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    Summary
    EudraCT Number:2015-002560-16
    Sponsor's Protocol Code Number:747-303
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2015-11-25
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2015-002560-16
    A.3Full title of the trial
    A Phase 3, Double-Blind, Randomized, Long-Term, Placebo-Controlled, Multicenter Study Evaluating the Safety and Efficacy of Obeticholic Acid in Subjects with Nonalcoholic Steatohepatitis.
    Estudio de fase 3, multicéntrico, aleatorizado, con doble enmascaramiento, a largo plazo y controlado con placebo para evaluar la seguridad y la eficacia del ácido obeticólico en sujetos con esteatohepatitis no alcohólica.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A clinical trial where neither the doctor, patient or sponsor know whether a placebo or active medicine is being given to the patient with non-alcoholic fatty liver disease to see if the medicine is effective and safe in the treatment of that disease.
    Un ensayo clínico donde ni el médico, ni el paciente ni el promotor conocen si el paciente toma el medicamento activo o el placebo con enfermedaded de higado graso no alcohólico para ver si el medicamento es efectivo y seguro en el tratamiento de esa enfermedad.
    A.3.2Name or abbreviated title of the trial where available
    REGENERATE
    A.4.1Sponsor's protocol code number747-303
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorIntercept Pharmaceuticals Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportIntercept Pharmaceuticals Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationChiltern International Spain S.A.
    B.5.2Functional name of contact pointRicardo Diaz - General Director
    B.5.3 Address:
    B.5.3.1Street AddressCentro Empresarial Euronova 3, Ronda de Poniente 10, 2ª Planta
    B.5.3.2Town/ cityTres Cantos (Madrid)
    B.5.3.3Post code28760
    B.5.3.4CountrySpain
    B.5.4Telephone number+34911872700
    B.5.5Fax number+34911872849
    B.5.6E-mailspain.regulatory@chiltern.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameObeticholic Acid
    D.3.2Product code INT-747, OCA,
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNObeticholic Acid
    D.3.9.1CAS number 459789-99-2
    D.3.9.2Current sponsor code6-ECDCA
    D.3.9.3Other descriptive nameOBETICHOLIC ACID
    D.3.9.4EV Substance CodeSUB91981
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameObeticholic Acid
    D.3.2Product code INT-747, OCA,
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNObeticholic Acid
    D.3.9.1CAS number 459789-99-2
    D.3.9.2Current sponsor code6-ECDCA
    D.3.9.3Other descriptive nameOBETICHOLIC ACID
    D.3.9.4EV Substance CodeSUB91981
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Non- alcoholic steatohepatitis
    Esteatohepatitis no alcohólica
    E.1.1.1Medical condition in easily understood language
    Fatty liver disease not related to alcohol intake.
    Enfermedad de hígado graso no relacionado con la toma de alcohol.
    E.1.1.2Therapeutic area Diseases [C] - Digestive System Diseases [C06]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 18.1
    E.1.2Level LLT
    E.1.2Classification code 10029530
    E.1.2Term Non-alcoholic fatty liver
    E.1.2System Organ Class 100000004871
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Primary Objective assessed at 18 mths:
    1. Evaluate the effect of OCA compared to placebo on histological improvement in NASH by assessing the following as co-primary endpoints using NASH CRN scoring criteria:
    a. Improvement in fibrosis by at least 1 stage with no worsening of NASH defined as no increase in hepatocellular ballooning or lobular inflammation.
    b. Resolution of NASH as defined by overall histopathological interpretation with no worsening of fibrosis.
    Primary Objective assessed at end of trial:
    1. Evaluate the effect of OCA compared to placebo on all-cause mortality and liver-related clinical outcomes as measured by the time to first occurrence of any of adjudicated events (clinical outcomes composite endpoint)
    Objetivo principal evaluado al cabo de 18 meses:
    1. Evaluar el efecto del AOC comparado con el placebo en cuanto a la mejoría histológica de la esteatohepatitis no alcohólica mediante la evaluación de los siguientes criterios de valoración principales conjuntos utilizando los criterios de puntuación de la Red de investigación clínica para la EHNA:
    a. Mejoría en al menos 1 estadio de la fibrosis sin empeoramiento de la EHNA, que se define como ausencia de incremento del balonamiento hepatocelular o inflamación lobular.
    b. Resolución de la EHNA, que se define por la interpretación histopatológica general sin empeoramiento de la fibrosis.
    Objetivo principal evaluado al final del estudio:
    1. Evaluar el efecto del AOC comparado con el placebo en la mortalidad por cualquier causa y los resultados clínicos hepáticos medidos en función del tiempo transcurrido hasta la manifestación por 1ª vez de cualquiera de los siguientes acontecimientos determinantes (..)
    E.2.2Secondary objectives of the trial
    Secondary objectives at 18 months:
    To evaluate the effect of OCA compared to placebo on histological improvement in NASH by using NASH CRN scoring criteria.

