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Effects of Exenatide (Byetta®) on Liver Function in Patients With Nonalcoholic Steatohepatitis (NASH)

Primary Purpose

Nonalcoholic Fatty Liver Disease

Status
Completed
Phase
Phase 4
Locations
Germany
Study Type
Interventional
Intervention
Exenatide
Sponsored by
Ruhr University of Bochum
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Nonalcoholic Fatty Liver Disease focused on measuring exenatide, hepatic steatosis, insulin resistance, insulin sensitizers, nonalcoholic fatty liver disease, - GLP1-Analog

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Age between 18 and 75 years, inclusive.
  2. Patients present with histologically proven non-alcoholic steatohepatitis ascertained by the single center pathologist between visit 1 and 2
  3. First liver biopsy was obtained not later than 6 months before visit 1
  4. Patients have HbA1c not exceeding 10.0%.
  5. Patients have a history of stable body weight (not varying by >10% for at least 3 months prior to screening

Exclusion Criteria:

  1. Patients are investigator site personnel directly affiliated with the study, or are immediate family of investigator site personnel directly affiliated with the study. Immediate family is defined as a spouse, parent, child, or sibling, whether biological or legally adopted.
  2. Females of childbearing potential who are pregnant, breast-feeding or intend to become pregnant or are not using adequate contraceptive methods (adequate contraceptive measures include sterilisation, hormonal intrauterine devices, oral contraceptives, sexual abstinence or vasectomised partner). A male subject who is sexually active and has not been surgically sterilised must be informed that he must either use a condom during intercourse, ensure that his partner practices contraception, or he must refrain from sexual intercourse during the trial and until 1 month after completion of the trial. This is to prevent the possibility of a pregnancy from spermatocytes that can potentially be damaged by trial medication. It is strongly recommended that the female partners use a highly effective contraception (Pearl Index < 1%).
  3. Patients have participated in an interventional medical, surgical, or pharmaceutical study (a study in which an experimental, drug, medical, or surgical treatment was given) within 30 days prior to screening. This criterion includes drugs that have not received regulatory approval for any indication at the time of study entry.
  4. Patients with evidence of viral or autoimmune hepatitis (positive testing for HBsAG, anti-HCV or anti-HIV, pos. AMA-screen, ANA-titer > 1:160)
  5. Patients with inherited liver diseases (e.g. Wilson's disease, Hemochromatosis)
  6. Patients have alcohol consumption (>20 g daily for males and >10 g daily for females)
  7. Patients have decompensated liver cirrhosis (Child-Pugh score >7)
  8. Patients have alanine aminotransaminase (ALT) greater than ten times the upper limit of the reference range.
  9. Patients have had greater than three episodes of severe hypoglycemia within 6 months prior to screening.
  10. Patients are undergoing therapy for a malignancy, other than basal cell or squamous cell skin cancer.
  11. Patients have cardiac disease that is Class III or IV, according to the New York Heart Association criteria.
  12. Patients have a known allergy or hypersensitivity to exenatide, or excipients contained in these agents.
  13. Patients have or had concomitant medication with thiazolidinediones.
  14. Patients have a history of renal transplantation or are currently receiving renal dialysis or have serum creatinine >1.8 mg/dL for males and greater than or equal to >1.5 mg/dL for females.
  15. Patients have known hemoglobinopathy or chronic anemia
  16. Patients are receiving chronic (lasting longer than 2 weeks) systemic glucocorticoid therapy (excluding topical and inhaled preparations) or have received such therapy within 2 weeks immediately prior to screening.
  17. Patients have used any prescription drug to promote weight loss within 3 months prior to screening.
  18. Patients have any other condition (including known drug or alcohol abuse or psychiatric disorder) that precludes them from following and completing the protocol, in the opinion of the investigator.
  19. Patients fail to satisfy the investigator of suitability to participate for any other reason.

Sites / Locations

  • Department of Medicine I; University Hospital St. Josef-Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Exenatide

Placebo

Arm Description

Drug (including placebo)

Outcomes

Primary Outcome Measures

histological activity of NASH (steatosis, necroinflammation, ballooning)

Secondary Outcome Measures

Liver fibrosis, as determined using the fibrosis score

Full Information

First Posted
September 23, 2010
Last Updated
September 23, 2010
Sponsor
Ruhr University of Bochum
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1. Study Identification

Unique Protocol Identification Number
NCT01208649
Brief Title
Effects of Exenatide (Byetta®) on Liver Function in Patients With Nonalcoholic Steatohepatitis (NASH)
Official Title
Effects of Exenatide (Byetta®) on Biochemical and Histological Parameters of Liver Function in Patients With Nonalcoholic Steatohepatitis (NASH)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2010
Overall Recruitment Status
Completed
Study Start Date
July 2008 (undefined)
Primary Completion Date
September 2010 (Actual)
Study Completion Date
September 2010 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Ruhr University of Bochum

