| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| Non-alcoholic Steatohepatitis (NASH) |
|
| E.1.1.1 | Medical condition in easily understood language |
| Fatty liver disease not related to alcohol intake |
|
| E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
| 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 |
|
| 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 |
| The primary objective of the study is to evaluate the efficacy of tropifexor + licogliflozin in combination therapy and each monotherapy treatment, as assessed by histologic improvement after 48 weeks compared to placebo in participants with NASH and stage 2 or 3 fibrosis. |
|
| E.2.2 | Secondary objectives of the trial |
To evaluate the efficacy of combination therapy and two monotherapies in NASH or fibrosis with a composite endpoint.
To evaluate improvement in fibrosis by at least one stage
To evaluate improvement in fibrosis by at least two stages with no worsening of NASH after 48 weeks of treatment
To evaluate reduction in body weight from Baseline after 48 weeks of treatment
To evaluate change in liver fat content after 48 weeks of treatment
To evaluate the relationship of investigational treatment and markers of hepatic inflammation in NASH (ALT and AST) after 48 weeks of treatment
To evaluate the relationship of investigational treatment and GGT, a marker of cholestasis and oxidative stress after 48 weeks of treatment
To evaluate the safety and tolerability of tropifexor (LJN452) in combination with licogliflozin (LIK066), and each monotherapy treatment, compared to placebo, after 48 weeks of treatment |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
Presence of NASH with fibrosis as confirmed by central reader's evaluation of liver biopsy obtained no more than 6 months before
randomization. demonstrated by the following:
- NASH using NAFLD Activity Score (NAS) >= 4 with at least 1 point each in inflammation and ballooning
and
- Fibrosis stage 2 or 3 using NASH CRN fibrosis criteria |
|
| E.4 | Principal exclusion criteria |
•Type 1 diabetes mellitus
•Uncontrolled type 2 diabetes defined as glycated hemoglobin (HbA1c) ≥ 9% at screening
•HbA1c < 6.5% at screening in Type 2 diabetics currently treated with insulin or sulfonylureas
•Clinical evidence of liver impairment as defined by the presence of any of the following abnormalities:
◦Abnormal platelet count
◦Serum albumin < LLN (see central lab manual)
◦International Normalized Radio (INR) > ULN
◦ALT or AST > 5xULN (in either of the 2 values)
◦Total bilirubin > ULN (see central lab manual) (including Gilbert's syndrome)
◦Alkaline phosphatase > 300 IU/L (in either of the 2 values during screening)
◦History of esophageal varices, ascites or hepatic encephalopathy
◦Splenomegaly
◦MELD >12 |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
Whether the participant has at least a one point improvement in fibrosis
without worsening of steatohepatitis (no worsening of hepatocellular ballooning or lobular inflammation) at Week 48 compared to baseline
- Whether the participant achieves resolution of steatohepatitis without worsening of fibrosis at Week 48 compared to baseline |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
| E.5.2 | Secondary end point(s) |
Whether the participant achieves resolution of NASH and no worsening of fibrosis OR improvement in fibrosis by at least one stage without worsening of NASH (no worsening of hepatocellular ballooning or lobular inflammation) at Week 48 compared with baseline.
• Whether the participant has at least one stage improvement in fibrosis at Week 48 compared with baseline
• Whether the participant has at least two stage improvement in fibrosis without worsening of NASH at Week 48 compared with baseline
•Whether the participant has 5% or more reduction in body weight at Week 48 compared to baseline
•Change in liver fat content based on MRI - PDFF (in 40% of participants) over time up to Week 48 compared with baseline
•Change in ALT and AST over time up to Week 48 compared with baseline
To determine the relationship of investigational treatment and markers of hepatic inflammation in NASH (ALT and AST)
•Change in GGT over time up to Week 48 compared with baseline
To determine the relationship of investigational treatment and GGT, a
marker of cholestasis and oxidative stress
Number of participants with adverse events
To evaluate the safety and tolerability of tropifexor (LJN452) in combination with licogliflozin (LIK066), and each monotherapy treatment compared to placebo after 48 weeks of treatment |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
| 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 | Yes |
| E.6.8 | Bioequivalence | No |
| E.6.9 | Dose response | No |
| E.6.10 | Pharmacogenetic | Yes |
| 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 | Yes |
| E.8.2.3.1 | Comparator description |
| Combination arms and each monotherapy compared to placebo. Placebo also used for blinding purposes |
|
| E.8.2.4 | Number of treatment arms in the trial | 4 |
| 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 | 3 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 37 |
| 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 | No |
| 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 |
| Argentina |
| Belgium |
| Brazil |
| Bulgaria |
| Canada |
| Chile |
| China |
| Colombia |
| Denmark |
| Egypt |
| Estonia |
| France |
| Germany |
| India |
| Israel |
| Italy |
| Japan |
| Korea, Republic of |
| Mexico |
| Portugal |
| Russian Federation |
| Saudi Arabia |
| Singapore |
| Slovakia |
| South Africa |
| Spain |
| Taiwan |
| Turkey |
| United Kingdom |
| United States |
|
| 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
|
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 2 |
| E.8.9.1 | In the Member State concerned months | 10 |
| E.8.9.1 | In the Member State concerned days | 19 |
| E.8.9.2 | In all countries concerned by the trial years | 2 |
| 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 | 19 |