The primary objectives of this study are: - To evaluate the efficacy of GFT505 80mg and GFT505 120mg once daily (according to adaptive design, after 6-month interim safety analysis of the 80mg data on at least 50% of patients) for 52 weeks versus…
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Source
Brief title
Condition
- Metabolism disorders NEC
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
After 52 weeks of daily administration of GFT505 80mg, or GFT505 120mg,
comparison of changes from baseline with those observed in the placebo group.
Primary Endpoint:
- Percentage of responders from baseline to Week 52, defined by the
disappearance of steatohepatitis (i.e. patients no longer
meeting the criteria for steatohepatitis) without
worsening of fibrosis.
- Worsening of fibrosis is evaluated using NASH CRN fibrosis staging system
and defined as:
o Progression to stage 3 or 4 for patients at stage 0, 1
or 2 on diagnostic liver biopsy
o Progression to stage 4 for patients at stage 3 on
diagnostic liver biopsy
Secondary outcome
Secondary Endpoints:
- Percentage of responders from baseline to Week 52, defined by the
disappearance of steatohepatitis (i.e. patients no longer
meeting the criteria for steatohepatitis).
- Change from baseline to week 52, in NAS score.
- Changes from baseline to Week 52, in stages of steatosis, hepatic activity
(lobular inflammation + ballooning).
- Changes from baseline to Week 52, in stages of fibrosis (NASH CRN scoring).
- Changes in area of fibrosis by morphometry.
- Changes from baseline to week 52, in liver enzymes.
- Changes from baseline to week 52, in non-invasive markers of fibrosis and
steatosis.
- Changes from baseline to week 52, in lipid parameters.
- Changes from baseline to week 52, in body weight.
- Changes from baseline to week 52, in insulin resistance.
- Changes from baseline to week 52, in inflammatory markers.
- Changes from baseline to week 52, in safety markers (renal or cardiac
function parameters).
- Changes from baseline to Week 52, in cardiovascular risk profile.
- To determine PK parameters of GFT505 and GFT1007 after 52 weeks of treatment.
- SAE, AE, physical examination, vital signs, medical history, ECG.
Background summary
Clinical data confirmed the beneficial effect of GFT505 on insulin-resistance
with improvement in liver and adipose tissue insulin sensitivity, and showed
relevant reductions in markers of liver injury such as GGT and ALT, and in
inflammatory markers. It demonstrated also improvement in lipid profile
resulting in a beneficial balance between pro and anti-atherogenic markers.
Moreover, it highlighted the good safety profile of GFT505, since no
significant adverse event neither major safety concern was reported during
these studies. Thus, considering the safety of use (toxicological and clinical
results), the liver targeting of GFT505 and GFT1007 and the highly favorable
effects of oral administration of GFT505 on numerous markers of metabolic
syndrome and NASH, the present Phase II study is designed to assess the
efficacy of GFT505 on reversion of liver histological abnormalities of NASH.
Study objective
The primary objectives of this study are:
- To evaluate the efficacy of GFT505 80mg and GFT505 120mg once daily
(according to adaptive design, after 6-month interim safety analysis of the
80mg data on at least 50% of patients) for 52 weeks versus placebo in reversing
histological steatohepatitis without worsening of fibrosis.
- Worsening of fibrosis is evaluated using NASH CRN fibrosis staging system and
defined as:
o Progression to stage 3 or 4 for patients at stage 0, 1
or 2 on diagnostic liver biopsy,
o Progression to stage 4 for patients at stage 3 on
diagnostic liver biopsy.
Study design
Randomized, Double blind, Three Parallel Groups: placebo, GFT505 80mg and
GFT505 120mg (secondarily after interim safety analysis of the 80mg data on at
least 50% of patients) once daily for 52 weeks.
A screening period (from 4 to 16 weeks*) will precede a 52-week double-blind
treatment period and a 3 months follow-up period.
Schedule:
• Screening visit : Week-16 to Week-4 prior to randomization
• Pre-randomization: at least 1 week before randomization
• Week 0 to Week 52: period of treatment with GFT505 80mg or GFT505 120mg, or
placebo for 52 weeks
• Week 52 to Week 64: 12 weeks follow-up period
Patients who satisfy all eligibility criteria will be randomized to one of the
following groups: placebo, GFT505 80mg or GFT505 120mg (after review of interim
safety analysis of the 80mg data on at least 50% of patients). A central
randomization system will be used (IWRS).
Two randomisation lists will be generated, in order to allow enrolment in 2
phases: a first phase of 80mg versus placebo, followed by a second phase
including the 120mg dose, after interim safety analysis review and
recommendation to go ahead with a higher dose by the DSMB. If the 120mg arm is
allowed, randomization will be adapted according to the recommendation of the
DSMB, in order to have a final equivalent distribution among the 3 treatment
arms.
