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Non-alcoholic Steatohepatitis (NASH) Phase 2 Binary Endpoint NCT03517540

Study of Safety, Tolerability, and Efficacy of a Combination Treatment of LJN452 and CVC in Adult Patients With NASH and Liver Fibrosis: Complete Statistical Analysis

This analysis examines the registry record for a randomized phase 2 study of tropifexor and cenicriviroc in adults with NASH and liver fibrosis. The posted primary outcome concerns adverse events; the record does not provide a single primary-outcome comparison across treatment arms.

Trial start: 2018-09-11  ·  Enrollment: 193  ·  Sponsor: Novartis Pharmaceuticals
Scope of this record

This page provides an independent statistical analysis and educational interpretation of publicly reported results. ClinicalTrials.gov provides the official trial registry record. Numerical trial results on this page are restricted to the results posted in the ClinicalTrials.gov record; calculations added by Clinical Biostats are labelled as such.

1. Trial at a Glance

This page covers the registry results for Study of Safety, Tolerability, and Efficacy of a Combination Treatment of LJN452 and CVC in Adult Patients With NASH and Liver Fibrosis (NCT03517540), a randomized phase 2 study. The primary outcome is Number of Participants With Adverse Events.

193
Enrollment
Phase 2
n/a
Arms
In the primary outcome
n/a
Effect
No re-analysis shown
n/a
95% CI
See limitations
FeatureRegistry value
ClinicalTrials.gov identifierNCT03517540
PhasePhase 2
ConditionNon-alcoholic Steatohepatitis (NASH)
AllocationRandomized
Design modelParallel
MaskingTriple
Enrollment193
Arms in the primary outcomen/a
Lead sponsorNovartis Pharmaceuticals
Results postedYes

2. Clinical Question

Population

Adults with nonalcoholic steatohepatitis (NASH) and liver fibrosis were the intended study population. The registry record identifies NASH as the condition and describes the study population as adult patients with NASH and liver fibrosis. It does not report the detailed eligibility criteria, how fibrosis was established, or the distribution of disease characteristics among enrolled participants.

Intervention

The study assessed tropifexor, also identified as LJN452, and cenicriviroc, or CVC, as individual treatments and in combination. The listed regimens were tropifexor 140 mcg once daily, CVC 150 mg once daily, tropifexor 140 mcg plus CVC 150 mg once daily, and tropifexor 90 mcg plus CVC 150 mg once daily. Each listed regimen was given orally.

Comparator

The randomized parallel-group design allocated participants among the listed regimens. The CVC-only and tropifexor-only arms offer comparisons with combination regimens, while the two combination arms differ in the listed tropifexor dose. The record does not state a placebo arm. It does not report the planned pairwise comparisons or identify which contrast was intended to answer a primary efficacy question.

Primary question

The posted primary outcome is the number of participants with adverse events, including serious adverse events, during the study-treatment period and follow-up described in the record. The broader study purpose was to assess safety, tolerability, and efficacy of tropifexor and CVC, separately and in combination. Secondary outcomes include improvement in fibrosis and resolution of steatohepatitis. The posted information does not establish a single comparative efficacy result for any regimen.

3. Trial Design

This was a randomized, parallel-group phase 2 study. The registry record describes masking as triple and the official title as double-blind. The record does not identify which participants, investigators, or other study personnel were masked, so the precise masking arrangement is not reported in the registry record. The sponsor was Novartis Pharmaceuticals.

Enrollment was 193. The study began on 2018-09-11, and primary completion was recorded as 2020-09-15; its status is completed. The registered population was adults with NASH and liver fibrosis. The registry record does not report detailed entry criteria or baseline characteristics that would show how closely enrolled participants matched that broad description.

Arm A received tropifexor 140 mcg once daily by mouth. Arm B received CVC 150 mg once daily by mouth. Arm C received tropifexor 140 mcg plus CVC 150 mg once daily by mouth. Arm D received tropifexor 90 mg plus CVC 150 mg once daily by mouth. These are the treatment regimens named in the arm descriptions; the registry record does not report adherence, dose interruptions, or treatment exposure by arm in the information summarized for the posted outcomes.

The primary outcome was the number of participants with adverse events, with collection from the first dose through the end of study treatment at week 48 and then up to a maximum duration of 66 weeks. The listed secondary outcomes concern at least a one point improvement in fibrosis and resolution of steatohepatitis. The record identifies 3 outcome measures and 8 analyses, but the primary outcome is not reduced to one comparison. Detailed allocation procedures, the sample-size justification, interim analyses, and the statistical plan are not reported in the registry record.

4. Participant Flow and Accounting

The registry reports how participants moved through each stage of the study. All counts below are exactly as posted; missing counts are not inferred from other stages.

Before assignment: 450 of 643 subjects discontinued during screening phase

Overall Study

StageArm A: Tropifexor (LJN452) - Dose 1Arm B: Cenicriviroc (CVC)Arm C: Tropifexor (LJN452) Dose 1 + CVCArm D: Tropifexor Dose 2 + CVC
STARTED50484748
COMPLETED36413843
NOT COMPLETED14795

Reasons for not completing this period:

ReasonArm A: Tropifexor (LJN452) - Dose 1Arm B: Cenicriviroc (CVC)Arm C: Tropifexor (LJN452) Dose 1 + CVCArm D: Tropifexor Dose 2 + CVC
Protocol Violation2001
Adverse Event9381
Withdrawal by Subject3413

Analysis population for the primary outcome, as defined in the registry: Safety set (SAF) - All patients who received at least one dose of study drug and had at least one post-baseline safety assessment. Of note, the statement that a patient had no AEs also constituted a safety assessment. Patients were analyzed according to the treatment received

5. Baseline Characteristics

The table reproduces the baseline characteristics posted in the registry, which describe the participants analysed at baseline and help show whether the randomized groups were comparable.

Population: Full analysis set (FAS) - All participants to whom study treatment was assigned (excluding patients who were mis-randomized and did not take investigational drug. Mis-randomized participants were those who were not qualified for randomization but were inadvertently randomized into the study). Following the intent-to-treat (ITT) principle, patients were analyzed according to the treatment they had been assigned to at randomization.

CharacteristicUnitArm A: Tropifexor (LJN452) - Dose 1Arm B: Cenicriviroc (CVC)Arm C: Tropifexor (LJN452) Dose 1 + CVCArm D: Tropifexor Dose 2 + CVCTotal
Participants analysed50484748193
Age, Continuousyears54.8 (SD 13.35)53.7 (SD 11.79)54.7 (SD 12.65)54.9 (SD 12.29)54.5 (SD 12.52)
Age, Customized: <65Participants35393738149
Age, Customized: >=65Participants159101044
Sex/Gender, Customized: MaleParticipants2017182580
Sex/Gender, Customized: FemaleParticipants30312923113
Race/Ethnicity, Customized: WhiteParticipants41444043168
Race/Ethnicity, Customized: AsianParticipants745521
Race/Ethnicity, Customized: BlackParticipants10203
Race/Ethnicity, Customized: UnknownParticipants10001

6. Primary Endpoint

The registry lists the primary outcome as Number of Participants With Adverse Events, measured over AEs were collected from first dose of study treatment until end of study treatment at week 48 and then up to maximum duration of 66 weeks.

ElementRegistry entry
Result typeCount Of Participants
Measure of spreadnot applicable
UnitParticipants
Endpoint classificationBinary Endpoint

The primary endpoint is the number of participants with adverse events. The registry description includes adverse events and serious adverse events, defining adverse events as untoward signs or symptoms occurring during study treatment and then up to 66 weeks. Collection began with the first dose and continued until the end of study treatment at week 48, followed by collection up to the maximum duration stated in the record. The safety population includes patients who received at least one dose and had at least one post-baseline safety assessment; a statement that a patient had no adverse events also counted as a safety assessment. Participants were analyzed according to treatment received.

In general, adverse-event outcomes are used to describe the safety experience observed during a study. Counts can show how many participants were recorded as experiencing an event, while serious and other adverse events provide distinct ways to describe the event data. These summaries do not, on their own, establish that treatment caused an event or explain its clinical context. A comparison between arms also requires a clearly defined contrast and analysis; the registry record does not present one single primary-outcome comparison for the several categories or time points. The listed secondary endpoints address fibrosis improvement and steatohepatitis resolution, but their results are not reported in the information summarized in the record.

7. Why No Re-analysis Is Shown

Reported as posted, not recalculated. Primary outcome has several categories or time points; not reduced to one comparison. A result is recalculated only when the posted data support a clean two-arm comparison, so no result is shown beyond what the sponsor posted.

8. Statistical Interpretation

Clinical Biostats interpretation

The posted primary outcome is a safety count, not a direct measure of change in NASH or liver fibrosis. The record lists serious adverse events and other adverse events for each treatment arm, with the number at risk and the number affected. For serious adverse events, the listed counts are 5 among 50 for tropifexor 140mg, 3 among 48 for CVC 150mg, 4 among 47 for tropifexor 140mcg plus CVC 150mg, and 10 among 48 for tropifexor 90 mg plus CVC 150 mg. For other adverse events, the counts are 39 among 50, 30 among 48, 33 among 47, and 32 among 48, respectively. Deaths are recorded as 0 in each arm.

These are descriptive arm-level counts. They do not establish whether differences between arms are statistically reliable or attributable to treatment. The registry record does not report confidence intervals, p-values, adjusted estimates, or a single prespecified contrast for this primary outcome. A reader should therefore avoid treating the counts as a ranked comparison of the regimens or as evidence that one regimen has a different safety profile from another. Differences in the number at risk also matter when interpreting raw counts; the counts alone do not express uncertainty around any comparison.

The record also lists serious adverse-event terms and percentages: COVID-19, 4.2%; acute lymphocytic leukaemia, 2.1%; cerebrovascular accident, 2.1%; depression suicidal, 2.1%; benign prostatic hyperplasia, 2.1%; and coronary artery disease, 2.1%. These entries describe terms listed in the registry record. The information summarized does not identify the arm for each term, provide further clinical details, or establish whether an event was caused by a study drug.

The study's broader purpose included efficacy, and its secondary outcomes concern fibrosis improvement and resolution of steatohepatitis. Their numerical results and comparative estimates are not reported in the registry record. Consequently, the posted safety counts cannot answer whether any regimen changed either disease outcome. The enrollment figure and completed status describe the study record, but neither substitutes for outcome estimates or information about precision. A cautious reading distinguishes the observed counts from an inferential treatment comparison, and distinguishes a safety description from a conclusion about efficacy.

9. Statistical Methods Explained

What kind of outcome is the primary endpoint?

The primary endpoint is a count of participants recorded as having adverse events. The registry record separately lists serious adverse events and other adverse events, alongside the number at risk in each arm. In general, this kind of outcome is binary at the participant level for a specified event definition: a participant is classified as having or not having the event under consideration. Summing those classifications produces a count. That count is not the same as a measure of event severity, duration, number of repeated events, or time until the first event unless those details are separately defined and reported. The registry record does not provide those additional summaries.

Why do the denominators matter?

The reported number at risk indicates the participants represented in each arm's safety summary. Raw counts are easiest to interpret alongside those denominators, because counts may reflect different numbers of participants at risk. In general, an arm-level count describes what was observed among the listed participants; it does not by itself quantify uncertainty or make an adjusted comparison. A confidence interval, when reported, expresses a range of values compatible with the data and the method used under specified assumptions. No confidence interval for a primary-outcome comparison is reported in the registry record.

What does randomization contribute?

In general, random allocation is intended to make treatment groups comparable at the point of assignment, including with respect to measured and unmeasured characteristics on average. Randomization does not guarantee that the groups have identical characteristics, and it does not remove the need to report the analysis population, outcome definitions, missing-data handling, and uncertainty. This study is recorded as randomized and parallel-group, but the allocation procedure and statistical methods for comparing arms are not reported in the registry record. The posted safety population was analyzed according to treatment received, which is distinct from an analysis based strictly on assigned treatment.

How should masking be understood?

The registry field describes masking as triple, while the official title uses the wording double-blind. These descriptions are both present in the record. The particular people masked and how masking was maintained are not reported in the registry record. In general, masking can reduce the influence of expectations on treatment delivery, reporting, or assessment, depending on who is masked and how outcomes are measured. The label alone does not reveal whether these effects occurred in this study.

What can be inferred from counts without a comparative analysis?

Counts allow a descriptive account of the number of participants recorded with events. A treatment comparison requires a defined estimand or contrast, a statistical method, and a way to express uncertainty. For binary outcomes, general approaches may compare proportions or model the probability of an event, but no particular method should be attributed to this trial without documentation. The registry record explicitly does not reduce the primary outcome, which has several categories or time points, to one comparison. It does not report a test statistic, p-value, confidence interval, or adjusted treatment effect for the primary endpoint.

In general, a p-value measures how unusual data at least as incompatible with a specified null hypothesis would be under the assumptions of a statistical model. It is not the probability that a treatment has no effect, and it does not measure the size or clinical importance of an effect. Since no primary-outcome p-value is reported in the registry record, there is no basis to describe a statistically significant or nonsignificant result for a defined primary comparison.

Why can event counts require careful interpretation?

Adverse events may differ in seriousness, type, timing, and recurrence. A single participant may experience more than one event, and a participant-level count does not reveal the total number of event episodes unless that is separately reported. The registry record provides participant counts for serious and other adverse events and lists selected serious-event terms, but the information summarized does not provide event-level detail, timing by arm, or causal assessments. In general, event counts are descriptive safety evidence and should not be read as proof of causation.

What is not established by the posted methods information?

The registry record does not report a sample-size justification, a prespecified statistical analysis plan, interim analyses, multiplicity procedures, or detailed missing-data methods. It also does not report confidence intervals or adjusted estimates for the primary outcome. The study's recorded enrollment and outcome counts should not be used to infer the design's intended power or the precision of a treatment comparison. Without the missing analysis details, the appropriate interpretation remains descriptive: the record reports event counts by treatment received, but does not supply a single inferential comparison for the primary endpoint.

10. Multiplicity, Missing Data and Analysis Populations

The record identifies 3 outcome measures and 8 analyses, and lists secondary outcomes for fibrosis improvement and resolution of steatohepatitis. It also notes that the primary outcome has several categories or time points and is not reduced to one comparison. The registry record does not report which comparisons were prespecified as primary, how the analyses relate to one another, or whether any adjustment for multiple testing was planned or applied. Without those details, the chance of false-positive findings across multiple comparisons cannot be evaluated from the posted information.

Missing-data handling is not reported in the registry record. The safety population is defined as patients who received at least one dose and had at least one post-baseline safety assessment. A statement that a patient had no adverse events counted as a safety assessment, and patients were analyzed according to treatment received. This definition clarifies who could enter the safety summaries, but it does not describe what happened when a participant had incomplete follow-up, discontinued treatment, or had missing outcome information. The record does not specify imputation methods, censoring rules, or sensitivity analyses for missing data.

The registry record also does not report the sample-size justification, interim analyses, or detailed statistical plan. Those omissions limit assessment of whether the analysis matched the intended design and how uncertainty or multiple outcomes were handled. The posted counts can be read descriptively within the stated safety population, but they do not resolve these methodological questions or support an unreported efficacy comparison.

11. Safety Results

The registry reports serious adverse events as affected participants divided by participants at risk.

ArmParticipants with serious adverse eventsParticipants at riskPercentage
Tropifexor 140mg55010.0%
CVC 150mg3486.2%
Tropifexor 140mcg + CVC 150mg4478.5%
Tropifexor 90 mg + CVC 150 mg104820.8%
Participants with at least one serious adverse event
Serious adverse events by armTropifexor 140mg10.0%CVC 150mg6.2%Tropifexor 140mcg + CVC 150mg8.5%Tropifexor 90 mg + CVC 150 mg20.8%% of participants with at least one serious adverse event

Deaths

ArmDeaths (participants affected of at risk)
Tropifexor 140mg0 of 50
CVC 150mg0 of 48
Tropifexor 140mcg + CVC 150mg0 of 47
Tropifexor 90 mg + CVC 150 mg0 of 48

Other (non-serious) adverse events

Participants with at least one non-serious event at or above the registry's 5% reporting threshold.

