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Resmetirom (MGL-3196) for the treatment of non-alcoholic steatohepatitis: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial.
Lancet 2019; 394(10213):2012-2024Lct

Abstract

BACKGROUND

Non-alcoholic steatohepatitis (NASH) is characterised by hepatic steatosis, inflammation, hepatocellular injury, and progressive liver fibrosis. Resmetirom (MGL-3196) is a liver-directed, orally active, selective thyroid hormone receptor-β agonist designed to improve NASH by increasing hepatic fat metabolism and reducing lipotoxicity. We aimed to assess the safety and efficacy of resmetirom in patients with NASH.

METHODS

MGL-3196-05 was a 36-week randomised, double-blind, placebo-controlled study at 25 centres in the USA. Adults with biopsy confirmed NASH (fibrosis stages 1-3) and hepatic fat fraction of at least 10% at baseline when assessed by MRI-proton density fat fraction (MRI-PDFF) were eligible. Patients were randomly assigned 2:1 by a computer-based system to receive resmetirom 80 mg or matching placebo, orally once a day. Serial hepatic fat measurements were obtained at weeks 12 and 36, and a second liver biopsy was obtained at week 36. The primary endpoint was relative change in MRI-PDFF assessed hepatic fat compared with placebo at week 12 in patients who had both a baseline and week 12 MRI-PDFF. This trial is registered with ClinicalTrials.gov, number NCT02912260.

FINDINGS

348 patients were screened and 84 were randomly assigned to resmetirom and 41 to placebo at 18 sites in the USA. Resmetirom-treated patients (n=78) showed a relative reduction of hepatic fat compared with placebo (n=38) at week 12 (-32·9% resmetirom vs -10·4% placebo; least squares mean difference -22·5%, 95% CI -32·9 to -12·2; p<0·0001) and week 36 (-37·3% resmetirom [n=74] vs -8·5 placebo [n=34]; -28·8%, -42·0 to -15·7; p<0·0001). Adverse events were mostly mild or moderate and were balanced between groups, except for a higher incidence of transient mild diarrhoea and nausea with resmetirom.

INTERPRETATION

Resmetirom treatment resulted in significant reduction in hepatic fat after 12 weeks and 36 weeks of treatment in patients with NASH. Further studies of resmetirom will allow assessment of safety and effectiveness of resmetirom in a larger number of patients with NASH with the possibility of documenting associations between histological effects and changes in non-invasive markers and imaging.

FUNDING

Madrigal Pharmaceuticals.

Authors+Show Affiliations

Pinnacle Clinical Research, San Antonio, TX, USA; Radcliffe Department of Medicine, University of Oxford, Oxford, UK. Electronic address: stephenharrison87@gmail.com.Department of Radiology, Center for Advanced Magnetic Resonance Development, Department of Pathology, and Division of Hepatology, Duke University Medical Center, Durham, NC, USA.Department of Radiology, Center for Advanced Magnetic Resonance Development, Department of Pathology, and Division of Hepatology, Duke University Medical Center, Durham, NC, USA.Medpace, Cincinnati, OH, USA.Department of Radiology, Center for Advanced Magnetic Resonance Development, Department of Pathology, and Division of Hepatology, Duke University Medical Center, Durham, NC, USA.Department of Medicine, University of California, San Diego, CA, USA.Division of Gastroenterology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.Division of Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.Department of Integrated Medicine, Florida Atlantic University, Miami, FL, USA.Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA.Madrigal Pharmaceuticals, Conshohocken, PA, USA.Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.

Pub Type(s)

Clinical Trial, Phase II
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31727409

