptor Modulators and Drug Discovery.
    Park SJ, Im DS. · · 2017 · cited 103× · PMID 28035084 · DOI 10.4062/biomolther.2016.160
  4. Sphingosine 1-Phosphate Receptor Modulators for the Treatment of Multiple Sclerosis.
    Chaudhry BZ, Cohen JA, Conway DS. · · 2017 · cited 99× · PMID 28812220 · DOI 10.1007/s13311-017-0565-4
  5. Blood-Brain Barrier: More Contributor to Disruption of Central Nervous System Homeostasis Than Victim in Neurological Disorders.
    Xiao M, Xiao ZJ, Yang B, Lan Z, et al · · 2020 · cited 87× · PMID 32903669 · DOI 10.3389/fnins.2020.00764
  6. Safety and Efficacy of Siponimod (BAF312) in Patients With Relapsing-Remitting Multiple Sclerosis: Dose-Blinded, Randomized Extension of the Phase 2 BOLD Study.
    Kappos L, Li DK, Stüve O, Hartung HP, et al · · 2016 · cited 79× · PMID 27380540 · DOI 10.1001/jamaneurol.2016.1451
  7. The S1P-S1PR Axis in Neurological Disorders-Insights into Current and Future Therapeutic Perspectives.
    Lucaciu A, Brunkhorst R, Pfeilschifter JM, Pfeilschifter W, et al · · 2020 · cited 53× · PMID 32580348 · DOI 10.3390/cells9061515
  8. Molecular and neuroimmune pharmacology of S1P receptor modulators and other disease-modifying therapies for multiple sclerosis.
    Kihara Y, Chun J. · · 2023 · cited 13× · PMID 37149155 · DOI 10.1016/j.pharmthera.2023.108432

Verify or expand the search:

Other trials of BAF312

Trials testing the same drug.

Other recruiting trials for Relapsing Remitting Multiple Sclerosis

Currently open trials in the same condition.

Other Novartis Pharmaceuticals trials

Trials by the same sponsor.

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