お知らせ • Jun 08
Madrigal Pharmaceuticals, Inc. Announces New Data from the Phase 3 MAESTRO-NASH Study of Rezdiffra (resmetirom) Presented at the EASL Congress
Madrigal Pharmaceuticals, Inc. announced results from new analyses of the Phase 3 MAESTRO-NASH trial of Rezdiffra being presented at the EASL Congress, which takes place from June 5-8, 2024 in Milan, Italy. Rezdiffra is a once-daily, oral, liver-directed thyroid hormone receptor (THR)-ß agonist designed to target key underlying causes of NASH. It is the first approved medication for the treatment of NASH. In the pivotal Phase 3 MAESTRO-NASH biopsy trial, Rezdiffra achieved both fibrosis improvement and NASH resolution primary endpoints, and 80% of patients treated with Rezdiffra 100 mg experienced improvement or stabilization of fibrosis. Rezdiffra is indicated in conjunction with diet and exercise for the treatment of adults with noncirrhotic NASH with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis). Continued approval for this indication may be contingent upon verification and description of clinical benefit in ongoing confirmatory trials. An AI-driven fibrosis assessment methodology, qFibrosis (Histoindex), has identified 30 specific fibrotic features on NASH liver biopsies that may be predictive of progression to cirrhosis and decompensated cirrhosis based on the SteatoSITE database. SteatoSITE contains integrated clinical and pathological data from 940 cases across the NASH spectrum with outcome data from electronic health record and pathologist-assigned fibrosis stage and RNA on baseline biopsy. In an analysis of MAESTRO-NASH data featured in a late-breaking presentation at EASL, total qFibrosis score showed a highly significant improvement in fibrosis with Rezdiffra treatment and less progression of fibrosis as compared with placebo; results were similar to pathologist scoring. Six qFibrosis progression features with the strongest correlations between baseline pathologist scoring and noninvasive tests were identified. At week 52, patients treated with Rezdiffra showed reduction from baseline in these key features compared to placebo, with the most marked reductions occurring in the F3 population. In analyses of noninvasive test results from MAESTRO-NASH, changes in vibration-controlled transient elastography (VCTE; an ultrasound-based measure of liver stiffness, a surrogate for fibrosis), controlled attenuation parameter (CAP; an ultrasound-derived measure of fat content in the liver), and magnetic resonance imaging-proton density fat fraction (MRI-PDFF; an MRI-based measure of triglyceride content in the liver) were assessed in the Rezdiffra 80mg, Rezdiffra 100mg, and placebo groups. Liver stiffness as measured by VCTE improved over time (up to three years) relative to placebo in Rezdiffra-treated patients, with both doses showing a similar durable response. At year three, 91% of patients treated with Rezdiffra had improved or stable liver stiffness, as compared to 9% who experienced a =30% increase in liver stiffness. CAP improvement was also stable over time, with both Rezdiffra doses showing a similar durable response through three years of treatment. CAP and MRI-PDFF improvements in patients treated with Rezdiffra predicted achieving both fibrosis improvement and NASH resolution responses on histology. However, CAP and MRI-PDFF improvements in placebo-treated patients did not predict fibrosis improvement, highlighting the importance of reducing liver fat directly in hepatocytes through THR-ß agonism. In the first analysis of health-related quality of life (HRQL) data from patients participating in the MAESTRO-NASH trial, changes in HRQL scores from baseline were evaluated in patients receiving Rezdiffra versus placebo and compared between patients with versus without biopsy response. By weeks 24 and 52, patients receiving both doses of Rezdiffra experienced improvement of HRQL scores in the Worry domain of the Chronic Liver Disease Questionnaire-NASH. At week 52, Rezdiffra-treated patients who achieved fibrosis improvement or NASH resolution experienced improvement in several HRQL domains, including domains for Worry, Health Distress and Stigma. The improvement in HRQL among Rezdiffra biopsy responders was contrasted by no similar improvement in the placebo group. Biopsy responders with stage F3 fibrosis at baseline had similar or more pronounced improvements of HRQL in comparison to those responders with F2 or F1B fibrosis at baseline. The first analysis of Rezdiffra treatment in MetALD included 75 patients from the Phase 3 MAESTRO-NASH study who were believed to have significant alcohol consumption in addition to NASH. Patients with probable MetALD were identified based on Carbohydrate Deficient Transferrin (CDT), a biomarker for chronic alcohol consumption, collected longitudinally through the study, and phosphatidylethanol (PEth) tests performed in patients suspected of increased alcohol consumption. Rezdiffra-treated patients in the MetALD group achieved rates of fibrosis improvement and steatohepatitis resolution that were similar to the positive results observed in the overall MAESTRO-NASH population and to patients with NASH with low alcohol consumption. In the MetALD group, 88% of patients treated with Rezdiffra 100 mg and 81% treated with Rezdiffra 80 mg showed a =30% reduction from baseline in MRI-PDFF, compared to 14% in the placebo group. MAESTRO-NASH is an ongoing Phase 3 trial that enrolled 1759 patients with biopsy-confirmed NASH. Patients were randomly assigned in a 1:1:1 ratio to receive once-daily Rezdiffra at a dose of 80 mg or 100 mg or placebo. The two primary endpoints at week 52 were NASH resolution with no worsening of fibrosis and an improvement in fibrosis by at least one stage with no worsening of the NAFLD activity score. The key secondary endpoint was the percent change from baseline in LDL cholesterol at week 24. Patients enrolled in the MAESTRO-NASH trial continue on therapy after the initial 52-week treatment period for up to 54 months to accrue and measure hepatic clinical outcome events including progression to cirrhosis on biopsy and hepatic decompensation events, as well as all-cause mortality. The 54-month outcomes portion of the trial is designed to generate confirmatory data that, if positive, will help verify Rezdiffra’s clinical benefit and may support full approval.