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MASH - Metabolic Dysfunction-Associated SteatohepatitisPhase 4NCT07848191

Rezdiffra® With Concomitant Therapies Commonly Used to Treat Comorbidities in Adults With MASH and F2-F3 Fibrosis

A Phase 4 study testing Rezdiffra, Resmetirom and ACTOS/pioglitazone in people with MASH - Metabolic Dysfunction-Associated Steatohepatitis, run by Madrigal Pharmaceuticals, Inc. at 16 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

To determine the safety of Rezdiffra (Resmetirom) when administered alongside common prescriptions for Diabetes Metellus (Farxiga/dapagliflozin \& Actos/pioglitazone) Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Rezdiffra, Resmetirom and ACTOS/pioglitazone
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
150 participants
Where
16 sitesUnited States
Study dates
7 Oct 2026to Nov 2027
Phase
Phase 4
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • All Subjects:
  • Willing to participate in the study and provide written informed consent.
  • Meets all requirements per REZDIFFRA Prescribing Information, in the opinion of the PI.
  • Male and female adults ≥18 of age at time of screening.
  • Evidence of hepatic steatosis consistent with MASH demonstrated by an MRI-PDFF fat fraction >5% obtained during second screening period.
  • Evidence of moderate-to-advanced fibrosis (F2-F3) without cirrhosis.
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  • Stable medical conditions and background medications (non-concomitant medications as defined in this protocol) per PI judgement.
  • Female subjects of reproductive potential are eligible if they have a negative serum pregnancy test (beta human chorionic gonadotropin), are not breastfeeding, and do not plan to become pregnant during the study and agree to use 1 highly effective birth control method during the study and for at least 30 days after newly introduced medication administration.
  • Highly effective birth control methods include hormonal and non-hormonal intrauterine device, combination estrogen-progesterone hormonal contraception (oral, transdermal, or vaginal), tubal ligation, a vasectomized or sterile male partner, or sexual abstinence (defined as refraining from heterosexual intercourse), from Screening throughout the study, and for at least 30 days after newly introduced medication administration. Reliance on abstinence from heterosexual intercourse is acceptable only if it is the subject's habitual practice. NOTE: Female subjects who are not of child-bearing potential (ie, surgically [bilateral oophorectomy, hysterectomy] or naturally sterile [>12 consecutive months without menses]) do not require contraception during the study.
  • Must be taking a stable dose of ACTOS/pioglitazone for at least 2 months prior to Baseline. (Group A1)
  • Must be taking a stable dose of FARXIGA/dapagliflozin for at least 2 months prior to Baseline. (Group A2)
  • Must be taking a stable dose of REZDIFFRA for at least 2 months prior to Baseline. (Groups B1 and B2)
  • Must not have previously taken RESMETIROM or ACTOS/pioglitazone or FARXIGA/dapagliflozin. (Group C)
  • For Groups A1, B1, and C1: Meets all requirements per ACTOS/pioglitazone Prescribing Information, in the opinion of the PI.
  • For Groups B1 and C1: (ie, naïve to ACTOS/pioglitazone): HbA1c at screening ≥7.0% and ≤10.0%.
  • For Groups A2, B2, and C2: Meets all requirements per FARXIGA/dapagliflozin Prescribing Information, in the opinion of the PI.
  • For Groups B2 and C2 (ie, naïve to FARXIGA/dapagliflozin): HbA1c at screening ≥7.0% and ≤10.0%.

Who cannot join

  • Off label use of the commercially available study medications.
  • Evidence of cirrhosis demonstrated by clinical, imaging, histologic, or NIT thresholds consistent with cirrhosis.
  • Other chronic liver diseases (eg, viral hepatitis, autoimmune hepatitis, hemochromatosis).
  • Documented history of decompensated liver disease.
  • Use of rosuvastatin or simvastatin at a dose greater than 20 mg/day, or pravastatin or atorvastatin at a dose greater than 40 mg/day, at the time of the first dose of resmetirom. Subjects receiving a statin dose above the applicable limit during the screening period may remain eligible if the dose is reduced to the applicable maximum permitted dose before the first dose of resmetirom.
  • Any other condition which, in the opinion of the investigator, would impede compliance, hinder completion of the study, compromise the well-being of the subject, or interfere with the study outcomes.
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  • Active or suspected bladder cancer.
  • Diagnosis of heart failure.
  • eGFR < 60mL/min/1.73 m2
  • Developmental/intellectual disability, limited capacity of recognition, any history of clinically important emotional and/or psychiatric illness, inability to follow the study procedures, or any other condition which, in the opinion of the Investigator, would impede compliance, hinder completion of the study, compromise the well-being of the patient, or interfere with the study outcomes.
  • Individuals who are currently incarcerated or who are anticipated to be incarcerated during the study period.
  • Groups B and C:
  • Unable to secure a prescription for a concomitant medication.

