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    Summary
    EudraCT Number:2018-004431-79
    Sponsor's Protocol Code Number:CC-90001-NASH-001
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2019-08-09
    Trial results View 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 number2018-004431-79
    A.3Full title of the trial
    A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTER, DOSEFINDING STUDY TO EVALUATE THE EFFICACY AND SAFETY OF CC-90001 IN SUBJECTS WITH NONALCOHOLIC STEATOHEPATITIS (NASH) AND STAGE 3 OR STAGE 4 LIVER FIBROSIS
    Estudio multicéntrico de fase 2 aleatorizado, doble ciego y controlado con placebo, de búsqueda de dosis, para evaluar la eficacia y la seguridad de CC-90001 en sujetos con esteatohepatitis no alcohólica (EHNA) y fibrosis hepática en estadio 3 o 4.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    STUDY TO EVALUATE THE EFFICACY AND SAFETY OF CC-90001 IN SUBJECTS WITH NONALCOHOLIC STEATOHEPATITIS (NASH) AND STAGE 3 OR STAGE 4 LIVER FIBROSIS
    Estudio para evaluar la eficacia y la seguridad de CC-90001 en sujetos con esteatohepatitis no alcohólica (EHNA) y fibrosis hepática en estadio 3 o 4.
    A.4.1Sponsor's protocol code numberCC-90001-NASH-001
    A.5.4Other Identifiers
    Name:IND NumberNumber:138213
    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 SponsorCelgene Corporation
    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 supportCelgene Corporation
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCelgene Corporation
    B.5.2Functional name of contact pointClinicalTrialDisclosure
    B.5.3 Address:
    B.5.3.1Street Address9225 Indian Creek Parkway, Suite 900
    B.5.3.2Town/ cityOverland Park, Kansas
    B.5.3.3Post code66210
    B.5.3.4CountryUnited States
    B.5.4Telephone number+34914229000
    B.5.6E-mailClinicalTrialDisclosure@celgene.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 nameCC-90001
    D.3.2Product code CC-90001
    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 INN-
    D.3.9.1CAS number 1403859-14-2
    D.3.9.2Current sponsor codeCC-90001
    D.3.9.3Other descriptive nameCC0491359
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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 nameCC-90001
    D.3.2Product code CC-90001
    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 INN-
    D.3.9.1CAS number 1403859-14-2
    D.3.9.2Current sponsor codeCC-90001
    D.3.9.3Other descriptive nameCC0491359
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    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
    D.8 Placebo: 2
    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
    Confirmed diagnosis of NASH and Stage 3 or Stage 4 fibrosis based upon the NASH Clinical Research Network (CRN) Histologic Scoring System and a nonalcoholic fatty liver disease (NAFLD) Activity Score (NAS) of 4 or higher, with a score of at least 1 for each of the three components (steatosis, hepatocellular ballooning, and lobular inflammation).
    Diagnóstico confirmado de EHNA y fibrosis en estadio 3 o 4 según el Sistema de puntuación histológica de la Clinical Research Network (CRN) para la EHNA y con una puntuación de actividad de la esteatosis hepática no alcohólica (EHNA) de 4 o más, con una puntuación de al menos 1 para cada uno de los tres componentes (esteatosis, balonamiento hepatocelular e inflamación lobulillar).
    E.1.1.1Medical condition in easily understood language
    Confirmed diagnosis of NONALCOHOLIC STEATOHEPATITIS (NASH) and Stage 3 or Stage 4 of liver fibrosis.
    Diagnóstico confirmado de Esteatoshepatitis No Alcohólica (EHNA) y fibrosis en estadio 3 o 4.
    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 22.0
    E.1.2Level PT
    E.1.2Classification code 10053219
    E.1.2Term Non-alcoholic steatohepatitis
    E.1.2System Organ Class 10019805 - Hepatobiliary disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to evaluate the effect of oral CC-90001, administered QD,
    compared with placebo, on liver histology in subjects with NASH and Stage 3 fibrosis.
    El objetivo principal del estudio consiste en evaluar el efecto de CC-90001 oral, administrado una vez al día, en comparación con placebo, sobre la histología hepática en sujetos con EHNA y fibrosis en estadio 3.
