Study to Evaluate the Safety and Efficacy of Larsucosterol in Participants With Alcohol-associated Hepatitis (AH)

RE-AHFIRM (RandomizEd Study of Larsucosterol in Alcohol-associated Hepatitis to Confirm saFety and effIcacy of tReatMent)

The primary purpose of this study is to evaluate the safety and efficacy of larsucosterol, as determined by transplant-free survival through Day 90 in participants with severe alcohol-associated hepatitis (AH) with pre-treatment Maddrey Discriminant Function (MDF) score greater than or equal to (>=) 32 and Model for End-stage Liver Disease (MELD) scores 21-30, inclusive.

Study Overview

• Status: Recruiting
• Conditions: Hepatitis
• Intervention / Treatment: Drug: Larsucosterol; Drug: Placebo

• Study Type: Interventional
• Enrollment (Estimated): 350
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Varsha Bhatt; Phone Number: 707-230-1712; Email: varsha.bhatt@bauschhealth.com
• Study Contact Backup: Name: Alycia Olsen; Phone Number: 201-846-8376; Email: Alycia.Olsen@bauschhealth.com

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • Recruiting
      • University of Alabama at Birmingham (UAB) Hospital
    • Mobile, Alabama, United States, 36602
      • Not yet recruiting
      • University Of South Alabama
  • Arizona
    • Phoenix, Arizona, United States, 85054
      • Not yet recruiting
      • Mayo Clinic - Phoenix
    • Phoenix, Arizona, United States, 85006
      • Recruiting
      • Banner - University Medical Center, Phoenix, Arizona
  • California
    • Coronado, California, United States, 92118
      • Not yet recruiting
      • Southern California GI & Liver Centers - Coronado
    • La Jolla, California, United States, 92037
      • Not yet recruiting
      • Scripps
    • Los Angeles, California, United States, 90048
      • Not yet recruiting
      • Cedars Sinai Medical Center
    • Los Angeles, California, United States, 90095
      • Not yet recruiting
      • UCLA Health - Ronald Reagan Medical Center
    • Redwood City, California, United States, 94063
      • Not yet recruiting
      • Stanford Medicine - Clinical and Translational Research Unit - Redwood City
    • Sacramento, California, United States, 95757
      • Not yet recruiting
      • University of California at Davis Medical Center
    • San Francisco, California, United States, 94109
      • Not yet recruiting
      • Sutter Health
  • Connecticut
    • New Haven, Connecticut, United States, 06510
      • Not yet recruiting
      • Yale School of Medicine
  • District of Columbia
    • Washington D.C., District of Columbia, United States, 20007
      • Not yet recruiting
      • Georgetown University Medical Center
  • Florida
    • Jacksonville, Florida, United States, 32202
      • Not yet recruiting
      • Mayo Clinic
    • Miami, Florida, United States, 33131
      • Not yet recruiting
      • Reliant Medical Research
    • Miami, Florida, United States, 33131
      • Not yet recruiting
      • University of Miami
    • Orlando, Florida, United States, 32804
      • Not yet recruiting
      • AdventHealth Transplant Institute
    • Tampa, Florida, United States, 33606
      • Not yet recruiting
      • Tampa General Hospital
    • Tampa, Florida, United States, 33602
      • Not yet recruiting
      • AdventHealth Medical Campus
  • Georgia
    • Atlanta, Georgia, United States, 30309
      • Recruiting
      • Piedmont Atlanta Hospital - Piedmont Transplant Institute
    • Augusta, Georgia, United States, 30901
      • Not yet recruiting
      • Augusta University
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Not yet recruiting
      • Rush University Medical Center
    • Chicago, Illinois, United States, 60601
      • Not yet recruiting
      • Northwestern University - Feinberg School of Medicine
    • Maywood, Illinois, United States, 60153
      • Not yet recruiting
      • Loyola University Medical Center (LUMC)
  • Indiana
    • Indianapolis, Indiana, United States, 46204
      • Not yet recruiting
      • Indiana Institute for Medical Research (Indiana VA)
  • Iowa
    • Iowa City, Iowa, United States, 52242
      • Recruiting
      • University of Iowa Hospitals & Clinics
  • Kentucky
    • Lexington, Kentucky, United States, 40507
      • Not yet recruiting
      • University of Kentucky -Chandler Medical Center
    • Louisville, Kentucky, United States, 40206
      • Not yet recruiting
      • Robley Rex VA Medical Center
  • Louisiana
    • New Orleans, Louisiana, United States, 70112
      • Recruiting
      • Tulane University Health Sciences Center - Tulane Avenue
  • Maine
    • Portland, Maine, United States, 04102-3134
      • Not yet recruiting
      • Maine Medical Center - Bramhall Campus
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Not yet recruiting
      • Johns Hopkins Hospital
    • Baltimore, Maryland, United States, 21202
      • Recruiting
      • Mercy Medical Center - The Institute for Digestive Health and Liver Disease
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Not yet recruiting
      • Massachusetts General Hospital
    • Boston, Massachusetts, United States, 02215
      • Not yet recruiting
      • Beth Israel Deaconess Medical Center
    • Boston, Massachusetts, United States, 02118
      • Not yet recruiting
      • Boston University School of Medicine
    • Boston, Massachusetts, United States, 02108
      • Not yet recruiting
      • Tufts Medical Center
    • Worcester, Massachusetts, United States, 01655
      • Not yet recruiting
      • Umass Chan Medical School
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • Not yet recruiting
      • University of Michigan
    • Detroit, Michigan, United States, 48202
      • Not yet recruiting
      • Henry Ford Hospital System
  • Minnesota
    • Minneapolis, Minnesota, United States, 55414-2924
      • Not yet recruiting
      • University of Minnesota Medical Center
  • Missouri
    • Kansas City, Missouri, United States, 64106
      • Not yet recruiting
      • Saint Luke's Hospital of Kansas City
  • Nevada
    • Las Vegas, Nevada, United States, 89101
      • Not yet recruiting
      • University of Nevada Las Vegas
  • New Jersey
    • Camden, New Jersey, United States, 08102
      • Not yet recruiting
      • Virtua Medical Group (VMG) - Virtua Center for Liver Disease - Toms River
    • Newark, New Jersey, United States, 07103-2425
      • Not yet recruiting
      • Rutgers University New Jersey Medical School
  • New Mexico
    • Albuquerque, New Mexico, United States, 87106-4713
      • Not yet recruiting
      • University of New Mexico (UNM) Hospital
  • New York
    • Manhasset, New York, United States, 11030
      • Recruiting
      • Northwell Health Physician Partners Sandra Atlas Bass Center for Liver Diseases
    • New York, New York, United States, 10016
      • Not yet recruiting
      • NYU Langone Health
    • New York, New York, United States, 10007
      • Not yet recruiting
      • Columbia University Medical Center (CUMC) - Presbyterian Hospital and Vanderbilt Clinic
    • Rochester, New York, United States, 14604
      • Not yet recruiting
      • University of Rochester Medical Center
    • The Bronx, New York, United States, 10467
      • Not yet recruiting
      • Montefiore Medical Center
  • North Carolina
    • Charlotte, North Carolina, United States, 28204
      • Not yet recruiting
      • Levine Cancer Institute / Atrium Health
    • Durham, North Carolina, United States, 27710
      • Not yet recruiting
      • Duke University Hospital
  • Ohio
    • Cleveland, Ohio, United States, 44106
      • Not yet recruiting
      • University Hospitals Cleveland Medical Center
    • Cleveland, Ohio, United States, 44114
      • Not yet recruiting
      • Cleveland Clinic
    • Columbus, Ohio, United States, 43210
      • Recruiting
      • The Ohio State University Wexner Medical Center (OSUWMC)
  • Oregon
    • Portland, Oregon, United States, 97204
      • Not yet recruiting
      • Oregon Health & Science University
  • Pennsylvania
    • Hershey, Pennsylvania, United States, 17033
      • Not yet recruiting
      • Penn State Health, Milton S. Hershey Medical Center
    • Philadelphia, Pennsylvania, United States, 19140
      • Not yet recruiting
      • Temple University Hospital
    • Philadelphia, Pennsylvania, United States, 19107
      • Not yet recruiting
      • Thomas Jefferson University Hospital
    • Philadelphia, Pennsylvania, United States, 19104
      • Not yet recruiting
      • University of Pennsylvania Hospital
    • Philadelphia, Pennsylvania, United States, 19104-4551
      • Not yet recruiting
      • VA Medical Center - Philadelphia
    • Philadelphia, Pennsylvania, United States, 19107
      • Not yet recruiting
      • Einstein Medical Center Philadelphia
    • Pittsburgh, Pennsylvania, United States, 15222
      • Not yet recruiting
      • University of Pittsburgh
  • South Carolina
    • Charleston, South Carolina, United States, 29425
      • Recruiting
      • Medical University of South Carolina
    • Charleston, South Carolina, United States, 29401
      • Not yet recruiting
      • Ralph H. Johnson Department of Veterans Affairs Medical Center
  • Tennessee
    • Chattanooga, Tennessee, United States, 37402
      • Not yet recruiting
      • Galen Medical Group - Galen Hepatology
    • Nashville, Tennessee, United States, 37219
      • Not yet recruiting
      • Vanderbilt University Medical Center
  • Texas
    • Dallas, Texas, United States, 75203
      • Recruiting
      • The Liver Institute at Methodist Dallas Medical Center
      • Contact: Parvez Mantry; Phone Number: 585-615-8870; Email: parvezmantry@mhd.com
    • Dallas, Texas, United States, 75246
      • Not yet recruiting
      • Baylor Scott White Research Institute - Dallas
    • Denton, Texas, United States, 76201
      • Not yet recruiting
      • North Texas Gastroenterology
    • Fort Worth, Texas, United States, 76104
      • Not yet recruiting
      • Baylor Scott & White All Saints Medical Center - Forth Worth
    • Houston, Texas, United States, 77030
      • Recruiting
      • Baylor College of Medicine (BCM) - Baylor Clinic
    • Houston, Texas, United States, 77002
      • Not yet recruiting
      • Clinical Trial Network - Houston
    • San Antonio, Texas, United States, 78205
      • Not yet recruiting
      • Methodist Healthcare - Methodist Hospital Specialty and Transplant
    • Temple, Texas, United States, 76501
      • Not yet recruiting
      • Baylor Scott White Research Institute - Temple
  • Utah
    • Murray, Utah, United States, 84107
      • Not yet recruiting
      • Intermountain Transplant Clinic
    • Salt Lake City, Utah, United States, 84132
      • Not yet recruiting
      • University of Utah Health - University of Utah
  • Virginia
    • Charlottesville, Virginia, United States, 22908
      • Recruiting
      • University of Virginia Health
    • Richmond, Virginia, United States, 23226
      • Recruiting
      • Bon Secours Liver Institute of Richmond
    • Richmond, Virginia, United States, 23249
      • Recruiting
      • Richmond VA Medical Center
  • Washington
    • Seattle, Washington, United States, 98101
      • Not yet recruiting
      • Swedish Medical Center
    • Seattle, Washington, United States, 98101
      • Not yet recruiting
      • UW Medicine-Harborview Medical Center
  • West Virginia
    • Huntington, West Virginia, United States, 25701
      • Not yet recruiting
      • Marshall Health
  • Wisconsin
    • Madison, Wisconsin, United States, 53703
      • Not yet recruiting
      • University of Wisconsin-Madison

