Liver Cirrhosis Network Rosuvastatin Efficacy and Safety for Cirrhosis in the United States (LCN RESCU)

Liver Cirrhosis Network (LCN) Rosuvastatin Efficacy and Safety for Cirrhosis in the United States (RESCU): A Double-Blind Randomized, Placebo-Controlled Phase 2 Study

This is a double-blind, phase 2 study to evaluate safety and efficacy of rosuvastatin in comparison to placebo after 2 years in patients with compensated cirrhosis.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

This study is a randomized, double-blind, placebo-controlled Phase 2 clinical trial, of 20mg of rosuvastatin by mouth, once daily. Participants will be randomized (1:1) to either once daily placebo or once daily rosuvastatin.

Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily. After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.

The total duration of the study will be 96 weeks in the assigned treatment arm plus the 4-week lead-in period. The primary outcome will be the mean change in liver stiffness from the baseline measurement to the end of study liver stiffness, as measured by ultrasound-based vibration-controlled transient elastography (VCTE).

There are 10 participating clinical centers, and we anticipate a total of 260 patients will be recruited for the initial lead-in as we estimate 20% of participants may dropout after the lead-in (260 x 0.8 = 208 for randomization into the study drug treatment phase).

Study Type

Interventional

Enrollment (Estimated)

260

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

    • California
      • La Jolla, California, United States, 92035
        • Recruiting
        • University of California San Diego NAFLD Research Center
        • Contact:
      • Los Angeles, California, United States, 90033
      • Los Angeles, California, United States, 90033
      • San Francisco, California, United States, 94143
      • San Francisco, California, United States, 94110
        • Recruiting
        • UCSF/Zuckerberg San Francisco General Hospital and Trauma Center
        • Contact:
    • Florida
      • Miami, Florida, United States, 33122
    • Michigan
      • Ann Arbor, Michigan, United States, 48109
    • Minnesota
      • Rochester, Minnesota, United States, 55901
    • New York
      • New York, New York, United States, 10021
      • New York, New York, United States, 10031
        • Recruiting
        • Columbia University Iriving School of Medicine
        • Contact:
    • North Carolina
    • Ohio
      • Cleveland, Ohio, United States, 44192
        • Recruiting
        • Cleveland Clinic
        • Contact:
    • Virginia
      • Richmond, Virginia, United States, 23298

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria

  1. Age 18-75 years

  2. Cirrhosis due to NAFLD, ALD, or chronic viral hepatitis (treated HBV or HCV)

  3. Clinical diagnosis of cirrhosis as defined by investigator confirmation and the following:

    a. At least one liver biopsy within 5 years prior to consent showing either: Metavir stage 4 fibrosis; Ishak Stage 5-6 fibrosis, OR b. At least 2 of the following: i. Evidence on imaging: Nodular liver with either splenomegaly or recanalized umbilical vein within the past 48 weeks ii. Liver stiffness: VCTE within 48 weeks prior to consent or during Screening ≥15.0 kPa or MRE within 48 weeks prior to consent or during Screening ≥5 kPa iii. Evidence of varices demonstrated on imaging or endoscopy within 3 years prior to consent or during Screening iv. Either: FIB-4>2.67 or platelets <150/mL within 6 months prior to consent or during Screening

  4. Two measures of VCTE: one at screening and one at the open-label dispense study visit, meeting the following criteria:

    1. The first measure must be ≥ 15.0 kPa.
    2. The two measures must be at least 2 hours apart and no more than 60 days apart from one another.
    3. The mean of two measurements must be ≥ 15.0 kPa.
    4. Additionally, both screening and open-label dispense liver stiffness measures must be ≤50 kPa
  5. Compensated defined by:

    1. Absence of ascites/hydrothorax, hepatic encephalopathy or variceal bleeding currently or in the last 48 weeks, as determined clinically by investigator.
    2. If prior history of decompensation, must be without current symptoms of decompensation and no longer requiring treatment of complications for the last 48 weeks, including the use of diuretics for the treatment of ascites, and/or rifaximin or lactulose for the treatment of hepatic encephalopathy. Use of non-selective beta blockers will be allowed.
    3. Child-Pugh score <8
  6. Provision of written informed consent. Exclusion Criteria

  1. Currently on a statin or any statin exposure within 24 weeks prior to consent.

  2. Known indication for statin therapy, defined as:

    1. Prior peripheral vascular, cardiovascular or cerebrovascular event for which statins are indicated for secondary prevention, OR
    2. Documented familial hypercholesterolemia, heterozygous familial hypercholesterolemia, OR
    3. Fasting LDL-C ≥ 190 mg/dL
  3. Myocardial infarction, Unstable angina, transient ischemic events, or stroke within 24 weeks of screening.

