Clinical trial NCT06730061: A Study of Elafibranor in Adult Japanese Participants With Primary Biliary Cholangitis (PBC)
Official title: A Phase III, Open-label, Single Arm Study to Investigate the Efficacy and Safety of Elafibranor 80 mg in Adult Japanese Participants With Primary Biliary Cholangitis (PBC)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Primary Biliary Cholangitis
Lead sponsor: Ipsen
Sponsor class: INDUSTRY
First posted: 2024-12-12
Enrollment: 18
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to find out about the safety and how well the study intervention (elafibranor) works in participants with PBC. The participants in this study will have confirmed PBC with inadequate response or intolerance to UDCA, which is a medication used in the management and treatment of cholestatic liver disease.

PBC is a slowly progressive disease characterised by damage of the bile ducts in the liver, leading to a build-up of bile acids which causes further damage. The liver damage in PBC may lead to scarring (cirrhosis).

PBC may also be associated with multiple symptoms. Many patients with PBC may require a liver transplant or may die if the disease progresses and a liver transplant is not done. In this study all participants will receive a daily dose of elafibranor (the study intervention).

The main aim of this study is to determine if elafibranor reduces alkaline phosphatase (ALP) and total bilirubin levels. High ALP and bilirubin levels in the blood can indicate liver disease.

There will be 4 periods in this study: A screening period (up to 10 weeks) to assess whether the participant can take part. A treatment period (52 weeks) where all eligible participants will receive elafibranor. A variable treatment extension period (2-5 years) from End Of Treatment (EOT) period up to the commercial availability of elafibranor in Japan. A follow-up period (4 weeks) where participants' health will be monitored.

Participants will undergo blood sampling, urine collections, physical examinations, clinical evaluations, electrocardiograms (ECG: recording of the electrical activity of heart), ultrasound examinations (a non-invasive test that passes a probe over skin to look at the bladder, urinary tract, and liver), and Fibroscan® examinations (to measure stiffness of the liver). They will also be asked to fill in questionnaires. Each participant will be in this study for up to approximately 6 years


Eligibility criteria: Inclusion Criteria:

* Must have provided written informed consent and agree to comply with the study protocol.
* Japanese male or female participants aged 18 to 75 years inclusive at Screening Visit 1 (SV1).
* PBC diagnosis as described in the study protocol
* ALP ≥1.67×ULN (mean value based on samples collected at SV1 and SV2).
* TB ≤2×ULN at SV1 and SV2.
* Must have at least 4 available values for PBC Worst Itch Numeric Rating Scale (NRS) during each of the 7-day intervals in the 14 days prior to visit (V)1, for a total of at least 8 values for PBC Worst Itch NRS in the last 14 days prior to V1.
* Participants taking UDCA for at least 12 months (stable dose ≥3 months) prior to screening, or unable to tolerate UDCA treatment (no UDCA for ≥3 months) prior to screening (per country standard-of-care dosing).
* If on colchicine, must be on a stable dose for ≥3 months prior to screening.
* Medications for management of pruritus (for example, cholestyramine, rifampicin, naltrexone, sertraline or nalfurafine hydrochloride) must be on a stable dose for ≥3 months prior to screening.
* Participants taking statins or ezetimibe must be on a stable dose for ≥2 months prior to screening.
* Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies

Exclusion Criteria

* History or presence of other concomitant liver disease
* Participants with known cirrhosis who have a Child-Pugh B or C classification.
* Participants with cirrhosis with Child-Pugh A classification are allowed.
* History or presence of clinically significant hepatic decompensation,
* Medical conditions that may cause non-hepatic increases in ALP (for example, Paget's disease) or which may diminish life expectancy to \<2 years, including known cancers.
* Known malignancy or history of malignancy within the last 5 years, with the exception of local, successfully treated basal cell carcinoma or in-situ carcinoma of the uterine cervix.
* Participant has a positive test for human immunodeficiency virus (HIV) Type 1 or 2 at screening, or participant is known to have tested positive for HIV.
* Evidence of any other unstable or untreated clinically significant immunological, endocrine, haematologic, gastrointestinal, neurological, or psychiatric disease as evaluated by the investigator; other clinically significant medical conditions that are not well controlled.
* History of alcohol abuse, defined as consumption of more than 30 g pure alcohol per day for men, and more than 20 g pure alcohol per day for women, or other substance abuse within 1 year prior to SV1.
* For female participants: known pregnancy, or has a positive serum pregnancy test, or breastfeeding.
* Administration of the following medications are prohibited as specified below:

