The goal of the EMBARK study is to see if the study medicine, maralixibat, can improve the liver health of children with biliary atresia.
For the first 6 months, this will be a placebo-controlled study, meaning half of the children will be randomly assigned to receive the study medicine (maralixibat) and the other half will receive a look-alike solution (placebo) with no active medicine. Neither you nor the study staff will know if your child is receiving maralixibat or placebo. Using placebo is required in clinical studies to scientifically compare and prove that the study medicine works. In the event of a medical emergency, your study doctor will be able to find out which group your child belongs to.
After the first 6 months of the study, all children will enter the long-term extension phase of the study. In this part of the study, all children, including those originally assigned to receive the placebo, will be given maralixibat. The long-term extension phase of the study will last for approximately 1.5 years.
There are some additional requirements to participate. A study representative will discuss them with you.
A clinical research study tests the safety and effectiveness of an investigational medicine in children or adults who agree to participate. Every medicine goes through the clinical research process before it is approved by regulators who then allow doctors to prescribe it outside of a research study. Study participants therefore play a very important role in advancing medicine for both present and future generations.
An investigational medicine has not been approved by the U.S. Food and Drug Administration (FDA) or other health authorities but has permission to be given to study participants for clinical research.
Maralixibat is a grape-flavored liquid taken by mouth. It is an investigational medicine being studied in several rare cholestatic liver diseases, including biliary atresia. Over 1,600 people have received maralixibat, including more than 120 children with liver disease. Maralixibat has been studied in children with other conditions where bile does not drain effectively from the liver, such as Alagille syndrome (ALGS) and Progressive Familial Intrahepatic Cholestasis (PFIC). The positive results from these studies have been used to support the application to health authorities for the use of maralixibat in patients with ALGS and PFIC.
Maralixibat reduces the level of bile acids circulating in the body by helping remove them during digestion. This results in more bile acids being in the feces (poop), a normal route for bile acids to leave the body. The lower levels of bile acids circulating in the body may lead to improved liver function, thereby potentially reducing liver damage caused by excess bile acids.
A placebo is similar in appearance to the study medicine but does not contain any active ingredients. In this study, all packaged study medicine components will be identical to avoid participants or study doctors knowing what each participant is receiving. The study analysis will compare the safety and effectiveness between maralixibat and placebo.
The study team will give the first dose of the study medicine to your child. They will also show you how to do this at home and give you instructions to take with you. The amount of medicine your child will need depends on how much your child weighs. Your study doctor will tell you how much this should be at each visit, but the volume will be less than 1ml (1/4 teaspoon) of liquid per dose. The study medicine should be given once in the morning and once in the evening. You will get dosing dispensers to squirt the study medicine into your child’s mouth.
The study will last approximately two years. For the first 6 months, half of the children will be randomly chosen to receive maralixibat, while the other half will receive a near identical liquid without the medicine in it (placebo). After the first 6 months, all children, including those originally assigned to receive the placebo, will be given maralixibat. This means that all children involved in this study have the opportunity to receive the potential benefits of maralixibat.
There is a chance that your child may experience the side effects associated with the study medicine.
Maralixibat has been studied in more than 1,600 people already, including over 120 children. In previous studies, maralixibat was generally well tolerated with the most common side effects including loose stools (diarrhea) and stomach pain. These symptoms were generally of mild or moderate intensity, were short in duration, and resolved on their own.
You are asked to follow the instructions in the Informed Consent Form for the study. If you are unable to follow these, your child may not continue the study.
To help protect your child’s health, the study will be supervised by a study doctor and their trained team. You may need to share information on your child’s current and past health during the screening period and at clinic visits.
You will be asked to complete a dosing diary, making note of what time and how much of the study medicine has been given to your child. We also ask a series of other questions such as whether you had to take any time off work because of your child’s biliary atresia. This helps us understand the full impact of the condition not only for the patients, but for their families as well.
If you have a family doctor, it is strongly recommended that you inform them of your interest in this study.
There is no cost to you and your family to participate in this study. Participants will receive reimbursement for any reasonable out-of-pocket costs associated with being part of the EMBARK study, such as travel, parking, and meals. We can also arrange for someone to book and pay for rail and flight tickets if you don’t live close to the study clinic. Certain limitations apply.
At the end of the EMBARK study, your study doctor will talk to you about your child’s future care. For those families who want to continue maralixibat treatment, Mirum will help ensure that opportunities to access this medicine continue to be available as appropriate.