Effects of zibotentan and dapagliflozin combined in patients with compensated cirrhosis: A randomized placebo-controlled exploratory study
Research output: Contribution to journal › Research article › Contributed › peer-review
Contributors
Abstract
Aims: Endothelin A (ETA) receptor antagonists may reduce cirrhosis-associated portal hypertension (PH). They are associated with fluid retention, which might be mitigated by sodium–glucose co-transporter 2 inhibitors (SGLT2is). Efficacy, safety and tolerability of combining the selective ETA receptor antagonist zibotentan and the selective SGLT2i dapagliflozin were investigated. Methods: Patients with compensated cirrhosis (Child-Pugh A) were randomized 1:1 to zibotentan 2.5 mg plus dapagliflozin 10 mg (zibo/dapa) or placebo in a 6-week parallel, double-blind Phase II study. The absolute change in hepatic venous pressure gradient (HVPG) from baseline to week 6 was evaluated in the full analysis set using analysis of covariance. Results: In 28 participants (n = 14 per group), median age was 64 years (range: 37–78), common causes of cirrhosis were metabolic dysfunction-associated steatotic (46%) or alcohol-associated liver disease (39%), and 46% were receiving stable doses of non-selective beta-blockers. Baseline HVPG was 6.5–19 mmHg, and 16/28 had clinically significant portal hypertension. Absolute change in HVPG at week 6 was not different between groups (1.02 mmHg [90% CI −0.31, 2.35]). There was a trend towards decreased HVPG in patients with baseline HVPG ≥12 mmHg receiving zibo/dapa. Systolic and diastolic blood pressure were also reduced by zibo/dapa vs. placebo. Three mild adverse events (peripheral oedema) were reported (zibotentan/dapagliflozin, n = 2; placebo, n = 1). No serious adverse events or drug-induced liver injuries were observed. Conclusions: Combined zibo/dapa was well tolerated and had a good safety profile in patients with compensated cirrhosis, but had no conclusive effect on HVPG.
Details
| Original language | English |
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| Pages (from-to) | 1326-1338 |
| Number of pages | 13 |
| Journal | British Journal of Clinical Pharmacology |
| Volume | 92 |
| Issue number | 5 |
| Early online date | 8 Dec 2025 |
| Publication status | Published - May 2026 |
| Peer-reviewed | Yes |
External IDs
| PubMed | 41362018 |
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Keywords
ASJC Scopus subject areas
Keywords
- Child-Pugh A, ET receptor antagonist, hepatic venous pressure gradient, SGLT2 inhibitor