A Study to Learn About the Safety of BIIB091 and Its Effect on Brain Inflammation When Taken Alone or With Diroximel Fumarate (DRF) in Adults With Relapsing Forms of Multiple Sclerosis (MS)

Last updated: February 18, 2026
Sponsor: Biogen
Overall Status: Completed

Phase

2

Condition

Neurologic Disorders

Multiple Sclerosis

Memory Loss

Treatment

BIIB091

Placebo

DRF

Clinical Study ID

NCT05798520
257MS201
2022-502552-31
2022-502552-31-00
  • Ages 18-55
  • All Genders

Study Summary

In this study, researchers will learn more about a study drug called BIIB091 in participants with MS who may be experiencing relapses. It is a 2-part study.

In Part 1, one set of participants will take either BIIB091 or diroximel fumarate (DRF). In Part 2, a different set of participants will take either a combination of BIIB091 and DRF or DRF alone.

The goal of the study is to learn more about the safety of BIIB091 and to compare the effects of the study drug when taken alone or together with DRF.

The main question researchers are trying to answer are:

  • How many participants have new or worsening medical problems (adverse events) after taking BIIB091 or DRF?

  • How many new areas of inflammation occur in the brain after treatment with BIIB091 and DRF?

Researchers will use magnetic resonance imaging (MRI) scans to compare images of the brain before and after treatment. They will also explore the effect of BIIB091 and DRF on the heart using electrocardiograms (ECGs).

The study will be done as follows:

  • After screening, participants who joined Part 1 will be randomly assigned to receive either a high or low dose of BIIB091, or the standard dose of DRF.

  • The results of Part 1 will be used to choose the best dose of BIIB091 to use in Part

  • Participants who join Part 2 will be randomly assigned to receive either a standard dose of DRF, a combo of BIIB091 and the standard dose of DRF, or a combo of BIIB91 with a low dose of DRF.

  • Neither the researchers nor the participants will know which drug or dose the participants will receive in either part of the study.

  • The treatment period will last 48 weeks in each part of the study. Participants will take the drugs by mouth 2 times a day.

  • Each part will also have a follow-up safety period that lasts up to 2 weeks.

  • In total, participants in each part will have 20 study visits, or more if they have a relapse. The total study duration for participants will be up to 54 weeks.

Eligibility Criteria

Inclusion

Key Inclusion Criteria:

  1. Diagnosis of RMS [relapsing-remitting multiple sclerosis (RRMS) or active secondaryprogressive multiple sclerosis (SPMS)] in accordance with the 2017 Revised McDonaldcriteria.

  2. Time since MS symptom onset is <20 years.

  3. Must have expanded disability status scale (EDSS) score of 0 through 5.0 atscreening and baseline.

  4. Must have at least 1 of the following occurring prior to Baseline (Day 1):

  • ≥2 clinical relapses in the last 24 months (but not within 30 days prior toBaseline [Day 1]) with at least 1 relapse during the last 12 months prior torandomization.

  • ≥1 clinical relapse within the past 24 months (but not within 30 days prior toBaseline [Day 1]) and ≥1 new brain MRI lesion (Gd-positive and/or new orenlarging T2 hyperintense lesion) within the past 12 months prior torandomization. The screening MRI could be used to satisfy this criterion (ifneeded for inclusion, local reading is required). For new or enlarging T2hyperintense lesions, the reference scan cannot be >12 months prior torandomization.

  • ≥1 GdE lesion on brain MRI within 6 months prior to randomization.

Exclusion

Key Exclusion Criteria:

  1. Diagnosis of primary progressive multiple sclerosis (PPMS) in accordance with the 2017 Revised McDonald criteria.

  2. An MS relapse that has occurred within 30 days prior to Baseline (Day 1) or theparticipant has not stabilized from a previous relapse at the time of screening.

  3. History of severe allergic, anaphylactic reactions or hypersensitivity reaction toBIIB091 or DRF, the excipients contained in the formulation, and if appropriate, anydiagnostic agents to be administered during the study, including the following:

  • Known hypersensitivity to any components of the study treatment

  • Known hypersensitivity to previous fumarate or bruton's tyrosine kinase (BTK)inhibitor treatments

  • History of hypersensitivity to parenteral administration of Gd-based contrastagents

  1. Evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectionwithin the past 4 weeks prior to Baseline.

  2. History of human immunodeficiency virus (HIV) infection or a positive orindeterminate test result at screening for HIV.

