A Phase 2A, Randomized, Double-Blind, Placebo-Controlled, Multi-Center Trial of ADI-PEG 20 or Placebo in Subjects With Nonalcoholic Steatohepatitis (NASH)
Evaluate efficacy and safety of ADI-PEG 20 in patients with NASH
• Males and non-lactating, pregnancy test negative females between 18 - 80 years of age with biopsy proven F1 - F4 (compensated cirrhosis, Child-Pugh A, score ≤6) NASH. Limit F1 fibrosis to ≤ 20% of total subject population.
• Willingness to use appropriate contraceptive measures throughout study treatment and for 90 days thereafter (see Appendix A).
• Body mass index (BMI) \> 23 kg/m2
• Must have confirmation of ≥ 5 % liver fat content on MRI-PDFF at screening.
• Biopsy-proven NASH confirmed by a central pathologist. Must have had a liver biopsy either during the screening period or a historical biopsy conducted within the last 6 months prior to pre-screening with fibrosis stage 1 to 4 (F score, F1-F4) and a non-alcoholic fatty liver disease (NAFLD) activity score (NAS) of ≥ 4 with at least a score of 1 in each of the following NAS components:
∙ Steatosis (scored 0 to 3),
‣ Ballooning degeneration (scored 0 to 2), and
‣ Lobular inflammation (scored 0 to 3).
• Must have no evidence of worsening of ALT and AST (within 50%) measurements within 2 months prior to screening (-8 weeks) visits.
• Screening laboratory parameters, as determined by the central laboratory:
∙ Estimated glomerular filtration rate (eGFR) ≥ 60 mL/min, as calculated by the Cockcroft- Gault equation;
‣ HbA1c ≤ 9.5% (or serum fructosamine ≤ 381 μmol if HbA1c is unable to be resulted);
‣ Hemoglobin ≥ 11 g/dL;
‣ INR ≤ 1.3, unless due to therapeutic anticoagulation;
‣ Direct bilirubin ≤ 0.5 mg/dL;
‣ Total bilirubin ≤ 1.3 x upper limit of normal (ULN), unless due to an alternate etiology such as Gilbert's syndrome or hemolytic anemia;
‣ Creatinine kinase \< 3 x ULN;
‣ Platelet count ≥ 150,000/μL;
‣ Serum triglyceride level ≤ 500 mg/dL;
∙ ALT \< 6 x ULN;
∙ AST \< 6 x ULN;
∙ ALP \< 2 x ULN.
• FibroScan® measurement \> 7.0 kPa and \< 20.0 kPa.
• Subjects on non-insulin dependent diabetic, weight loss, or lipid-modifying medication(s) must be on stable dose(s) for at least 3 months prior to the diagnostic liver biopsy through randomization.
⁃ Subjects on vitamin E and pioglitazone must maintain a stable dosage before the diagnostic liver biopsy and during the study period.