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NASH - Nonalcoholic SteatohepatitisPhase 2NCT05039450

A Study of Efruxifermin in Subjects With Compensated Cirrhosis Due to Nonalcoholic Steatohepatitis (NASH) (Symmetry)

A Phase 2 study testing EFX in people with NASH - Nonalcoholic Steatohepatitis, run by Akero Therapeutics, Inc at 49 sites in 3 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a multi-center evaluation of efruxifermin (EFX) in a randomized, double-blind, placebo-controlled study in cirrhotic subjects with biopsy-proven F4 compensated NASH. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
NASH - Nonalcoholic Steatohepatitis
What is being tested?
EFX
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
213 participants
Where
49 sitesin 3 countries
Study dates
30 Jul 2021to 28 Aug 2025
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Males and non-pregnant, non-lactating females between 18-75 years of age inclusive, based on the date of signing informed consent.
  • Main Study Only: Previous history or presence of Type 2 diabetes or 2 out of 4 components of metabolic syndrome (obesity, dyslipidemia, elevated blood pressure, elevated fasting glucose).
  • Main Study Only: Biopsy-proven compensated cirrhosis due to NASH.
  • Cohort D Only: Diagnosis of type 2 diabetes
  • Cohort D Only: Use of GLP-1R agonist for at least 90 days
  • Cohort D Only: Biopsy-proven liver fibrosis stages 1, 2, or 3

Who cannot join

  • Main Study Only: Weight loss > 10% in the 90 days prior to screening until randomization or from the time of collection of the liver biopsy used to assess subject eligibility until randomization, whichever is longer.
  • Type 1 diabetes or uncontrolled Type 2 diabetes
  • Cohort D Only: Weight loss > 5% in the 90 days prior to screening
  • Cohort D Only: Presence of cirrhosis on liver biopsy
  • Other inclusion and exclusion criteria may apply

Trial locations and contacts

49 sites in 3 countries.

49 sites in 3 countries

United States46 sites
  • Akero Clinical Study Site

    Austin, Texas, 78746

  • Akero Clinical Study Site

    Bastrop, Louisiana, 71220

  • Akero Clinical Study Site

    Chandler, Arizona, 85224

  • Akero Clinical Study Site

    Clearwater, Florida, 33761

  • Akero Clinical Study Site

    Concord, North Carolina, 28027

  • Akero Clinical Study Site

    Dallas, Texas, 75246

  • Akero Clinical Study Site

    Edinburg, Texas, 78504

  • Akero Clinical Study Site

    Edinburg, Texas, 78539

  • Akero Clinical Study Site

    Englewood, Colorado, 80113

  • Akero Clinical Study Site

    Fayetteville, North Carolina, 28304

  • Akero Clinical Study Site

    Fort Myers, Florida, 33907

  • Akero Clinical Study Site

    Fort Myers, Florida, 33912

  • Akero Clinical Study Site

    Fort Worth, Texas, 75044

  • Akero Clinical Study Site

    Fort Worth, Texas, 76104

  • Akero Clinical Study Site

    Fresno, California, 93720

  • Akero Clinical Study Site

    Glendale, Arizona, 85306

  • Akero Clinical Study Site

    Greenville, South Carolina, 29605

  • Akero Clinical Study Site

    Greenwood, South Carolina, 29646

  • Akero Clinical Study Site

    Hialeah Gardens, Florida, 33016

  • Akero Clinical Study Site

    Houston, Texas, 77030

  • Akero Clinical Study Site

    Houston, Texas, 77079

  • Akero Clinical Study Site

    Lakewood Rch, Florida, 34211

  • Akero Clinical Study Site

    Las Vegas, Nevada, 89109

  • Akero Clinical Study Site

    Long Beach, California, 90808

  • Akero Clinical Study Site

    Los Angeles, California, 90036

  • Akero Clinical Study Site

    Marrero, Louisiana, 70072

  • Akero Clinical Study Site

    Miami Lakes, Florida, 33016

  • Akero Clinical Study Site

    Morehead City, North Carolina, 28557

  • Akero Clinical Study Site

    Nashville, Tennessee, 37211

  • Akero Clinical Study Site

    North Little Rock, Arkansas, 72117

  • Akero Clinical Study Site

    Ocala, Florida, 34471

  • Akero Clinical Study Site

    Ogden, Utah, 84405

  • Akero Clinical Study Site

    Pasadena, California, 91105

  • Akero Clinical Study Site

    Richmond, Virginia, 23298

  • Akero Clinical Study Site

    San Antonio, Texas, 78215

  • Akero Clinical Study Site

    Sarasota, Florida, 34240

  • Akero Clinical Study Site

    South Bend, Indiana, 46635

  • Akero Clinical Study Site

    Springboro, Ohio, 45066

  • Akero Clinical Study Site

    Summerville, South Carolina, 29485

  • Akero Clinical Study Site

    Topeka, Kansas, 66606

  • Akero Clinical Study Site

    Tucson, Arizona, 85711

  • Akero Clinical Study Site

    Tucson, Arizona, 85712

  • Akero Clinical Study Site

    Waco, Texas, 76710

  • Akero Clinical Study Site

    Webster, Texas, 77598

  • Akero Clinical Study Site

    Westlake, Ohio, 44145

  • Akero Clinical Study Site

    Wichita Falls, Texas, 76301

Other trials in United States

Mexico2 sites
  • Akero Clinical Study Site

    Mexico City

  • Akero Clinical Study Site

    Monterrey

Other trials in Mexico

Puerto Rico1 site
  • Akero Clinical Study Site

    San Juan, 00927

Other trials in Puerto Rico

About this study

Official title: A Phase 2b, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Safety and Efficacy of Efruxifermin in Subjects With Compensated Cirrhosis Due to Nonalcoholic Steatohepatitis (NASH)

This is a multi-center evaluation of efruxifermin (EFX) in a randomized, double-blind, placebo-controlled study in cirrhotic subjects with biopsy-proven F4 compensated NASH.

Being tested
EFX, Placebo
Medical subject headings
Non-alcoholic Fatty Liver Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EFXDrug

    Investigational drug, Efruxifermin

  • PlaceboDrug

    Placebo

Study groups in NCT05039450
Study groupRoleWhat they receive
EFX 28 mg (Main Study)ExperimentalNot described
Receives: Drug: EFX
EFX 50 mg (Main Study)ExperimentalNot described
Receives: Drug: EFX
Placebo (Main Study)Placebo comparatorNot described
Receives: Drug: Placebo
EFX 50 mg (Cohort D)ExperimentalNot described
Receives: Drug: EFX
Placebo (Cohort D)Placebo comparatorNot described
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Main: Change From Baseline in Fibrosis With no Worsening Steatohepatitis Assessed by NASH CRN System

    Proportion of subjects who achieve ≥ 1 stage improvement in fibrosis (based on NASH CRN fibrosis score) and no worsening of steatohepatitis at Week 36. No worsening of steatohepatitis was defined as no increase in score for any of the 3 components of NAS. The evaluation of the NAS endpoint was calculated using the following 3 categorical features: steatosis [0-3], lobular inflammation [0-3], and hepatocellular ballooning [0-2]. NAS was derived as the unweighted sum of steatosis, lobular inflammation, and hepatocellular ballooning scores.

    Measured: Week 36

Secondary outcomes (17)
  1. Main: Resolution of NASH Assessed by the NASH CRN System

    Proportion of subjects who achieve NASH resolution (defined as a NAS of 0-1 for inflammation and 0 for ballooning) as determined by the NASH CRN criteria at Week 36 and Week 96.

    Measured: Week 36, Week 96

  2. Main: Fibrosis Improvement and Resolution of NASH Assessed by the NASH CRN System

    Proportion of subjects who achieve NASH resolution (defined as a NAS of 0-1 for inflammation and 0 for ballooning) and ≥ 1 stage improvement in fibrosis (based on NASH CRN fibrosis score) at Week 36 and Week 96

    Measured: Week 36, Week 96

  3. Main: Change From Baseline in Fibrosis With no Worsening of Steatohepatitis Assessed by the NASH CRN System

    Proportion of subjects who achieve ≥ 1 stage improvement in fibrosis (based on NASH CRN fibrosis score) and no worsening of steatohepatitis at Week 96

    Measured: Week 96

  4. Main: Change From Baseline in Fibrosis by NASH CRN System

    Proportion of subjects who achieve ≥ 1 stage improvement in fibrosis (based on NASH CRN fibrosis score) at Week 36 and Week 96

    Measured: Week 36, Week 96

  5. Main: Change From Baseline in S-Pro-C3

    Change from baseline in Serum Pro-C3 (N-terminal type III collagen propeptide), a biomarker of type III collagen formation reflecting fibrogenesis, measured in ug/L.

    Measured: Week 36, Week 48, Week 72, Week 96

  6. Main: Change From Baseline in Enhanced Liver Fibrosis (ELF) Score

    ELF score is a composite serum biomarker score derived from HA, PIIINP, and TIMP-1 concentrations. Scores range approximately from 6 to 16, with higher scores indicating greater liver fibrosis severity.