  3. Current or history of hepatitis C infection regardless of viral load.

  4. Current or history of hepatitis B infection.

  5. Current enrollment or plan to enroll in any other drug, biological, device, clinicalstudy, or treatment with an investigational drug or approved therapy forinvestigational use within 90 days prior to randomization or 5 half-lives of thedrug or therapy, whichever is longer.

NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.

Study Design

Total Participants: 127
Treatment Group(s): 3
Primary Treatment: BIIB091
Phase: 2
Study Start date:
July 25, 2023
Estimated Completion Date:
February 10, 2026

Study Description

The primary objectives of this study are to investigate the safety and tolerability of BIIB091 monotherapy in participants with relapsing multiple sclerosis (RMS) in Part 1 and to evaluate the effects of BIIB091 combination therapy with DRF compared with the DRF monotherapy arm on the key MRI measure of active central nervous system (CNS) inflammation in Part 2.

The secondary objectives of Part 1 of the study are to evaluate the effects of BIIB091 monotherapy on the MRI measures of active CNS inflammation and to assess the effect of BIIB091 monotherapy on QTc and other ECG parameters. The secondary objectives of Part 2 are to evaluate the effects of BIIB091 combination therapy with DRF compared with the DRF monotherapy arm on additional MRI measures of active CNS inflammation, the safety and tolerability of BIIB091 combination therapy with DRF in participants with RMS, and the effect of BIIB091 combination therapy with DRF on QTc and other ECG parameters.

Part 1 of the study was concluded normally. Sponsor decision was to not conduct part 2.

Connect with a study center

  • 'MHAT Avis - Medica' OOD

    Pleven, 5800
    Bulgaria

    Site Not Available

  • UMHAT 'Dr. Georgi Stranski', EAD

    Pleven, 5800
    Bulgaria

    Active - Recruiting

  • 'MHAT Avis - Medica' OOD

    Pleven 728203, 5800
    Bulgaria

    Site Not Available

  • UMHAT 'Dr. Georgi Stranski', EAD

    Pleven 728203, 5800
    Bulgaria

    Site Not Available

  • UMHAT 'Sv. Georgi', EAD

    Plovdiv, 4002
    Bulgaria

    Site Not Available

  • UMHAT 'Sv. Georgi', EAD

    Plovdiv 728193, 4002
    Bulgaria

    Site Not Available

  • Acibadem City Clinic Tokuda University Hospital Ead

    Sofia, 1407
    Bulgaria

    Active - Recruiting

  • DCC Neoclinic EAD

    Sofia, 1408
    Bulgaria

    Active - Recruiting

  • Diagnostic Consultation Center CONVEX EOOD

    Sofia, 1680
    Bulgaria

    Active - Recruiting

  • MHATNP 'Sv.Naum', EAD

    Sofia, 1113
    Bulgaria

    Site Not Available

  • UMHAT "Sv. Ivan Rilski", EAD

    Sofia, 1431
    Bulgaria

    Active - Recruiting

  • University First MHAT-Sofia, 'St. Joan Krastitel' EAD

    Sofia, 1142
    Bulgaria

    Active - Recruiting

  • Acibadem City Clinic Tokuda University Hospital Ead

    Sofia 727011, 1407
    Bulgaria

    Site Not Available

  • DCC Neoclinic EAD

    Sofia 727011, 1408
    Bulgaria

    Site Not Available

  • Diagnostic Consultation Center CONVEX EOOD

    Sofia 727011, 1680
    Bulgaria

    Site Not Available

  • MHATNP 'Sv.Naum', EAD

    Sofia 727011, 1113
    Bulgaria

    Site Not Available

  • UMHAT "Sv. Ivan Rilski", EAD

    Sofia 727011, 1431
    Bulgaria

    Site Not Available

  • University First MHAT-Sofia, 'St. Joan Krastitel' EAD

    Sofia 727011, 1142
    Bulgaria

    Site Not Available

  • Ospedale Regionale di Lugano

    Lugano, Ticino 6903
    Czechia

    Active - Recruiting

  • Fakultni nemocnice u sv. Anny v Brne

    Brno, 65691
    Czechia

    Site Not Available

  • Fakultni nemocnice u sv. Anny v Brne

    Brno 3078610, 65691
    Czechia

    Site Not Available

  • Fakultni nemocnice Hradec Kralove

    Hradec Kralove, 50005
    Czechia

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  • Fakultni nemocnice Hradec Kralove

