Efficacy of a Novel Digital Therapeutic Lifestyle Intervention Program for Patients With MASLD
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 入组人数
- 120
- 主要终点
- Clinically significant liver fat loss
研究概览
简要总结
The ENLIGHTEN study that will evaluate the efficacy of a novel DTx lifestyle intervention in participants with non-cirrhotic MASH. People who have MASH, the progressive subtype of MASLD, have the highest risk for liver disease progression and poor outcomes, including cirrhosis and hepatocellular carcinoma, and greater overall mortality. Thus, these participants are expected to experience the greatest benefit from treatment.
This is a randomized, controlled trial comparing DTx lifestyle intervention in participants with non-cirrhotic MASH to standard clinical care. The study includes a screening period (up to 2 wks.) followed by randomization, 52-wk treatment period and 12-wk follow-up period (total duration up to 64 wks.).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18-75 years at the time of signing informed consent
- •MASH defined by any of the following within 12-months prior to SV (V1):
- •Liver biopsy with definitive MASH with NAS >4 with >1 in each component (i.e., steatosis, lobular inflammation, ballooning) or;
- •Imaging study (e.g., ultrasound) with hepatic steatosis and one of the following:
- •i) FIB-4 >1.3 or; ii) ELF test >7.7 or; iii) VCTE measured liver stiffness >8kPa or FAST score >0.35 or; iv) MRE measured liver stiffness >2.55kPa or MAST score >0.165
- •Possession of a smartphone (iPhone6s or newer with iOS version 15.6 or above; Android device with Android version 6 or above)
- •If participants are on GLP1-RA or other regulatory agency approved anti-obesity medication (e.g., orlistat, buproprion/naltrexone, phentermine-topiramate, phentermine, loreaserin), the medication dose must be stable (no change in dose) for the 3 mos. before SV.
- •Stable body weight for 3 mos. before screening visit defined as <5% weight loss or weight gain
排除标准
- •Recent (within 3 mos. of SV) participation in lifestyle intervention program or use of supplements marked for weight loss or appetite.
- •Plans to undergo bariatric surgery or initiate anti-obesity medication.
- •History of cirrhosis and/or hepatic decompensation (e.g., ascites, encephalopathy, variceal bleeding)
- •Liver disease of other etiologies (e.g., viral hepatitis), including liver transplantation
- •History of excessive alcohol consumption defined by self-report (men >30g/d or women >20g/d), AUDIT-C >4 or PETH > 20ug/L
- •History of malignancy within last 5 yrs., excluding successful treatment of non-melanoma skin cancer
- •Participant in any clinical trial or use of drugs under investigation for treatment of MASH within 3 mos. of SV
- •History of type 1 diabetes or uncontrolled type 2 diabetes (A1c >9.5% or changes in diabetes medication doses within 3 mos. of SV)
- •Recent (within 3 mos. of SV) initiation or change in dose of medications used to treat MASH (e.g., vitamin E, pioglitazone)
- •Recent (within 3 mos. of SV) use of drugs associated with the development of steatotic liver disease (e.g., methotrexate, tamoxifen)
- •Known or suspected history of drug abuse within the last 2 years prior to SV at the discretion of study investigator
- •Vulnerable participants (e.g., protected adults under guardianship or committed to an institution by governmental or judicial order)
- •Participants who cannot communicate with the study investigators or use digital technology reliably
- •Severe medical comorbidities that may hinder study participation at the discretion of study investigator
- •Current pregnancy or plans to become pregnant during the study period
研究组 & 干预措施
Standard of Care
Participants in this group will receive counseling about best MASLD clinical practices in accordance with AASLD and ACSM practice guidelines Because in-office hepatology counseling for lifestyle intervention occurs every 12-24 wks,standard counseling will occur at each in-person visit. Mediterranean-informed, hypocaloric dietary counseling will be provided by a study investigator, with specific instructions to limit carbohydrates and saturated fat and enrich dietary intake with high fiber and unsaturated fats. Physical activity goals of 150 min/wk. of moderate intensity of 75 min/wk. of vigorous intensity activity will be suggested. To reinforce this education and promote self-monitoring, participants in this group will also receive a digital scale and fitness activity tracker.
Intervention
This commercially available program (Noom Weight) promotes clinically significant body weight loss and behavior change in multiple populations including our pilot study in individuals with MASLD. The program is delivered through a smartphone application and includes self-monitoring and feedback features for diet, physical activity, and body weight, as well as digital access to a 1:1 behavior change coach, a support group facilitated by a health coach, and a curriculum delivered via daily articles focused on nutrition, physical activity, and sustainable behavioral change.
干预措施: Noom Weight Application (Other)
结局指标
主要结局
Clinically significant liver fat loss
时间窗: 16 weeks
Proportion of participants achieving \>30% relative reduction in MRI-PDFF after Wk. 16.
次要结局
- Liver fat and liver stiffness using imaging analysis(52 weeks)
- Clinically meaningful improvement in liver fat and stiffness(52 weeks)
- Circulating biomarkers of hepatic injury(52 weeks)
- Circulating biomarkers of liver fibrosis and fibrogenesis(52 weeks)
- Sustained clinically significant body weight loss(52 weeks)
- Sustained clinically significant body weight loss(16 weeks)
- Liver fat and liver stiffness using imaging analysis(16 weeks)
- Clinically meaningful improvement in liver fat and stiffness(16 weeks)
- Circulating biomarkers of hepatic injury(16 Weeks)
- Circulating biomarkers of liver fibrosis and fibrogenesis(16 Weeks)
研究者
Stephanie Patton
Compliance Specialist, Penn State Health
Milton S. Hershey Medical Center