This study is designed to establish the effect of 2 doses of vonafexor on the kidney. This will be investigated in subjects with mild or moderate reduced estimated glomerular filtration rate (eGFR) and suspected MASH. In addition, the non-invasive multiparametric magnetic resonance imaging assessment of functional and structural changes in the kidney and in the liver will be investigated.

开始日期2025-07-01

申办/合作机构

ENYO Pharma SA

CTIS2023-509638-20-00

/ Recruiting临床2期

Vonafexor fixed dose-escalation safety and proof-of-concept study in patients with at risk of progression Alport syndrome - EYP001-208

开始日期2024-10-07

申办/合作机构

ENYO Pharma SA

NCT06425055

/ Active, not recruiting临床2期

Vonafexor Fixed Dose-escalation Safety and Proof-of-concept Study in Patients With at Risk of Progression Alport Syndrome

This study is a proof-of-concept trial of vonafexor safety, its effects on kidney function in subjects with at risk of progression Alport syndrome.

开始日期2024-08-01

申办/合作机构

ENYO Pharma SA

100 项与 Vonafexor 相关的临床结果

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100 项与 Vonafexor 相关的转化医学

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100 项与 Vonafexor 相关的专利（医药）

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项与 Vonafexor 相关的文献（医药）

2025-09-21·BRITISH JOURNAL OF CANCER

New mechanistic understanding of FXR agonist Vonafexor: inducing sublethal damage of HBV-positive liver cancer cells via promoting anti-tumor immunity

Article

作者: Chen, Siyan ; Wang, Xiaoqian ; Ye, Dongjie ; Pan, Banglun ; Yao, Yuxin ; Luo, Yue ; Tang, Nanhong ; Zhang, Zhu ; Wu, Hao ; Zhang, Xiaoxia

BACKGROUND:

In hepatitis B virus (HBV)-infected patients, there's an increase in exhausted T and NK cells, as well as myeloid-derived suppressor cells (MDSCs) in liver, suggesting that boosting immune responses is beneficial. While Vonafexor inhibits HBV transcriptional activity, its effects on the immune microenvironment of HBV-positive hepatocellular carcinoma (HCC) and the mechanisms of immune clearance of these infected cells are not well understood.

METHODS:

In this study, tumor tissues from HBV-positive HCC patients were orthotopically transplanted into the livers of Hu-SRC mice to replicate the tumor microenvironment of the patients. Immunofluorescence, flow cytometry, immunoblotting, and RT-qPCR were used to investigate the mechanism by which Vonafexor promoted sublethal damage of virus-positive HCC cells.

RESULTS:

We found that the therapeutic efficacy of Vonafexor in inducing sublethal damage of HBV-positive HCC cells was attributed to its ability to inhibit CD36-mediated free fatty acid intake and enhance GZMB expression in T and NK cells. This effect was mediated through the downregulation of hepatitis B e antigen, which inhibited mitochondrial ROS, thereby augmenting their cytotoxicity via cGAS-STING-NF-κB signaling. Additionally, Vonafexor blocked c-Rel nuclear entry in MDSCs, reducing their infiltration.

CONCLUSIONS:

Our study indicated that Vonafexor showed potential as an immunotherapy for HBV-positive HCC.

2025-05-01·JHEP Reports

A novel in vitro system for simultaneous infections with hepatitis B, C, D and E viruses

Article

作者: Diaz, Olivier ; Meuleman, Philip ; Wedemeyer, Heiner ; Michelet, Maud ; Salvetti, Anna ; Durantel, David ; Passot, Guillaume ; Verrier, Eloi R ; Verhoye, Lieven ; Doceul, Virginie ; De Meyer, Amse ; Pons, Caroline ; Fouillé, Roxanne ; Rivoire, Michel ; Pavio, Nicole ; Steinmann, Eike ; Lucifora, Julie ; Darteil, Raphaël ; Barnault, Romain

Background & Aims:

The liver, and more precisely hepatocytes, can be infected by several hepatotropic viruses, including HBV, HDV, HCV and HEV, with chronic infection leading to end-stage liver diseases. Since no in vitro model allowing multi-infections with the four viruses is reported, limited data are available on their interplay as well as on the potential cross-reactivity of antivirals in multi-infection cases. The aim of our study was to set up such a model.

Methods:

HuH7.5-NTCP cells were cultured with 2% DMSO (dimethyl sulfoxide) for 1 week to allow partial differentiation into hepatocytes (dHuH7.5-NTCP) before infection with the different viruses and treatment with known antiviral molecules.

Results:

We observed increased expression of liver specific transcripts and production of ApoB containing VLDL in dHuH7.5-NTCP cells and replication of HBV, HDV, HCV and HEV for at least 4 weeks after mono or multiple infections. We recapitulated the known antiviral effect of sofosbuvir on HCV and HEV (>90% reduction in the levels of intracellular viral RNAs, p <0.0005) and of IFN-α on HCV, HEV and HDV (80% reduction in the levels of intracellular viral RNAs, p <0.0005). Besides its already described antiviral effect on HBV and HDV, we observed that GW4064, a farnesoid X receptor (FXR) agonist, also strongly inhibited HEV replication (85 to 95% reduction in the levels of intracellular HEV RNAs, p <0.0005). Using HEV-infected HuHep mice, we confirmed the antiviral effect of vonafexor, an FXR agonist, that is currently being tested clinically against HBV/HDV.

Conclusions:

We set-up the first in vitro model allowing multi-infections with hepatitis viruses that can be used for broad drug screening and highlighted FXR ligands as potential broad-acting antivirals.

Impact and implications:

Hepatitis virus infections caused by HBV, HCV, HDV, and HEV represent a global health threat. Treatment options remain limited, notably due to the lack of knowledge about molecular virus-host interactions. Moreover, the interplay between these four viruses in the context of co-infections remains unknown. In this study, we report the first in vitro system that allows for mono and multi-infections with these four viruses and characterize the broad antiviral activity of farnesoid X receptor agonists, paving the way for the development of new strategies for viral cure.

2023-04-01·European journal of medicinal chemistry

Machine learning- and structure-based discovery of a novel chemotype as FXR agonists for potential treatment of nonalcoholic fatty liver disease

Article

作者: Zhang, Wenxuan ; Xia, Jie ; Shen, Zhufang ; Qin, Tong ; Feng, Jing ; Hu, Yuhua ; Lei, Lei ; Zhang, Liangren ; Liu, Zhenming ; Huan, Yi ; Gao, Xuefeng ; Wu, Song

Farnesoid X receptor (FXR) is a promising target for drug discovery against nonalcoholic fatty liver disease (NAFLD). However, no FXR agonist has been approved for NAFLD so far. The R & D of FXR agonists are somewhat hindered by the lack of effective and safe chemotypes. To this end, we developed a multi-stage computational workflow to screen the Specs and ChemDiv chemical library for FXR agonists, which consisted of machine learning (ML)-based classifiers, shape-based and electrostatic-based models, a FRED-based molecular docking protocol, an ADMET prediction protocol and substructure search. As a result, we identified a novel chemotype that has never been reported before, with compound XJ02862 (ChemDiv ID: Y020-6413) as the representative. By designing an asymmetric synthesis strategy, we were able to prepare four isomers of compound XJ02862. Interestingly, one of the isomers, 2-((S)-1-((2S,4R)-2-methyl-4-(phenylamino)-3,4-dihydroquinolin-1(2H)-yl)-1-oxopropan-2-yl)hexahydro-1H-isoindole-1,3(2H)-dione (XJ02862-S2), showed potent FXR agonistic activity in HEK293T cells. The molecular docking, molecular dynamics simulations and site-directed mutagenesis suggested the hydrogen bond between compound XJ02862-S2 and HIS294 of FXR is essential for ligand binding. We further demonstrated that compound XJ02862-S2 had no agonistic effect on TGR5. Further biological experiments have shown that compound XJ02862-S2 could ameliorate hypercholesterolemia, hepatic steatosis, hyperglycemia, insulin resistance (IR) in high-fat-diet induced obese (DIO) mice. In term of molecular mechanism, compound XJ02862-S2 regulates the expression of FXR downstream genes involved in lipogenesis, cholesterol transport and bile acid biosynthesis and transport. Taken together, we have discovered a novel chemotype as potent FXR agonists for NAFLD by computational modeling, chemical synthesis and biological evaluation.

项与 Vonafexor 相关的新闻（医药）

2025-06-12

·Business Wire

ENYO Pharma Announces Completion of Series C Financing With Vesalius Biocapital and Continued Progress of Its ALPESTRIA-1 Clinical Phase 2 Study in Alport Syndrome Patients

LYON, France--(BUSINESS WIRE)--ENYO Pharma (“ENYO”), a clinical-stage biotechnology company focused on developing FXR agonists for the treatment of severe kidney diseases, today announced the smooth continuation of its Phase 2 ALPESTRIA-1 trial in 26 Alport syndrome patients. The topline results from the trial are on track for the fourth quarter of 2025. In parallel, ENYO has finalized its Series C financing round with a €6 million investment from Vesalius Biocapital IV, bringing the total Series C raise to €32 million. The ongoing ALPESTRIA-1 study evaluates Vonafexor, a highly selective and oral FXR agonist, in patients with Alport syndrome, a rare genetic kidney disease with no approved therapy. The trial involves a 24-week ascending doses regimen followed by a 12-week off-treatment observation period. ALPESTRIA-1 was launched mid 2024 in 4 countries (US, F, SP and D) following Orphan Drug Designation from both the FDA and EMA. The new funding from Vesalius Biocapital IV extends ENYO’s cash runway through the second half of 2026 and enables the initiation of two new clinical programs: A proof-of-concept trial in patients with Chronic Kidney Disease (CKD) grade 3 and concurrent F2/F3 MASH , building on the promising renal results from the previous Phase 2 LIVIFY clinical study ; A PK/PD head-to-head comparison of Vonafexor and its analog EYP651 in healthy subjects. In addition, ENYO will continue to expand its preclinical portfolio, notably in Autosomal Dominant Polycystic Kidney Disease (ADPKD), where the Vonafexor franchise could offer a novel and disease-modifying approach. “We are pleased with the continued progress of ALPESTRIA-1 and honored to welcome Vesalius Biocapital to our investor syndicate and Dr. Jean-Christophe Renondin as new Board member,” said Dr. Jacky Vonderscher, CEO of ENYO. “This additional investment will allow us to accelerate the development of our FXR agonist pipeline in both rare and more prevalent kidney diseases. We share a common belief with Vesalius in the transformative potential of Vonafexor and EYP651 for patients suffering from inflammation- and fibrosis-driven renal conditions.” “Vesalius Biocapital is excited to support ENYO as it progresses into the next phase of clinical development for Vonafexor and its analog EYP651,” commented Dr. Jean-Christophe Renondin, Managing Partner at Vesalius Biocapital IV. “There is an immense need for new treatments in kidney conditions such as Alport Syndrome and CKD. We believe Vonafexor has the potential to help these patients and make a meaningful impact on their lives. I look forward to working with ENYO’s excellent leadership team to advance this promising therapeutic candidate.” About ENYO Pharma: ENYO is a clinical-stage biopharmaceutical company headquartered in Lyon (France) and developing proprietary drug candidates to improve quality of life and avoid end stage renal disease and dialysis/transplantation for patients with rare and common kidney diseases. Since its inception ENYO collected extensive phase I/II clinical data through nine completed clinical studies with ca. 400 subjects. ENYO is supported by a strong syndicate of global investors: OrbiMed, Morningside, AndEra, BPIFrance (InnoBio and Large Venture), Sofinnova Partners and Vesalius). For more information: ENYO Pharma About Vesalius Biocapital: Vesalius is a specialist life sciences venture capital investor, investing in companies in later stage companies in drug development, medical device diagnostic and e-health since 2007. Vesalius Biocapital IV, launched in June 2023, targets first and best-in-class European life science companies in drug development and digital health. Its investment portfolio is well balanced between drug development and non-drug development investments and committed to providing capital to science-backed innovation and ambitious entrepreneurs. The team is based in Europe to explore investment opportunities and valuation potential for the portfolio. Managing Partners include Guy Geldhof, Dr Jean-Christophe Renondin and Stéphane Verdood. https://www.vesaliusbiocapital-4.com/

临床2期孤儿药

2025-01-30

·PRNewswire

Metabolic Dysfunction-Associated Steatohepatitis Market to Register Stunning Growth at a CAGR of 17.9% in the US by 2034 | DelveInsight

The MASH treatment landscape is evolving rapidly, driven by a diverse array of therapeutic classes, each with unique mechanisms and potential impacts. The forecast period reveals significant shifts and emerging trends that will shape future market dynamics. LAS VEGAS, Jan. 30, 2025 /PRNewswire/ -- DelveInsight's Metabolic Dysfunction-Associated Steatohepatitis Market Insights report includes a comprehensive understanding of current treatment practices, MASH emerging drugs, market share of individual therapies, and current and forecasted market size from 2020 to 2034, segmented into 7MM [the United States, the EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan]. Key Takeaways from the Metabolic Dysfunction-Associated Steatohepatitis Market Report According to DelveInsight's analysis, the market size for MASH was found to be USD 2.1 billion in the 7MM in 2023. In 2023, there were an estimated 42 million prevalent cases of MASH in the 7MM. Out of these, a total of ~15 million cases were diagnosed, and this number is projected to increase by the end of 2034 in the 7MM. Leading MASH companies such as Inventiva Pharma, Novo Nordisk A/S, Cirius Therapeutics, Akero Therapeutics, 89bio, Boehringer Ingelheim, Zealand Pharma, Galectin Therapeutics, Lipocine, Viking Therapeutics, Eli Lilly and Company, Boston Pharmaceuticals, Pfizer, HighTide Biopharma, CytoDyn, Merck & Co., Hanmi Pharmaceutical, Hepagene (Shanghai), Hepion Pharmaceuticals, Enyo Pharmaceuticals, Gilead Sciences, Poxel SA, Zydus Therapeutics, Sagimet Biosciences, Ionis Pharmaceuticals, Corcept Therapeutics, and others are developing novel MASH drugs that can be available in the MASH market in the coming years. The promising MASH therapies in the pipeline include Lanifibranor (IVA337), Semaglutide, Azemiglitazone (MSDC-0602K), Efruxifermin (EFX), BIO89-100 (Pegozafermin), Survodutide (BI 456906), GR-MD-02 (Belapectin), LPCN1144, VK2809, Tirzepatide, BOS-580, Ervogastat (PF-06865571) + Clesacostat (PF-05221304), HTD1801, Leronlimab (PRO 140), Efinopegdutide, HPG1860, Rencofilstat (CRV431), EYP001 (Vonafexor), Semaglutide/Cilofexor/Firsocostat, PXL065, Saroglitazar Magnesium, Denifanstat (TVB-2640), ION224, Miricorilant (CORT118335), and others. In March 2024, Madrigal Pharmaceuticals' groundbreaking product, REZDIFFRA (resmetirom), a once-daily, oral THR-ß agonist, received accelerated endorsement from the US FDA based on results from the Phase III MAESTRO-NASH trial. This approval marks a significant stride in the medical landscape, as REZDIFFRA becomes the inaugural and sole FDA-sanctioned therapy for adults afflicted with non-cirrhotic MASH, accompanied by moderate to advanced liver scarring (fibrosis) corresponding to stages F2–F3 fibrosis. Discover which therapies are expected to grab the major MASH market share @ Metabolic Dysfunction-Associated Steatohepatitis Market Report Metabolic Dysfunction-Associated Steatohepatitis Overview Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease that stems from metabolic dysfunction, often linked to obesity, diabetes, and other conditions of metabolic syndrome. MASH is characterized by the accumulation of fat in liver cells, accompanied by inflammation and liver cell injury, which can progress to fibrosis, cirrhosis, or even liver cancer. The primary drivers of MASH include insulin resistance, obesity, type 2 diabetes, and dyslipidemia. Genetic predisposition and a sedentary lifestyle also play significant roles. Environmental factors, such as a poor diet high in sugars and fats, exacerbate the condition. MASH is often asymptomatic in its early stages. When symptoms occur, they can include fatigue, vague abdominal discomfort, or pain in the upper right quadrant. In advanced stages, signs of liver dysfunction such as jaundice, swelling of the abdomen or legs, and confusion may arise. Diagnosis involves a combination of clinical history, physical examination, and diagnostic tests. Blood tests measuring liver enzymes (ALT, AST) often indicate liver inflammation. Imaging techniques like ultrasound, MRI, or FibroScan can identify liver fat and fibrosis. In some cases, a liver biopsy is required to confirm the diagnosis and assess disease severity. Metabolic Dysfunction-Associated Steatohepatitis Epidemiology Segmentation The MASH epidemiology section provides insights into the historical and current MASH patient pool and forecasted trends for the 7MM. It helps recognize the causes of current and forecasted patient trends by exploring numerous studies and views of key opinion leaders. The MASH market report proffers epidemiological analysis for the study period 2020–2034 in the 7MM segmented into: Prevalent Cases of MASH Diagnosed Prevalent Cases of MASH Gender-specific Diagnosed Prevalent Cases of MASH Severity-specific Diagnosed Prevalent Cases of MASH Metabolic Dysfunction-Associated Steatohepatitis Treatment Market The approval of REZDIFFRA (resmetirom) in March 2024 represents a pivotal achievement in medical innovation, transforming the treatment landscape for MASH disease. This groundbreaking therapy addresses the root causes of MASH, offering renewed hope to patients grappling with this challenging condition. Clinical trials have shown impressive results, with REZDIFFRA effectively reducing symptoms like inflammation and fibrosis, enhancing liver function, and improving patients' quality of life. By providing healthcare professionals with a robust treatment option, this approval addresses a critical unmet need and has the potential to significantly alleviate the complications linked to advanced liver disease. The prevalence of MASLD is strongly linked to type 2 diabetes mellitus and obesity, particularly in individuals with a higher body mass index. However, MASLD occurrence is reduced in T2DM patients receiving treatments such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, GLP-1 receptor agonists, and insulin. Vitamin E, with its antioxidant properties, is regarded as a first-line pharmacological option for managing MASH, especially when dietary and lifestyle interventions are insufficient. Antifibrotic agents can help prevent the progression of liver fibrosis and MASLD into fibrotic MASH. The role of pioglitazone, an anti-diabetic medication, in improving MASH histology in T2DM patients is well-documented, but concerns remain regarding potential side effects like weight gain, fluid retention, cancer risk, and bone fractures. Additional therapeutic targets for MASLD and MASH include G protein-coupled receptors (GPCRs), estrogen-related receptor alpha (ERRα), bone morphogenetic proteins (BMPs), and KLFs. Bariatric surgery, or weight loss surgery, is the most effective intervention for treating obesity and diabetes, as it reduces food absorption while influencing gut hormone secretion and metabolic function. To know more about MASH treatment guidelines, visit @ Metabolic Dysfunction-Associated Steatohepatitis Management Metabolic Dysfunction-Associated Steatohepatitis Pipeline Therapies and Key Companies Lanifibranor (IVA337): Inventiva Pharma Semaglutide: Novo Nordisk A/S Azemiglitazone (MSDC-0602K): Cirius Therapeutics Efruxifermin (EFX): Akero Therapeutics BIO89-100 (Pegozafermin): 89bio Survodutide (BI 456906): Boehringer Ingelheim/Zealand Pharma GR-MD-02 (Belapectin): Galectin Therapeutics LPCN1144: Lipocine VK2809: Viking Therapeutics