Clinical trial NCT05402371: A Study to Evaluate the Efficacy and Safety of Rencofilstat in Subjects With NASH and Advanced Liver Fibrosis
Official title: A Phase 2B, Randomized, Multi-Center, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Rencofilstat in Adult Subjects With Nonalcoholic Steatohepatitis and Advanced Liver Fibrosis
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE2
Conditions: Nonalcoholic Steatohepatitis (NASH)
Fibrosis, Liver
NAFLD
Keywords: Nonalcoholic Steatohepatitis
NAFLD
NASH
liver fibrosis
Lead sponsor: Hepion Pharmaceuticals, Inc.
Sponsor class: INDUSTRY
First posted: 2022-06-02
Enrollment: 120
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: blinded, placebo controlled, randomized
Primary purpose: TREATMENT

Brief summary: This is a randomized, double-blind, placebo-controlled, parallel-dosing, multi-center study to evaluate the efficacy and safety of Rencofilstat as evidenced by histopathological improvements in fibrosis in adult NASH subjects with F2 or F3 fibrosis (NASH CRN system). Antifibrotic biomarker activity will be evaluated on an exploratory basis.

Detailed description: This is a randomized, double-blind, placebo-controlled, parallel-dosing, multi-center study to evaluate the efficacy and safety of Rencofilstat as evidenced by histopathological improvements in fibrosis in adult NASH subjects with F2 or F3 fibrosis (NASH CRN system). Antifibrotic biomarker activity will be evaluated on an exploratory basis.

This study consists of 3 phases: (i) Screening and Randomization; (ii) treatment; and (iii) follow up. During Screening, each subject will provide informed consent prior to starting any study specific procedures. The randomization of the F2/F3 NASH subjects will be performed in a 1:1:1:1 ratio between Rencofilstat 75mg, Rencofilstat 150mg, Rencofilstat 225mg, and matching placebo. Subjects will be stratified by presence or absence of Type 2 diabetes, fibrosis stage and a maximum of 34 F2 subjects in each cohort.

Eligibility criteria: Inclusion Criteria Subjects must fulfill all the following inclusion criteria to be eligible for participation in the study.

1. Male or female between 18 and 75 years of age (inclusive).
2. Capable of giving written informed consent and able to effectively communicate with the investigator and study personnel.
3. Histologic evidence of NASH based on central readings of the screening biopsy obtained no more than 6 months before Screening defined by presence of all 3 key histological features, Nonalcoholic Fatty Liver Disease Activity Score (NAS) ≥ 4 with at least 1 point each in lobular inflammation and hepatocyte ballooning.

   a. Historical biopsy may be substituted for Screening biopsy to determine eligibility if the following are met: i. Historical biopsy was obtained no more than 180 ± 5 days prior to the first day of Screening.

   ii. Hepatic tissue or slides are available for central histologic evaluation. iii. No new therapeutic intervention for NASH was made 90 days prior to screening (e.g., obeticholic acid, vitamin E ≥ 400 IU/day, pioglitazone, incretins \[e.g., liraglutide, semaglutide\], sodium-glucose cotransporter-2 \[SGLT2\] inhibitors).

   iv. Subjects must have been metabolically stable since the biopsy (no significant weight loss ≥ 7% of body weight, no major deterioration of glycemic control, and no introduction of new or investigational drugs for the treatment of Type 2 Diabetes).
4. Histologic liver fibrosis stage 2 or 3 as defined by the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) scoring of liver fibrosis based on central reading of the Screening biopsy (refer to criteria 4a regarding use of a historical biopsy as a substitute for the Screening biopsy).
5. Blood pressure up to 160/100 mmHg; potential subjects who meet other eligibility requirements, but who have out of range blood pressure measurements deemed to be not clinically significant by the investigator, may still be considered for study inclusion.

Exclusion Criteria Subjects who meet any of the following criteria prior to the first dose of study drug are not eligible for randomization.