    Exploratory objectives at 18 months:
    To evaluate the effect of OCA compared to placebo on liver histology

    Exploratory objectives at end of trial:
    1. To evaluate the effect of OCA compared to placebo
    2. To evaluate the correlation between histology and non-invasive scores of liver fibrosis with clinical outcomes at the end of the study
    Objetivos secundarios evaluados al cabo de 18 meses:
    Evaluar el efecto del AOC comparado con el placebo en cuanto a la mejoría histológica de la EHNA mediante la evaluación de los siguientes elementos utilizando los criterios de puntuación de la Red de investigación clínica (CRN, por sus siglas en inglés) para la EHNA.

    Objetivos exploratorios evaluados al cabo de 18 meses:
    Evaluar el efecto del AOC comparado con el placebo en la histológía hepática.

    Objetivos exploratorios evaluados al FDE:
    1. Evaluar el efecto del AOC comparado con el placebo.
    2. Evaluar la correlación entre la histología y las puntuaciones no invasivas de la fibrosis hepática con los resultados clínicos al finalizar el estudio.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Histologic evidence of NASH upon central read of a liver biopsy obtained no more than 6 months before Day 1 defined by presence of all 3 key histological features of NASH with a score of at least 1 for each and a combined score of 4 or greater out of a possible 8 points according to NASH CRN criteria.
    2. Histologic evidence of fibrosis stage 2 (perisinusoidal and portal/periportal) or stage 3 (bridging fibrosis) as defined by the NASH CRN scoring of fibrosis, or Histologic evidence of fibrosis stage 1a or stage 1b (mild or moderate, zone 3 perisinusoidal) as defined by the NASH CRN scoring of fibrosis if accompanied by ?1 of the following risk factors:
    a. Obesity (body mass index [BMI] ?30 kg/m2)
    b. Type 2 diabetes diagnosed per 2013 American Diabetes Association criteria (hemoglobin A1c [HbA1c] ?6.5%, fasting plasma glucose ?126 mg/dL, 2-hour plasma glucose ?200 mg/dL during oral glucose tolerance test, or random plasma glucose ?200 mg/dL)
    c. Alanine aminotransferase (ALT) >1.5 × upper limit of normal (ULN).
    3. Is either not taking or is on stable doses of :
    a. TZDs or vitamin E for 6 months before Day 1
    b. Therapies for diabetes (excluding TZDs) and weight loss for 90 days before Day 1
    c. Allowed concomitant medications and supplements for 30 days before Day 1.
    4. Stable body weight (ie, not varying by >10% for at least 3 months) before Day 1.
    5. Age ?18 years.
    6. Female subjects of childbearing potential must use ?1 effective method of contraception during the study and until 30 days following the last dose of investigational product. Effective methods of contraception are considered to be those listed below
    a. Double barrier method, ie, condom (male or female) or diaphragm with spermicide
    b. Intrauterine device
    c. Vasectomy (partner)
    d. Hormonal (eg, contraceptive pill, patch, intramuscular implant or injection)
    e. Abstinence (refraining from heterosexual intercourse)
    7. Must provide written informed consent and agree to comply with the study protocol.
    1. Indicios histológicos de EHNA según lectura central de una biopsia hepática obtenida en un plazo no superior a 6 meses antes del día 1, que se define por la presencia de las 3 características histológicas clave de la EHNA con una puntuación mínima de 1 para cada una de ellas y una puntuación combinada de 4 o superior de una puntuación posible de 8 puntos, siguiendo los criterios de CRN para EHNA.
    2. Indicios histológicos de fibrosis en estadio 2 (perisinusoidal y portal/periportal) o en estadio 3 (fibrosis en puente) definida por la puntuación de fibrosis de CRN para EHNA, o bien Indicios histológicos de fibrosis en estadio 1a o en estadio 1b (perisinusoidal en zona 3 leve o moderada) definida por la puntuación de fibrosis de CRN para EHNA si está acompañada de al menos 1 de los siguientes factores de riesgo:
    a. Obesidad (índice de masa corporal ?30 kg/m2).
    b. Diabetes de tipo 2 diagnosticada según los criterios de la Asociación Estadounidense de Diabetes de 2013 (hemoglobina A1c [HbA1c] ?6,5 %, glucosa plasmática en ayunas ?126 mg/dl, glucosa plasmática a las 2 horas ?200 mg/dl durante una prueba de tolerancia a glucosa oral, o bien glucosa plasmática aleatoria ?200 mg/dl).
    c. Alanina aminotransferasa >1,5 veces el límite superior de la normalidad (LSN).
    3. El sujeto no toma o toma dosis estables de:
    a. TZD o vitamina E durante 6 meses antes del día 1.
    b. Tratamiento para la diabetes (salvo TZD) y la pérdida de peso durante 90 días antes del día 1.
    c. Medicamentos concurrentes y suplementos permitidos durante 30 días antes del día 1.
    4. Peso corporal estable (es decir, con variaciones no superiores al 10 % durante al menos 3 meses) antes del día 1.
    5. Edad ?18 años.
