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    Summary
    EudraCT Number:2021-003901-23
    Sponsor's Protocol Code Number:K-001-201
    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:2021-12-28
    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 number2021-003901-23
    A.3Full title of the trial
    A Phase 2, Multicenter, Placebo-Controlled, Randomized, Double-Blind, 48-Week Study to Evaluate the Efficacy and Safety of Combination Therapy of K-877-ER and CSG452 in Patients with Noncirrhotic Nonalcoholic Steatohepatitis (NASH) with Liver Fibrosis
    Estudio fase II, multicéntrico, controlado con placebo, aleatorizado, doble ciego, de 48 semanas de duración para evaluar la eficacia y la seguridad del tratamiento combinado de K-877-ER y CSG452 en pacientes con esteatohepatitis no alcohólica (EHNA) no cirrótica con fibrosis hepática
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2, Multicenter, Placebo-Controlled, Randomized, Double-Blind, 48-Week Study to Evaluate the Efficacy and Safety of Combination Therapy of K-877-ER and CSG452 in Patients with Noncirrhotic Nonalcoholic Steatohepatitis (NASH) with Liver Fibrosis
    Estudio fase II, multicéntrico, controlado con placebo, aleatorizado, doble ciego, de 48 semanas de duración para evaluar la eficacia y la seguridad del tratamiento combinado de K-877-ER y CSG452 en pacientes con esteatohepatitis no alcohólica (EHNA) no cirrótica con fibrosis hepática
    A.4.1Sponsor's protocol code numberK-001-201
    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 SponsorKowa Research Institute, 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 supportKowa Research Institute, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationKowa Research Institute, Inc.
    B.5.2Functional name of contact pointNoboru Kaneta
    B.5.3 Address:
    B.5.3.1Street Address430 Davis Drive, Suite 200
    B.5.3.2Town/ cityMorrisville
    B.5.3.3Post code27560
    B.5.3.4CountryUnited States
    B.5.4Telephone number1919433-1600
    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 namePemafibrate
    D.3.2Product code K-877-ER
    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 INNPEMAFIBRATE
    D.3.9.1CAS number 848259–27–8
    D.3.9.2Current sponsor codeK-877-ER
    D.3.9.4EV Substance CodeSUB188943
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.4
    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 nameTofogliflozin
    D.3.2Product code CSG452
    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 INNTOFOGLIFLOZIN
    D.3.9.1CAS number 903565-83-3
    D.3.9.2Current sponsor codeCSG452
    D.3.9.4EV Substance CodeSUB177215
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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
    Noncirrhotic Nonalcoholic Steatohepatitis (NASH) with Liver Fibrosis
    esteatohepatitis no alcohólica (EHNA) no cirrótica con fibrosis hepática
    E.1.1.1Medical condition in easily understood language
    NASH
    EHNA
    E.1.1.2Therapeutic area Body processes [G] - Metabolic Phenomena [G03]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 24.1
    E.1.2Level LLT
    E.1.2Classification code 10086370
    E.1.2Term NASH with fibrosis
    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
    The primary objective of this study is to evaluate the superiority of K-001 QD (combination therapy of K-877 ER 0.4 mg QD and CSG452 20 mg QD), K-877-ER 0.4 mg QD, or CSG452 20 mg QD compared with placebo in histological primary efficacy endpoint at Week 48 when K-001, K 877 ER 0.4 mg QD, CSG452 20 mg QD, or placebo are administered for 48 weeks in patients with noncirrhotic NASH with liver fibrosis.
    El objetivo principal de este estudio es evaluar la superioridad de K-001 1 v/d (tratamiento combinado de K-877‐ER 0,4 mg 1 v/d y CSG452 20 mg 1 v/d), K-877-ER 0,4 mg 1 v/d o CSG452 20 mg 1 v/d comparado con placebo en el criterio de valoración principal de la eficacia histológica en la semana 48 cuando se administran K-001, K-877‐ER 0,4 mg 1 v/d, CSG452 20 mg 1 v/d o placebo durante 48 semanas en pacientes con EHNA no cirrótica con fibrosis hepática.
    E.2.2Secondary objectives of the trial
    The secondary objectives of the study are the following:
    • To explore the superiority of K-001 QD compared with K 877 ER 0.4 mg QD alone in the primary efficacy endpoint at Week 48
    • To explore the superiority of K-001 QD compared with CSG452 20 mg QD alone in the primary efficacy endpoint at Week 48
    • To explore the superiority of K-001 QD, K-877 ER 0.4 mg QD alone, or CSG452 20 mg QD alone compared with placebo in the key secondary efficacy endpoints at Week 48
    • To explore the superiority of K-001 QD compared with K 877 ER 0.4 mg QD alone in the key secondary efficacy endpoints at Week 48
    • To explore the superiority of K-001 QD compared with CSG452 20 mg QD alone in the key secondary efficacy endpoints at Week 48
    • To explore the efficacy of K 001 QD, K 877 ER 0.4 mg QD alone, CSG452 20 mg QD alone, and placebo in the other secondary efficacy endpoints
    • To evaluate the safety and tolerability of K 001 QD, K 877 ER 0.4 mg QD alone, CSG452 20 mg QD alone, and placebo
    • Explorar superioridad de K-001 QD versus K-877‐ER 0,4 mg QD solo en criterio de valoración principal de eficacia en semana 48
    • Explorar superioridad de K-001 QD versus CSG452 20 mg QD solo en criterio de valoración principal de eficacia en semana 48
    • Explorar superioridad de K-001 QD, K-877‐ER 0,4 mg QD solo o CSG452 20 mg QD solo versus placebo en criterios de valoración secundarios claves de eficacia en semana 48
    • Explorar superioridad de K-001 QD versus K-877‐ER 0,4 mg QD solo en criterios de valoración secundarios claves de eficacia en semana 48
    • Explorar superioridad de K-001 QD versus CSG452 20 mg QD solo en criterios de valoración secundarios claves de eficacia en semana 48
    • Explorar eficacia de K-001 1 QD, K-877 ER 0,4 mg QD solo, CSG452 20 mg QD solo y placebo en otros criterios de valoración secundarios de eficacia
    • Evaluar seguridad y tolerabilidad de K-001 QD, K-877‐ER 0,4mg QD solo, CSG452 20mg QD solo y placebo
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Criteria for Inclusion:
    Patients are eligible for the study if all of the following criteria are met:
    1. Able to understand and comply with study procedures and give written informed consent
    2. Age > or = 18 years
    3. NAS > or = 4 with a score of at least 1 in each component of the NAS (steatosis, lobular inflammation, and ballooning) at Visit 2 liver biopsy, or a historical liver biopsy performed within 12 weeks of randomization
    4. Fibrosis stage of 1 or greater and below 4 on NASH CRN fibrosis staging system at Visit 2 liver biopsy, or a historical liver biopsy performed within 12 weeks of randomization
    5. Patient can be with or without T2DM, but T2DM patients must be well controlled on a stable dose of antidiabetic medication for at least 3 months prior to randomization. Patients without T2DM must have fasting plasma glucose > or = 100 mg/dL at Visit 1
    6. Patients must not be breastfeeding and must have a negative serum pregnancy test at Visit 1. Female patients of childbearing potential must use one of the following acceptable birth control methods as specified before enrollment and throughout the study:
    a. Surgical sterilization (bilateral tubal ligation, hysterectomy, or bilateral oophorectomy) at least 6 months before the first dose of study drug
    b. Intrauterine device in place for at least 3 months before the first dose of study drug and throughout the study
    c. Barrier method (condom or diaphragm) with spermicide for at least 30 days before the first dose of study drug and throughout the study
    d. Surgical sterilization of the male partner (vasectomy at least 6 months before the first dose of study drug)
    e. Hormonal contraceptives with a barrier method for at least 3 months before the first dose of study drug and throughout the study
    Female patients are not considered to be of childbearing potential if they meet at least one of the following two criteria as documented by the Investigator:
    - They have had a hysterectomy, bilateral salpingectomy, or bilateral oophorectomy at minimum 1 menstrual cycle prior to signing the Informed Consent Form
    - They are postmenopausal, defined as 1 year since the last menstrual period for women > or = 55 years of age and have a follicle-stimulating hormone (FSH) level in menopausal range (defined as > or =20 miU/mL and <122 miU/mL) for women <55 years of age
    1. Capacidad para entender y cumplir con los procedimientos del estudio y facilitar el consentimiento informado por escrito
    2. Edad > o = 18 años
    3. NAS > o = 4 con una puntuación de al menos 1 en cada componente del NAS (esteatosis, inflamación lobular y abultamiento) en la biopsia hepática de la visita 2 o una biopsia hepática histórica realizada en el plazo de 12 semanas desde la aleatorización
    4. Estadio de fibrosis igual o superior a 1 e inferior a 4 en el sistema de estadificación de la fibrosis NASH CRN en la biopsia hepática de la visita 2, o una biopsia hepática histórica realizada en el plazo de 12 semanas desde la aleatorización
    5. Los pacientes pueden tener o no DMT2, pero los pacientes con DMT2 deben estar bien controlados con una dosis estable de medicación antidiabética durante al menos 3 meses antes de la aleatorización. Los pacientes sin DMT2 deben presentar glucosa plasmática en ayunas > o = 100 mg/dl en la visita 1
    6. Las pacientes no deben estar lactando y deben tener una prueba de embarazo sérica negativa en la visita 1. Las pacientes en edad fértil deben utilizar uno de los siguientes métodos anticonceptivos aceptables, tal como se especifica antes de la inscripción y durante todo el estudio:
    a. Esterilización quirúrgica (ligadura de trompas bilateral, histerectomía u ooforectomía bilateral) al menos 6 meses antes de la primera dosis del fármaco del estudio
    b. Dispositivo intrauterino colocado durante al menos 3 meses antes de la primera dosis del fármaco del estudio y durante todo el estudio
    c. Método de barrera (preservativo o diafragma) con espermicida durante al menos 30 días antes de la primera dosis del fármaco del estudio y durante todo el estudio
    d. Esterilización quirúrgica de la pareja masculina (vasectomía al menos 6 meses antes de la primera dosis del fármaco del estudio)
    e. Anticonceptivos hormonales con un método de barrera durante al menos 3 meses antes de la primera dosis del fármaco del estudio y a lo largo del estudio
    Las pacientes no se considerarán en edad fértil si cumplen al menos uno de los dos criterios siguientes según lo documentado por el investigador:
    - Se han sometido a una histerectomía, salpingectomía bilateral u ooforectomía bilateral al menos 1 ciclo menstrual antes de firmar el formulario de consentimiento informado
    - Son posmenopáusicas, o sea, ha pasado 1 año desde la última menstruación para las mujeres > o = 55 años de edad y tienen un nivel de folitropina (FSH) en rango menopáusico (definido como > o = 20 kU/ml y < 122 kU/ml) para las mujeres mayores de 55 años
    E.4Principal exclusion criteria
    -Participation in another clinical trial involving an investigational agent within 30 days prior to signing the Informed Consent Form for this study.
    -Ongoing or recent consumption of significant amounts of alcohol. Significant alcohol consumption is defined as >21 standard drinks per week in men and >14 standard drinks per week in women over a 2-year period prior to randomization. A standard alcoholic drink is any drink that contains about 14 g of pure alcohol.-Evidence of other forms of chronic liver disease -Patients listed for liver transplantation, or a history of liver transplantation -Initiation of, or change in, current doses of thiazolidinediones, agents with GLP-1 receptor agonist activity, or vitamin E within 6 months of randomization -Current or planned use of fibrates, agents with potent selective peroxisome proliferator-activated receptor alpha (PPARalpha) agonist activity, or sodium glucose co transporter 2 (SGLT2) inhibitors within 6 months of randomization -Patients with type 1 diabetes mellitus -Patients with poorly controlled T2DM as defined by HbA1c >10% at Visit 1 -Patients with severe ketosis, diabetic coma, or pre-coma -Initiation of, or change in, current TG-lowering therapy within 3 months of randomization -TG-lowering therapy is defined as niacin >100 mg/day or dietary supplements or prescription of omega-3 fatty acids 1000 mg/day. -Initiation of, or change in, current doses of orlistat, lorcaserin, phentermine, topiramate, naltrexone, or bupropion or any other medication that could promote weight loss in the opinion of the investigator within 3 months of randomization -Patients with severe infections, during a perioperative period, or with serious injuries -Patients with urinary tract infection or genital infection -History of symptomatic gallstone disease -Patients with severe renal impairment at Visit 1, who are receiving dialysis at Visit 1, or who have had a kidney transplant, regardless of level of renal function -Patients with weight change of 5% or more within 3 months of randomization -Patients who performed significant attempt to change diet and exercise, at the investigator’s opinion, within 6 months of screening -Model for End-stage Liver Disease (MELD) score >12 at Visit 1 -Presence of clinical or histological evidence of compensated cirrhosis, or biochemical evidence of compensated cirrhosis -Inability to safely obtain a liver biopsy -Inability to safely obtain a MRI -History or evidence of major and clinically significant, cardiovascular, pulmonary, renal, hematologic, gastrointestinal endocrine, immunologic, dermatologic, neurologic, psychiatric, oncologic, or allergic disease that would interfere with the conduct of the study or interpretation of the data
    -History of malignancy within the past 5 years, except for basal or squamous cell skin carcinoma that has undergone curative therapy -Any past history of hepatocellular carcinoma (HCC) and/or HCC treatment -History of bariatric surgery within 5 years of Screening -Uncontrolled hypertension at Visit 1 (systolic blood pressure 160 mm Hg and/or diastolic blood pressure 100 mm Hg after 5 minutes of sitting) Patients with evidence of portal hypertension -Known infection with human immunodeficiency virus (HIV) 1 or HIV 2 -Known hypersensitivity or intolerance to fibrates, PPARalfa agonists or SGLT2 inhibitors -Anticipation of major surgery during the study -Current or anticipated chronic use of cyclosporine, rifampicin, or other inhibitors of OATP1B1, or OATP1B3 -Thyroid-stimulating hormone >1.5 × upper limit of normal (ULN), clinical evidence of hypothyroidism, or thyroid hormone therapy that is not stable for at least 6 weeks prior to Screening -ALT and/or AST >200 IU/L at Visit 1, or Visit 2 -ALT instability during the screening period, defined as a substantial change in ALT from Visit 1 to Visit 2 (Visit 2 ALT is both >50% AND >30 IL/U different from Visit 1 ALT). In such cases, Visit 2.1 must be scheduled by the Investigator at least 2 weeks after Visit 2 to re-test ALT once, unless the subject failed screening due to meeting other exclusion criteria. If ALT level at Visit 2.1 is not substantially different from Visit 1 or Visit 2 values and does not suggest clinically significant ALT instability and/or clinically unfavorable trend in the opinion of the Investigator, the patient will be allowed to participate in the study ALP > or = 2 × ULN, at Visit 1 or Visit 2 -Unexplained creatinine kinase (CK) concentration >5 × ULN or CK elevation due to known muscle disease at Visit 1, or Visit 2 -Patients who have previously received K-877 or CSG452 within 1 year of Visit 1 -Current or past history of illicit drug use or alcohol abuse within 1 year of Visit 1 -Any condition or therapy, which, in the opinion of the Investigator, might pose a risk to the patient or make participation in the study not in the best interest of the patient -Special or vulnerable status
    1. Participación en otro ensayo clínico en el plazo de los 30 días anteriores a la firma del consentimiento informado.
    2. Consumo actual o reciente de cantidades significativas de alcohol.
    3. Indicios de otras formas de enfermedad hepática crónica
    4. Pacientes en lista de espera para un trasplante de hígado, o con antecedentes de trasplante de hígado
    5. Inicio o cambio de las dosis actuales de tiazolidinedionas, agentes con actividad agonista del receptor de GLP-1 o vitamina E en el plazo de 6 meses desde la aleatorización
    6. Uso actual o previsto de fibratos, agentes con una potente actividad agonista selectiva de los receptores activados por el proliferador de peroxisomas alfa (PPARalfa), o inhibidores del transportador de sodio-glucosa tipo 2 (SGLT2) en un plazo de 6 meses desde la aleatorización
    7. Diabetes mellitus tipo 1
    8. DMT2 mal controlada, definida por una HbA1c >10% en la visita 1
    9. Cetosis aguda, coma diabético o pre-coma
    10. Inicio o cambio del tratamiento actual de reducción de los TG en el plazo de 3 meses desde la aleatorización
    11. Inicio o cambio de las dosis actuales de orlistat, lorcaserina, fentermina, topiramato, naltrexona o bupropión o cualquier otro medicamento que pueda favorecer la pérdida de peso a criterio del investigador en el plazo de 3 meses desde la aleatorización
    12. Infecciones graves, durante un periodo perioperatorio o con lesiones graves
    13. Infección de las vías urinarias o infección genital
    14. Antecedentes de enfermedad sintomática de cálculos biliares
    15. Insuficiencia renal grave (es decir, TFGe <45 ml/min/1,73 m2) en la visita 1, que reciben diálisis en la visita 1 o que han recibido un trasplante de riñón, independientemente del nivel de función renal
    16. Cambio de peso del 5% o más en el plazo de 3 meses desde la aleatorización
    17. Intento significativo de cambiar la dieta y el ejercicio, a criterio del investigador, en el plazo de 6 meses desde la selección
    18. MELD >12 en la visita 1
    19. Evidencia clínica o histológica de cirrosis compensada, o evidencia bioquímica de cirrosis compensada (es decir, bilirrubina total  1,5 mg/dl, excepto síndrome de Gilbert o índice internacional normalizado  1,3. Se puede permitir una repetición de la prueba)
    20. Incapacidad para obtener una biopsia de hígado de forma segura
    21. Incapacidad para obtener una RM de forma segura
    22. Antecedentes o evidencia de enfermedades cardiovasculares, pulmonares, renales, hematológicas, gastrointestinales (incluida la malabsorción clínicamente significativa), endocrinas (distintas de la DMT2), inmunológicas, dermatológicas, neurológicas, psiquiátricas, oncológicas o alérgicas importantes y clínicamente significativas que pudieran interferir con la realización del estudio o la interpretación de los datos
    23. Antecedentes de neoplasias en los últimos 5 años, excepto carcinoma de piel de células basales o escamosas que haya sido sometido a terapia curativa
    24. Antecedente anterior de carcinoma hepatocelular (CHC) o tratamiento del CHC
    25. Antecedentes de cirugía bariátrica en el plazo de 5 años desde la selección
    26. Hipertensión no controlada en la visita 1 (tensión arterial sistólica 160 mm Hg o presión arterial diastólica 100 mm Hg después de 5 minutos de estar sentado)
    27. Evidencia de hipertensión portal
    28. Infección conocida por el virus de la inmunodeficiencia humana (VIH) 1 o VIH 2
    29. Hipersensibilidad o intolerancia conocida a fibratos, agonistas PPARalfa o inhibidores de SGLT2
    30. Cirugía mayor prevista durante el estudio
    31. Uso crónico actual o previsto de ciclosporina, rifampicina u otros inhibidores de OATP1B1 u OATP1B3
    32. Hormona estimulante del tiroides > 1,5 veces el límite superior de la normalidad (LSN), indicios clínicos de hipotiroidismo o tratamiento con hormona tiroidea que no permanezcan estables durante al menos 6 semanas antes de la selección
    33. ALT o AST >200 UI/L en la visita 1 o en la visita 2
    34. Inestabilidad de la ALT durante el periodo de selección, definida como un cambio sustancial en la ALT de la visita 1 a la visita 2
    35. ALP > o = 2 veces el LSN, en la visita 1 o visita 2
    36. CK >5 veces el LSN o elevación de la CK debido a una enfermedad muscular conocida (por ejemplo, polimiositis, disfunción mitocondrial) en la visita 1 o en la visita 2
    37. Pacientes que hayan recibido previamente K-877 o CSG452 en un plazo de 1 año
    38. Antecedentes actuales o pasados de abuso de drogas o alcohol en un plazo de 1 año
    39. Cualquier condición o tratamiento que, a criterio del investigador, pueda suponer un riesgo para el paciente o hacer que la participación en el estudio no sea lo mejor para el paciente
    40. Estado especial o vulnerable
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy endpoint is improvement from Baseline (defined by central reading of a liver biopsy obtained at Visit 2, or within 12 weeks of randomization) in disease activity and no worsening of liver fibrosis on the NASH Clinical Research Network (CRN) fibrosis score at Week 48. The improvement in disease activity is defined as improvement in NAFLD Activity Score (NAS) > o = 2 points. The worsening of fibrosis is defined as any numerical increase in the stage.
    El criterio de valoración principal de la eficacia es la mejora con respecto al inicio (definida por la lectura central de una biopsia hepática obtenida en la visita 2, o en las 12 semanas siguientes a la aleatorización) de la actividad de la enfermedad y la ausencia de empeoramiento de la fibrosis hepática según la puntuación de fibrosis de la Red de Investigación Clínica (NASH CRN, por sus siglas en inglés) de EHNA en la semana 48. La mejora de la actividad de la enfermedad se define como una mejora en la puntuación de actividad de HGNA (NAS) > or = 2 puntos. El empeoramiento de la fibrosis se define como cualquier aumento numérico en la fase.
    E.5.1.1Timepoint(s) of evaluation of this end point
    48 weeks
    48 semanas
    E.5.2Secondary end point(s)
    Key secondary efficacy endpoints
    • Resolution of steatohepatitis on overall histopathological reading and no worsening of liver fibrosis on the NASH CRN fibrosis score at Week 48. Resolution of steatohepatitis is defined as absent fatty liver disease or isolated or simple steatosis without steatohepatitis and a NAS score of 0–1 for inflammation, 0 for ballooning, and any value for steatosis.
    • Improvement from Baseline in liver fibrosis score > or = 1 and no worsening of steatohepatitis (defined as no increase in NAS for ballooning, inflammation, or steatosis) at Week 48
    • Both resolution of steatohepatitis and improvement in liver fibrosis score > or = 1 from Baseline at Week 48
    • Resolution of steatohepatitis on overall histopathological reading at Week 48.
    • Improvement from Baseline in liver fibrosis score > or = 1 at Week 48
    • Improvement from Baseline in each of the NAS components (inflammation, ballooning, and steatosis) > or = 1 point at Week 48
    Other secondary efficacy endpoints
    • Improvement from Baseline in liver fat content measured by magnetic resonance imaging-derived proton density fat fraction (MRI PDFF) (defined as a > o = 30% reduction) at Week 48
    • Improvement from Baseline in alanine aminotransferase (ALT) (defined as an ALT < or = 40 U/L with a > o = 1 30% decrease from baseline) at Week 48
    • Change and percent change from baseline to Week 48 in NAS, each score of NAS components (inflammation, ballooning, and steatosis), NASH CRN fibrosis score, liver fat content by MRI-PDFF, ALT, alkaline phosphatase (ALP), AST, gamma GTP, Cytokeratin18, bile acid, ProC3, hyaluronic acid, type IV collagen 7S domain, Mac-2 binding protein glycan isomer (M2BPGi), nonalcoholic fatty liver disease (NAFLD) fibrosis score, NAFIC score, enhanced liver fibrosis (ELF) test, fibrosis-4 (FIB 4) score, TG, total cholesterol (TC), LDL C, high-density lipoprotein cholesterol (HDL C), free fatty acids (FFA), fasting plasma glucose (FPG), fasting insulin, hemoglobin A1C (HbA1c), homeostasis model assessment of insulin resistance (HOMA IR), homeostasis model assessment of beta-cell function (HOMA beta), body weight, body mass index (BMI), and waist circumference
    Criterios de valoración secundarios claves de la eficacia
    • Resolución de la esteatohepatitis en la lectura histopatológica global y ausencia de empeoramiento de la fibrosis hepática en la puntuación de fibrosis NASH CRN en la semana 48. La resolución de la esteatohepatitis se define como ausencia de enfermedad del hígado graso o esteatosis aislada o simple sin esteatohepatitis y una puntuación NAS de 0-1 para la inflamación, 0 para los abultamientos y cualquier valor para la esteatosis.
    • Mejora con respecto al inicio en la puntuación de fibrosis hepática > o = 1 y ausencia de empeoramiento de la esteatohepatitis (definida como ausencia de aumento del NAS para el abultamiento, la inflamación o la esteatosis) en la semana 48
    • Resolución de la hepatitis y mejora en la puntuación de la fibrosis hepática > o =1 desde el inicio en la semana 48
    • Resolución de la esteatohepatitis en la lectura histopatológica global en la semana 48.
    • Mejora respecto al inicio en la puntuación de fibrosis hepática > o = 1 en la semana 48
    • Mejora respecto al inicio en cada uno de los componentes del NAS (inflamación, abultamiento y esteatosis) > o = 1 punto en la semana 48
    Otros criterios de valoración secundarios de la eficacia
    • Mejora respecto al inicio en el contenido de grasa hepática medida por la fracción de grasa de densidad (definida como una reducción > o = 1 30 %) con resonancia magnética nuclear (RMN-PDFF) obtenida en la semana 48
    • Mejora con respecto al inicio en la alanina aminotransferasa (ALT) (definida como una ALT < o = 40 microlL con una disminución > o = 1 30% con respecto al inicio) en la semana 48
    • Cambio y porcentaje de cambio desde el inicio hasta la semana 48 en el NAS, cada puntuación de los componentes del NAS (inflamación, abultamiento y esteatosis), puntuación de fibrosis NASH CRN, contenido de grasa en el hígado por MRI-PDFF, ALT, fosfatasa alcalina (ALP), gamma-GTP), citoqueratina18, ácido biliar, ProC3, ácido hialurónico, dominio 7S del colágeno tipo IV, isómero del glicano de la proteína de unión Mac-2 (M2BPGi), puntuación de fibrosis de la enfermedad del hígado graso no alcohólico (HGNA), puntuación NAFIC, prueba de fibrosis hepática mejorada (ELF), puntuación de fibrosis-4 (FIB-4), TG, colesterol total (CT), LDL-C, colesterol de lipoproteínas de alta densidad (HDL-C), ácidos grasos libres (FFA), glucosa plasmática en ayunas (GPA), insulina en ayunas, hemoglobina A1C (HbA1c), evaluación del modelo de homeostasis de la resistencia a la insulina (HOMA-IR), evaluación del modelo de homeostasis de la función de las células beta (HOMA-beta), peso corporal, índice de masa corporal (IMC) y diámetro de la cintura
    E.5.2.1Timepoint(s) of evaluation of this end point
    48 weeks
    48 semanas
    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 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) 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 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 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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA9
    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
    Brazil
    Bulgaria
    Canada
    Spain
    United States
    E.8.7Trial has a data monitoring committee No
    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
    Last patient last visit or last contact, whichever occurs last.
    Última visita del último paciente o último contacto, lo que ocurra primero
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    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 years4
    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: 400
    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 state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 45
    F.4.2.2In the whole clinical trial 400
    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)
    None
    Ninguno
    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 Decision2022-05-11
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-05-04
    P. End of Trial
    P.End of Trial StatusOngoing
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