  4. Alcohol Use Disorder Identification Test (AUDIT) total score of ≥8 at screening.

  5. Patients with limitations in attending study visits.

  6. Prisoners.

  7. Known prior or current hepatocellular carcinoma (HCC) or cholangiocarcinoma.

  8. Known transjugular intrahepatic portosystemic shunt (TIPS), balloon retrograde transvenous obliteration (BRTO) or porto-systemic shunt surgery regardless of time of occurrence.

  9. Current (in past 24 weeks prior to consenting) use of medications known to cause hepatic fibrogenesis or confound endpoint assessment, defined as:

    1. amiodarone
    2. methotrexate
    3. warfarin
  10. Current (in past 24 weeks prior to consenting) use of medications which may increase risk for rosuvastatin-related myositis or DILI, defined as:

    1. fenofibrate

    2. erythromycin

    3. gemfibrozil

    4. niacin (500 mg or more)

    5. HIV protease inhibitors (darunivar, indinavir, nelfinavir, amprenavir)

    6. colchicine

    7. cyclosporin

    8. Additional medications that will be excluded:

      atazanavir/ritonavir capmatinib darolutamide dasabuvir/ombitasvir/paritaprevir/ritonavir ledipasvir/sofosbuvir elbasvir/grazoprevir erythromycin lopinavir/ritonavir regorafenib ritonavir, in any combination simeprevir sofbuvir/velpatasvir/voxilaprevir sofosbuvir/velpatasvir tafamidis tamoxifen teriflunomide

      *If exposure was for 7 or less days for one of these medications can consider enrollment after 28 days from final dose.

  11. Presence of portal or hepatic vein thrombosis

  12. Diagnosis of untreated hypothyroidism or on unstable treatment regimen for hypothyroidism

  13. Receiving an elemental diet or parenteral nutrition

  14. Chronic pancreatitis or pancreatic insufficiency

  15. Etiology of cirrhosis other than ALD, NAFLD, or viral hepatitis (excluded diagnoses include cryptogenic immune-mediated such as AIH, PSC and PBC, cardiac cirrhosis or Fontan-associated liver disease, A1AT, Wilson's disease, etc.)

  16. Conditions which may confound study outcome:

    a. Unstable or active inflammatory bowel disease b. Active infection c. Any malignant disease (other than squamous or basal cell carcinoma of the skin) within previous 3 years d. Prior solid organ or hematopoietic cell transplant e. Bariatric surgery in the last 24 weeks prior to consent or planned bariatric surgery within the next 96 weeks f. Current liver-unrelated end-stage organ failures such as end-stage renal disease on dialysis, stage 3-4 congestive heart failure (CHF), current chronic obstructive pulmonary disease (COPD) on home oxygen.

  17. Known current medical or psychiatric conditions which, in the opinion of the investigator, would make the participant unsuitable for the study for safety reasons or interfere with or prevent adherence to the protocol.

  18. The following laboratory abnormalities within 90 days of screening:

    a. Hemoglobin <10 g/dL b. Albumin <3.0 g/dL c. Prolonged international normalized ratio (INR) >1.5 d. Total bilirubin ≥ 2.0 mg/dl (unless due to Gilbert's syndrome or hemolysis as denoted by normal direct bilirubin fraction) e. Direct bilirubin ≥ 0.9 f. Uncontrolled diabetes (HbA1c ≥ 9.5%) within past 90 days.

  19. Kidney function abnormalities including:

    1. Dialysis
    2. Baseline eGFR < 30 cc/min with CKD-Epi equation
    3. Known nephrotic proteinuria, defined as 3g or greater of protein in 24-hour urine collection
  20. Recent (within 48 weeks) or present hepatic decompensation with ascites/hydrothorax, hepatic encephalopathy or variceal bleeding

  21. Untreated chronic hepatitis B or C infection

    1. HCV eligible for enrollment if HCV RNA negative at baseline or documentation of prior SVR12
    2. HBV eligible if an HBV DNA <100 IU/mL within the last 48 weeks and on treatment
  22. Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 200 U/L within the past 24 weeks or alkaline phosphatase (ALP) ≥ 300.

  23. Documented history of intolerance to statins

  24. Serious comorbid medical disease which in the investigator's opinion renders a life-expectancy less than 96 weeks

  25. Active illicit substance use (other than THC), including inhaled or injected drugs, in the 24 weeks prior to screening

  26. Pregnancy, planned pregnancy or breastfeeding

  27. Current participation in active medication treatment trials (within 24 weeks prior to randomization) or planned participation in active medication treatment trials simultaneous to participation in present trial.

