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A Placebo-Controlled, Multicenter, Double-Blind, Phase 2 Randomised Trial of the Pan-Caspase Inhibitor Emricasan in Patients with Acutely Decompensated Cirrhosis

Mehta, G; Rousell, S; Burgess, G; Morris, M; Wright, G; McPherson, S; Frenette, C; ... Jalan, R; + view all (2017) A Placebo-Controlled, Multicenter, Double-Blind, Phase 2 Randomised Trial of the Pan-Caspase Inhibitor Emricasan in Patients with Acutely Decompensated Cirrhosis. Journal of Clinical and Experimental Hepatology , 8 (3) pp. 224-234. 10.1016/j.jceh.2017.11.006. Green open access

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Abstract

Background: Cirrhosis and acute-on-chronic liver failure (ACLF) are associated with systemic inflammation, and caspase-mediated hepatocyte cell death. Emricasan is a novel, pan-caspase inhibitor. Aims of this study were to assess the pharmacokinetics, pharmacodynamics, safety and clinical outcomes of emricasan in acute decompensation (AD) of cirrhosis. Methods: This was a phase 2, multicentre, double-blind, randomised trial. The primary objective was to evaluate the pharmacokinetics, pharmacodynamics and safety of emricasan in patients with cirrhosis presenting with AD and organ failure. AD was defined as an acute decompensating event ≤6 weeks' duration. Patients were randomised proportionately to emricasan 5. mg bid, emricasan 25. mg bid, emricasan 50. mg bid or placebo. Treatment was continued to 28 days, or voluntary discontinuation. Results: Twenty-three subjects were randomised, of whom 21 were dosed (placebo n = 4; 5. mg n = 5; 25. mg n = 7; 50. mg n = 5). Pharmacokinetic data showed 5. mg dose was associated with low plasma levels ( < 50. ng/ml), and 25. mg and 50. mg doses showed comparable pharmacokinetic profiles. Therefore, for analysis of secondary endpoints, placebo and 5. mg groups were merged into a 'placebo/low-dose' group, and 25. mg and 50. mg groups were merged into a 'high-dose' group. Five deaths occurred amongst the 21 patients, all due to progression of liver disease (2 in placebo/low-dose, 3 in high-dose). No statistically significant changes from baseline MELD score or CLIF-C ACLF score were noted between placebo/low-dose and high-dose groups at day 7 (MELD -1 vs -1, CLIF-C ACLF 0.7 vs 0.8). An initial reduction in cleaved keratin M30 fragment was noted between placebo/low-dose and high-dose groups (percent relative change: day 2: -11.6 vs -42.6, P = 0.017, day 4: -3.5 vs -38.9 P = 0.017) although this did not persist to day 7 (-3.1 vs -20.8, P = 0.342). Conclusion: This study demonstrates that emricasan is safe and well tolerated in advanced liver disease. However, this study fails to provide proof-of-concept support for caspase inhibition as a treatment strategy for ACLF. Trial registration: EudraCT 2012-004245-33.

Type: Article
Title: A Placebo-Controlled, Multicenter, Double-Blind, Phase 2 Randomised Trial of the Pan-Caspase Inhibitor Emricasan in Patients with Acutely Decompensated Cirrhosis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jceh.2017.11.006
Publisher version: https://doi.org/10.1016/j.jceh.2017.11.006
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Cirrhosis, apoptosis, cell death, liver failure
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10040713
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