| Peer-Reviewed

Phase 1 Study of EDP-305, a Novel Once-Daily Oral Farnesoid X Receptor Agonist, in Healthy Subjects and Those with Presumptive Nonalcoholic Fatty Liver Disease

Received: 21 October 2021    Accepted: 9 November 2021    Published: 17 November 2021
Views:       Downloads:
Abstract

Introduction: EDP-305 is a farnesoid X Receptor (FXR) agonist that selectively activates FXR and is currently under investigation for with the treatment of nonalcoholic steatohepatitis (NASH). The primary objective was to assess the safety of EDP-305 in healthy subjects and subjects with presumptive NAFLD. Methods: In this placebo-controlled double-blind Phase 1 study, healthy subjects (aged 20-55 years) were randomized to single or multiple oral doses of once daily EDP-305 or placebo and subjects with presumptive NAFLD (aged 25-52 years) were randomized to multiple oral doses of once daily EDP-305 or placebo for 14 days. Six cohorts received EDP-305 1 mg, 5 mg, 10 mg, 20 mg, 40 mg or 80 mg in the SAD phase including a food effect cohort that received EDP-305 10 mg. In the MAD phase, 12 cohorts received EDP-305 0.5 mg, 1 mg, 2.5 mg, 5 mg, 10 mg or 20 mg (six cohorts in healthy subjects and six in presumptive NAFLD). Results: In the SAD phase, 38 subjects received EDP-305 and 12 subjects received placebo, and in the MAD phase, 72 subjects received EDP-305 and 24 subjects received placebo. No serious adverse events were reported, and the most common treatment-emergent adverse events (TEAEs) in EDP-305 treated subjects were constipation, headache, and pruritus. The majority of TEAEs were mild to moderate in severity. EDP-305 exposure increased with single and multiple doses in both healthy subjects and those with presumptive NAFLD. EDP-305 exposure was approximately 3-fold higher in fed vs. fasted subjects. Strong FXR target engagement was demonstrated in both healthy and presumptive NAFLD subjects in the MAD phase with FGF19 increases and C4 reductions compared with placebo. Conclusion: EDP-305 was well tolerated, with pruritus the most common treatment-emergent adverse event at EDP-305 doses ≥10 mg and with minimal effects on lipids. Dose proportional PK support once daily dosing. Significant elevations of FGF19 and diminutions in C4 demonstrated potent engagement of the FXR receptor at doses that neither elicit adverse effects on lipids nor result in pruritus. These results supported further evaluation of EDP-305 in patients with NASH.

Published in International Journal of Gastroenterology (Volume 5, Issue 2)
DOI 10.11648/j.ijg.20210502.16
Page(s) 68-79
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Nonalcoholic Fatty Liver Disease, Farnesoid X Receptor, EDP-305, Pharmacokinetics, Safety

