A Phase 3 Study to Evaluate the Effect of Resmetirom on Clinical Outcomes in Patients With Well-compensated NASH Cirrhosis (MAESTRO-NASH-OUTCOMES)

Last updated: June 9, 2025
Sponsor: Madrigal Pharmaceuticals, Inc.
Overall Status: Active - Not Recruiting

Phase

3

Condition

Scar Tissue

Hyponatremia

Hepatic Fibrosis

Treatment

Placebo

Resmetirom

Clinical Study ID

NCT05500222
MGL-3196-19
  • Ages > 18
  • All Genders

Study Summary

This study will determine the effect of oral 80 mg resmetirom administered once daily on participants with well-compensated non-alcoholic steatohepatitis (NASH) cirrhosis by measuring the time to experiencing a Composite Clinical Outcome event.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Definitive (by histologic documentation) or probable NASH as causative agent forcirrhosis, following a modified version of the NASH Cirrhosis: Liver Forum ConsensusDefinitions for Clinical Trials.

  • a. Most recent biopsy (within last 5 years) shows cirrhosis with a NAS of ≥ 2, andat least two components: one being steatosis and at least one other component; ORNAS of ≥ 2, if steatosis = 0 or is ungraded with inflammation and/or ballooning,eligible with an MRI-PDFF >5%. If steatosis and ballooning and/or steatosis andinflammation are noted by the local pathologist, then the biopsy qualifies even if aNAS is not provided (Approximately 70% of the study patient population) b.Historical biopsy (within last 5 years) showed NASH with significant fibrosis withpathology report documenting "F2" or "F3", with at least steatosis either by biopsywith no minimal percentage required or by MRI-PDFF >5%, AND inflammation orballooning. Now with cirrhosis, either by clinical history or current features,imaging, noninvasive tests, or biopsy (see Appendix 7) (Up to approximately 20% ofstudy patient population) c. Historical biopsy (within last 5 years) showssteatosis. Pathology report documents steatosis with no minimal percentage required.Now with cirrhosis, either by clinical history or current features, imaging,noninvasive tests, or biopsy (see Appendix 7). Prescreening metabolic risk factorsmust include obesity and/or T2D. (Up to approximately 10% of study patientpopulation.)

  • Well-compensated NASH cirrhosis at screening and baseline with Child-Pugh A (scoreof 5-6) (no history of hepatic decompensation event).

  • At least 3 metabolic risk factors

  • Magnetic Resonance Imaging Proton Density Fat Fraction (MRI-PDFF) that is obtainedduring the Screening period or a historic MRI-PDFF at ≤8 weeks old at the time ofrandomization with no weight change ≥5% weight change in that interval.

  • MRE ≥4.2 where MRE is available.

  • Enhanced liver function (ELF) ≥9.8, only if MRE is unavailable or contraindicated.

Exclusion

Exclusion Criteria:

  • Participants with a chronic liver diseases other than NASH cirrhosis, such asprimary biliary cholangitis, primary sclerosing cholangitis, Hepatitis B positive,Hepatitis C, history or evidence of current active autoimmune hepatitis, history orevidence of Wilson's disease, history or evidence of alpha-1-antitrypsin deficiency,history or evidence of genetic hemochromatosis (hereditary, primary), evidence ofdrug-induced liver disease, as defined on the basis of typical exposure and history,known bile duct obstruction, or suspected or confirmed liver cancer, are excluded.

  • Participants with MELD score ≥12 due to liver disease are excluded.

  • Participants with a history of hepatic decompensation or impairment are excluded.

Study Design

Total Participants: 700
Treatment Group(s): 2
Primary Treatment: Placebo
Phase: 3
Study Start date:
August 26, 2022
Estimated Completion Date:
January 31, 2027

Study Description

This is a multi-national, multicenter, double-blind, randomized, placebo-controlled study in participants with well-compensated NASH cirrhosis. Participants will be randomized 3:1 in a blinded manner to receive 80 mg resmetirom or matching placebo given orally once daily in the morning for the duration of the study (until the required number of Composite Clinical Outcome events are achieved). Composite Clinical Outcome events are defined as any of the following: liver-related and CV mortality, liver transplant, and significant hepatic events, including potential hepatic decompensation events (ascites, hepatic encephalopathy, or gastroesophageal variceal hemorrhage), and confirmed increase of Model for End-stage Liver Disease (MELD) score from <12 to ≥15. The study comprises an up to 60-day screening period and an approximately 3-year treatment period.

