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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04365868
Registration number
NCT04365868
Ethics application status
Date submitted
24/04/2020
Date registered
28/04/2020
Titles & IDs
Public title
Study Evaluating the Efficacy and Safety of Belapectin for the Prevention of Esophageal Varices in NASH Cirrhosis
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Scientific title
A Seamless, Adaptive, Phase 2b/3, Double-Blind, Randomized, Placebo-controlled, Multicenter, International Study Evaluating the Efficacy and Safety of Belapectin (GR MD-02) for the Prevention of Esophageal Varices in NASH Cirrhosis
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Secondary ID [1]
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GT-031
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Universal Trial Number (UTN)
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Trial acronym
NAVIGATE
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Prevention of Esophageal Varices
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NASH - Nonalcoholic Steatohepatitis
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Cirrhosis
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Condition category
Condition code
Oral and Gastrointestinal
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0
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0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Metabolic and Endocrine
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0
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0
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Metabolic disorders
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Diet and Nutrition
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0
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Obesity
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Cardiovascular
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Diseases of the vasculature and circulation including the lymphatic system
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Inflammatory and Immune System
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Connective tissue diseases
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Inflammatory and Immune System
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0
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Other inflammatory or immune system disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - belapectin
Treatment: Drugs - Placebo
Experimental: belapectin 2 mg/kg lean body mass (LBM) - Phase 2b: Belapectin 2 mg/kg lean body mass administered intravenously (IV) every other week for 78 weeks (18 months)
Phase 3: The patient will be switched to the optimal dose
Experimental: belapectin 4 mg/kg lean body mass (LBM) - Phase 2b: Belapectin 4 mg/kg lean body mass administered intravenously (IV) every other week for 78 weeks (18 months)
Phase 3: The patient will be switched to the optimal dose
Placebo comparator: Placebo - Phase 2b: Placebo, administered intravenously (IV) every other week for 78 weeks (18 months)
Phase 3:Placebo, administered intravenously (IV) every other week for 78 weeks (18 months)
Treatment: Drugs: belapectin
intravenous
Treatment: Drugs: Placebo
intravenous
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Proportion of patients in the belapectin treatment groups who develop new esophageal varices at 78 weeks [18 months] of treatment compared to placebo
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Assessment method [1]
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Proportion of patients in the belapectin treatment groups who develop new esophageal varices at 78 weeks \[18 months\] of treatment compared to placebo
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Timepoint [1]
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At 78 weeks [18 months]
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Secondary outcome [1]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop varices (esophageal or gastric) requiring treatment
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Assessment method [1]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop varices (esophageal or gastric) requiring treatment
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Timepoint [1]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [2]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop variceal bleed requiring hospitalization
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Assessment method [2]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop variceal bleed requiring hospitalization
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Timepoint [2]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [3]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop clinically significant ascites requiring hospitalization
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Assessment method [3]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop clinically significant ascites requiring hospitalization
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Timepoint [3]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [4]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop spontaneous bacterial peritonitis
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Assessment method [4]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop spontaneous bacterial peritonitis
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Timepoint [4]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [5]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop hepatic encephalopathy (West Haven score =2 and requiring hospitalization)
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Assessment method [5]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop hepatic encephalopathy (West Haven score =2 and requiring hospitalization)
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Timepoint [5]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [6]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop mortality (all-cause)
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Assessment method [6]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop mortality (all-cause)
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Timepoint [6]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [7]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop liver transplant
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Assessment method [7]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop liver transplant
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Timepoint [7]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [8]
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Efficacy: Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop model for end-stage liver disease (MELD) score =15
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Assessment method [8]
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Cumulative incidence rate of patients in the belapectin treatment groups, compared to placebo, who develop model for end-stage liver disease (MELD) score =15
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Timepoint [8]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [9]
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Efficacy: Cumulative incidence rate of patients in the belapectin Phase 3 treatment group who progress to large varices (gastric or esophageal) or develop red wales compared to placebo.
