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RecruitingInterventionalPhase 3

A Randomized, Double-blind, Placebo-controlled Phase III Study to Evaluate the Efficacy, Safety, and Tolerability of Remibrutinib in Patients With Generalized Myasthenia Gravis, Followed by an Open-label Extension Phase

NCT ID: NCT06744920Sponsor: Novartis PharmaceuticalsLast updated: 2026-06-01

Summary

A study to evaluate the efficacy, safety and tolerability of Remibrutinib versus placebo in adult patients with Generalized Myasthenia Gravis who are on stable, standard-of-care (SOC) treatment.

Detailed description

This study is a randomized, double-blind, placebo-controlled, multicenter, Phase III study, to evaluate the efficacy, safety and tolerability of remibrutinib in gMG patients who are on stable SOC treatment. Approximately 180 eligible participants will be randomized in a ratio of 1:1, to receive either remibrutinib or matching placebo. The study consists of a Core Part (6-months double-blind treatment) and an Extension Part (up to 60-month open-label treatment).

Arms & interventions

  • DrugRemibrutinib (Blinded)

    Remibrutinib (Blinded) active treatment

  • OtherPlacebo

    Placebo

  • DrugRemibrutinib (Open Label)

    Remibrutinib (Open Label) active treatment

Outcome measures

Primary

  • Change from baseline to Month 6 in Myasthenia Gravis Activity of Daily Living (MG-ADL) total score

    The MG-ADL is a categorical scale that assesses MG symptoms and their effects on daily activities. MG-ADL is composed of items related to patient's assessment of functional disability secondary to ocular (2 items), bulbar (3 items), respiratory (1 item), and gross motor or limb (2 items) impairment related to effects from MG. Each item is assessed on a 4-points scale where a score 0 represents normal function and a score 3 represents loss of ability to perform that function (total score 0 to 24).

    Time frame: Baseline to Month 6

Secondary

  • Change from baseline to Month 6 in Quantitative Myasthenia Gravis (QMG) total score

    Time frame: Baseline to Month 6

  • Proportion of participants with ≥ 5 points reduction from baseline to Month 6 of QMG total score without rescue medication and/or strongly confounding prohibited medication

    Time frame: Baseline to Month 6

  • Proportion of participants with ≥ 3 points reduction from baseline to Month 6 of Myasthenia Gravis Activity of Daily Living (MG-ADL) scale total score without rescue medication and/or strongly confounding prohibited medication

    Time frame: Baseline to Month 6

  • Proportion of participants achieving Minimal Symptom Expression (MSE) at Month 6, defined as MG-ADL score of 0 or 1 at Month 6 without rescue therapy and/or strongly confounding prohibited medication

    Time frame: Month 6

  • Change from baseline to Month 6 in Myasthenia Gravis Composite score (MGC) total score

    Time frame: Baseline to Month 6

  • Change from baseline to Month 6 in revised Myasthenia Gravis Quality of Life Questionnaire (MG-QOL15r) survey score

    Time frame: Baseline to Month 6

  • Incidence of adverse events

    Time frame: Baseline to Month 6

  • Proportion of time during which participants showed a reduction of ≥ 2 points in MG-ADL total score, that was maintained up to Month 6

    Time frame: Baseline to Month 6

  • Proportion of early MG-ADL responders during treatment (early responders with first MG-ADL improvement from baseline of ≥ 2 points occurring by week 4)

    Time frame: Baseline to week 4

  • Change from baseline to Month 6 in EuroQol-5 Dimensions-5 Level (EQ-5D-5L)

    Time frame: Baseline to Month 6

  • Proportion of participants achieving a reduction from baseline of ≥ 3 points in MGC total score at Month 6

    Time frame: Baseline to Month 6

  • Change from baseline in MG-ADL total score

    Time frame: Baseline to Month 66

  • Proportion of participants achieving a reduction from core part in oral corticosteroids (OCS) dose till the end of extension part