References
[1] Kasper P, Martin A, Lang S, et al. NAFLD and cardiovascular diseases: a clinical review. Clin Res Cardiol 2021; 110: 921-937.
[2] Stahl EP, Dhindsa DS, Lee SK, et al. Nonalcoholic fatty liver disease and the heart: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73: 948-963.
[3] Tana C, Ballestri S, Ricci F, et al. Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications. Int J Environ Res Public Health 2019; 16: 3104.
[4] Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence and outcomes. Hepatology. 2016; 64: 73-84.
[5] Cotter TG, Rinella M. Nonalcoholic Fatty Liver Disease 2020: The State of the Disease. Gastroenterology 2020; 158: 1851-1864.
[6] Younossi ZM, Stepanova M, Ong J, et al. Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in the United States. Clin Gastroenterol Hepatol 2021; 19: 580-589.
[7] Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2015; 149: 389-397.
[8] Sheka AC, Adeyi O, Thompson J, et al. Nonalcoholic steatohepatitis: A review. JAMA 2020; 323: 1175-1183.
[9] Taylor RS, Taylor RJ, Bayliss S, et al; Collaborators. Association between fibrosis stage and outcomes of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis. Gastroenterology 2020’; 158: 1611-1625.
[10] Anisfeld AM, Kast-Woelbern HR, et al. Activation of the nuclear receptor FXR induces fibrinogen expression: a new role for bile acid signaling. J Lipid Res 2005; 46: 458-468.
[11] McMahan RH, Wang XX, Cheng LL, et al. Bile acid receptor activation modulates hepatic monocyte activity and improves nonalcoholic fatty liver disease. J Biol Chem 2013; 288: 11761-11770.
[12] Alemi F, Kwon E, Poole DP, et al. The TGR5 receptor mediates bile acid-induced itch and analgesia. J Clin Invest 2013; 123: 1513-1530.
[13] Lieu T, Jayaweera G, Zhao P, et al. The bile acid receptor TGR5 activates the TRPA1 channel to induce itch in mice. Gastroenterology 2014; 147: 1417-1428.
[14] Fiorucci S, Biagioli M, Sepe V, Zampella A, Distrutti E. Bile acid modulators for the treatment of nonalcoholic steatohepatitis (NASH). Expert Opin Investig Drugs 2020; 29: 623-632.
[15] Connelly MA, Velez Rivera J, Guyton JR, et al. Review article: the impact of liver-directed therapies on the atherogenic risk profile in non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2020; 52: 619-636.
[16] Guirguis E, Grace Y, Bolson A, DellaVecchia MJ, Ruble M. Emerging therapies for the treatment of non-alcoholic steatohepatitis: A systematic review. Pharmacotherapy 2020 2021; 41: 315-328.
[17] An P, Wei G, Huang P, et al. A novel non-bile acid FXR agonist EDP-305 potently suppresses liver injury and fibrosis without worsening of ductular reaction. Liver Int 2020; 40: 1655-1669.
[18] Chau M, Li Y, Roqueta-Rivera M, et al. Characterization of EDP-305, a highly potent and selective farnesoid x receptor agonist, for the treatment of non-alcoholic steatohepatitis. Int J Gastroenterol 2019; 3: 4-16.
[19] Erstad DJ, Farrar CT, Ghoshal S, et al. Molecular magnetic resonance imaging accurately measures the antifibrotic effect of EDP-305, a novel farnesoid X receptor agonist. Hepatol Commun 2018; 2: 821-835.
[20] Li S, Ghoshal S, Sojoodi M, et al. The farnesoid X receptor agonist EDP-305 reduces interstitial renal fibrosis in a mouse model of unilateral ureteral obstruction. FASEB J 2019; 33: 7103-7112.
[21] Stofan M, Guo GL. Bile acids and FXR: Novel targets for liver diseases. Front Med (Lausanne). 2020; 7: 544.
[22] Standards of Medical Care in Diabetes. 2. Classification and Diagnosis of Diabetes. Diabetes Care 2015; 38 (Suppl. 1): S8–S16.
[23] Neuschwander-Tetri BA, Loomba R, Sanyal AJ, et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385: 956-965.
[24] Nevens F, Andreone P, Mazzella G, et al. A placebo controlled trial of obeticholic acid in primary biliary cholangitis. N Engl J Med 2016; 375: 631-643.
[25] Eisendle K, Müller H, Ortner E, et al. Pruritus of unknown origin and elevated total serum bile acid levels in patients without clinically apparent liver disease. J Gastroenterol Hepatol 2011; 26: 716-721.
[26] Badman MK, Chen J, Desai S, et al. Safety, Tolerability, Pharmacokinetics, and pharmacodynamics of the novel non-bile acid FXR agonist tropifexor (LJN452) in healthy volunteers. Clin Pharmacol Drug Dev 2020; 9: 395-410.
[27] Charlton M, Wang Y, Zhang Q, et al. TERN-101, a liver selective, FXR agonist, is well-tolerated and produces potent 7a-C4 reductions and FGF19 increases with no pruritus in healthy participants. Poster 1702 presented at the Liver Meeting, November 2020.
[28] Inagaki T, Choi M, Moschetta A, et al. Fibroblast growth factor 15 functions as an enterohepatic signal to regulate bile acid homeostasis. Cell Metab 2005; 2: 217-225.
[29] Keely SJ, Walters JR The farnesoid X receptor: good for BAD. Cell Mol Gastroenterol Hepatol 2016; 2: 725-732.
[30] Pencek R, Lee K-J, Lee J, Chen H. MET642, FXR agonist with a unique chemotype, demonstrates a safe, sustained profile in a 14-day randomized study in healthy subjects. Presented at 2021 NASH-TAG Conference, March 2021, Park City, UT.
[31] Pencek R, Marmon T, Roth JD, et al. Effects of obeticholic acid on lipoprotein metabolism in healthy volunteers. Diabetes Obes Metab 2016; 18: 936-940.
[32] Mudaliar S, Henry RR, Sanyal AJ, et al. Efficacy and safety of the farnesoid X receptor agonist obeticholic acid in patients with type 2 diabetes and nonalcoholic fatty liver disease. Gastroenterology 2013; 145: 574-582.
Cite This Article
  • APA Style

