The primary objective of this study is:• To evaluate whether selonsertib (SEL, previously known as GS 4997) can cause fibrosis regression and reduce associated complications in subjects with cirrhosis due to NASH. The secondary objective of this…
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Brief title
Condition
- Hepatic and hepatobiliary disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The primary efficacy endpoint at Week 48 includes the proportion of subjects
who achieve a >= 1-stage improvement in fibrosis (according to the NASH CRN
classification) without worsening of NASH (defined as a >= 1-point increase in
hepatocellular ballooning or lobular inflammation).
The clinical efficacy endpoint at Week 240 is event-free survival (EFS). EFS
will be assessed by time to the first clinical event including liver
decompensation events, liver transplantation, or all-cause mortality.
Secondary outcome
Secondary Endpoints:
• Proportion of subjects who have a >= 1-stage improvement in fibrosis without
worsening of NASH at Week 240;
• Proportion of subjects who have a >= 1-stage improvement in fibrosis at Week
48 and Week 240;
• Proportion of subjects who have NASH resolution at Week 48 and Week 240
The safety of SEL in subjects with cirrhosis due to NASH will be assessed
during the study through the reporting of AEs, clinical laboratory tests, vital
sign assessments and concomitant medication usage.
An external Data Monitoring Committee (DMC) that consists of three
hepatologists and a PhD statistician will review the progress of the study.
They will convene after 50 subjects have completed the Week 4 visit and
approximately every 6 months thereafter to monitor the study for safety events.
Background summary
see protocol page 19 "1.1 background"
Study objective
The primary objective of this study is:
• To evaluate whether selonsertib (SEL, previously known as GS 4997) can cause
fibrosis regression and reduce associated complications in subjects with
cirrhosis due to NASH.
The secondary objective of this study is:
• To assess the safety and tolerability of SEL in subjects with NASH and
cirrhosis
Study design
This is a Phase 3, randomized, double-blind, placebo-controlled study
evaluating the safety and efficacy of SEL in subjects with compensated
cirrhosis due to NASH.
Subjects meeting the study*s entry criteria will be randomly assigned in a
2:2:1 ratio.
Randomization will be stratified by the presence or absence of diabetes
mellitus (as determined by medical history or based on Screening lab values if
previously undiagnosed [i.e. hemoglobin A1c (HbA1c) >= 6.5% or fasting plasma
glucose >= 126 milligram/deciliter [mg/dL]) and by Enhanced Liver Fibrosis
(ELF*) score >= 11.27 or < 11.27 during Screening.
Subjects who experience a hepatic clinical event prior to completing the Week
240 Visit of the Randomized Phase will be offered the option to rollover into
an Open Label (OL) Phase of the study. Each of these clinical events (except
all-cause mortality and liver transplantation) will require confirmation by a
Hepatic Events Adjudication Committee. All deaths will be reviewed by this
committee to determine if liver-related.
Once the clinical event (except all-cause mortality and liver transplantation)
is confirmed by the Hepatic Events Adjudication Committee, the subject will no
longer participate in the Randomized Phase and will be offered the option to
receive SEL 18 mg in the OL Phase for a total treatment duration of 240 weeks
inclusive of the Randomized Phase. Rollover into the OL Phase of the study must
occur within 60 days of confirmation of the event. Subjects starting the OL
Phase of the study will complete the same study procedures as during the
Randomized Phase of the study, starting with the Day 1 visit with the exception
of liver biopsy, and intensive PK substudy. Hepatic clinical events will only
be adjudicated during the Randomized Phase of the study.
Cardiovascular events including cardiovascular death, myocardial infarction,
stroke, hospitalization for unstable angina, hospitalization for cardiac
failure, and coronary revascularization will be adjudicated by an independent
Cardiovascular Events Adjudication Committee. Subjects experiencing a
cardiovascular event will continue in the Randomized Phase and not rollover
into the OL Phase. Cardiovascular events will be adjudicated during the
Randomized Phase and the OL Phase of the study.
Intervention
• Treatment Group A: one SEL 6 mg tablet + one PTM SEL 18 mg tablet
administered orally once daily
• Treatment Group B: one PTM SEL 6 mg tablet + one SEL 18 mg tablet
administered orally once daily
• Treatment Group C: one PTM SEL 6 mg tablet + one PTM SEL 18 mg tablet
administered orally once daily
Study burden and risks
Selonsertib (SEL, formerly GS-4997) has been studied in 13 Phase 1 and 2
clinical studies involving approximately 800 subjects including patients and
healthy volunteers. In 3 Phase 2 studies of 557 patientssubjects (72 with
non-alcoholic steatohepatitis [NASH], 151 with pulmonary artery hypertension
[PAH], and 334 with diabetic kidney disease [DKD]) who were treated for up to
48 weeks with SEL, most side effects reported were mild. The most common side
effects occurring in greater than 10% of SEL treated patients in any of the 3
Phase 2 studies were:
• Headache
• Diarrhea
• Nausea
• Sinusitis (inflammation of the sinuses)
• Nasopharyngitis and upper respiratory tract infection (common cold)
• Cough
• Dizziness
• Fatigue (feeling tired)
Abnormal liver tests have been observed with SEL.
In animal studies, SEL has been associated with embryofetal toxicity
(malformations in fetuses and spontaneous abortions).
Lakeside Drive 333
Foster City CA 94404
US
Lakeside Drive 333
Foster City CA 94404
US
Listed location countries
Age
Inclusion criteria
Subjects must meet all of the following inclusion criteria to be eligible for participation in this study.
