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

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT05011305
Recruitment Status : Recruiting
First Posted : August 18, 2021
Last Update Posted : August 19, 2021
Sponsor:
Information provided by (Responsible Party):
Zydus Therapeutics Inc.

Brief Summary:
Saroglitazar Magnesium for the Treatment of Nonalcoholic Steatohepatitis

Condition or disease Intervention/treatment Phase
Nonalcoholic Steatohepatitis Fibrosis Drug: Saroglitazar Magnesium 2 mg Drug: Saroglitazar Magnesium 4 mg Drug: Placebo Phase 2

Detailed Description:
A Phase 2b, Prospective, Multicenter, Randomized, Double-blind, Placebo-controlled Study to Evaluate Efficacy and Safety of Saroglitazar Magnesium in Subjects with Nonalcoholic Steatohepatitis and Fibrosis.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 240 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: 240 subjects randomized in a 1:1:1 ratio to Saroglitazar 2 mg, Saroglitazar 4 mg or Placebo.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: Double-blind Masking
Primary Purpose: Treatment
Official Title: A Phase 2b, Prospective, Multicenter, Randomized, Double-blind, Placebo-controlled Study to Evaluate Efficacy and Safety of Saroglitazar Magnesium in Subjects With Nonalcoholic Steatohepatitis and Fibrosis
Actual Study Start Date : August 18, 2021
Estimated Primary Completion Date : November 2023
Estimated Study Completion Date : December 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Magnesium

Arm Intervention/treatment
Experimental: Saroglitazar Magnesium 2 mg
Saroglitazar Magnesium 2 mg tablet orally administered once daily in the morning before breakfast without food, for the duration of treatment (76 weeks).
Drug: Saroglitazar Magnesium 2 mg
Patients randomly assigned to this group will receive Saroglitazar Magnesium 2 mg tablet orally once daily in the morning before breakfast without food, for the duration of treatment (76 weeks).
Other Name: Investigational Product

Experimental: Saroglitazar Magnesium 4 mg
Saroglitazar Magnesium 4 mg tablet orally administered once daily in the morning before breakfast without food, for the duration of treatment (76 weeks).
Drug: Saroglitazar Magnesium 4 mg
Patients randomly assigned to this group will receive Saroglitazar Magnesium 4 mg tablet orally once daily in the morning before breakfast without food, for the duration of treatment (76 weeks).
Other Name: Investigational Product

Placebo Comparator: Placebo
Placebo tablet orally administered once daily in the morning before breakfast without food, for the duration of treatment (76 weeks).
Drug: Placebo
Patients randomly assigned to this group will receive Placebo tablet orally once daily in the morning before breakfast without food, for the duration of treatment (76 weeks).
Other Name: Comparator Agent




Primary Outcome Measures :
  1. Resolution of steatohepatitis with no worsening of fibrosis [ Time Frame: 76 Weeks/EOT ]
    Resolution of steatohepatitis is defined as absent fatty liver disease or isolated or simple steatosis without steatohepatitis and a NAS of 0-1 for inflammation, 0 for ballooning, and any value for Steatosis


Secondary Outcome Measures :
  1. Improvement in liver fibrosis with no increase in NAS for ballooning, inflammation or steatosis [ Time Frame: Week 76/EOT ]
    Proportion of subjects achieving improvement in liver fibrosis (reduction of at least one stage) with no increase in NAS for ballooning, inflammation or steatosis

  2. 2 points improvement in NAS [ Time Frame: Week 76/EOT ]
    Proportion of subjects with at least 2 points improvement in NAS at Week 76/EOT with at least 1-point improvement in either ballooning or inflammation and no worsening of liver fibrosis

  3. Improvement in steatosis, ballooning, inflammation and fibrosis from liver biopsy [ Time Frame: Week 76/EOT ]
    Proportion of subjects with ≥1 point improvement in steatosis, ballooning, inflammation and fibrosis

  4. Decrease in SAF score on liver biopsy [ Time Frame: Week 76/EOT ]
    Proportion of subjects with decrease in SAF score ≥2 combining hepatocellular inflammation and ballooning without worsening of fibrosis

  5. Histological score changes in steatosis, ballooning, inflammation, and fibrosis [ Time Frame: Week 76/EOT ]
    Change from baseline in steatosis, ballooning, inflammation, and fibrosis

  6. Change in liver enzyme parameters including (ALT, AST, ALP, GGT, total bilirubin, albumin) [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in liver enzyme parameters (ALT, AST, ALP, GGT, total bilirubin, albumin)

  7. Change in non-invasive markers of steatosis [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in non-invasive markers of steatosis (Enhanced Liver Fibrosis [ELF] test, Fibrosis 4 [FIB 4], APRI [AST to Platelet Ratio Index], NFS [NAFLD Fibrosis Score], PRO-C3)

  8. Change in n lipid parameters including (TG, LDLC, TC, HDL-C, non-HDL-C, VLDL-C [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in lipid parameters (TG, LDLC, TC, HDL-C, non-HDL-C, VLDL-C)

  9. Change in body weight (any change from baseline) [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in body weight

  10. Change in insulin resistance marker, HOMA-IR [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in insulin resistance marker (HOMA-IR)

  11. Change in inflammatory markers including (CK-18 [M30], IL-6, CRP) [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in inflammatory markers (CK-18 [M30], IL-6, CRP)

  12. Change in glucose homeostasis markers including (HbA1c, FPG) [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in glucose homeostasis markers (HbA1c, FPG)