    E.2.2Secondary objectives of the trial
    To evaluate the effects of oral CC-90001, administered QD, compared with placebo, in subjects with NASH and Stage 3 fibrosis, on:
    - Liver biopsy-based endpoints
    - Liver imaging-based endpoints (magnetic resonance elastography [MRE], and
    magnetic resonance imaging-proton density fat fraction [MRI-PDFF])
    - Liver biochemistry
    - Metabolic parameters

    To evaluate the effects of oral CC-90001, administered QD, compared with placebo, in subjects with NASH and Stage 3 or Stage 4 fibrosis, and all subjects combined, on:
    - Dose response
    - Safety and tolerability
    - Pharmacokinetics (PK)
    • Evaluar los efectos de CC-90001 oral, administrado una vez al día, en comparación con placebo, en sujetos con EHNA y fibrosis en estadio 3 sobre:
    - Criterios de valoración basados en la biopsia hepática.
    - Criterios de valoración basados en los estudios de imagen hepáticos (ERM y RM-FGDP).
    - Bioquímica hepática.
    - Parámetros metabólicos.

    • Evaluar los efectos de CC-90001 oral, administrado una vez al día, en comparación con placebo, en sujetos con EHNA y fibrosis en estadio 3 o 4, y en todos los sujetos combinados, sobre:
    - Relación dosis-respuesta.
    - Seguridad y tolerabilidad.
    - Farmacocinética (FC).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Subjects must satisfy the following criteria to be enrolled in the study:
    1. Subject is male or female ≥ 18 years of age at the time of signing the informed consent form (ICF).
    2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.
    3. Subject is willing and able to adhere to the study visit schedule and other protocol requirements.
    4. Diagnosis of NASH with presence of Stage 3 or Stage 4 fibrosis based upon central reading of the NASH CRN Histologic Scoring System and a NAFLD Activity Score (NAS) of 4 or higher, with a score of at least 1 for each of the three components (steatosis scored 0 to 3, ballooning degeneration scored 0 to 2, and lobular inflammation scored 0 to 3) within 6 months of Screening. Note: Subjects who do not have pathological specimens from a prior liver biopsy obtained within 6 months of Screening and available for central reading, must undergo liver biopsy during Screening. Appendix B and Appendix C outline an algorithm to help determine which potential subjects may proceed to liver biopsy.
    5. If histopathological specimens are submitted from a historical liver biopsy, the subject’s weight must have been documented to be stable since the liver biopsy (eg, within 5% if the liver biopsy was obtained 4 to 6 months prior to Screening or within 2.5% if the liver biopsy was obtained less than 4 months prior to Screening).
    6. If receiving any of the following agents, the doses must have been stable within 3 months prior to Screening and the subject agrees to maintain stable doses during the course of the study, unless required to adjust doses due to safety reasons: vitamin E, ursodeoxycholic acid, gemfibrozil, metformin, sodium-glucose co-transporter 2 (SGLT2) inhibitors (eg, canagliflozin), dipeptidyl peptidase-4 inhibitors (‘gliptins’) (such as sitagliptin), glucagon peptide-1 agonists (eg, liraglutide [1.2 mg or 1.8 mg QD] for indications other than weight loss).
    7. If receiving thiazolidinediones (eg, pioglitazone), the doses must have been stable with 6 months prior to Screening.
    8. Females of childbearing potential (FCBP) must:
    a. Have two negative pregnancy tests as verified by the Investigator prior to starting investigational product (IP). She must agree to ongoing pregnancy testing during the course of the study, and after end of study treatment. This applies even if the subject practices true abstinence* from heterosexual contact.
    b. Either commit to true abstinence* from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree to use two forms of effective birth control methods (for example: birth control pills, condoms, etc.) (one of which is highly effective)at the same time, and be able to comply with, effective contraception without interruption, 28 days prior to starting IP, during the study therapy (including dose interruptions), and for 28 days after discontinuation of IP.
    Approved options for birth control are:
    • Any one of the following highly effective methods: Hormonal contraception (for example, birth control pills, intravaginal ring, transdermal patch, injection, implant); intrauterine device (IUD); tubal ligation (tying your tubes); or a partner with a vasectomy. Note: Certain drugs may reduce the effectiveness of hormonal contraceptives during and up to one month after discontinuation of these concomitant therapies.
    • Any effective method, for example, condoms.
    9. Male subjects must:
    Practice true abstinence* (which must be reviewed on a monthly basis) or agree to use condomsa latex condom or nonlatex condom not made out of natural [(animal]) membrane (eg, polyurethane) during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions and for at least 28 days following IP discontinuation, even if he has undergone a successful vasectomy.
    *True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception).
