A randomized, double-blind, multicenter, phase 2b study to evaluate the safety and efficacy of a combination of tropifexor and cenicriviroc in patients with nonalcoholic steatohepatitis and liver fibrosis: Study design of the TANDEM trial. Terminated. The aim of this concise review is to explore the therapeutic potential of cenicriviroc by summarizing key results of major preclinical and clinical studies and discussing the future direction for cenicriviroc as a potential treatment for NASH. Patients will be randomized in a 1:1:1:1 ratio to receive TXR 140ug qd, CVC 150mg qd, TXR 140ug + CVC 150mg qd or TXR 90ug + CVC 150mg qd. Evolving Role for Pharmacotherapy in NAFLD/NASH. Am J Gastroenterol. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Overall comparison of the three trial arms confirmed a trend towards greater fibrosis regression of 1stage in the pooled group of patients treated with CVC in Arm A (CVC 150 mg daily for 2 years) and Arm B (placebo for 1 year followed by CVC 150 mg for 1 year) versus patients randomized to Arm C (placebo for 2 years) (19.9% vs 11.1%, p=0.09). Cenicriviroc (TAK-652) | CCR Antagonist | Cas# 497223-25-3 - GlpBio JavaScript seems to be disabled in your browser. Ju C, Tacke F. Hepatic macrophages in homeostasis and liver diseases: from pathogenesis to novel therapeutic strategies. Clin Transl Sci. . Hepatology. Combination strategies for pharmacologic treatment of non-alcoholic steatohepatitis. The Phase 3 NASH trials are similar in structure. The primary objective of the phase 2b TANDEM trial is to evaluate the safety and tolerability of a TXR plus CVC combination regimen compared with TXR and CVC monotherapy in 200 patients with NASH and liver fibrosis stage F2/F3 over 48 weeks. Web Design by Adhesion. Moreno Traspas R, Teoh TS, Wong PM, Maier M, Chia CY, Lay K, Ali NA, Larson A, Al Mutairi F, Al-Sannaa NA, Faqeih EA, Alfadhel M, Cheema HA, Dupont J, Bzieau S, Isidor B, Low DY, Wang Y, Tan G, Lai PS, Piloquet H, Joubert M, Kayserili H, Kripps KA, Nahas SA, Wartchow EP, Warren M, Bhavani GS, Dasouki M, Sandoval R, Carvalho E, Ramos L, Porta G, Wu B, Lashkari HP, AlSaleem B, BaAbbad RM, Abreu Ferro AN, Karageorgou V, Ordonez-Herrera N, Khan S, Bauer P, Cogne B, Bertoli-Avella AM, Vincent M, Girisha KM, Reversade B. Nat Genet. doi:10.1038/cmi.2015.104, 15. AIDS. Preclinical models have confirmed that CCR2/5 antagonism may block fat accumulation and Kupffer cell activation and disrupt monocyte/macrophage recruitment and hepatic stellate cell activation responsible for fibrogenesis. The https:// ensures that you are connecting to the Calkin AC, Tontonoz P. Transcriptional integration of metabolism by the nuclear sterol-activated receptors LXR and FXR. February 2, 2022 Terminated. Pharmacologic inhibition of CCR2/5 signaling prevents and reverses alcohol-induced liver damage, steatosis, and inflammation in mice. Cenicriviroc Terminated Phase 3 Trials for Non Alcoholic Steatohepatitis (NASH) Treatment. Detailed Description: The AURORA study will be conducted in 2 parts. Cenicriviroc, a selective dual inhibitor/antagonist of CCR2/CCR5 chemokine receptors, represents a prototype immune modulator and distinctive anti-NASH candidate that defy the norm by exerting. Anstee QM, Neuschwander-Tetri BA, Wong VW, et al. TXR is a non-bile acid farnesoid X receptor (FXR) agonist which has demonstrated important effects on bile acid, glucose, and lipid metabolism.34,35 TXR alone has shown efficacy in preclinical models of NASH in which it has reduced bile acid and triglyceride synthesis, and has decreased hepatic steatosis, hepatic inflammation, and hepatocyte ballooning.36 Preclinical and phase 1 studies evaluating the combination of TXR plus CVC have revealed a significant reduction in hepatic inflammation and ballooning with acceptable safety and tolerability. Its effect on decreasing the migration of monocytes was proven in a thioglycolate-induced peritonitis mouse model in which CVC reduced monocyte infiltration into the peritoneal cavity.20 Likewise, in a carbon tetrachloride (CCl4) mouse model, CVC significantly decreased MoMF in acutely injured liver tissue21 but did not change hepatic lymphoid populations in vivo.21 Additionally, the antifibrotic properties of CVC were demonstrated in a streptozocin/high fat mouse model, with significant reduction of collagen deposition in the liver, percentage of fibrosis area and NAFLD activity score (NAS).20 In the choline-deficient/high fat mouse model of NASH, CVC resulted in significant decreases in histologic and molecular markers (hepatic hydroxyproline levels, COL1A1 mRNA expression) of hepatic fibrosis, although without significant changes in hepatic steatosis or inflammation.22 These findings were corroborated by findings from a thioacetamide (TAA) rat model in which CVC resulted in a significant reduction of liver collagen deposition,20 and a decrease in insulin