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Open Label Study to Evaluate Efficacy and Long Term Safety of LUM001 (Maralixibat) in the Treatment of Cholestatic Liver Disease in Patients With Progressive Familial Intrahepatic Cholestasis (INDIGO)

Primary Purpose

Progressive Familial Intrahepatic Cholestasis (PFIC)

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
LUM001 (Maralixibat)
Sponsored by
Mirum Pharmaceuticals, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Progressive Familial Intrahepatic Cholestasis (PFIC) focused on measuring Bile duct diseases, Intrahepatic Cholestasis, Cholestasis, PFIC, Pruritus, Cholestatic Liver Disease

Eligibility Criteria

12 Months - 18 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria 1. Male or female subjects between the ages of 12 months and 18 years inclusive. 2. Diagnosis of PFIC based on: Intrahepatic cholestasis manifest by total serum bile acid >3x upper limit of normal (ULN) for age and, b or c: Two documented mutant alleles in ATP8B1, or ABCB11. Evidence of chronic liver disease, excluding those listed in (see Section 16.3), with one or more of the following criteria: Duration of biochemical or clinical abnormalities of >6 months, or Pathologic evidence of progressive liver disease, or Sibling of known individual affected by PFIC (predicted to be chronic). 3. GGTP <100 IU/L at screening. 4. Females of childbearing potential must have a negative urine or serum pregnancy test [β human chorionic gonadotropin (β-hCG)] during screening and a negative urine pregnancy test at the Baseline (Day 0) visit. 5. Males and females of child-bearing potential who are sexually active, or are not currently sexually active during the study, but become sexually active during the period of the study and 30 days following the last dose of study drug, must agree and use acceptable contraception during the trial, as described in Section 8.7.1. of the protocol 6. Informed consent and assent (per IRB/EC) as appropriate. 7. Access to phone for scheduled calls from study site. 8. Caregivers and children above the age of assent must have the ability to read and understand one of the following languages: English, Spanish, US Spanish, French, German or Polish. 9. Subjects expected to have a consistent caregiver(s) for the duration of the first 13 weeks of the study. 10. Caregivers (and age appropriate subjects) must be willing and able to use an eDiary device as required by the study. To accommodate potential cultural restrictions within the FIC1 affected population a paper version of the ItchRO diary will be made available. 11. Caregivers (and age appropriate subjects) using the eDiary must digitally accept the licensing agreement in the eDiary software at the outset of the study. 12. Caregivers (and age appropriate subjects) must complete at least 10 eDiary reports (morning or evening) during each of two consecutive weeks of the screening period, prior to assignment (maximum possible reports = 14 per week). Subjects using a paper diary must complete the same number of reports within the same timeframe Exclusion Criteria Chronic diarrhea requiring specific intravenous fluid or nutritional intervention for the diarrhea and/or its sequelae. Surgical disruption of the enterohepatic circulation at the time at screening. Subjects who have undergone reversal of a prior surgical procedure intended to disrupt enterohepatic circulation and who and have a permanently restored flow of bile acids from the liver to the terminal ileum may be eligible for the study upon consultation with the Medical Monitor. Liver transplant. Decompensated cirrhosis [international normalized ratio (INR) > 1.5, albumin < 30 g/L, history or presence of clinically significant ascites, variceal hemorrhage, and/or encephalopathy]. ALT >15×ULN at screening. History or presence of other liver disease (see Section 16.3). History or presence of any other disease or condition known to interfere with the absorption, distribution, metabolism or excretion of drugs, including bile salt metabolism in the intestine (e.g., inflammatory bowel disease). Liver mass on imaging. Known diagnosis of human immunodeficiency virus (HIV) infection. Cancers except for in situ carcinoma, or cancers treated at least 5 years prior to screening with no evidence of recurrence. Any female who is pregnant or lactating or who is planning to become pregnant within 20 weeks of assignment. Any known history of alcohol or substance abuse. Administration of bile acid or lipid binding resins within 30 days prior to Baseline / Day 0 and throughout the trial. Administration of sodium phenylbutyrate within 30 days prior to Baseline / Day 0 and throughout the trial. Investigational drug, biologic, or medical device within 30 days prior to screening, or 5 half-lives of the study agent, whichever is longer. History of non-adherence to medical regimens, unreliability, mental instability or incompetence that could compromise the validity of informed consent or lead to non-adherence with the study protocol based on Investigator judgment. Any other conditions or abnormalities which, in the opinion of the Investigator or Medical monitor, may compromise the safety of the subject, or interfere with the subject participating in or completing the study

Sites / Locations

  • Children's Hospital Los Angeles
  • Children's Hospital Colorado
  • Cincinnati Children's Hospital Medical Center
  • The Children's Hospital of Philadelphia
  • Children's Hospital of Pittsburgh of UPMC
  • Hopital Femme Mere Enfant De Lyon
  • The Children's Memorial Health Institute
  • Birmingham Children's Hospital
  • Leeds Teaching Hospital NHS Trust
  • Kings College Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

LUM001 (Maralixibat)

Arm Description

Participants will receive LUM001, also known as Maralixibat (MRX) twice a day (BID).

Outcomes

Primary Outcome Measures

Change From Baseline to Endpoint (Week 13) in Fasting sBA Level

Secondary Outcome Measures

Change From Baseline to Week 13/ET in Pruritus as Measured by ItchRO(Obs)
This secondary efficacy endpoint is the change from baseline to Week 13 in pruritus as measured by ItchRO(Obs) weekly average morning score. ItchRO scores range from 0 to 4; the higher score indicates increasing itch severity (0 = none; 4 = very severe).
Change From Baseline to Week 13/ET in Pruritus as Measured by ItchRO(Pt)
This secondary efficacy endpoint is the change from baseline to Week 13 in pruritus as measured by ItchRO(Pt) weekly average morning score. ItchRO scores range from 0 to 4; the higher score indicates increasing itch severity (0 = none; 4 = very severe).
Change From Baseline to Week 13/ET in ALT
Change From Baseline to Week 13/ET in Total Bilirubin
Change From Baseline to Week 13/ET in Direct Bilirubin

Full Information

First Posted
February 5, 2014
Last Updated
October 18, 2023
Sponsor
Mirum Pharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02057718
Brief Title
Open Label Study to Evaluate Efficacy and Long Term Safety of LUM001 (Maralixibat) in the Treatment of Cholestatic Liver Disease in Patients With Progressive Familial Intrahepatic Cholestasis
Acronym
INDIGO
Official Title
Open Label Study of the Efficacy and Long Term Safety of LUM001 (Maralixibat), an Apical Sodium-Dependent Bile Acid Transporter Inhibitor (ASBTi), in the Treatment of Cholestatic Liver Disease in Pediatric Patients With Progressive Familial Intrahepatic Cholestasis
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
March 1, 2014 (Actual)
Primary Completion Date
May 8, 2020 (Actual)
Study Completion Date
May 8, 2020 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is an open label study in children with Progressive Familial Intrahepatic Cholestasis (PFIC) designed to evaluate the safety and efficacy of LUM001, also known as Maralixibat (MRX). Efficacy will be assessed by evaluating the effect of LUM001 on pruritus and the biochemical markers of pruritus associated with PFIC.
Detailed Description
The study is divided into 5 parts: a 4-week dose escalation period, a 4-week stable dosing period, a 5-week stable dosing period, a 59-week long-term exposure period, and an optional follow-up treatment period for eligible participants who continue treatment with LUM001. Participants in the optional follow-up treatment period will continue to receive study drug until they are eligible to enter another LUM001 study or until LUM001 is available commercially, whichever occurs first.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Progressive Familial Intrahepatic Cholestasis (PFIC)
Keywords
Bile duct diseases, Intrahepatic Cholestasis, Cholestasis, PFIC, Pruritus, Cholestatic Liver Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
33 (Actual)

8. Arms, Groups, and Interventions

Arm Title
LUM001 (Maralixibat)
Arm Type
Experimental
Arm Description
Participants will receive LUM001, also known as Maralixibat (MRX) twice a day (BID).
Intervention Type
Drug
Intervention Name(s)
LUM001 (Maralixibat)
Intervention Description
LUM001 also known as Maralixibat (MRX) oral dose up to twice a day (BID).
Primary Outcome Measure Information:
Title
Change From Baseline to Endpoint (Week 13) in Fasting sBA Level
Time Frame
Baseline (Day 0) to Week 13
Secondary Outcome Measure Information:
Title
Change From Baseline to Week 13/ET in Pruritus as Measured by ItchRO(Obs)
Description
This secondary efficacy endpoint is the change from baseline to Week 13 in pruritus as measured by ItchRO(Obs) weekly average morning score. ItchRO scores range from 0 to 4; the higher score indicates increasing itch severity (0 = none; 4 = very severe).
Time Frame
Baseline (Day 0) to Week 13
Title
Change From Baseline to Week 13/ET in Pruritus as Measured by ItchRO(Pt)
Description
This secondary efficacy endpoint is the change from baseline to Week 13 in pruritus as measured by ItchRO(Pt) weekly average morning score. ItchRO scores range from 0 to 4; the higher score indicates increasing itch severity (0 = none; 4 = very severe).
Time Frame
Baseline (Day 0) to Week 13
Title
Change From Baseline to Week 13/ET in ALT
Time Frame
Baseline (Day 0) to Week 13
Title
Change From Baseline to Week 13/ET in Total Bilirubin
Time Frame
Baseline (Day 0) to Week 13
Title
Change From Baseline to Week 13/ET in Direct Bilirubin
Time Frame
Baseline (Day 0) to Week 13

