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Primary Sclerosing CholangitisPhase 2NCT06905054

Pharmacologic Approaches to Preventing Primary Sclerosing Cholangitis Recurrence After Liver Transplantation

A Phase 2 study testing Fenofibrate (drug), Blood draw for the laboratory assessment and MRI using a hepatobiliary phase contrast agent (Gd-EOB-DPTA) in people with Primary Sclerosing Cholangitis and Liver Transplant, Complications, run by Mayo Clinic at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study aims to determine the efficacy of 36 months once-daily fenofibrate in preventing clinically-detectable recurrence of primary sclerosing cholangitis after liver transplantation, compared with a historical control cohort that was not treated with Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
Fenofibrate (drug), Blood draw for the laboratory assessment and MRI using a hepatobiliary phase contrast agent (Gd-EOB-DPTA)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
80 participants
Where
1 siteUnited States
Study dates
15 Apr 2025to 1 Jul 2028
Phase
Phase 2
Are there results?
Not yet: the study is under way

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

  • Adults aged 18-75 irrespective of gender who have undergone LT for PSC or PSC-related liver malignancy between 1 year and 7 years (inclusive) prior to study enrollment
  • Absence of rPSC at time of study enrollment
  • At least one of the following additional features that increase risk of rPSC
  • LT performed for cholangiocarcinoma
  • Concurrent inflammatory bowel disease
  • Any episode of cytomegalovirus viremia in the post-transplant period before study enrollment
Show all 9Show fewer
  • Any episode of acute cellular rejection in the post-transplant period before the study enrollment
  • If target enrollment of 40 patients is not achieved during the first 6 months of study, we will remove f(iii) inclusion criteria to expand enrollment to any patient meeting the other inclusion/exclusion criteria.
  • Due to lab requirements, we will only enrol patients who are within a 3 hour driving distance of Mayo Clinic Arizona and/or are willing to travel to Mayo Clinic Arizona at 4 month intervals during the study at own cost.

Who cannot join

  • Presence of ischemic cholangiopathy which can mimic rPSC
  • LT performed for primary biliary cholangitis or autoimmune hepatitis, or PSC with overlapping primary biliary cholangitis or autoimmune hepatitis, which may recur after LT and confound assessment of cholestasis
  • Unaddressed post-LT hepatic artery compromise (e.g thrombosis, stenosis) which can mimic rPSC
  • History of total colectomy for curative treatment of ulcerative colitis which reduces risk of rPSC
  • Baseline GFR <30 ml/min which precludes administration of fenofibrate
  • Previously known intolerance or allergy to fenofibrate
  • Other clinically significant comorbid condition, including inability to provide consent and psychiatric conditions, which in the opinion of the study team, may interfere with patient treatment, safety, assessment, or compliance with the treatment
  • Female participants that are pregnant or planning to become pregnant

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

United States1 site, 1 recruiting
  • Mayo Clinic in Arizona

    Scottsdale, Arizona, 85259

    Han Ly, 480-574-2321, ly.ngochan@mayo.edu

    Channa Jayasekera

    Recruiting

Other trials in United States

About this study

Official title: Peroxisome Proliferator-Activated Receptor Agonists to Prevent Primary Sclerosing Cholangitis Recurrence After Liver Transplantation

This study aims to determine the efficacy of 36 months once-daily fenofibrate in preventing clinically-detectable recurrence of primary sclerosing cholangitis after liver transplantation, compared with a historical control cohort that was not treated with

Read the detailed description

Primary sclerosing cholangitis (PSC), an immune-mediated, progressive cholestatic disease with no well-established pharmacologic treatment, has an annual incidence of 2.0 per 100,000 and is responsible for 5% of liver transplants (LT) performed in the United States. Recurrent PSC (rPSC) after LT occurs in 8-27% at 5 years and is associated with an over 40% risk of graft loss.

Because PSC patients undergo LT at a younger age than non-PSC patients (median 40-50 years vs 60 years for most other LT indications), rPSC poses significant lifetime morbidity and mortality risk, and development of its early signs of biliary injury, particularly the development cholestasis (elevated alkaline phosphatase), is routinely monitored in the post-transplant setting.

There is no established pharmacologic treatment for rPSC, and the disease is usually characterized by progressive cholestasis to biliary stricturing, cholangitis, allograft fibrosis and ultimately liver failure. Trials of ursodeoxycholic acid and oral vancomycin have been inconclusive. Since most transplants for PSC are performed with Roux-en-Y biliary reconstructions that make re-transplantation challenging, any pharmacologic intervention to reduce the risk of rPSC would represent a breakthrough in disease management.

Cholestasis appears to be a surrogate for PSC disease progression since improvement in alkaline phosphatase levels is associated with slower disease progression, lower rates of cholangiocarcinoma, and improved survival in the pre-transplant setting. Peroxisome proliferator-activated receptor (PPAR) agonists (e.g. fenofibrate, bezafibrate, seladelpar, elafibranor) reduce bile acid-mediated biliary injury by downregulating their synthesis and activity, and promoting choleresis. PPAR agonists have demonstrated efficacy in potently improving cholestasis in PSC pre-transplant, and other cholestatic liver diseases post-transplant.

While fibrates have been shown to improve both biochemical and clinical parameters of PSC in non-transplant patients, whether they can prevent clinically detectable rPSC after transplantation has not been studied. Extrapolating the pre-transplant data to the post-transplant setting, this study hypothesizes that mitigating cholestasis with the use of fibrates in transplant recipients may impede the development of rPSC.

In this study, the primary aim is to assess the efficacy of once daily fenofibrate-a well-tolerated, generic PPAR-alpha agonist widely used for dyslipidemia-in preventing clinically detectable rPSC after 36 months of treatment, compared to an untreated control group. (rPSC diagnosis based on established criteria outlined below).

This study also investigates novel serum biomarkers of biliary inflammation may serve as early signals of disease either as an alternative or an adjunct to alkaline phosphatase, and before biliary stricturing occurs. The study will also employ quantitative biliary flow dynamics with gadoxetate-enhanced margentic resonance imaging (MRI) which can identify early biliary strictures, hepatocyte function and onset of fibrosis is being studied as a modality to assess pre-transplant PSC severity.

rPSC diagnosis: The study utilizes established criteria for diagnosis of rPSC, with additional inclusion and exclusion criteria for more stringent rule-out of other post-transplant complications of the biliary tree, as follows.1 The criteria will be applied to patients who are between 1 and 7 years from LT.

  • Explant findings consistent with PSC and
  • Absence of untreated hepatic arterial thrombosis, stenosis, or other reason for diminished hepatic arterial resistive indices after LT, and
  • Absence of ischemic cholangiopathy after LT, defined as the development of biliary strictures within the first year of LT as defined elsewhere32, and
  • Absence of untreated biliary anastomotic (post-surgical) stricture, and
  • Presence of intrahepatic and/or extrahepatic biliary stricturing characteristic of PSC by magnetic resonance cholangiography, endoscopic retrograde cholangiography, or percutaneous transhepatic cholangiography, and/or
  • Liver biopsy with fibrous cholangitis and/or fibro-obliterative lesions with or without ductopenia, consistent with PSC
Being tested
Fenofibrate (drug), Blood draw for the laboratory assessment, MRI using a hepatobiliary phase contrast agent (Gd-EOB-DPTA)
Keywords
primary sclerosing cholangitis, recurrent primary sclerosing cholangitis, liver transplant complication, fenofibrate, fibrate, PPAR agonist, peroxisome proliferated activated receptor agonist
Medical subject headings
Cholangitis, Sclerosing

What participants receive

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

  • Fenofibrate (drug)Drug

    Once daily fenofibrate for 36 months

  • Blood draw for the laboratory assessmentDiagnostic test

    Serum assessments will be performed every 3 months during the study period

  • MRI using a hepatobiliary phase contrast agent (Gd-EOB-DPTA)Diagnostic test

    Participants will undergo a quantitative gadoxetate-enhanced MRI and MRCP at baseline, and at 12 months and 36 months of trial participation.

Study groups in NCT06905054
Study groupRoleWhat they receive
TreatmentExperimentalIndividuals who underwent liver transplantation for primary sclerosing cholangitis 1-7 years before study initiation, and meeting study criteria, will receive fenofibrate 160mg oral daily for 36 months Participants will undergo the following serum assessments as part of the study every 3 months during the study period: total bile acids, bile acid profile, fibroblast growth factor 19, and 7-alpha-C4 Participants will undergo gadoxate-enhanced magnetic resonance imaging at baseline, 12 months, and 36 months.
Receives: Drug: Fenofibrate (drug); Diagnostic Test: Blood draw for the laboratory assessment; Diagnostic Test: MRI using a hepatobiliary phase contrast agent (Gd-EOB-DPTA)
Historical controlNo interventionHistorical control of individuals who underwent liver transplantation for primary sclerosing cholangitis who were not treated with any peroxisome proliferator activated receptor agonist treatment.

What is being measured

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

  1. To determine the incidence of rPSC in LT recipients treated with fenofibrate, compared with an untreated control cohort.

    Proportion of recipients transplanted for PSC who develop rPSC during a 36-month fenofibrate treatment period, compared to the rate of rPSC in a untreated cohort. The diagnosis of rPSC will be made based on established diagnostic criteria (see Study Design)

    Measured: 36 months

Secondary outcomes (6)
  1. To quantify the associations between serum alkaline phosphatase and rPSC development in LT recipients treated with fenofibrate

    Quantify the relative risk between serum alkaline phosphatase level (IU/L) and the diagnosis of rPSC (based on established diagnostic criteria - see Study Design) at 36 months of fenofibrate treatment

    Measured: 36 months

  2. To quantify the associations between total serum bile acid level and rPSC development in LT recipients treated with fenofibrate

    Quantify the relative risk between total serum bile acid level (micromol/liter) with a diagnosis of rPSC (based on established diagnostic criteria - see Study Design) at 36 months of treatment

    Measured: 36 months

  3. To quantify the associations between serum bile acid profile and rPSC development in LT recipients treated with fenofibrate

    Quantify the relative risk between primary bile acids level (nanonmol/mL), secondary bile acid level (nanonmol/mL), and glycine:taurine conjugate bile acid level (nanonmol/mL) with a diagnosis of rPSC (based on established diagnostic criteria - see Study Design) at 36 months of fenofibrate treatment

    Measured: 36 months

  4. To quantify the associations between fibroblast growth factor 19 level and rPSC development in LT recipients treated with fenofibrate

    Quantify the relative risk between serum fibroblast growth factor 19 level (picogram/ml) with a diagnosis of rPSC (based on established diagnostic criteria - see Study Design) at 36 months of treatment

    Measured: 36 months

  5. To quantify the associations between serum 7-alpha-hydroxy-4-cholesten-3-one level and rPSC development in LT recipients treated with fenofibrate

    Quantify the relative risk between serum 7-alpha-hydroxy-4-cholesten-3-one (7-alpha-C4) (nanogram/mL) levels with a diagnosis of rPSC (based on established diagnostic criteria - see Study Design) at 36 months of treatment

    Measured: 36 months

  6. To quantify the association between quantitative biliary flow dynamics demonstrated by gadoxetate-enhanced and T1 mapping magnetic resonance imaging with rPSC development in LT recipients treated with fenofibrate

    The ANALI score, biliary transit time, and relative enhancement index of the hepatic parenchyma will be quantified by gadoxetate-enhanced MRI/MRCP. These measures will be correlated with the development of rPSC (based on established diagnostic criteria - see Study Design) during fenofibrate treatment period at 12 months, and 36 months.

    Measured: 36 months

Timeline

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

  1. First posted1 Apr 2025
  2. Study start15 Apr 2025
  3. Primary completion30 Mar 2028 (estimated)
  4. Study completion1 Jul 2028 (estimated)

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
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
80 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06905054
Sponsor's protocol ID
24-007598
Status last verified
Jul 2026
First submitted
28 Feb 2025
Last updated
17 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Fenofibrate (drug), Blood draw for the laboratory assessment and MRI using a hepatobiliary phase contrast agent (Gd-EOB-DPTA) in people with Primary Sclerosing Cholangitis and Liver Transplant, Complications, run by Mayo Clinic at 1 site in United States.

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 9 inclusion and 8 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: looking for participants now, as of the sponsor's last update on 17 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 1 site in United States. 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. 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?

This study is still under way. Results are not available in the source record yet.

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

Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

To determine the incidence of rPSC in LT recipients treated with fenofibrate, compared with an untreated control cohort. (time frame: 36 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 17 Jul 2026.

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