PERSEUS: Preliminary Efficacy and Safety of Cenicriviroc in Adult Participants With Primary Sclerosing Cholangitis

Phase 2

Completed

Conditions: Primary Sclerosing Cholangitis

Interventions: Drug: Cenicriviroc 150 mg

Registration Number: NCT02653625

Lead Sponsor: Tobira Therapeutics, Inc.

Brief Summary: This is an open label, proof of concept (PoC) study of Cenicriviroc (CVC) in adult participants with Primary Sclerosing Cholangitis (PSC). The main objective of this PoC study is to assess changes in alkaline phosphatase (ALP) both individually and as a group, over 24 weeks of treatment with CVC.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 24

Inclusion Criteria

Participants with chronic cholestatic liver disease for at least 6 months
Clinical diagnosis of Primary Sclerosing Cholangitis (PSC) as evident by chronic cholestasis of more than six months duration with either a consistent magnetic resonance cholangiopancreatography (MRCP)/endoscopic retrograde cholangiopancreatography (ERCP) showing sclerosing cholangitis, or a liver biopsy taken at any time consistent with PSC in the absence of a documented alternative etiology for sclerosing cholangitis. If diagnosis of PSC was made by histology alone, it must require the presence of fibro-obliterative lesions (i.e., onion skin lesions)
Participants with or without Inflammatory Bowel Disease (IBD) are allowed. If participant has IBD, documented evidence of IBD either by prior endoscopy or in previous medical records, for ≥ 6 months. In addition, participants will be required to enter the study with a Partial Mayo Risk score of 0-3, inclusively
In participants receiving treatment with ursodeoxycholic acid (UDCA), therapy must be stable for at least 3 months, and at a dose not greater than 20 mg/kg/day
Serum ALP greater than 1.5 × upper limit of normal (ULN)
Ability to understand and sign a written informed consent form (ICF)
Participants receiving allowed concomitant medications need to be on stable therapy for 28 days prior to the Baseline Visit with the exception of UDCA in which participants need to be on stable therapy for ≥ 3 months

Exclusion Criteria

Presence of documented secondary sclerosing cholangitis (such as ischemic cholangitis, recurrent pancreatitis, intraductal stone disease, severe bacterial cholangitis, surgical or blunt abdominal trauma, recurrent pyogenic cholangitis, choledocholithiasis, toxic sclerosing cholangitis due to chemical agents, or any other cause of secondary sclerosing cholangitis) on prior clinical investigations
Small duct PSC
Presence of percutaneous drain or bile duct stent
History of cholangiocarcinoma or high clinical suspicion over dominant stricture within 1 year by MRCP/ERCP or clinical judgment
Ascending cholangitis within 60 days prior to Screening
Alcohol consumption greater than 21 units/week for males or 14 units/week for females (one unit of alcohol is ½ pint of beer [285 mL], 1 glass of spirits [25 mL] or 1 glass of wine [125 mL])
Prior or planned liver transplantation
Presence of alternative causes of chronic liver disease, including alcoholic liver disease, non-alcoholic steatohepatitis, primary biliary cirrhosis, autoimmune hepatitis
History of cirrhosis and/or hepatic impairment (Child-Pugh classes A, B and C) and/or hepatic decompensation including ascites, encephalopathy or variceal bleeding. Participants who show evidence of significant worsening of hepatic function will be excluded
Participants with fibrosis evidence of cirrhosis, as determined by local transient elastography (TE, e.g., Fibroscan) values of ≥ 13.0 kPa, taken within the last 6 months. If TE has not been conducted within the 6 months prior to screening, then one will be conducted during the screening period and can be used as the Baseline value.
Moderate to Severe active IBD or flare in colitis activity within the last 90 days requiring intensification of therapy beyond Baseline treatment. Participants with stable mild to moderate IBD, who are on treatment, are allowed provided they are stable for 3 months with 5-amino salicylic acid drugs or Azathioprine (allowed dose of azathioprine is 50-200 mg/day)
Use of oral prednisolone > 10 mg/day, biologics and/or hospitalization for colitis within 90 days are disallowed
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT); above the allowed cut-offs, as determined by Screening values:
- AST > 200 IU/L males and females
- ALT: males > 250 IU/L and females > 200 IU/L
Total Bilirubin and Direct Bilirubin; above the allowed cut-offs, as determined by Screening values:
- Total Bilirubin > 2.0 mg/dL
- Direct Bilirubin > 0.8 mg/dL
International normalized ratio > 1.3 in the absence of anticoagulants
Immunoglobulin G4 (IgG4) > 4 × ULN at Screening or evidence of IgG4-related sclerosing cholangitis
Females who are pregnant or breastfeeding
Any other clinically significant disorders or prior therapy that, in the opinion of the investigator, would make the participant unsuitable for the study or unable to comply with the dosing and protocol requirements

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Cenicriviroc 150 mg	Cenicriviroc 150 mg	One tablet of Cenicriviroc 150 mg once daily with food in the morning for 24 weeks.

Primary Outcome Measures

Name	Time	Method
Percentage Change From Baseline Through Week 24 in Serum Alkaline Phosphatase (ALP)	Baseline (Day 1) to Week 24	ALP was used as a primary surrogate marker for measuring Primary Sclerosing Cholangitis disease. The percent change from Baseline was defined as 100\*(value at each visit - Baseline value)/Baseline value. The Baseline value was defined as the last non-missing value on or before the Baseline visit (Day 1). A negative percentage change from baseline indicates an improvement.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants Who Normalized ALP at Week 24	Week 24	ALP was used as a primary surrogate marker for measuring Primary Sclerosing Cholangitis disease. Normalization was defined as ALP values outside of the central laboratory reference range at baseline, but within the central laboratory reference range at Week 24.
Percentage of Participants Who Discontinued Due to a TEAE	Baseline (Day 1) to Week 24	An adverse event was defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, regardless of whether related to the medicinal (investigational) product. A TEAE was defined as an AE with an onset that occurred after receiving treatment.
Percentage of Participants Who Achieved Serum ALP of Less Than 1.5 Times Upper Limit of Normal (ULN) in Serum ALP at Week 24	Week 24	ALP was used as a primary surrogate marker for measuring Primary Sclerosing Cholangitis disease. The upper limit of normal ALP was defined according to the central laboratory reference ranges.
Percentage of Participants Who Achieved a 50% Decrease in ALP at Week 24	Week 24	ALP was used as a primary surrogate marker for measuring Primary Sclerosing Cholangitis disease.
Percentage of Participants With a Treatment-emergent Adverse Event (TEAE)	Baseline (Day 1) to Week 24	An adverse event (AE) was defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, regardless of whether related to the medicinal (investigational) product. A TEAE was defined as an AE with an onset that occurred after receiving treatment.

Trial Locations

Locations (9): Scripps Clinic
🇺🇸
La Jolla, California, United States
University of Calgary, Liver Unit
🇨🇦
Calgary, Alberta, Canada
Toronto University Health Center
🇨🇦
Toronto, Ontario, Canada
University of Alberta, Zeidler Ledcor Centre
🇨🇦
Edmonton, Alberta, Canada
Sutter Health, California Pacific Medical Center
🇺🇸
San Francisco, California, United States
University of Manitoba
🇨🇦
Winnipeg, Manitoba, Canada
University of California, Davis Medical Center
🇺🇸
Sacramento, California, United States
University of Miami
🇺🇸
Miami, Florida, United States
Icahn School of Medicine
🇺🇸
New York, New York, United States