Safety and Efficacy of Efimosfermin Alfa in Participants with Biopsy‑Confirmed F2‑ or F3‑Stage Metabolic Dysfunction‑Associated Steatohepatitis (MASH)

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What is this study about?

The trial focuses on adults with a liver condition called Metabolic Dysfunction-Associated Steatohepatitis (often shortened to MASH). This disease causes excess fat buildup in the liver, inflammation, and can lead to scarring known as fibrosis. Diagnosis is confirmed by a tiny tissue sample called a biopsy, which is examined under a microscope.

The investigational treatment is an injectable form of efimosfermin alfa, given under the skin (subcutaneous injection). Participants are randomly assigned to receive either the study drug or a placebo, and neither the participants nor the study staff know which one is given (double‑blind). The study lasts about one year, with regular clinic visits for injections and safety checks.

The main goal is to see whether the drug can improve liver health by reducing inflammation and decreasing scarring (fibrosis) compared with the placebo. Researchers will look at changes in the liver tissue, blood tests, and overall health over the treatment period.

1 randomization and assignment

after enrollment, the participant is randomly assigned to receive either efimosfermin alfa or a matching placebo in a double‑blind manner.

the assignment determines which subcutaneous injection the participant will receive for the duration of the study.

2 baseline assessments

a liver biopsy confirming f2 or f3 stage metabolic dysfunction‑associated steatohepatitis (mash) is performed.

additional baseline measurements such as laboratory tests, imaging, and questionnaires are collected to establish the participant’s initial status.

3 initiation of study medication

the participant receives the first subcutaneous injection of the assigned product (efimosfermin alfa or placebo).

the dose and frequency are defined by the study protocol; the specific dose is not disclosed in the provided information.

treatment is planned for a total period of 52 weeks, with the possibility of continuation for up to 48 months for extended evaluation.

4 regular treatment visits

the participant returns to the study site at scheduled intervals to receive additional subcutaneous injections according to the protocol.

at each visit safety assessments, including monitoring for treatment‑emergent adverse events, are performed.

efficacy assessments such as laboratory tests, imaging, and questionnaires may be repeated according to the study schedule.

5 week 52 evaluation

after 52 weeks of treatment, a liver biopsy is repeated to evaluate histologic resolution of mash and improvement in fibrosis.

the primary objectives are assessed: proportion of participants with at least one‑stage improvement in fibrosis without worsening of steatohepatitis, and proportion with resolution of steatohepatitis without fibrosis worsening.

additional safety and laboratory evaluations are conducted.

6 optional continuation to month 48

participants may continue receiving the assigned injection for up to 48 months.

periodic assessments are performed to determine the time to a composite liver‑related clinical outcome and to monitor long‑term safety.

efficacy endpoints such as fibrosis improvement, steatohepatitis resolution, and changes in imaging and laboratory markers are evaluated at month 48.

7 study completion and final assessments

at the end of the study period, the participant completes final safety evaluations, laboratory tests, and questionnaires.

all data are compiled for analysis of the primary and secondary endpoints.

the participant is then discharged from the study protocol.

Who Can Join the Study?

  • You must be able to read, understand, and sign a written informed consent form before any study activities begin; this document explains the study and your rights.
  • You must be at least 18 years old and not older than 75 years when you join the study.
  • You need to have at least two of the five health problems that make up metabolic syndrome (such as high blood pressure, high blood sugar, excess belly fat, high triglycerides, or low “good” cholesterol) as defined by the American Heart Association.
  • A doctor must have taken a small sample of your liver (liver biopsy) that shows you have MASH (Metabolic Dysfunction‑Associated Steatohepatitis) with scar tissue at a level called stage F2 or F3 fibrosis, and the sample must have a NAS score of 4 or higher, confirmed by a specialist pathologist.

Who Cannot Join the Study?

  • Cannot have a problem that makes a percutaneous liver biopsy (a needle procedure to take a small liver sample) unsafe or impossible.
  • Blood test showing glycated hemoglobin (a measure of average blood sugar) 9.0% or higher.
  • Model for End-Stage Liver Disease (MELD) score 12 or higher, unless the high score is due to a condition that does not affect liver function, such as Gilbert’s syndrome.
  • Blood test showing phosphatidylethanol (PEth) (a marker of recent alcohol use) 80 ng/mL or higher at screening.
  • Current infection with any of the following: human immunodeficiency virus (HIV), hepatitis B virus (detectable surface antigen), or hepatitis C virus (HCV).
  • Any other chronic liver disease, including but not limited to alcoholic liver disease, evidence of portal hypertension, viral hepatitis, or any history or evidence of cirrhosis on the screening liver biopsy; or advanced liver problems such as fluid buildup in the abdomen (ascites), bleeding from enlarged veins in the esophagus or stomach (gastroesophageal varices), kidney failure caused by liver disease (hepatorenal syndrome), or brain effects of liver disease (hepatic encephalopathy) before screening or Day 1.
  • Drinking large amounts of alcohol for three months or more within the 12‑month period before screening.
  • Liver enzymes ALT or AST that are five times the upper limit of normal (ULN).
  • Total bilirubin (a substance that colors stool and urine) 1.3 mg/dL or higher, unless the person has documented Gilbert’s syndrome with an isolated increase in total bilirubin of ≥1.3 mg/dL and direct bilirubin ≤20 % of total bilirubin.
  • Serum albumin 3.5 g/dL or lower.
  • International Normalized Ratio (INR) 1.3 or higher, unless it is due to therapeutic blood‑thinning medication.
  • Alkaline phosphatase (ALP) 2 times the upper limit of normal (ULN).
  • Platelet count less than 140,000 per cubic millimeter (mm³); individuals with a count between 110,000 and 140,000 may be considered after discussion with the study medical monitor.
  • Serum creatinine 1.5 mg/dL or higher, or creatinine clearance 60 mL/min/1.73 m² or lower (a measure of kidney function).
  • Alpha‑fetoprotein 20 ng/mL or higher.

Where you can join this trial?

Verified and Recommended Sites

No sites found in this category

Verified Sites

Site Name City Country Status
Cliniques Universitaires Saint-Luc Woluwe-Saint-Lambert Belgium
University Multiprofile Hospital For Active Treatment Saint Georgi EAD Plovdiv Bulgaria
Hippokration Hospital Athens Greece
Landeskrankenanstalten-Betriebsgesellschaft Kabeg Klagenfurt am Wörthersee Austria
Evangelismos S.A. Athens Greece
Diagnostic Consultative Centre Ascendent OOD Sofia Bulgaria
Laiko General Hospital Of Athens Athens Greece
University General Hospital Of Thessaloniki Ahepa Thessaloniki Greece
Hospital Vall d’Hebron Barcelona Spain
Diagnostic-consultative center “Aleksandrovska” EOOD Sofia Bulgaria
Universitätsklinikum des Saarlandes – Homburg/Saar, Klinik für Urologie und Kinderurologie Homburg Germany
Multispecialty hospital for active treatment Sveta Sofia EOOD Sofia Bulgaria
Hospital Universitario da A Coruna A Coruna Galicia Spain
Virgen del Rocío University Hospital Sevilla Spain
Medical University Of Vienna Vienna Austria
Amsterdam UMC Amsterdam The Netherlands
Charite Universitaetsmedizin Berlin KöR Berlin Germany
Erasmus Universitair Medisch Centrum Rotterdam (Erasmus MC) Rotterdam The Netherlands
Center For Pediatric And Adolescent Medicine Of The Johannes Gutenberg University Mainz Mainz Germany
Hospital Universitario De Leon Leon Spain
Hospital General Universitario De Valencia Valencia Spain
Universitaetsklinikum Muenster AöR Munster Germany
Universitaetsklinikum Heidelberg AöR Heidelberg Germany
Klinik Hietzing Vienna Austria
Multiprofile Hospital For Active Treatment Hadji Dimitar OOD Sliven Bulgaria
Universitaet Leipzig Leipzig Germany
Hospital De La Santa Creu I Sant Pau Barcelona Spain
Medizinische Universitaet Innsbruck Innsbruck Austria
University Of Antwerp Edegem Belgium
University Medical Center Hamburg-Eppendorf Hamburg Germany
Centre hospitalier universitaire de Liege Liege Belgium
Universitair Ziekenhuis Gent Gent Belgium
Hospital General Universitario Gregorio Maranon Madrid Spain
Hospital Universitario De La Princesa Madrid Spain
Hospital Universitario Marques De Valdecilla Santander Spain
Az Maria Middelares Gent Gent Belgium
University General Hospital Of Heraklion Heraklion Greece
Hospital Quironsalud Barcelona Barcelona Spain
Acibadem City Clinic Diagnostic And Consultation Center Tokuda EAD Sofia Bulgaria
Hospital Clinico Universitario De Valladolid Valladolid Spain
Multiprofile Hospital For Active Treatment St. Ivan Rilski Gorna Oriahovitsa EOOD Gorna Oryahovitsa Bulgaria
Université Libre de Bruxelles – Hôpital Erasme Brussels Belgium
Azienda Ospedaliera di Padova Padua Italy
IRCCS Humanitas Research Hospital Rozzano Italy
Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan Italy
Ospedale San Raffaele S.r.l. Milan Italy
Universita’ Campus Bio-medico Di Roma Rome Italy
Universita’ Politecnica Delle Marche Ancona Italy
Azienda Ospedaliera Universitaria Citta’ Della Salute E Della Scienza Di Torino Turin Italy
Azienda Ospedaliero Universitaria Ospedali Riuniti Foggia Italy
Azienda Unita Sanitaria Locale Di Bologna Bologna Italy
Azienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
Azienda Ospedaliero Universitaria Careggi Florence Italy
Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
Samodzielny Publiczny Zaklad Opieki Zdrowotnej Szpital Uniwersytecki W Krakowie Cracow Poland
Santa Sp. z o.o. Lodz Poland
Hopital Saint Antoine Paris France
Hopitaux Universitaires Pitie Salpetriere Paris France
CHU Croix Rousse-Lyon Lyon France
Hospital Paul Brousse Villejuif France
Sante Atlantique Saint-Herblain France
Besancon University Hospital Center Besançon France
CHRU De Nancy Vandoeuvre Les Nancy France
Centre Hospitalier Universitaire De Lille Lille France
Centre Hospitalier Universitaire De Rennes Rennes France
Centre Hospitalier Lyon Sud Pierre Benite France
Hopital Beaujon Clichy France
Centre Hospitalier Regional D’Angers Angers France
University Hospital Of Clermont-Ferrand Clermont Ferrand France
Hôpitaux Universitaires Strasbourg – Hôpital de Hautepierre STRASBOURG, Alsace France
WIP Warsaw IBD Point Profesor Kierkus Warsaw Poland
Centre Hospitalier Universitaire De Bordeaux Bordeaux France
Centre Hospitalier Universitaire De Nice Nice France
Medical University Of Graz Graz Austria
Centre Hospitalier Universitaire Amiens Picardie Amiens France
Military Medical Academy Pleven Bulgaria