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective is to test the hypothesis that 24 weeks of treatment with exenatide will improve the histological acitvity of NASH (steatosis,necroinflammation, ballooning), summarized in the recently introduced NASH-score in patients with normal, impaired or diabetic glucose tolerance compared to dietary guidance alone.
Detailed Description
Non alcoholic steatohepatitis (NASH), a chronic liver disease characterized by insulin resistance, accumulation of hepatic fat and hepatocellular necroinflammation, has been recognized as a leading cause of (cryptogenic) liver cirrhosis in developed countries. Given the rising prevalence of NASH and the associated socio-economic burden associated, novel therapeutic options are warranted. The incretin mimetic Exenatide (Byetta®) exhibits strong glucoregulatory activities through its multiple biological effects. In addition, exenatide treatment has been shown to improve lipid homeostasis and reduce body weight. Since the development of NASH has been tightly linked to the presence of obesity, hyperlipidaemia and diabetes, this study will examine, whether 24 weeks of treatment with exenatide will also result in improvements in liver function in patients with NASH. 60 patients with histologically proven NASH will be randomized to receive either exenatide (2 x 5 µg s.c. for 4 weeks, 2 x 10 µg thereafter) or placebo treatment, in a 1:1 ratio. Liver biopsies will be performed after 24 weeks of treatment. In addition, a non-invasive assessment of hepatic mitochondrial function will be carried-out using a 13C-methionine breath test at baseline, and at weeks 12 and 24. Insulin sensitivity and glucose tolerance will be assessed by a hyperinsulinaemic-euglycaemic clamp (baseline and week 24) and an oral glucose tolerance test (baseline, weeks 12 and 24). Hepatic fat content will be measured by magnetic resonance tomography. Liver enzymes will be monitored closely throughout the study period. These studies will clarify whether exenatide treatment, in addition to its beneficial effects on glucose homeostasis and body weight, will also result in improvements of liver function in patients with NASH.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nonalcoholic Fatty Liver Disease
Keywords
exenatide, hepatic steatosis, insulin resistance, insulin sensitizers, nonalcoholic fatty liver disease, - GLP1-Analog

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
13 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Exenatide
Arm Type
Active Comparator
Arm Description
Drug (including placebo)
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Exenatide
Intervention Description
Exenatide; 48 weeks 10 microg injection s.c., twice daily, before the morning and evening meal with a four week wash-in phase with 5 microg injection s.c.twice daily
Primary Outcome Measure Information:
Title
histological activity of NASH (steatosis, necroinflammation, ballooning)
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Liver fibrosis, as determined using the fibrosis score
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age between 18 and 75 years, inclusive. Patients present with histologically proven non-alcoholic steatohepatitis ascertained by the single center pathologist between visit 1 and 2 First liver biopsy was obtained not later than 6 months before visit 1 Patients have HbA1c not exceeding 10.0%. Patients have a history of stable body weight (not varying by >10% for at least 3 months prior to screening Exclusion Criteria: Patients are investigator site personnel directly affiliated with the study, or are immediate family of investigator site personnel directly affiliated with the study. Immediate family is defined as a spouse, parent, child, or sibling, whether biological or legally adopted. Females of childbearing potential who are pregnant, breast-feeding or intend to become pregnant or are not using adequate contraceptive methods (adequate contraceptive measures include sterilisation, hormonal intrauterine devices, oral contraceptives, sexual abstinence or vasectomised partner). A male subject who is sexually active and has not been surgically sterilised must be informed that he must either use a condom during intercourse, ensure that his partner practices contraception, or he must refrain from sexual intercourse during the trial and until 1 month after completion of the trial. This is to prevent the possibility of a pregnancy from spermatocytes that can potentially be damaged by trial medication. It is strongly recommended that the female partners use a highly effective contraception (Pearl Index < 1%). Patients have participated in an interventional medical, surgical, or pharmaceutical study (a study in which an experimental, drug, medical, or surgical treatment was given) within 30 days prior to screening. This criterion includes drugs that have not received regulatory approval for any indication at the time of study entry. Patients with evidence of viral or autoimmune hepatitis (positive testing for HBsAG, anti-HCV or anti-HIV, pos. AMA-screen, ANA-titer > 1:160) Patients with inherited liver diseases (e.g. Wilson's disease, Hemochromatosis) Patients have alcohol consumption (>20 g daily for males and >10 g daily for females) Patients have decompensated liver cirrhosis (Child-Pugh score >7) Patients have alanine aminotransaminase (ALT) greater than ten times the upper limit of the reference range. Patients have had greater than three episodes of severe hypoglycemia within 6 months prior to screening. Patients are undergoing therapy for a malignancy, other than basal cell or squamous cell skin cancer. Patients have cardiac disease that is Class III or IV, according to the New York Heart Association criteria. Patients have a known allergy or hypersensitivity to exenatide, or excipients contained in these agents. Patients have or had concomitant medication with thiazolidinediones. Patients have a history of renal transplantation or are currently receiving renal dialysis or have serum creatinine >1.8 mg/dL for males and greater than or equal to >1.5 mg/dL for females. Patients have known hemoglobinopathy or chronic anemia Patients are receiving chronic (lasting longer than 2 weeks) systemic glucocorticoid therapy (excluding topical and inhaled preparations) or have received such therapy within 2 weeks immediately prior to screening. Patients have used any prescription drug to promote weight loss within 3 months prior to screening. Patients have any other condition (including known drug or alcohol abuse or psychiatric disorder) that precludes them from following and completing the protocol, in the opinion of the investigator. Patients fail to satisfy the investigator of suitability to participate for any other reason.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wolfgang E. Schmidt, Prof. Dr.
Organizational Affiliation
Ruhr-University Bochum
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Wolfgang E. Schmidt, Prof. Dr.
Organizational Affiliation
Ruhr-University Bochum
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Medicine I; University Hospital St. Josef-Hospital
City
Bochum
ZIP/Postal Code
44791
Country
Germany

12. IPD Sharing Statement

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Effects of Exenatide (Byetta®) on Liver Function in Patients With Nonalcoholic Steatohepatitis (NASH)

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