Saroglitazar Magnesium for Treatment of Primary Biliary Cholangitis


About this study

The purpose of this study is to to evaluate the effectiveness and safety of Saroglitazar Magnesium’s optimal dose (1 or 2 mg) and placebo in subjects with primary biliary cholangitis (PBC).

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

1. Males or females, between 18 and 75 years of age, both inclusive at screening.

2. Subjects on Ursodeoxycholic acid (UDCA) for at least 12 months at a therapeutic dose
(at least 13 mg/kg per day) and a stable dose for 6 months prior to Screening Visit
and having ALP ≥ 1.67 x ULN.

OR Subjects who are unable to tolerate UDCA and did not receive UDCA for at least 3
months prior to the date of screening and having ALP ≥ 1.67 x ULN.

3. History of confirmed PBC diagnosis, based on American Association for the Study of
Liver Disease [AASLD] and European Association for Study of the Liver [EASL] Practice
Guidelines, as demonstrated by the presence of at least ≥ 2 of the following 3
diagnostic factors:

1. History of elevated ALP levels for at least 6 months prior to screening

2. The subjects should have positive anti-mitochondrial antibodies (AMA) titer OR if
AMA is negative or in low titer (< 1:80), then the subjects should have PBC
specific antibodies (anti-GP210 and/or anti-SP100 and/or antibodies against the
major M2 components [PDC-E2, 2-oxo-glutaric acid dehydrogenase complex])

3. Liver biopsy consistent with PBC

4. ALP ≥ 1.67 x ULN at both Visits 1 and 2 and with < 30% variance between the levels
from Visit 1 to Visit 2

5. Total bilirubin < 2 x ULN at screening (Visit 1)

6. Must provide written informed consent and agree to comply with the trial protocol

Exclusion Criteria:

1. Consumption of 2 standard alcohol drinks per day if male and 1 standard alcohol drink
per day if female for at least 3 consecutive months (12 consecutive weeks) within 5
year before screening (Note: 1 unit = 12 ounces of beer, 4 ounces of wine or 1 ounce
of spirits/hard liquor).

2. History or presence of other concomitant liver diseases at screening:

1. Chronic hepatitis B or C virus (HBV, HCV) infection. (Note: However, If the
subject has been treated for the HCV infection and has been cured for a duration
of more than 2 years from screening, such subjects can be enrolled in the study)

2. Primary sclerosing cholangitis (PSC).

3. Alcoholic liver disease.

4. Autoimmune hepatitis (AIH) indicative of PBC with overlap syndrome.

Note: The Paris criteria are commonly used to define the presence of PBC with
features of AIH and have been endorsed by EASL and AASLD. According to these
criteria, a diagnosis can be made in a patient with PBC as follows:

At least two of the following:

I. ALP > 2 x ULN or GGT > 5 x ULN. II. AMA > 1:40. III. Florid bile duct lesion
on histology. AND

At least two of the following three features:

I. ALT > 5 x ULN. II. Immunoglobulin G serum levels > 2 x ULN or smooth muscle
autoantibody positive.

III. Moderate to severe interface hepatitis on histology.

5. Hemochromatosis.

6. Non-alcoholic steatohepatitis (NASH) on historical biopsy.

3. Cirrhosis with complications, including history or presence of: spontaneous bacterial
peritonitis, hepatocellular carcinoma, encephalopathy, known large esophageal varices
or history of variceal bleeding and active or history of hepatorenal syndrome at

4. Clinically silent compensated cirrhosis (at screening), defined as (a) nodular liver
contour by abdominal imaging with at least one sign of liver dysfunction (> ULN INR or
< LLN serum albumin); or (b) prolonged INR (> ULN) and diminished albumin (< LLN); or
(c) platelet count <140x109/L with INR > ULN or serum albumin < LLN.

5. Medical conditions that may cause non-hepatic increases in ALP (e.g., Paget's disease)
or which may diminish life expectancy to < 2 years, including known cancers.

6. Use of thiazolidinediones or fibrates (within 12 weeks prior to screening).

7. Use of obeticholic acid (OCA), azathioprine, cyclosporine, methotrexate,
mycophenolate, pentoxifylline, budesonide and other systemic corticosteroids (Note:
Prednisone dose should not be more than 10 mg per day); potentially hepatotoxic drugs
(including ?-methyl-dopa, sodium valproic acid, isoniazid, or nitrofurantoin) (within
12 weeks prior to screening).

8. Use of drugs that are known CYP2C8 inhibitors/substrate within 4 weeks prior to
screening (refer to Appendix 7 for List of Known CYP2C8 Inhibitors/Substrate).

9. History of bowel surgery (gastrointestinal [bariatric] surgery in the preceding 1 year
or undergoing evaluation for gastrointestinal surgery (bariatric surgery for obesity,
extensive small-bowel resection) or orthotopic liver transplant (OLT) or listed for

10. Type 1 diabetes mellitus.

11. Unstable cardiovascular disease, including:

1. Unstable angina, (i.e., new or worsening symptoms of coronary heart disease in
the 12 weeks before screening and throughout the Screening Period), acute
coronary syndrome in the 24 weeks before screening and throughout the Screening
Period, acute myocardial infarction in the 12 weeks before screening and
throughout the Screening Period or heart failure of New York Heart Association
class (III - IV) or worsening congestive heart failure, or coronary artery
intervention, in the 24 weeks before screening and throughout the Screening

2. History/current unstable cardiac dysrhythmias.

3. Uncontrolled hypertension at screening.

4. Stroke or transient ischemic attack in the 24 weeks before screening.

12. History of intracranial hemorrhage, arteriovenous malformation, bleeding disorder,
coagulation disorders, or screening blood tests that, in the opinion of the
Investigator, indicate altered coagulability (e.g., PT, INR, aPTT) at screening.

13. An uncontrolled thyroid disorder

1. Uncontrolled hyperthyroidism: defined as any history of hyperthyroidism that has
either not been treated with either radioactive iodine and/or surgery or that has
been treated with radioactive iodine and/or surgery, but has required ongoing
continuous or intermittent use of thyroid hormone synthesis inhibitors (i.e.,
methimazole or propylthiouracil) in the 24 weeks before screening.

2. Uncontrolled hypothyroidism: defined as initiation of thyroid hormone replacement
therapy or dose adjustment of replacement therapy in the 12 weeks before

14. History of myopathies or evidence of active muscle disease demonstrated by CPK ≥ 5 x
ULN at screening.

15. Subjects whose ALT, AST, or ALP exceeds by more than 50% on Visit 2 reading compared
to Visit 1. Note: If the ALT, AST, or ALP values on Visit 2 exceed by more than 50%
from Visit 1, then a third value will be measured (within 1- 2 weeks) to assess for
the trend. If the third value shows continued increase ≥ 10%, then subject is
considered ineligible for randomization.

16. Any of the following laboratory values at screening:

1. Platelets < 100 × 109/L

2. Albumin < 3.2 g/dL

3. eGFR < 60 mL/min/1.73 m2

4. ALP > 10 x ULN

5. ALT or AST > 250 U/L

17. Participation in another interventional clinical study and receipt of any other
investigational medication (within 12 weeks prior to randomization up to end of

18. History of malignancy in the past 5 years and/or active neoplasm with the exception of
resolved superficial non-melanoma skin cancer.

19. Contraindications to Saroglitazar Magnesium or has any conditions affecting the
ability to evaluate the effects of Saroglitazar Magnesium.

20. Known allergy, sensitivity, or intolerance to the study drug, comparator, or
formulation ingredients.

21. Pregnancy-related exclusions, including:

1. Pregnant/lactating female (including positive pregnancy test at screening).

2. Fertile women and men, UNLESS using effective contraceptive methods (such as an
intra-uterine device or other mechanical contraception method with condom or
diaphragm and spermicide) throughout the study. For male subjects, contraception
measures (condom and spermicide) must be taken during the study, either by the
male participant or his female partner. (Note: Enrolled females otherwise must be
surgically sterilized for at least 24 weeks before screening or postmenopausal,
defined as 52 weeks with no menses without an alternative medical cause or
following sexual abstinence.)

22. History or other evidence of severe illness or any other conditions that would make
the subject, in the opinion of the Investigator, unsuitable for the study (such as
poorly controlled psychiatric disease, HIV, coronary artery disease, or active
gastrointestinal conditions that might interfere with drug absorption).

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Rochester, Minn.

Mayo Clinic principal investigator

John Eaton, M.D.

Open for enrollment

Contact information:

Mitchell Clayton

(507) 284-2698

Jacksonville, Fla.

Mayo Clinic principal investigator

Denise Harnois, D.O.

Open for enrollment

Contact information:

Sasha Dorestin

More information


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