ArmParticipants affected of at risk
Tropifexor 140mg39 of 50
CVC 150mg30 of 48
Tropifexor 140mcg + CVC 150mg33 of 47
Tropifexor 90 mg + CVC 150 mg32 of 48

Most frequent serious adverse event terms

Event termOrgan systemTropifexor 140mgCVC 150mgTropifexor 140mcg + CVC 150mgTropifexor 90 mg + CVC 150 mg
COVID-19Infections and infestations0 of 500 of 480 of 472 of 48
Cerebrovascular accidentNervous system disorders0 of 500 of 481 of 471 of 48
Coronary artery diseaseCardiac disorders0 of 501 of 480 of 470 of 48
Myocardial infarctionCardiac disorders0 of 500 of 480 of 471 of 48
Duodenal ulcerGastrointestinal disorders1 of 500 of 480 of 470 of 48
GastritisGastrointestinal disorders1 of 500 of 480 of 470 of 48
Oesophageal ulcerGastrointestinal disorders1 of 500 of 480 of 470 of 48
Pancreatitis acuteGastrointestinal disorders0 of 501 of 480 of 470 of 48
Non-cardiac chest painGeneral disorders1 of 500 of 480 of 470 of 48
Biliary dyskinesiaHepatobiliary disorders0 of 500 of 480 of 471 of 48

Most frequent non-serious adverse event terms

Event termOrgan systemTropifexor 140mgCVC 150mgTropifexor 140mcg + CVC 150mgTropifexor 90 mg + CVC 150 mg
PruritusSkin and subcutaneous tissue disorders20 of 5010 of 4815 of 4710 of 48
NauseaGastrointestinal disorders2 of 506 of 487 of 476 of 48
FatigueGeneral disorders7 of 504 of 485 of 474 of 48
ConstipationGastrointestinal disorders5 of 502 of 486 of 473 of 48
Urinary tract infectionInfections and infestations7 of 503 of 482 of 474 of 48
ArthralgiaMusculoskeletal and connective tissue disorders6 of 503 of 486 of 471 of 48
Abdominal painGastrointestinal disorders5 of 503 of 485 of 472 of 48
Upper respiratory tract infectionInfections and infestations3 of 502 of 485 of 475 of 48
AstheniaGeneral disorders4 of 502 of 485 of 473 of 48
DiarrhoeaGastrointestinal disorders2 of 507 of 484 of 470 of 48

Serious events with the highest arm-level rate: covid-19 (4.2%), acute lymphocytic leukaemia (2.1%), cerebrovascular accident (2.1%), depression suicidal (2.1%), benign prostatic hyperplasia (2.1%).

Do not overextend the safety comparison. Serious-adverse-event counts are safety observations, not efficacy outcomes, and should not be combined with the primary result into a single benefit-risk number.

The safety summaries distinguish serious adverse events from other adverse events and give the number at risk and affected in each arm. For serious adverse events, the registry lists 5 affected among 50 at risk with tropifexor 140mg; 3 among 48 with CVC 150mg; 4 among 47 with tropifexor 140mcg plus CVC 150mg; and 10 among 48 with tropifexor 90 mg plus CVC 150 mg. The other-adverse-event counts are 39 among 50, 30 among 48, 33 among 47, and 32 among 48, respectively. The registry records 0 deaths for each arm.

These are participant counts, not a comparative estimate with an uncertainty interval. In general, a serious adverse event is a category defined by seriousness criteria; a count does not indicate that all events had the same clinical nature or outcome. The registry lists COVID-19 at 4.2%, and acute lymphocytic leukaemia, cerebrovascular accident, depression suicidal, benign prostatic hyperplasia, and coronary artery disease at 2.1% each among the top serious terms. Arm attribution and further clinical context for those terms are not reported in the registry record. The listed event counts do not establish causation or a statistically reliable difference between treatments.

12. What the Result Does, and Does Not, Mean

The registry record describes a randomized phase 2 study of tropifexor and CVC in adults with NASH and liver fibrosis. Its posted primary endpoint is a safety outcome: the number of participants with adverse events. The record gives serious and other adverse-event counts by treatment received and records no deaths in the listed groups. These registry entries describe the safety experience captured in the registry summaries during the stated observation period.