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Assessment method [9]
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Cumulative incidence rate of patients in the belapectin Phase 3 treatment group who progress to large varices (gastric or esophageal) or develop red wales compared to placebo
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Timepoint [9]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [10]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, progression to large varices or red wales
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Assessment method [10]
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Event-free survival by time to first cirrhosis related clinical event, progression to large varices or red wales
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Timepoint [10]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [11]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, esophageal variceal hemorrhage requiring hospitalization
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Assessment method [11]
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Event-free survival by time to first cirrhosis related clinical event, esophageal variceal hemorrhage requiring hospitalization
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Timepoint [11]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [12]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, clinically significant ascites requiring hospitalization
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Assessment method [12]
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Event-free survival by time to first cirrhosis related clinical event, clinically significant ascites requiring hospitalization
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Timepoint [12]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [13]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, spontaneous bacterial peritonitis
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Assessment method [13]
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Event-free survival by time to first cirrhosis related clinical event, spontaneous bacterial peritonitis
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Timepoint [13]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [14]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, overt hepatic encephalopathy (West Haven score =2 and requiring hospitalization)
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Assessment method [14]
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Event-free survival by time to first cirrhosis related clinical event, overt hepatic encephalopathy (West Haven score =2 and requiring hospitalization)
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Timepoint [14]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [15]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, Child-Turcotte-Pugh (CTP) score increase of =2 points (from baseline)
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Assessment method [15]
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Event-free survival by time to first cirrhosis related clinical event, Child-Turcotte-Pugh (CTP) score increase of =2 points (from baseline)
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Timepoint [15]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [16]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, model for end-stage liver disease (MELD) score increase to =15 as measured on 2 consecutive occasions
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Assessment method [16]
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Event-free survival by time to first cirrhosis related clinical event, model for end-stage liver disease (MELD) score increase to =15 as measured on 2 consecutive occasions
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Timepoint [16]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [17]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, liver transplant
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Assessment method [17]
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Event-free survival by time to first cirrhosis related clinical event, liver transplant
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Timepoint [17]
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Through study end, 78 weeks or 156 weeks
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Secondary outcome [18]
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Efficacy: Event-free survival by time to first cirrhosis related clinical event, liver-related death
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Assessment method [18]
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Event-free survival by time to first cirrhosis related clinical event, liver-related death
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Timepoint [18]
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Through study end, 78 weeks or 156 weeks
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Eligibility
Key inclusion criteria
Each subject must meet all of the following criteria to be enrolled in this study:
1. Is male or female, = 18 and = 75 years of age at the time of Screening.
2. Is willing and able to provide written informed consent prior to the initiation of any study-specific procedures.
3. Has evidence of portal hypertension, with either one of the following:
1. platelet count <150,000/mm3
OR
2. documented hepatic venous pressure gradient (HVPG) measurement >6 mmHg
OR
3. at least two of the following:
* spleen size =14 cm (documented by ultrasound, MRI, or CT scan)
* abdominal collateral circulation (documented by ultrasound, MRI, or CT scan or physical examination, ie, caput medusae)
* documented liver transient elastography (eg, FibroScan) =20 kilopascals (kPa).
* aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >1.
4. Has a history confirming nonalcoholic steatohepatitis (NASH) cirrhosis, with at least one of the following:
* There is a historical liver biopsy showing cirrhosis with steatohepatitis. There is no evidence for a competing etiology for the cirrhosis.
* There is a historical liver biopsy showing steatohepatitis, and there is evidence of cirrhosis from clinical or imaging data or a second liver biopsy showing cirrhosis without all features of NASH (as the histological NASH lesions may have burnt out). There is no evidence for a competing etiology. There is at least 1 co-existing metabolic comorbidity at Screening: obesity (with either body mass index [BMI] =30 kg/m2 or waist circumference =102 cm [40 in, men] or =88 cm [35 in, women], or by ethnically appropriate cutpoints); hypertension (either on anti hypertensive drug therapy for at least 1 year or systolic/diastolic blood pressure (BP) >140/80 mm Hg); Type 2 diabetes (glycated hemoglobin [HbA1c] =6.5%, or on anti-diabetic medication for at least 1 year); or dyslipidemia (triglycerides =150 mg/dL or on drug therapy for hypertriglyceridemia for at least 6 months; high-density lipoprotein cholesterol =40 mg/dL [men] or =50 mg/dL [women]) to corroborate a diagnosis of nonalcoholic fatty liver disease (NAFLD).
* There is a historical liver biopsy showing cirrhosis with steatosis but not steatohepatitis. There is no evidence for a competing etiology. There are at least 2 co-existing (or history of) metabolic comorbidities (with obesity or diabetes being one of them) to corroborate a diagnosis of NAFLD.
* There is a historical liver biopsy showing steatosis but now with cirrhosis either by clinical examination, imaging, or biopsy. If there is a current biopsy, it does not show evidence of steatosis or steatohepatitis as histological lesions may have burned out. There is no evidence for a competing etiology. There are at least 2 co existing (or history of) metabolic comorbidities (with obesity or diabetes being one of them) to corroborate a diagnosis of NAFLD.
* Patient with cirrhosis with current or previous imaging showing steatosis. There is no liver histology available. There is no evidence for a competing etiology. There are at least two co-existing or history of metabolic comorbidities with obesity or diabetes being one of them to corroborate a diagnosis of NAFLD.
* For patients not meeting the above mentioned criteria, a screening liver biopsy is necessary.
Note: All liver biopsy blocks and/or slides for eligibility assessments (including those from historical biopsies) will be reviewed by the central study pathologist while the subject is in Screening. Results from the central study pathologist must be available before the subject is randomized.
5. Absence of hepatocellular carcinoma (HCC) by valid imaging (eg, ultrasound, CT scan, or MRI) within 6 months prior to randomization. If no such imaging result is available, then ultrasound imaging should be performed as part of standard of care.
6. Patients with diabetes mellitus can be enrolled, if they are adequately controlled on a stable dose or doses of antidiabetic medication(s) for at least 3 months before Screening, and their screening HbA1c is =9.5%.
7. Patients on vitamin E or pioglitazone can be enrolled if they are on a stable dose and regimen for at least 3 months before screening, and the dose is expected to be held constant during the trial.
8. Patients on a statin can be enrolled if they are on a stable regimen for at least 3 months before Screening, and expected to be held stable during the trial.
9. Is not pregnant and must have a negative serum pregnancy test result prior to randomization.
10. Is of non-childbearing potential or if a fertile man or woman participating in heterosexual relations, agrees to use two acceptable means of contraception (ie, 2 effective methods of contraception, one of which must be a physical barrier method [eg, male or female condom, diaphragm] when combined with a highly effective method of contraception [ie, a method with a failure rate of <1% per year when used consistently and correctly]) throughout his/her participation in this study and for 90 days after discontinuation of study treatment.
Highly effective forms of contraception include:
* combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (such as oral, intravaginal, transdermal) methods
* progestogen-only hormonal contraception associated with inhibition of ovulation (such as oral, injectable, implantable)
* hormone-releasing intrauterine system (IUS)
* intrauterine device (IUD)
* bilateral tubal occlusion
* a vasectomized partner, provided that partner is the sole sexual partner of the women of childbearing potential trial participant and that the vasectomized partner has received medical assessment of the surgical success
* sexual abstinence (ie, a refraining from heterosexual intercourse during the entire period of the clinical trial, if it is the preferred and usual lifestyle of the subject).
Surgically sterile males and females are not required to use contraception provided they have been considered surgically sterile for at least 6 months. Surgical sterility includes history of surgically successful vasectomy, hysterectomy, or bilateral salpingo-oophorectomy. Postmenopausal women who have been amenorrheic for at least 2 years at the time of Screening will be considered sterile.
11. If a lactating woman, agrees to discontinue nursing before the start of study treatment and refrain from nursing until 90 days after the last dose of study treatment.
12. If a man, agrees to refrain from sperm donation throughout the study period and for a period of 90 days following the last dose of investigational medicinal product (IMP). Female subjects may not begin a cycle of ova donation or harvest throughout the study period and for a period of 90 days following the last dose of IMP.
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Minimum age
18
Years
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Maximum age
75
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Subjects meeting any of the following criteria will be excluded from the study:
1. Presence of esophageal, gastroesophageal, or isolated gastric varices, based on an upper gastrointestinal (GI) esophagogastroduodenoscopy (EGD) exam conducted during Screening. Patients with portal hypertensive gastropathy could be enrolled.
2. History of hepatic cirrhosis decompensation including any episode of variceal bleeding, ascites not controlled by medication, spontaneous bacterial peritonitis or overt hepatic encephalopathy (West Haven grade =2 as assessed by the principal investigator), OR develops signs of hepatic cirrhosis decompensation during Screening.
3. Known or suspected abuse of alcohol (>20 g/day for women or >30 g/day for men [on average per day]), as per medical history. Significant alcohol consumption is defined as more than 20 grams per day in females and more than 30 grams per day in males. On average, a standard drink in the United States is considered to be 14 grams of alcohol, equivalent to 12 fluid ounces of regular beer (5% alcohol), 5 fluid ounces of table wine (12% alcohol), or 1.5 fluid ounces of 80 proof spirits (40% alcohol).
4. Alcohol dependence (ie, a score >8 on the Alcohol Use Disorders Identification Test)
5. Narcotics or any other drug abuse or dependence in the last 5 years
6. Prior trans-jugular intrahepatic portal-systemic (TIPS) shunt procedure
7. Documented causes of liver disease other than NASH, including but not restricted to:
* Viral hepatitis, unless eradicated at least 3 years prior to Screening
* acute hepatitis A infection (presence of hepatitis A immunoglobulin M [IgM] at Screening)
* positive hepatitis B surface antigen
* positive hepatitis C virus (HCV) ribonucleic acid (to be performed prior to randomization in case of positive HCV antibody)
* Documented drug-induced liver disease
* Alcoholic liver disease
* Autoimmune hepatitis
* Wilson's disease
* Hemochromatosis
* Primary biliary cholangitis
* Primary sclerosing cholangitis
* Genetic hemochromatosis
* History or planned liver transplantation
* Alpha-1 antitrypsin deficiency
8. History of human immunodeficiency virus (HIV), or positive HIV test at Screening
9. Any of the following test or score:
* serum alanine aminotransferase (ALT) > 5 × upper limit of normal (ULN)*
* serum aspartate aminotransferase (AST) > 5 × ULN*
*Screening values will be obtained at Screening Visit 1 (SV1) and Screening Visit 2(SV2) (which will be separated by 2 to 4 weeks). A second screening value that is >50% higher than the first value should prompt re-evaluation of the severity of the underlying liver disease and eligibility for this trial. If a transaminase level at SV2 is >33% different from the level at SV1, then additional measurements should be performed at Screening Visit 3 (SV3). In such cases, the baseline transaminase levels will be established for subjects using the mean value of 4 evaluations [ie, at SV1, SV2, SV3, and Baseline (ie, pre-dose during Visit 1)].