    Alaa Ahmad, Kristin Sanderson, Daniel Dickerson, Nathalie Adda. (2021). Phase 1 Study of EDP-305, a Novel Once-Daily Oral Farnesoid X Receptor Agonist, in Healthy Subjects and Those with Presumptive Nonalcoholic Fatty Liver Disease. International Journal of Gastroenterology, 5(2), 68-79. https://doi.org/10.11648/j.ijg.20210502.16

    Copy | Download

    ACS Style

    Alaa Ahmad; Kristin Sanderson; Daniel Dickerson; Nathalie Adda. Phase 1 Study of EDP-305, a Novel Once-Daily Oral Farnesoid X Receptor Agonist, in Healthy Subjects and Those with Presumptive Nonalcoholic Fatty Liver Disease. Int. J. Gastroenterol. 2021, 5(2), 68-79. doi: 10.11648/j.ijg.20210502.16

    Copy | Download

    AMA Style

    Alaa Ahmad, Kristin Sanderson, Daniel Dickerson, Nathalie Adda. Phase 1 Study of EDP-305, a Novel Once-Daily Oral Farnesoid X Receptor Agonist, in Healthy Subjects and Those with Presumptive Nonalcoholic Fatty Liver Disease. Int J Gastroenterol. 2021;5(2):68-79. doi: 10.11648/j.ijg.20210502.16

