Saroglitazar Magnesium pro léčbu nealkoholické steatohepatitidy s fibrózou (NASH)
Fáze 2b, prospektivní, multicentrická, randomizovaná, dvojitě zaslepená, placebem kontrolovaná studie k hodnocení účinnosti a bezpečnosti saroglitazar magnesia u pacientů s nealkoholickou steatohepatitidou a fibrózou
Saroglitazar Magnesium for the Treatment of Nonalcoholic Steatohepatitis
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
A Phase 2b, Prospective, Multicenter, Randomized, Double-blind, Placebo-controlled Study to Evaluate Efficacy and Safety of Saroglitazar Magnesium in Subjects with Nonalcoholic Steatohepatitis and Fibrosis.
Typ studie
Typ studie
Zápis (Aktuální)
Zápis
Fáze
Fáze
- Fáze 2
Kontakty a umístění
Studijní místa
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Buenos Aires, Argentina, B1629ODT
- Zydus AR004
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CABA, Argentina, C1056ABJ
- Zydus AR001
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CABA, Argentina, C1180AAX
- Zydus AR013
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CABA, Argentina, C1199ABB
- Zydus AR007
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CABA, Argentina, C1221ADC
- Zydus AR006
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CABA, Argentina, C1264AAA
- Zydus AR005
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CABA, Argentina, C1425AGC
- Zydus AR008
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CABA, Argentina, C1426ABP
- Zydus AR012
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CABA, Argentina, CP143CKE
- Zydus AR003
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Mar del Plata, Argentina, B7600
- Zydus AR009
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Mar del Plata, Argentina
- Zydus AR011
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Ramos Mejía, Argentina
- Zydus AR002
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Rosario, Argentina, S2002KDS
- Zydus AR010
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Puerto Rico
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San Juan, Puerto Rico, Portoriko, 00927
- Zydus US097
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Alabama
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Birmingham, Alabama, Spojené státy, 35294
- Zydus US032
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Homewood, Alabama, Spojené státy, 35209
- Zydus US079
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Arizona
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Phoenix, Arizona, Spojené státy, 85013
- Zydus US047
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Tucson, Arizona, Spojené státy, 85712
- Zydus US025
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Tucson, Arizona, Spojené státy, 85712
- Zydus US087
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Tucson, Arizona, Spojené státy, 85724
- Zydus US029
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California
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Chula Vista, California, Spojené státy, 91911
- Zydus US118
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Fresno, California, Spojené státy, 93720
- Zydus US041
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Gardena, California, Spojené státy, 90247
- Zydus US111
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Huntington Park, California, Spojené státy, 90255
- Zydus US013
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La Jolla, California, Spojené státy, 92037
- Zydus US065
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Lancaster, California, Spojené státy, 93534
- Zydus US094
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Long Beach, California, Spojené státy, 90808
- Zydus US080
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Long Beach, California, Spojené státy, 90815
- Zydus US090
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Los Angeles, California, Spojené státy, 90027
- Zydus US022
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Los Angeles, California, Spojené státy, 90033
- Zydus US062
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Murrieta, California, Spojené státy, 92563
- Zydus US023
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Orange, California, Spojené státy, 92868
- Zydus US052
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Panorama City, California, Spojené státy, 91402
- Zydus US012
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Colorado
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Aurora, Colorado, Spojené státy, 80045
- Zydus US039
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Florida
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Clearwater, Florida, Spojené státy, 33761
- Zydus US122
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Fort Myers, Florida, Spojené státy, 33907
- Zydus US057
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Hallandale, Florida, Spojené státy, 33009
- Zydus US108
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Hialeah Gardens, Florida, Spojené státy, 33016
- Zydus US096
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Lakeland, Florida, Spojené státy, 33803
- Zydus US003
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Lakewood Rch, Florida, Spojené státy, 34211
- Zydus US016
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Largo, Florida, Spojené státy, 33777
- Zydus US125
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Maitland, Florida, Spojené státy, 32751
- Zydus US001
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Maitland, Florida, Spojené státy, 32751
- Zydus US124
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Miami, Florida, Spojené státy, 33014
- Zydus US007
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Miami, Florida, Spojené státy, 33135
- Zydus US024
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Miami, Florida, Spojené státy, 33136
- Zydus US034
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Miami, Florida, Spojené státy, 33136
- Zydus US038
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Miami, Florida, Spojené státy, 33155
- Zydus US121
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Miami, Florida, Spojené státy, 33173
- Zydus US054
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Miami Lakes, Florida, Spojené státy, 33016
- Zydus US098
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Naples, Florida, Spojené státy, 34102
- Zydus US099
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Ocala, Florida, Spojené státy, 34471
- Zydus US081
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Orlando, Florida, Spojené státy, 32806
- Zydus US085
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Port Orange, Florida, Spojené státy, 32127
- Zydus US104
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Winter Park, Florida, Spojené státy, 32789
- Zydus US004
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Georgia
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Dalton, Georgia, Spojené státy, 30720
- Zydus US107
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Gainesville, Georgia, Spojené státy, 30501
- Zydus US113
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Marietta, Georgia, Spojené státy, 30060
- Zydus US114
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Savannah, Georgia, Spojené státy, 31406
- Zydus US119
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Indiana
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Indianapolis, Indiana, Spojené státy, 46202
- Zydus US020
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Iowa
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West Des Moines, Iowa, Spojené státy, 50652
- Zydus US100
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Kansas
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Kansas City, Kansas, Spojené státy, 66160
- Zydus US049
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Louisiana
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Houma, Louisiana, Spojené státy, 70363
- Zydus US071
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Marrero, Louisiana, Spojené státy, 70072
- Zydus US014
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West Monroe, Louisiana, Spojené státy, 71291
- Zydus US123
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Massachusetts
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Boston, Massachusetts, Spojené státy, 02215
- Zydus US017
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Michigan
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Chesterfield, Michigan, Spojené státy, 48047
- Zydus US092
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Wyoming, Michigan, Spojené státy, 49519
- Zydus US019
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Minnesota
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Saint Paul, Minnesota, Spojené státy, 55101
- Zydus US115
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Missouri
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Columbia, Missouri, Spojené státy, 65201
- Zydus US074
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Kansas City, Missouri, Spojené státy, 64131
- Zydus US120
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Nevada
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Reno, Nevada, Spojené státy, 89511
- Zydus US116
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New Jersey
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Sparta, New Jersey, Spojené státy, 07871
- Zydus US077
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New York
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Manhasset, New York, Spojené státy, 11030
- Zydus US069
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New York, New York, Spojené státy, 10033
- Zydus US066
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North Carolina
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Asheville, North Carolina, Spojené státy, 28801
- Zydus US018
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Charlotte, North Carolina, Spojené státy, 28204
- Zydus US027
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Ohio
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Cincinnati, Ohio, Spojené státy, 45044
- Zydus US010
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Cincinnati, Ohio, Spojené státy, 45267-0595
- Zydus US009
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Cleveland, Ohio, Spojené státy, 44109
- Zydus US035
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Springboro, Ohio, Spojené státy, 45066
- Zydus US072
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Pennsylvania
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Hershey, Pennsylvania, Spojené státy, 17033
- Zydus US060
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Philadelphia, Pennsylvania, Spojené státy, 19141
- Zydus US053
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South Carolina
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Charleston, South Carolina, Spojené státy, 29401
- Zydus US015
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Charleston, South Carolina, Spojené státy, 29425
- Zydus US030
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Columbia, South Carolina, Spojené státy, 29204
- Zydus US073
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Greenwood, South Carolina, Spojené státy, 29646
- Zydus US075
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Summerville, South Carolina, Spojené státy, 29485
- Zydus US112
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Tennessee
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Hermitage, Tennessee, Spojené státy, 37067
- Zydus US011
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Nashville, Tennessee, Spojené státy, 37232
- Zydus US028
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Texas
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Arlington, Texas, Spojené státy, 76012
- Zydus US002
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Austin, Texas, Spojené státy, 78745
- Zydus US051
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Austin, Texas, Spojené státy, 78757
- Zydus US101
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Bellaire, Texas, Spojené státy, 77401
- Zydus US089
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Brownsville, Texas, Spojené státy, 78520
- Zydus US105
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Edinburg, Texas, Spojené státy, 78539
- Zydus US095
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Edinburg, Texas, Spojené státy, 78539
- Zydus US106
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Fort Worth, Texas, Spojené státy, 76104
- Zydus US061
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Houston, Texas, Spojené státy, 77030
- Zydus US067
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Houston, Texas, Spojené státy, 77030
- Zydus US109
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Houston, Texas, Spojené státy, 77058
- Zydus US005
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Houston, Texas, Spojené státy, 77079
- Zydus US110
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Katy, Texas, Spojené státy, 77084
- Zydus US117
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San Antonio, Texas, Spojené státy, 78215
- Zydus US031
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San Antonio, Texas, Spojené státy, 78222
- Zydus US103
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San Antonio, Texas, Spojené státy, 78229
- Zydus US036
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San Antonio, Texas, Spojené státy, 78229
- Zydus US102
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San Antonio, Texas, Spojené státy, 78234
- Zydus US043
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San Antonio, Texas, Spojené státy, 78240
- Zydus US008
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Waco, Texas, Spojené státy, 76712
- Zydus US078
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Wichita Falls, Texas, Spojené státy, 76301
- Zydus US076
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Utah
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Ogden, Utah, Spojené státy, 84405
- Zydus US088
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Virginia
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Manassas, Virginia, Spojené státy, 20110
- Zydus US070
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Richmond, Virginia, Spojené státy, 23236
- Zydus US082
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Richmond, Virginia, Spojené státy, 23298
- Zydus US021
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Adana, Turecko (Türkiye), 01240
- Zydus TR003
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Ankara, Turecko (Türkiye), 06230
- Zydus TR002
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Ankara, Turecko (Türkiye), 06800
- Zydus TR001
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Bursa, Turecko (Türkiye), 16059
- Zydus TR004
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Gaziantep, Turecko (Türkiye), 27310
- Zydus TR005
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Istanbul, Turecko (Türkiye), 34093
- Zydus TR009
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Istanbul, Turecko (Türkiye), 34760
- Zydus TR008
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Izmir, Turecko (Türkiye), 35100
- Zydus TR007
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Izmir, Turecko (Türkiye), 35150
- Zydus TR006
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Kayseri, Turecko (Türkiye), 38039
- Zydus TR011
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Kocaeli, Turecko (Türkiye), 41000
- Zydus TR010
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Mersin, Turecko (Türkiye), 33110
- Zydus TR012
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Rize, Turecko (Türkiye), 53020
- Zydus TR013
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Trabzon, Turecko (Türkiye), 61080
- Zydus TR014
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Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
- Males or females, between 18 and 75 years of age, both inclusive at screening.
- BMI ≤45 kg/m²
- Histological confirmation of NASH with liver fibrosis by central pathologist on a diagnostic liver biopsy with a NAS ≥4 with at least one-point score in each of the three components of the NAFLD activity score [NAS] (steatosis scored 0-3, ballooning degeneration scored 0-2, and lobular inflammation scored 0-3) and NASH by pattern recognition Note: The biopsy must not have been performed more than 24 weeks before randomization.
- The subjects must have a stable body weight (no more than 5% change) between the time of biopsy and randomization.
- Fibrosis stage 2 and 3, according to the NASH CRN fibrosis staging, reported by central pathologist.
- If the subjects have type 2 diabetes mellitus, then it must be moderately controlled with HbA1c ≤ 9.5% and on a stable dose of permitted anti-diabetic medication for at least 90 days before screening until randomization.
- If the subjects are taking vitamin E > 400 IU/day, then it must be on a stable dose for at least 24 weeks prior to screening or, if a historical biopsy is used, at least 24 weeks prior to baseline liver biopsy until randomization.
- Must provide written informed consent and agree to comply with the trial protocol.
Exclusion Criteria:
-
Consumption of >2 units of alcohol per day (>14 units per week) if male and >1 units of alcohol per day (>7 units per week) if female for at least 12 consecutive weeks within 5 years before screening (Note: 1 unit = 12 ounces of beer, 4 ounces of wine or 1 ounce of spirits/hard liquor)
-
History or presence of other concomitant liver diseases at screening:
- Chronic hepatitis B (HBV) or hepatitis C virus (HCV) infection (However, If the subject has been treated for the HCV infection and has been cured at least 5 years from screening, such subjects can be enrolled in the study)
- Primary biliary cholangitis (PBC)
- Primary sclerosing cholangitis (PSC)
- Definite autoimmune liver disease or overlap syndrome
- Alcoholic liver disease
- Hemochromatosis
- Wilsons disease
- Alpha-1 antitrypsin deficiency
-
Subject with known cirrhosis, either based on histology, clinical criteria or any non-invasive diagnostic modality, within 24 weeks prior to the randomization.
-
Evidence of portal hypertension (low platelet count, esophageal varices, ascites, history of hepatic encephalopathy, splenomegaly) at screening.
-
Treatment with glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium glucose cotransporter- 2 (SGLT-2) inhibitors, and dipeptidyl peptidase 4 inhibitors (gliptins) unless stable for 120 days prior to screening or, if a historical biopsy is used, from 120 days prior to baseline liver biopsy until randomization.
-
Use of concurrent medications prior to screening including:
- Anti-NASH therapy(s) including S-adenosyl methionine (SAMe), ursodeoxycholic acid (UDCA), and obeticholic acid in the period from 90 days prior to screening or, if a historical biopsy is used, from 90 days prior to baseline liver biopsy until randomization. For resmetirom; 120 days prior to screening or if a historical biopsy is used, from 120 days prior to baseline liver biopsy until randomization.
- Antidiabetic mediation which may impact NASH histology including thiazolidinediones (pioglitazone, rosiglitazone) in the period from 90 days prior to screening or, if a historical biopsy is used, from 90 days prior to baseline liver biopsy until randomization.
- Immune modulatory agents including anti-TNF-α therapies (infliximab, adalimumab, etanercept) or anti-integrin therapy (namixilab) in the period from 28 days prior to screening or if a historical biopsy is used from 28 days prior to baseline liver biopsy until randomization.
- Any treatment or anticipated initiation (intended use for more than 14 consecutive days) of medications known to have an effect on steatosis (e.g. treatment with corticosteroids [topical and inhaled are allowed]), methotrexate, tamoxifen, valproic acid, amiodarone or tetracycline, estrogens in doses higher than used in oral contraceptives, vitamin A, L-asparaginase, valproate, chloroquine, or antiretroviral drugs in the period from 28 days prior to screening or, if a historical biopsy is used, from 28 days prior to baseline liver biopsy until randomization.
- Treatment with orlistat, zonisamide, topiramate, phentermine, lorcaserin, bupropion, or naltrexone alone, or in combination or any other medication, that could promote weight loss, in the opinion of the investigator, in the period from 28 days prior to screening or if a historical biopsy is used from 28 days prior to baseline liver biopsy until randomization.
-
Changing doses of statins (simvastatin, pitavastatin, pravastatin, atorvastatin, fluvastatin, lovastatin, rosuvastatin) or fibrates (clofibrate, Fenofibrate) in the 90 days preceding screening until randomization.
-
Use of drugs that are known CYP2C8 inhibitors/substrate in the 28 days preceding screening until randomization.
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History of liver transplant
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Any weight reduction surgery in the 2 years prior to screening or planned during the study (weight reduction surgery is disallowed during the study), and malabsorptive weight loss surgery (Rouxen-Y or distal gastric bypass) at any time prior to screening.
Note: Lap banding, if the band has been removed >6 months before baseline liver biopsy, or intragastric balloon, if the balloon has been removed > 6 months before baseline liver biopsy, is allowed.
-
Type 1 diabetes mellitus
-
History of stomach or intestinal surgery or resection within the six months prior to screening that would potentially alter absorption and/or excretion of orally administered drugs as judged by the investigator.
-
Unstable cardiovascular disease, including:
- unstable angina, (i.e., new or worsening symptoms of coronary heart disease) in the 90 days before screening and throughout the screening period; acute coronary syndrome in the 24 weeks before screening and throughout the screening period;
- acute myocardial infarction in the 90 days before screening and throughout the screening period; or heart failure of New York Heart Association class (III - IV), worsening congestive heart failure, or coronary artery intervention, in the 24 weeks before screening and throughout the screening period.
- history of unstable cardiac dysrhythmias
- uncontrolled hypertension at screening
- stroke or transient ischemic attack in the 24 weeks before screening
-
History of myopathies or evidence of active muscle disease demonstrated by CPK ≥ 5 times ULN at screening.
-
For subjects with elevated baseline ALT, AST, or ALP; ALT, AST, or ALP exceeding by more than 50% at Visit 2 reading compared to Visit 1 Note: If the ALT, AST or ALP values at Visit 2 exceed by more than 50% from Visit 1, then a third value will be measured to assess for the trend. If the third value shows continued increase ≥ 10%, then subject is considered ineligible for randomization.
-
Any of the following laboratory values at screening:
- Hemoglobin <9 g/dL
- WBC count <2.5 × 103/µL
- Neutrophil count <1.5 × 103/µL
- Platelets <140 × 103/µL [if low platelet count is due to reasons other than liver disease as assessed by a hematologist, participants may be eligible if the platelet count is > 75 x 103/µL] as per investigator's discretion]
- INR ≥ 1.3 (in the absence of anticoagulants)
- Total bilirubin > ULN except in Gilbert's syndrome. In subjects with known Gilbert's syndrome, direct bilirubin > 2 x ULN
- Albumin <3.5 g/dL
- eGFR <60 mL/min/1.73 m2
- ALP ≥ 2x ULN
- ALT or AST ≥ 250 U/L
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Participation in any other therapeutic clinical study and on active treatment in the past 90 days of the screening.
-
History of benign or malignant bladder tumors, and/or hematuria or has current hematuria except due to a urinary tract infection.
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History of malignancy in the past 5 years and/or active neoplasm with the exception of resolved superficial nonmelanoma skin cancer.
-
Known allergy, sensitivity or intolerance to the study drug, comparator or formulation ingredients.
-
Pregnancy-related exclusions, including:
- Pregnant/lactating female (including positive pregnancy test at screening)
- Pregnancy should be avoided by male and female participants either by true abstinence or the use of an acceptable effective contraceptive measures for the duration of the study and for at least 1 month after the end of the study treatment
-
History or other evidence of severe illness or any other conditions that would make the subject, in the opinion of the investigator, unsuitable for the study (such as poorly controlled psychiatric disease, HIV, coronary artery disease or active gastrointestinal conditions that might interfere with drug absorption)
-
Receiving an elemental diet or parenteral nutrition.
-
Chronic pancreatitis or pancreatic insufficiency.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Čtyřnásobek
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Experimentální: Saroglitazar Magnesium 2 mg
Saroglitazar Magnesium 2 mg tablet orally administered once daily in the morning before breakfast without food, for the duration of treatment. |
Patients randomly assigned to this group will receive Saroglitazar Magnesium 2 mg tablet orally once daily in the morning before breakfast without food, for the duration of treatment.
Ostatní jména:
|
|
Experimentální: Saroglitazar Magnesium 4 mg
Saroglitazar Magnesium 4 mg tablet orally administered once daily in the morning before breakfast without food, for the duration of treatment. |
Patients randomly assigned to this group will receive Saroglitazar Magnesium 4 mg tablet orally once daily in the morning before breakfast without food, for the duration of treatment.
Ostatní jména:
|
|
Komparátor placeba: Placebo
Placebo tablet orally administered once daily in the morning before breakfast without food, for the duration of treatment. |
Patients randomly assigned to this group will receive Placebo tablet orally once daily in the morning before breakfast without food, for the duration of treatment.
Ostatní jména:
|
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Resolution of steatohepatitis with no worsening of fibrosis
Časové okno: 52 Weeks/EOT
|
Resolution of steatohepatitis is defined as absent fatty liver disease or isolated or simple steatosis without steatohepatitis and a NAS of 0-1 for inflammation, 0 for ballooning, and any value for Steatosis |
52 Weeks/EOT
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Improvement in liver fibrosis with no increase in NAS for ballooning, inflammation or steatosis
Časové okno: Week 52/EOT
|
Proportion of subjects achieving improvement in liver fibrosis (reduction of at least one stage) with no increase in NAS for ballooning, inflammation or steatosis |
Week 52/EOT
|
|
2 points improvement in NAS
Časové okno: Week 52/EOT
|
Proportion of subjects with at least 2 points improvement in NAS at Week 52/EOT with at least 1-point improvement in either ballooning or inflammation and no worsening of liver fibrosis |
Week 52/EOT
|
|
Improvement in steatosis, ballooning, inflammation and fibrosis from liver biopsy
Časové okno: Week 52/EOT
|
Proportion of subjects with ≥1 point improvement in steatosis, ballooning, inflammation and fibrosis |
Week 52/EOT
|
|
Decrease in SAF score on liver biopsy
Časové okno: Week 52/EOT
|
Proportion of subjects with decrease in SAF score ≥2 combining hepatocellular inflammation and ballooning without worsening of fibrosis |
Week 52/EOT
|
|
Histological score changes in steatosis, ballooning, inflammation, and fibrosis
Časové okno: Week 52/EOT
|
Change from baseline in steatosis, ballooning, inflammation, and fibrosis |
Week 52/EOT
|
|
Change in liver enzyme parameters including (ALT, AST, ALP, GGT, total bilirubin, albumin)
Časové okno: Week 52/EOT
|
Change from baseline in liver enzyme parameters (ALT, AST, ALP, GGT, total bilirubin, albumin) |
Week 52/EOT
|
|
Change in non-invasive markers of steatosis
Časové okno: Week 52/EOT
|
Change from baseline in non-invasive markers of steatosis (Enhanced Liver Fibrosis [ELF] test, Fibrosis 4 [FIB 4], APRI [AST to Platelet Ratio Index], NFS [NAFLD Fibrosis Score], PRO-C3) |
Week 52/EOT
|
|
Change in n lipid parameters including (TG, LDLC, TC, HDL-C, non-HDL-C, VLDL-C
Časové okno: Week 52/EOT
|
Change from baseline in lipid parameters (TG, LDLC, TC, HDL-C, non-HDL-C, VLDL-C) |
Week 52/EOT
|
|
Change in body weight (any change from baseline)
Časové okno: Week 52/EOT
|
Change from baseline in body weight |
Week 52/EOT
|
|
Change in insulin resistance marker, HOMA-IR
Časové okno: Week 52/EOT
|
Change from baseline in insulin resistance marker (HOMA-IR) |
Week 52/EOT
|
|
Change in inflammatory markers including (CK-18 [M30], IL-6, CRP)
Časové okno: Week 52/EOT
|
Change from baseline in inflammatory markers (CK-18 [M30], IL-6, CRP) |
Week 52/EOT
|
|
Change in glucose homeostasis markers including (HbA1c, FPG)
Časové okno: Week 52/EOT
|
Change from baseline in glucose homeostasis markers (HbA1c, FPG) |
Week 52/EOT
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Ředitel studie: Deven V. Parmar, MD, FCP, Zydus Therapeutics Inc.
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Začátek studia
Primární dokončení (Aktuální)
Primární dokončení
Dokončení studie (Aktuální)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
Další identifikační čísla studie
Další identifikační čísla studie
- SARO.20.002
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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