    Measured: Week 36, Week 48, Week 72, Week 96

  7. Main: Change From Baseline in Liver Stiffness Assessed by Liver Elastography (kPa)

    Change from baseline in liver stiffness assessed by liver elastography (kPa)

    Measured: Week 36, Week 48, Week 72, Week 96

  8. Main: Change From Baseline in Lipoproteins

    Change from baseline in Triglycerides (mg/dL), total cholesterol (mg/dL), high-density lipoprotein (HDL-C) (mg/dL), non-HDL-C (mg/dL), and low-density lipoprotein (LDL-C) (mg/dL)

    Measured: Week 36, Week 48, Week 72, Week 96

  9. Main: Change From Baseline in HbA1c (%)

    Glycated hemoglobin (HbA1c), expressed as a percentage, reflects average blood glucose levels over approximately 2 to 3 months and is used as a measure of glycemic control

    Measured: Week 36, Week 48, Week 72, Week 96

  10. Main: Change From Baseline in C-peptide (ug/L)

    C-peptide reflects endogenous insulin secretion and pancreatic beta-cell function. Change from baseline represents the difference between the post-baseline value and the baseline measurement.

    Measured: Week 36, Week 48, Week 72, Week 96

  11. Main: Change From Baseline in Adiponectin (mg/L)

    Adiponectin is involved in glucose and lipid metabolism and is used as a marker of metabolic status. Change from baseline represents the difference between the post-baseline value and the baseline measurement.

    Measured: Week 36, Week 48, Week 72, Week 96

  12. Main: Change From Baseline in Insulin (mIU/L)

    Insulin reflects endogenous insulin levels measured after a period of fasting. Change from baseline represents the difference between the post-baseline value and the baseline measurement.

    Measured: Week 36, Week 48, Week 72, Week 96

  13. Main: Change From Baseline in HOMA-IR

    HOMA-IR has no fixed upper limit. Values near 1 are typically observed in individuals with normal insulin sensitivity, while progressively higher values indicate increasing insulin resistance. The clinical significance of a given value may vary depending on the population and assay methodology. Change from baseline represents the difference between the post-baseline value and the baseline measurement.

    Measured: Week 36, Week 48, Week 72, Week 96

  14. Main: Change From Baseline in Body Weight

    Change from baseline in body weight (kg)

    Measured: Week 36, Week 48, Week 96

  15. Main: Number of Participants With ADA Against EFX

    Detect and measure ADA against EFX

    Measured: Through Week 96

  16. Main: To Assess the Safety and Tolerability of EFX

    Safety and tolerability will be assessed through the reporting of AEs, clinical laboratory tests, ECGs, ultrasounds, vital sign assessments, and concomitant medication usage

    Measured: Through Week 96

  17. Cohort D: To Assess the Safety and Tolerability of EFX Compared to Placebo When Added to an Existing GLP-1R Agonist in Subjects With Type 2 Diabetes and Liver Fibrosis Due to NASH

    Safety and tolerability will be assessed through the reporting of AEs, clinical laboratory assessments, ECGs, ultrasounds, vital sign assessments, and concomitant medication usage

    Measured: Through Week 12

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Sep 2021
  2. Study start30 Jul 2021
  3. Primary completion15 Dec 2023
  4. Study completion28 Aug 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
213 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05039450
Sponsor's protocol ID
AK-US-001-0103
Status last verified
Jun 2026
First submitted
29 Jul 2021
Last updated
21 Jul 2026
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Noureddin M, Rinella ME, Chalasani NP, Neff GW, Lucas KJ, Rodriguez ME, Rudraraju M, Patil R, Behling C, Burch M, Chan DC, Tillman EJ, Zari A, de Temple B, Shringarpure R, Jain M, Rolph T, Cheng A, Yale K. Efruxifermin in Compensated Liver Cirrhosis Caused by MASH. N Engl J Med. 2025 Jun 26;392(24):2413-2424. doi: 10.1056/NEJMoa2502242. Epub 2025 May 9.

    PubMed 40341827
  • Harrison SA, Frias JP, Lucas KJ, Reiss G, Neff G, Bollepalli S, Su Y, Chan D, Tillman EJ, Moulton A, de Temple B, Zari A, Shringarpure R, Rolph T, Cheng A, Yale K. Safety and Efficacy of Efruxifermin in Combination With a GLP-1 Receptor Agonist in Patients With NASH/MASH and Type 2 Diabetes in a Randomized Phase 2 Study. Clin Gastroenterol Hepatol. 2025 Jan;23(1):103-113. doi: 10.1016/j.cgh.2024.02.022. Epub 2024 Mar 4.

    PubMed 38447814

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing EFX in people with NASH - Nonalcoholic Steatohepatitis, run by Akero Therapeutics, Inc at 49 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 49 sites in United States, Mexico, Puerto Rico. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 21 Jul 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Main: Change From Baseline in Fibrosis With no Worsening Steatohepatitis Assessed by NASH CRN System (time frame: Week 36). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05039450, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Jul 2026.

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