Connect with a study center

  • FDI Clinical Research (Fundacion de Investigacion de Diego)

    San Juan, 00927
    Puerto Rico

    Site Not Available

  • Latin Clinical Trials Center

    San Juan, 00909
    Puerto Rico

    Site Not Available

  • University of Alabama at Birmingham (UAB)

    Birmingham, Alabama 35249
    United States

    Site Not Available

  • Arizona Liver Health - Chandler

    Chandler, Arizona 85224
    United States

    Site Not Available

  • Arizona Liver Health - Peoria

    Peoria, Arizona 85381
    United States

    Site Not Available

  • Adobe Clinical Research

    Tucson, Arizona 85712
    United States

    Site Not Available

  • Arizona Liver Health - Tucson

    Tucson, Arizona 85712
    United States

    Site Not Available

  • Arkansas Diagnostic Center/Liver Wellness Center

    Little Rock, Arkansas 72205-6414
    United States

    Site Not Available

  • Arkansas Gastroenterology

    North Little Rock, Arkansas 72117
    United States

    Site Not Available

  • Southern California Research Center

    Coronado, California 92118
    United States

    Site Not Available

  • University of California, San Francisco-Fresno

    Fresno, California 93701
    United States

    Site Not Available

  • Univ. of California San Diego School of Medicine

    La Jolla, California 92037
    United States

    Site Not Available

  • Keck School of Medicine of USC

    Los Angeles, California 90033
    United States

    Site Not Available

  • California Liver Research Institute

    Pasadena, California 91105
    United States

    Site Not Available

  • South Denver Gastroenterology

    Englewood, Colorado 80113
    United States

    Site Not Available

  • Hi Tech and Global Research

    Coral Gables, Florida 33134
    United States

    Site Not Available

  • Top Medical Research Inc

    Cutler Bay, Florida 33189
    United States

    Site Not Available

  • Covenant Research - Fort Myers

    Fort Myers, Florida 33912
    United States

    Site Not Available

  • Nature Coast Clinical Research - Inverness

    Inverness, Florida 34452
    United States

    Site Not Available

  • Jacksonville Center for Clinical Research

    Jacksonville, Florida 32216
    United States

    Site Not Available

  • Ocala GI Research DBA Lake Center for Clinical Research

    Lady Lake, Florida 32159
    United States

    Site Not Available

  • Florida Research Institute

    Lakewood Ranch, Florida 34238
    United States

    Site Not Available

  • Sanchez Clinical Research

    Miami, Florida 33157
    United States

    Site Not Available

  • Ocala GI Research

    Ocala, Florida 34471
    United States

    Site Not Available

  • St Johns Center for Clinical Research

    Saint Augustine, Florida 32086
    United States

    Site Not Available

  • Covenant Research

    Sarasota, Florida 34240
    United States

    Site Not Available

  • International Center for Research

    Tampa, Florida 33614
    United States

    Site Not Available

  • Florida Medical Clinic

    Zephyrhills, Florida 33542
    United States

    Site Not Available

  • Summit Clinical Research

    Athens, Georgia 30607
    United States

    Site Not Available

  • Gastrointestinal Specialists of Georgia

    Marietta, Georgia 30060
    United States

    Site Not Available

  • Kansas Medical Clinic - Gastroenterology

    Topeka, Kansas 666006
    United States

    Site Not Available

  • Delta Research Partners - Bastrop

    Bastrop, Louisiana 71220
    United States

    Site Not Available

  • Louisiana Research Center

    Shreveport, Louisiana 71105
    United States

    Site Not Available

  • Mercy Medical Center

    Baltimore, Maryland 21202
    United States

    Site Not Available

  • Kansas City Research Institute

    Kansas City, Missouri 64131
    United States

    Site Not Available

  • Premier Health Research

    Sparta, New Jersey 07871
    United States

    Site Not Available

  • Lucas Research

    Morehead City, North Carolina 28557
    United States

    Site Not Available

  • Regional Gastroenterology Associates of Lancaster

    Flourtown, Pennsylvania 19031
    United States

    Site Not Available

  • Rapid City Medical Center

    Rapid City, South Dakota 57701
    United States

    Site Not Available

  • Premier Medical Group

    Clarksville, Tennessee 37040
    United States

    Site Not Available

  • Gastro One

    Cordova, Tennessee 38018
    United States

    Site Not Available

  • Texas Clinical Research Institute

    Arlington, Texas 76012-3216
    United States

    Site Not Available

  • Pinnacle Clinical Research - Austin

    Austin, Texas 78757
    United States

    Site Not Available

  • South Texas Research Institute - Brownsville

    Brownsville, Texas 78520
    United States

    Site Not Available

  • Liver Center of Texas

    Dallas, Texas 75234
    United States

    Site Not Available

  • The Liver Institute at Methodist Dallas Medical Center

    Dallas, Texas 75203
    United States

    Site Not Available

  • South Texas Research Institute - Edinburg

    Edinburg, Texas 78539
    United States

    Site Not Available

  • Pinnacle Clinical Research - Georgetown

    Georgetown, Texas 78626
    United States

    Site Not Available

  • Houston Research Institute

    Houston, Texas 77079
    United States

    Site Not Available

  • Pinnacle Clinical Research - San Antonio

    San Antonio, Texas 78229
    United States

    Site Not Available

  • Digestive Health Research of Central Texas

    Waco, Texas 76712
    United States

    Site Not Available

  • Impact Research Institute

    Waco, Texas 76710
    United States

    Site Not Available

  • GI Select Health Research

    Richmond, Virginia 23236
    United States

    Site Not Available

  • Hunter Holmes McGuire VA Medical Center

    Richmond, Virginia 23249
    United States

    Site Not Available

  • Liver Institute Northwest

    Seattle, Washington 98105
    United States

    Site Not Available

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