  1. 1 month prior to screening: fibrates.
  2. 2 months prior to screening: glitazones.
  3. For participants with previous exposure to obeticholic acid (OCA), OCA should be discontinued 3 months prior to screening.
  4. 3 months prior to screening: azathioprine, cyclosporine (systemic), methotrexate, mycophenolate, pentoxifylline, budesonide and other systemic corticosteroids (parenteral and oral chronic administration only); potentially hepatotoxic drugs (including α-methyldopa, sodium valproate/valproic acid isoniazid, or nitrofurantoin).
  5. 12 months prior to screening: antibodies or immunotherapy directed against interleukins (ILs) or other cytokines or chemokines.
* Participants who are currently participating in, plan to participate in, or have participated in an investigational drug study or medical device study containing active substance within 30 days or 5 half-lives, whichever is longer, prior to screening; for participants with previous exposure to seladelpar, seladelpar should be discontinued 3 months prior to screening.
* Participants with previous exposure to elafibranor.
* SV1 or SV2 value ALT and/or AST \>5×ULN.
* For participants with aminotransferases or TB \>ULN at SV1, variability (between SV1 and SV2) of aminotransferases or TB \>40%.
* SV1 value albumin \<3.0 g/dL.
* Severely advanced participants according to Rotterdam criteria (TB \>ULN and albumin \<LLN).
* SV1 international normalised ratio (INR) \>1.3 due to altered hepatic function.
* SV1 creatine phosphokinase (CPK) \>2×ULN.
* SV1 serum creatinine \>1.5 mg/dL.
* Significant renal disease, including nephritic syndrome, chronic kidney disease (defined as participants with markers of kidney failure damage or estimated glomerular filtration rate (eGFR) \<60 mL/min/1.73 m2) calculated by modification of diet in renal disease study (MDRD).
* SV1 platelet count \<150×103/μL.
* Alpha-fetoprotein (AFP) \>20 ng/mL with 4-phase liver computerised tomography (CT) or magnetic resonance imaging (MRI) imaging suggesting presence of liver cancer.
* Known hypersensitivity to the investigational product or to any of the formulation excipients of the elafibranor tablet.
* Mental instability or incompetence, such that the validity of informed consent or ability to be compliant with the study is uncertain.