    Hradec Králové 3074967, 50005
    Czechia

    Site Not Available

  • Nemocnice Jihlava p.o.

    Jihlava, 58633
    Czechia

    Site Not Available

  • Nemocnice Jihlava p.o.

    Jihlava 3074199, 58633
    Czechia

    Site Not Available

  • Fakultni Thomayerova nemocnice

    Praha 4-Krc, 14059
    Czechia

    Site Not Available

  • Krajska zdravotni a.s. - Nemocnice Teplice o.z.

    Teplice, 41529
    Czechia

    Site Not Available

  • Krajska zdravotni a.s. - Nemocnice Teplice o.z.

    Teplice 3064288, 41529
    Czechia

    Site Not Available

  • Studienzentrum fur Neurologie und Psychiatrie

    Boeblingen, Baden Wuerttemberg 71034
    Germany

    Site Not Available

  • Studienzentrum fur Neurologie und Psychiatrie

    Böblingen 2947444, Baden-Wurttemberg 2953481 71034
    Germany

    Site Not Available

  • Klinikum Bayreuth GmbH- Hohe Warte

    Bayreuth 2951825, Bavaria 2951839 95445
    Germany

    Site Not Available

  • Neuropraxis Muenchen Sued

    Unterhaching 2819465, Bavaria 2951839 82008
    Germany

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  • Klinikum Bayreuth GmbH- Hohe Warte

    Bayreuth, Bayern 95445
    Germany

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  • Neuropraxis Muenchen Sued

    Unterhaching, Bayern 82008
    Germany

    Site Not Available

  • Universitaetsklinikum Duesseldorf AoeR

    Duesseldorf, Nordrhein Westfalen 40225
    Germany

    Site Not Available

  • ZNS - Zentrum fuer Neurologisch-Psychiatrische Studien

    Siegen, Nordrhein Westfalen 57076
    Germany

    Site Not Available

  • Universitaetsklinikum Duesseldorf AoeR

    Düsseldorf 2934246, North Rhine-Westphalia 2861876 40225
    Germany

    Site Not Available

  • ZNS - Zentrum fuer Neurologisch-Psychiatrische Studien

    Siegen 2832495, North Rhine-Westphalia 2861876 57076
    Germany

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  • Universitaetsklinikum Carl Gustav Carus TU Dresden

    Dresden, 01307
    Germany

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  • Universitaetsklinikum Carl Gustav Carus TU Dresden

    Dresden 2935022, 01307
    Germany

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  • I.R.C.C.S. Neuromed-Istituto Neurologico Mediterraneo

    Pozzilli, Isernia 86077
    Italy

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  • I.R.C.C.S. Neuromed-Istituto Neurologico Mediterraneo

    Pozzilli 3170006, Isernia 86077
    Italy

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  • Fondazione Istituto G.Giglio di Cefalù

    Cefalù, Palermo 90015
    Italy

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  • Fondazione Istituto G.Giglio di Cefalù

    Cefalù 2525041, Palermo 90015
    Italy

    Site Not Available

  • IRCCS Ospedale Policlinico San Martino

    Genova, 16132
    Italy

    Site Not Available

  • IRCCS Ospedale Policlinico San Martino

    Genova 8969657, 16132
    Italy

    Site Not Available

  • Azienda Ospedaliera Universitaria- Università degli Studi della Campania "Luigi Vanvitelli"

    Napoli, 80138
    Italy

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  • Azienda Ospedaliera Universitaria- Università degli Studi della Campania "Luigi Vanvitelli"

    Napoli 9031661, 80138
    Italy

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  • Fondazione Istituto Neurologico Casimiro Mondino