    6. Los sujetos que sean mujeres en edad fértil deben usar al menos 1 método anticonceptivo eficaz durante el estudio y hasta 30 días después de recibir la última dosis del producto en fase de investigación. Se consideran métodos anticonceptivos eficaces los que se enumeran a continuación:
    a. Método de doble barrera, esto es, preservativo (masculino o femenino) o diafragma con espermicida.
    b. Dispositivo intrauterino.
    c. Vasectomía (de la pareja).
    d. Hormonales (p. ej., píldora, parche, implante o inyección intramuscular anticonceptivos).
    e. Abstinencia (definida como la ausencia de coito heterosexual).
    7. Los sujetos deben otorgar su consentimiento informado por escrito y aceptar cumplir el protocolo del estudio.
    E.4Principal exclusion criteria
    1. Current or history of significant alcohol consumption for a period of more than 3 consecutive months within 1 year before Screening (significant alcohol consumption is defined as more than 2 units/day for females and more than 4 units/day for males, on average).
    2. Prior or planned (during the study period) bariatric surgery (eg, gastric bands, gastroplasty, roux-en-Y gastric bypass) or ileal resection.
    3. HbA1c ?9.0% within 60 days before Day 1.
    4. Evidence of other forms of chronic liver disease including:
    a. Positive test result at Screening for hepatitis B surface antigen (HbsAg) or hepatitis C (HCV) antibody (and positive HCV ribonucleic acid [RNA])
    b. PBC, PSC, autoimmune hepatitis, or overlap syndrome
    c. Alcoholic liver disease
    d. Wilson?s disease, hemochromatosis, or iron overload
    e. Alpha-1-antitrypsin (A1AT) deficiency as defined by diagnostic features in liver histology (confirmed by A1AT level below the lower limit of normal [LLN] or exclusion at the Investigator?s discretion)
    f. Prior known drug-induced liver injury within 5 years before Day 1
    g. Known or suspected HCC
    h. History of liver transplant, current placement on a liver transplant list, or current MELD score >12
    5. Histological presence of cirrhosis.
    6. Total bilirubin >1.5 mg/dL at Screening (subjects with Gilbert?s syndrome may be enrolled despite a total bilirubin level >1.5 mg/dL if their conjugated bilirubin is <1.5× ULN).
    7. AST or ALT >/= to 10× ULN, international normalized ratio (INR) >1.3, or serum creatinine ?1.5 mg/dL at Screening.
    8. Creatine phosphokinase >5x ULN at screening
    9. Platelet count <100,000/mm3 at Screening.
    10. LDL ?190 mg/dL and already on a stable dose statin therapy at Screening for >/= 30 days
    11. Inability to safely undergo a liver biopsy.
    12. History of biliary diversion.
    13. Known positivity for human immunodeficiency virus infection.
    14. Subjects with recent history (within 1 year of Day 1) of significant atherosclerotic cardiovascular disease (myocardial infarction, unstable angina, or acute coronary syndrome cerebrovascular accident [stroke], cerebrovascular ischemia, or transient ischemic attack or peripheral vascular disease requiring intervention). Such subjects may be identified by different means, including but not limited to, an abnormal ECG, a history or planned cardiovascular intervention such as coronary revascularization (eg, percutaneous coronary intervention or coronary artery bypass graft), coronary angioplasty, stenting, carotid atherectomy, or placement of a cardiac pacemaker or defibrillator.
    a. Controlled hypertension without other recent manifestations of significant atherosclerotic cardiovascular disease and placement of cardiac pacemaker or defibrillator for reasons other than atherosclerotic cardiovascular disease (eg, for treatment of atrial fibrillation subsequent to nodal ablation) is not exclusionary.
    15. Other medical conditions that may diminish life expectancy to <2 years, including known cancers (except carcinomas in situ or other stable, relatively benign carcinomas).
    16. Known substance abuse in the year before Screening.
    17. Pregnancy, planned pregnancy, potential for pregnancy (ie, unwillingness to use effective birth control during the study), or current or planned breast feeding.
    18. Participated in a clinical research study with any investigational product being evaluated for the treatment of diabetes, weight loss, or NASH in the 6 months before Day 1.
    19. Received any investigational product not being evaluated for the treatment of diabetes, weight loss, or NASH within 30 days before Day 1 or within 5 half-lives of the compound (whichever was longer) before Day 1.
    20. Previous exposure to OCA.
    21. Mental instability or incompetence, such that the validity of informed consent or ability to be compliant with the study, is uncertain.
    22. History of known or suspected clinically significant hypersensitivity to OCA or any of its components.
    23. Any other condition that, in the opinion of the Investigator, would impede compliance or hinder completion of the study.
