Cited by 298Liver Diseases and ImmunityInflammatory Bowel DiseasePediatric Hepatobiliary Diseases and Treatments

norUrsodeoxycholic acid improves cholestasis in primary sclerosing cholangitis

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Fickert, Peter, Hirschfield, Gideon M., Denk, Gerald, Marschall, Hanns-Ulrich, Altorjay, Istvan, Färkkilä, Martti, Schramm, Christoph, Spengler, Ulrich +12 more·2017·Journal of Hepatology

Abstract

BACKGROUND & AIM: homologue of UDCA and has shown potent anti-cholestatic, anti-inflammatory and anti-fibrotic properties in a preclinical PSC mouse model. A randomized controlled trial, including 38 centers from 12 European countries, evaluated the safety and efficacy of three doses of oral norUDCA (500mg/d, 1,000mg/d or 1,500mg/d) compared with placebo in patients with PSC. METHODS: One hundred sixty-one PSC patients without concomitant UDCA therapy and with elevated serum alkaline phosphatase (ALP) levels were randomized for a 12-week treatment followed by a 4-week follow-up. The primary efficacy endpoint was the mean relative change in ALP levels between baseline and end of treatment visit. RESULTS: norUDCA reduced ALP levels by -12.3%, -17.3%, and -26.0% in the 500, 1,000, and 1,500mg/d groups (p=0.029, p=0.003, and p<0.0001 when compared to placebo), respectively, while a +1.2% increase was observed in the placebo group. Similar dose-dependent results were found for secondary endpoints, such as ALT, AST, γ-GT, or the rate of patients achieving ALP levels <1.5× ULN. Serious adverse events occurred in seven patients in the 500mg/d, five patients in the 1,000mg/d, two patients in the 1500mg/d group, and three in the placebo group. There was no difference in reported pruritus between treatment and placebo groups. CONCLUSIONS: norUDCA significantly reduced ALP values dose-dependently in all treatment arms. The safety profile of norUDCA was excellent and comparable to placebo. Consequently, these results justify a phase III trial of norUDCA in PSC patients. Lay summary: Effective medical therapy for primary sclerosing cholangitis (PSC) is urgently needed. In this phase II clinical study in PSC patients, a side chain-shortened derivative of ursodeoxycholic acid, norursodeoxycholic acid (norUDCA), significantly reduced serum alkaline phosphatase levels in a dose-dependent manner during a 12-week treatment. Importantly, norUDCA showed a favorable safety profile, which was similar to placebo. The use of norUDCA in PSC patients is promising and will be further evaluated in a phase III clinical study. ClinicalTrials.gov number: NCT01755507.

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Crossref · 10.1016/j.jhep.2017.05.009

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  • Clinically, norUDCA improved biochemical markers of cholestasis in a phase 2 clinical trial in PSC irrespective of prior exposure and response to UDCA.

    “Clinically, norUDCA improved biochemical markers of cholestasis in a recent phase 2 clinical trial in PSC irrespective of prior exposure and response to UDCA212”

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Research works printed but not linked: 1

