Resmetirom (MGL-3196) for the treatment of non-alcoholic steatohepatitis: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial
Autor: | Sam E. Moussa, Rong Zhou, Juan P. Frias, Mustafa R. Bashir, Cynthia A. Moylan, Rebecca Taub, Stephen A. Harrison, Seth J. Baum, Cynthia D. Guy, Meena B. Bansal, Naim Alkhouri, Brent A. Neuschwander-Tetri |
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Rok vydání: | 2019 |
Předmět: |
Adult
Diarrhea Liver Cirrhosis Male medicine.medical_specialty 030204 cardiovascular system & hematology Placebo Gastroenterology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Double-Blind Method law Fibrosis Non-alcoholic Fatty Liver Disease Internal medicine Biopsy medicine Clinical endpoint Humans 030212 general & internal medicine Uracil Inflammation medicine.diagnostic_test business.industry Alanine Transaminase Nausea Thyroid Hormone Receptors beta General Medicine Middle Aged medicine.disease Lipids Magnetic Resonance Imaging Clinical trial Pyridazines Lipotoxicity Liver Liver biopsy Female Steatohepatitis Steatosis business Biomarkers |
Zdroj: | Lancet (London, England). 394(10213) |
ISSN: | 1474-547X 0291-2260 |
Popis: | Non-alcoholic steatohepatitis (NASH) is characterised by hepatic steatosis, inflammation, hepatocellular injury, and progressive liver fibrosis. Resmetirom (MGL-3196) is a liver-directed, orally active, selective thyroid hormone receptor-β agonist designed to improve NASH by increasing hepatic fat metabolism and reducing lipotoxicity. We aimed to assess the safety and efficacy of resmetirom in patients with NASH.MGL-3196-05 was a 36-week randomised, double-blind, placebo-controlled study at 25 centres in the USA. Adults with biopsy confirmed NASH (fibrosis stages 1-3) and hepatic fat fraction of at least 10% at baseline when assessed by MRI-proton density fat fraction (MRI-PDFF) were eligible. Patients were randomly assigned 2:1 by a computer-based system to receive resmetirom 80 mg or matching placebo, orally once a day. Serial hepatic fat measurements were obtained at weeks 12 and 36, and a second liver biopsy was obtained at week 36. The primary endpoint was relative change in MRI-PDFF assessed hepatic fat compared with placebo at week 12 in patients who had both a baseline and week 12 MRI-PDFF. This trial is registered with ClinicalTrials.gov, number NCT02912260.348 patients were screened and 84 were randomly assigned to resmetirom and 41 to placebo at 18 sites in the USA. Resmetirom-treated patients (n=78) showed a relative reduction of hepatic fat compared with placebo (n=38) at week 12 (-32·9% resmetirom vs -10·4% placebo; least squares mean difference -22·5%, 95% CI -32·9 to -12·2; p0·0001) and week 36 (-37·3% resmetirom [n=74] vs -8·5 placebo [n=34]; -28·8%, -42·0 to -15·7; p0·0001). Adverse events were mostly mild or moderate and were balanced between groups, except for a higher incidence of transient mild diarrhoea and nausea with resmetirom.Resmetirom treatment resulted in significant reduction in hepatic fat after 12 weeks and 36 weeks of treatment in patients with NASH. Further studies of resmetirom will allow assessment of safety and effectiveness of resmetirom in a larger number of patients with NASH with the possibility of documenting associations between histological effects and changes in non-invasive markers and imaging.Madrigal Pharmaceuticals. |
Databáze: | OpenAIRE |
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