    Para poder participar en el estudio, los sujetos deberán cumplir los criterios siguientes:
    1. Varón o mujer y edad mínima de 18 años en el momento de firmar el consentimiento informado.
    2. Comprensión y firma voluntaria del consentimiento informado antes de realizar ninguna de las evaluaciones y procedimientos relacionados con el estudio.
    3. Disposición y capacidad de cumplir el calendario de visitas del estudio y los demás requisitos del protocolo.
    4. Diagnóstico de EHNA con presencia de fibrosis en estadio 3 o 4 según la interpretación centralizada del sistema de puntuación histológica NASH CRN y una puntuación NAS (Puntuación de actividad de la esteatosis hepática no alcohólica) de 4 o superior, con una puntuación mínima de 1 en cada uno de los tres componentes (esteatosis puntuada de 0 a 3, degeneración balonizante puntuada de 0 a 2 e inflamación lobulillar puntuada de 0 a 3) en los 6 meses previos a la selección. Nota: Los sujetos que no dispongan de muestras histopatológicas procedentes de una biopsia hepática previa obtenida en los 6 meses previos a la selección y disponibles para interpretación centralizada deberán someterse a una biopsia hepática durante la fase de selección. En el Apéndice B y el Apéndice C se describe un algoritmo para ayudar a determinar qué sujetos potenciales podrán someterse a una biopsia hepática (véase la Sección 6.1 para obtener más detalles).
    5. En caso de enviarse muestras histopatológicas procedentes de una biopsia hepática histórica, deberá haberse documentado que el peso del sujeto se ha mantenido estable desde dicha biopsia (es decir, con una diferencia no superior al 5 % cuando la biopsia se haya obtenido entre 4 y 6 meses antes de la selección o no superior al 2,5 % cuando se haya obtenido menos de 4 meses antes de la selección).
    6. En caso de estar recibiendo alguno de los fármacos siguientes, las dosis deberán haberse mantenido estables durante 3 meses antes de la selección y el sujeto deberá comprometerse a mantenerlas estables durante el estudio, a menos que sea necesario ajustarlas por motivos de seguridad: vitamina E, ácido ursodesoxicólico, gemfibrozilo, metformina, inhibidores del cotransportador de sodio-glucosa 2 (SGLT2) (p. ej., canagliflozina), inhibidores de la dipeptidil peptidasa-4 ('gliptinas', como sitagliptina) y agonistas del péptido glucagonoide-1 (p. ej., liraglutida [1,2 o 1,8 mg una vez al día] por indicaciones distintas de la pérdida de peso).
    7. En caso de estar recibiendo tiazolidinodionas (p. ej, pioglitazona), las dosis deberán haberse mantenido estables durante 6 meses antes de la selección.
    8. Las mujeres en edad fértil (MEF) tendrán que:
    a. Tener dos pruebas de embarazo negativas comprobadas por el investigador antes de empezar a recibir el producto en investigación (PEI). Acceder a someterse a pruebas de embarazo periódicamente durante el estudio y después de finalizar el tratamiento del estudio. Esto será aplicable incluso a las mujeres que practiquen abstinencia completa* de relaciones heterosexuales.
    b. Comprometerse a practicar abstinencia completa* de relaciones heterosexuales (que deberá revisarse mensualmente y documentarse) o a utilizar dos métodos anticonceptivos eficaces (uno de ellos muy eficaz) al mismo tiempo y ser capaz de cumplirlo, sin interrupción, 28 días antes de empezar a recibir el PEI, durante el tratamiento del estudio (incluidas las interrupciones de la administración) y hasta 28 días después de suspender el PEI.
    Los métodos anticonceptivos aprobados son:
    • Cualquiera de los siguientes métodos anticonceptivos muy eficaces: anticonceptivos hormonales (p. ej., anticonceptivos orales, anillo intravaginal, parche transdérmico, inyección o implante), dispositivo intrauterino (DIU), ligadura de trompas o pareja con vasectomía.
    Nota: Ciertos medicamentos pueden reducir la eficacia de los anticonceptivos hormonales durante y hasta un mes después de interrumpir estos tratamientos concomitantes.
    • Cualquier método eficaz, por ejemplo, preservativo.
    9. Los varones tendrán que:
    Practicar abstinencia completa* (que deberá revisarse mensualmente) o comprometerse a utilizar preservativo de látex o sin látex no elaborado con membranas naturales (animales) (p. ej., poliuretano) durante las relaciones sexuales con una mujer embarazada o en edad fértil mientras participe en el estudio, durante las interrupciones de la administración y hasta al menos 28 días después de suspender el PEI, aunque se haya sometido a una vasectomía con éxito.