    Pavia, 27100
    Italy

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  • Fondazione Istituto Neurologico Casimiro Mondino

    Pavia 3171366, 27100
    Italy

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  • Azienda Ospedaliera Universitaria Policlinico Tor Vergata

    Roma, 00133
    Italy

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  • Azienda Ospedaliera Universitaria Policlinico Umberto I - Università di Roma La Sapienza

    Roma, 00161
    Italy

    Active - Recruiting

  • Azienda Ospedaliera Universitaria Policlinico Tor Vergata

    Roma 8957247, 00133
    Italy

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  • Azienda Ospedaliera Universitaria Policlinico Umberto I - Università di Roma La Sapienza

    Roma 8957247, 00161
    Italy

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  • COPERNICUS Podmiot Leczniczy Sp. z o. o.,

    Gdansk, 80-803
    Poland

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  • COPERNICUS Podmiot Leczniczy Sp. z o. o.,

    Gdansk 3099434, 80-803
    Poland

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  • Samodzielny Publiczny Specjalistyczny Szpital Zachodni im. Jana Pawla II

    Grodzisk Mazowiecki, 05-825
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  • Samodzielny Publiczny Specjalistyczny Szpital Zachodni im. Jana Pawla II

    Grodzisk Mazowiecki 771401, 05-825
    Poland

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  • Centrum Medyczne Pratia Katowice

    Katowice, 40-081
    Poland

    Site Not Available

  • M.A. - LEK A.M.Maciejowscy SC.

    Katowice, 40-571
    Poland

    Active - Recruiting

  • Nzoz Novo-Med

    Katowice, 40-650
    Poland

    Active - Recruiting

  • Centrum Medyczne Pratia Katowice

    Katowice 3096472, 40-081
    Poland

    Site Not Available

  • M.A. - LEK A.M.Maciejowscy SC.

    Katowice 3096472, 40-571
    Poland

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    Katowice 3096472, 40-650
    Poland

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  • Resmedica Sp.z o.o

    Kielce, 25-726
    Poland

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  • Resmedica Sp.z o.o

    Kielce 769250, 25-726
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  • MCD Medical

    Krakow, 31-637
    Poland

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  • Szpital Uniwersytecki w Krakowie

    Krakow, 31-503
    Poland

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  • Szpital Uniwersytecki w Krakowie

    Krakow 3094802, 31-503
    Poland

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  • Centrum Neurologii K. Selmaj

    Lodz, 90-324
    Poland

    Site Not Available

  • Centrum Neurologii K. Selmaj

    Lodz 3093133, 90-324
    Poland

    Site Not Available

  • Instytut Zdrowia dr Boczarska-Jedynak sp.z.o.o, Sp.K

    Oswiecim, 32-600
    Poland

    Site Not Available

  • Instytut Zdrowia dr Boczarska-Jedynak sp.z.o.o, Sp.K

    Oświęcim 3089658, 32-600
    Poland

    Site Not Available

  • Med-Polonia Sp. z o.o.

    Poznan, 60-693
    Poland

    Active - Recruiting

  • NZOZ 'NEURO-KARD', 'Ilkowski i Partnerzy' Sp. Partn. Lek.

    Poznan, 61-853
    Poland

    Site Not Available

  • Med-Polonia Sp. z o.o.

    Poznan 3088171, 60-693
    Poland

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  • NZOZ 'NEURO-KARD', 'Ilkowski i Partnerzy' Sp. Partn. Lek.

    Poznan 3088171, 61-853
    Poland

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  • Nzoz Palomed

    Rzeszów, 35-323
    Poland

    Site Not Available

  • Nzoz Palomed

    Rzeszów 759734, 35-323
    Poland

    Site Not Available

  • NeuroProtect Sp. z o.o.

    Warsaw 756135, 01-684
    Poland

    Site Not Available

  • NeuroProtect Sp. z o.o.