    1. Antecedentes previos o consumo actual significativo de alcohol durante un período de más de 3 meses consecutivos en el plazo de 1 año anterior a la selección (consumo significativo se define como una media de más de 2 unidades al día para las mujeres y más de 4 unidades al día para los hombres).
    2. Cirugía bariátrica anterior o programada (durante el período del estudio) (p. ej.,bandas gástricas, gastroplastia, bypass gástrico en Y de Roux) o resección del íleon.
    3. HbA1c ?9,0 % en el plazo de 60 días antes del día 1.
    4. Indicios de otras variedades de enfermedad hepática crónica como por ejemplo:
    a. Resultado positivo en las pruebas de selección para antígeno de superficie de la hepatitis B o anticuerpos de hepatitis C (y ácido ribonucléico de VHC positivo).
    b. Cirrosis biliar primaria, colangitis esclerosante primaria, hepatitis autoinmune o síndrome de superposición.
    c. Hepatopatía alcohólica.
    d. Enfermedad de Wilson, hemocromatosis o sobrecarga de hierro.
    e. Deficiencia de alfa-1-antitripsina (A1AT) definida por las características de diagnóstico de la histología hepática (confirmada por un nivel de A1AT por debajo del límite inferior de normalidad o exclusión según el criterio del investigador).
    f. Lesión hepática anterior conocida inducida por fármacos en el período de 5 años antes del día 1.
    g. Sospecha o certeza de CHC.
    h. Antecedentes de trasplante hepático, inclusión vigente en una lista de trasplante hepático o puntuación actual >12 en la escala MELD.
    5. Presencia histológica de cirrosis.
    6. Bilirrubina total >1,5 mg/dl en el momento de la selección (los sujetos con síndrome de Gilbert pueden inscribirse aun teniendo un nivel de bilirrubina total >1,5 mg/dl si el valor de bilirrubina conjugada es <1,5 veces el LSN).
    7. ASAT o ALAT ?10 veces el LSN, cociente internacional normalizado (CIN) >1,3, o valor de creatinina sérica ?1,5 mg/dl en el momento de la selección.
    8. Valor de creatina-cinasa >5 veces el LSN en el momento de la selección.
    9. Recuento plaquetario <100 000/mm3 en el momento de la selección.
    10. Valor de LDL ?190 mg/dl con dosis estable de tratamiento con estatinas en el momento de la selección durante ?30 días.
    11. Imposibilidad de someterse a una biopsia hepática de forma segura.
    12. Antecedentes de derivación biliar.
    13. Certeza de resultado positivo de infección por el virus de inmunodeficiencia humana.
    14. Sujetos con antecedentes recientes (en el plazo de 1 año antes del día 1) de enfermedad cardiovascular ateroesclerótica importante (infarto de miocardio, angina inestable, síndrome coronario agudo, accidente cerebrovascular [ictus], isquemia cerebrovascular, accidente isquémico transitorio o enfermedad vascular periférica que precise una intervención). La identificación de estos sujetos puede realizarse por diversos medios, entre otros, un ECG anómalo, antecedentes o intervención cardiovascular programada, como por ejemplo revascularización coronaria (p. ej.,intervención coronaria percutánea o derivación arterial coronaria), angioplastia coronaria, colocación de endoprótesis, aterectomía de la arteria carótida o colocación de un marcapasos o un desfibrilador cardíaco.
    a. No es una condición excluyente la hipertensión controlada sin otras manifestaciones recientes de enfermedad cardiovascular ateroesclerótica importante y colocación de marcapasos o desfibrilador cardíaco por motivos diferentes de la enfermedad cardiovascular aterosclerótica (p. ej., tratamiento de fibrilación auricular secundario a una ablación nodular).
    15. Otras dolencias que puedan disminuir la esperanza de vida a <2 años, como por ejemplo cánceres conocidos (excepto carcinomas in situ u otros carcinomas estables, relativamente benignos).
    16. Consumo excesivo de sustancias en el plazo de un año antes de la selección.
    17. El sujeto mujer está embarazada, tiene previsto quedarse embarazada o puede quedarse embarazada (p. ej., no está dispuesta a usar un método anticonceptivo eficaz durante el estudio) o está en período de lactancia o tiene planes de iniciar la lactancia.
    18. El sujeto participó en un estudio de investigación clínica con cualquier producto en fase de investigación evaluado para el tratamiento de la diabetes, pérdida de peso o EHNA en el período de 6 meses antes del día 1.
    19. El sujeto ha recibido algún producto en fase de investigación que no está siendo evaluado para el tratamiento de la diabetes, la pérdida de peso o la EHNA en el período de 30 días antes del día 1 o en el plazo equivalente a 5 semividas del compuesto (el período que fuera más largo) antes del día 1.
    20. Exposición previa al AOC.
    21. Inestabilidad o incompetencia mental, que plantee dudas sobre la validez del consentimiento informado o la capacidad de cumplimiento terapéutico en el estudio.
    22. Antecedentes de hipersensibilidad clínicamente significativa conocida o sospechada al AOC o a cualquiera de sus componentes.
    23. Cualquier otra afección (..)
    E.5 End points
    E.5.1Primary end point(s)
    At 18 months:
    a. Histological outcomes

