E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Primary Biliary Cholangitis (PBC) and Elevated Liver Stiffness |
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E.1.1.1 | Medical condition in easily understood language |
Liver disease caused by autoimmune attack on the small to medium bile ducts |
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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 | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10080429 |
E.1.2 | Term | Primary biliary cholangitis |
E.1.2 | System Organ Class | 10019805 - Hepatobiliary disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the effect of setanaxib on biochemical response at Week 52 in patients with PBC and with elevated liver stiffness and intolerance or inadequate response to ursodeoxycholic acid (UDCA) |
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E.2.2 | Secondary objectives of the trial |
- To evaluate the effect of setanaxib on liver stiffness at Week 52 - To evaluate the effect of setanaxib on fatigue at Week 52 - To evaluate the effect of setanaxib on pruritus at Week 52 - To evaluate the safety and tolerability of setanaxib over a 52 week treatment period - To further evaluate the safety and tolerability of setanaxib in patients with PBC and with elevated liver stiffness and intolerance or inadequate response to UDCA (Extension phase) |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or female patient aged ≥18 years, inclusive at the time of informed consent. 2. Willing and able to give written informed consent and to comply with the requirements of the study. 3. Definite or probable PBC diagnosis as demonstrated by the presence of ≥2 of the following 3 diagnostic factors: a. Documented history of elevated ALP levels ≥1.67×ULN of the local reference range b. Positive AMA titer or, if AMA negative or in low titer (<1:80), positive PBC specific antibodies (anti-GP210 and/or anti-SP100 and/or antibodies against the major M2 components [PDC-E2, 2-oxo-glutaric acid dehydrogenase complex]) c. Liver biopsy consistent with PBC. 4. Serum ALP ≥1.67×ULN at Screening. One repeat blood sampling (with analysis by the central laboratory) can be performed at the discretion of the Investigator at Screening Visit 2 for patients who do not meet this inclusion criterion at Screening Visit 1. If this inclusion criterion is then met at Screening Visit 2, the patient may be eligible for the study. 5. Liver stiffness measured by transient elastography (FibroScan®) of ≥8.8 kPa at Screening and at Baseline (a minimum of 10 valid readings, with at least a 70% success rate and an interquartile range of ≤30% of the median value, are taken with the results expressed in kilopascals [kPa]). 6. UDCA prescriptional dose use for the past 6 months (at a stable dose for >3 months prior to Screening) OR intolerant to UDCA (last dose of UDCA >3 months prior to Screening). 7. For patients receiving OCA, fenofibrate, or bezafibrate treatment for at least 6 months and stable dose for >3 months prior to Screening. 8. For patients intolerant to OCA, OCA must have been discontinued >3 months prior to Screening. 9. For patients previously treated with bezafibrate or fenofibrate, these agents must have been be discontinued >3 months prior to Screening. 10. Female patients of childbearing potential must use a highly effective method of contraception to prevent pregnancy for ≥4 weeks before Randomization and must agree to continue strict contraception up to 90 days after the last dose of IMP. a. For the purposes of this trial, women of childbearing potential are defined as “All female patients after menarche unless they are postmenopausal for at least 2 years or are surgically sterile.” b. For female patients ≤55 years of age who are considered postmenopausal and who are not on concomitant estrogen replacement therapy, confirmation of postmenopausal status will be required with follicle stimulating hormone (FSH) test results in the postmenopausal range for age at Screening. c. Highly effective contraception is defined as use of 2 barrier methods (eg, female diaphragm and male condoms) or use of at least 1 barrier method in combination with spermicide, an intrauterine device or hormonal contraceptives (eg, implant or oral). 11. Female patients of childbearing potential must have a negative serum pregnancy test at Screening and a negative urine pregnancy test at Baseline/Randomization before dosing. 12. Male patients with female partners of childbearing potential must be willing to use a condom and require their partner to use an additional form of adequate contraception as approved by the Investigator, such as an established form of hormonal contraceptive, a diaphragm or cervical/vault cap, or intrauterine device. This requirement begins at the time of informed consent and ends 90 days after receiving the last dose of IMP. 13. Male patients must be willing not to donate sperm, and female study participants must be willing not to donate eggs, from Baseline until 90 days after the last dose of IMP.