  13. Change from baseline in non-invasive markers of fibrosis [ Time Frame: Week 52 and Week 76/EOT ]
    Change from baseline in non-invasive markers of fibrosis (Enhanced Liver Fibrosis [ELF] test, Fibrosis 4 [FIB 4], APRI [AST to Platelet Ratio Index], NFS [NAFLD Fibrosis Score], PRO-C3)



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:

  • 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 a diagnostic liver biopsy with a NAS ≥5 with at least one-point score in each of the three components of the NAFLD activity score [NAS] (steatosis scored 0-3, ballooning degeneration scored 0-2, and lobular inflammation scored 0-3) and NASH by pattern recognition Note: The biopsy must not have been performed more than 24 weeks before randomization.
  • The subjects must have a stable body weight (no more than 5% change) between the time of biopsy and randomization.
  • Fibrosis stage 2 and 3, according to the NASH CRN fibrosis staging, reported by central pathologist.
  • If the subjects have type 2 diabetes mellitus, then it must be moderately controlled with HbA1c ≤ 9% and on a stable dose of permitted anti-diabetic medication for at least 90 days before screening.
  • If the subjects are taking vitamin E > 400 IU/day, then it must be on a stable dose for at least 24 weeks prior to screening or, if a historical biopsy is used, at least 24 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 units of alcohol per day (>14 units per week) if female for at least 12 consecutive weeks within 5 years before screening (Note: 1 unit = 12 ounces of beer, 4 ounces of wine or 1 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 the subject has been treated for the HCV infection and has been cured at least 5 years 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 glucose cotransporter- 2 (SGLT-2) inhibitors, and dipeptidyl peptidase 4 inhibitors (gliptins) unless stable for 90 days prior to screening or, if a historical biopsy is used, from 90 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 to screening or, if a historical biopsy is used, from 90 days prior to baseline liver biopsy until time of screening.
    2. Antidiabetic mediation which may impact NASH histology including thiazolidinediones (pioglitazone, rosiglitazone) in the period from 90 days prior to screening or, if a historical biopsy is used, from 90 days prior to baseline liver biopsy until time of screening.
    3. Immune modulatory agents including anti-TNF-α therapies (infliximab, adalimumab, etanercept) or anti-integrin therapy (namixilab) in the period from 28 days prior to screening or if a historical biopsy is used from 28 days prior to baseline liver biopsy until time of screening.
    4. Any treatment or anticipated initiation (intended use for more than 14 consecutive days) of medications known to have an effect on steatosis (e.g. treatment with corticosteroids [topical and inhaled are allowed]), methotrexate, tamoxifen, valproic acid, amiodarone or tetracycline, estrogens in doses higher than used in oral contraceptives, vitamin A, L-asparaginase, valproate, chloroquine, or antiretroviral drugs in the period from 28 days prior to screening or, if a historical biopsy is used, from 28 days prior to baseline liver biopsy until time of screening.
    5. Treatment with orlistat, zonisamide, topiramate, phentermine, lorcaserin, bupropion, or naltrexone alone, or in combination or any other medication, that could promote weight loss, in the opinion of the investigator, in the period from 28 days prior to screening or if a historical biopsy is used from 28 days prior to baseline liver biopsy until time of screening.
  • Changing doses of statins (simvastatin, pitavastatin, pravastatin, atorvastatin, fluvastatin, lovastatin, rosuvastatin) or fibrates (clofibrate, Fenofibrate) in the 90 days preceding screening.
  • Use of drugs that are known CYP2C8 inhibitors/substrate in the 28 days preceding screening.
  • History of liver transplant
  • Any weight reduction surgery in the 2 years prior to screening or planned during the study (weight reduction surgery is disallowed during the study), and malabsorptive weight loss surgery (Rouxen-Y or distal gastric bypass) at any time prior to screening.

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.)

  • 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.

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): NCT05011305


Contacts
Layout table for location contacts
Contact: Deven Parmar, MD +91-9974252975 dparmar@zydustherapeutics.com
Contact: James Bainbridge, JD 1-609-559-0760 jbainbridge@zydustherapeutics.com

Locations
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United States, California
Zydus US014 Not yet recruiting
Los Angeles, California, United States, 70072
Zydus US012 Recruiting
Panorama City, California, United States, 91402
Contact: Vanessa         
United States, Florida
Zydus US003 Not yet recruiting
Lakeland, Florida, United States, 33803
Zydus US004 Not yet recruiting
Winter Park, Florida, United States, 32789
United States, Tennessee
Zydus US011 Not yet recruiting
Hermitage, Tennessee, United States, 37067
Sponsors and Collaborators
Zydus Therapeutics Inc.
Investigators
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Study Director: Deven V. Parmar, MD, FCP Zydus Therapeutics Inc.
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Responsible Party: Zydus Therapeutics Inc.
ClinicalTrials.gov Identifier: NCT05011305    
Other Study ID Numbers: SARO.20.002
First Posted: August 18, 2021    Key Record Dates
Last Update Posted: August 19, 2021
Last Verified: August 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Zydus Therapeutics Inc.:
Saroglitazar Magnesium
Nonalcoholic Steatohepatitis
NASH
Fibrosis
Additional relevant MeSH terms:
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Fatty Liver
Non-alcoholic Fatty Liver Disease
Fibrosis
Pathologic Processes
Liver Diseases
Digestive System Diseases