Intervention
The Study Drug is GFT505: Propanoic acid,
2-[2,6-dimethyl-4-[3-[4-(methylthio)phenyl]-3-oxo-1(E)-propenyl]
phenoxy]-2-methyl-
This study is blinded and there are 3 parallel groups:
• placebo group
• GFT505 80mg group
• GFT505 120mg group (after review of interim safety analysis)
GFT505 will be supplied in hard gelatin capsules dosed at 40mg. Matching
placebo will be presented in identical capsules.
The patient will be instructed to take the treatment orally (3 capsules per
day) before breakfast with a glass of water.
Study burden and risks
Risks and inconveniences related to study drugs:
During toxicology studies in animals, the main adverse effects were observed in
rats and mice (increase of hepatic enzyme levels, increase of the volume of the
liver and increased incidence of liver tumors). However, compared to monkeys
and humans, these rodent species are oversensitive to this kind of long term
liver toxicity. Accordingly, a 1 year treatment of monkeys with high doses of
GFT505 did not reveal any sign of liver toxicity and in all clinical trials
performed to date, GFT505 rather showed signs of hepatoprotection which are of
medical interest for the treatment of NASH.
During all studies involving human beings, there was no drug-related serious
adverse effect. Side effects were reported, but they were quite seldom, and
their intensity was mild or moderate. Generally the most reported effects are
related to gastric and intestinal disorders, headaches or muscular pain with
low intensity. Apart from the expected improvement in plasma lipids and
glucose, no relevant modification of clinical and biological parameters was
reported.
Risks and inconveniences related to study procedures:
Blood sampling will be performed at several visits. Sometimes the blood
sampling may be a little uncomfortable and may cause pain, some redness or
swelling in the area where blood has been taken. Some people also experience
faintness.
Being fasted for 12 hours before each visit can induce dizziness, headaches,
abdominal pains and seldom fainting.
There is no known side effect related to ECG, except a cutaneous irritation at
the place where the electrode is applied.
The most commonly used technique to collect the liver sample is a percutaneous
liver biopsy. For this method, a hollow needle is inserted through the abdomen
into the liver to remove a small piece of tissue. After the biopsy, the
spatient must lie on the right side for up to 2 hours to reduce the risk of
bleeding. The patient will be then monitored for an additional 2 to 4 hours
before being sent home. Pain is the most frequent risk occurring in about 20%
of patients. In some rare cases, other inconveniences may occur such as
hemorrhage, pneumothorax or vesicular perforation.
Liver biopsy is usually done under local anesthesia. Nevertheless, in case
general anesthesia is chosen,some adverse events may occur, like nausea,
vomiting, sore throat, dizziness,headache, and pain at the injection area. More
rarely, urinary difficulty, pulmonary infection, mouth injury, nervous lesion,
allergy or even death can occur.
What are the possible benefits of taking part?
We hope that patients treated by this new drug will show an improvement in
their histological steatohepatitis, and that this will improve their health
status, but this cannot be guaranteed.
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Age
Inclusion criteria
1. Provide written informed consent prior to enrolment.;2. Males or females able to read.;3. Females participating in the study must be either of non-child bearing potential (surgically sterilized at least 6 months prior to screening or postmenopausal) or using an efficient double contraception: hormonal contraception (including patch, contraceptive ring, etc.), intra-uterine device or other mechanical contraception method + condom or diaphragm or spermicide for all the duration of the study.;4. Aged from 18 to 75 years inclusive at screening.;5. BMI <= 45 kg/m².;6. Patients agree to have one liver biopsy during the screening period for diagnostic purpose (if no historical biopsy within 6 months before randomization is available) and one at the end of the treatment period for assessment of the treatment effects.;7. For hypertensive patients, hypertension must be controlled by stable dose of anti-hypertensive medication for at least 2 months prior to screening (and the stable dose can be maintained throughout the study).;8. Patients treated with vitamin E (>400IU/d), or PUFAs (>2g/day) or Ursodeoxycholic acid can be included if drugs are stopped at least 3 months prior to diagnostic liver biopsy and up to the end of the study.;9. Histological confirmation of steatohepatitis on a diagnostic liver biopsy (biopsy obtained within 6 months prior to randomization or during the screening period). Histological diagnostic is confirmed by central reading of the slides (steatosis > 5% + lobular inflammation, any grade + ballooning, any amount).;10. For patients with Type 2 Diabetes, glycemia must be controlled (HbA1c<=8.5%). If glycemia is controlled by anti-diabetic drugs, qualitative change (i.e. implementation of a new antidiabetic drug) is not permitted within 6 months prior to randomization and should be avoided during the study. Treatments with metformin, DPPIV inhibitors, GLP1 agonists, sulfamides, insulin are authorised. Sulfamides and insulin are permitted if glycemia is self-monitored by the patient.;11. Patients agree to come to the study visits within the protocol-specified delay.
