E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Nonalcoholic steatohepatitis (NASH) |
Nonalcoholic steatohepatitis (NASH) |
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E.1.1.1 | Medical condition in easily understood language |
Nonalcoholic steatohepatitis (NASH) |
Nonalcoholic steatohepatitis (NASH) |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 22.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10053219 |
E.1.2 | Term | Non-alcoholic steatohepatitis |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the safety and the efficacy on the activity part of the Steatosis Activity Fibrosis histological score (inflammation and ballooning) of a 24-week treatment with two doses of IVA337 (800, 1200 mg/24h) in NASH adult patients. |
To assess the safety and the efficacy on the activity part of the Steatosis Activity Fibrosis histological score (inflammation and ballooning) of a 24-week treatment with two doses of IVA337 (800, 1200 mg/24h) in NASH adult patients. |
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E.2.2 | Secondary objectives of the trial |
Pharmacokinetics. |
To assess the safety and the efficacy on the activity part of the Steatosis Activity Fibrosis histological score (inflammation and ballooning) of a 24-week |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
-Adult subjects, age =18 years. -NASH histological diagnosis according to the currently accepted definition of both EASL and AASLD (1–3), requiring the combined presence of steatosis (any degree = 5%) + lobular inflammation of any degree + liver cell ballooning of any amount, on a liver biopsy performed = 6 months before screening in the study and confirmed by central reading during the screening period and a.SAF Activity score of 3 or 4 (>2) b.SAF Steatosis score = 1 c.SAF Fibrosis score: < 4 -Subject agrees to have a liver biopsy performed after 24 weeks of treatment -Compensated liver disease with the following hematologic and biochemical criteria on entry into protocol: oALT < 10N oHemoglobin > 11 g/dL for females and > 12 g/dL for males oWhite blood cell (WBC) > 2.5 K/µL oNeutrophil count > 1.5 K/µL oPlatelets > 100 K/µL oTotal bilirubin < 35µmol/L. Patients with bilirubin > 35µmol/L can be included if non-conjugated bilirubin in the setting of a Gilbert syndrome. oAlbumin > 36 g/L oTP > 80% or INR > 1.4 oSerum creatinin <1.3 mg/dL (men) or <1.1 (women) or estimated glomerular filtration rate = 60 mL/min/1.73m2 -No other cause of chronic liver disease (autoimmune, primary biliary cholangitis, HBV, HCV, Wilson’s, a-1-antitrypsin deficiency, hemochromatosis etc…) -If applicable, have a stable type 2 diabetes, defined as HgbA1c < 8.5% and fasting glycemia <10 mmol/L, no changes in medication in the previous 6 months, and no new symptoms associated with decompensated diabetes in the previous 3 months. -Have a stable weight since the liver biopsy was performed defined by no more than a 5 % loss of initial body weight - Negative pregnancy test or post-menopausal. Women with childbearing potential (i.e.fertile, following menarche and until becoming post-menopausal unless permanently sterile) must be using a highly effective method of contraception (i.e. combined (estrogen and progestogen containing) hormonal/ progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device, intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomised partner). The contraceptive method will have to be followed for at least one menstruation cycle after the end of the study - Subjects having given her/his written informed consent.
