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A Clinical Trial to Evaluate the Efficacy and Safety of Two Aramchol Doses Versus Placebo in Patients With NASH (Aramchol_005)

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ClinicalTrials.gov Identifier: NCT02279524
Recruitment Status : Completed
First Posted : October 31, 2014
Last Update Posted : June 26, 2018
Sponsor:
Collaborators:
Sharp Clinical Services
Diamond Pharma Services
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
ClinIntel
Itamar-Medical, Israel
One Way Liver OWL
Medical University of Graz
Tel-Aviv Sourasky Medical Center
DSG EDC
TransPerfect
Clinical Reference Laboratory
Information provided by (Responsible Party):
Galmed Pharmaceuticals Ltd

Brief Summary:

This is a multicenter, Phase IIb, randomized, double blind, placebo-controlled study designed to evaluate the efficacy and safety of two Aramchol doses in subjects that are 18 to 75 years of age, with Non-Alcoholic Steatohepatitis (NASH) confirmed by liver biopsy performed in a period of 6 months before entering the study, with overweight or obesity and who are pre diabetic or type II diabetic.

Eligible subjects will be enrolled into three treatments arms: Aramchol 400 and 600 mg tablets and placebo tablets in ratio 2:2:1.

The subjects will be evaluated at study sites for 11 scheduled visits during one year (52 weeks). After completion of the study treatment period, the subjects will be followed for an additional period of 13 weeks without study medication (until visit 11 (week 65)).


Condition or disease Intervention/treatment Phase
Fatty Liver Drug: Aramchol Phase 2 Phase 3

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 247 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase IIb, Double Blind Randomized, Controlled Clinical Trial, to Evaluate the Efficacy and Safety of Two Aramchol Doses Versus Placebo in Patients With Non-Alcoholic Steatohepatitis (NASH) - Aramchol 005 Study
Study Start Date : January 2015
Actual Primary Completion Date : May 22, 2018
Actual Study Completion Date : May 22, 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Aramchol 600mg
One tablet of Aramchol 400 mg and one tablet of Aramchol 200 mg.
Drug: Aramchol

Subjects will be administered Aramchol as follows:

  • One tablet of Aramchol 400 mg and one tablet of matching placebo for Aramchol.
  • One tablet of Aramchol 400 mg and one tablet of Aramchol 200 mg.
  • Two tablet of Aramchol matching placebo. The tablets should be taken orally in the morning within 30 min after breakfast with a glass of water (250 ml).

Subjects are allowed to omit study drugs up to 3 consecutive days during the study.

Other Name: Placebo

Experimental: Aramchol 400mg
One tablet of Aramchol 400 mg and one tablet of matching placebo for Aramchol.
Drug: Aramchol

Subjects will be administered Aramchol as follows:

  • One tablet of Aramchol 400 mg and one tablet of matching placebo for Aramchol.
  • One tablet of Aramchol 400 mg and one tablet of Aramchol 200 mg.
  • Two tablet of Aramchol matching placebo. The tablets should be taken orally in the morning within 30 min after breakfast with a glass of water (250 ml).

Subjects are allowed to omit study drugs up to 3 consecutive days during the study.

Other Name: Placebo

Placebo Comparator: Placebo
Two tablet of Aramchol matching placebo.
Drug: Aramchol

Subjects will be administered Aramchol as follows:

  • One tablet of Aramchol 400 mg and one tablet of matching placebo for Aramchol.
  • One tablet of Aramchol 400 mg and one tablet of Aramchol 200 mg.
  • Two tablet of Aramchol matching placebo. The tablets should be taken orally in the morning within 30 min after breakfast with a glass of water (250 ml).

Subjects are allowed to omit study drugs up to 3 consecutive days during the study.

Other Name: Placebo




Primary Outcome Measures :
  1. % change in the liver triglycerides concentration measured by NMRS between Aramchol treated arms and placebo arm at start and end of the study. [ Time Frame: At screening and at week 52 ]
    To evaluate the safety and efficacy as measured with NMRS of two Aramchol doses (400 mg and 600 mg), once daily for 52 weeks in overweight or obesity and type II Diabetes Mellitus or pre-diabetes in patients diagnosed with Non-Alcoholic Steatohepatitis (NASH).