They do not establish that a study drug caused an event, that a regimen is safer than another, or that any observed difference between arms is statistically reliable. The registry record does not provide a single primary-outcome comparison, confidence intervals, p-values, or adjusted estimates. The posted event terms also do not supply enough detail to assess individual cases or attribute each term to a particular treatment arm.

The study's stated purpose also included efficacy, and the listed secondary outcomes concern improvement in fibrosis and resolution of steatohepatitis. Their results are not reported in the registry information, so no conclusion about those outcomes follows from the safety counts. The completed status and enrollment of 193 describe trial conduct, not the size, precision, or clinical importance of a treatment effect.

In general, trial results need to be interpreted in light of the outcome definitions, populations analyzed, missing data, analysis methods, and uncertainty. Several of those details are not reported in the registry record. The soundest reading is therefore limited: the record reports arm-level safety counts for the defined safety population, but does not supply a comprehensive statistical comparison or efficacy result.

13. Why This Trial Matters Statistically

This trial is statistically notable because it places single-agent and combination regimens in a randomized parallel-group study, while the posted primary endpoint is a count-based safety outcome. That structure makes it important to distinguish descriptions within each arm from inferential comparisons between arms. Seeing counts side by side is not equivalent to having a prespecified contrast, an estimate of the difference, or an uncertainty interval.

The safety population is defined according to treatment received and requires at least one dose and a post-baseline safety assessment. This is useful context for understanding who contributes to the posted safety counts, but it is not interchangeable with every possible randomized analysis population. The record does not report the allocation procedure or detailed missing-data handling, so readers cannot assess those aspects of the statistical analysis from the registry information.

The record also lists secondary outcomes addressing fibrosis improvement and steatohepatitis resolution, yet the results for those outcomes are not reported in the information summarized. This illustrates why a trial's stated purpose and outcome list should be kept separate from the results actually available in a registry record. A broad study aim does not establish a treatment effect on a disease outcome.

Finally, the primary outcome is recorded across several categories or time points without one consolidated comparison. Without details about multiplicity, the analysis plan, or uncertainty estimates, the posted counts support a descriptive reading rather than a definitive ranking of regimens. Recognizing that distinction is central to statistical interpretation in clinical research.

14. Limitations

Several trial-specific limitations follow from what the registry record does not report. Detailed eligibility criteria and baseline characteristics are not included in the information summarized, which limits assessment of the enrolled population beyond the broad description of adults with NASH and liver fibrosis. The record does not describe allocation procedures, the people masked, or how masking was maintained. The official title and masking description use different wording, and the record does not clarify the practical masking arrangement.

The primary outcome has several categories or time points and is not presented as one comparison. No confidence intervals, p-values, adjusted estimates, or detailed statistical methods for this endpoint are reported. The record also does not provide the sample-size justification, interim analyses, or multiplicity procedures. Missing-data methods and sensitivity analyses are not reported, leaving uncertainty about how incomplete follow-up was handled.

For safety, the arm-level counts do not provide event-level timing, recurrence, further clinical context, or causal assessment. The listed serious-event terms are not linked to arms in the information summarized. The secondary outcomes are named, but their numerical results are not reported. These gaps restrict interpretation to the posted safety counts and prevent assessment of efficacy or a comprehensive comparative treatment effect. The information summarized should not be treated as a substitute for a complete results report.

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18. Record Summary

The registry record describes NCT03517540, a completed randomized phase 2 parallel-group study sponsored by Novartis Pharmaceuticals. Enrollment was 193, and the recorded study dates are 2018-09-11 for start and 2020-09-15 for primary completion. The study enrolled adults with NASH and liver fibrosis and assessed tropifexor, CVC, and combination regimens.

The primary outcome was the number of participants with adverse events, collected from the first dose through treatment ending at week 48 and then up to a maximum duration of 66 weeks. The record lists serious and other adverse-event counts by treatment received and 0 deaths in each arm. Secondary outcomes concern fibrosis improvement and resolution of steatohepatitis, but their results are not reported in the information summarized. The registry record does not provide a single primary-outcome comparison, detailed statistical methods, confidence intervals, or p-values.

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