A Study to Assess the Safety and Efficacy of LB-P8 in Patients With PSC

A Phase 2 Randomized, Double Blind, Placebo Controlled, Parallel Study Evaluating the Safety and Efficacy of LB P8 in Patients With Primary Sclerosing Cholangitis (PSC)

The study is designed to assess the safety and efficacy of LB-P8 in patients with primary sclerosing cholangitis.

This is phase 2, randomized, double-blind, placebo-controlled, multicenter study to assess the safety and efficacy of LB-P8 in adult patients with primary sclerosing cholangitis(PSC).

• Part 1 will evaluate safety and tolerability of 2 pre-selected dose level of LB-P8 (low-dose[1×10^10 CFU/capsule] and high dose [1×10^11 CFU/capsule]) in adult patients with PSC. Part 1 plans to enroll a maximum number of 12 patients based on a "3+3" study design.
• Part 2 will evaluate safety and efficacy in adult patients with PSC. Eligible patients with PSC will be randomized in a 1:1:1 ratio to receive treatment with low-dose LB-P8(1×10^10 CFU/capsule), high-dose LB-P8(1×10^11 CFU/capsule) or matched placebo capsule. Part 2 plans to enroll and randomize 75 patients to obtain 60 evaluable patients.

Inclusion Criteria:

• Age: 18 to 75 years
• A diagnosis of PSC based on cholangiographic evidence of PSC in accordance with American Association for the Study of Liver Diseases (AASLD) guidelines
• ALP >1.5 times the ULN at screening
• PSC with or without IBD, such as ulcerative colitis or Crohn's disease
• If patients are being administered biologic or advanced therapeutic treatments, immunosuppressants, systemic corticosteroids, obeticholic acid, fibrates, or statins, they must be on a stable dose for ≥3 months prior to, and including, Day 0 and plan to remain on a stable dose throughout the study
• If patients are receiving ursodeoxycholic acid, they must be on a stable dose (not exceeding 23 mg/kg/day) for >3 months prior to screening
• Patient agrees to stop all probiotics for at least 2weeks prior to treatment
• Patient is unable to conceive and/or patient who's partner is unable to become pregnant and/or agree to use effective methods of contraception when engaging in heterosexual intercourse

Exclusion Criteria:

• Treatment with any investigational agents within 3 months or 5 half-lives, whichever is longer prior to treatment or during the study. Gene therapy or other long-lasting investigational agents with unknown half-life is not allowed
• History of a liver transplant or anticipated need for a liver transplant within 1 year
• Patients who show evidence of significant worsening of hepatic function will be excluded.
• Evidence of compensated or decompensated cirrhosis based on histology, relevant medical complications, or laboratory parameters
• Model for end-stage liver disease (MELD) score as below, unless the MELD is driven by anticoagulant therapy, vitamin deficiency, or kidney disease:
• MELD Score of >12 (decompensated cirrhosis) for Part 1 of the study
• MELD Score of >12 for Part 2 of the study
• Small-duct PSC (in the absence of large duct PSC)
• Secondary causes of sclerosing cholangitis including IgG4 associated sclerosing cholangitis
• Any history of cholangiocarcinoma, gallbladder cancer, or hepatocellular carcinoma
• History of any malignancy with lymph node or regional metastases within 5 years or current malignancy undergoing active treatment
• Patients who require chronic use of antibiotics, received antibiotics in the last 1 month, or received Rebyota or Vowst (applicable for patients with Clostridioides difficile infection)
• In patients with ulcerative colitis, partial Mayo score of >6 or, patients with Crohn's disease if CDAI of >220
• Chronic kidney injury
• Recent acute cholangitis (within 90 days)
• Patients with indwelling biliary drain (or stent), total proctocolectomy with ileal anal pouch, partial large bowel resections or history of small bowel resection
• Other causes of liver disease, such as autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), AIH/PSC overlap syndrome, alpha-1-antitrypsin deficiency, viral hepatitis, iron overload syndrome, Wilson disease, nonalcoholic steatohepatitis, and/or alcohol related liver disease. Additionally, positive serology for hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (anti HCV) (detectable HCV RNA in the serum), or human immunodeficiency virus antibodies (anti HIV)
• Active drug (known or suspected use of illicit drugs or drugs of abuse) or alcohol abuse disorder
• Female patients who are pregnant, nursing, or planning to become pregnant during the study
• Clinically significant and/or active infection
• Subjects with a greater degree of immunosuppression, as evidenced by Alsolute neutrophil count <500 cells/mL or in the investigator's judgement immunosuppressed and at higher risk of infection