Secondary Outcome Measures :
  1. Proportion (%) of subjects with CRN Fibrosis Score Improvement without worsening of NASH [ Time Frame: At screening and at week 52 ]
  2. Proportion (%) of subjects with NAS Score Improvement (>=2 points) without worsening of CRN Fibrosis Score [ Time Frame: At screening and at week 52 ]
  3. Proportion (%) of subjects with SAF Activity Score Improvement (>=2 points) without worsening of CRN Fibrosis Score [ Time Frame: At screening and at week 52 ]
  4. Proportion (%) of subjects with NASH Resolution (ballooning 0; inflammation 0 or 1) without worsening of CRN Fibrosis Score [ Time Frame: At screening and at week 52 ]
  5. Change from Baseline to Week 52/Termination in ALT [ Time Frame: At baseline until week 52 ]

Other Outcome Measures:
  1. Change from Baseline to Week 52/Termination in HOMA-IR [ Time Frame: At baseline until week 52 ]
  2. Change from Baseline to Week 52/Termination in HEMOGLOBIN A1C (%) [ Time Frame: At baseline until week 52 ]
  3. Change from Baseline to Week 52/Termination in ADIPONECTIN (TOTAL) (mg/L) [ Time Frame: At baseline and week 52 ]
  4. Change from Baseline to Week 52/Termination in LEPTIN (pg/mL) / ADIPONECTIN (TOTAL) (mg/L) Ratio (LAR) [ Time Frame: At baseline and week 52 ]
  5. Inflammation and Fibrosis Biomarkers [ Time Frame: At baseline until week 52 ]
  6. Change from Baseline to Week 52/Termination in Body Weight [ Time Frame: At baseline until week 52 ]
  7. Change from Baseline to Week 52/Termination in Waist Circumference [ Time Frame: At baseline until week 52 ]
  8. Change from Baseline to Week 52/Termination in Fatty Liver Index (FLI) [ Time Frame: At baseline and week 52 ]
  9. Endothelial Function [ Time Frame: At baseline and week 52 ]
  10. Aramchol Blood Trough Level [ Time Frame: At baseline until week 52 ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Male or female age 18 to 75 years.
  2. BMI between 25kg/m2 to 40kg/m2 or waist circumference between 88 cm to 200 cm for women, and between 102 cm to 200 cm for men. If there is deviation above the upper limit, please consult the MRI center, to ensure that the machine is suitable for the patient.
  3. Known type II Diabetes Mellitus or pre-Diabetes according to American Diabetes Association. One of the following 3 criteria is needed for pre-Diabetes: Fasting Plasma Glucose > 100mg/dl (5.5 mmol/l) or 2hPG following 75g OGTT > 140 (7.8 mmol/l) mg/dl or HbA1c > 5.7%. HbA1c can be repeated at Investigator's discretion.
  4. Histologically proven Steatohepatitis on a diagnostic liver biopsy performed either during screening or within 6 months before screening visit, confirmed by central laboratory reading of the slides.(Steatosis ≥1 + inflammation ≥1 + ballooning ≥1).Total activity NAS score of 4 or more.
  5. Liver fat concentration in the liver of 5.5% or more as measured by NMRS.
  6. Biopsies with an activity NAS score of 4 or more.
  7. Normal synthetic liver function (serum albumin >3.2g/dl, INR 0.8-1.2, conjugated bilirubin < 35 µmol/L).
  8. Understanding the nature of the study and signature of the written informed consent.
  9. Negative pregnancy test at study entry for females of child bearing potential.
  10. Females of child bearing potential practicing reliable contraception throughout the study period (including oral contraceptives) as well as negative pregnancy test at study entry.
  11. Hypertensive patients must be well controlled by stable dose of anti-hypertensive medication for at least 2 months prior to screening.
  12. Patients previously treated with vitamin E (>400IU/day), Polyunsaturated fatty acid (>2g/day) or Ursodeoxycholic acid or fish oil can be included if stopped or at least maintained on stable dose at least 3 months prior to diagnostic liver biopsy (and are not started during the trial). These treatments-dosages are allowed if they were stable for at least 12 months prior to biopsy and can remain stable throughout the study. (Dosages less than the amounts stated above are allowed without washout- or stable-period restrictions).
  13. For patients with type II Diabetes, glycaemia must be controlled (Glycosylated Hemoglobin A1c ≤9%) while any HbA1c change should not exceed 1.5% during 6 months prior to enrolment). Treatments with anti-diabetic medications (except for those mentioned in Exclusion 16) are permitted if glycaemia is self-monitored by the patient. HbA1c can be repeated at Investigator's discretion.