    Time frame: Baseline to month 66

  • Incidence of adverse events

    Time frame: Month 7 to month 66

Eligibility criteria

Sex: AllAge: 18 Years to 75 YearsHealthy volunteers: No
Inclusion Criteria: * Adult patients with gMG (age 18-75 years) * Confirmed diagnosis of Myasthenia Gravis Foundation of America (MGFA) Class II-IV gMG at screening and likely not in need of a respirator for the duration of the study, as judged by the Investigator * Documented evidence of positive serologic testing for AChR+ antibody or MuSK+ antibody at screening, OR seronegative for both AChR and MuSK antibodies at screening * Baseline MG-ADL score ≥ 6 with ≥ 50% of the total score due to non ocular symptoms * Participants who have been on a stable dose of standard-of-care treatment as specified in the protocol * Able to safely swallow the study medication according to investigator clinical judgement based on a bedside swallowing test or another formal swallowing test in line with local practice, both at Screening and Baseline Exclusion Criteria: * Prior to baseline have been treated with intravenous immunoglobulins or plasma exchange (IVIg/PLEX) in the past month, with rituximab in the past 6 months, eculizumab in the past 2 months, ravulizumab or other complement inhibitors in the past 3 months, efgartigimod or other anti-FcRn therapies in the past 3 months, or had a thymectomy in the past 6 months or a planned thymectomy during the trial period * Women of child bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during dosing and for 1 week after stopping of study treatment Other protocol-defined inclusion/exclusion criteria may apply.

Study locations (24)

Neuromuscular Research Center

Phoenix, Arizona, 85013

Recruiting
Lucia Rodriguez · Contact
Kumaraswamy Sivakumar · Principal Investigator

Honor Health Research Institute

Scottsdale, Arizona, 85258

Recruiting
Kristy Osgood · Contact
Anne Hatch · Principal Investigator

Fullerton Neuro and Headache Ctr

Fullerton, California, 92835

Recruiting
Alexandra Vasquez · Contact
Jack H Florin · Principal Investigator

University Of Southern California

Los Angeles, California, 90033

Recruiting
Said R Beydoun. · Principal Investigator

Univ Cali Irvine ALS Neuromuscular

Orange, California, 92868

Recruiting
Karina Bjazevic · Contact
Ali Habib · Principal Investigator

California Pacific Medical Center

Sacramento, California, 94115

Recruiting
Liberty Jenkins · Principal Investigator

Medstar Washington Hospital Center

Washington D.C., District of Columbia, 20010-2975

Recruiting
Anu Bhooshan · Contact
Nicholas Streicher · Principal Investigator

SFM Clinical Research LLC

Boca Raton, Florida, 33487

Recruiting
Gabrielle Demaria · Contact
Marc Feinberg · Principal Investigator

Homestead Assoc In Research Inc

Homestead, Florida, 33033

Recruiting
Christopher Jimenez · Principal Investigator

Neurology Associates PA

Maitland, Florida, 32751

Recruiting
Kelly Holley · Contact
Arnaldo Isa · Principal Investigator

AdventHealth

Orlando, Florida, 32804

Recruiting
Anita Fletcher · Principal Investigator

Neurological Services of Orlando PA

Orlando, Florida, 32806

Recruiting
Tanya Palafox · Contact
Daniel H Jacobs · Principal Investigator

University of Chicago Medical Centr

Chicago, Illinois, 60637

Recruiting
Deekshitha Turaka · Contact
Kourosh Rezania · Principal Investigator

Mid Atlantic Epilepsy and Sleep Ctr

Bethesda, Maryland, 20817-1807

Recruiting
Arkady Barber · Contact
Jonathan Ross · Principal Investigator

Neuromuscular Diagnostic Center

Boston, Massachusetts, 02114

Recruiting
Amanda Guidon · Principal Investigator

Michigan State University-Department of Neurology

East Lansing, Michigan, 48824

Recruiting
Aubrey Alexander · Contact
Amit Sachdev · Principal Investigator

Dent Neurological Institute

Buffalo, New York, 14209

Recruiting
Bennett Myers · Principal Investigator

Univ of Cincinnati Medical Center

Cincinnati, Ohio, 45219

Recruiting
Hani Kushlaf · Principal Investigator

Cleveland Clinic Foundation

Cleveland, Ohio, 44195

Recruiting
Debbie Hastings · Contact
Yuebing Li · Principal Investigator

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, 15213

Recruiting
Gabriela Niizawa · Contact
Fang Sun · Principal Investigator

Houston Methodist Hospital

Houston, Texas, 77030

Recruiting
Ericka Greene · Principal Investigator

UT Health Science Center

Houston, Texas, 77030

Recruiting
Ari Broussard · Contact
Thy Nguyen · Principal Investigator

University of WA Division of Cardio

Seattle, Washington, 98195

Recruiting
Kaycie Opiyo · Contact
Barbara Jane Distad · Principal Investigator

Center for Neurological Disorders G

Greenfield, Wisconsin, 53228-1321

Recruiting
Emily Barraza · Contact
Bhupendra Khatri. · Principal Investigator