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E.4 | Principal exclusion criteria |
1. A positive pregnancy test or breastfeeding for female patients. 2. Any historical or current hepatic decompensation event defined as variceal/portal hypertension bleed and/or hepatic encephalopathy, spontaneous bacterial peritonitis, ascites requiring treatment, or liver transplantation list inclusion. 3. History of liver transplantation, current placement on a liver transplant list or current MELD score of ≥12 unless the patient is on anticoagulant therapy, or a Child Pugh Score of ≥6. 4. Cirrhosis with complications, including history or presence of hepatocellular carcinoma. 5. Total bilirubin >2×ULN. In case of total bilirubin elevation >ULN the Screening serum albumin must be within the reference range. One repeat blood sampling (with analysis by the central laboratory) can be performed at the discretion of the Investigator at Screening Visit 2 for patients who meet this exclusion criterion at Screening Visit 1. If this exclusion criterion is not met at Screening Visit 2, the patient may be eligible for the study. 6. Plasma ALT >3×ULN and/or AST >3×ULN. One repeat blood sampling (with analysis by the central laboratory) can be performed at the discretion of the Investigator at Screening Visit 2 for patients who meet this exclusion criterion at Screening Visit 1. If this exclusion criterion is not met at Screening Visit 2, the patient may be eligible for the study. 7. INR >1.2 unless patient is on anticoagulant therapy. 8. Estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2, as calculated by the central laboratory using the chronic kidney disease epidemiology collaboration (CKD EPI) equation. 9. Thyroid stimulating hormone >ULN at Screening. 10. Competing etiology for liver disease (eg, hepatitis C [unless effectively cured of hepatitis C, with a sustained virologic response for at least 6 months prior to Screening], active hepatitis B [HBsAg positive], nonalcoholic steatohepatitis [NASH], alcoholic liver disease, autoimmune hepatitis, autoimmune hepatitis PBC overlap syndrome, primary sclerosing cholangitis, Gilbert’s Syndrome). 11. Medical conditions that could cause nonhepatic increases in ALP (eg, Paget's disease). 12. Known history of HIV infection. If the anti-HIV antibody test is positive, HIV RNA negativity has to be confirmed by the central laboratory. 13. Surgery (eg, stomach bypass) or medical condition that might significantly affect absorption of medicines (as judged by the Investigator). 14. Positive urine drug screen (if not due to prescriptional use of a concomitant medication, as confirmed by the Investigator) at Screening. 15. Patients receiving prohibited medications within 3 months of Screening Visit 1 including oral and systemic corticosteroids (see Section 6.6 for exceptions), colchicine, mycophenolate mofetil, azathioprine, methotrexate, sulfasalazine, leflunomide, cyclophosphamide, valproate, isoniazid, or nitrofurantoin. Any biologic agent within 12 weeks or 5 half lives prior to Screening, whichever is longer. In the case of rituximab, use within 168 days (24 weeks) of Screening is exclusionary. See the complete list of prohibited medications in Section 6.6. 16. Treatment with any investigational agent within 12 weeks of Screening Visit 1 or 5 half-lives of the IMP (if known) (whichever is longer) or current enrollment in an interventional clinical trial. 17. Evidence of any of the following cardiac conduction abnormalities: A QTc Fredericia interval >450 milliseconds for males or >470 milliseconds for females, as calculated by the central reader. Patients with a second or third degree atrioventricular block are to be excluded. 18. Treatment or planned treatment, with a pacemaker, implanted cardioverter defibrillator, or other implanted electronic device. 19. History of a malignancy within 5 years of Screening with the following exceptions: a. Adequately treated carcinoma in situ of the cervix b. Adequately treated basal or squamous cell cancer or other localized nonmelanoma skin cancer. 20. The occurrence of any acute infection requiring systemic antibiotic therapy within the 2 weeks prior to Screening Visit 1. 21. A history of bone marrow disorder including aplastic anemia, or any current marked anemia defined as hemoglobin <10.0 g/dL. 22. Prior treatment with setanaxib or participation in a previous setanaxib clinical trial. 23. Unstable cardiovascular disease as defined by any of the following: a. Unstable angina within 6 months prior to Screening b. Myocardial infarction, coronary artery bypass graft surgery, or coronary angioplasty within 6 months prior to Screening c. Cerebrovascular accident within 6 months prior to Screening d. New York Heart Association Class III or IV heart failure 24. Presence of any laboratory abnormality or condition that, in the opinion of the Investigator, could interfere with or compromise a patient’s treatment, assessment, or compliance with the protocol and/or study procedures.
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E.5 End points |
E.5.1 | Primary end point(s) |
Proportion of patients achieving a biochemical response at Week 52, defined as: - Alkaline phosphatase (ALP) reduction to <1.67×upper limit of normal (ULN) and - ALP reduction of ≥15% from Baseline and - Total bilirubin ≤1×ULN
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
- Change in liver stiffness at Week 52 compared to Baseline, as assessed by transient elastography (FibroScan®) - Change in fatigue at Week 52 compared to Baseline, as assessed by the PBC-40 item questionnaire (PBC 40) fatigue domain and the fatigue domain of the Patient Reported Outcomes Measurement Information System (PROMIS) 29 questionnaire - Change in pruritus at Week 52 compared to Baseline, as assessed by the PBC-40 itch domain, 5 D itch scale, and Pruritus Visual Analogue Scale (VAS) in patients with pruritus at Baseline - Adverse events (AEs). Monitoring for AEs at all visits. - AEs of special interest (AESIs): Drug induced liver injury (DILI) Anemia Hypothyroidism - Laboratory tests: Hematology Biochemistry Urinalysis Thyroid function - Vital signs - 12-lead electrocardiograms (ECGs): clinically significant abnormalities
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | Yes |
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 | Yes |
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) | Yes |
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 | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 76 |
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 |
Australia |
Canada |
Israel |
New Zealand |
United States |
Austria |
Belgium |
Denmark |
France |
Germany |
Hungary |
Italy |
Netherlands |
Poland |
Spain |
Sweden |
Switzerland |
United Kingdom |
Czechia |
Greece |
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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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The end of the study is defined as the date of the last visit or last procedure of the last patient in the study. |
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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 | 4 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | 21 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 11 |
E.8.9.2 | In all countries concerned by the trial days | 0 |