    End of Study:
    a. Clinical outcomes composite endpoint

    Exploratory Outcomes at end of study:
    a. Individual components of the clinical outcomes composite endpoint and liver-related death
    b. Health-related quality of life
    c. Measure of health status for the assessment of health utilities
    d. Non-invasive scores of liver fibrosis
    e. Adjudicated cardiovascular events
    f. Long-term safety and tolerability

    Exploratory outcomes at end of study in a subset of patients:
    a. Non-invasive radiological liver fibrosis measurements

    Safety

    Efficacy Analyses
    Primary and key secondary efficacy hypothesis testing will be based on the ITT population including only fibrosis stage 2 and stage 3 subjects only. Exploratory analyses will be conducted using PP population and all fibrosis stages (mITT Population).
    The total 2-sided alpha allocated to all testing conducted (ie, at Month 18, Month 48, and EOS) in this single study will be 0.05. In order to control the overall family-wise type I error at these 2 different timepoints while also adjusting for multiplicity, the total 2-sided alpha will be split between the 2 different timepoints with an alpha level of 0.01 at Month 18 and an alpha level of 0.04 at EOS. In addition, the alpha will be further split between the 2 doses at Month 18 with an alpha level of 0.005 for each dose. At the end of the study, doses will be tested in a closed sequential testing procedure.
    A los 18 meses:
    a. Indicios histológicos.

    Final del ensayo:
    a. Indicios clínicos de valoración compusta.

