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Efficacy and safety of ofatumumab and siponimod compared to fingolimod in pediatric patients with multiple sclerosis
The study is divided into a Core Part and Extension Part. The Core Part is a 24-month, double-blind, triple dummy, randomized, 3-arm active-controlled in children/adolescent patients aged 10-17 years old with Multiple Sclerosis (MS). The Extension Part is 60-month (5 year) open label (except for first 12 weeks transition which will remain double-blind) treatment for patients who complete the Core Part of the study and meet all inclusion/exclusion criteria. The targeted enrollment is 120 participants with multiple sclerosis which will include at least 5 participants with body weight (BW) ≤40 kg and at least 5 participants with age 10 to 12 years in each of the ofatumumab and siponimod arms. There is a minimum 6 month follow up period for all participants (core and extension). Total duration of the study could be up to 7 years.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ofatumumab - 20 mg injection/ placebo | Experimental | Ofatumumab as a solution for injection in an autoinjector containing 20 mg ofatumumab (50 mg/mL, 0.4 mL content) for subcutaneous administration. A loading dose at Day1, Day 7 and Day 14 and then injections every 4 weeks/ 6 weeks (depending on patient's body weight). |
|
| siponimod - 0.5 mg, 1 mg or 2 mg/ placebo | Experimental | Siponimod tablet administered orally once daily. Titration period, Day 1 to Day 6, first dose is either 0.1 mg or 0.25 mg up to daily dose of either 0.5 mg, 1 mg or 2 mg (depending on CYP2C9 genotype and body weight). |
|
| fingolimod - 0.5 mg or 0.25 mg/ placebo | Active Comparator | Fingolimod capsule administered orally once daily at a dose of either 0.5 mg or 0.25 mg (depending on patient's body weight). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fingolimod | Drug | Fingolimod capsule administered orally once daily at a dose of either 0.5 mg or 0.25 mg (depending on patient's body weight). |
|
| Measure | Description | Time Frame |
|---|---|---|
| Annualized relapse rate (ARR) in target pediatric participants | Frequency of relapses assessed by the annualized relapse rate (ARR). The ARR is defined as the average number of confirmed relapses per year (total number of confirmed relapses divided by the total days in the study multiplied by 365.25). | Baseline up to 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Annualized relapse rate (ARR) as compared to historical interferon β-1a data | Frequency of relapses assessed by the annualized relapse rate (ARR) to historical interferon β-1a data. The ARR is defined as the average number of confirmed relapses per year. The historical data for interferon β-1a will derived from prior phase 3 studies. | Baseline up to 24 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Novartis Pharmaceuticals | Novartis Pharmaceuticals | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Arkansas Childrens Hosp Rsch Inst | Little Rock | Arkansas | 72202 | United States | ||
| Childrens Hospital Los Angeles |
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations.
This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest
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The core part of the study and the first 12 weeks of the extension period (transition) will be double-blinded and the remainder of the extension period will be open label.
|
| Ofatumumab | Drug | Ofatumumab as a solution for injection in an autoinjector containing 20 mg ofatumumab (50 mg/mL, 0.4 mL content) for subcutaneous administration. A loading dose at Day1, Day 7 and Day 14 and then injections every 4 weeks/ 6 weeks (depending on patient's body weight). |
|
|
| Siponimod | Drug | Siponimod tablet administered orally once daily. Titration period, Day 1 to Day 6, first dose is either 0.1 mg or 0.25 mg up to daily dose of either 0.5 mg, 1 mg or 2 mg (depending on CYP2C9 genotype and body weight). |
|
|
| Fingolimod placebo | Other | Fingolimod matching placebo capsule |
|
| Siponimod placebo | Other | Siponimod matching placebo tablet |
|
| Ofatumumab placebo | Other | Ofatumumab matching placebo autoinjector |
|
| Annualized T2 lesion rate | Number of new/newly enlarged T2 lesions per year | Baseline up to 24 months |
| Neurofilament light chain (NfL) concentrations | Neurofilament light chain (NfL) concentration in serum of ofatumumab and/or siponimod versus fingolimod | Day 1, Months 3,6,12,18,24 |
| Plasma Concentrations of ofatumumab | Ofatumumab plasma concentrations | Day 1, pre-dose for Day 7, Months 2,3,5,6,12,18,24 |