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria-

A participant will be eligible for inclusion in this study if he/she meets all the following criteria:

1. Able to provide written informed consent (either from participant or participant's legally acceptable representative).
2. Onset of jaundice within 8 weeks before hospital admission.
3. Average daily consumption of greater than (>) 40 (females) or >60 (males) grams alcohol for 6 months or longer, with less than (<) 8 weeks of abstinence before the onset of jaundice. Judgment regarding daily and long-term alcohol use and onset of jaundice will be made and documented by the site Investigator.

4. The determination of AH will be based on typical serum chemistry (as determined by local laboratory):

   1. Serum total bilirubin >3.0 milligrams per deciliter (mg/dL) (required at randomization)
   2. ALT <400 international unit per Liter (IU/L) (required at randomization)
   3. 50 <AST <400 IU/L
   4. AST <400 IU/L (required at randomization)
   5. AST >50 IU/L (at any time since current hospital admission or leading to this current hospitalization)
   6. AST/ALT >1.5 (at any time since current hospital admission or leading to this current hospitalization)

5. Maddrey discriminant function (MDF) >=32, assuming a control prothrombin time of 12 seconds.

   NOTE: If a local laboratory's control time differs from 12 seconds, then the local laboratory's control time should be used. If control time is not stated or is stated as a range, the control time should be calculated by the formula prothrombin time/INR.