    *La abstinencia completa es aceptable si es concordante con el modo de vida preferido y habitual del sujeto. (La abstinencia periódica (p. ej., métodos del calendario, de la ovulación, sintotérmico o postovulación) y el coito interrumpido no son métodos anticonceptivos aceptables.)
    E.4Principal exclusion criteria
    1.Subject has any significant medical condition, laboratory abnormality (other than NASH related dyscrasias), or psychiatric illness or place the subject at unacceptable risk if he/she were to participate in the study
    2. History or evidence of decompensated liver disease, including clinical ascites, hepatic encephalopathy, or variceal bleeding
    3.Hepatitis and fibrosis more likely related to etiologies other than NASH such as, but not limited to, alcoholic steatohepatitis, autoimmune hepatitis, hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, primary biliary cirrhosis, primary biliary cholangitis, Wilson's disease, alpha-1-antitrypsin deficiency, hemochromatosis or iron overload, drug-induced liver disease
    4.Hemoglobin A1c (HbA1c)>8% at Screening
    5.Subjects with evidence of worsening liver function based on two liver function tests during Screening period (refer Section 6.1)
    6.Subject with a QTcF >450msec
    7.Subject is likely to have liver transplantation or bariatric surgery during the study
    8. Current or history of recreational drug abuse or significant alcohol consumption for a period of more than 3 consecutive months within 1 year prior to screening. Significant alcohol consumption is defined as more than 14 oz (420mL) per wk in females and more than 21 oz (630 mL) per wk in males, on average (1 oz/30mL of alcohol is present in one 12 oz/360mL beer, one 4 oz/120mL glass of wine, and a 1 oz/30mL measure of 40% proof alcohol).
    9.Subject has urine ethyl glucuronide(EtG)>500ng/mL at Screening
    10.Use of drugs historically associated with nonalcoholic fatty liver disease (NAFLD) for more than 2 consecutive wks within a year prior to randomization or any drugs that are known to cause hepatotoxicity, such as, but not limited to, acetaminophen at dosages of >3grams/day and niacin at dosages of >2grams/day within 2 wks of randomization
    11.Receiving any biologic agents, or cytokine inhibitors within 3 months of Screening
    12.Use of approved weight-loss medications within 3 months of Screening
    13. Active or history of recurrent bacterial, viral, fungal, mycobacterial or other infections (including, but not limited to, atypical mycobacterial disease and herpes zoster), or any major episode of infection requiring hospitalization or treatment with IV or oral antibiotics within 4 wks of Screening Visit and at any time during the Screening Phase, up through the first dose of IP
    14.History of active or latent or active tuberculosis (TB), unless there is medical record documentation of successful completion of a standard course of treatment considered appropriate, based on local prevalence of multi-drug resistant TB and consistent with WHO guidelines.Note: If a subject has adequate documentation of successful treatment for either latent or active TB, the QuantiFERON-TB Gold test is not needed. Instead, a chest radiograph, obtained within the 12 wks prior to Screening, without changes suggestive of active TB infection as determined by a qualified radiologist, will be sufficient to permit further participation in the study for these subjects. Documentation of adequate treatment for TB must be obtained prior to randomization
    15.Subject has had a household contact with a person with active TB and subject did not receive appropriate and documented prophylaxis for TB.Note: Household contact is a person who shared the same enclosed living space as the index case for one or more nights or for frequent or extended daytime periods during the 3 months before the start of current treatment
    16.History for positive screen for human immunodeficiency virus infection or congenital or acquired immunodeficiencies
    17.History of HBV and/or HCV
    18.History of cardiac valve replacement requiring chronic anticoagulation therapy
    19.History of inflammatory bowel disease
    20.History of bleeding peptic ulcer or bleeding diverticular disease within the last 5 yrs
    21.Subject has 2 positive fecal occult blood tests during Screening, collected at least 4wks apart
    22.Subjects with Type 1 DM
    23.History of malignancy (exceptions: excised and cured basal/squamous cell skin carcinomas & cervical carcinoma in situ with no recurrence in 5yrs)
    24.Use of any medications that are substrates of the transporters P-gp, BCRP, OAT3, OATP1B1, OATP1B3, and OCT2 (See Appendix D) and have a narrow therapeutic index
    25.Use of strong CYP3A inhibitors (Refer Appendix G and the following link: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers)
    26.Use of vitamin K antagonists within 2 wks prior to Screening
    27.Pregnancy or lactation
    28.Subject has a known hypersensitivity to CC-90001 or any ingredient in the IP
    29.Participation in any investigational study of an investigational drug within one month or 5PK or PD half-lives, whichever is longer, prior to Screening
    30.Prior use of obeticholic acid or participation of obeticholic acid clinical trial
    1. Presencia de cualquier trastorno médico, anomalía analítica (aparte de las discrasias relacionadas con la EHNA) o enfermedad psiquiátrica importante que pueda dificultar la capacidad de interpretar los datos, impedir la participación del sujeto o suponer un riesgo inaceptable para el sujeto en caso de que participara en el estudio.
