Zibotentan and Dapagliflozin Combination, EvAluated in Liver Cirrhosis (ZEAL Study)

Launched by ASTRAZENECA · Aug 24, 2022

Keywords

ClinConnect Summary

The ZEAL Study is a clinical trial that is exploring the effectiveness and safety of two medications, zibotentan and dapagliflozin, for individuals with liver cirrhosis, a serious condition where the liver is damaged and can lead to complications like portal hypertension (increased pressure in the blood vessels of the liver). This study is looking at how well these medications work alone and in combination compared to a placebo (a harmless pill with no active ingredients). The trial is currently recruiting participants aged 18 and older who have specific health criteria related to their liver condition.

To be eligible for the study, participants should not have received certain liver medications recently, and their liver function must meet specific requirements. For example, they should have a diagnosis of cirrhosis without significant liver failure symptoms. Those who join the study will be randomly assigned to receive either the combination of the two medications, one of the medications alone, or a placebo. Throughout the trial, participants will be monitored closely for how well they tolerate the treatment and any side effects. This research is important as it may help improve treatment options for people suffering from liver cirrhosis.

Gender

ALL

Eligibility criteria

• • Study principal inclusion criteria For both Part A and Part B
• • 1. No current or prior (within 1 month of enrolment) medical treatment with an SGLT2 inhibitor or ERAs.
• • 2. On no or a stable dose of beta blockers, with no major dose changes within 1 month prior to the first dose of study intervention.
• • 3. Provision of signed and dated, written ICF prior to any mandatory study-specific procedures, sampling, and analyses.
• 4. Female participants of non-childbearing potential confirmed at screening by fulfilling one of the following criteria:
• • 1. Post-menopausal: defined as amenorrhoea for at least 12 months or more following cessation of all exogenous hormonal treatments; and also, FSH levels in the post-menopausal range by central laboratory.
• • 2. Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation.
• • 5. Female participants must have a negative pregnancy test at screening and must not be lactating
• Part A participants who have the following:
• • 1. Clinical and/or histological diagnosis of cirrhosis with either (i) features of portal hypertension or (ii) liver stiffness ≥ 21 kPa.
• • 2. MELD score \< 15.
• • 3. Child-Pugh score ≤ 6.
• • 4. No clinically evident ascites.
• • 5. No evidence of worsening of hepatic function (eg, no clinically significant change in signs, symptoms, or laboratory parameters of hepatic disease status) within the last month prior to dosing, as determined by the investigator or usual practitioner.
• • 6. HVPG recording of good enough quality as judged by a central reader.
• Part B participants who have the following:
• • 1. Clinical and/or histological diagnosis of cirrhosis and either history of decompensation or compensated cirrhosis with signs of clinically significant portal hypertension.
• • 2. HVPG recording of good enough quality and HVPG \> 10 mmHg, as judged by a central reader.
• • 3. MELD score \< 15.
• • 4. Child-Pugh score \< 10.
• • 5. No ascites or ascites up to grade 2 without change in diuretic treatment within the last month prior to first dose and no paracentesis within the last month or planned paracentesis in the next 4 months at screening.
• • 6. No evidence of worsening of hepatic function (eg, no clinically significant change in signs, symptoms, or laboratory parameters of hepatic disease status) within the last month prior to dosing, as determined by the investigator or usual practitioner.
• Study principal exclusion criteria:
• • 1. Any evidence of a clinically significant disease which in the investigator's opinion makes it undesirable for the participant to participate in the study.
• • 2. Liver cirrhosis caused by chronic cholestatic liver disease
• • 3. ALT or AST ≥ 150 U/L and/or total bilirubin ≥ 3 × ULN
• • 4. Acute liver injury caused by drug toxicity or by an infection.
• • 5. Any history of hepatocellular carcinoma.
• • 6. Liver transplant or expected liver transplantation within 6 months of screening.
• • 7. History of TIPS or a planned TIPS within 6 months from enrolment into the study.
• • 8. Active treatment for HCV within the last 1 year or HBV antiviral therapy for less than 1 year.
• • 9. Participants with T1DM.
• • Medical Conditions (Part A only)
• • 1. INR \> 1.5.
• • 2. Serum/plasma levels of albumin ≤ 35 g/L.
• • 3. Platelet count \< 75 × 109/L.
• • 4. History of ascites
• • 5. History of hepatic hydrothorax
• • 6. History of portopulmonary syndrome
• • 7. History of hepatic encephalopathy
• • 8. History of variceal haemorrhage
• • 9. History of acute kidney injury
• • 10. History of heart failure, including high output heart failure (eg, due to hyperthyroidism or Paget's disease)
• • Medical Conditions (Part B only)
• • 1. INR \> 1.7.
• • 2. Serum/plasma levels of albumin ≤ 28 g/L.
• • 3. Platelet count \< 50 × /109L.
• • 4. Acute kidney injury within 3 months of screening.
• • 5. History of encephalopathy of West Haven grade 2 or higher within 6 months prior to screening.
• • 6. History of variceal haemorrhage within 6 months prior to screening.
• • 7. NYHA functional heart failure class III or IV or with unstable heart failure requiring hospitalisation for optimisation of heart failure treatment and who are not yet stable on heart failure therapy within 6 months prior to screening.
• • 8. Heart failure due to cardiomyopathies that would primarily require specific other treatment: eg, cardiomyopathy due to pericardial disease, amyloidosis or other infiltrative diseases, cardiomyopathy related to congenital heart disease, primary hypertrophic cardiomyopathy, cardiomyopathy related to toxic or infective conditions (ie, chemotherapy, infective myocarditis, septic cardiomyopathy).
• • 9. High output heart failure (eg, due to hyperthyroidism or Paget's disease).
• • 10. Heart failure due to primary cardiac valvular disease/dysfunction, severe functional mitral or tricuspid valve insufficiency, or planned cardiac valve repair/replacement.