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A Phase 3 Study to Evaluate the Efficacy and Safety of MGL-3196 (Resmetirom) in Patients With NASH and Fibrosis (MAESTRO-NASH)

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ClinicalTrials.gov Identifier: NCT03900429
Recruitment Status : Recruiting
First Posted : April 3, 2019
Last Update Posted : December 6, 2022
Information provided by (Responsible Party):
Madrigal Pharmaceuticals, Inc.

Brief Summary:
A double-blind placebo controlled randomized Phase 3 study to determine if 80 or 100 mg of MGL-3196 as compared with placebo resolves NASH and/or reduces fibrosis on liver biopsy and prevents progression to cirrhosis and/or advanced liver disease

Condition or disease Intervention/treatment Phase
NASH - Nonalcoholic Steatohepatitis Drug: MGL-3196 Drug: Placebo Phase 3

Detailed Description:
Primary and secondary endpoint population at Week 52 will be at least 900 patients, more than half F3, the remainder F2 and <10% F1B based on final liver biopsy baseline fibrosis score.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 2000 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase 3, Multinational, Double-Blind, Randomized, Placebo-Controlled Study of MGL-3196 (Resmetirom) in Patients With Non-Alcoholic Steatohepatitis (NASH) and Fibrosis to Resolve NASH and Reduce Progression to Cirrhosis and/or Hepatic Decompensation
Actual Study Start Date : March 28, 2019
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : May 2026

Arm Intervention/treatment
Placebo Comparator: Matching Placebo
Placebo Daily
Drug: Placebo
Matching Tablets

Active Comparator: 80 mg MGL-3196
80 mg daily
Drug: MGL-3196
Other Name: Resmetirom

Active Comparator: 100 mg MGL-3196
100 mg daily
Drug: MGL-3196
Other Name: Resmetirom

Primary Outcome Measures :
  1. Week 52 Dual Primary Objectives: To determine the effect of 80 or 100 mg MGL-3196 vs matching placebo on liver biopsy (NASH CRN score) at Week 52 compared with Baseline [ Time Frame: 52 weeks ]
    1. Proportion with resolution of NASH (ballooning 0, inflammation 0,1) associated with at least 2-point reduction in NAFLD Activity Score (NAS) without worsening of fibrosis stage OR
    2. Proportion with at least a 1-point improvement in fibrosis stage with no worsening of NAS

  2. Month 54 Primary Objective: Time to experiencing an adjudicated Composite Clinical Outcome event (Final Primary Endpoint, at 54 months) [ Time Frame: up to 54 months ]
    The Composite Clinical Outcome is composed of all-cause mortality, liver transplant, and significant hepatic events (including hepatic decompensation events [ascites, encephalopathy, or variceal hemorrhage], histological progression to cirrhosis, and a confirmed increase of MELD score from <12 to ≥15).

Secondary Outcome Measures :
  1. Week 52 Key Secondary Objective: To determine the effect of once-daily, oral administration of MGL-3196 80 or 100 mg versus matching placebo on the percent change from Baseline at 24 weeks in directly measured low-density lipoprotein cholesterol (LDL-C) [ Time Frame: 24 weeks ]
    Assess the effect of MGL-3196 80 mg or 100 mg compared to placebo on LDL-C measured by percent change from Baseline at 24 weeks.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Must be willing to participate in the study and provide written informed consent.
  2. Male and female adults ≥ 18 years of age.
  3. Suspected or confirmed diagnosis of NASH

    1. Metabolic risk factors and AST > 20 U/L
    2. Criteria consistent with liver fibrosis as defined as one of the following:

      • Biochemical test for fibrosis OR
      • Fibroscan test OR
      • Historical liver biopsy with diagnosis of NASH with fibrosis Stage 2 or 3
  4. MRI-PDFF with increased fat fraction
  5. Biopsy-proven NASH (Baseline liver biopsy) based on a liver biopsy obtained within 24 weeks before anticipated date of randomization (if the biopsy is deemed acceptable for interpretation by the central reader) with fibrosis stage 1A, 1B, 2, or 3 on liver biopsy and NAS of ≥ 4 with a score of at least 1 in each of the following NAS components:

    1. Steatosis (scored 0 to 3)
    2. Ballooning degeneration (scored 0 to 2)
    3. Lobular inflammation (scored 0 to 3)

Exclusion Criteria:

  1. History of significant alcohol consumption for a period of more than 3 consecutive months within 1 year prior to Screening.
  2. Regular use of drugs historically associated with NAFLD
  3. History of bariatric surgery or intestinal bypass surgery within the 5 years prior to randomization or planned during the conduct of the study.
  4. Recent significant weight gain or loss
  5. HbA1c ≥ 9.0%.
  6. Glucagon-like peptide 1 [GLP-1] agonist, high dose Vitamin E (> 400 IU/day), or pioglitazone therapy unless stable dose for 24 weeks prior to biopsy.
  7. Presence of cirrhosis on liver biopsy defined as stage 4 fibrosis.
  8. Diagnosis of hepatocellular carcinoma (HCC).
  9. MELD score ≥12, as determined at Screening, unless due to therapeutic anti coagulation.
  10. Hepatic decompensation
  11. Chronic liver diseases other than NASH
  12. Active autoimmune disease
  13. Serum ALT > 250 U/L.
  14. Active, serious medical disease with a likely life expectancy < 2 years.
  15. Participation in an investigational new drug trial in the 60 days or 5 half-lives, whichever is longer.
  16. Any other condition which, in the opinion of the Investigator, would impede compliance, hinder completion of the study, compromise the well-being of the patient, or interfere with the study outcomes.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03900429

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Contact: Kimberly Dorney, RN, MSN 267-520-0252 info@madrigalpharma.com

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Sponsors and Collaborators
Madrigal Pharmaceuticals, Inc.
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Study Director: Rebecca Taub, MD Madrigal Pharmaceuticals, Inc.
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Madrigal Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT03900429    
Other Study ID Numbers: MGL-3196-11
First Posted: April 3, 2019    Key Record Dates
Last Update Posted: December 6, 2022
Last Verified: November 2022

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Fatty Liver
Non-alcoholic Fatty Liver Disease
Liver Diseases
Digestive System Diseases