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Months
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria 1. Male or female subjects between the ages of 12 months and 18 years inclusive. 2. Diagnosis of PFIC based on: Intrahepatic cholestasis manifest by total serum bile acid >3x upper limit of normal (ULN) for age and, b or c: Two documented mutant alleles in ATP8B1, or ABCB11. Evidence of chronic liver disease, excluding those listed in (see Section 16.3), with one or more of the following criteria: Duration of biochemical or clinical abnormalities of >6 months, or Pathologic evidence of progressive liver disease, or Sibling of known individual affected by PFIC (predicted to be chronic). 3. GGTP <100 IU/L at screening. 4. Females of childbearing potential must have a negative urine or serum pregnancy test [β human chorionic gonadotropin (β-hCG)] during screening and a negative urine pregnancy test at the Baseline (Day 0) visit. 5. Males and females of child-bearing potential who are sexually active, or are not currently sexually active during the study, but become sexually active during the period of the study and 30 days following the last dose of study drug, must agree and use acceptable contraception during the trial, as described in Section 8.7.1. of the protocol 6. Informed consent and assent (per IRB/EC) as appropriate. 7. Access to phone for scheduled calls from study site. 8. Caregivers and children above the age of assent must have the ability to read and understand one of the following languages: English, Spanish, US Spanish, French, German or Polish. 9. Subjects expected to have a consistent caregiver(s) for the duration of the first 13 weeks of the study. 10. Caregivers (and age appropriate subjects) must be willing and able to use an eDiary device as required by the study. To accommodate potential cultural restrictions within the FIC1 affected population a paper version of the ItchRO diary will be made available. 11. Caregivers (and age appropriate subjects) using the eDiary must digitally accept the licensing agreement in the eDiary software at the outset of the study. 12. Caregivers (and age appropriate subjects) must complete at least 10 eDiary reports (morning or evening) during each of two consecutive weeks of the screening period, prior to assignment (maximum possible reports = 14 per week). Subjects using a paper diary must complete the same number of reports within the same timeframe Exclusion Criteria Chronic diarrhea requiring specific intravenous fluid or nutritional intervention for the diarrhea and/or its sequelae. Surgical disruption of the enterohepatic circulation at the time at screening. Subjects who have undergone reversal of a prior surgical procedure intended to disrupt enterohepatic circulation and who and have a permanently restored flow of bile acids from the liver to the terminal ileum may be eligible for the study upon consultation with the Medical Monitor. Liver transplant. Decompensated cirrhosis [international normalized ratio (INR) > 1.5, albumin < 30 g/L, history or presence of clinically significant ascites, variceal hemorrhage, and/or encephalopathy]. ALT >15×ULN at screening. History or presence of other liver disease (see Section 16.3). History or presence of any other disease or condition known to interfere with the absorption, distribution, metabolism or excretion of drugs, including bile salt metabolism in the intestine (e.g., inflammatory bowel disease). Liver mass on imaging. Known diagnosis of human immunodeficiency virus (HIV) infection. Cancers except for in situ carcinoma, or cancers treated at least 5 years prior to screening with no evidence of recurrence. Any female who is pregnant or lactating or who is planning to become pregnant within 20 weeks of assignment. Any known history of alcohol or substance abuse. Administration of bile acid or lipid binding resins within 30 days prior to Baseline / Day 0 and throughout the trial. Administration of sodium phenylbutyrate within 30 days prior to Baseline / Day 0 and throughout the trial. Investigational drug, biologic, or medical device within 30 days prior to screening, or 5 half-lives of the study agent, whichever is longer. History of non-adherence to medical regimens, unreliability, mental instability or incompetence that could compromise the validity of informed consent or lead to non-adherence with the study protocol based on Investigator judgment. Any other conditions or abnormalities which, in the opinion of the Investigator or Medical monitor, may compromise the safety of the subject, or interfere with the subject participating in or completing the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Study Director
Organizational Affiliation
Mirum
Official's Role
Study Director
Facility Information:
Facility Name
Children's Hospital Los Angeles
City
Los Angeles
State/Province
California
ZIP/Postal Code
90027
Country
United States
Facility Name
Children's Hospital Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Facility Name
The Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Children's Hospital of Pittsburgh of UPMC
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Facility Name
Hopital Femme Mere Enfant De Lyon
City
Bron
ZIP/Postal Code
69677
Country
France
Facility Name
The Children's Memorial Health Institute
City
Warsaw
ZIP/Postal Code
04-730
Country
Poland
Facility Name
Birmingham Children's Hospital
City
Birmingham
State/Province
West Midlands
ZIP/Postal Code
B4 6NH
Country
United Kingdom
Facility Name
Leeds Teaching Hospital NHS Trust
City
Leeds
ZIP/Postal Code
LS1 3EX
Country
United Kingdom
Facility Name
Kings College Hospital
City
London
ZIP/Postal Code
SE5 9RS
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35507739
Citation
Loomes KM, Squires RH, Kelly D, Rajwal S, Soufi N, Lachaux A, Jankowska I, Mack C, Setchell KDR, Karthikeyan P, Kennedy C, Dorenbaum A, Desai NK, Garner W, Jaecklin T, Vig P, Miethke A, Thompson RJ. Maralixibat for the treatment of PFIC: Long-term, IBAT inhibition in an open-label, Phase 2 study. Hepatol Commun. 2022 Sep;6(9):2379-2390. doi: 10.1002/hep4.1980. Epub 2022 May 4.
Results Reference
derived

Learn more about this trial

Open Label Study to Evaluate Efficacy and Long Term Safety of LUM001 (Maralixibat) in the Treatment of Cholestatic Liver Disease in Patients With Progressive Familial Intrahepatic Cholestasis

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