    Copy | Download

  • @article{10.11648/j.ijg.20210502.16,
      author = {Alaa Ahmad and Kristin Sanderson and Daniel Dickerson and Nathalie Adda},
      title = {Phase 1 Study of EDP-305, a Novel Once-Daily Oral Farnesoid X Receptor Agonist, in Healthy Subjects and Those with Presumptive Nonalcoholic Fatty Liver Disease},
      journal = {International Journal of Gastroenterology},
      volume = {5},
      number = {2},
      pages = {68-79},
      doi = {10.11648/j.ijg.20210502.16},
      url = {https://doi.org/10.11648/j.ijg.20210502.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20210502.16},
      abstract = {Introduction: EDP-305 is a farnesoid X Receptor (FXR) agonist that selectively activates FXR and is currently under investigation for with the treatment of nonalcoholic steatohepatitis (NASH). The primary objective was to assess the safety of EDP-305 in healthy subjects and subjects with presumptive NAFLD. Methods: In this placebo-controlled double-blind Phase 1 study, healthy subjects (aged 20-55 years) were randomized to single or multiple oral doses of once daily EDP-305 or placebo and subjects with presumptive NAFLD (aged 25-52 years) were randomized to multiple oral doses of once daily EDP-305 or placebo for 14 days. Six cohorts received EDP-305 1 mg, 5 mg, 10 mg, 20 mg, 40 mg or 80 mg in the SAD phase including a food effect cohort that received EDP-305 10 mg. In the MAD phase, 12 cohorts received EDP-305 0.5 mg, 1 mg, 2.5 mg, 5 mg, 10 mg or 20 mg (six cohorts in healthy subjects and six in presumptive NAFLD). Results: In the SAD phase, 38 subjects received EDP-305 and 12 subjects received placebo, and in the MAD phase, 72 subjects received EDP-305 and 24 subjects received placebo. No serious adverse events were reported, and the most common treatment-emergent adverse events (TEAEs) in EDP-305 treated subjects were constipation, headache, and pruritus. The majority of TEAEs were mild to moderate in severity. EDP-305 exposure increased with single and multiple doses in both healthy subjects and those with presumptive NAFLD. EDP-305 exposure was approximately 3-fold higher in fed vs. fasted subjects. Strong FXR target engagement was demonstrated in both healthy and presumptive NAFLD subjects in the MAD phase with FGF19 increases and C4 reductions compared with placebo. Conclusion: EDP-305 was well tolerated, with pruritus the most common treatment-emergent adverse event at EDP-305 doses ≥10 mg and with minimal effects on lipids. Dose proportional PK support once daily dosing. Significant elevations of FGF19 and diminutions in C4 demonstrated potent engagement of the FXR receptor at doses that neither elicit adverse effects on lipids nor result in pruritus. These results supported further evaluation of EDP-305 in patients with NASH.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Phase 1 Study of EDP-305, a Novel Once-Daily Oral Farnesoid X Receptor Agonist, in Healthy Subjects and Those with Presumptive Nonalcoholic Fatty Liver Disease
    AU  - Alaa Ahmad
    AU  - Kristin Sanderson
    AU  - Daniel Dickerson
    AU  - Nathalie Adda
    Y1  - 2021/11/17
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijg.20210502.16
    DO  - 10.11648/j.ijg.20210502.16
    T2  - International Journal of Gastroenterology
    JF  - International Journal of Gastroenterology
    JO  - International Journal of Gastroenterology
    SP  - 68
    EP  - 79
    PB  - Science Publishing Group
    SN  - 2640-169X
    UR  - https://doi.org/10.11648/j.ijg.20210502.16
    AB  - Introduction: EDP-305 is a farnesoid X Receptor (FXR) agonist that selectively activates FXR and is currently under investigation for with the treatment of nonalcoholic steatohepatitis (NASH). The primary objective was to assess the safety of EDP-305 in healthy subjects and subjects with presumptive NAFLD. Methods: In this placebo-controlled double-blind Phase 1 study, healthy subjects (aged 20-55 years) were randomized to single or multiple oral doses of once daily EDP-305 or placebo and subjects with presumptive NAFLD (aged 25-52 years) were randomized to multiple oral doses of once daily EDP-305 or placebo for 14 days. Six cohorts received EDP-305 1 mg, 5 mg, 10 mg, 20 mg, 40 mg or 80 mg in the SAD phase including a food effect cohort that received EDP-305 10 mg. In the MAD phase, 12 cohorts received EDP-305 0.5 mg, 1 mg, 2.5 mg, 5 mg, 10 mg or 20 mg (six cohorts in healthy subjects and six in presumptive NAFLD). Results: In the SAD phase, 38 subjects received EDP-305 and 12 subjects received placebo, and in the MAD phase, 72 subjects received EDP-305 and 24 subjects received placebo. No serious adverse events were reported, and the most common treatment-emergent adverse events (TEAEs) in EDP-305 treated subjects were constipation, headache, and pruritus. The majority of TEAEs were mild to moderate in severity. EDP-305 exposure increased with single and multiple doses in both healthy subjects and those with presumptive NAFLD. EDP-305 exposure was approximately 3-fold higher in fed vs. fasted subjects. Strong FXR target engagement was demonstrated in both healthy and presumptive NAFLD subjects in the MAD phase with FGF19 increases and C4 reductions compared with placebo. Conclusion: EDP-305 was well tolerated, with pruritus the most common treatment-emergent adverse event at EDP-305 doses ≥10 mg and with minimal effects on lipids. Dose proportional PK support once daily dosing. Significant elevations of FGF19 and diminutions in C4 demonstrated potent engagement of the FXR receptor at doses that neither elicit adverse effects on lipids nor result in pruritus. These results supported further evaluation of EDP-305 in patients with NASH.
    VL  - 5
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Enanta Pharmaceuticals Inc., Watertown, the United States

  • Enanta Pharmaceuticals Inc., Watertown, the United States

  • PRA Health Sciences, Lenexa, the United States

  • Enanta Pharmaceuticals Inc., Watertown, the United States

  • Sections