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随机临床研究:GR-MD-02,一种半乳糖凝集素-3 抑制剂,与安慰剂在非酒精性脂肪性肝炎伴晚期纤维化患者中的比较。

Randomised clinical study: GR-MD-02, a galectin-3 inhibitor, vs. placebo in patients having non-alcoholic steatohepatitis with advanced fibrosis.

机构信息

Fort Sam Houston, TX, USA.

Indianapolis, IN, USA.

出版信息

Aliment Pharmacol Ther. 2016 Dec;44(11-12):1183-1198. doi: 10.1111/apt.13816. Epub 2016 Oct 24.

Abstract

BACKGROUND

Non-alcoholic steatohepatitis (NASH) and resultant liver fibrosis is a major health problem without approved pharmacotherapy. Pre-clinical results of GR-MD-02, a galectin-3 inhibitor, suggested potential efficacy in NASH with advanced fibrosis/cirrhosis and prompted initiation of a clinical development programme in NASH with advanced fibrosis.

AIM

To evaluate the safety, pharmacokinetics and exploratory pharmacodynamic markers of GR-MD-02 in subjects having NASH with bridging fibrosis.

METHODS

The GT-020 study was a first-in-human, sequential dose-ranging, placebo controlled, double-blinded study with the primary objective to assess the safety, tolerability and dose limiting toxicity of GR-MD-02, in subjects with biopsy-proven NASH with advanced fibrosis (Brunt stage 3). The secondary objectives were to characterise first-dose and multiple-dose pharmacokinetic profiles and to evaluate changes in potential serum biomarkers and liver stiffness as assessed by FibroScan.

RESULTS

GR-MD-02 single and three weekly repeated of 2, 4 and 8 mg/kg revealed no meaningful clinical differences in treatment emergent adverse events, vital signs, electrocardiographic findings or laboratory tests. Pharmokinetic parameters showed a dose-dependent relationship with evidence of drug accumulation following 8 mg/kg (~twofold).

CONCLUSIONS

GR-MD-02 doses were in the upper range of the targeted therapeutic dose determined from pre-clinical data and were safe and well tolerated with evidence of a pharmacodynamic effect. These results provide support for a Phase 2 development programme in advanced fibrosis due to NASH.

摘要

背景

非酒精性脂肪性肝炎(NASH)和由此导致的肝纤维化是一种重大的健康问题,目前尚无批准的药物治疗方法。Galectin-3 抑制剂 GR-MD-02 的临床前研究结果表明,其在晚期纤维化/肝硬化的 NASH 中具有潜在疗效,并促使其在晚期纤维化的 NASH 中启动了临床开发项目。

目的

评估 GR-MD-02 在桥接纤维化的 NASH 受试者中的安全性、药代动力学和探索性药效标志物。

方法

GT-020 研究是一项首次人体、连续剂量递增、安慰剂对照、双盲研究,主要目的是评估 GR-MD-02 在经活检证实的晚期纤维化(Brunt 3 期)NASH 受试者中的安全性、耐受性和剂量限制性毒性。次要目的是描述单次和多次给药的药代动力学特征,并评估潜在的血清生物标志物和肝脏硬度的变化,由 FibroScan 评估。

结果

GR-MD-02 单次和每周三次重复给药 2、4 和 8mg/kg,在治疗中出现的不良事件、生命体征、心电图发现或实验室检查方面没有明显的临床差异。药代动力学参数显示与剂量相关的关系,8mg/kg 时存在药物蓄积的证据(约两倍)。

结论

GR-MD-02 剂量处于从临床前数据确定的靶向治疗剂量的上限范围内,具有安全性和良好的耐受性,且具有药效学作用的证据。这些结果为 NASH 所致晚期纤维化的 2 期开发项目提供了支持。

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