Exclusion criteria
1. Known heart failure (Grade I to IV of NYHA classification). ;2. Weight loss of more than 5% within 6 months prior to randomization. ;3. History of bariatric surgery. ;4. Uncontrolled Blood Pressure (SBP> 160 mmHg and/or DBP>95 mmHg). ;5. Type 1 diabetes patients. ;6. Patients who had an acute cardiovascular episode within the 6 months prior to screening, or with a history of coronary angioplasty, history of stroke, TIA (Transient Ischemic Attack), Coronary Heart Disease (Angina pectoris, myocardial infarction, revascularisation procedures). ;7. Compensated and uncompensated cirrhosis (clinical and/or histological evidence of cirrhosis). Notably, NASH patients with fibrosis stage = 4 according to the NASH CRN fibrosis staging system are excluded. ;8. Known alcohol and/or any other drug abuse or dependence in the last five years. Alcohol consumption of more than 2 drink units per day for women and 3 drink units per day for men is considered abusive. One drink unit is defined as 30 mL distilled spirits, 120 mL wine, or 330 mL beer. ;9. Patients who have donated blood or blood products within the previous month prior to screening or who plan to donate blood or blood products at any time during the trial and in the 3 months following the end of the study. ;10. Pregnant or lactating females. ;11. Other well documented causes of chronic liver disease according to standard diagnostic procedures including, but not restricted to: positive HBsAg, positive HCV RNA, suspicion of drug-induced liver disease, autoimmune hepatitis, Wilson*s disease, primary biliary cirrhosis, primary sclerosing cholangitis, genetic hemochromatosis documented by homozygosity for the C282Y HFE gene mutation. ;12. Patients not covered by Health Insurance System and/or not in compliance with the recommendations of National Law in force. ;13. When applicable and according to National Law in force, patient of legal age unable of giving consent or under legal protection or deprived of freedom by judicial or administrative decision. ;14. Patients who cannot be contacted in case of emergency. ;15. Known intolerance or contra-indication to the list of excipients of GFT505. ;16. Patients are currently participating in, plan to participate in, or have participated in an investigational drug or medical device trial within 30 days or five half-lives, whichever is longer, prior to screening. ;17. Glitazones (rosiglitazone and pioglitazone) are not permitted 6 months before diagnostic liver biopsy and up to the end of the study. ;18. Non-statin lipid-lowering medications such as fibrates are not permitted 8 weeks before randomization and up to the end of the study. Non-statin lipid lowering medications can be washed-out during the screening period. Patients that used statins before screening may participate if the dosage has been kept constant for the past 3 months, and is kept constant and stable during the study. ;19. Vitamin E (>400IU/day), PUFAs (>2g/day) and Ursodeoxycholic acid should have been stopped 3 months before diagnostic liver biopsy (and can be washed-out during the screening period in case of no available historical biopsy). They are not permitted up to the end of the study. ;20. Currently taking drugs that can induce Steatosis/steatohepatitis: corticosteroids (parenteral administration only), amiodarone (Cordarone), Tamoxifen (Nolvadex), methotrexate (Rheumatrex, Trexall). ;21. Currently taking any medication that could interfere with study medication absorption, distribution, metabolism or excretion or could lead to induction or inhibition of microsomal enzymes.
22. Antiplatelet or anticoagulant medications are not permitted one week before screening and to the end of the study.
23. Evidence of any other unstable or, untreated clinically significant immunological, neoplasic, endocrine, haematological, gastrointestinal, neurological or psychiatric disorder. ;24. Patients who have serious or unstable medical or psychological conditions which, in the opinion of the Investigator, would lead the patient to be non-compliant or uncooperative during the study or would compromise the patient*s safety or successful participation in the study. ;25. Positive HBsAg, Positive anti-HIV, positive HCV-RNA. ;26. Uncontrolled hypothyroidism defined as TSH > 2X the upper limit of normal (ULN). Thyroid dysfunction controlled for at least 6 months prior to screening is permitted. ;27. Significant renal disease, including nephritic syndrome, chronic renal failure (defined as creatinine clearance < 60 mL/mn according to MDRD formula and serum creatinine >180 µmol/L). ;28. Unexplained serum creatine phosphokinase (CPK) > 3X the upper limit of normal (ULN). Patients with a reason for CPK elevation may have the measurement repeated prior to randomization; a CPK retest > 3X ULN leads to exclusion.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2012-000295-42-NL |
CCMO | NL41771.091.12 |