Tirzepatide: Eli Lilly and Company BOS-580: Boston Pharmaceuticals Ervogastat (PF-06865571) + Clesacostat (PF-05221304): Pfizer HTD1801: HighTide Biopharma Leronlimab (PRO 140): CytoDyn Efinopegdutide: Merck & Co./Hanmi Pharmaceutical HPG1860: Hepagene (Shanghai) Rencofilstat (CRV431): Hepion Pharmaceuticals EYP001 (Vonafexor): Enyo Pharmaceuticals Semaglutide/ Cilofexor/ Firsocostat: Gilead Sciences PXL065: Poxel SA Saroglitazar Magnesium: Zydus Therapeutics Denifanstat (TVB-2640): Sagimet Biosciences ION224: Ionis Pharmaceuticals Miricorilant (CORT118335): Corcept Therapeutics Discover more about MASH drugs in development @ Metabolic Dysfunction-Associated Steatohepatitis Clinical Trials Metabolic Dysfunction-Associated Steatohepatitis Market Dynamics The MASH market dynamics are expected to change in the coming years. Growing research activities and multiple clinical trials for MASH, driven by the rapid surge in its prevalence due to rising obesity and type 2 diabetes rates, highlight an active drug development pipeline and an expanding market size. The large pool of patients and lucrative growth opportunities present attractive prospects for key players, further supported by ongoing preclinical studies aimed at advancing imaging techniques for MASH diagnosis, potentially eliminating the need for invasive biopsy-based histopathological confirmation. Furthermore, potential therapies are being investigated for the treatment of MASH, and it is safe to predict that the treatment space will significantly impact the MASH market during the forecast period. Moreover, the anticipated introduction of emerging therapies with improved efficacy and a further improvement in the diagnosis rate are expected to drive the growth of the MASH market in the 7MM. However, several factors may impede the growth of the MASH market. Lack of awareness and negligence in the early stages of MASH by physicians often lead to disease progression, culminating in irreversible damage where liver transplantation becomes the only viable option. Diagnosing advanced MASH typically requires procedures like liver biopsy, which are costly, invasive, and risky. Regulatory challenges also pose hurdles, as the FDA mandates achieving one MASH endpoint for approval, while the EMA's draft guidance requires efficacy in both endpoints, potentially delaying first-mover approvals in major European markets. Additionally, access to expensive MASH treatments may be limited in certain regions, further hindering patient adoption. Moreover, MASH treatment poses a significant economic burden and disrupts patients' overall well-being and QOL. Furthermore, MASH market growth may be offset by failures and discontinuation of emerging therapies, unaffordable pricing, market access and reimbursement issues, and a shortage of healthcare specialists. In addition, the undiagnosed, unreported cases and the unawareness about the disease may also impact MASH market growth. Scope of the Metabolic Dysfunction-Associated Steatohepatitis Market Report Therapeutic Assessment: Metabolic Dysfunction-Associated Steatohepatitis current marketed and emerging therapies Metabolic Dysfunction-Associated Steatohepatitis Market Dynamics: Key Market Forecast Assumptions of Emerging Metabolic Dysfunction-Associated Steatohepatitis Drugs and Market Outlook Competitive Intelligence Analysis: SWOT analysis and Market entry strategies Unmet Needs, KOL's views, Analyst's views, Metabolic Dysfunction-Associated Steatohepatitis Market Access and Reimbursement Download the report to understand which factors are driving MASH market trends @ Metabolic Dysfunction-Associated Steatohepatitis Market Trends Table of Contents Related Reports Non-Alcoholic Steatohepatitis Epidemiology Forecast Non-Alcoholic Steatohepatitis Epidemiology Forecast – 2034 report delivers an in-depth understanding of the disease, historical and forecasted NASH epidemiology in the 7MM, i.e., the United States, EU4 (Germany, France, Italy, Spain), the United Kingdom, and Japan. Nonalcoholic Steatohepatitis Pipeline Nonalcoholic Steatohepatitis Pipeline Insight – 2024 report provides comprehensive insights about the pipeline landscape, pipeline drug profiles, including clinical and non-clinical stage products, and the key nonalcoholic steatohepatitis companies, including Madrigal Pharmaceuticals, Intercept Pharmaceuticals, Cirius Therapeutics, Novo Nordisk, Inventiva, Galmed Pharmaceuticals, AstraZeneca, Galectin Therapeutics, Viking Therapeutics, Eli Lilly and Company, Terns Pharmaceuticals, Sinew Pharma, 89bio, Inc., Eccogene, Novartis Pharmaceuticals, Poxel SA, AngioLab, Pfizer, Arrowhead Pharma, LG Chem, Redx Pharma, Lipocine, Inc., CytoDyn, Inc., Alnylam Pharmaceuticals, Inc., Chemomab Therapeutics, NuSirt Biopharma, HK inno. N, Aligos Therapeutics, Altimmune, Inc., Kowa Pharmaceutical, Ionis Pharmaceuticals, NorthSea Therapeutics, Rivus Pharmaceuticals, Hanmi Pharmaceutical, Hepagene Therapeutics, HighTide Biopharma, Akero Therapeutics, Merck Sharp & Dohme LLC, Cascade Pharmaceuticals, Hepion Pharmaceuticals, Chipscreen Biosciences, Boston Pharmaceuticals, Bristol-Myers Squibb, Sunshine Lake Pharma, GSK plc., Future Medicine, Gilead Sciences, ENYO Pharma, Histogen, among others. Non-Alcoholic Fatty Liver Disease Market Non-Alcoholic Fatty Liver Disease Market Insight, Epidemiology, and Market Forecast – 2034 report delivers an in-depth understanding of the market trends, market drivers, market barriers, and key NAFLD companies, including MediciNova, Eli Lilly and Company, AstraZeneca, Inventiva Pharma, Oasis Pharmaceuticals, LLC, Madrigal Pharmaceuticals, Inc., BioMarin Pharmaceutical, GlaxoSmithKline, Zydus Therapeutics Inc., Akero Therapeutics, Inc, Pfizer, Boehringer Ingelheim, Neuraly, Inc., Merck Sharp & Dohme LLC, Rivus Pharmaceuticals, Inc., Hepion Pharmaceuticals, Inc. , among others. Non-Alcoholic Fatty Liver Disease Pipeline Non-Alcoholic Fatty Liver Disease Pipeline Insight – 2024 report provides comprehensive insights about the pipeline landscape, pipeline drug profiles, including clinical and non-clinical stage products, and the key NAFLD companies, including BeiGene, Inventiva Pharma, Cirius Therapeutics, Madrigal Pharma, Novo Nordisk, Galmed Pharmaceuticals, AstraZeneca, Galectin Therapeutics, Viking Therapeutics, Dr. Falk Pharma GmbH, Sagimet Biosciences, Eli Lilly and Company, Terns Pharmaceuticals, Sinew Pharma, Novartis Pharmaceuticals, Afimmune, Poxel SA, AngioLab, Pfizer, Oramed Pharmaceuticals, Can Fite Biopharma, MediciNova, Metacrine, Inc., Lipocine, Inc., CytoDyn, Inc., Alnylam Pharmaceuticals, Inc., Mitsubishi Tanabe Pharma, Chemomab Therapeutics, NuSirt Biopharma, HK inno.N, Kowa Pharmaceutical, Ionis Pharmaceuticals, NorthSea Therapeutics, Rivus Pharmaceuticals, Hanmi Pharmaceutical, Hepagene Therapeutics, HighTide Biopharma, Akero Therapeutics, Enanta Pharmaceuticals, Cascade Pharmaceuticals, among others. About DelveInsight DelveInsight is a leading Business Consultant and Market Research firm focused exclusively on life sciences. It supports pharma companies by providing comprehensive end-to-end solutions to improve their performance. Get hassle-free access to all the healthcare and pharma market research reports through our subscription-based platform PharmDelve . Contact Us Shruti Thakur [email protected] +14699457679 Logo: SOURCE DelveInsight Business Research, LLP WANT YOUR COMPANY'S NEWS FEATURED ON PRNEWSWIRE.COM? 440k+ Newsrooms & Influencers 9k+ Digital Media Outlets 270k+ Journalists Opted In GET STARTED

