title: Inhibition of 11β-HSD1 with RO5093151 for non-alcoholic fatty liver disease: a multicentre, randomised, double-blind, placebo-controlled trial.
abstract: BACKGROUND
  The prevalence of non-alcoholic fatty liver disease is increasing worldwide and an effective and safe pharmacological treatment is needed. We investigated whether inhibition of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1, also known as HSD11B1) by RO5093151 could safely and effectively decrease liver-fat content in patients with this disorder.
  
  
  METHODS
  We did this phase 1b trial at four centres in Germany and Austria. Participants with non-alcoholic fatty liver disease (defined as (1)H magnetic resonance spectroscopy liver-fat content >5·56%), insulin resistance (homoeostatic model assessment of insulin resistance [HOMA-IR] of at least 2·0 mmol/L·mU/L), BMI greater than 27 kg/m(2), and aged 35-65 years were randomly assigned by interactive voice response system in a 1:1 ratio, stratified for triglyceride concentration (<1·7 mmol/L or ≥1·7 mmol/L), to oral RO5093151 (200 mg twice daily) or matching placebo for 12 weeks. The main exclusion criteria were other liver diseases, aspartate aminotransferase or alanine aminotransferase concentrations of more than two and a half times the upper limit of normal, history of diabetes or bariatric surgery, and use of weight lowering drugs. Participants and investigators were masked to assignment throughout the study. The primary endpoint was change in liver-fat content from baseline to week 12. Efficacy analysis was by modified intention to treat, including all patients who received at least one dose of study drug and had a baseline and follow-up measurement of liver-fat content. Safety analyses included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT01277094.
  
  
  RESULTS
  We did this trial between Jan 13, 2011, and March 28, 2012. 41 patients were randomly assigned to RO5093151 and 41 to placebo. 35 patients in the RO5093151 group and 39 in the placebo group were included in the efficacy analysis. Mean liver-fat content decreased in the RO5093151 group (from 16·75% [SD 8·67] to 14·28% [8·89]), but not in the placebo group (from 18·53% [10·00] to 18·46% [10·78], p=0·02 for between group difference). 26 participants (65%) in the RO5093151 group had adverse events, compared with 21 (53%) in the placebo group. The most common adverse events were gastrointestinal disorders (12 patients [30%] in the RO5093151 group vs seven [18%] in the placebo group), and infections and infestations (eight [20%] vs nine [23%]). Nervous system disorders occurred in significantly more patients in the RO5093151 group than in the placebo group (nine [23%] vs two [5%]; p=0·02); all other differences in adverse events were non-significant. One participant (3%) in the placebo group and three participants (8%) in the RO5093151 group had serious adverse events. All serious adverse events were deemed unrelated to study treatment.
  
  
  CONCLUSIONS
  Inhibition of 11β-HSD1 by RO5093151 was effective and safe in reducing liver-fat content, suggesting that targeting of 11β-HSD1 might be a promising approach for the treatment of non-alcoholic fatty liver disease.
  
  
  BACKGROUND
  F Hoffmann-La Roche.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases, University of Tübingen, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany. Electronic address: norbert.stefan@med.uni-tuebingen.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Stefan
authors.affiliation: F Hoffmann-La Roche Ltd, Basel, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Ramsauer
authors.affiliation: F Hoffmann-La Roche Ltd, Basel, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Jordan
authors.affiliation: German Center for Diabetes Research, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Nowotny
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases, University of Tübingen, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kantartzis
authors.affiliation: Institute of Diabetes Research and Metabolic Diseases, University of Tübingen, Tübingen, Germany; Section on Experimental Radiology, University of Tübingen, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Machann
authors.affiliation: German Center for Diabetes Research, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Jong-Hee
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: German Center for Diabetes Research, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Nowotny
authors.affiliation: German Center for Diabetes Research, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Kahl
authors.affiliation: Internal Medicine III, Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Harreiter
authors.affiliation: German Center for Diabetes Research, Neuherberg, Germany; Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam, Nuthetal, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Hornemann
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.affiliation: School of Medicine, University of Leeds, Leeds, UK.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Stewart
authors.affiliation: German Center for Diabetes Research, Neuherberg, Germany; Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam, Nuthetal, Germany.
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Pfeiffer
authors.affiliation: Internal Medicine III, Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
authors.affiliation: German Center for Diabetes Research, Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany; Department of Endocrinology and Diabetology, University Clinical Düsseldorf, Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Roden
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases, University of Tübingen, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Häring
authors.affiliation: F Hoffmann-La Roche Ltd, Basel, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Fürst-Recktenwald
mesh_terms: D043205:11-beta-Hydroxysteroid Dehydrogenase Type 1 / Q000037:antagonists & inhibitors*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000188:drug therapy* / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D043205:11-beta-Hydroxysteroid Dehydrogenase Type 1