    2. Antecedentes o signos de hepatopatía descompensada, como ascitis clínica, encefalopatía hepática o varices hemorrágicas.
    3. Hepatitis y fibrosis más probablemente relacionadas con etiologías distintas de la EHNA como, entre otras, esteatohepatitis alcohólica, hepatitis autoinmunitaria, infección por el virus de la hepatitis B (VHB), infección por el virus de la hepatitis C (VHC), cirrosis biliar primaria, colangitis biliar primaria, enfermedad de Wilson, déficit de α1-antitripsina, hemocromatosis o sobrecarga de hierro y hepatopatía medicamentosa.
    4. Hemoglobina A1c (HbA1c) > 8 % en la fase de selección.
    5. Presencia de datos de empeoramiento de la función hepática según dos pruebas de función hepática obtenidas durante la fase de selección (véase la Sección 6.1).
    6. Intervalo QTcF > 450 ms.
    7. Antecedentes de trasplante de hígado o cirugía bariátrica o es probable que el sujeto se someta a un trasplante de hígado o a cirugía bariátrica durante el estudio.
    8. Abuso actual o previo de drogas o consumo importante de alcohol durante un período de más de 3 meses consecutivos en el año previo a la selección. El consumo importante de alcohol se define como más de 420 ml por semana en las mujeres y más de 630 ml por semana en los varones, por término medio (30 ml de alcohol están presentes en una cerveza de 360 ml, un vaso de vino de 120 ml o una medida de 30 ml de una bebida alcohólica con una graduación del 40 %).
    9. Concentración urinaria de etilglucurónido (EtG) > 500 ng/ml en la fase de selección.
    10. Uso de fármacos asociados históricamente a esteatosis hepática no alcohólica durante más de 2 semanas consecutivas en el año previo a la aleatorización o de fármacos causantes de hepatotoxicidad como, por ejemplo, paracetamol en dosis > 3 g/día y niacina en dosis > 2 g/día en las 2 semanas previas a la aleatorización.
    11. Tratamiento con cualquier biofármaco o inhibidores de citoquinas en los 3 meses previos a la selección.
    12. Uso de medicamentos para adelgazar aprobados, en los 3 meses previos a la selección.
    13. Antecedentes o presencia de infecciones bacterianas, víricas, micóticas, micobacterianas o de otro tipo recurrentes o cualquier otro episodio importante de infección con necesidad de hospitalización o tratamiento con antibióticos intravenosos u orales en las 4 semanas previas a la visita de selección y en cualquier momento durante la fase de selección, hasta la primera dosis del PEI.
    14. Antecedentes de tuberculosis activa o latente, a menos que exista documentación en la historia clínica de la finalización satisfactoria de un ciclo convencional de tratamiento que se considere apropiado, basándose en la prevalencia local de tuberculosis multirresistente y de conformidad con las directrices de la Organización Mundial de la Salud.
    15. Haber tenido contacto doméstico con una persona con tuberculosis activa y no haber recibido profilaxis adecuada y documentada de la tuberculosis.
    16. Antecedentes o cribado positivo de infección por el virus de la inmunodeficiencia humana (VIH) o inmunodeficiencias congénitas o adquiridas.
    17. Antecedentes de hepatitis B o C.
    18. Antecedentes de valvuloplastia cardíaca con necesidad de tratamiento anticoagulante crónico.
    19. Antecedentes de enfermedad inflamatoria intestinal.
    20. Antecedentes de úlcera péptica hemorrágica o enfermedad diverticular hemorrágica en los últimos 5 años.
    21. Presencia de dos pruebas de sangre oculta en heces positivas durante la fase de selección, obtenidas con 4 semanas de diferencia como mínimo.
