Conatus fluffs its second Encore

Conatus and Novartis’s Nash project emricasan has struck out for a second time with the failure of the Encore-NF trial in Nash fibrosis. But Conatus seems inexplicably determined to press on. The company admitted yesterday that emricasan, a caspase inhibitor, did not work in the earlier-stage Nash fibrosis patients enrolled in Encore-NF, but suggested it might still have utility in those who had progressed to cirrhosis. One problem with this theory is that the Encore-PH trial, in Nash cirrhosis, failed in December. Still, Encore-PH homed in on patients who also had portal hypertension, so Conatus is clearly clinging to the hope of a different result in its next trial, Encore-LF, in patients with decompensated Nash cirrhosis, the most severe form. The primary endpoint is event-free survival and data are due in mid-2019. Hopes are low, especially after the failed Encore-PH study found a worsening in hepatic venous pressure gradient in a subgroup of decompensated cirrhosis patients treated with 5mg and 25mg of emricasan – the doses being tested in Encore-LF. Conatus shares plunged 56% in premarket trading today. With not much else in its pipeline, it is understandable that the company wants to find a path forward. Novartis might not feel the same.

Conatus's pipeline programmes
Project Setting Trial Status
Emricasan Nash cirrhosis with portal hypertension Encore-PH, NCT02960204 Failed, extension data due mid-2019
Emricasan Nash fibrosis stage F1-F3 Encore-NF, NCT02686762 Failed
Emricasan Decompensated Nash cirrhosis Encore-LF, NCT03205345 Topline data due mid-2019
Emricasan Combination with Novartis's tropifexor - Preclinical; decision to be made by Novartis on clinical development
CTS-2090 Inflammasome-related diseases - Preclinical  
Source: Company website, clinicaltrials.gov.

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