临床3期

2024-10-28

·药智网

2024年集体爆发的MASH市场，竞争格局几何？

继今年3月，全球首款MASH新药——Resmetirom获FDA批准用于治疗伴有肝纤维化的成人MASH患者，填补了MASH药物的空白状态后，近段时间以来，国内MASH领域的“新药曝光度”有目共睹的在增加。 10月15日，微芯生物宣布，其研发的西格列他钠治疗非酒精性脂肪性肝炎（NASH）/代谢相关性脂肪性肝炎（MASH）的2期临床研究（CGZ203试验）摘要入选美国肝病研究学会年会（AASLD 2024），11月17日以口头报告形式公布。 10月18日，中国国家药监局药品审评中心（CDE）官网公示，康弘药业1类THR-β新药KH629片获得临床试验默示许可，拟开发用于治疗成人非酒精性脂肪性肝炎。为何沉寂40余年的MASH新药研究，短时间内俨然成为“流量”的代名词，成为众多药企争相入局的潜力市场，其背后又是怎样的底层逻辑使然？患病率高涨 MASH是临床需求愈发迫切其实，与大多数肝脏慢性病不同，近年来非酒精性脂肪性肝病（NAFLD）的患病率不降反增，现阶段已取代乙肝成为我国最常见的慢性肝病。资料显示，中国成年人中NAFLD患病率高达29.2%，10年内整体增长10%，中国MASH患病率约为2.4%～6.1%，我国NAFLD/MASH患者疾病负担极其沉重。据弗若斯特沙利文报告预计， 2030 年全球 MASH 患病人数将达到 4.9 亿人，全球MASH药物市场将达到 322 亿美元。作为NAFLD中最严重的发展阶段，原理上MASH是一种与代谢紊乱相关的肝脏疾病，其特征是肝脏中脂肪的异常积累，伴随着炎症和肝细胞损伤，早年间被称为非酒精性脂肪性肝炎（NASH）。 40余年的相关研究下，人们对MASH的发病机制仍尚未完全明确，目前认为其乃是一种代谢应激性肝损伤，与多种因素相关，复杂的级联反应下的肝细胞损伤机制有以下几种，主要包括胰岛素抵抗、氧化应激、炎症反应和脂质代谢异常等多个环节。在临床表现方面，MASH通常情况下起病隐匿且缓慢，且通常无症状，多于常规检查过程中无意发现，并且由于MASH通常情况下难以自发缓解，在早期无干预的情况下进展为肝纤维化的风险很高，大约有15%的患者会发展为肝硬化、肝衰竭和肝细胞癌。临床药物缺乏 MASH传统治疗局限性大在Resmetirom获FDA批准上市之前，全球尚无治疗 NAFLD/NASH 的靶向性药物，而由于MASH与肥胖、2 型糖尿病、高血压、血脂紊乱等疾病的密切相关性，目前普遍认为控制这些疾病可有效改善 NAFLD/NASH的代谢状态，从而延缓疾病进展。因此，NAFLD以及MASH的治疗基础仍是生活方式的干预和饮食方案的优化，生活习惯的改善，尤其饮食的控制及锻炼减重等可减少肝脏脂肪沉积，有利于改善 MASH 的生化指标和肝组织学病变，相关研究显示，体重减轻 3% 即可改善 NAFLD患者脂肪肝病情程度，减重 7% 可改善肝脏炎症等组织学指标，减重 10% 可逆转肝纤维化水平。而在药物治疗方面，临床上主要针对抗胰岛素抵抗、抗氧化应激、降血脂、促进脂质代谢及保护肝细胞膜等对MASH进行治疗，如二甲双胍、维生素 E、熊去氧胆酸、FXR激动剂奥贝胆酸、肝损伤治疗药物等保肝药物的使用。但同时，上述药物治疗方式的局限性也很大，一者药物的治疗剂量、有效性及安全性均尚不明确，有待进一步研究；二者，如奥贝胆酸等FXR激动剂的不良反应也极大限制了其在MASH领域的应用。故现阶段的MASH临床治疗上，迫切需要一种副作用低、能逆转肝纤维化、患者顺应性佳的创新疗法。四大方向推动MASH机制逐渐清晰就目前而言，通过对MASH的发病机制研究，目前已有多款靶点给予了MASH有效干预，是目前乃至未来MASH治疗的主要方向。从类型上来看主要分为代谢、消化、抗炎、抗纤维化四种方向：代谢类：改善胰岛素敏感性、抑制脂肪生成各种酶、促进线粒体摄取脂肪酸等。消化类：调控肝肠轴的循环、改善胆汁酸的循环与信号传导、改善肠道菌群的平衡等。抗炎类：抑制炎症细胞聚集、阻断炎性信号传导、降低氧化作用和内质网应激反应、防止肝细胞凋亡等。抗纤维化：针对肝脏中的星形细胞、减轻肝脏中胶原蛋白的沉积、增强纤维分解等。而在这四种类型药物之下，又可以细分出不同的靶点选择，各靶点方向之下又存在不同的技术优势与产品差异。数据来源：公开数据整理（点击查看大图）据不完全统计，全球现有MASH在研疗法已突破350款。其中代谢类与消化类的数量最多，而前者主要机制集中于肝内，在逆转纤维化方面具有优势，而后者则是从肝外机制着手，在降低肝脏脂肪积累与纤维化进展方面优势明显，两者机制各有优劣，未来大概率会是协同合作的关系。临床阶段方面，虽绝大多数创新疗法均集中在临床前阶段，但跨入临床阶段的产品依旧不少，其中以临床II期管线数量最多，共计108款；而进入临床III期产品则也有18款之多。表1.MASH临床III期管线药品名称靶点适应症最高阶段原研单位利莫纳班 rimonabant CB1 临床Ⅲ期赛诺菲依碳酸瑞格列净 remogliflozin etabonate SLC5A2 临床Ⅲ期 BHV Pharma Inc;格兰马克制药有限公司沙格列扎镁 aroglitazar magnesium INS 临床Ⅲ期 Zydus Lifesciences Ltd 司美格鲁肽 semaglutide GLP-1R 临床Ⅲ期丹麦诺和诺德公司腺苷蛋氨酸 ademetionine Transferase 临床Ⅲ期雅培制药芦比前列酮 lubiprostone CFTR;ClC-2;PGE1 临床Ⅲ期 Sucampo Pharma LLC 佩玛贝特 pemafibrate PPAR-alpha 临床Ⅲ期 Kowa Co Ltd 塞拉德帕 seladelpar PPAR-delta 临床Ⅲ期 CymaBay Therapeutics Inc;强生创新制药 aramchol SCD1 临床Ⅲ期 Galmed Pharmaceuticals Ltd survodutide GLP-1R;GCGR 临床Ⅲ期 Zealand Pharma A/S;勃林格殷格翰 FXR314 NR1H4 临床Ⅲ期 Organovo Holdings inc 拉尼兰诺 lanifibranor PPAR-alpha;PPAR-delta;PPAR-gamma 临床Ⅲ期 Inventiva 可妥度肽 cotadutide GLP-1;GCGR 临床Ⅲ期阿斯利康瑟隆舍替selonsertib MAP3K5 临床Ⅲ期美国吉利德科学公司塞尼韦洛 cenicriviroc CCR2;CCR5 临床Ⅲ期 Tobira Therapeutics Inc;武田药品工业株式会社 ENB-106 / 临床Ⅲ期上海轶诺药业有限公司依鲁西夫明 efruxifermin FGF21 临床Ⅲ期安进公司 norucholic acid / 临床Ⅲ期德国霍克大药厂数据来源：药智数据三大靶点引领MASH新药加速落地就MASH在研药物靶点分布上而言，glp-1、FXR、THR-β、FGF19/21与PPAR是现阶段MASH最主要的在研药物类型。数据来源：药智数据从数量上来看，FXR激动剂、GLP1在研发热度上远超其他靶点，其在研数量也最多，目前均有超过30款相关疗法布局；其次是THR-β、FGF19/21与PPAR，分别有19、18与13款新药布局；其余靶点数量则相对较少，其临床阶段也相对靠后。从趋势上来看，FXR激动剂虽然是MASH领域的老牌靶点之一，但由于靶点特殊作用机制，其在副作用上的局限性太大，直接影响了其在临床上的应用潜力。至少就现在而言，反而是glp-1与THR-β两种机制的MASH新药更受关注，未来也更容易占据头牌。数据来源：药智数据 GLP-1 由于原理上GLP-1类似物能够有效改善糖脂代谢异常，因此GLP-1受体激动剂在糖尿病与减重适应症外，也被视为潜在的MASH治疗药物。表2.GLP-1应用于MASH的创新疗法药品名称靶点原研单位适应症最高阶段司美格鲁肽 semaglutide GLP-1R 丹麦诺和诺德公司临床Ⅲ期 survodutide GLP-1R;GCGR Zealand Pharma A/S;勃林格殷格翰临床Ⅲ期可妥度肽 cotadutide GLP-1;GCGR 阿斯利康临床Ⅲ期替尔泊肽 tirzepatide GIPR;GLP-1R 礼来制药临床Ⅱ期 RAY-1225 GLP-1;GIP 广东众生睿创生物科技有限公司临床Ⅱ期 HEC-88473 FGF21;GLP-1R 东莞市东阳光生物药研发有限公司临床Ⅱ期派维度肽 pemvidutide GLP-1R;GCGR Altor BioScience Corp合作：Altimmune Inc 临床Ⅱ期尤曲格鲁肽 utreglutide GLP-1R 印度太阳药业有限公司临床Ⅱ期巴度肽 bamadutide GLP-1R;GCGR 赛诺菲临床Ⅱ期依福培肽 efocipegtrutide GIPR;GLP-1R;GCGR 韩美药品株式会社临床Ⅱ期数据来源：药智数据截止目前，随着人们对 GLP-1 的焦点由减肥向在抗 MASH转变之下，已有超30种GLP-1药物正在研究其治疗MASH的潜力，临床上推进较快的产品不少，较出名的产品有诺和诺德的司美格鲁肽、勃林格殷格翰的survodutide、阿斯利康的cotadutide、礼来制药的tirzepatide。其中，Semaglutide与替尔泊肽作为GLP-1两大重磅产品，在关于MASH的治疗研究中均显示出减少肝脏脂肪积累、降低炎症水平的潜力，极大地振奋了行业对GLP-1作用于MASH的信心。但与此同时，GLP-1在治疗MASH上的局限性也逐渐体现，即虽然在减少肝脏脂肪积累和纤维化方面的效果显著，但对逆转肝脏纤维化上却缺乏足够、全面、多维度的有效证据。这就导致GLP-1疗法单药治疗既无法完全满足现有的临床需求，也很难与其他疗法拉开差距。对此，有关人士表示，GLP-1未来要想在MASH领域站稳脚跟，要么就逆转纤维化做出更多差异化成果，要么依靠肝外机制改善代谢紊乱的特点，与众多肝内机制的MASH疗法形成联动与互补，以协同策略解决MASH的临床需求。 Fxr（NR1H4）作为曾经治疗MASH最重要的靶点，也是MASH早期阶段最主要的在研药物形式，FXR作为一种肠肝调节因子，不仅参与胆汁酸信号传导，调控胆汁酸合成和转运，还可以调节葡萄糖稳态、脂质和胆固醇代谢等其他生理功能以及抑制炎症，在MASH治疗上，目前已显示出一定的治疗效果。截止目前，除已经宣布终止MASH适应症开发的奥贝胆酸外，领域内仍有超过30款Fxr激动剂涉及MASH适应症，其中Organovo的FXR314已进入了临床III期，是现阶段推进最快的Fxr激动剂；之后，还有10余款管线进入了临床II期，较受期待的有吉利德的cilofexor、诺华制药的nidufexor、东阳光药业HEC96719等。