1) Willing and able to give informed consent prior to any study specific procedures being performed
2) Liver biopsy consistent with NASH (defined as the presence of at least grade 1 steatosis, hepatocellular ballooning, and lobular inflammation according to the NAFLD Activity Score [NAS]) and cirrhosis (F4 fibrosis) according to the NASH CRN classification, in the opinion of the central reader
a) A historical liver biopsy within 12 months of the Screening visit may be accepted as the Screening biopsy if the sample is deemed acceptable for interpretation by the central reader
b) If the subject is deemed ineligible for this study, the liver biopsy, if performed according to protocol specifications and is within 6 months of the Screening visit, may be used to determine eligibility for study GS-US-384-1943
3) Subject has the following laboratory parameters at the Screening visit, as determined by the central laboratory:
a) ALT <= 8 x ULN
b) CLcr >= 30 mL/min, as calculated by the Cockcroft-Gault equation
c) HbA1c <= 9.5% (or serum fructosamine <= 381 µmol if HbA1c is unable to be resulted)
d) INR <= 1.4, unless due to therapeutic anti-coagulation
e) Platelet count >= 100,000/µL
4) Body Mass Index (BMI) >= 18 kg/m2 at Screening
5) Males and non-pregnant, non-lactating females between 18 70 years of age; inclusive based on the date of the Screening visit
6) Females of childbearing potential (as defined in Appendix 3) must have a negative pregnancy test at Screening and Day 1
7) Male subjects and female subjects of childbearing potential who engage in heterosexual intercourse must agree to use protocol specified method(s) of contraception as described in Appendix 3.
Exclusion criteria
Subjects who meet any of the following exclusion criteria are not to be enrolled in this study.
1) Prior history of decompensated liver disease, including clinical ascites, HE, or variceal bleeding
2) CP score > 7, as determined at Screening, unless due to therapeutic anti-coagulation
3) MELD score > 12, as determined at Screening, unless due to therapeutic anti-coagulation
4) Chronic HBV infection (HBsAg positive)
5) Chronic HCV infection (HCV Ab and HCV RNA positive). Subjects cured of HCV infection less than 5 years prior to the Screening visit are not eligible
6) Other causes of liver disease including, but not limited to, alcoholic liver disease, hepatitis B, hepatitis C, autoimmune disorders (e.g., primary biliary cholangitis, primary sclerosing cholangitis, and autoimmune hepatitis), drug-induced hepatotoxicity, Wilson disease, iron overload, and alpha-1-antitryspin deficiency, based on medical history and/or centralized review of liver histology
7) History of liver transplantation
8) Current or history of HCC
9) 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 (e.g., Roux-en-Y or distal gastric bypass) at any time prior to Screening
10) Weight loss > 10% within 6 months of Screening
11) HIV infection (HIV Ab and HIV ribonucleic acid [HIV RNA] positive)
12) Current alcohol consumption greater than 21 oz/week for males or 14 oz/week for females (1oz/30mL of alcohol is present in 1 12oz/360mL beer, 1 4oz/120mL glass of wine, and a 1 oz/30 mL measure of 40 proof alcohol)
13) Positive urine drug screen for amphetamines, cocaine or opiates (i.e. heroin, morphine) at Screening. Subjects on stable methadone or buprenorphine maintenance treatment for at least 6 months prior to Screening may be included in the study. Subjects with a positive urine drug screen due to prescription opioid based medication are eligible if the prescription and diagnosis are reviewed and approved by the investigator
14) Unstable cardiovascular disease as defined by any of the following:
a) Unstable angina, myocardial infarction, coronary artery bypass graft surgery or coronary angioplasty within 6 months prior to Screening
b) Transient ischemic attack or cerebrovascular accident within 6 months prior to Screening
c) Symptomatic obstructive valvular heart disease or hypertrophic cardiomyopathy
d) Symptomatic congestive heart failure
e) Uncontrolled or recurrent ventricular tachycardia or other arrhythmia requiring an automatic implantable cardioverter defibrillator (AICD). Stable, controlled atrial fibrillation is allowed.
15) Use of any prohibited concomitant medication as described in Section 5.4. Subjects on Vitamin E must be on a stable dose for at least 6 months prior to the diagnostic liver biopsy and subjects on antidiabetic medications must be on a stable dose for at least 3 months prior to diagnostic liver biopsy
16) History of a malignancy within 5 years of Screening with the following exceptions:
a) Adequately treated carcinoma in situ of the cervix
b) Adequately treated basal or squamous cell cancer or other localized non-melanoma skin cancer
17) Unable to safely undergo a liver biopsy
18) Participation in another investigational study of a drug or device within 30 days or within 5 half-lives of the prior investigational agent (whichever is longer) prior to Screening
19) Concurrent participation in another therapeutic clinical study
20) Known hypersensitivity to SEL, the metabolites, or formulation excipient
21) Any laboratory abnormality or condition that, in the investigator*s opinion, could adversely affect the safety of the subject or impair the assessment of study results
22) Presence of any condition that could, in the opinion of the investigator, compromise the subject*s ability to participate in the study, including a history of substance abuse or a psychiatric condition requiring hospitalization or emergency room visit within 2 years of Screening
23) Unavailable for follow-up assessment or concern for subject*s compliance with the protocol procedures
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 | EUCTR2016-004148-13-NL |
ClinicalTrials.gov | NCT03053063 |
CCMO | NL61100.042.17 |