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A Study of IDN-6556 in Cirrhotic Subjects With Portal Hypertension (PH)

Primary Purpose

Liver Cirrhosis, Hepatic Cirrhosis, Portal Hypertension

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
IDN-6556
Sponsored by
Conatus Pharmaceuticals Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Liver Cirrhosis focused on measuring Liver Cirrhosis, Hepatic Cirrhosis, Portal Hypertension

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female subjects of minimum adult legal age (according to local laws for signing the informed consent document), able to provide written informed consent, and able to understand and willing to comply with the requirements of the study
  • Clinical, radiological, or biochemical evidence of liver cirrhosis
  • Evidence of portal hypertension as evidenced by any of the following:

    1. Splenomegaly, on imaging and/or clinical evaluation, with platelet count of <120,000 at study entry, or
    2. Presence of small sized varices on screening endoscopy and/or collateral circulation on imaging, or
    3. Presence of medium/large varices that have never bled and have been obliterated with endoscopic ligation
  • Portal hypertension defined as a hepatic venous pressure gradient (HVPG) >5 mmHg at Screening
  • Willingness to utilize two reliable forms of contraception (for both males and females of childbearing potential) from Screening to one month after the last dose of study drug.

Exclusion Criteria:

  • Decompensated cirrhosis as defined by the presence of overt ascites (requiring diuretics), overt encephalopathy (requiring specific therapy), or history of variceal hemorrhage.
  • Known infection with HIV
  • Hepatic failure defined as total bilirubin ≥12 mg/dL
  • Other non-liver organ failure, including:

    1. Renal failure defined as creatinine ≥ 2.0 mg/dL
    2. Cerebral failure defined as hepatic encephalopathy grade III or IV
    3. Coagulation failure defined as INR ≥ 2.5 or platelets ≤ 20x109/L
    4. Hemodynamic requirement for inotropic support
  • Child-Pugh score of 10-15 (Child-Pugh C classification)
  • Use of vasoactive drugs (at or within 3 months of Screening) that may impair hepatic blood flow; examples include but are not limited to:

    1. β-blockers, including carvedilol
    2. Nitrates
    3. Vasopressin (or analogues)
    4. Phosphodiesterase inhibitors (prescribed daily for pulmonary hypertension; p.r.n. use for erectile dysfunction is permitted)
  • Change in dose or regimen within 3 months of Screening of:

    1. Fibrates or statins
    2. Angiotensin II receptor antagonist or angiotensin converting enzyme (ACE) inhibitor
  • Use of the following drugs within 2 months of Screening:

    1. Systemic corticosteroids
    2. Pentoxifylline
    3. Known or suspected use of illicit drugs or drugs of abuse (allowed if medically prescribed or indicated)
  • Concomitant pancreatitis
  • Evidence of portal vein thrombosis on Doppler ultrasound of the portal vasculature
  • Active inflammatory bowel disease
  • Diagnosed or suspected systemic lupus erythematosus (SLE) and/or rheumatoid arthritis (RA)
  • Autoimmune hepatitis
  • Hepatitis C Virus (HCV) infected subjects receiving or planning on receiving anti-viral therapy during the course of the study
  • Hepatitis B Virus (HBV) infected subjects who have been on stable anti-HBV therapy for less than 3 months
  • Hepatocellular carcinoma (HCC) at entry into the study
  • Active non-liver malignancies other than curatively treated skin cancer (basal cell or squamous cell carcinomas)
  • History or presence of clinically concerning cardiac arrhythmias, or prolongation of screening (pre-treatment) QT or QTc interval of >480 milliseconds (msec)
  • Significant systemic or major illness other than liver disease, including coronary artery disease, cerebrovascular disease, pulmonary disease, renal failure, serious psychiatric disease, that, in the opinion of the Investigator would preclude the subject from participating in and completing the study
  • Any subject that has received any investigational drug or device within 30 days of dosing or who is scheduled to receive another investigational drug or device in the course of the study
  • If female, known pregnancy, or has a positive urine or serum pregnancy test, or lactating/breastfeeding.

Sites / Locations

  • VA Connecticut Healthcare System
  • Johns Hopkins Sibley Memorial Hospital
  • University of Miami
  • Johns Hopkins Hospital
  • University of Mississippi Medical Center
  • Rutgers New Jersey Medical School
  • North Shore University Hospital
  • New York University Lagone Medical Center
  • University of Pennsylvania
  • Albert Einstein Medical Center
  • St. Luke's Health Baylor College of Medicine
  • University of Texas Health Science Center at Houston
  • University of Utah Hospital
  • Bon Secours Mary Immaculate Hospital
  • Bon Secours St. Mary's Hospital
  • McGuire DVAMC

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

IDN-6556 - Overall population

IDN-6556 - Subgroup with Baseline HVPG < 12 mmHg

IDN-6556 - Subgroup Baseline HVPG ≥ 12 mmHg

Arm Description

Overall evaluable population treated with IDN-6556 25 mg twice daily

Subgroup for patients with Baseline HVPG < 12 mmHg that have been treated with IDN-6556 25 mg twice daily