表3.MASH中Fxr激动剂创新疗法药品名称靶点原研单位适应症最高阶段奥贝胆酸 obeticholic acid NR1H4 Intercept Pharmaceuticals Inc 注册申请 FXR314 NR1H4 Organovo Holdings inc 临床Ⅲ期昔洛法克索 cilofexor NR1H4 Phenex Pharmaceuticals AG;美国吉利德科学公司临床Ⅱ期尼度法克索 nidufexor NR1H4 诺华制药临床Ⅱ期 HEC96719 NR1H4 广东东阳光药业股份有限公司临床Ⅱ期卓匹非索 tropifexor NR1H4 诺华制药临床Ⅱ期 CS-0159 NR1H4 Van Andel Institute;中国科学院上海药物研究所;凯思凯迪（上海）医药科技有限公司临床Ⅱ期 EDP-305 NR1H4 Enanta Pharmaceuticals Inc 临床Ⅱ期 TERN-101 NR1H4 上海拓臻生物科技有限公司;礼来制药临床Ⅱ期 MET-642 NR1H4 Metacrine Inc 临床Ⅱ期 MET-409 NR1H4 Metacrine Inc 临床Ⅱ期 HPG1860 NR1H4 雅创医药技术（上海）有限公司临床Ⅱ期 EYP-001 NR1H4 Poxel SA 临床Ⅱ期数据来源：药智数据而与此同时，虽然近年来Fxr激动剂领域用于MASH治疗的研究开发正在进入快速发展期，但临床获益有限，副作用严重等局限性也制约了其在临床上应用，最显著的例子就是奥贝胆酸，其2015年获FDA突破性疗法资格认定，是全球第一个进入临床3期的MASH候选产品，但最终仍因获益不确定性、副作用较大而折戟，经历多次被FDA否决后，最终无奈宣布终止其用于MASH领域的开发。因此，对于Fxr激动剂整体而言，在保证创新疗法的有效性，研究机构未来更大的精力或将集中于创新疗法的不良反应的减少与安全性的提高上。 THR-β THR-β是一种核激素受体，其主要在肝脏中高表达，能够调节脂代谢，降低低密度脂蛋白胆固醇（LDL-C）、甘油三酯和致动脉粥样硬化性脂蛋白，因此成为理论上MASH最具潜力的治疗靶点。此外，THR-β还可以通过促进脂肪酸的分解和刺激线粒体的生物发生来减少脂肪毒性并改善肝功能，进而减少肝脏脂肪。这也是为何THR-β激动剂会具备调控多种肝脏代谢通路来治疗MASH的潜力的原因。其在MASH上的主要作用有以下5点：调控脂肪合成调控脂肪酸氧化作用调控胆固醇代谢调控线粒体功能通过抑制TGF-β信号通路发挥抗炎和抗纤维化作用 2024年3月，Resmetirom成为首款获FDA批准上市的治疗代谢功能障碍相关脂肪性肝炎（MASH）的新药，也是THR-β激动剂领域首款撞线的产品。表4.MASH中THR-β激动剂创新疗法药品名称靶点原研单位适应症最高阶段瑞司美替罗 resmetirom THRB Madrigal Pharmaceuticals Inc;罗氏制药批准上市 VK-2809 THRB Ligand Pharmaceuticals Inc;Viking Therapeutics Inc 临床Ⅱ期 ASC41 THRB 歌礼制药有限公司;甘莱制药有限公司临床Ⅱ期 TERN-501 THRB 上海拓臻生物科技有限公司临床Ⅱ期 HSK-31679 THRB 海思科医药集团股份有限公司临床Ⅱ期 ALG-055009 THRB Aligos Therapeutics Inc 临床Ⅰ期 ASC-43-F THRB;NR1H4 歌礼制药有限公司;甘莱制药有限公司临床Ⅰ期 RJ-4287 THRB 南京奥利墨斯医药科技有限公司临床Ⅰ期 Kylo-0603 THRB 厦门甘宝利生物医药有限公司临床Ⅰ期 CS-060304 THRB 凯思凯迪（上海）医药科技有限公司临床Ⅰ期 CS-060380 THRB 凯思凯迪（上海）医药科技有限公司临床Ⅰ期数据来源：药智数据 Resmetirom的成功获批一方面为MASH患者的治疗提供了新手段，同时另一方面也证明了THR-β激动剂路线的可行性。也正是因此，THR-β激动剂成为全球MASH新药研发的主要集中方向，多款THR-β激动剂紧随其后，均表现出不俗的潜力，目前临床阶段进展较快的主要有四款，分别是Ligand的VK-2809、歌礼制药的ASC41、拓臻生物的TERN-501以及海思科的HSK-31679，均已进入了临床II期。而更值得注意的是，THR-β激动剂也是目前国内MASH在研新药最集中的方向，处于领先地位（临床进度靠前）的创新疗法数量远高于其他几种类型。未来，不出意外的话，国内在该领域的突破大概率也将集中此，或许还有望领先于海外药企，成为MNC争夺的关键。小结纵观MASH领域40余年的发展历史，从致病机制的不断完善，到临床上的对症治疗出现，再到今年首款新药获批上市，MASH的新药研发充满坎坷。但随着MASH新药研发的四大机制方向、10余款创新靶点的逐步落地，领域内似乎正在逐渐形成一个系统化、宏观化的研发格局，过程中不断有更多如GLP-1、THR-β等全新的疗法加入，至少目前看来俨然一副百废待兴，可大展拳脚的状态。而对于国内药企而言，虽然某种程度上做不到如海外一般全赛道布局，但在个别如THR-β激动剂等潜力领域的优势却反而更大，或许这种强调聚焦的国内赛道模式，未来或许真能让中国企业站上国际舞台，成为MASH领域的龙头之一。来源 | 博药（药智网获取授权转载）撰稿 | 头孢责任编辑 | 八角声明：本文系药智网转载内容，图片、文字版权归原作者所有，转载目的在于传递更多信息，并不代表本平台观点。如涉及作品内容、版权和其它问题，请在本平台留言，我们将在第一时间删除。商务合作 | 王存星 19922864877（同微信）阅读原文，是受欢迎的文章哦