Exclusion Criteria:

  1. Patients with other active (acute or chronic) liver disease other than NASH (e.g. viral hepatitis, unless eradicated at least 3 years prior to screening; genetic hemochromatosis; Wilson disease; alpha 1antitripsin deficiency; alcohol liver disease; drug-induced liver disease) at the time of randomization.
  2. Patients with clinically or histologically documented liver cirrhosis
  3. Known alcohol and/or any other drug abuse or dependence in the last five years.
  4. Known history or presence of clinically significant cardiovascular, gastrointestinal, metabolic other than Diabetes Mellitus, neurologic, pulmonary, endocrine, psychiatric, neoplastic disorder or nephrotic syndrome, that in the opinion of the Investigator warrant exclusion from the study.
  5. Patients with familial (i.e., genetic) hypertriglyceridemia and familial (i.e., genetic) hypercholesterolemia.
  6. History or presence of any disease or condition known to interfere with the absorption distribution, metabolism or excretion of drugs including bile salt metabolites (e.g. inflammatory bowel disease (IBD)), previous intestinal (ileal or colonic) operation, chronic pancreatitis, celiac disease or previous vagotomy. Ongoing Chronic constipation
  7. Patients with heart or brain pacemaker (i.e., implantable neurological devices).
  8. Surgery during the last three month before screening which involved stent implantation of metal devices (e.g. knee, hip etc.)
  9. Weight loss of more than 5% within 6 months prior to randomization.
  10. History of bariatric surgery within 5 years of liver biopsy.
  11. Uncontrolled arterial hypertension.
  12. Women who are pregnant and breast feeding.
  13. Diabetes Mellitus other than type II (type I, endocrinopathy, genetic syndromes etc.).
  14. Patients with HIV infection.
  15. Daily alcohol intake >20 g/day for women and >30 g/day for men (on average per day) as per medical history.
  16. Treatment with other anti-diabetic medications:

    GLP-1 receptor agonists and Thiazolidinediones (TZDs), unless started at least 12 months prior to biopsy and on stable dose for 6 months. In case of GLP-1 receptor agonists stopped, it should be at least 6 months before biopsy as per medical history.

  17. SGLT-2 Inhibitors, Metformin, fibrates, statins, insulin, DPP-4 inhibitors and sulfonylurea unless prescribed dose has been stable for the last 6 months prior to the biopsy.
  18. Treatment with Valproic acid, Tamoxifen, Methotrexate, Amiodarone or chronic treatment with anti-cholinergic agents, corticosteroids, high dose estrogen and tetracycline within 12 months prior to the screening visit.
  19. Chronic treatment with antibiotics (e.g. Rifaximin).
  20. Homeopathic and/or alternative treatments. Any treatment should be stopped during the screening period at least 48 hours before randomization.
  21. Uncontrolled hypothyroidism defined as Thyroid Stimulating hormone >2X the upper limit of normal (ULN). Thyroid dysfunction controlled for at least 6 months prior to screening is permitted.
  22. Patients with renal dysfunction eGFR< 40.
  23. Unexplained serum creatine phosphokinase (CPK) >3X the upper limit of normal (UNL). Patients with a reason for CPK elevation may have the measurement repeated prior to randomization; a CPK retest > 3X ULN leads to exclusion.
  24. Patients with condition(s) that makes them unsuitable to perform the NMRS (as determined by the PI or the MRI facility).
  25. Hypersensitivity to Aramchol or to any of the excipients in the tablets
  26. Hypersensitivity to cholic acid or bile acid sequestrants

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02279524


  Show 78 Study Locations
Sponsors and Collaborators
Galmed Pharmaceuticals Ltd
Sharp Clinical Services
Diamond Pharma Services
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
ClinIntel
Itamar-Medical, Israel
One Way Liver OWL
Medical University of Graz
Tel-Aviv Sourasky Medical Center
DSG EDC
TransPerfect
Clinical Reference Laboratory
Investigators
Principal Investigator: Vlad Ratziu, MD, PhD Professor of Hepatology at the Université Pierre et Marie Curie and the Hopital Pitie Salpetriere Medical University in Paris.

Additional Information:
Responsible Party: Galmed Pharmaceuticals Ltd
ClinicalTrials.gov Identifier: NCT02279524     History of Changes
Other Study ID Numbers: Aramchol005
First Posted: October 31, 2014    Key Record Dates
Last Update Posted: June 26, 2018
Last Verified: June 2018

Keywords provided by Galmed Pharmaceuticals Ltd:
NASH

Additional relevant MeSH terms:
Fatty Liver
Liver Diseases
Digestive System Diseases