The ELMWOOD- Phase II trial

The ELMWOOD Phase II trial is a clinical study evaluating the efficacy and safety of elafibranor (brand name Iqirvo) for the treatment of primary sclerosing cholangitis (PSC). PSC is a rare, chronic liver disease that causes inflammation, scarring, and narrowing of the bile ducts, which can eventually lead to liver failure. Currently, there are no approved treatments for PSC, making this an area of significant unmet medical need.

### Key Findings from the ELMWOOD Phase II Trial:

1. **Study Design**:

• The trial included an open-label extension phase, where patients who initially received a placebo were switched to elafibranor at a 120 mg daily dose. Other participants either continued on their original treatment dose or had their dose increased.

2. **Efficacy Results**:

• **Alkaline Phosphatase (ALP)**:
• ALP is a key liver enzyme and biomarker linked to disease activity in PSC.
• Patients who switched from placebo to elafibranor (120 mg daily) experienced rapid and sustained reductions in ALP levels:
• A 36% reduction in ALP at week 4.
• A 40% reduction in ALP at week 28.
• Patients who had been on the 120 mg dose from the start of the trial achieved even greater reductions:
• A 46% reduction in ALP at week 28.
• Patients whose dose was increased from 80 mg to 120 mg showed a 35.6% reduction in ALP, indicating continued improvement with higher dosing.
• **Other Liver Enzymes**:
• Elafibranor also improved levels of other liver enzymes, including ALT, AST, GGT, and bilirubin, across all treatment groups.
• **Pruritus (Itching)**:
• Itching, one of the most debilitating symptoms of PSC, improved in all treatment cohorts.
• **Fibrosis Assessments**:
• Noninvasive measures of liver fibrosis showed stabilization or modest improvement, suggesting potential long-term benefits for liver health.

3. **Safety Profile**:

• The safety findings were generally acceptable:
• 52% of patients reported treatment-emergent side effects, most of which were mild. Common side effects included COVID-19, nausea, itching, and weight gain.
• Serious adverse events occurred in 5% of participants, but none were attributed to elafibranor.
• The safety data supports the continued development of elafibranor for PSC.

4. **Significance**:

• The interim results indicate that elafibranor is a promising therapeutic candidate for PSC. It has demonstrated meaningful improvements in liver markers, symptoms like pruritus, and potentially slowed disease progression. This is particularly important given the lack of approved treatments for this rare and serious liver disease.

### Conclusion:

The ELMWOOD Phase II trial highlights elafibranor's potential to address the significant unmet medical need in PSC. Its ability to improve liver enzyme levels, alleviate symptoms, and potentially impact long-term liver health makes it a promising therapy for further clinical development.