6. Original Model for End-stage Liver Disease (MELD; not MELD-Na) score: 21-30 (inclusive).
7. Male or female participants 18 years of age or older.
8. Women of child-bearing potential (defined as females who are not surgically sterile or who are not over the age of 52 and amenorrheic for at least 12 months) must utilize appropriate birth control throughout the 90-day portion of the study. Acceptable methods that may be used are abstinence, birth control pills ("The Pill") or patch, diaphragm, IUD (coil), vaginal ring, condom, surgical sterilization or progestin implant or injection, or sexual activity limited to a sterile (e.g., vasectomized) male partner.
9. Male participants must agree to use a medically acceptable method of contraception/birth control and refrain from sperm donation throughout the 90-day portion of the study.
10. Participants must agree to participate in an alcohol abstinence support program recommended by the local institution's addiction specialists.
11. Participants must be dosed within 9 calendar days (216 hours) of hospital admission inclusive of time spent in other hospital(s)

Exclusion Criteria-

A participant will be excluded from the study if he or she meets any of the following criteria:

1. Participants using systemic corticosteroids for current AH before enrollment or having a history of using systemic corticosteroids for more than 8 days in the last 30 days prior to screening.

   NOTE: Inhaled, topical, or local corticosteroid injections are permitted NOTE: A participant who has a confirmed diagnosis of hypoadrenalism and is taking a physiological replacement dose of hydrocortisone (or equivalent) is permitted to take part in the trial

2. Participants experiencing or considered at high risk for alcohol withdrawal seizures or delirium tremens.

3. Active infection (such as spontaneous bacterial peritonitis [SBP], urinary tract infection [UTI], cellulitis, pneumonia, bacteremia, acute viral hepatitis, uncontrolled HIV, and active SARS CoV2 infection).

   1. Participants who are febrile with leukocytosis are also excluded until active infection has been excluded to the satisfaction of the PI in consultation with the medical monitor.
   2. Participants with bacterial infections may be enrolled provided they remain in the enrollment window and the infection is adequately treated. For example, participants with bacterial peritonitis may be considered for enrollment once the infection has been treated and follow up paracentesis confirms the absence of SBP.
   3. Participants with systemic fungal infection of any kind cannot be considered for this trial.
4. Serum creatinine >2.5 mg/dL.
5. Participants undergoing continuous veno-venous hemodialysis (CVVH).
6. Gastrointestinal bleeding not controlled by local therapy (i.e., band ligation or injection sclerotherapy). Participant who are at high risk of rebleeding or likely in need of TIPS insertion should be excluded.
7. TIPS insertion or variceal embolization within the last 4 weeks.
8. Known portal vein occlusion.
9. A history of pre-admission refractory ascites defined as more than 4 paracenteses in the previous 8 weeks despite diuretic therapy.
10. Liver biopsy (if carried out) with findings not compatible with AH. NOTE: A post-dose liver biopsy that is not compatible with AH will not be considered a protocol deviation.
11. Stage >=3 hepatic encephalopathy by West Haven criteria.

12. Participants with medical conditions that are expected to pose a high risk of short-term (less than or equal to [<=] 90 days) mortality unrelated to alcohol-associated hepatitis, or that may confound assessment of 90-day survival in the Investigator's judgement. Examples include, but are not limited to:

    1. Severe concomitant cardiopulmonary disease (e.g., New York Heart Association [NYHA] Class III or IV heart failure)
    2. Clinically significant cardiac arrhythmia (e.g., sustained ventricular tachycardia, unmanaged atrial fibrillation, QTc >=500 msec, or high-grade AV block)
    3. Ventilator-dependent respiratory failure, or Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stage III or IV chronic obstructive pulmonary disease [COPD])
    4. End-stage renal disease requiring chronic, ongoing dialysis
    5. Severe uncontrolled endocrine or metabolic disorders
    6. Severe psychiatric illness likely to interfere with study participation
    7. Hypotension/shock as defined by the North American Consortium for the study of End-stage Liver Disease (NACSELD) criteria (i.e., Mean Arterial Pressure [MAP] <60 millimeter of mercury (mmHg), despite adequate fluid resuscitation and cardiac output)