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-Adult subjects, age =18 years. -NASH histological diagnosis according to the currently accepted definition of both EASL and AASLD (1–3), requiring the combined presence of steatosis (any degree = 5%) + lobular inflammation of any degree + liver cell ballooning of any amount, on a liver biopsy performed = 6 months before screening in the study and confirmed by central reading during the screening period and a.SAF Activity score of 3 or 4 (>2) b.SAF Steatosis score = 1 c.SAF Fibrosis score: < 4 -Subject agrees to have a liver biopsy performed after 24 weeks of treatment -Compensated liver disease with the following hematologic and biochemical criteria on entry into protocol: oALT < 10N oHemoglobin > 11 g/dL for females and > 12 g/dL for males oWhite blood cell (WBC) > 2.5 K/µL oNeutrophil count > 1.5 K/µL oPlatelets > 100 K/µL oTotal bilirubin < 35µmol/L. Patients with bilirubin > 35µmol/L can be included if non-conjugated bilirubin in the setting of a Gilbert syndrome. oAlbumin > 36 g/L oTP > 80% or INR > 1.4 oSerum creatinin <1.3 mg/dL (men) or <1.1 (women) or estimated glomerular filtration rate = 60 mL/min/1.73m2 -No other cause of chronic liver disease (autoimmune, primary biliary cholangitis, HBV, HCV, Wilson’s, a-1-antitrypsin deficiency, hemochromatosis etc…) -If applicable, have a stable type 2 diabetes, defined as HgbA1c < 8.5% and fasting glycemia <10 mmol/L, no changes in medication in the previous 6 months, and no new symptoms associated with decompensated diabetes in the previous 3 months. -Have a stable weight since the liver biopsy was performed defined by no more than a 5 % loss of initial body weight - Negative pregnancy test or post-menopausal. Women with childbearing potential (i.e. 8.fertile, following menarche and until becoming post-menopausal unless permanently sterile) must be using a highly effective method of contraception (i.e. combined (estrogen and progestogen containing) hormonal/ progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device, intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomised partner). The contraceptive method will have to be followed for at least one menstruation cycle after the end of the study - Subjects having given her/his written informed consent.
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E.4 | Principal exclusion criteria |
- Evidence of another form of liver disease. -History of sustained excess alcohol ingestion: daily alcohol consumption > 30 g/day (3 drinks per day) for males and > 20 g/day (2 drinks/day) for females. -Unstable metabolic condition: Weight change > 5kg in the last three months, diabetes with poor glycemic control (HgbA1c > 8.5%), introduction of an antidiabetic or of an anti-obesity drug/malabsorptive or restrictive bariatric (weight loss) surgery in the past 6 months prior to screening. -History of gastrointestinal malabsorptive bariatric surgery within less than 5 years or ingestion of drugs known to produce hepatic steatosis including corticosteroids, high-dose estrogens, methotrexate, tetracycline or amiodarone in the previous 6 months. -Significant systemic or major illnesses other than liver disease, including congestive heart failure (class C and D of the AHA), unstable coronary artery disease, cerebrovascular disease, pulmonary disease, renal failure, organ transplantation, serious psychiatric disease, malignancy that, in the opinion of the investigator, would preclude treatment with IVA337 and/or adequate follow up. -HB antigen >0, HCV PCR >0 (patients with a history of HCV infection can be included if HCV PCR is negative since more than 3 years), HIV infection. -Pregnancy/lactation or inability to adhere to adequate contraception in women of child-bearing potential. -Active malignancy except cutaneous basocellular carcinoma. -Any other condition which, in the opinion of the investigator would impede competence or compliance or possibly hinder completion of the study -Body mass index (BMI) >45 kg/m2. - Type 1 diabetes and type 2 diabetic patient on insulin. - Diabetic ketoacidosis - Fasting Triglycerides > 300 mg/dL. - Hemostasis disorders or current treatment with anticoagulants. - Contra-indication to liver biopsy. - History of, or current cardiac dysrhythmias and/or a history of cardiovascular disease event, including myocardial infarction, except patients with only well controlled hypertension. Any clinically significant ECG abnormality reported by central ECG reading - Participation in any other investigational drug study within the previous 3 months. - Have a known hypersensitivity to any of the ingredients or excipients of the IMP including: - Lactose monohydrate, Hypromellose, Sodium laurilsulfate, Sodium starch glycolate (type A), Magnesium stearate, Opadry™ II 85F18422 - Be possibly dependent on the Investigator or the sponsor (e.g., including, but not limited 19.to, affiliated employee). - Creatine phosphokinase (CPK)>5 x ULN 20. Osteopenia or any other well documented Bone disease. Patient whitout well documented - osteopenia treated with vitamin D and/or Calcium based supplements for preventive reasons can be included. |