    Warszawa, 01-684
    Poland

    Site Not Available

  • Wielospecjalistyczne Centrum Medyczne Ibismed

    Zabrze, 41-800
    Poland

    Site Not Available

  • Wielospecjalistyczne Centrum Medyczne Ibismed

    Zabrze 3080985, 41-800
    Poland

    Site Not Available

  • Caribbean Center for Clinical Research

    Guaynabo, San Juan 4568138 00968
    Puerto Rico

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  • S.C Neurocity S.R.L

    Bucharest 683506, 11302
    Romania

    Site Not Available

  • Spitalul Universitar de Urgenta Elias

    Bucharest 683506, 11461
    Romania

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  • Spitalul Universitar de Urgenta Elias

    Bucuresti, 11461
    Romania

    Site Not Available

  • S.C Neurocity S.R.L

    București, 11302
    Romania

    Site Not Available

  • S.C Clubul Sanatatii SRL

    Campulung Muscel, 115100
    Romania

    Site Not Available

  • S.C Clubul Sanatatii SRL

    Campulung Muscel 681850, 115100
    Romania

    Site Not Available

  • Hospital Universitario Quironsalud Madrid

    Pozuelo de Alarcon, Madrid 28223
    Spain

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  • Hospital Universitario Quironsalud Madrid

    Pozuelo de Alarcón 3112989, Madrid 3117732 28223
    Spain

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  • Hospital Universitario Virgen de la Arrixaca

    El Palmar, Murcia 30120
    Spain

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  • Hospital Universitario Virgen de la Arrixaca

    El Palmar 2518294, Murcia 2513413 30120
    Spain

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  • Hospital del Mar

    Barcelona, 08003
    Spain

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    Barcelona 3128760, 08003
    Spain

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  • Hospital Universitario Reina Sofia

    Cordoba, 14011
    Spain

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  • Hospital Universitario Reina Sofia

    Córdoba 2519240, 14011
    Spain

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  • Hospital Universitario Ramon y Cajal

    Madrid, 28034
    Spain

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  • Hospital Universitario Ramon y Cajal

    Madrid 3117735, 28034
    Spain

    Site Not Available

  • Hospital Regional Universitario de Malaga

    Malaga, 29010
    Spain

    Site Not Available

  • Hospital Regional Universitario de Malaga

    Málaga 2514256, 29010
    Spain

    Site Not Available

  • Ospedale Regionale di Lugano

    Lugano 2659836, Canton Ticino 2658370 6903
    Switzerland

    Site Not Available

  • Ospedale Regionale di Lugano

    Lugano, Ticino 6903
    Switzerland

    Site Not Available

  • Inselspital - Universitaetsspital Bern

    Bern, 3010
    Switzerland

    Site Not Available

  • Inselspital - Universitaetsspital Bern

    Bern 2661552, 3010
    Switzerland

    Site Not Available

  • Universitaetsspital Zuerich

    Zuerich, 8091
    Switzerland

    Site Not Available

  • Universitaetsspital Zuerich

    Zurich 2657896, 8091
    Switzerland

    Site Not Available

  • HonorHealth Neurology

    Scottsdale, Arizona 85251
    United States

    Site Not Available

  • HonorHealth Neurology

    Scottsdale 5313457, Arizona 5551752 85251
    United States

    Site Not Available

  • Alta Bates Summit Medical Center

    Berkeley, California 94705
    United States

    Site Not Available

  • University of California at Irvine Medical Center

    Orange, California 92868
    United States

    Site Not Available

  • Alta Bates Summit Medical Center

    Berkeley 5327684, California 5332921 94705
    United States

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  • University of California at Irvine Medical Center

    Orange 5379513, California 5332921 92868
    United States

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  • University of Colorado School of Medic

    Aurora, Colorado 80045
    United States

    Site Not Available

  • University of Colorado School of Medic

    Aurora 5412347, Colorado 5417618 80045
    United States

    Site Not Available

  • University of Miami Miller School of Medicine

    Miami, Florida 33136
    United States

    Site Not Available

  • University of South Florida

    Tampa, Florida 33612
    United States

    Site Not Available

  • Vero Beach Neurology and Research Institute

    Vero Beach, Florida 32960
    United States

    Site Not Available

  • University of Miami Miller School of Medicine

    Miami 4164138, Florida 4155751 33136
    United States

    Site Not Available

  • University of South Florida

    Tampa 4174757, Florida 4155751 33612
    United States

    Site Not Available

  • Vero Beach Neurology and Research Institute

    Vero Beach 4176409, Florida 4155751 32960
    United States

    Site Not Available

  • Fort Wayne Neurological Center

    Fort Wayne, Indiana 46804
    United States

    Site Not Available

  • Fort Wayne Neurology

    Fort Wayne, Indiana 46845
    United States

    Active - Recruiting

  • Fort Wayne Neurological Center

    Fort Wayne 4920423, Indiana 4921868 46804
    United States

    Site Not Available

  • University of Kansas Medical Center Research Institute, Inc.

    Kansas City, Kansas 66160
    United States

    Site Not Available

  • University of Kansas Medical Center Research Institute, Inc.

    Kansas City 4273837, Kansas 4273857 66160
    United States

    Site Not Available

  • International Neurorehabilitation Institute

    Lutherville, Maryland 21093
    United States

    Site Not Available

  • International Neurorehabilitation Institute

    Lutherville 4361379, Maryland 4361885 21093
    United States

    Site Not Available

  • Washington University

    Saint Louis, Missouri 63110
    United States

    Site Not Available

  • Washington University

    St Louis 4407066, Missouri 4398678 63110
    United States

    Site Not Available

  • Holy Name

    Teaneck, New Jersey 07666
    United States

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  • Holy Name

    Teaneck 5105262, New Jersey 5101760 07666
    United States

    Site Not Available

  • University of New Mexico

    Albuquerque, New Mexico 87131-0001
    United States

    Site Not Available

  • University of New Mexico

    Albuquerque 5454711, New Mexico 5481136 87131-0001
    United States

    Site Not Available

  • South Shore Neurologic Associates, P.C.

    Patchogue, New York 11772
    United States

    Site Not Available

  • South Shore Neurologic Associates, P.C.

    Patchogue 5130672, New York 5128638 11772
    United States

    Site Not Available

  • Wake Forest University - School of Medicine - Central

    Winston-Salem, North Carolina 27157
    United States

    Site Not Available

  • Wake Forest University - School of Medicine - Central

    Winston-Salem 4499612, North Carolina 4482348 27157
    United States

    Site Not Available

  • University of Cincinnati Physicians Company

    Cincinnati, Ohio 45267
    United States

    Site Not Available

  • The Cleveland Clinic Foundation

    Cleveland, Ohio 44195
    United States

    Site Not Available

  • The Boster Center for MS

    Columbus, Ohio 43235
    United States

    Active - Recruiting

  • The Boster Center for Multiple Sclerosis

    Columbus, Ohio 43235
    United States

    Site Not Available

  • University of Cincinnati Physicians Company

    Cincinnati 4508722, Ohio 5165418 45267
    United States

    Site Not Available

  • The Cleveland Clinic Foundation

    Cleveland 5150529, Ohio 5165418 44195
    United States

    Site Not Available

  • The Boster Center for Multiple Sclerosis

    Columbus 4509177, Ohio 5165418 43235
    United States

    Site Not Available

  • Neurology Clinic, PC

    Cordova, Tennessee 38018
    United States

    Site Not Available

  • Vanderbilt MS Center

    Nashville, Tennessee 37215
    United States

    Site Not Available

  • Neurology Clinic, PC

    Cordova 4050552, Tennessee 4662168 38018
    United States

    Site Not Available

  • Vanderbilt MS Center

    Nashville 4644585, Tennessee 4662168 37215
    United States

    Site Not Available

  • The University of Texas Health Science Center San Antonio

    San Antonio, Texas 78229-3900
    United States

    Site Not Available

  • The University of Texas Health Science Center San Antonio

    San Antonio 4726206, Texas 4736286 78229-3900
    United States

    Site Not Available

  • University of Wisconsin Hospital and Clinics

    Madison, Wisconsin 53792
    United States

    Site Not Available

  • The Medical College of Wisconsin

    Milwaukee, Wisconsin 53226
    United States

    Site Not Available

  • University of Wisconsin Hospital and Clinics

    Madison 5261457, Wisconsin 5279468 53792
    United States

    Site Not Available

  • The Medical College of Wisconsin

    Milwaukee 5263045, Wisconsin 5279468 53226
    United States

    Site Not Available

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