13. Other concomitant cause(s) of liver disease as a result of:

    1. Autoimmune liver disease
    2. Ischemic hepatitis
    3. Wilson disease or alpha 1 antitrypsin deficiency
    4. Vascular liver disease (e.g., Budd-Chiari)
    5. Drug induced liver disease
    6. Surface antigen positive hepatitis B (HBsAg+). NOTE: Participants with isolated core antibody (anti-HBc) or who are on stable antiviral medication with known viral suppression are not excluded, but appropriate HBV prophylaxis should be considered if steroid dosing >4 weeks is anticipated.
    7. Acute hepatitis A (if test performed per SOC)
    8. Acute HCV or chronic hepatitis C with a history of decompensated cirrhosis. NOTE: participants with stable chronic HCV or successfully treated HCV are not excluded
    9. Acute hepatitis E (if test performed per SOC)
    10. Acute cytomegalovirus (CMV) viral hepatitis (if test performed per SOC)
14. Any known active malignancy or any malignancy diagnosed within the last five years other than curable skin cancer (basal cell or squamous cell carcinomas).
15. Existing or intended pregnancy or breast feeding.
16. Participation in another interventional clinical trial within 30 days of Screening.
17. History of organ transplantation other than corneal transplant.
18. Underlying disease that, in the opinion of the site Investigator, might be complicated or exacerbated by proposed treatments or might confound assessment of study drug.
19. Participant listed for liver transplant (LT) prior to study drug administration.
20. Concern of participant's willingness and ability to be compliant with the schedule of protocol assessments, per the Investigator's judgement.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Larsucosterol 30 mg; Participants will receive Larsucosterol 30 milligrams (mg) intravenous infusion on Day 1.	Drug: Larsucosterol; Larsucosterol intravenous infusion.; Other Names: DUR928; DV928
Placebo Comparator: Placebo; Participants will receive intravenous infusion of placebo matched to Larsucosterol on Day 1.	Drug: Placebo; Matching-placebo (sterile water for injection) intravenous infusion.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Transplant Free Survival up to Day 90	Up to Day 90

Secondary Outcome Measures

Outcome Measure	Time Frame
Overall Survival at Day 90	Day 90
Time to Death up to Day 90	Up to Day 90
Number of Participants with Days Alive and Out of Hospital up to Day 90	Up to Day 90
Time to First Post Discharge All-cause Hospitalization up to Day 90	Up to Day 90
Number of Participants with Intensive Care Unit (ICU) Utilization up to Day 90	Up to Day 90
Change from Baseline in Model for End-Stage Liver Disease (MELD) Score	Day 7 up to Day 180
Change from Baseline in Bilirubin Levels	Up to Day 180
Transplant Free Survival up to Day 180	Up to Day 180
Overall Survival at Day 180	Day 180

Collaborators and Investigators

• Sponsor: Bausch Health Americas, Inc.
• Collaborators: Durect
• Investigators: Study Director: Jimin Lee, MD, Bausch Health Americas, Inc.

Study record dates

Study Major Dates

• Study Start (Actual): January 29, 2026
• Primary Completion (Estimated): November 1, 2027
• Study Completion (Estimated): February 1, 2028

Study Registration Dates

• First Submitted: February 19, 2026
• First Submitted That Met QC Criteria: February 19, 2026
• First Posted (Actual): February 23, 2026

Study Record Updates

• Last Update Posted (Actual): July 22, 2026
• Last Update Submitted That Met QC Criteria: July 21, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Alcoholic hepatitis; alcohol-associated liver disease (ALD); Liver transplant (LT); Alcohol-associated hepatitis (AH)
• Additional Relevant MeSH Terms: Digestive System Diseases; Liver Diseases; Substance-Related Disorders; Chemically-Induced Disorders; Alcohol-Related Disorders; Liver Diseases, Alcoholic; Alcohol-Induced Disorders; Hepatitis; Hepatitis, Alcoholic
• Other Study ID Numbers: LCAH3141

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No