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This is a multicenter, double-blind, randomized, placebo-controlled trial involving subjects with a diagnosis of "definite NASH" with fibrosis (excluding cirrhosis) as determined by the central histopathologist. Upon successful screening, subjects will be randomized to receive either emricasan 50 mg BID or emricasan 5 mg BID or matching placebo BID.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Emricasan (5 mg) | Active Comparator | Subjects with Non-alcoholic Steatohepatitis (NASH) Fibrosis will be administered orally with emricasan (5 mg) twice a day. |
|
| Emricasan (50 mg) | Active Comparator | Subjects with Non-alcoholic Steatohepatitis (NASH) Fibrosis will be administered orally with emricasan (50 mg) twice a day. |
|
| Matching Placebo | Placebo Comparator | Subjects with Non-alcoholic Steatohepatitis (NASH) Fibrosis will be administered orally with a matching placebo twice a day. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Emricasan (5 mg) | Drug | Subjects with Non-alcoholic Steatohepatitis (NASH) Fibrosis will be administered orally with emricasan (5 mg) twice a day. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Fibrosis improvement by at least one stage without worsening of steatohepatitis | Proportion of subjects who improve fibrosis on liver biopsy by at least one stage without worsening of steatohepatitis in the emricasan group compared to placebo | Week 72 |
| Measure | Description | Time Frame |
|---|---|---|
| Steatohepatitis resolution (based on liver biopsy) | The proportion of subjects who resolve steatohepatitis without worsening of fibrosis in the emricasan group compared to placebo | Baseline & Week 72 |
| Improvement in the Non-alcoholic fatty liver disease (NAFLD) Activity Score |
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Inclusion Criteria:
Male or female subjects 18 years or older, able to provide written informed consent, and able to understand and willing to comply with the requirements of the study
Histological evidence of definite NASH based on NASH CLinical Research Network (CRN) criteria, as confirmed by the central histopathologist, on a liver biopsy obtained no more than 6 months prior to Day 1
NAFLD Activity Score (NAS) of 4 or greater with a score of at least 1 in each component of the NAS (steatosis scored 0-3, lobular inflammation scored 0-3, ballooning scored 0-2)
Fibrosis stage 1 (limited to 20% of subjects), stage 2, or stage 3 using the NASH CRN Histologic Scoring System
a. Subjects with fibrosis stage 1 must also have diabetes mellitus or metabolic syndrome
Willingness to utilize effective contraception (for both males and females of childbearing potential) from Screening to 4 weeks after the last dose of study drug
If on vitamin E or pioglitazone, subjects must have been on a stable dose for at least 3 months prior to the biopsy (whether historical or qualifying biopsy)
Exclusion Criteria:
Current or history of significant alcohol consumption, defined as more than 20 g/day for females and more than 30 g/day in males on average, or inability to reliably quantify alcohol consumption based on investigator's judgement
Use of the following drugs (which may have potential hepatotoxic effects) within 6 months prior to Day 1: amiodarone, methotrexate, tamoxifen, valproic acid, estrogens at doses greater than those used for hormone replacement or contraception, anabolic steroids, or systemic glucocorticoids for more than 4 weeks at doses greater than replacement doses
Uncontrolled diabetes (HbA1c ≥9%) within 60 days prior to Day 1
Presence of cirrhosis on liver biopsy (fibrosis stage 4 based on the central histopathologist reading)
Hepatitis and fibrosis more likely related to etiologies other than NASH such as:
ALT or AST >5 times upper limit of normal (ULN) or total bilirubin >1.5 times ULN during screening (unless subject has elevated total bilirubin due to Gilbert's as documented in the medical records)
Alpha-fetoprotein >200 ng/mL
Hemoglobin <10 g/dL
White blood cell count <2.0 x 10^3/mm3
Estimated creatinine clearance <30 mL/min
