Theratechnologies Inc., a biopharmaceutical company focused on the development and commercialization of innovative therapies, is pleased to announce that it plans to pursue Phase 3 clinical development of tesamorelin for the treatment of Non-Alcoholic Steatohepatitis (NASH) in the general population.
“After careful review of our file and discussions with our scientific advisers, we made the decision to pursue the Phase 3 development of tesamorelin for the treatment of NASH in the general population,” said Mr. Paul Lévesque, President and Chief Executive Officer, Theratechnologies.
“From 10 years of real-life experience, the safety profile of tesamorelin in HIV patients with lipodystrophy is well established. Based on current scientific evidence showing a reduction in liver fat and delayed progression of liver fibrosis in patients with HIV infection and NAFLD or NASH, combined with robust intellectual property, a new investigational formulation and the development of a multi-dose pen injector, we believe that we have a potential best-in-class candidate for the treatment of NASH in the general population,” added Mr. Lévesque.
It was recently published in JCI Insight, a peer-reviewed medical journal, that in HIV-associated NAFLD/NASH, tesamorelin has a positive effect on gene expression related to oxidative phosphorylation, decreased gene expression related to inflammation, tissue repair and cell division while improving gene expression associated with favorable hepatocellular carcinoma (HCC) prognosis. Based on its unique mode of action, tesamorelin is designed to work upstream to reduce the accumulation of liver fat, which can lead to NASH.
“Given that tesamorelin improves critical mechanistic NASH pathways common to both the general population and in people living with HIV, we believe tesamorelin could bring favorable results in both patient populations,” said Dr. Steven Grinspoon, Professor of Medicine, Harvard Medical School, Chief of the Metabolism Unit at Massachusetts General Hospital and study Principal Investigator.
“NASH is a silent killer that affects a growing number of people each year worldwide. There is a dire need for safe and effective treatments for NASH as patients and physicians currently do not have access to any approved drugs. Given its clinical history, recent positive data in patients with HIV-associated NAFLD and its mode of action, we believe tesamorelin has the potential to reverse NASH and NASH related fibrosis in the Phase 3 trial for the management of this serious and deadly condition,” said Dr. Rohit Loomba, Professor of Medicine (with tenure) in the Division of Gastroenterology, and Adjunct Professor in the Division of Epidemiology at the University of California, San Diego.
Phase 3 clinical trial
Theratechnologies intends to submit its Phase 3 study protocol to the United States Food and Drug Administration (FDA) and the European regulatory agencies in the coming weeks. Subject to feedback from the regulatory agencies, the trial would involve approximately 650 patients with fibrosis scores of 2 and 3 and with a NAS score of at least 4 and also include a cohort of 50 people living with HIV. The enrollment of patients is planned for the first quarter of 2021. Patients will be treated for a period of 18 months. As per published regulatory guidelines, the primary endpoints will assess NAS score normalisation and absence of worsening of fibrosis stage, or fibrosis improvement ≥ 1 stage and no worsening of NAS.
Theratechnologies intends to use a new investigational formulation of tesamorelin, known as “F8”, for the Phase 3 trial in NASH. In addition, a supplemental Biologics License Application (sBLA) is expected to be filed with the FDA in early 2022 in HIV-associated lipodystrophy using a convenient, multi-dose pen injector currently being developed for this new formulation.
The F8 is patent protected in the U.S. until 2033 and until 2034 in major European countries. Furthermore, a notice of allowance was issued by the United States Patent and Trademark Office on a pending US patent application filed by the Massachusetts General Hospital (MGH) in March 2020 relating to the treatment of hepatic disease using GHRH or analogues thereof. This patent application claims, amongst other things, a method for the treatment of NAFLD or NASH in a patient via the administration of tesamorelin.
Theratechnologies has an exclusive license with the MGH to this patent application. Theratechnologies continues to explore the filing of additional patent applications in the NAFLD/NASH field.
Investigator-initiated study results published in The Lancet HIV On October 11, 2019, results from an investigator-initiated randomized, double-blind, multicenter study assessing the effect of tesamorelin on liver fat and histology in people living with HIV with NAFLD/NASH were published in The Lancet HIV. This publication followed prior data published in the Journal of Clinical Endocrinology and Metabolism showing that tesamorelin also significantly reduced ectopic adipose tissue in non-HIV patients.
At baseline, liver biopsies revealed that 43% of patients had liver fibrosis and 33% had NASH. A total of 61 patients received 2mg of tesamorelin daily or an identical placebo for a period of 12 months. The primary endpoint of the study was a change in hepatic fat fraction. After 12 months of treatment, liver fat in patients on tesamorelin had decreased by 32% while it had increased by 5% in placebo patients, from baseline, (p=0.02), amounting to a 37% relative reduction in liver fat. Furthermore, 35% of patients in the tesamorelin group returned to liver fat values below 5% in comparison to only 4% of patients on placebo (p=0.007). The study concluded that only 10.5% of patients in the tesamorelin group experienced progression of liver fibrosis compared to 37.5% in patients receiving a placebo (p=0.04). Exploratory analyses showed that the higher the baseline NASH score was, the more change was seen among the tesamorelin-treated individuals (r=-0.48, P=0.04), whereas a similar relationship was not observed in the placebo group (r=-0.14, P=0.52). The safety profile of tesamorelin in this study was comparable to that observed in HIV patients with lipodystrophy.
About NAFLD /NASH
According to the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, experts estimate that 20 percent of Americans with NAFLD have NASH. It is believed that 3 to 12 percent of adult Americans have NASH. NAFLD is an umbrella term for a spectrum of liver conditions that begin with a build-up of hepatic fat, which can set the stage for inflammation that may promote scarring known as fibrosis. Over time, fibrosis can progress to potentially fatal cirrhosis and even a form of liver cancer called hepatocellular carcinoma.
Usually, NAFLD and NASH are silent diseases with few or no symptoms. A patient may not show symptoms even if they develop cirrhosis due to NASH. There is currently no approved treatment for NAFLD and NASH in the North America and Europe.