| Plasma Concentrations of siponimod | Siponimod plasma concentrations | Day 1 (2,3,4,6 h), Day 3 (2,3,4,6 h), pre-dose for Months 1 (pre, 3h), 3,5,12 |
| Plasma Concentrations of siponimod metabolite (M17) | Siponimod metabolite (M17) plasma concentration | Pre-dose Month 3, 5 and Month 12 |
| Percentage of participants with anti-ofatumumab antibodies | Anti-ofatumumab antibodies to demonstrate immunogenicity of ofatumumab | Day 1, Pre-Dose Months 2,3,5,6,12,18,24 |
| Number of adverse events and serious adverse events | Any clinically relevant finding that meets the criteria of an adverse event (as determined by the investigator) identified during the safety assessments (ECG, laboratory and ophthalmological data, pulmonary function tests and vital signs) will be reported as an adverse event | Baseline up approximately 66 months |
| Los Angeles |
| California |
| 90027 |
| United States |
| Childrens National Medical Center | Washington D.C. | District of Columbia | 20010 | United States |
| Axiom Clinical Research of Florida | Tampa | Florida | 33609 | United States |
| Childrens Hospital of Philadelphia | Philadelphia | Pennsylvania | 19104 4399 | United States |
| Medical College of Wisconsin | Milwaukee | Wisconsin | 53226 | United States |
| Novartis Investigative Site | CABA | C1181ACH | Argentina |
| Novartis Investigative Site | Parkville | Victoria | 3052 | Australia |
| Novartis Investigative Site | Vienna | 1090 | Austria |
| Novartis Investigative Site | Esneux | 4130 | Belgium |
| Novartis Investigative Site | Ghent | 9000 | Belgium |
| Novartis Investigative Site | Curitiba | Paraná | 81210-310 | Brazil |
| Novartis Investigative Site | Porto Alegre | Rio Grande do Sul | 90430-001 | Brazil |
| Novartis Investigative Site | São Paulo | São Paulo | 05403-000 | Brazil |
| Novartis Investigative Site | Montreal | Quebec | H3A 2B4 | Canada |
| Novartis Investigative Site | Montreal | Quebec | H3T 1C5 | Canada |
| Novartis Investigative Site | Lo Barnechea | Santiago Metropolitan | 7691236 | Chile |
| Novartis Investigative Site | Zagreb | 10000 | Croatia |
| Novartis Investigative Site | Tallinn | 11315 | Estonia |
| Novartis Investigative Site | Le Kremlin-Bicêtre | 94275 | France |
| Novartis Investigative Site | Montpellier | 34090 | France |
| Novartis Investigative Site | Strasbourg | 67000 | France |
| Novartis Investigative Site | Freiburg im Breisgau | Baden-Wurttemberg | 79106 | Germany |
| Novartis Investigative Site | Göttingen | Lower Saxony | 37075 | Germany |
| Novartis Investigative Site | Bochum | 44791 | Germany |
| Novartis Investigative Site | Guatemala City | 01015 | Guatemala |
| Novartis Investigative Site | New Delhi | National Capital Territory of Delhi | 110017 | India |
| Novartis Investigative Site | Lucknow | Uttar Pradesh | 226014 | India |
| Novartis Investigative Site | Kolkata | West Bengal | 700017 | India |
| Novartis Investigative Site | Petah Tikva | 4920235 | Israel |
| Novartis Investigative Site | Roma | RM | 00165 | Italy |
| Novartis Investigative Site | Naples | 80131 | Italy |
| Novartis Investigative Site | Riga | LV-1004 | Latvia |
| Novartis Investigative Site | Mexico City | Mexico City | 06700 | Mexico |
| Novartis Investigative Site | Mexico City | Mexico City | 06720 | Mexico |
| Novartis Investigative Site | Gdansk | 80-214 | Poland |
| Novartis Investigative Site | Lodz | 93-338 | Poland |
| Novartis Investigative Site | Poznan | 60-355 | Poland |
| Novartis Investigative Site | Warsaw | 04-730 | Poland |
| Novartis Investigative Site | Coimbra | 3000-602 | Portugal |
| Novartis Investigative Site | Lisbon | 1169-050 | Portugal |
| Novartis Investigative Site | Belgrade | 11000 | Serbia |
| Novartis Investigative Site | Bratislava | 833 40 | Slovakia |
| Novartis Investigative Site | Barakaldo | Vizcaya | 48903 | Spain |
| Novartis Investigative Site | Seville | 41009 | Spain |
| Novartis Investigative Site | Tainan | 704302 | Taiwan |
| Novartis Investigative Site | Taipei | 10002 | Taiwan |
| Novartis Investigative Site | Samsun | Atakum | 55200 | Turkey (Türkiye) |
| Novartis Investigative Site | Istanbul | Fatih | 34098 | Turkey (Türkiye) |
| Novartis Investigative Site | Izmir | Karsiyaka | 35575 | Turkey (Türkiye) |
| Novartis Investigative Site | Kocaeli | 41380 | Turkey (Türkiye) |
| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D012008 | Recurrence |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000068876 | Fingolimod Hydrochloride |
| C527517 | ofatumumab |
| C578989 | siponimod |
| ID | Term |
|---|---|
| D013110 | Sphingosine |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
| D011409 | Propylene Glycols |
| D006018 | Glycols |
| D000588 | Amines |
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