resistance, steatohepatitis and liver fibrosis in human liver tissue from patients with NASH.23 Furthermore, pharmacologic inhibition of CCR2/5 signaling with CVC was associated with prevention and reversal of alcohol-induced liver injury, steatosis, and inflammation in a mouse model.24, A favorable safety and tolerability profile for CVC has been supported by several clinical studies including the Phase 1, open-label, nonrandomized, single-center study.25 In this study, 29 participants with mild (Child-Pugh class A) and moderate (Child-Pugh class B) hepatic insufficiency (HI) were matched by age, body weight and gender with healthy participants and were administered CVC 150mg daily for 14 days. doi:10.1038/nrm3312, 36. doi:10.1016/j.jhep.2017.02.026, 20. Patient-reported outcomes will assess changes in health outcomes from baseline (Chronic Liver Disease Questionnaire - NAFLD; Work Productivity and Activity Impairment in NASH; 36-Item Short Form Health Survey version 2). Human hepatic stellate cells express CCR5 and RANTES to induce proliferation and migration. Intervention Type. 4. [3] It is being developed by Takeda and Tobira Therapeutics . Cenicriviroc (Allergan/Takeda) is a potent immunomodulator that blocks the chemokine receptors-2/5 (CCR-2/5). The Phase II CENTAUR results demonstrated an underwhelming inflammation impact, and the observed placebo effect madeavailable data harder to interpret, interviewed experts noted. Join us in exploring an investigational product for liver fibrosis in NASH. In fact, the foggy Phase IIb data may have contributed to AURORA patient accrual delays, this news service subsequently reported 13 April 2019. doi:10.1002/hep.29466, 10. doi: 10.1371/journal.ppat.1010547. Younossi ZM, Stepanova M, Rafiq N, et al. doi:10.1016/S0016-5085(99)70506-8, 4. CVC is designed to block chemokine receptors CCR2 and CCR5, and so would have an anti-inflammatory effect in Covid-19. Cenicriviroc is an oral inhibitor of the chemokine ligand 2/C-C chemokine receptor 2 pathway, which plays . 2016;13(3):316327. UK VAT Group: GB 365 4626 36. The Phase 3 AURORA trial assessing cenicriviroc has a primary completion date of Sept. 16, 2020, according to the federal database clinicaltrials.gov. Cenicriviroc Treatment for Adults with Nonalcoholic Steatohepatitis and Fibrosis: final Analysis of the Phase 2b CENTAUR Study. Participants were randomized 2:1:1 to arm A (CVC 150mg daily for 2 years), arm B (placebo for 1 year then CVC 150mg daily for 1 year), or arm C (placebo for 2 years).24 The primary outcome was NASH improvement, defined as 2-point improvement in NAS (with 1-point reduction in either lobular inflammation or hepatocellular ballooning) and no worsening of fibrosis on liver biopsy upon completion of 1 year of treatment. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Two specific pathways, macrophage-mediated inflammation and hepatic stellate cell activation, have been identified as key pathways in disease progression (Figure 1).11 Accumulation of fat in the liver may be associated with inflammation and hepatic injury (ballooning), which in turn may activate hepatocytes, liver macrophages (Kupffer cells) and hepatic stellate cells (HSC) to release chemokines which interact with the CCR2 receptor on circulating monocytes to promote infiltration into the liver where they differentiate into pro-inflammatory macrophages.12,13 This population of cells is referred to as monocyte-derived macrophages (MoMF) which are distinct from the tissue-resident macrophages, Kupffer cells (KC).12,13 Both MoMF and KC release proinflammatory cytokines such as transforming growth factor (TGF-) and platelet-delivered growth factor (PDGF) which activates HSC.14,15 Activated HSC differentiate into myofibroblast-like cells which produce collagen resulting in liver fibrosis.16 The CCR5 chemokine receptor is also expressed in a subpopulation of lymphocytes and HCS and contributes to profibrogenic activation and proliferation.17,18 Cenicriviroc (CVC), an oral dual CCR2/CCR5 antagonist is under investigation as a potential treatment for NASH due to its broad spectrum of anti-inflammatory and anti-fibrotic effects.19. Its effect on decreasing the migration of monocytes was proven in a thioglycolate-induced peritonitis mouse model in which CVC reduced monocyte infiltration into the peritoneal cavity.20 Likewise, in a carbon tetrachloride (CCl4) mouse model, CVC significantly decreased MoMF in acutely injured liver tissue21 but did not change hepatic lymphoid populations in vivo.21 Additionally, the antifibrotic properties of CVC were demonstrated in a streptozocin/high fat mouse model, with significant reduction of collagen deposition in the liver, percentage of fibrosis area and NAFLD activity score (NAS).20 In the choline-deficient/high fat mouse model of NASH, CVC resulted in significant decreases in histologic and molecular markers (hepatic hydroxyproline levels, COL1A1 mRNA expression) of hepatic fibrosis, although without significant changes in hepatic steatosis or inflammation.22 These findings were corroborated by findings from a thioacetamide (TAA) rat model in which CVC resulted in a significant reduction of liver collagen deposition,20 and a decrease in insulin resistance, steatohepatitis and liver fibrosis in human liver tissue from patients with NASH.23 Furthermore, pharmacologic inhibition of CCR2/5 signaling with CVC was associated with prevention and reversal of alcohol-induced liver injury, steatosis, and inflammation in a mouse model.24, A favorable safety and tolerability profile for CVC has been supported by several clinical studies including the Phase 1, open-label, nonrandomized, single-center study.25 In this study, 29 participants with mild (Child-Pugh class A) and moderate (Child-Pugh class B) hepatic insufficiency (HI) were matched by age, body weight and gender with healthy participants and were administered CVC 150mg daily for 14 days. Accordingly, modulation of macrophage trafficking might represent an attractive therapeutic strategy in this population. Enter your details here to receive your free Whitepaper. Shan L, Wang F, Zhai D, Meng X, Liu J, Lv X. Angulo P, Kleiner DE, Dam-Larsen S, et al. There is no guarantee that cenicriviroc will receive health authority approval or become commercially available in any country for the uses being investigated. As there are currently no approved treatments indicated for NASH, the AURORA CVC Phase 3 study addresses an unmet medical need. We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. Mechanisms of hepatic stellate cell activation, Human hepatic stellate cells express CCR5 and RANTES to induce proliferation and migration, Targeting hepatic macrophages to treat liver diseases, Antifibrotic effects of the dual CCR2/CCR5 antagonist cenicriviroc in animal models of liver and kidney fibrosis, Differential impact of the dual CCR2/CCR5 inhibitor cenicriviroc on migration of monocyte and lymphocyte subsets in acute liver injury, Prolonged cenicriviroc therapy reduces hepatic fibrosis despite steatohepatitis in a diet-induced mouse model of nonalcoholic steatohepatitis, Pharmacologic inhibition of CCR2/5 signaling prevents and reverses alcohol-induced liver damage, steatosis, and inflammation in mice, Therapeutic inhibition of inflammatory monocyte recruitment reduces steatohepatitis and liver fibrosis. Year 1 primary analysis of the 2-year CENTAUR study showed that CVC had an antifibrotic effect without impacting steatohepatitis. Copyright 2020 The Authors. -Primary completion date for is estimated to be in Oct 2021. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. Additional study measures include liver fat content using MRI-PDFF, non-invasive fibrosis markers (enhanced liver fibrosis test, AST platelet ratio index, fibrosis-4 and NAFLD score, transient elastography), lipid parameters, markers for target engagement (fibroblast growth factor 19 and cholesten-3-one C4) and markers of systemic inflammation and apoptosis. Hepatology. 2017;60(24):99609973. Asses the efficacy and durability of short and prolonged CVC therapy in a diet induced mouse model of NASH, Mice received 4 or 14 weeks of standard chow or the choline deficient, L-amino acid-defined high fat diet (CDAHFD). The role of macrophages in obesity-driven chronic liver disease. Files DC, Tacke F, O'Sullivan A, Dorr P, Ferguson WG, Powderly WG. The .gov means its official. Tick the boxes of the newsletters you would like to receive. Nasr P, Ignatova S, Kechagias S, Ekstedt M. Natural history of nonalcoholic fatty liver disease: A prospective follow-up study with serial biopsies. Part 1 includes 1200 participants with histological evidence of NASH and stage F2 or F3 fibrosis who are randomized 2:1 to CVC 150mg daily or placebo with primary endpoint at end of Year 1 of liver fibrosis regression 1 stage without worsening of SH. Herein we review results from the phase 2b CENTAUR trial and study designs for the phase 2b TANDEM and phase 3 AURORA trials and discuss the potential role of cenicriviroc in future pharmacotherapy for NASH fibrosis. Non-alcoholic steatohepatitis (NASH) is associated with significant morbidity and mortality due to liver cirrhosis, liver failure, and hepatocellular carcinoma, and represents a leading indication for liver transplantation in the United States (U.S.). Cenicriviroc (CVC) is a novel, orally administered, and potent CCR2 and CCR5 receptor antagonist which is currently in clinical development for the treatment of liver fibrosis in adults with NASH, having received Fast Track designation by the US Food and Drug Administration. Primary efficacy endpoints will include the proportion of subjects with 1-stage improvement in liver fibrosis and no worsening of steatohepatitis at Month 12 relative to screening (Part 1), and time to first occurrence of any adjudicated event: death; histopathologic progression to cirrhosis; liver transplant; Model of End-Stage Liver Disease score 15; ascites; hospitalization due to liver decompensation (Part 2). Based on 95 publications in PubMed 10 10 95. Tobira gains rights to second asset for NASH in North America, Europe & Australia First combination study with cenicriviroc to begin late 2016 Conference Call Scheduled for today at 8:30 a.m. 2022 Aug;54(8):1214-1226. doi: 10.1038/s41588-022-01120-0. sharing sensitive information, make sure youre on a federal 2018;2(2):199210. doi:10.1053/j.gastro.2016.01.038, 30. Back to Cenicriviroc. Headache and gastrointestinal complaints were reported in two participants, and one patient experienced an increase in serum transaminases. Herein, we report the final data from Year 2 exploratory analyses. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Combination approaches to incorporate novel investigational agents targeting both metabolic and fibrosis endpoints are under active exploration to augment efficacy in histologic and clinical endpoints. To define molecular mechanisms of cenicriviroc action, we studied changes in the activation/influx of glial and immune cells and, simultaneously, the expression of CCR2, CCR5, and important pronociceptive cytokines (IL-1beta, IL-6, IL-18, CCL2, CCL3, CCL5) in the spinal cord and DRG. doi:10.1080/13543784.2020.1718106, 12. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease, Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. MeSH Get access to cutting edge treatment via Cenicriviroc. doi:10.1016/j.jhepr.2019.02.004, 13. 2012;13(4):213224. No significant difference in adverse effects were observed between subjects on CVC versus matched controls, with matching of baseline levels of proinflammatory cytokines and bacterial translocation biomarkers.25. This work is published and licensed by Dove Medical Press Limited. Nonalcoholic steatohepatitis (NASH) is a sub-classification of nonalcoholic fatty liver disease (NAFLD) characterized by increased risk of progressive liver fibrosis. Lefebvre E, Moyle G, Reshef R, et al. doi:10.1021/acs.jmedchem.7b00907, 37. This boom can be linked to a financing frenzy spurred by the quick adoption of technology and innovative solutions by start-ups gaining traction in response to the pandemic. NASH is associated with substantial morbidity and mortality, and in the absence of an FDA-approved treatment, novel pharmacologic agents are urgently needed. Bethesda, MD 20894, Web Policies The all-oral combination of TXR and CVC is anticipated to demonstrate antisteatotic, anti-inflammatory and antifibrotic effects. doi:10.1002/hep4.1134, 3. CVC was initiated simultaneously with the CDAHFD, -High dose CVC in CDAHFD mice for 4 and 14 weeks inhibited intrahepatic accumulation of bone marrow derived macrophages. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. Hope remains that Roches prasinezumab can overcome recent string of failures in Parkinsons disease, Akeso concludes subject enrolment in Phase III NSCLC antibody trial. In the NASH model, cenicriviroc significantly reduces the non-alcoholic fatty liver disease activity score. The https:// ensures that you are connecting to the There is no guarantee that cenicriviroc will receive health authority approval or become commercially available in any country for the uses being investigated. The primary objective of part 2 is to compare CVC vs placebo on the composite endpoint of histopathologic progression to cirrhosis, liver-related outcomes and all-cause mortality. The portal can access those files and use them to remember the user's data, such as their chosen settings (screen view, interface language, etc. NASH is a complex entity in which numerous signaling pathways are involved in disease pathophysiology. 2016;99(5):693698. The study will be terminated when prespecified adjudicated events, including death, histopathologic progression to cirrhosis, liver transplant, MELD score 15, ascites requiring intervention, or hospitalization (as defined by a stay of 24 hours) for onset of variceal bleed, hepatic encephalopathy, or spontaneous bacterial peritonitis, have been accrued in approximately 367 unique subjects, Historical biopsy may be substituted as specified in the protocol, Male and female subjects aged between 18-75 years, Histological evidence of NASH based on central reading of the Screening biopsy*, Histological evidence of Stage 2 or 3 liver fibrosis per the NASH CRN System based on central reading of the Screening biopsy*. Patients will be randomized in a 1:1:1:1 ratio to receive TXR 140ug qd, CVC 150mg qd, TXR 140ug + CVC 150mg qd or TXR 90ug + CVC 150mg qd. Cenicriviroc for the treatment of liver fibrosis in adults with nonalcoholic steatohepatitis: AURORA Phase 3 study design.
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