Citation

Harrison, Stephen A., et al. "Resmetirom (MGL-3196) for the Treatment of Non-alcoholic Steatohepatitis: a Multicentre, Randomised, Double-blind, Placebo-controlled, Phase 2 Trial." Lancet (London, England), vol. 394, no. 10213, 2019, pp. 2012-2024.
Harrison SA, Bashir MR, Guy CD, et al. Resmetirom (MGL-3196) for the treatment of non-alcoholic steatohepatitis: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial. Lancet. 2019;394(10213):2012-2024.
Harrison, S. A., Bashir, M. R., Guy, C. D., Zhou, R., Moylan, C. A., Frias, J. P., ... Moussa, S. E. (2019). Resmetirom (MGL-3196) for the treatment of non-alcoholic steatohepatitis: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial. Lancet (London, England), 394(10213), pp. 2012-2024. doi:10.1016/S0140-6736(19)32517-6.
Harrison SA, et al. Resmetirom (MGL-3196) for the Treatment of Non-alcoholic Steatohepatitis: a Multicentre, Randomised, Double-blind, Placebo-controlled, Phase 2 Trial. Lancet. 2019 11 30;394(10213):2012-2024. PubMed PMID: 31727409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resmetirom (MGL-3196) for the treatment of non-alcoholic steatohepatitis: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial. AU - Harrison,Stephen A, AU - Bashir,Mustafa R, AU - Guy,Cynthia D, AU - Zhou,Rong, AU - Moylan,Cynthia A, AU - Frias,Juan P, AU - Alkhouri,Naim, AU - Bansal,Meena B, AU - Baum,Seth, AU - Neuschwander-Tetri,Brent A, AU - Taub,Rebecca, AU - Moussa,Sam E, Y1 - 2019/11/11/ PY - 2019/07/12/received PY - 2019/09/26/revised PY - 2019/10/01/accepted PY - 2019/11/16/pubmed PY - 2019/11/16/medline PY - 2019/11/16/entrez SP - 2012 EP - 2024 JF - Lancet (London, England) JO - Lancet VL - 394 IS - 10213 N2 - BACKGROUND: Non-alcoholic steatohepatitis (NASH) is characterised by hepatic steatosis, inflammation, hepatocellular injury, and progressive liver fibrosis. Resmetirom (MGL-3196) is a liver-directed, orally active, selective thyroid hormone receptor-β agonist designed to improve NASH by increasing hepatic fat metabolism and reducing lipotoxicity. We aimed to assess the safety and efficacy of resmetirom in patients with NASH. METHODS: MGL-3196-05 was a 36-week randomised, double-blind, placebo-controlled study at 25 centres in the USA. Adults with biopsy confirmed NASH (fibrosis stages 1-3) and hepatic fat fraction of at least 10% at baseline when assessed by MRI-proton density fat fraction (MRI-PDFF) were eligible. Patients were randomly assigned 2:1 by a computer-based system to receive resmetirom 80 mg or matching placebo, orally once a day. Serial hepatic fat measurements were obtained at weeks 12 and 36, and a second liver biopsy was obtained at week 36. The primary endpoint was relative change in MRI-PDFF assessed hepatic fat compared with placebo at week 12 in patients who had both a baseline and week 12 MRI-PDFF. This trial is registered with ClinicalTrials.gov, number NCT02912260. FINDINGS: 348 patients were screened and 84 were randomly assigned to resmetirom and 41 to placebo at 18 sites in the USA. Resmetirom-treated patients (n=78) showed a relative reduction of hepatic fat compared with placebo (n=38) at week 12 (-32·9% resmetirom vs -10·4% placebo; least squares mean difference -22·5%, 95% CI -32·9 to -12·2; p<0·0001) and week 36 (-37·3% resmetirom [n=74] vs -8·5 placebo [n=34]; -28·8%, -42·0 to -15·7; p<0·0001). Adverse events were mostly mild or moderate and were balanced between groups, except for a higher incidence of transient mild diarrhoea and nausea with resmetirom. INTERPRETATION: Resmetirom treatment resulted in significant reduction in hepatic fat after 12 weeks and 36 weeks of treatment in patients with NASH. Further studies of resmetirom will allow assessment of safety and effectiveness of resmetirom in a larger number of patients with NASH with the possibility of documenting associations between histological effects and changes in non-invasive markers and imaging. FUNDING: Madrigal Pharmaceuticals. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/31727409/Resmetirom__MGL_3196__for_the_treatment_of_non_alcoholic_steatohepatitis:_a_multicentre_randomised_double_blind_placebo_controlled_phase_2_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(19)32517-6 DB - PRIME DP - Unbound Medicine ER -