Current use of the following medications that are considered significant inhibitors of OATP1B1 and OATP1B3 transporters: atazanavir, cyclosporine, eltrombopag, gemfibrozil, indinavir, lopinavir, ritonavir, rifampin, saquinavir, simeprevir, telaprevir, tipranovir, or some combination of these medications
Symptoms of biliary colic, e.g. due to symptomatic gallstones, within the last 6 months, unless resolved following cholecystectomy
Inability to safely obtain a liver biopsy
Known human immunodeficiency virus (HIV) infection
Weight loss ≥ 10% within 6 months of Day 1
Use of controlled substances (including inhaled or injected drugs) or non-prescribed use of prescription drugs within 1 year of screening to the point of interfering with the subject's ability to comply with study procedures and study drug administration in the investigator's judgement
History of or active malignancies, other than those successfully treated with curative intent and believed to be cured
Significant systemic or major illness other than liver disease that in the opinion of the investigator would preclude the subject from participating in and completing the study, including but not limited to acute coronary syndrome or stroke within 6 months of screening or major surgery within 3 months of screening
History or presence of clinically concerning cardiac arrhythmias, or prolongation of Screening (pre-treatment) QTcF interval >480 milliseconds (msec)
Prior or planned (during the time frame of the study) bariatric surgery
If female: planned or known pregnancy, positive urine or serum pregnancy test, or lactating/breastfeeding
Previous treatment with emricasan or active investigational medication in a clinical trial within 6 months prior to Day 1
Prior liver transplant
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| Name | Affiliation | Role |
|---|---|---|
| Jean L Chan, MD | Conatus Pharmaceuticals Inc. | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Alabama at Birmingham | Birmingham | Alabama | 35233 | United States | ||
| University of Arizona Clinical and Translational Sciences Research Center |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31887369 | Derived | Harrison SA, Goodman Z, Jabbar A, Vemulapalli R, Younes ZH, Freilich B, Sheikh MY, Schattenberg JM, Kayali Z, Zivony A, Sheikh A, Garcia-Samaniego J, Satapathy SK, Therapondos G, Mena E, Schuppan D, Robinson J, Chan JL, Hagerty DT, Sanyal AJ. A randomized, placebo-controlled trial of emricasan in patients with NASH and F1-F3 fibrosis. J Hepatol. 2020 May;72(5):816-827. doi: 10.1016/j.jhep.2019.11.024. Epub 2019 Dec 27. |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Nov 21, 2019 | |
| Reset | Dec 11, 2019 |
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| Emricasan (50 mg) | Drug | Subjects with Non-alcoholic Steatohepatitis (NASH) Fibrosis will be administered orally with emricasan (50 mg) twice a day. |
|
|
| Placebo | Drug | Subjects with Non-alcoholic Steatohepatitis (NASH) Fibrosis will be administered orally with a matching placebo twice a day. |
|
The proportion of subjects who improve the NAFLD Activity Score (NAS), its components (steatosis, lobular inflammation, ballooning), and portal inflammation, in the emricasan group compared to placebo |
| Baseline & Week 72 |
| Caspase 3/7 Relative Light Units and Alanine aminotransferase (ALT) | To asses whether emricasan compared to placebo improves biomarkers Caspase 3/7 RLU and ALT Unit/Liter (U/L) in subjects with NASH fibrosis. | Day 1, week 4, 24, 48, and 72 |
| Tucson |
| Arizona |
| 85724 |
| United States |
| Preferred Research Partners, Inc. | Little Rock | Arkansas | 72211 | United States |
| Fresno Clinical Research Center | Freestone | California | 93701 | United States |
| UCLA The Pfleger Liver Institute | Los Angeles | California | 90024 | United States |
| Gastrointestinal Biosciences | Los Angeles | California | 90067 | United States |
| Surinder Singh Saini, M.D., Inc. | Newport Beach | California | 92660 | United States |
| California Liver Research Institute | Pasadena | California | 91105 | United States |
| Inland Empire Liver Foundation | Rialto | California | 92377 | United States |
| University of California Davis Medical Center | Sacramento | California | 95817 | United States |
| University of California San Diego Medical Center | San Diego | California | 92103 | United States |
| Cedars Sinai Medical Center | West Hollywood | California | 90048 | United States |
| Yale University School of Medicine | New Haven | Connecticut | 06510 | United States |
| Sibley Memorial Hospital | Washington D.C. | District of Columbia | 20016 | United States |
| Howard University | Washington D.C. | District of Columbia | 20059 | United States |
| UF Hepatology Research at CTRB | Gainesville | Florida | 32610 | United States |
| Florida Digestive Health Specialist | Lakewood Rch | Florida | 34211 | United States |
| Miami Veterans Administration Healthcare System | Miami | Florida | 33125 | United States |
| University of Miami/Schiff Center for Liver Diseases | Miami | Florida | 33136 | United States |
| Florida Hospital Orlando Transplant Institute | Orlando | Florida | 32804 | United States |
| Tampa General Medical Group | Tampa | Florida | 33606 | United States |
| iResearch Atlanta LLC | Decatur | Georgia | 30030 | United States |
| Gastrointestinal Specialists of Georgia | Marietta | Georgia | 30060 | United States |
| Northwestern Memorial Hospital | Chicago | Illinois | 60611 | United States |
| Rush University Medical Center | Chicago | Illinois | 60612 | United States |
| The University of Chicago Medical Center | Chicago | Illinois | 60637 | United States |
| Aquiant Research | New Albany | Indiana | 47150 | United States |
| Iowa Digestive Disease Center, P.C | Clive | Iowa | 50325 | United States |
| UnityPoint Clinic Center For Liver Disease | Des Moines | Iowa | 50309 | United States |
| University of Louisville | Louisville | Kentucky | 40202 | United States |
| Ochsner Clinic Foundation | New Orleans | Louisiana | 70121 | United States |
| Louisiana Research Center, LLC | Shreveport | Louisiana | 71105 | United States |
| Mercy Medical Center | Baltimore | Maryland | 21202 | United States |
| Walter Reed National Military Medical Center | Bethesda | Maryland | 20889 | United States |
| Massachusetts General Hospital | Boston | Massachusetts | 02114 | United States |
| Beth Israel Deaconess Medical Center | Boston | Massachusetts | 02215 | United States |
| Lahey Clinic Medical Center | Burlington | Massachusetts | 01803 | United States |
| Henry Ford Health System | Detroit | Michigan | 48202 | United States |
| Mayo Clinic | Rochester | Minnesota | 55905 | United States |
| Kansas City VA Medical Center | Kansas City | Missouri | 64128 | United States |
| Kansas City Research Institute | Kansas City | Missouri | 64131 | United States |
| Washington University School of Medicine-Infectious Disease Clinical Research Unit | St Louis | Missouri | 63110 | United States |
| Doctors Office Center | Newark | New Jersey | 07103 | United States |
| State University of New York | Buffalo | New York | 14203 | United States |
| Northwell Health, Inc. | Manhasset | New York | 11030 | United States |
| Mount Sinai Beth Israel Medical Center | New York | New York | 10003 | United States |
| NYU Langone Medical Center | New York | New York | 10016 | United States |
| Columbia University Medical Center (CUMC) | New York | New York | 10032 | United States |
| Weill Cornell Medical College | New York | New York | 10065 | United States |
| Montefiore Medical Center | The Bronx | New York | 10467 | United States |
| Asheville Gastroenterology Associates, PA | Asheville | North Carolina | 28801 | United States |
| Carolinas Healthcare System, Center for Liver Disease | Charlotte | North Carolina | 28204 | United States |
| Duke University Medical Center, Duke South Clinics | Durham | North Carolina | 27710 | United States |
| Rex Healthcare | Raleigh | North Carolina | 27607 | United States |
| Consultants for Clinical Research | Cincinnati | Ohio | 45249 | United States |
| University Hospitals Case Medical Center | Cleveland | Ohio | 44106 | United States |
| Options Health Research, LLC | Tulsa | Oklahoma | 74104 | United States |
| Hospital of the University of Pennsylvania | Philadelphia | Pennsylvania | 19104 | United States |
| Thomas Jefferson University | Philadelphia | Pennsylvania | 19107 | United States |
| Temple University Hospital | Philadelphia | Pennsylvania | 19140 | United States |
| Albert Einstein Medical Center | Philadelphia | Pennsylvania | 19141 | United States |
| University Gastroenterology | Providence | Rhode Island | 02905 | United States |
| Medical University of South Carolina | Charleston | South Carolina | 29425 | United States |
| PMG Research at Charleston | Charleston | South Carolina | 29461 | United States |
| ClinSearch, LLC | Chattanooga | Tennessee | 37421 | United States |
| Gastro One | Germantown | Tennessee | 38138 | United States |
| Methodist University Hospital | Memphis | Tennessee | 38104 | United States |
| Vanderbilt University Medical Center - Digestive Disease Center | Nashville | Tennessee | 37232 | United States |
| Texas Clinical Research Institute | Arlington | Texas | 76012 | United States |
| University of Texas Southwestern Medical Center | Dallas | Texas | 75390 | United States |
| Baylor All Saints Medical Center | Fort Worth | Texas | 76104 | United States |
| Baylor College of Medicine | Houston | Texas | 77030 | United States |
| Liver Associates of Texas, P.A. | Houston | Texas | 77030 | United States |
| Research Specialists of Texas | Houston | Texas | 77030 | United States |
| Pinnacle Clinical Research, PLLC | Live Oak | Texas | 78233 | United States |
| American Research Corporation at the Texas Liver Institue | San Antonio | Texas | 78215 | United States |
| Brooke Army Medical Center | San Antonio | Texas | 78219 | United States |
| University of Utah Health Sciences Center | Salt Lake City | Utah | 84132 | United States |
| University of Vermont | Burlington | Vermont | 05405 | United States |
| Bon Secours Richmond Health System | Newport News | Virginia | 23602 | United States |
| Digestive and Liver Disease Specialists | Norfolk | Virginia | 23502 | United States |
| McGuire VA Medical Center | Richmond | Virginia | 23249 | United States |
| University of Washington Harborview Medical Center | Seattle | Washington | 98104 | United States |
| Universitätsklinikum der RWTH Aachen | Aachen | North Rhine-Westphalia | 52074 | Germany |
| Universitätsklinikum Bonn | Bönning | North Rhine-Westphalia | 53127 | Germany |
| Universitätsklinikum Münster | Münster | North Rhine-Westphalia | 48149 | Germany |
| Charité - Universitätsmedizin Berlin | Berlin | 13353 | Germany |
| Universitätsklinikum Freiburg | Freiburg im Breisgau | 79106 | Germany |
| Universitätsklinikum Hamburg Eppendorf | Hamburg | 20246 | Germany |
| Medizinische Hochschule Hannover | Hanover | 30625 | Germany |
| Eugastro GmbH | Leipzig | 04103 | Germany |
| Universitätsmedizin der Johannes Gutenberg-Universität Mainz | Mainz | 55131 | Germany |
| Hospital Universitario Vall d'Hebron | Barcelona | 08035 | Spain |
| Hospital Clinic de Barcelona | Barcelona | 08036 | Spain |
| Hospital Universitario de Donostia | Donostia / San Sebastian | 20014 | Spain |
| Hospital Universitario de La Princesa | Madrid | 28006 | Spain |
| Hospital General Universitario Gregorio Marañon | Madrid | 28007 | Spain |
| Hospital Universitario Ramon y Cajal | Madrid | 28034 | Spain |
| Hospital Universitario La Paz | Madrid | 28046 | Spain |
| Hospital Universitario Puerta de Hierro - Majadahonda | Majadahonda | 28222 | Spain |
| Hospital Universitario Marques de Valdecilla | Santander | 39008 | Spain |
| Hospital Clinico Universitario de Valencia | Valencia | 46010 | Spain |
| Hospital General Universitario de Valencia | Valencia | 46104 | Spain |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Nov 21, 2019 | Dec 11, 2019 |
| ID | Term |
|---|---|
| D065626 | Non-alcoholic Fatty Liver Disease |
| D005355 | Fibrosis |
| D008107 | Liver Diseases |
| ID | Term |
|---|---|
| D005234 | Fatty Liver |
| D004066 | Digestive System Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| C487112 | 3-(2-(2-tert-butylphenylaminooxalyl)aminopropionylamino)-4-oxo-5-(2,3,5,6-tetrafluorophenoxy)pentanoic acid |
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