* serum alkaline phosphatase (ALP) > 2 × ULN
* mean platelet count < 50,000/mm3
* total bilirubin = 2.0 mg/dL (subjects with a documented history of Gilbert's syndrome can be enrolled if the direct bilirubin is within normal reference range)
* model for end-stage liver disease (MELD) score =12
* Child-Turcotte-Pugh (CTP) Score =7 Note: Following Phase 2b, subjects with CTP scores =7 may be enrolled if recommended* by the Data Safety Monitoring Board (DSMB) and approved by the Trial Steering Committee (TSC), based on the planned interim analysis (IA). [*based on DSMB review of preliminary results from a separate hepatic impairment clinical trial (Study GT-032) which is assessing belapectin safety and pharmacokinetic (PK) in cirrhotic subjects with CTP scores =7.
* estimated glomerular filtration rate < 45 mL/min* *Note: per Modification of Diet in Renal Disease algorithm
10. Taking an angiotensin converting enzyme inhibitor, angiotensin II receptor blocker, or ß-1 selective adrenergic receptor inhibitor, unless on a stable regimen for at least 3 months prior to Screening and no changes in the regimen are anticipated during the study. Subjects taking a non-selective beta blocker are not eligible to be enrolled (Investigators are encouraged to substitute another medication, if clinically warranted).
11. History of major surgery during Screening.
12. History of a solid organ transplant requiring immunosuppressive therapy.
13. History of bariatric surgery within 1 year of randomization, or plan to undergo bariatric surgery during the study.
14. Has positive screening test for illicit drugs of abuse at Screening.
15. Has participated in an investigational new drug study within 30 days or 5 half-lives whichever is longer, prior to randomization.
16. Has a history of malignancy within 5 years of randomization, except for basal cell carcinoma, squamous cell carcinoma, and adequately treated in situ uterine cervical cancer.
17. Has clinically significant cardiovascular disease (eg, uncontrolled hypertension, myocardial infarction, unstable angina), New York Heart Association Grade II or greater congestive heart failure, serious cardiac arrhythmia requiring intervention (eg, pacemaker/ablation) or Grade II or greater peripheral vascular disease.
18. Has a history of clinically significant hematologic, renal, hepatic, pulmonary, neurological, psychiatric, gastrointestinal, systemic inflammatory, metabolic or endocrine disorder or any other condition that, in the opinion of the Investigator, renders the subject a poor candidate for inclusion into the study.
19. Has known allergies to the IMP or any of its excipients.
20. Has previously received belapectin within 6 months of randomization.
21. Is an employee or family member of the Investigator or study center personnel.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
22/06/2020
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/12/2024
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Actual
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Sample size
Target
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Accrual to date
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Final
357
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Recruitment in Australia
Recruitment state(s)
NSW,SA,VIC,WA
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Recruitment hospital [1]
0
0
Nepean Hospital - Kingswood
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Recruitment hospital [2]
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Royal Adelaide Hospital - Adelaide
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Recruitment hospital [3]
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Box Hill Hospital - Box Hill
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Recruitment hospital [4]
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Monash Medical Centre Clayton - Clayton
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Recruitment hospital [5]
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Fiona Stanley Hospital - Murdoch
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Recruitment postcode(s) [1]
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2750 - Kingswood
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Recruitment postcode(s) [2]
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5000 - Adelaide
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Recruitment postcode(s) [3]
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3128 - Box Hill
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Recruitment postcode(s) [4]
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3168 - Clayton
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Recruitment postcode(s) [5]
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6150 - Murdoch
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Recruitment outside Australia
Country [1]
0
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United States of America
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Alabama
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Colorado
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Kentucky
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LD
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NGM
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
Galectin Therapeutics Inc.
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Summary
Brief summary
This seamless, adaptive, two-stage, Phase 2b/3, randomized, double-blind, multicenter, parallel-groups, placebo-controlled study will assess the efficacy, safety, and tolerability of belapectin compared with placebo in patients with nonalcoholic steatohepatitis (NASH) cirrhosis and clinical signs of portal hypertension but without esophageal varices at baseline.
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Trial website
https://clinicaltrials.gov/study/NCT04365868
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Public notes
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Contacts
Principal investigator
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Pol Boudes, M.D.
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Galectin Therapeutics Inc.
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04365868