  1. M.P.M.: study design/conception, interpreta- tion of data; M.T.: study design/conception, interpretation of data, manuscript writing. Data have been presented at the International Liver Congress of EASL, April 13-17, 2016 in Barcelona, Spain, and AASLD Liver Meeting, November 11-15, 2016 in Boston, USA. à Complete list of partcipating countries and study centers AUSTRIA: Vienna: Principle Investigator (PI) M. Trauner; Sub- investigators (SIs): H. Hofer, S. Traussnigg, E. Halilbasic; Graz: PI P. Fickert; SIs: E. Krones, F. Durchschein; Innsbruck: PI W. Vogel, SIs: H. Zoller, H. Steinle, H. Schwaighofer, A. Viveiros; BEL- GIUM: Leuven: PI F. Nevens; SIs: W. van Steenbergen, S. Van der Merwe; DENMARK: Odense: PI T. Havelund; SI: A. A. Krag; FIN- LAND: Helsinki: PI: M. Faerkkilae; SI: K. Jokelainen; GERMANY: Hannover: PI M. Manns; SIs: M. Cornberg, K. Deterding, H.-W. Wedemeyer; K. Port; Mainz: PI P. Galle; SIs: J. Schattenberg, A. Grambihler; Essen: PI G. Gerken; SIs: A.E. Canbay, A. Kahraman, J. Best, C. Jochum; Heidelberg: PI D. Gotthardt; SIs: K.-H. Weiss, A. Wannhoff, C. Rupp; Kiel: PI R. Guenther; SIs: T. Bielefeld, P. Wietzke-Braun, H. Vollbrecht, A. Koepke; Homburg (Saar): PI F. Lammert; SIs: B. Appenrodt, C. Juengst; Munich: PI G. Denk; SIs: S. Hohenester, F. Reiter; Hamburg: PI C. Schramm; SIs: C. Weiler-Normann, S. Lueth, M. Lang, M. Wehmeyer; Bonn: PI U. Spengler; SIs: R. Hueneburg, Z. Balta, C. Bless-Paar; Aachen: PI C. Trautwein; SIs: J. Tischendorf, H. Lutz, S. Voigt, F. Tacke; Frank- furt (Main): PI S. Zeuzem; SIs: T. Welzel, S. Klein, S. Luhne, J. Schrewe; Wuerzburg: PI A. Geier; SIs: T. Kudlich, O. Goetze, J. Weiss, C. Hoell; Erlangen: PI A. Kremer; SIs: S. Zopf, J. Siebler, M. Waldner, R. Goertz; Tuebingen: PI C. Berg; SIs: D. Egetemeyr, C. Werner, J. Schwarz, V. Scheble; Duesseldorf: PI D. Haeus- singer; SIs: H. Bock, V. Keitel, U. Heinzel-Pleines; Berlin: PI E. Schott; SIs: D. Beha, T. Mueller, C. Plehm, M. Schulz; Mannheim: PI C. Antoni; SIs: T. Zimmerer, W. Reindl; HUNGARY: Budapest: PI Z. Tulassay; SI: G. Lengyel; Debrecen: PI I. Altorjay; SIs: K. Palatka, I. Tornai; LITHUANIA: Kaunas: PI L. Kupc ˇinskas; SIs: V. Petrenkiene, J. Kondrackiene; NETHERLANDS: Amsterdam: PI U. Beuers; SIs: R. Van Dijk, L. Ailette de Buy Wenninger, S. Aron- son; Rotterdam: PI H. van Buuren; SI: W. Lammers; Nijmegen: PI J. Drenth; SIs: F. Berden, M. Broekman, S. Pape; Leiden: PI B. van Hoek; SIs: M. Coenraad, A. Inderson; NORWAY: Oslo: PI K. M. Boberg; SI: E. Schrumpf; Bergen: PI G.G. Dimcevski; SI: M. Vesterhus; SPAIN: Barcelona: PI A. Pares; SI: L. Caballería; SWE- DEN: Gothenburg: PI H.-U. Marschall; SIs: I. Friis-Liby, A. Schult; Stockholm: PI A. Bergquist; SIs: K. Said, S. Haas; UNITED KING- DOM: Oxford: PI R. Chapman; SIs: K. Williamson, J. Ryan; Nor- wich: PI S. Rushbrook; SI: E. Goode; Birmingham: PI G. Hirschfield; SIs: P. Trivedi, P. Eddowes. References

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Authors
Fickert, P., Hirschfield, G. M., Denk, G., Marschall, H.-U., Altorjay, I., Färkkilä, M., Schramm, C., Spengler, U., Chapman, R., Bergquist, A., Schrumpf, E., Nevens, F., Trivedi, P., Reiter, F. P., Tornai, I., Halilbasic, E., Greinwald, R., Pröls, M., Manns, M. P., & Trauner, M.
Affiliations
  • Medical University of Graz (AT)
  • University of Birmingham (GB)
  • LMU Klinikum (DE)
  • University of Gothenburg (SE)
  • University of Helsinki (FI)
  • University Medical Center Hamburg-Eppendorf (DE)
  • University of Bonn (DE)
  • John Radcliffe Hospital (GB)
  • Karolinska University Hospital (SE)
  • Oslo University Hospital (NO)
  • KU Leuven (BE)
  • Medical University of Vienna (AT)
  • Dr Falk Pharma (Germany) (DE)
  • Medizinische Hochschule Hannover (DE)
Corresponding author
Trauner, Michael
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2017-09
Volume
67
Issue
3
Pages
549-558
ISSN
0168-8278 (ISSN-L)
OpenAlex
W2616282068
Cited by
297
References
45
Citations by year
2026: 30 · 2025: 22 · 2024: 38 · 2023: 25 · 2022: 35 · 2021: 43 · 2020: 36 · 2019: 29 · 2018: 28 · 2017: 9 · 2012: 1
FWCI
17.19
Type
journal article
Language
en
Open access
Locations
  • Journal of Hepatology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion, cc-by-nc-nd)
  • University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion, cc-by-nc-nd)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
Funders
  • Falk Foundation
  • Pfizer
  • Gilead Sciences
  • National Institute for Health and Care Research
  • Astellas Pharma
  • Dr. Falk Pharma
  • Cilag
Topics
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
  • Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
Keywords
primary sclerosing cholangitis, cholestasis, alkaline phosphatase, dose-dependent effects, safety profile, pruritus, liver fibrosis
MeSH terms
Adult, Alkaline Phosphatase, Cholestasis, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Middle Aged, Ursodeoxycholic Acid, Cholangitis, Sclerosing

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