1. Pregnant or breastfeeding or planning to become pregnant during the study period.
2. Known allergy to Rencofilstat, cyclosporine, or any of their inactive ingredients.
3. Positive test for hepatitis B surface antigen (HBsAg), hepatitis C virus antibodies (HCVAb) or human immunodeficiency virus antibodies (HIVAb). If HCVAb test is positive, then an HCV-RNA test will be performed. If this test is negative, the subject is allowed to participate in the study, as long as the subject meets all other inclusion criteria and has never been treated for HCV or was treated \>2 years ago and achieved a sustained virologic response at that time.
4. Subjects with suspected and symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection identified prior to first dose.
5. Subjects with a history of clinically significant acute cardiac events within 30 days prior to Screening such as stroke, transient ischemic attack, or coronary heart disease (angina pectoris requiring therapy, myocardial infarction, revascularization procedures with left ventricular ejection fraction \[LVEF\] \<50% as determined by previous echocardiography or multiple gated acquisition \[MUGA\] scan).
6. Subjects with uncontrolled or unstable cardiac arrhythmias:

   1. Severe conduction disturbance (e.g., second-degree or third-degree AV block).
   2. History of congenital long QT syndrome, congenital short QT syndrome, Torsades de Pointes, or Wolff Parkinson White syndrome.
7. Subjects with transaminases \>5 x upper limit of normal (ULN).
8. Subjects with ALP \>2 x ULN.
9. Subjects with total serum bilirubin \>1.5 x ULN.
10. Subjects with a platelet count \<100,000/mm3.
11. Subjects with an INR ≥ 1.3 in the absence of anticoagulants.
12. Subjects with albumin \<3.5 g/dL.
13. Model for End-Stage Liver Disease (MELD) score \>12, unless due to an alternate etiology such as therapeutic anticoagulation.
14. Current or previous (within the past 6 months) Child-Pugh (CP) score ≥ 7 for F2 or F3 subjects, unless due to an alternative etiology such as Gilbert's syndrome or therapeutic anticoagulation.
15. An estimated glomerular filtration rate (eGFR) \<60 mL/min/1.73 m2 (calculated by the Chronic Kidney Disease Epidemiology Collaboration \[CKD-EPI\] method).
16. Subjects with hemoglobin A1c (HbA1c) \>9.5%.
17. Subjects with any history or presence of decompensated cirrhosis including ascites, hepatic encephalopathy or variceal bleeding.
18. Other well documented causes of chronic liver disease according to standard diagnostic procedures including, but not restricted to:

    1. Suspicion of drug-induced liver disease.
    2. Alcoholic liver disease.
    3. Autoimmune hepatitis.
    4. Wilson's disease.
    5. Primary biliary cholangitis, primary sclerosing cholangitis.
    6. Genetic hemochromatosis (Homozygosity for C282Y or C282Y/H63D compound heterozygote).
    7. Known or suspected hepatocellular carcinoma (HCC).
    8. History or planned liver transplant.
    9. Clinical evidence of portal hypertension such as esophageal varices, ascites, history of hepatic encephalopathy, or splenomegaly.
19. History of hepatic decompensating events or subjects who develop manifestations of hepatic decompensation between screening and enrollment should not be randomized, inclusive of new or worsening jaundice and ascites, new esophageal varices, etc.
20. Subjects with Type 2 diabetes who have recent (\< 3 months) changes in medication class or dose of the following antidiabetic medications: Glucagon-like-peptide-1 (GLP-1) receptor agonist, dipeptidyl peptidase-4 (DPP-4) inhibitor, sodium/glucose cotransporter 2 (SGLT2) inhibitor, thiazolidinediones (TZD).
21. Received an investigational drug or investigational vaccine or used an investigational medical device within 60 days prior to first dose of study drug.
22. Received any investigation products being evaluated for the treatment of liver fibrosis or NASH in the 6 months prior to the Screening liver biopsy.
23. Inability to undergo MRE procedure due to unremovable metal or foreign object(s) or contraindication for any other reason including but not limited to pacemaker, shrapnel injury, extensive tattoos, severe claustrophobia, ear (cochlea) implant.

