Saroglitazar Magnesium for the Treatment of Nonalcoholic Steatohepatitis With Fibrosis (NASH)

S
Samer Gawrieh, MD

Primary Investigator

Administratively Closed
18 years - 75 years
All
Phase 2
240 participants needed
1 Location

Brief description of study

Saroglitazar Magnesium for the Treatment of Nonalcoholic Steatohepatitis

Detailed description of study

A Phase 2b, Prospective, Multicenter, Randomized, Double-blind, Placebo-controlled Study tovaluate Efficacy and Safety of Saroglitazar Magnesium in Subjects with Nonalcoholichepatitis and Fibrosis.

Eligibility of study

You may be eligible for this study if you meet the following criteria:

  • Conditions: Nonalcoholic Steatohepatitis, Fibrosis
  • Age: 18 years - 75 years
  • Gender: All

Inclusion Criteria:
  • Males or females, between 18 and 75 years of age, both inclusive at screening.
  • BMI ≤45 kg/m²
  • Histological confirmation of NASH with liver fibrosis by central pathologist on adiagnostic liver biopsy with a NAS ≥5 with at least one-point score in each of thehree components of the NAFLD activity score [NAS] (steatosis scored 0-3, ballooningdegeneration scored 0-2, and lobular inflammation scored 0-3) and NASH by patterngnition Note: The biopsy must not have been performed more than 24 weeks beforedomization.
  • The subjects must have a stable body weight (no more than 5% change) between the timebiopsy and randomization.
  • Fibrosis stage 2 and 3, according to the NASH CRN fibrosis staging, reported byhologist.
  • If the subjects have type 2 diabetes mellitus, then it must be moderately controlledwith HbA1c ≤ 9% and on a stable dose of permitted anti-diabetic medication for at90 days before screening.
  • If the subjects are taking vitamin E > 400 IU/day, then it must be on a stable dose24 weeks prior to screening or, if a historical biopsy is used, at least24 weeks prior to baseline liver biopsy until time of screening.
  • Must provide written informed consent and agree to comply with the trial protocol.
Exclusion Criteria:
  • Consumption of >3 units of alcohol per day (>21 units per week) if male and >2 unitshol per day (>14 units per week) if female for at least 12 consecutive weekswithin 5 years before screening (Note: 1 unit = 12 ounces of beer, 4 ounces of wine or1 ounce of spirits/hard liquor)
  • History or presence of other concomitant liver diseases at screening:
    1. Chronic hepatitis B (HBV) or hepatitis C virus (HCV) infection (However, If theubject has been treated for the HCV infection and has been cured at least 5years from screening, such subjects can be enrolled in the study)
    2. Primary biliary cholangitis (PBC)
    3. Primary sclerosing cholangitis (PSC)
    4. Definite autoimmune liver disease or overlap syndrome
    5. Alcoholic liver disease
    6. Hemochromatosis
    7. Wilsons disease
    8. Alpha-1 antitrypsin deficiency
  • Subject with known cirrhosis, either based on histology, clinical criteria or any
    non-invasive diagnostic modality, within 24 weeks prior to the randomization.
  • Evidence of portal hypertension (low platelet count, esophageal varices, ascites,history of hepatic encephalopathy, splenomegaly) at screening.
  • Treatment with glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium glucose2 (SGLT-2) inhibitors, and dipeptidyl peptidase 4 inhibitors (gliptins)unless stable for 90 days prior to screening or, if a historical biopsy is used, from90 days prior to baseline liver biopsy until time of screening.
  • Use of concurrent medications prior to screening including:
    1. Anti-NASH therapy(s) including S-adenosyl methionine (SAMe), ursodeoxycholic acid(UDCA), obeticholic acid and milk thistle in the period from 90 days prior tog or, if a historical biopsy is used, from 90 days prior to baselinever biopsy until time of screening.
    2. Antidiabetic mediation which may impact NASH histology includinghiazolidinediones (pioglitazone, rosiglitazone) in the period from 90 days priorg or, if a historical biopsy is used, from 90 days prior to baselinever biopsy until time of screening.
    3. Immune modulatory agents including anti-TNF-α therapies (infliximab, adalimumab,) or anti-integrin therapy (namixilab) in the period from 28 days priorg or if a historical biopsy is used from 28 days prior to baselinever biopsy until time of screening.
    4. Any treatment or anticipated initiation (intended use for more than 14utive days) of medications known to have an effect on steatosis (e.g.with corticosteroids [topical and inhaled are allowed]), methotrexate,valproic acid, amiodarone or tetracycline, estrogens in doses higherhan used in oral contraceptives, vitamin A, L-asparaginase, valproate,hloroquine, or antiretroviral drugs in the period from 28 days prior tog or, if a historical biopsy is used, from 28 days prior to baselinever biopsy until time of screening.
    5. Treatment with orlistat, zonisamide, topiramate, phentermine, lorcaserin,bupropion, or naltrexone alone, or in combination or any other medication, thatuld promote weight loss, in the opinion of the investigator, in the period from28 days prior to screening or if a historical biopsy is used from 28 days priorbaseline liver biopsy until time of screening.
  • Changing doses of statins (simvastatin, pitavastatin, pravastatin, atorvastatin,
    fluvastatin, lovastatin, rosuvastatin) or fibrates (clofibrate, Fenofibrate) in the 90days preceding screening.
  • Use of drugs that are known CYP2C8 inhibitors/substrate in the 28 days precedingg.
  • History of liver transplant
  • Any weight reduction surgery in the 2 years prior to screening or planned during theudy (weight reduction surgery is disallowed during the study), and malabsorptiveweight loss surgery (Rouxen-Y or distal gastric bypass) at any time prior tog.
Note: Lap banding, if the band has been removed >6 months before baseline liver biopsy, or intragastric balloon, if the balloon has been removed > 6 months before baseline liver biopsy, is allowed.
  • Type 1 diabetes mellitus
  • History of stomach or intestinal surgery or resection within the six months prior to screening that would potentially alter absorption and/or excretion of orally administered drugs as judged by the investigator.
  • Unstable cardiovascular disease, including:
    1. unstable angina, (i.e., new or worsening symptoms of coronary heart disease) in the 90 days before screening and throughout the screening period; acute coronary syndrome in the 24 weeks before screening and throughout the screening period;
    2. acute myocardial infarction in the 90 days before screening and throughout the screening period; or heart failure of New York Heart Association class (III - IV), worsening congestive heart failure, or coronary artery intervention, in the 24 weeks before screening and throughout the screening period.
    3. history of unstable cardiac dysrhythmias
    4. uncontrolled hypertension at screening
    5. stroke or transient ischemic attack in the 24 weeks before screening
  • History of myopathies or evidence of active muscle disease demonstrated by CPK ≥ 5 times ULN at screening.
  • Subjects whose ALT, AST, or ALP exceeds by more than 50% at Visit 2 reading compared to Visit 1
Note: If the ALT, AST or ALP values at Visit 2 exceed by more than 50% from Visit 1, then a third value will be measured to assess for the trend. If the third value shows continued increase ≥ 10%, then subject is considered ineligible for randomization.
  • Any of the following laboratory values at screening:
    1. Hemoglobin <9 g/dL
    2. WBC count <2.5 × 103/µL
    3. Neutrophil count <1.5 × 103/µL
    4. Platelets <140 × 103/µL
    5. INR ≥ 1.3 (in the absence of anticoagulants)
    6. Total bilirubin > ULN except in Gilbert's syndrome. In subjects with known Gilbert's syndrome, direct bilirubin > 2 x ULN
    7. Albumin <3.5 g/dL
    8. eGFR <60 mL/min/1.73 m2
    9. ALP ≥ 2x ULN
    10. ALT or AST ≥ 250 U/L
  • Participation in any other therapeutic clinical study and on active treatment in the past 90 days of the screening.
  • History of benign or malignant bladder tumors, and/or hematuria or has current hematuria except due to a urinary tract infection.
  • History of malignancy in the past 5 years and/or active neoplasm with the exception of resolved superficial nonmelanoma skin cancer.
  • Known allergy, sensitivity or intolerance to the study drug, comparator or formulation ingredients.
  • Pregnancy-related exclusions, including:
    1. Pregnant/lactating female (including positive pregnancy test at screening)
    2. Fertile women and men, UNLESS using effective contraceptive methods (such as an intrauterine device or other mechanical contraception method with condom or diaphragm and spermicide or proper use of hormonal contraceptives that inhibit ovulation) throughout the study. For male subjects, contraception measures (condom and spermicide) must be taken during the study, either by the male participant or his female partner.(Note: Enrolled females otherwise must be surgically sterilized for at least 24 weeks before screening; postmenopausal, defined as 52 weeks with no menses without an alternative medical cause; or following sexual abstinence.)
(Note: Enrolled females otherwise must be surgically sterilized for at least 24 weeks before screening; postmenopausal, defined as 52 weeks with no menses without an alternative medical cause; or following sexual abstinence.)
  • History or other evidence of severe illness or any other conditions that would make the subject, in the opinion of the investigator, unsuitable for the study (such as poorly controlled psychiatric disease, HIV, coronary artery disease or active gastrointestinal conditions that might interfere with drug absorption)
  • Receiving an elemental diet or parenteral nutrition.
  • Chronic pancreatitis or pancreatic insufficiency

    Updated on 01 Aug 2024. Study ID: SARO.20.002, GI-ZYDUS-SARO-20-002, 10516

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