Zydus, a leading discovery based, global pharmaceutical company, announced that it has received permission from the US FDA to initiate the phase 2(b)/3 prospective, multi-centre, randomized, double-blind, placebo-controlled adaptive clinical trial to evaluate efficacy and safety of Saroglitazar magnesium in subjects with primary biliary cholangitis (PBC).
 
The EPICS-III trial will randomise 192 subjects in a 1:1:1 ratio to Saroglitazar 1 mg, Saroglitazar 2 mg or Placebo and will study the Saroglitazar magnesium (1 or 2 mg) relative to placebo based on the composite endpoints of alkaline phosphatase (ALP), total bilirubin, liver stiffness measurement (LSM) by FibroScan, liver enzyme parameters (ALT, AST, GGT, total bilirubin, and albumin), lipid parameters (TG, LDL-C, HDL-C, VLDL-C, total cholesterol, and non-HDL-C), health related quality of life using PBC 40 questionnaire (a patient-derived, disease specific quality of life measure developed and validated for use in PBC) and other outcome measures over a period of 52 weeks [NCT05133336].
 
The change in Pruritus (60- 70 % of patients with PBC liver disease develop systemic itch of the skin that significantly impairs activity and sleep) will be studied using 5-Domains (5-D) itch scale, patient global impression of change scale, patient global therapeutic benefit scale and patient global impression of worst itch severity scale. The EPICS-III phase 2(b)/3 trial will be led by Professor. Naga Chalasani, M.D., Interim Chair, Department of Medicine, Indiana University School of Medicine as Principal Investigator.
 
Speaking on the new development, chairman of Cadila Healthcare Ltd., Pankaj R. Patel said, "Primary biliary cholangitis is a severe liver disease leading to cirrhosis of the liver, liver failure, and possibly death. PBC patients have limited treatment options and approximately 50% of the PBC patients are not able to benefit from the existing therapy due to lack of response or intolerable side effects. Based on the positive results from our earlier phase 2 study, we have now initiated the pivotal EPICS III trial in both cirrhotic and non-cirrhotic PBC patients."
 
The phase 2(a) EPICS trials results published in Journal of Hepatology has demonstrated that Saroglitazar holds immense potential based on its safety and efficacy profile. The global market for PBC treatment is expected to grow at a CAGR of 36.3% from 2018 - 2026, and is expected to reach USD 10.8 billion by 2026 as per Coherent market insights.
 
Saroglitazar Mg is an investigational compound in the USA, and is yet to be approved by the US Food & Drug Administration (FDA) or European Medicines Agency (EMA). The US FDA has granted 'Orphan Drug Designation' and 'Fast Track Designation' to Saroglitazar Mg for PBC.
 
The European Medicines Agency (EMA) has designated "Saroglitazar magnesium" with orphan status for treatment of primary biliary cholangitis. Orphan drug designation provides eligibility for certain development incentives, regulatory fee exemptions, seven-year marketing exclusivity upon US FDA approval and a 10-year period of market exclusivity if the treatment eventually is approved by EMA.