- Evidence of another form of liver disease. -History of sustained excess alcohol ingestion: daily alcohol consumption > 30 g/day (3 drinks per day) for males and > 20 g/day (2 drinks/day) for females. -Unstable metabolic condition: Weight change > 5kg in the last three months, diabetes with poor glycemic control (HgbA1c > 8.5%), introduction of an antidiabetic or of an anti-obesity drug/malabsorptive or restrictive bariatric (weight loss) surgery in the past 6 months prior to screening. -History of gastrointestinal malabsorptive bariatric surgery within less than 5 years or ingestion of drugs known to produce hepatic steatosis including corticosteroids, high-dose estrogens, methotrexate, tetracycline or amiodarone in the previous 6 months. -Significant systemic or major illnesses other than liver disease, including congestive heart failure (class C and D of the AHA), unstable coronary artery disease, cerebrovascular disease, pulmonary disease, renal failure, organ transplantation, serious psychiatric disease, malignancy that, in the opinion of the investigator, would preclude treatment with IVA337 and/or adequate follow up. -HB antigen >0, HCV PCR >0 (patients with a history of HCV infection can be included if HCV PCR is negative since more than 3 years), HIV infection. -Pregnancy/lactation or inability to adhere to adequate contraception in women of child-bearing potential. -Active malignancy except cutaneous basocellular carcinoma. -Any other condition which, in the opinion of the investigator would impede competence or compliance or possibly hinder completion of the study -Body mass index (BMI) >45 kg/m2. - Type 1 diabetes and type 2 diabetic patient on insulin. - Diabetic ketoacidosis - Fasting Triglycerides > 300 mg/dL. - Hemostasis disorders or current treatment with anticoagulants. - Contra-indication to liver biopsy. - History of, or current cardiac dysrhythmias and/or a history of cardiovascular disease event, including myocardial infarction, except patients with only well controlled hypertension. Any clinically significant ECG abnormality reported by central ECG reading - Participation in any other investigational drug study within the previous 3 months. - Have a known hypersensitivity to any of the ingredients or excipients of the IMP including: - Lactose monohydrate, Hypromellose, Sodium laurilsulfate, Sodium starch glycolate (type A), Magnesium stearate, Opadry™ II 85F18422 - Be possibly dependent on the Investigator or the sponsor (e.g., including, but not limited 19.to, affiliated employee). - Creatine phosphokinase (CPK)>5 x ULN 20. Osteopenia or any other well documented Bone disease. Patient whitout well documented - osteopenia treated with vitamin D and/or Calcium based supplements for preventive reasons can be included. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is a binary outcome (responder / non responder). A responder is defined as a decrease from baseline to week 24 of at least 2 points of the SAF activity score combining hepatocellular inflammatory and ballooning score without fibrosis progression. Responder rates will be compared between the placebo and IMP groups at the end of the treatment period (week 24) using a Cochran Mantel Haenzel test stratified on diabetes. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At the end of the treatment period (week 24) |
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E.5.2 | Secondary end point(s) |
The following changes from baseline to 24 weeks of treatment will be evaluated:
¿NASH improvers defined as subjects with a decrease of at least 2 points in NAS, and no worsening in fibrosis in NASH from baseline to end of treatment (week 24).
¿Percent of patients with reversal of NASH (Steatosis without ballooning and with or without mild inflammation and no worsening of fibrosis) from baseline to end of treatment (week 24).
¿Percent of patients with a change in components of SAF score from baseline to end of treatment (week 24):
-Steatosis: -1 point
-Lobular inflammation: -1 point
-Balloonning: -1 point
¿Immunohistochemistry: change in the semiquantitative score of ballooning and stellate cell activation from baseline to end of treatment (week 24).
¿Change in fibrosis score on a 4-point scale (SAF) and modified Ishak: - 1 point from baseline to end of treatment (week 24). Comparison of mean change in fibrosis area assessed by morphometry (CPA) from baseline to end of treatment (week 24).
¿Liver enzymes (ALT, AST, ¿GT) change from baseline to end of treatment (week 24).
¿Inflammatory markers (fibrinogen, hs-CRP, alpha2 macroglobulin and haptoglobin levels) change from baseline to end of treatment (week 24).
¿Glucose metabolism (fasting glucose and insulin, HOMA index and, in subjects with T2DM, HbA1c) change from baseline to end of treatment (week 24).
¿Main plasma lipids levels (TC, HDL-C, calculated LDL-C, TG and apoA1) change from baseline to end of treatment (week 24).
¿Adiponectin change from baseline to end of treatment (week 24).
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
From baseline to 24 weeks of treatment |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 30 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial 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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 0 |