Effects of zibotentan and dapagliflozin combined in patients with compensated cirrhosis: A randomized placebo-controlled exploratory study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Juan Carlos Garcia-Pagan - , CIBER - Liver and Digestive Diseases (Author)
  • Lise Lotte Gluud - , University of Copenhagen (Author)
  • Mattias Mandorfer - , Medical University of Vienna (Author)
  • Jörn M. Schattenberg - , Saarland University (Author)
  • Andrea De Gottardi - , Cantonal Hospital Luzern (Author)
  • Annalisa Berzigotti - , University of Bern (Author)
  • José Ignacio Fortea - , Hospital Universitario Marques de Valdecilla (Author)
  • Agustin Albillos Martínez - , Hospital Ramon y Cajal (Author)
  • Edilmar Alvarado-Tapias - , Autonomous University of Barcelona (Author)
  • Marco Berning - , Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Pawel Petryszyn - , AstraZeneca (Author)
  • Emilia Henricson - , AstraZeneca (Author)
  • Niklas Berglind - , AstraZeneca (Author)
  • Min Lin - , AstraZeneca (Author)
  • Kevin Persson - , AstraZeneca (Author)
  • Anne Kristina Mercier - , AstraZeneca (Author)
  • Phil Ambery - , AstraZeneca (Author)
  • Jaime Bosch - , University of Bern (Author)
  • Jan Oscarsson - , AstraZeneca (Author)
  • Don C. Rockey - , Medical University of South Carolina (Author)

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 languageEnglish
Pages (from-to)1326-1338
Number of pages13
JournalBritish Journal of Clinical Pharmacology
Volume92
Issue number5
Early online date8 Dec 2025
Publication statusPublished - May 2026
Peer-reviewedYes

External IDs

PubMed 41362018

Keywords

ASJC Scopus subject areas

Keywords

  • Child-Pugh A, ET receptor antagonist, hepatic venous pressure gradient, SGLT2 inhibitor