Subgroup for patients with Baseline HVPG ≥ 12 mmHg that have been treated with IDN-6556 25 mg twice daily

Outcomes

Primary Outcome Measures

Hepatic Venous Pressure Gradient (HVPG)
Mean change of HVPG [mmHg] from Baseline to Day 28/EOT (end of treatment) for IDN-6556
cCK18/M30
Absolute Mean Change of caspase-cleaved cytokeratin serum levels (cCK18/M30); the statistical analysis is based on the mean change in log-transformed cCK18/M30 from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Change in cCK18/M30
Median change of caspase-cleaved cytokeratin serum levels (cCK18/M30) from Baseline to Day 28/EOT (end of treatment) for IDN-6556

Secondary Outcome Measures

Change in Alanine Aminotransferase (ALT)
Median change of ALT from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Change in Aspartate Aminotransferase (AST)
Median change of AST from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Concentration of Caspase 3/7 RLU
Median change of concentration of Caspase 3/7 Relative Light Units from Baseline to Day 28/EOT (end of treatment) for IDN-6556

Full Information

First Posted
August 28, 2014
Last Updated
October 28, 2016
Sponsor
Conatus Pharmaceuticals Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02230683
Brief Title
A Study of IDN-6556 in Cirrhotic Subjects With Portal Hypertension
Acronym
PH
Official Title
An Open-Label Pilot Trial to Evaluate the Safety, Tolerability and Efficacy of IDN-6556 in Cirrhotic Subjects With Portal Hypertension
Study Type
Interventional

2. Study Status

Record Verification Date
October 2016
Overall Recruitment Status
Completed
Study Start Date
August 2014 (undefined)
Primary Completion Date
May 2015 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Conatus Pharmaceuticals Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is an open-label pilot study to evaluate the safety, tolerability, and efficacy of IDN-6556 in treating portal hypertension in subjects with liver cirrhosis.
Detailed Description
Studies in patients with liver disease have demonstrated that cCK18 is elevated in the serum of patients and has been associated with disease severity. Studies have also shown that cCK18 is generally elevated to a higher degree in cirrhosis than in other liver diseases. In addition, increasing stages of cirrhosis from Child-Pugh A, Child-Pugh B to Child-Pugh C are associated with progressively higher levels of caspase cleaved cytokeratin 18. This suggests that apoptosis and caspase activity are associated with the severity of disease. IDN-6556 and its ability to inhibit inflammation and apoptosis may have a beneficial impact on both the dynamic and structural components associated with the pathogenesis of portal hypertension in cirrhosis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Liver Cirrhosis, Hepatic Cirrhosis, Portal Hypertension
Keywords
Liver Cirrhosis, Hepatic Cirrhosis, Portal Hypertension

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
23 (Actual)

8. Arms, Groups, and Interventions

Arm Title
IDN-6556 - Overall population
Arm Type
Experimental
Arm Description
Overall evaluable population treated with IDN-6556 25 mg twice daily
Arm Title
IDN-6556 - Subgroup with Baseline HVPG < 12 mmHg
Arm Type
Experimental
Arm Description
Subgroup for patients with Baseline HVPG < 12 mmHg that have been treated with IDN-6556 25 mg twice daily
Arm Title
IDN-6556 - Subgroup Baseline HVPG ≥ 12 mmHg
Arm Type
Experimental
Arm Description
Subgroup for patients with Baseline HVPG ≥ 12 mmHg that have been treated with IDN-6556 25 mg twice daily
Intervention Type
Drug
Intervention Name(s)
IDN-6556
Other Intervention Name(s)
emricasan, PF-013491390
Intervention Description
25 mg BID
Primary Outcome Measure Information:
Title
Hepatic Venous Pressure Gradient (HVPG)
Description
Mean change of HVPG [mmHg] from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Time Frame
Baseline to Day 28/EOT (end of treatment)
Title
cCK18/M30
Description
Absolute Mean Change of caspase-cleaved cytokeratin serum levels (cCK18/M30); the statistical analysis is based on the mean change in log-transformed cCK18/M30 from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Time Frame
Change from Baseline to Day 28/EOT
Title
Change in cCK18/M30
Description
Median change of caspase-cleaved cytokeratin serum levels (cCK18/M30) from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Time Frame
Baseline to Day 28/EOT (end of treatment)
Secondary Outcome Measure Information:
Title
Change in Alanine Aminotransferase (ALT)
Description
Median change of ALT from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Time Frame
Baseline to 28 days/EOT
Title
Change in Aspartate Aminotransferase (AST)
Description
Median change of AST from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Time Frame
Baseline to 28 days/EOT
Title
Concentration of Caspase 3/7 RLU
Description
Median change of concentration of Caspase 3/7 Relative Light Units from Baseline to Day 28/EOT (end of treatment) for IDN-6556
Time Frame
Baseline to 28 days/EOT

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects of minimum adult legal age (according to local laws for signing the informed consent document), able to provide written informed consent, and able to understand and willing to comply with the requirements of the study Clinical, radiological, or biochemical evidence of liver cirrhosis Evidence of portal hypertension as evidenced by any of the following: Splenomegaly, on imaging and/or clinical evaluation, with platelet count of <120,000 at study entry, or Presence of small sized varices on screening endoscopy and/or collateral circulation on imaging, or Presence of medium/large varices that have never bled and have been obliterated with endoscopic ligation Portal hypertension defined as a hepatic venous pressure gradient (HVPG) >5 mmHg at Screening Willingness to utilize two reliable forms of contraception (for both males and females of childbearing potential) from Screening to one month after the last dose of study drug. Exclusion Criteria: Decompensated cirrhosis as defined by the presence of overt ascites (requiring diuretics), overt encephalopathy (requiring specific therapy), or history of variceal hemorrhage. Known infection with HIV Hepatic failure defined as total bilirubin ≥12 mg/dL Other non-liver organ failure, including: Renal failure defined as creatinine ≥ 2.0 mg/dL Cerebral failure defined as hepatic encephalopathy grade III or IV Coagulation failure defined as INR ≥ 2.5 or platelets ≤ 20x109/L Hemodynamic requirement for inotropic support Child-Pugh score of 10-15 (Child-Pugh C classification) Use of vasoactive drugs (at or within 3 months of Screening) that may impair hepatic blood flow; examples include but are not limited to: β-blockers, including carvedilol Nitrates Vasopressin (or analogues) Phosphodiesterase inhibitors (prescribed daily for pulmonary hypertension; p.r.n. use for erectile dysfunction is permitted) Change in dose or regimen within 3 months of Screening of: Fibrates or statins Angiotensin II receptor antagonist or angiotensin converting enzyme (ACE) inhibitor Use of the following drugs within 2 months of Screening: Systemic corticosteroids Pentoxifylline Known or suspected use of illicit drugs or drugs of abuse (allowed if medically prescribed or indicated) Concomitant pancreatitis Evidence of portal vein thrombosis on Doppler ultrasound of the portal vasculature Active inflammatory bowel disease Diagnosed or suspected systemic lupus erythematosus (SLE) and/or rheumatoid arthritis (RA) Autoimmune hepatitis Hepatitis C Virus (HCV) infected subjects receiving or planning on receiving anti-viral therapy during the course of the study Hepatitis B Virus (HBV) infected subjects who have been on stable anti-HBV therapy for less than 3 months Hepatocellular carcinoma (HCC) at entry into the study Active non-liver malignancies other than curatively treated skin cancer (basal cell or squamous cell carcinomas) History or presence of clinically concerning cardiac arrhythmias, or prolongation of screening (pre-treatment) QT or QTc interval of >480 milliseconds (msec) Significant systemic or major illness other than liver disease, including coronary artery disease, cerebrovascular disease, pulmonary disease, renal failure, serious psychiatric disease, that, in the opinion of the Investigator would preclude the subject from participating in and completing the study Any subject that has received any investigational drug or device within 30 days of dosing or who is scheduled to receive another investigational drug or device in the course of the study If female, known pregnancy, or has a positive urine or serum pregnancy test, or lactating/breastfeeding.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Hagerty, MD
Organizational Affiliation
Conatus Pharmaceuticals
Official's Role
Study Chair
Facility Information:
Facility Name
VA Connecticut Healthcare System
City
West Haven
State/Province
Connecticut
ZIP/Postal Code
06516
Country
United States
Facility Name
Johns Hopkins Sibley Memorial Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20016
Country
United States
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Johns Hopkins Hospital
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
University of Mississippi Medical Center
City
Jackson
State/Province
Mississippi
ZIP/Postal Code
39216
Country
United States
Facility Name
Rutgers New Jersey Medical School
City
Newark
State/Province
New Jersey
ZIP/Postal Code
07103
Country
United States
Facility Name
North Shore University Hospital
City
Manhasset
State/Province
New York
ZIP/Postal Code
11030
Country
United States
Facility Name
New York University Lagone Medical Center
City
NYC
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Albert Einstein Medical Center
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19141
Country
United States
Facility Name
St. Luke's Health Baylor College of Medicine
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
University of Texas Health Science Center at Houston
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
University of Utah Hospital
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Facility Name
Bon Secours Mary Immaculate Hospital
City
Newport News
State/Province
Virginia
ZIP/Postal Code
23602
Country
United States
Facility Name
Bon Secours St. Mary's Hospital
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23226
Country
United States
Facility Name
McGuire DVAMC
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23249
Country
United States

12. IPD Sharing Statement

Learn more about this trial

A Study of IDN-6556 in Cirrhotic Subjects With Portal Hypertension

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