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Safety, Tolerability and Efficacy of Saroglitazar Mg 4 mg in Liver Transplant Recipients With NAFLD

Primary Purpose

Liver Transplant; Complications, NAFLD

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Saroglitazar
Sponsored by
Zydus Therapeutics Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Liver Transplant; Complications focused on measuring Peroxisome proliferator-activated receptors, NAFLD, NASH, Post Transplant Metabolic Syndrome

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Able and willing to give written informed consent.
  • Males or females, 18 to 75 years of age.
  • Patients who are at least 6 months post-transplant for nonalcoholic steatohepatitis (NASH) or cryptogenic cirrhosis thought to be secondary to NASH are eligible for enrolment.
  • The presence of NAFLD determined by MRI-PDFF prior to enrollment.
  • Patients with ≤20% variance in the levels of ALT, AST, ALP and total bilirubin between Visit 1 and Visit 1.1.
  • History of medical compliance with immunosuppression.
  • Female subjects of non-child bearing potential or on highly effective contraception. For male subjects with female partners of childbearing potential, willing to follow highly effective contraception measures during the study, either by the male participant or his female partner or both.

Exclusion Criteria:

  • Pregnant or lactating females.
  • Patient with abnormal transaminases due to secondary intercurrent illness.
  • Patients with bile duct strictures.
  • Other causes of chronic liver disease after liver transplantation including autoimmune, viral, and alcoholic liver disease.
  • Graft cirrhosis as defined by:

    1. Cirrhosis on historical liver biopsy.
    2. Evidence of cirrhosis on imaging including portal venous collaterals.
    3. Prior history of decompensated liver disease including ascites, hepatic encephalopathy or variceal bleeding.
    4. Evidence of esophageal varices on prior endoscopy.
  • Body mass index (BMI) <18 kg/m².
  • Subjects with change in body weight >5% in the 3 months prior to enrollment.
  • Subjects requiring corticosteroid or anticoagulation therapy.
  • History of myopathies or evidence of active muscle diseases.
  • Unstable cardiovascular disease.
  • History of bladder disease and/or hematuria or has current hematuria unless due to a urinary tract infection.
  • Active malignancy post-liver transplantation.
  • History of malignancy in the past 5 years and/or active neoplasm.
  • History of chronic rejection of liver transplant graft.
  • Acute cellular rejection of liver transplant graft within the past 6 months.
  • Evidence of Acute cellular rejection (ACR) or chronic rejection (CR) or alternative etiologies to NAFLD.
  • Poorly controlled diabetes as defined by an HbA1c >8.5% within the past 6 months.
  • History of excessive alcohol intake.
  • Subject tests positive for a urine drug screen.
  • Subject has a history of chronic (uncontrolled) pain.

Sites / Locations

  • Virginia Commonwealth University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Saroglitazar Magnesium 4 mg

Arm Description

Saroglitazar Magnesium tablet once daily in the morning 60 minutes before breakfast

Outcomes

Primary Outcome Measures

Number of participants with adverse events assessed by CTCAE
Safety measured by adverse events, vital signs, physical exams, body weight, electrocardiograms (ECGs) and lab results (including hematology, chemistry and urinalysis)

Secondary Outcome Measures

Hepatic fat
Changes in hepatic fat as determined by MRI-PDFF and MRE from baseline to end-of-treatment (EOT)
Metabolic flexibility
Changes in metabolic flexibility from baseline to EOT
Frequently sampled intravenous glucose tolerance test (Insulin resistance marker)
Changes in frequently sampled intravenous glucose tolerance test (FSIVGTT) from baseline to EOT
Glycosylated hemoglobin (Insulin resistance marker)
Changes in glycosylated hemoglobin (HbA1c) from baseline to EOT
Fructosamine (Insulin resistance marker)
Changes in fructosamine from baseline to EOT
Serum liver enzymes
Changes in serum liver enzymes from baseline to EOT
Serum lipids
Changes in serum lipids from baseline to EOT
Small dense low-density lipoprotein (Atherogenic lipoprotein)
Changes in small dense low-density lipoprotein (sdLDL) from baseline to EOT
LDL size and concentration (Atherogenic lipoprotein)
Changes in LDL size and concentration from baseline to EOT
Very low-density lipoprotein (Atherogenic lipoprotein)
Changes in subtypes of very low-density lipoprotein (VLDL) from baseline to EOT
High-density lipoprotein (Atherogenic lipoprotein)
Changes in high-density lipoprotein (HDL) from baseline to EOT
Quality of life (SF-36 Health Survey)
Change in Quality of life score from baseline to EOT
Peak plasma concentration [Cmax]
Pharmacokinetics of Saroglitazar following first and last dose
Time to reach peak plasma concentration [Tmax]
Pharmacokinetics of Saroglitazar following first and last dose
Area under plasma concentration vs. time curve till the last time point [AUC0-t]
Pharmacokinetics of Saroglitazar following first and last dose
Area under plasma concentration vs. time curve extrapolated to the infinity [AUC0-∞] after first dose
Pharmacokinetics of Saroglitazar following first dose
Area under plasma concentration vs. time curve in a 24 h dosing interval [AUCtau]
Pharmacokinetics of Saroglitazar following first and last dose
Elimination rate constant [λz]
Pharmacokinetics of Saroglitazar following first and last dose
Elimination half-life [t1/2]
Pharmacokinetics of Saroglitazar following first and last dose
Apparent volume of distribution [Vd/F]
Pharmacokinetics of Saroglitazar following first and last dose
Apparent clearance [CL/F]
Pharmacokinetics of Saroglitazar following first and last dose
Minimal or trough plasma concentration [Cmin] -for last dose only
Pharmacokinetics of Saroglitazar following last dose
Accumulation index calculated as a ratio of AUCtau (last dose)/AUCtau (first dose)
Pharmacokinetics of Saroglitazar following first and last dose
Fluctuation index
Pharmacokinetics of Saroglitazar following first and last dose

Full Information

First Posted
August 15, 2018
Last Updated
October 6, 2023
Sponsor
Zydus Therapeutics Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03639623
Brief Title
Safety, Tolerability and Efficacy of Saroglitazar Mg 4 mg in Liver Transplant Recipients With NAFLD
Official Title
A Phase 2A, Single Center, Open-label, Single-arm, 24-week Study to Evaluate the Safety, Tolerability and Efficacy of Saroglitazar Magnesium 4 mg in Liver Transplant Recipients With Nonalcoholic Fatty Liver Disease (EVIDENCES VIII)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
February 25, 2019 (Actual)
Primary Completion Date
December 13, 2021 (Actual)
Study Completion Date
December 13, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Zydus Therapeutics 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 a phase 2A, single center, open-label, single-arm, 24-week study to evaluate the safety, tolerability and efficacy of Saroglitazar Magnesium 4 mg in liver transplant recipients with NAFLD.
Detailed Description
This is a phase 2A, single center, open-label, single-arm, 24-week study to evaluate the safety, tolerability and efficacy of Saroglitazar Magnesium 4 mg in liver transplant recipients with NAFLD. The study will be conducted over a period of up to 33 weeks and will include 5 weeks screening, a 24 week treatment period and 4 week follow-up period. The primary end point of the study is to assess the safety of Saroglitazar Magnesium 4 mg in liver transplant recipients with NAFLD over 24 weeks of treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Liver Transplant; Complications, NAFLD
Keywords
Peroxisome proliferator-activated receptors, NAFLD, NASH, Post Transplant Metabolic Syndrome

