TY - JOUR
T1 - Emricasan to prevent new decompensation in patients with NASH-related decompensated cirrhosis
AU - IDN-6556-17 Study Investigators
AU - Frenette, Catherine
AU - Kayali, Zeid
AU - Mena, Edward
AU - Mantry, Parvez S.
AU - Lucas, Kathryn J.
AU - Neff, Guy
AU - Rodriguez, Miguel
AU - Thuluvath, Paul J.
AU - Weinberg, Ethan
AU - Bhandari, Bal R.
AU - Robinson, James
AU - Wedick, Nicole
AU - Chan, Jean L.
AU - Hagerty, David T.
AU - Kowdley, Kris V.
AU - Corey, Kathleen
AU - Bernstein, David
AU - Noureddin, Mazen
AU - Kemmer, Nyingi
AU - DeLemos, Andrew
AU - Pyrsopoulos, Nikolaos
AU - Lee, William
AU - Ghabril, Marwan
AU - Scanga, Andrew
AU - McKenzie, Mark
AU - Lawitz, Eric
AU - Figueroa-Diaz, Viviana
AU - Simonetto, Douglas
AU - Frederick, Richard
AU - Brown, Kimberly
AU - Therapondos, George
AU - Sheikh, Aasim
AU - Brandman, Danielle
AU - Stein, Lance
AU - Ankoma-Sey, Victor
AU - Bhamidimarri, Kalyan
AU - Landis, Charles
AU - Fortune, Brett
AU - Vargas, Hugo
AU - Abdelmalek, Manal
AU - Freilich, Bradley
AU - Rockey, Don
AU - Vierling, John
AU - Tatum, Harvey
AU - Curry, Michael
AU - Shiffman, Mitchell
AU - Bambha, Kiran
AU - Ghalib, Reem
AU - Stratton, Amy
AU - Torres, Dawn
N1 - Publisher Copyright:
© 2020 European Association for the Study of the Liver
PY - 2021/2
Y1 - 2021/2
N2 - Background & Aims: Non-alcoholic steatohepatitis is a leading cause of end-stage liver disease. Hepatic steatosis and lipotoxicity cause chronic necroinflammation and direct hepatocellular injury resulting in cirrhosis, end-stage liver disease and hepatocellular carcinoma. Emricasan is a pan-caspase inhibitor that inhibits excessive apoptosis and inflammation; it has also been shown to decrease portal pressure and improve synthetic function in mice with carbon tetrachloride-induced cirrhosis. Methods: This double-blind, placebo-controlled study randomized 217 individuals with decompensated NASH cirrhosis 1:1:1 to emricasan (5 mg or 25 mg) or placebo. Patients were stratified by decompensation status and baseline model for end-stage liver disease-sodium (MELD-Na) score. The primary endpoint comprised all-cause mortality, a new decompensation event (new or recurrent variceal hemorrhage, new ascites requiring diuretics, new unprecipitated hepatic encephalopathy ≥grade 2, hepatorenal syndrome, spontaneous bacterial peritonitis), or an increase in MELD-Na score ≥4 points. Results: There was no difference in event rates between either of the emricasan treatment groups and placebo, with hazard ratios of 1.02 (95% CI 0.59–1.77; p = 0.94) and 1.28 (95% CI 0.75–2.21; p = 0.37) for 5 mg and 25 mg of emricasan, respectively. MELD-Na score progression was the most common outcome. There was no significant effect of emricasan treatment on MELD-Na score, international normalized ratio, total serum bilirubin, albumin level or Child-Pugh score. Emricasan was generally safe and well-tolerated. Conclusions: Emricasan was safe but ineffective for the treatment of decompensated NASH cirrhosis. However, this study may guide the design and conduct of future clinical trials in decompensated NASH cirrhosis. Lay summary: Patients with decompensated cirrhosis related to non-alcoholic steatohepatitis are at high risk of additional decompensation events and death. Post hoc analyses in previous pilot studies suggested that emricasan might improve portal hypertension and liver function. In this larger randomized study, emricasan did not decrease the number of decompensation events or improve liver function in patients with a history of decompensated cirrhosis related to non-alcoholic steatohepatitis. ClinicalTrials.gov Identifier: NCT03205345.
AB - Background & Aims: Non-alcoholic steatohepatitis is a leading cause of end-stage liver disease. Hepatic steatosis and lipotoxicity cause chronic necroinflammation and direct hepatocellular injury resulting in cirrhosis, end-stage liver disease and hepatocellular carcinoma. Emricasan is a pan-caspase inhibitor that inhibits excessive apoptosis and inflammation; it has also been shown to decrease portal pressure and improve synthetic function in mice with carbon tetrachloride-induced cirrhosis. Methods: This double-blind, placebo-controlled study randomized 217 individuals with decompensated NASH cirrhosis 1:1:1 to emricasan (5 mg or 25 mg) or placebo. Patients were stratified by decompensation status and baseline model for end-stage liver disease-sodium (MELD-Na) score. The primary endpoint comprised all-cause mortality, a new decompensation event (new or recurrent variceal hemorrhage, new ascites requiring diuretics, new unprecipitated hepatic encephalopathy ≥grade 2, hepatorenal syndrome, spontaneous bacterial peritonitis), or an increase in MELD-Na score ≥4 points. Results: There was no difference in event rates between either of the emricasan treatment groups and placebo, with hazard ratios of 1.02 (95% CI 0.59–1.77; p = 0.94) and 1.28 (95% CI 0.75–2.21; p = 0.37) for 5 mg and 25 mg of emricasan, respectively. MELD-Na score progression was the most common outcome. There was no significant effect of emricasan treatment on MELD-Na score, international normalized ratio, total serum bilirubin, albumin level or Child-Pugh score. Emricasan was generally safe and well-tolerated. Conclusions: Emricasan was safe but ineffective for the treatment of decompensated NASH cirrhosis. However, this study may guide the design and conduct of future clinical trials in decompensated NASH cirrhosis. Lay summary: Patients with decompensated cirrhosis related to non-alcoholic steatohepatitis are at high risk of additional decompensation events and death. Post hoc analyses in previous pilot studies suggested that emricasan might improve portal hypertension and liver function. In this larger randomized study, emricasan did not decrease the number of decompensation events or improve liver function in patients with a history of decompensated cirrhosis related to non-alcoholic steatohepatitis. ClinicalTrials.gov Identifier: NCT03205345.
KW - Ascites
KW - Hepatic encephalopathy
KW - MELD-Na
KW - NASH
KW - Variceal hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=85097059605&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2020.09.029
DO - 10.1016/j.jhep.2020.09.029
M3 - Article
C2 - 33038432
AN - SCOPUS:85097059605
SN - 0168-8278
VL - 74
SP - 274
EP - 282
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 2
ER -