    Objetivos exploratorios evaluados al FDE:
    Evaluar el efecto del AOC comparado con el placebo con relación a:
    a. Componentes individuales del criterio de valoración compuesto de resultados clínicos y muerte de origen hepático.
    b. Calidad de vida relacionada con la salud.
    c. Parámetros del estado de salud para la evaluación de utilidades de salud.
    d. Puntuaciones no invasivas de fibrosis hepática.
    e. Acontecimientos cardiovasculares determinantes.
    f. Seguridad y tolerabilidad a largo plazo

    Objetivos exploratorios evaluados al final del estudio (subconjunto de sujetos)
    a. Mediciones radiológicas no invasivas de la fibrosis hepática

    Seguridad

    Análisis de eficacia
    Las pruebas de hipótesis de eficacia principales y secundarias fundamentales se basarán en la población IDT, que incluye solamente a los sujetos con fibrosis en estadio 2 y en estadio 3. Los análisis exploratorios se llevarán a cabo con la población por protocolo de todos los estadios de fibrosis (población IDTm).
    El valor alfa bilateral total asignado a todas las pruebas realizadas (p. ej., en el mes 18, en el mes 48 y en el FDE) en este estudio será de 0,05. A fin de controlar el error de tipo I general en estos 2 puntos temporales diferentes y al mismo tiempo ajustar la multiplicidad, el valor alfa bilateral total se dividirá entre los 2 puntos temporales diferentes con un nivel alfa de 0,01 en el mes 18 y un nivel alfa de 0,04 al FDE. Además, el valor alfa se dividirá posteriormente entre las 2 dosis en el mes 18 con un nivel alfa de 0,005 para cada dosis. Al finalizar el estudio, se analizarán las dosis mediante un procedimiento de prueba secuencial cerrada.
    E.5.1.1Timepoint(s) of evaluation of this end point
    6 years
    6 años
    E.5.2Secondary end point(s)
    Interim Key Secondary Efficacy Analyses:
    Key secondary efficacy endpoints at Month 18 are:
    a. Improvement of fibrosis and NASH as a composite endpoint and as defined by improvement in fibrosis by at least 1 stage and improvement in NAS by at least 2 points with at least 1 point improvement each for hepatocellular ballooning and lobular inflammation from baseline
    b. Resolution of fibrosis

    Interim Analyses of Clinical Outcomes:
    Interim analyses of the clinical outcomes composite endpoint, including all-cause mortality and liver-related clinical outcomes at approximately 18 Months and 48 Months will be conducted using group sequential approach in accordance to the statistical analysis plan (SAP) and DSMC Charter. The SAP will specify the methods and alpha levels for interim analyses and EOS final analyses. The DSMC will review the interim criterion for efficacy in conjunction with detailed safety data and other relevant information to determine whether to continue the study.
    Análisis de eficacia secundarios clave provisionales:
    Los criterios de valoración de eficacia secundarios clave en el mes 18 son:
    a. Mejoría de la fibrosis y de la EHNA como criterio de valoración compuesto, que se define como la mejoría en al menos 1 estadio de la fibrosis y mejoría de al menos 2 puntos de la puntuación de NAS, con mejoría de al menos 1 punto tanto en el balonamiento hepatocelular como en la inflamación lobular con respecto al valor
    b. Resolución de la fibrosis

    Análisis provisionales de resultados clínicos:
    Los análisis provisionales del criterio de valoración compuesto de resultados clínicos, incluidos la mortalidad por cualquier causa y los resultados clínicos hepáticos producidos aproximadamente al cabo de 18 y 48 meses se realizarán con un planteamiento secuencial de grupo conforme al plan de análisis estadístico (PAE) y los estatutos del CVD. El PAE especificará los métodos y los niveles alfa para los análisis provisionales y los análisis de FDE. El CVD revisará el criterio provisional de eficacia junto con los datos detallados de seguridad y demás información relevante a fin de determinar si se ha de continuar con el estudio.
    E.5.2.1Timepoint(s) of evaluation of this end point
    18 months and 48 months
    18 meses y 48 meses
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA135
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Australia
    Austria
    Belgium
    Canada
    Chile
    Denmark
    Finland
    France
    Germany
    Italy
    Mexico
    Netherlands
    New Zealand
    Poland
    Portugal
    Spain
    Sweden
    Switzerland
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Investigational product due to Investigator or Sponsor decision are expected to be followed through to study closure, and the study will only terminate at the time when the needed number of adjudicated events has accrued (or at the discretion of the Sponsor).
    Last patient last visit
    Según la decisión del investigador o el promotor, el producto en investigación se espera ser estudiado hasta el final del estudio y el estudio terminará sólo cuando el número de acontecimientos adjudicado haya ocurrido (o según el criterio del promotor).
    Última visita del último paciente.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years6
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years6
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 1865
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 200
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state176
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 1000
    F.4.2.2In the whole clinical trial 2065
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Standard of care
    Tratamiento convencional.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2016-02-25
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-02-16
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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