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适应症	最高研发状态	国家/地区	公司	日期
慢性肾病	临床2期	德国	ENYO Pharma SA	2025-07-01
Alport 综合征	临床2期	美国	ENYO Pharma SA	2024-08-01
Alport 综合征	临床2期	法国	ENYO Pharma SA	2024-08-01
Alport 综合征	临床2期	西班牙	ENYO Pharma SA	2024-08-01
慢性乙型肝炎	临床2期	美国	ENYO Pharma SA	2020-05-12
慢性乙型肝炎	临床2期	澳大利亚	ENYO Pharma SA	2020-05-12
慢性乙型肝炎	临床2期	中国香港	ENYO Pharma SA	2020-05-12
慢性乙型肝炎	临床2期	波兰	ENYO Pharma SA	2020-05-12
代谢功能障碍相关脂肪性肝炎	临床2期	美国	ENYO Pharma SA	2019-01-30
代谢功能障碍相关脂肪性肝炎	临床2期	比利时	ENYO Pharma SA	2019-01-30

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适应症

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研究	分期	人群特征	评价人数	分组	结果	评价	发布日期


NCT03812029 (CTgov)	临床2期	代谢功能障碍相关脂肪性肝炎	120	Placebo (Placebo Part B)	觸蓋鏇糧繭構繭鏇膚壓(淵廠鏇淵築膚窪範獵窪) = 廠襯鑰鬱憲夢構廠膚夢鑰構餘窪簾壓蓋醖鬱鑰 (願衊鏇獵顧網餘襯廠獵, 構鬱夢壓繭夢壓鑰壓窪 ~ 鬱膚鑰窪簾淵觸構醖淵) 更多	-	2023-05-06
				Vonafexor (Vonafexor 100 mg QD Part B)	觸蓋鏇糧繭構繭鏇膚壓(淵廠鏇淵築膚窪範獵窪) = 獵夢網壓鹽窪窪繭膚網鑰構餘窪簾壓蓋醖鬱鑰 (願衊鏇獵顧網餘襯廠獵, 築積鏇糧築製窪鹹淵鏇 ~ 醖簾鹽製餘願窪糧顧蓋) 更多
NCT04465916 (CTgov)	临床2期	慢性乙型肝炎	26	Nucleotide analogue (Entecavir or Tenofovir Disoproxil)+EYP001a (Experimental Arm)	鏇鹽簾衊鹹願淵製積淵(鏇糧簾選齋鹹艱醖淵淵) = 淵積艱餘範醖蓋鹹願選選餘醖觸觸夢襯鏇鏇顧 (構淵膚襯蓋鏇襯鏇淵夢, 0.0195) 更多	-	2022-10-12
				Nucleotide analogue (Entecavir or Tenofovir Disoproxil) (Control Arm)	鏇鹽簾衊鹹願淵製積淵(鏇糧簾選齋鹹艱醖淵淵) = 簾齋構遞顧齋簾膚蓋糧選餘醖觸觸夢襯鏇鏇顧 (構淵膚襯蓋鏇襯鏇淵夢, 0.0348) 更多
NCT04365933 (EYP001-203, BusinessWire) 人工标引	临床2期	慢性乙型肝炎	20	Entecavir+Peginterferon alfa-2a+Vonafexor	鑰襯繭壓壓選願窪淵構(夢鬱繭壓遞鹹觸鬱襯淵) = 觸膚憲遞襯簾簾衊蓋糧蓋蓋醖蓋鹽構醖夢構遞 (網鹹製鏇蓋膚蓋鬱衊夢 )	积极	2021-07-30
				Peginterferon alfa-2a+Vonafexor	鑰襯繭壓壓選願窪淵構(夢鬱繭壓遞鹹觸鬱襯淵) = 襯範鹹範襯鹹鹽遞糧衊蓋蓋醖蓋鹽構醖夢構遞 (網鹹製鏇蓋膚蓋鬱衊夢 )