Primary outcomes:
measure: Proportion of subjects with improvement in fibrosis by at least 1 stage (NASH CRN system) OR NASH resolution without worsening of fibrosis.
timeFrame: dosing period of 1 year with 1 month observation and follow up period
Secondary outcomes:
measure: Proportion of subjects with improvement in fibrosis by at least 1 stage (NASH CRN system), regardless of effect on NASH.
timeFrame: dosing period of 1 year with 1 month observation and follow up period
measure: Proportion of subjects with improvement in fibrosis by at least 2 stages (NASH CRN system), regardless of effect on NASH.
timeFrame: dosing period of 1 year with 1 month observation and follow up period
measure: Proportion of subjects with improvement in fibrosis by at least 2 stages (NASH CRN system) AND no worsening of NASH.
timeFrame: dosing period of 1 year with 1 month observation and follow up period
measure: Change from baseline in ALT.
timeFrame: dosing period of 1 year with 1 month observation and follow up period
measure: Change from baseline in AST.
timeFrame: dosing period of 1 year with 1 month observation and follow up period
measure: Change from baseline in Pro-C3, type III collagen neo-epitopes.
timeFrame: dosing period of 1 year with 1 month observation and follow up period
Other outcomes:
Locations:
city: Huntsville
country: United States
facility: Medical Affiliated Research Center
state: Alabama
city: Chandler
country: United States
facility: Arizona Liver Health-Chandler
state: Arizona
city: Peoria
country: United States
facility: Arizona Liver Health
state: Arizona
city: Tucson
country: United States
facility: Adobe Clinical Research, LLC
state: Arizona
city: Tucson
country: United States
facility: Arizona Liver Health-Tuscon
state: Arizona
city: Little Rock
country: United States
facility: Preferred Research Partners, Inc.
state: Arkansas
city: North Little Rock
country: United States
facility: Arkansas Gastroenterology
state: Arkansas
city: Huntington Park
country: United States
facility: National Research Institute
state: California
city: Los Angeles
country: United States
facility: National Research Institute
state: California
city: Panorama City
country: United States
facility: National Research Institute
state: California
city: Santa Ana
country: United States
facility: National Research Institute
state: California
city: Bradenton
country: United States
facility: Synergy Healthcare, LLC
state: Florida
city: Clearwater
country: United States
facility: Tampa Bay Medical Research, Inc.
state: Florida
city: Cutler Bay
country: United States
facility: Top Medical Research, Inc.
state: Florida
city: Doral
country: United States
facility: Integrity Clinical Research, LLC
state: Florida
city: Hialeah Gardens
country: United States
facility: Evolution Clinical Trials, Inc.
state: Florida
city: Jacksonville
country: United States
facility: Borland Groover Clinical Research
state: Florida
city: Lady Lake
country: United States
facility: Ocala GI Research
state: Florida
city: Lakeland
country: United States
facility: Accel Research Sites-Lakeland CRU
state: Florida
city: Miami
country: United States
facility: Future Care Solutions, LLC
state: Florida
city: Miami
country: United States
facility: Entrust Clinical Research
state: Florida
city: Miami
country: United States
facility: United Reseach Group
state: Florida
city: Orlando
country: United States
facility: Omega Research Consultants, LLC
state: Florida
city: Port Orange
country: United States
facility: Progressive Medical Research
state: Florida
city: Sarasota
country: United States
facility: Covenant Research and Clinics
state: Florida
city: Dalton
country: United States
facility: Southeast Clinical Research Center
state: Georgia
city: Marietta
country: United States
facility: Gastrointestinal Specialists of Georgia, PC
state: Georgia
city: South Bend
country: United States
facility: Digestive Research Alliance of Michiana, LLC
state: Indiana
city: Bastrop
country: United States
facility: Delta Research Partners
state: Louisiana
city: Greenbelt
country: United States
facility: Mid-Atlantic GI Research, LLC
state: Maryland
city: Florham Park
country: United States
facility: AIG Digestive Disease Research, LLC
state: New Jersey
city: Austin
country: United States
facility: Pinnacle Clinical Research-Austin
state: Texas
city: Brownsville
country: United States
facility: South Texas Research Institute
state: Texas
city: Edinburg
country: United States
facility: South Texas Research Institute
state: Texas
city: Pearland
country: United States
facility: LinQ Research, LLC
state: Texas
city: San Antonio
country: United States
facility: Pinnacle Clinical Research-San Antonio
state: Texas
city: Newport News
country: United States
facility: Bon Secours Liver Institute of Hampton Roads
state: Virginia
city: Richmond
country: United States
facility: GI Select Health Research, LLC
state: Virginia
city: Spokane
country: United States
facility: Velocity Clinical Spokane
state: Washington
city: Pessac
country: France
facility: Hopital du Haut Leveque
city: Mexico City
country: Mexico
facility: Centro de Investigacion y Gastroenterologia SC
Study officials:
affiliation: Pinnacle Clinical Research
name: Stephen Harrison, MD
role: PRINCIPAL_INVESTIGATOR
References: