Emricasan, a Caspase Inhibitor, for Evaluation in Subjects With Non-Alcoholic Steatohepatitis (NASH) Fibrosis



Status:Active, not recruiting
Conditions:Gastrointestinal, Gastrointestinal
Therapuetic Areas:Gastroenterology
Healthy:No
Age Range:18 - Any
Updated:5/2/2018
Start Date:January 26, 2016
End Date:January 2019

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A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial of Emricasan (IDN-6556-12), an Oral Caspase Inhibitor, in Subjects With Non-alcoholic Steatohepatitis (NASH) Fibrosis

This is a multicenter, double-blind, randomized, placebo-controlled trial involving subjects
with a diagnosis of "definite NASH" with fibrosis (excluding cirrhosis) as determined by the
central histopathologist. Upon successful screening, subjects will be randomized to receive
either emricasan 50 mg BID or emricasan 5 mg BID or matching placebo BID.


Inclusion Criteria:

1. Male or female subjects 18 years or older, able to provide written informed consent,
and able to understand and willing to comply with the requirements of the study

2. Histological evidence of definite NASH based on NASH CLinical Research Network (CRN)
criteria, as confirmed by the central histopathologist, on a liver biopsy obtained no
more than 6 months prior to Day 1

3. NAFLD Activity Score (NAS) of 4 or greater with a score of at least 1 in each
component of the NAS (steatosis scored 0-3, lobular inflammation scored 0-3,
ballooning scored 0-2)

4. Fibrosis stage 1 (limited to 20% of subjects), stage 2, or stage 3 using the NASH CRN
Histologic Scoring System

a. Subjects with fibrosis stage 1 must also have diabetes mellitus or metabolic
syndrome

5. Willingness to utilize effective contraception (for both males and females of
childbearing potential) from Screening to 4 weeks after the last dose of study drug

6. If on vitamin E or pioglitazone, subjects must have been on a stable dose for at least
3 months prior to the biopsy (whether historical or qualifying biopsy)

Exclusion Criteria:

1. Current or history of significant alcohol consumption, defined as more than 20 g/day
for females and more than 30 g/day in males on average, or inability to reliably
quantify alcohol consumption based on investigator's judgement

2. Use of the following drugs (which may have potential hepatotoxic effects) within 6
months prior to Day 1: amiodarone, methotrexate, tamoxifen, valproic acid, estrogens
at doses greater than those used for hormone replacement or contraception, anabolic
steroids, or systemic glucocorticoids for more than 4 weeks at doses greater than
replacement doses

3. Uncontrolled diabetes (HbA1c ≥9%) within 60 days prior to Day 1

4. Presence of cirrhosis on liver biopsy (fibrosis stage 4 based on the central
histopathologist reading)

5. Hepatitis and fibrosis more likely related to etiologies other than NASH such as:

1. alcoholic steatohepatitis

2. autoimmune hepatitis

3. hepatitis B virus (HBV) infection

4. hepatitis C virus (HCV) infection

5. primary biliary cirrhosis

6. primary sclerosing cholangitis

7. Wilson's disease

8. alpha-1-antitrypsin deficiency

9. hemochromatosis or iron overload

10. drug-induced liver disease

11. other biliary liver disease

6. ALT or AST >5 times upper limit of normal (ULN) or total bilirubin >1.5 times ULN
during screening (unless subject has elevated total bilirubin due to Gilbert's as
documented in the medical records)

7. Alpha-fetoprotein >200 ng/mL

8. Hemoglobin <10 g/dL

9. White blood cell count <2.0 x 10^3/mm3

10. Estimated creatinine clearance <30 mL/min

11. Current use of the following medications that are considered significant inhibitors of
OATP1B1 and OATP1B3 transporters: atazanavir, cyclosporine, eltrombopag, gemfibrozil,
indinavir, lopinavir, ritonavir, rifampin, saquinavir, simeprevir, telaprevir,
tipranovir, or some combination of these medications

12. Symptoms of biliary colic, e.g. due to symptomatic gallstones, within the last 6
months, unless resolved following cholecystectomy

13. Inability to safely obtain a liver biopsy

14. Known human immunodeficiency virus (HIV) infection

15. Weight loss ≥ 10% within 6 months of Day 1

16. Use of controlled substances (including inhaled or injected drugs) or non-prescribed
use of prescription drugs within 1 year of screening to the point of interfering with
the subject's ability to comply with study procedures and study drug administration in
the investigator's judgement

17. History of or active malignancies, other than those successfully treated with curative
intent and believed to be cured

18. Significant systemic or major illness other than liver disease that in the opinion of
the investigator would preclude the subject from participating in and completing the
study, including but not limited to acute coronary syndrome or stroke within 6 months
of screening or major surgery within 3 months of screening

19. History or presence of clinically concerning cardiac arrhythmias, or prolongation of
Screening (pre-treatment) QTcF interval >480 milliseconds (msec)

20. Prior or planned (during the time frame of the study) bariatric surgery

21. If female: planned or known pregnancy, positive urine or serum pregnancy test, or
lactating/breastfeeding

22. Previous treatment with emricasan or active investigational medication in a clinical
trial within 6 months prior to Day 1

23. Prior liver transplant
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