Announcement • 12h
Gilead Sciences Announces Statistically Significant Composite ALP Normalization With Livdelzi In Phase 3 IDEAL Trial In Primary Biliary Cholangitis
Gilead Sciences, Inc. announced positive results from a Phase 3 study in people with primary biliary cholangitis (PBC), showing that treatment with Livdelzi (seladelpar) led to significantly more patients achieving normalization of alkaline phosphatase (ALP), a key liver marker of disease progression, compared with placebo after 52 weeks. The primary endpoint was defined as a composite of ALP = 1.0× upper limit of normal (ULN) and a = 15% decrease from baseline. These findings were observed in people with inadequately controlled disease, defined as having ALP levels above the ULN and below 1.67×ULN, with an incomplete response or intolerance to ursodeoxycholic acid (UDCA). The safety profile of seladelpar observed in IDEAL was consistent with previously reported Livdelzi studies, with no new safety concerns identified. These results extend the evidence base for Livdelzi to a broader population of people living with PBC and support ALP normalization as an achievable therapeutic goal in patients with ALP between 1 to 1.67xULN. In PBC, ALP is a key disease marker associated with disease activity and long-term outcomes. ALP levels above normal, including in the 1.0 to 1.67×ULN range, are associated with increased risk of progression to liver transplant or death compared with normalized ALP levels. Full data will be presented at an upcoming medical congress, and Gilead will engage with global regulatory authorities to discuss these results. The IDEAL study is a Phase 3, double-blind, placebo-controlled trial designed to evaluate Livdelzi in adults living with primary biliary cholangitis (PBC) who have inadequately controlled disease, defined as having alkaline phosphatase (ALP) levels above normal but less than 1.67× ULN despite treatment with ursodeoxycholic acid (UDCA) or with UDCA intolerance. Its primary objective is to evaluate the effect of Livdelzi treatment at Week 52 compared to placebo, assessing rates of ALP normalization, defined as a composite of ALP = 1.0× upper limit of normal (ULN) and = 15% decrease from baseline in PBC participants with an ALP value greater than ULN but less than 1.67× ULN. A composite was used for the primary endpoint to ensure rigorous evaluation of ALP normalization over time. The study enrolled 96 adults aged 18–75 years. Livdelzi (seladelpar) is an oral PPAR-delta agonist, or delpar, for the treatment of primary biliary cholangitis (PBC). PPAR-delta is known to regulate key metabolic and liver disease pathways. Preclinical and clinical data indicate that Livdelzi has anticholestatic, anti-inflammatory, antipruritic, and antifibrotic effects. Clinical trial data have shown that Livdelzi can support meaningful improvements in key markers of disease activity, including biochemical response and alkaline phosphatase (ALP) normalization, with durable effects observed over long-term follow-up in multiple studies. Livdelzi has the potential to help address ongoing unmet needs for people living with PBC, including those who remain inadequately controlled on existing therapies. Pruritus is a common symptom of PBC that can significantly impair quality of life, and prior studies have demonstrated improvements in pruritus with Livdelzi compared with placebo. Livdelzi is indicated for the treatment of primary biliary cholangitis (PBC) in combination with ursodeoxycholic acid (UDCA) in adults who have had an inadequate response to UDCA, or as monotherapy in patients unable to tolerate UDCA. The FDA approved this indication under accelerated approval based on a reduction of alkaline phosphatase (ALP). Improvement in survival or prevention of liver decompensation events have not been demonstrated. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trial(s). Use of Livdelzi is not recommended in patients who have or develop decompensated cirrhosis (e.g., ascites, variceal bleeding, hepatic encephalopathy). Fractures occurred in 4% of LIVDELZI-treated patients compared to no placebo-treated patients. Consider the risk of fracture in the care of patients treated with LIVDELZI and monitor bone health according to current standards of care. LIVDELZI has been associated with dose-related increases in serum transaminase (AST and ALT) levels > 3 x ULN in patients receiving 50 mg and 200 mg once daily (5x and 20x higher than the recommended dosage of 10 mg once daily). Perform baseline clinical and laboratory testing when starting LIVDELZI and monitor thereafter according to routine patient management. Interrupt treatment if the liver tests (ALT, AST, total bilirubin, and/or ALP) worsen, or if the patient develops signs and symptoms of clinical hepatitis (e.g., jaundice, right upper quadrant pain, eosinophilia). Consider permanent discontinuation if liver tests worsen after restarting LIVDELZI. Avoid use of LIVDELZI in patients with complete biliary obstruction. If biliary obstruction is suspected, interrupt LIVDELZI and treat as clinically indicated. The most common adverse reactions (=5%) with LIVDELZI were headache (8%), abdominal pain (7%), nausea (6%), abdominal distension (6%), and dizziness (5%). OAT3 Inhibitors and Strong CYP2C9 Inhibitors: Avoid coadministration with LIVDELZI due to increased LIVDELZI exposure. Rifampin: Monitor biochemical response (e.g., ALP and bilirubin) when patients initiate rifampin during LIVDELZI treatment. Coadministration may result in delayed or suboptimal biochemical response of LIVDELZI. Dual Moderate CYP2C9 and Moderate-to-Strong CYP3A4 Inhibitors and BCRP Inhibitors (e.g., cyclosporine): Monitor closely for adverse effects. Concomitant administration with LIVDELZI may increase LIVDELZI exposure. CYP2C9 Poor Metabolizers Using Moderate-to-Strong CYP3A4 Inhibitors: Monitor more frequently for adverse reactions as concomitant use of a moderate-to-strong CYP3A4 inhibitor in patients who are CYP2C9 poor metabolizers may increase LIVDELZI exposure and risk of LIVDELZI adverse reactions. Bile Acid Sequestrants: Administer LIVDELZI at least 4 hours before or 4 hours after taking a bile acid sequestrant, or at as great an interval as possible. Pregnancy: There are insufficient data from human pregnancies exposed to LIVDELZI to allow an assessment of a drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Report pregnancies to Gilead Sciences, Inc. Lactation: There are no data on the presence of LIVDELZI in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for LIVDELZI and any potential adverse effects on the breastfed infant from LIVDELZI.