    22. Diabetes mellitus de tipo 1.
    23. Antecedentes de neoplasia maligna.
    24. Uso de cualquier medicamento que sea sustrato de los transportadores gp-P, BCRP, OAT3, OATP1B1, OATP1B3 y OCT2 y tenga un índice terapéutico estrecho.
    25. Uso de inhibidores potentes de la enzima CYP3A (véase el Apéndice G y el siguiente enlace a la lista de inhibidores potentes de la enzima CYP3A: https://www.fda.gov/drugs/drug-interactions-labeling/drug- development-and-drug-interactions-table-substrates-inhibitors-and-inducers).
    26. Uso de antagonistas de la vitamina K en las 2 semanas previas a la selección.
    27. Embarazo o lactancia.
    28. Hipersensibilidad conocida a CC-90001 o a cualquier otro componente del PEI.
    29. Participación en cualquier estudio de investigación de un fármaco experimental en el mes previo a la selección o el período equivalente a 5 semividas farmacocinéticas o farmacodinámicas, lo que suponga más tiempo.
    30. Uso previo de ácido obeticólico o participación en un ensayo clínico sobre el ácido obeticólico.
    E.5 End points
    E.5.1Primary end point(s)
    Liver fibrosis score-Proportion of subjects who achieve a ≥1 stage improvement in liver fibrosis using the NASH clinical research network (CRN) Histological Scoring System (Stage 3 subjects only)
    Proporción de sujetos que logren una mejoría ≥ 1 estadio de la fibrosis hepática según el sistema de puntuación histológica NASH CRN (únicamente en los sujetos en estadio 3).
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 52
    Semana 52
    E.5.2Secondary end point(s)
    Combined assessment of liver fibrosis score and steatohepatitis, Nonalcoholic fatty liver disease (NAFLD) activity score (NAS), Resolution of NASH, Progression to cirrhosis, Liver stiffness measurements (LSM) by 2 dimensional magnetic resonance elastography (MRE), Magnetic resonance imaging-proton density fat fraction (MRI-PDFF), Liver biochemistry, Metabolic parameters, Dose response, Safet, PK
    Evaluación combinada de la puntuación de fibrosis hepática y la esteatohepatitis, puntuación NAS (Puntuación de actividad de la esteatosis hepática no alcohólica), resolución de la EHNA, progresión a cirrosis, mediciones de la rigidez hepática (MRH) mediante elastografía por resonancia magnética (ERM) bidimensional, fracción grasa por densidad protónica en la resonancia magnética (RM-FGDP), bioquímica hepática, parámetros metabólicos, relación dosis-respuesta, seguridad, farmacocinética (FC)
    E.5.2.1Timepoint(s) of evaluation of this end point
    Week 52.
    Safety through week 106.
    PK: Day 1 and week 4.
    Liver biochemistry and Metabolic parameters: Through week 52
    Semana 52.
    Seguridad hasta la semana 106.
    FC: Día 1 y semana 4.
    Bioquímica hepática y parámetros metabólicos: Hasta la semana 52.
    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 No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    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) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    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 Yes
    E.8.1.7.1Other trial design description
    La fase controlada con placebo doble ciego es seguida por una fase de tratamiento activo doble cieg
    The double blind placebo controlled phase is followed by double blind active treatment phase
    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 trial4
    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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA22
    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
    Australia
    Canada
    France
    Germany
    Korea, Republic of
    Spain
    United Kingdom
    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
    The End of Trial is defined as either the date of the last visit of the last subject to complete the post-treatment follow-up, or the date of receipt of the last data point from the last subject that is required for primary, secondary and/or exploratory analysis, as prespecified in the protocol, whichever is the later date.
    El final del ensayo se define como la fecha de la última visita del último sujeto que complete el seguimiento postratamiento, o la fecha de recepción de los últimos datos correspondientes al último sujeto que sean necesarios para los análisis principal, secundarios o exploratorios especificados en el protocolo, lo que ocurra más tarde.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months6
    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: 300
    F.1.3Elderly (>=65 years) No
    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 state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 133
    F.4.2.2In the whole clinical trial 300
    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)
    No plans for treatment or care for treatment after participation different from the expected local standard of care
    No hay planes para el tratamiento o cuidado para el tratamiento después de la participación
    diferente del cuidado estándar local esperado.
    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 Decision2020-01-07
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2019-09-26
    P. End of Trial
    P.End of Trial StatusOngoing
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