A Phase 2B Randomized, Double-Blind, Placebo-Controlled Study of the Efficacy and Safety of Namodenoson in the Treatment of Non-Alcoholic Steatohepatitis (NASH)
Subjects with biopsy-proven NASH will be randomly assigned in a 2:1 ratio to oral doses of namodenoson 25 mg every 12 hours or matching placebo every 12 hours for 36 weeks. Subjects will be evaluated regularly for safety, and efficacy biomarkers will be measured at Baseline and Weeks 6, 12, 24, and 36. At Week 36, all subjects will undergo liver biopsy.
• At least 18 years of age.
• AST at Screening of ≥20 IU/L.
• FibroScan LSM ≥8.5 kPa
• Diagnosis of NASH by biopsy at Screening showing NAS ≥4 by central read, with a score of at least 1 point in each of the 3 histologic categories of steatosis, inflammation, and hepatocellular ballooning (Kleiner 2005). If the subject has had a qualifying liver biopsy within 6 months prior to Baseline and the slides are available for central read prior to randomization, this biopsy can be waived.
• Concomitant biopsy-proven Stage 1-3 hepatic fibrosis by NASH CRN criteria by central read (Kleiner 2005).
• At least 2 of the following criteria for the metabolic syndrome:
‣ Obesity, defined waist circumference \>88 cm for women or \>102 cm for men
⁃ Hypertriglyceridemia, defined as \>150 mg/dL (\>1.7 mmol/L) or on drug treatment for hypertriglyceridemia
⁃ Reduced high-density lipoprotein (HDL) cholesterol, defined as \<40 mg/dL (\<1.03 mmol/L) in men or \<50 mg/dL (\<1.3 mmol/L) in women
⁃ History of hypertension, currently controlled in the judgment of the Investigator
⁃ Elevated fasting glucose, defined as ≥100 mg/dL (≥5.6 mmol/L).
• Acceptable hepatic metabolic and synthetic function, as indicated at Screening by:
‣ Serum albumin ≥3.5 gm/dL
⁃ International normalized ratio ≤1.3
⁃ Serum total bilirubin ≤2.0 mg/dL (unless subject has known Gilbert's Syndrome).
• The following laboratory values must be documented at Screening:
‣ Absolute neutrophil count at least 1.0 x 109/L
⁃ Platelet count at least 150 x 109/L
⁃ Estimated glomerular filtration rate (eGFR) ≥50 mL/min/1.73m2
• Female subjects may be enrolled if they are not of childbearing potential, permanently sterile or are post-menopausal, defined as no menses for at least 1 year without an alternative medical cause and FSH levels in the post-menopausal range.
⁃ Male subjects must refrain from sperm donation during treatment and until at least 90 days after the end of study drug dosing. Male subjects with fertile or pregnant partners must agree to use condoms throughout the course of the trial and for 3 months after.
⁃ Patients taking herbal supplements, homeopathic medications, or other alternative treatments, must be on a stable regimen for at least 3 months prior to randomization.
⁃ Understand and provide written informed consent to participate.
⁃ Willing to undergo 2 liver biopsies.
⁃ Willing to comply with scheduled visits, treatment plans, laboratory assessments, and other study-related procedures.