Primary outcomes:
measure: Percentage of participants with Alkaline phosphatase (ALP) <1.67x ULN, ALP decrease ≥15% and Total Bilirubin (TB) ≤ ULN
timeFrame: At Week 52
Secondary outcomes:
measure: Percentage of Participants who normalised ALP Levels
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in ALP Levels
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of Participants With ALP Level response
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with ALP <1.5×ULN, ALP decrease ≥40% and TB ≤ULN.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with ALP <3×ULN, aspartate aminotransferase (AST) <2×ULN and Total Bilirubin (TB) <1 mg/dL (Paris I criteria).
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with ALP ≤1.5×ULN, AST ≤1.5×ULN and TB ≤ULN (Paris II criteria).
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with TB response rate of 15% change.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with normalisation of abnormal TB and/or albumin (Rotterdam criteria).
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with TB ≤0.6×ULN
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with ALP ≤1.67×ULN and TB ≤1 mg/dL.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with no worsening of TB Levels
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with complete biochemical response
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with ALP ≤1.67×ULN, ALP decrease ≥15% and TB ≤ULN.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with ALP <1.5×ULN, ALP decrease ≥15% and TB ≤ULN.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants with ALP ≤ULN and TB ≤ULN.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in PBC risk scores based in Global PBC Study Group (GLOBE) score
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in PBC risk scores based on United Kingdom (UK)-PBC score.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Response based on the normalisation of bilirubin.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Response based on the normalisation of albumin Levels.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in hepatobiliary injury and liver function
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in lipid parameters
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in liver stiffness measurement (LSM)
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in pruritus
timeFrame: At Week 26, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Proportion of responders in PBC Worst Itch NRS according to clinically meaningful change from baseline
timeFrame: At Week 26 and at Week 52 and every 26 weeks until the end of study (up to 6 years)
measure: Proportion of participants with no worsening of pruritus from baseline
timeFrame: At Week 26 and at Week 52 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in 5D-Itch scale
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form 7a scores
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in Epworth Sleepiness Scale (ESS).
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in PBC-40.
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in EuroQol 5-dimensional 5-level questionnaire (EQ-5D-5L)
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in Patient Global Impression of Severity (PGI-S)
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Patient Global Impression of Change (PGI-C)
timeFrame: At Week 4, Week 13, Week 26, Week 39, and Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)]
measure: Time to the first occurrence of each of individual adjudicated clinical outcome events
timeFrame: At Week 4, Week 13, Week 26, Week 39, Week 52, Week 78 and every 26 weeks until the end of study (up to 6 years)
measure: Percentage of participants who experience Treatment Emergent Adverse Events (TEAEs), treatment related TEAEs, Serious Adverse Events (SAEs), and Adverse Events of Special Interest (AESIs).
timeFrame: From baseline to end of study (up to 6 years)
measure: Percentage of participants who develop clinically significant changes from baseline in physical examination findings
timeFrame: From baseline to end of study (up to 6 years)
measure: Percentage of participants who develop clinically significant changes from baseline in vital signs
timeFrame: From baseline to end of study (up to 6 years)
measure: Percentage of participants with clinically significant changes in laboratory parameters (blood chemistry, hematology, liver tests, renal tests (including urinalysis).
timeFrame: From baseline to end of study (up to 6 years)
measure: Percentage of participants who develop clinically significant changes from baseline in ECG readings
timeFrame: From baseline to end of study (up to 6 years)
measure: Change from baseline in fasting plasma glucose (FPG) Levels
timeFrame: At Week 52 and every 26 weeks until the end of study (up to 6 years)
measure: Change from baseline in serum markers of bone turnover and in bone mineral density (hip and lumbar)
timeFrame: At Week 52 and every 26 weeks until the end of study (up to 6 years)
measure: Area under the plasma concentration-time curve from time 0 to 24 hours: AUC0-24
timeFrame: At Week 4
measure: Maximum (peak) plasma drug concentration: Cmax
timeFrame: At Week 4
measure: Time to reach maximum (peak) plasma concentration following drug administration): Tmax
timeFrame: At Week 4
Other outcomes:
Locations:
city: Chiba
country: Japan
facility: Nippon Medical School - Chiba Hokusoh Hospital
city: Fukushima
country: Japan
facility: Fukushima Medical University Hospital
city: Hiroshima
country: Japan
facility: Chugoku Rosai Hospital
city: Hokkaido
country: Japan
facility: Teine Keijinkai Hospital
city: Kagawa
country: Japan
facility: Kagawa University Hospital
city: Kagoshima
country: Japan
facility: Kagoshima University Hospital
city: Nagano
country: Japan
facility: Shinshu University Hospital
city: Nagasaki
country: Japan
facility: National Hospital Organization Nagasaki Medical Center
city: Nara
country: Japan
facility: Nara Medical University Hospital
city: Niigata
country: Japan
facility: Nagaoka Red Cross Hospital
city: Niigata
country: Japan
facility: Niigata University Medical & Dental Hospital
city: Osaka
country: Japan
facility: National Hospital Organization Osaka National Hospital
city: Shizuoka
country: Japan
facility: Hamamatsu University Hospital
city: Tokyo
country: Japan
facility: Juntendo University Hospital
city: Tokyo
country: Japan
facility: Teikyo University Hospital
city: Tokyo
country: Japan
facility: Tokyo Metropolitan Komagome Hospital
Study officials:
affiliation: Ipsen
name: Ipsen Medical, Director
role: STUDY_DIRECTOR
References: