A Study to Assess the Safety, Tolerability, Pharmacokinetics and Efficacy of EDP-305 in Subjects With Primary Biliary Cholangitis

Enanta Pharmaceuticals, Inc68 enrolled

Overview

A randomized, double-blind study to assess the safety, tolerability, PK and efficacy of EDP-305 in subjects with primary biliary cholangitis

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Primary Biliary Cholangitis

Interventions

EDP-305 1 mgDRUG

Two tablets daily for 12 weeks

EDP-305 2.5 mgDRUG

Two tablets daily for 12 weeks

PlaceboDRUG

Two tablets daily for 12 weeks

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * An informed consent document signed and dated by the subject. * Male and female subjects of any ethnic origin between the ages of 18 and 75 years, inclusive * Male or female with a diagnosis of PBC by at least two of the following criteria: * History of ALP above ULN for at least six months * Positive Anti-Mitochondrial Antibodies (AMA) titers (\>1/40 on immunofluorescence or M2 positive by enzyme linked immunosorbent assay (ELISA) or positive PBC-specific antinuclear antibodies) * For subjects with no documented liver biopsy performed within 2 years, subjects must undergo a transient elastography (Fibroscan) showing liver stiffness \< 14.0 kPA * Must be on a stable dose of UDCA12-20 mg/kg/day for at least 6 months prior to Screening or intolerant of UDCA in the opinion of the Investigator (no UDCA for at least 12 weeks prior to Screening) * Alkaline Phosphatase (ALP) ≥ 1.67 × ULN and/or total bilirubin \>ULN but \< 2×ULN (\<2.4 mg/dL) * Subjects must have Screening laboratory values for Hepatitis B surface antigen (HBsAg), anti-HCV antibodies and HCV RNA negative and Human Immunodeficiency Virus (HIV) 1 and 2 antibodies (Ab) as seronegative. Note: subjects previously infected by chronic hepatitis C and treated with direct acting antivirals (DAAs) with sustained virologic response (SVR) for at least 3 years will be allowed. * Female subjects of childbearing potential must agree to use two effective methods of contraception from the date of Screening until 90 days after the last dose of EDP-305. * All male participants who have not had a vasectomy must use effective contraception from Day -1 to 90 days after their last dose of study drug. * Male subjects must agree to refrain from sperm donation from the date of Screening until 90 days after their last dose of study drug * Screening body mass index (BMI) of ≥18 kg/m2 * Subject must be willing and able to adhere to the assessments, visit schedule, prohibitions and restrictions, as described in this protocol Exclusion Criteria: * Laboratory Screening Results: * AST \>5 x ULN * ALT \>5 x ULN * Patients with Gilbert's syndrome will not be allowed due to interpretability of bilirubin levels * Total white blood cells (WBC) \<3000 cells/mm3 * Absolute neutrophil count (ANC) \<1500 cells/mm3 * Platelet count \<140,000/mm3 * Prothrombin time (international normalized ratio, INR) \>1.2 * Serum creatinine \>2 mg/dL or creatinine clearance \<60 mL/min (based on Cockroft-Gault Method) * Suspected to have relevant nonalcoholic fatty liver disease (NAFLD) as based on the judgment of the Investigator at Screening * Use of immunosuppressants known to have an effect on the liver of patients with PBC (eg, colchicine, methotrexate, azathioprine, or systemic steroids) in the three months preceding screening * Current use of fibrates, including fenofibrates. Note: Subjects who discontinued fibrates for at least 3 months before Screening can participate * Use of an experimental treatment for PBC within the past 6 months * Co-existing liver or biliary diseases, such as primary sclerosing cholangitis, choledocholithiasis, acute or chronic hepatitis, autoimmune hepatitis, alcoholic liver disease, nonalcoholic steatohepatitis (NASH), acute infection of bile duct system or gall bladder, history of gastrointestinal bleeding (secondary to portal hypertension), cirrhosis, cholangiocarcinoma diagnosed or suspected liver cancers * Cirrhosis with or without complications, including history or presence of: spontaneous bacterial peritonitis, hepatocellular carcinoma * Hepatorenal syndrome (type I or II) or Screening serum creatinine \> 2 mg/dL (178 μmol/L) * Prior variceal hemorrhage, uncontrolled encephalopathy, Child-Pugh Class A, B and C, esophageal varices, or refractory ascites within the previous 6 months of Screening (defined as date informed consent signed) * Medical conditions that may cause nonhepatic increases in ALP (e.g., Paget's disease) * Use of a new statin regimen from Screening and throughout study duration. NOTE: Subjects on a stable dose of statins for at least 3 months prior to Screening are allowed. No dose modification during the study will be allowed. * Use of immunosuppressants (eg, systemic corticosteroids) for more than 2 consecutive weeks in duration within 1 year prior to Screening.

Locations (86)

Outcomes

Primary Outcomes

Percentage of Participants With At Least a 20% Reduction in Alkaline Phosphatase (ALP) or Normalization of ALP at Week 12 Compared to Baseline

Percent change was calculated as \[(ALP at Week 12 - ALP at Baseline)/ALP at Baseline\] \*100. The participant was considered to have successfully achieved a 20% reduction in ALP if the result was ≤-20. The participant was considered to have successfully achieved ALP normalization if ALP was abnormal at Baseline and normal at Week 12.

Time frame: Baseline and Week 12

Secondary Outcomes

Percentage of Participants With a Treatment-Emergent Adverse Event (TEAE) During On-Treatment Period

An adverse event (AE) was defined as any event, side effect, or untoward medical occurrence in a subject enrolled in a clinical trial whether or not it is considered to have a causal relationship to the study drug. A TEAE was an AE that first occurred or began previous to and worsened on or after the first dose date and before the last dose date +7 days.

Time frame: Up to approximately Week 12

Percentage of Participants With a Treatment-Emergent Serious Adverse Event (SAE) During On-Treatment Period

A SAE is any untoward medical occurrence at any dose that results in death, is a life-threatening event, requires inpatient hospitalization or prolonged hospitalization of an existing hospitalization, results in permanent or prolonged disability or incapacity, is a congenital anomaly or birth defect in the offspring of a study subjects, or is a medically important event.

Time frame: Up to approximately Week 12

Percentage of Participants Who Stopped Study Treatment Due to a Treatment-Emergent Adverse Event (TEAE) During On-Treatment Period

Data from ClinicalTrials.gov

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Digestive Health Specialists of the Southeast

Dothan, Alabama, United States

Arkansas Diagnostic Center

Little Rock, Arkansas, United States

Texas Clinical Research Institute

Little Rock, Arkansas, United States

Southern California Research Center

Coronado, California, United States

Cedars-Sinai Medical Center

Los Angeles, California, United States

California Liver Research Institue

Pasadena, California, United States

Pasadena Liver Center

Pasadena, California, United States

Inland Empire Liver Foundation

Rialto, California, United States

California Pacific Medical Center

San Francisco, California, United States

South Denver Gastroenterology - Swedish Medical Center Office

Englewood, Colorado, United States

...and 76 more locations

Time frame: Up to approximately Week 12

Change From Baseline to Week 12 in Total, Conjugated and Unconjugated Bilirubin

The data presented below was measured using least square mean change from baseline.

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), and Gamma Glutamyl Transferase (GGT)

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Noninvasive Liver Fibrosis Markers: Enhanced Liver Fibrosis (ELF) Panel and N-terminal Type III Collagen Propeptide (PRO C3)

The ELF panel included hyaluronic acid (HA), procollagen III amino terminal peptide (PIIINP), and tissue inhibitor of metalloproteinase 1 (TIMP 1). This endpoint also presents PRO C3 results.

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Noninvasive Liver Fibrosis Markers: AST to Platelet Ratio Index (APRI) Score

APRI was calculated as (\[AST level/AST upper limit of normal\]/\[Platelet count 1\^09/L\])×100. AST is aspartate aminotransferase. The aspartate transaminase to platelet ratio index (APRI) is used to assess liver fibrosis in participants with chronic liver disease. Scores range from 0 to ≥ 2.0, with scores \< 0.5 predictive of no liver fibrosis; scores \>1.5 significant fibrosis; and scores \> 2.0 indicative of cirrhosis. A negative change from baseline indicates a decrease in fibrosis.

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Noninvasive Liver Fibrosis Markers: Fibrosis-4 (FIB-4) Score

Fibrosis-4 is the ratio of age in years and aminotransferase to platelet count. It is a non-invasive hepatic fibrosis index score that is calculated using formula: FIB-4 = (Age \[years\] x AST \[U/L\]) / (platelets \[10\^9/L\] x (square root of ALT \[U/L\])). A FIB-4 index of \< 1.45 indicates no or moderate fibrosis and an index of \> 3.25 indicates extensive fibrosis/cirrhosis. A positive change from Baseline indicates increased fibrosis.