Other Sites

Site Name City Country Status
Bernhoven B.V. Uden The Netherlands
Gyncentrum Sp. z o.o. Katowice Poland
Medrise Sp. z o.o. Lublin Poland
Pratia S.A. Skorzewo Poland
Uuhbqmsooh Hjncefcl Lkgtwcdb Sofia Bulgaria
Uooudgdgri Mogawghagxpt Hgqfwfoj Fti Afsecz Tqjepklbc Arp Erjbyigmy Mhltjfbe N I Pdgniyv Sofia Bulgaria
Madqqnf Cxjqje Hkxb Empj Sofia Bulgaria
Muqoqlr Chsgno Fteodegqkf Ezgt Plovdiv Bulgaria
Ezoeft Gxjavzleuxtc fbrj esxijnbtpbojiwiz urw kejbeggin Fvpvttdnh if dqi Mwzdquy muv Berlin Germany
Hnwtucyt Glvdcbl Dp Tptwzmeyh Tomelloso Spain
Pviockkiqjq Gnvveltc Smeq Donostia / San Sebastian Spain
Eupvasez Ggkt Leipzig Germany
Mlbkggko Cqndgy Sijvol Barcelona Spain
Mvzrocfmouqa Hksjqjuu Fsi Aorkab Temzbzhsfwuuo Hlcviqgj Lepu Panagyurishte Bulgaria
Mkfr Thgqka Ebwz Stara Zagora Bulgaria
Iw Czxmln Myslowice Poland
Shabzox Cxjijqu Mdbnxbyx Svd z odwb Poznan Poland
Awmhdrh Sks z opfr Syns Lodz Poland
Mpofiz Myqfkeg ssv z obci Wroclaw Poland

Want to learn more about this study or check if you can participate? Contact us.

Trial status

Country Status Recruitment Start
Austria Austria
Recruiting
06.07.2026
Belgium Belgium
Recruiting
06.07.2026
Bulgaria Bulgaria
Recruiting
06.07.2026
France France
Recruiting
06.07.2026
Germany Germany
Recruiting
06.07.2026
Greece Greece
Recruiting
06.07.2026
Italy Italy
Recruiting
06.07.2026
Poland Poland
Recruiting
06.07.2026
Spain Spain
Recruiting
06.07.2026
The Netherlands The Netherlands
Not yet recruiting
06.07.2026

Trial locations

EFIMOSFERMIN ALFA is a medication being tested to treat Metabolic Dysfunction‑Associated Steatohepatitis (MASH), a liver disease that can cause scarring and damage. In this study, participants receive the drug as a powder that is mixed with liquid and injected under the skin. The goal is to see if the medicine can improve the liver’s appearance under a microscope, reduce inflammation, and slow or reverse the buildup of scar tissue (fibrosis) over a year of treatment.

Metabolic Dysfunction-Associated Steatohepatitis (MASH) – It is a liver condition where excess fat builds up together with inflammation. Over time the inflammation can cause scarring that becomes thicker and more rigid. The scarring may increase step by step, making the liver less flexible. The amount of fat and inflammation can grow gradually, especially when risk factors such as an unhealthy diet are present. The disease can move from simple fat accumulation to this inflamed state and then to more advanced scarring.

Trial ID:
2025-523675-39-00
Protocol code:
301160
NCT ID:
NCT07221227
Trial Phase:
Therapeutic confirmatory (Phase III)

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