An Evaluation of the Safety and Efficacy of NTZ on Collagen Turnover in NASH Patients With Fibrosis

Based on the anti-fibrotic properties demonstrated in the animal models of fibrosis, this
proof of concept clinical study aims at evaluating NTZ in patients with non-alcoholic
steatohepatitis (NASH) and fibrosis stage 2 and 3. Although NTZ has been evaluated in liver
disease populations (viral hepatitis C) up to 60 weeks, this is the first study evaluating
NTZ treatment in a population with NASH induced stage 2 and 3 fibrosis. The aim of this study
is to evaluate the safety and tolerability of NTZ 500 mg BID after 24 weeks of treatment in
this population.

This proof of concept study will also evaluate the anti-fibrotic effect of NTZ as a secondary
objective.

The methods of evaluation of fibrosis will include an innovative method of metabolic
labeling. This approach is based on the concept that liver status can be determined by
measuring the ratio of newly synthesized/pre-existing proteins. The turn-over rate of newly
synthesized collagen and proteins represents the hepatic fibrogenic disease activity.
Patients will be given "heavy water" to drink. Heavy water contains D20, deuterium being a
stable isotope of hydrogen. Mass spectrometry is used to identify individual proteins and to
quantify the ratio of labeled protein to total protein. The results are expressed as
fractional synthesis rate of these proteins (FSR). This method has been previously published
(Decaris et al, 2017).

Other non-invasive methods will be used to evaluate the liver stiffness changes after NTZ
treatment: Magnetic Resonance Elastography (MRE) and FibroScan®.

Inclusion Criteria:

1. Males or females aged from 18 to 75 years inclusive the Screening Visit.

2. Must provide signed written informed consent and agree to comply with the study
protocol.

3. Females participating in this study must be of non-childbearing potential or using
highly efficient contraception for the full duration of the study

4. Histological confirmation of steatohepatitis on a diagnostic liver biopsy (biopsy
obtained within 6 months prior to Screening or during the Screening Period) with at
least 1 in each component of the NAS (steatosis scored 0-3, ballooning degeneration
scored 0-2, and lobular inflammation scored 0-3).

5. Fibrosis stage of 2 or 3, according to the NASH CRN fibrosis staging system on a
diagnostic liver biopsy (biopsy obtained within 6 months prior to Screening or during
the Screening Period).

Exclusion Criteria:

1. History of efficient bariatric surgery within 5 years prior to Screening, or planned
bariatric surgery in the course of the study.

2. Patients with HbA1c >10.0%. If abnormal at the first Screening Visit, the HbA1c
measurement can be repeated. A repeated abnormal HbA1c (HbA1c >10.0%) leads to
exclusion.

3. Patients with a history of clinically significant acute cardiac event within 6 months
prior to Screening such as: stroke, transient ischemic attack, or coronary heart
disease (angina pectoris, myocardial infarction, revascularization procedures).

4. Weight loss of more than 10% within 6 months prior to Randomization.

5. Patient with any history or presence of decompensated cirrhosis.

6. Current or recent history (<1 year) of significant alcohol consumption. For men,
significant consumption is typically defined as higher than 30 g pure alcohol per day.
For women, it is typically defined as higher than 20 g pure alcohol per day.

7. Current or history of other substance abuse within 1 year prior to screening.

8. Pregnant or lactating females or females planning to become pregnant during the study
period.

9. Other well documented causes of chronic liver disease according to standard diagnostic
procedures including, but not restricted to:

1. Positive hepatitis B surface antigen (HBsAg)

2. Positive HCV RNA, (tested for in case of known cured HCV infection, or positive
HCV Ab at Screening)

3. Suspicion of drug-induced liver disease

4. Alcoholic liver disease

5. Autoimmune hepatitis

6. Wilson's disease

7. Primary biliary cirrhosis, primary sclerosing cholangitis

8. Genetic homozygous hemochromatosis

9. Known or suspected HCC

10. History or planned liver transplant, or current MELD score >15.

10. Patients who cannot be contacted in case of emergency.

11. Known hypersensitivity to the investigation product or any of its formulation
excipients.

12. Patients who are taking warfarin or other highly plasma protein-bound drugs with
narrow therapeutic indices.

13. Patients who are currently participating in, plan to participate in, or have
participated in an investigational drug trial or medical device trial containing
active substance within 30 days or five half-lives, whichever is longer, prior to
Screening.

14. Evidence of any other unstable or, untreated clinically significant immunological,
endocrine, hematological, gastrointestinal, neurological, neoplastic, or psychiatric
disease.

15. Mental instability or incompetence, such that the validity of informed consent or
ability to be compliant with the study is uncertain.

16. History of noncompliance with medical regimens, or patients who are considered to be
unreliable.

17. Positive anti-human immunodeficiency virus (HIV) antibody.

18. AST and/or ALT >10 x upper limit of normal (ULN).

19. Conjugated bilirubin >2.0 mg/dL due to altered hepatic function. Note: Gilbert Disease
patients are allowed into the study.

20. INR >1.50 due to altered hepatic function.

21. Platelet count <100,000/mm3 due to portal hypertension.

22. Significant renal disease, including nephritic syndrome, chronic kidney disease
(defined as patients with markers of kidney damage or eGFR of less than 60 ml/min/1.73
m2).