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Fibrinogen and C Reactive Protein (CRP) Levels

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Interleukin (IL) and Tumor Necrosis Factor (TNF) Levels

For IL, both IL6 and IL1β variants were analysed. For TNF, both TNF α and TNF β (also known as lymphotoxin alpha) variants were analyzed.

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Haptoglobin and Alpha2 Macroglobulin Levels

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Triglycerides (TG), Total Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C)

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Domain and Total Scores on the 5D-Itch Scale

The 5D-Itch scale is a multidimensional questionnaire completed by participants to quantify the magnitude of pruritus, assessed considering the past 2 weeks. Scale range is 1 to 5 covering five dimensions: duration (1=Less than 6 hrs/day to 5=All day), degree (1=Not present to 5=Unbearable), direction (1=Completely resolved to 5=Getting worse), disability (for Sleep rated as 1=Never affects sleep to 5=Delays falling asleep and frequently wakes me up at night; for Leisure/Social, Housework/Errands and Work/School rated as 1=Never affects activity to 5=Always affects activity), and distribution (assess if itching is present in 16 body locations, scored as 1=present at 0-2 locations to 5=present at 14-16 locations). Total scores (including highest disability score obtained from any of the daily activities) ranged between 5 and 25 where higher scores indicated more severe itching. Negative change scores indicate improvement from the baseline score.

Time frame: Baseline and Week 12

Change From Baseline to Week 12 in Visual Analog Score (VAS) for Itching

An itch VAS (0-100mm) was used to record the intensity of the event. Participants drew a line on a scale corresponding to the maximum intensity of itch. Lines drawn towards the right of the line indicated greater itching and higher scores indicated more severe itching. Negative change from baseline indicates decrease in itching.

Time frame: Baseline to Week 12

Change From Baseline to Week 12 in Domain Scores on the Primary Biliary Cholangitis-40 (PBC-40) Quality of Life (QoL) Assessment

The PBC-40 is a survey measuring health related quality of life in participants with PBC. The 40 questions from the PBC-40 questionnaire are scored from 1-5, with 5 representing the highest impact and 1 the lowest impact of PBC on the quality of life. Six domains were computed from the 40 questions: symptoms (score range 7-35), itch (0-15), fatigue (11-55), cognition (6-30), social (8-50) and emotional (1-15). Higher scores indicate worse quality of life and negative change scores indicate improvement from the baseline score.

Time frame: Baseline and Week 12

Maximum Plasma Concentration (Cmax) of EDP-305 and Its Metabolites

Metabolites of EDP-305 are EP-022571, EP-022572, and EP-022679.

Time frame: Day 1 and Week 12: Pre-dose and 2, 6 and 8 hours post-dose

Time to Maximum Plasma Concentration (Tmax) of EDP-305 and Its Metabolites

Metabolites of EDP-305 are EP-022571, EP-022572, and EP-022679.

Time frame: Day 1 and Week 12: Pre-dose and 2, 6 and 8 hours post-dose

Area Under the Plasma Concentration-time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUClast) of EDP-305 and Its Metabolites

Metabolites of EDP-305 are EP-022571, EP-022572, and EP-022679.

Time frame: Day 1 and Week 12: Pre-dose and 2, 6 and 8 hours post-dose

Percentage Change From Baseline to Week 12 in Fibroblast Growth Factor 19 (FGF19), 7α-OH-4-cholesten-3-one (C4) and Bile Acid (BA) Concentrations

FGF19 was measured in plasma. BA was measured in serum. C4 was measured in serum.

Time frame: Baseline and Week 12

Percentage Change From Baseline to Week 12 in AUC0-8 and AUC2-8 of Fibroblast Growth Factor 19 (FGF19), 7α-OH-4-cholesten-3-one (C4) and Bile Acid (BA)

AUC0-8 is area under the biomarker concentration-time curve from time zero to 8 hours. AUC2-8 is area under the biomarker concentration-time curve from 2 hours to 8 hours. FGF19 was measured in plasma. BA was measured in serum. C4 was measured in serum.

Time frame: Day 1 and Week 12: Pre-dose and 2, 6 and 8 hours post-dose