  28. Significant existing muscle pain or tenderness or prior history of myasthenia gravis as determined by a site physician.

  29. Failure or inability to provide informed consent.

  30. East Asian Descent within one degree of relatedness (e.g., if the participant's parents are of East Asian descent)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Active

Open-label lead-in period of 4 weeks on 20 mg rosuvastatin by mouth once daily, followed by a period of 96 weeks rosuvastatin 20 mg daily.

Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily . After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.

Other Names:
  • Rosuvastatin 20 mg
Placebo Comparator: Placebo

Open-label lead-in period of 4 weeks on 20 mg rosuvastatin by mouth once daily, followed by a period of 96 weeks placebo.

Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily . After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.

Other Names:
  • Rosuvastatin 20 mg

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mean change in liver stiffness
Time Frame: 96 weeks

Mean change in liver stiffness as measured in kilopascal with Vibration-Controlled Transient Elastography between study entry and week 96. Range: 2 to 75 kilopascal. Higher stiffness indicates increased disease progression

96 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time to disease progression
Time Frame: 96 weeks

Time to disease progression defined as time to development of decompensation event (ascites, hepatic encephalopathy, variceal bleed) or hepatocellular carcinoma. Analyzed as time-to-event; binary if low counts.

96 weeks
All-cause mortality
Time Frame: 96 weeks

All-cause mortality: time-to-event, binary if low counts

96 weeks
Time to development of ascites
Time Frame: 96 weeks

Ascites: time-to-event, binary if low counts

96 weeks
Time to development of overt hepatic encephalopathy
Time Frame: 96 weeks

Time to development of overt hepatic encephalopathy: time-to-event, binary if low counts

96 weeks
Time to development of variceal bleed
Time Frame: 96 weeks

Variceal bleed: time-to-event, binary if low counts

96 weeks
Time to development of hepatocellular carcinoma
Time Frame: 96 weeks

Hepatocellular carcinoma: time-to-event, binary if low counts

96 weeks
Change in spleen stiffness as measured by Vibration-Controlled Transient Elastography (VCTE)
Time Frame: 96 weeks

Units: kilopascal; Range: 5 to 100 kilopascal; higher stiffness indicates increased disease progression

96 weeks
Change in Child-Turcotte-Pugh score
Time Frame: 96 weeks

Ordinal score from 5 to 15; higher score indicates further disease progression

96 weeks
Change in Model for End Stage Liver Disease - Sodium (MELD-Na)
Time Frame: 96 weeks

Unitless; Range: 6-40; higher score indicates further disease progression

96 weeks
Change in liver stiffness via Magnetic Resonance Elastography
Time Frame: 96 weeks

Units: kilopascal; Range: 0 to 20; higher stiffness indicates increased disease progression

96 weeks
Change in Enhanced Liver Fibrosis test
Time Frame: 96 weeks

Unitless; Range: 5 to 11; Higher score is worse

96 weeks
Change in Fibrosis-4
Time Frame: 96 weeks

Unitless; Range: 0 to 10; higher score indicates more stiffness

96 weeks
Change in patient-reported quality of life scores
Time Frame: 96 weeks

Patient Reported Outcomes Measurement Information System (29-item version) Global Health T-Score: Population centered at 50 points, standard deviation of 10 (higher score signifies "better" health)

96 weeks
Rate of adverse events
Time Frame: 96 weeks

Count

96 weeks
Rate of serious adverse events
Time Frame: 96 weeks

Count

96 weeks
Rate of adverse events of special interest
Time Frame: 96 weeks

Rate of adverse events of special interest (myopathy, drug-induced liver injury, cardiovascular events, cancer other than hepatocellular carcinoma, new onset diabetes as separate outcomes): Count

96 weeks
Time to cardiovascular events
Time Frame: 96 weeks

Cardiovascular events: time-to-event, binary if low counts

96 weeks
Time to new onset diabetes
Time Frame: 96 weeks

New onset diabetes: time-to-event, binary if low counts

96 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Investigators

  • Principal Investigator: Abigail Smith, PhD, Northwestern University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 7, 2023

Primary Completion (Estimated)

August 31, 2029

Study Completion (Estimated)

August 31, 2029

Study Registration Dates

First Submitted

March 24, 2023

First Submitted That Met QC Criteria

April 14, 2023

First Posted (Actual)

April 27, 2023

Study Record Updates

Last Update Posted (Actual)

September 28, 2026

Last Update Submitted That Met QC Criteria

September 23, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Other Study ID Numbers

  • Pro00070580
  • 5U24DK130164-04 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Dataset with National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Repository.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ICF

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.