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Saroglitazar Magnesium 4 mg
Arm Type
Experimental
Arm Description
Saroglitazar Magnesium tablet once daily in the morning 60 minutes before breakfast
Intervention Type
Drug
Intervention Name(s)
Saroglitazar
Other Intervention Name(s)
Not any
Intervention Description
Saroglitazar magnesium 4 mg tablet once daily (OD) in the morning 60 minutes before breakfast without food
Primary Outcome Measure Information:
Title
Number of participants with adverse events assessed by CTCAE
Description
Safety measured by adverse events, vital signs, physical exams, body weight, electrocardiograms (ECGs) and lab results (including hematology, chemistry and urinalysis)
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Hepatic fat
Description
Changes in hepatic fat as determined by MRI-PDFF and MRE from baseline to end-of-treatment (EOT)
Time Frame
24 weeks
Title
Metabolic flexibility
Description
Changes in metabolic flexibility from baseline to EOT
Time Frame
24 weeks
Title
Frequently sampled intravenous glucose tolerance test (Insulin resistance marker)
Description
Changes in frequently sampled intravenous glucose tolerance test (FSIVGTT) from baseline to EOT
Time Frame
24 weeks
Title
Glycosylated hemoglobin (Insulin resistance marker)
Description
Changes in glycosylated hemoglobin (HbA1c) from baseline to EOT
Time Frame
24 weeks
Title
Fructosamine (Insulin resistance marker)
Description
Changes in fructosamine from baseline to EOT
Time Frame
24 weeks
Title
Serum liver enzymes
Description
Changes in serum liver enzymes from baseline to EOT
Time Frame
24 weeks
Title
Serum lipids
Description
Changes in serum lipids from baseline to EOT
Time Frame
24 weeks
Title
Small dense low-density lipoprotein (Atherogenic lipoprotein)
Description
Changes in small dense low-density lipoprotein (sdLDL) from baseline to EOT
Time Frame
24 weeks
Title
LDL size and concentration (Atherogenic lipoprotein)
Description
Changes in LDL size and concentration from baseline to EOT
Time Frame
24 weeks
Title
Very low-density lipoprotein (Atherogenic lipoprotein)
Description
Changes in subtypes of very low-density lipoprotein (VLDL) from baseline to EOT
Time Frame
24 weeks
Title
High-density lipoprotein (Atherogenic lipoprotein)
Description
Changes in high-density lipoprotein (HDL) from baseline to EOT
Time Frame
24 weeks
Title
Quality of life (SF-36 Health Survey)
Description
Change in Quality of life score from baseline to EOT
Time Frame
24 weeks
Title
Peak plasma concentration [Cmax]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Time to reach peak plasma concentration [Tmax]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Area under plasma concentration vs. time curve till the last time point [AUC0-t]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Area under plasma concentration vs. time curve extrapolated to the infinity [AUC0-∞] after first dose
Description
Pharmacokinetics of Saroglitazar following first dose
Time Frame
24 weeks
Title
Area under plasma concentration vs. time curve in a 24 h dosing interval [AUCtau]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Elimination rate constant [λz]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Elimination half-life [t1/2]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Apparent volume of distribution [Vd/F]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Apparent clearance [CL/F]
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Minimal or trough plasma concentration [Cmin] -for last dose only
Description
Pharmacokinetics of Saroglitazar following last dose
Time Frame
24 weeks
Title
Accumulation index calculated as a ratio of AUCtau (last dose)/AUCtau (first dose)
Description
Pharmacokinetics of Saroglitazar following first and last dose
Time Frame
24 weeks
Title
Fluctuation index
Description
Pharmacokinetics of Saroglitazar following first and last dose
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
No
Eligibility Criteria
Inclusion Criteria: Able and willing to give written informed consent. Males or females, 18 to 75 years of age. Patients who are at least 6 months post-transplant for nonalcoholic steatohepatitis (NASH) or cryptogenic cirrhosis thought to be secondary to NASH are eligible for enrolment. The presence of NAFLD determined by MRI-PDFF prior to enrollment. Patients with ≤20% variance in the levels of ALT, AST, ALP and total bilirubin between Visit 1 and Visit 1.1. History of medical compliance with immunosuppression. Female subjects of non-child bearing potential or on highly effective contraception. For male subjects with female partners of childbearing potential, willing to follow highly effective contraception measures during the study, either by the male participant or his female partner or both. Exclusion Criteria: Pregnant or lactating females. Patient with abnormal transaminases due to secondary intercurrent illness. Patients with bile duct strictures. Other causes of chronic liver disease after liver transplantation including autoimmune, viral, and alcoholic liver disease. Graft cirrhosis as defined by: Cirrhosis on historical liver biopsy. Evidence of cirrhosis on imaging including portal venous collaterals. Prior history of decompensated liver disease including ascites, hepatic encephalopathy or variceal bleeding. Evidence of esophageal varices on prior endoscopy. Body mass index (BMI) <18 kg/m². Subjects with change in body weight >5% in the 3 months prior to enrollment. Subjects requiring corticosteroid or anticoagulation therapy. History of myopathies or evidence of active muscle diseases. Unstable cardiovascular disease. History of bladder disease and/or hematuria or has current hematuria unless due to a urinary tract infection. Active malignancy post-liver transplantation. History of malignancy in the past 5 years and/or active neoplasm. History of chronic rejection of liver transplant graft. Acute cellular rejection of liver transplant graft within the past 6 months. Evidence of Acute cellular rejection (ACR) or chronic rejection (CR) or alternative etiologies to NAFLD. Poorly controlled diabetes as defined by an HbA1c >8.5% within the past 6 months. History of excessive alcohol intake. Subject tests positive for a urine drug screen. Subject has a history of chronic (uncontrolled) pain.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Deven Parmar, MD FCP
Organizational Affiliation
Zydus Therapeutics Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Virginia Commonwealth University
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23298
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
28296807
Citation
Bhati C, Idowu MO, Sanyal AJ, Rivera M, Driscoll C, Stravitz RT, Kohli DR, Matherly S, Puri P, Gilles H, Cotterell A, Levy M, Sterling RK, Luketic VA, Lee H, Sharma A, Siddiqui MS. Long-term Outcomes in Patients Undergoing Liver Transplantation for Nonalcoholic Steatohepatitis-Related Cirrhosis. Transplantation. 2017 Aug;101(8):1867-1874. doi: 10.1097/TP.0000000000001709.
Results Reference
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Safety, Tolerability and Efficacy of Saroglitazar Mg 4 mg in Liver Transplant Recipients With NAFLD

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