Trial locations and contacts

16 sites in 1 country. Contact the study team or a site near you to ask about taking part.

16 sites in 1 country

United States16 sites, 16 recruiting
  • Texas Clinical Research Institute

    Arlington, Texas, 76012-3216

    Not yet recruiting
  • Arizona Liver Health - Chandler

    Chandler, Arizona, 85224

    Not yet recruiting
  • University Diabetes and Endocrine Consultants

    Chattanooga, Tennessee, 37411

    Not yet recruiting
  • Gastro Health Research

    Cincinnati, Ohio, 45219

    Recruiting
  • Southern California Research Center

    Coronado, California, 92118

    Not yet recruiting
  • South Texas Endocrinology & Metabolism Center

    Corpus Christi, Texas, 78414

    Not yet recruiting
  • The Liver Institute at Methodist Dallas Medical Center

    Dallas, Texas, 75234

    Not yet recruiting
  • Elevate Clinical Research

    Lake Charles, Louisiana, 70605

    Recruiting
  • Florida Research Institute

    Lakewood Rch, Florida, 34211

    Not yet recruiting
  • Elevate Clinical Research - McAllen - PPDS

    McAllen, Texas, 78504

    Not yet recruiting
  • Gastro Health PLLC Galloway

    Miami, Florida, 33176

    Recruiting
  • Med Research of Florida, LLC

    Miami, Florida, 33186

    Not yet recruiting
  • Centricity Research - Morehead City - Multispecialty - PPDS

    Morehead City, North Carolina, 28557

    Not yet recruiting
  • Arkansas Gastroenterology

    North Little Rock, Arkansas, 72117

    Not yet recruiting
  • Inland Empire Liver Foundation

    Rialto, California, 37411

    Not yet recruiting
  • Diabetes and Glandular Disease Clinic, PA

    San Antonio, Texas, 78229

    Not yet recruiting

Other trials in United States

About this study

Official title: A Phase 4, Open-label, Multi-group Study of Rezdiffra® in Combination With Concomitant Therapies Commonly Used to Treat Comorbidities in Adults With MASH and Moderate to Advanced (F2-F3) Fibrosis, Administered According to Their Approved Labeling

To determine the safety of Rezdiffra (Resmetirom) when administered alongside common prescriptions for Diabetes Metellus (Farxiga/dapagliflozin \& Actos/pioglitazone)

Read the detailed description

This Phase 4 study will evaluate the safety and tolerability of REZDIFFRA® (resmetirom) when used in combination with concomitant therapies commonly used to treat diabetes in adults with metabolic dysfunction-associated steatohepatitis (MASH) and noncirrhotic, moderate-to-advanced (F2-F3) fibrosis. The concomitant therapies evaluated in this study will include ACTOS®/pioglitazone and FARXIGA®/dapagliflozin. All study medications will be administered according to their approved labeling.

Participants will be assigned to one of six cohorts based on their existing therapy and the concomitant medication being evaluated. In Group A, participants who are receiving a stable dose of pioglitazone or dapagliflozin will initiate resmetirom. In Group B, participants who are receiving a stable dose of REZDIFFRA will initiate pioglitazone or dapagliflozin. In Group C, participants who are not currently receiving either treatment will initiate resmetirom and either pioglitazone or dapagliflozin in a staggered manner, with a 4- to 6-week run-in period between initiation of the first and second medications.

Approximately 25 participants are planned for each of the six cohorts, for a maximum planned enrollment of approximately 150 participants. Following initiation of combination treatment, participants will be followed for 24 weeks, with a safety follow-up visit approximately 4 weeks after completion of treatment.

Safety and tolerability will be characterized through assessment of treatment-emergent adverse events, physical examinations, vital signs, clinical laboratory parameters, treatment discontinuations, and dose interruptions or reductions. Exploratory assessments will evaluate changes in liver fat by MRI-PDFF, noninvasive measures of hepatic steatosis and fibrosis, and biomarkers related to MASH disease state, insulin resistance, glucose homeostasis, body weight, and liver function.

Being tested
Rezdiffra, Resmetirom, ACTOS/pioglitazone, FARXIGA/dapagliflozin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RezdiffraDrug

    All study medications will be administered according to their labels:

    • REZDIFFRA- Label weight-based dosing:
    • <100 kg: 80 mg orally once daily.
    • ≥100 kg: 100 mg orally once daily
  • ResmetiromDrug

    Resmetirom - weight-based dosing:

    • <100 kg: 80 mg orally once daily.
    • ≥100 kg: 100 mg orally once daily
  • ACTOS/pioglitazoneDrug

    Label dosing recommendations indicated for patients without congestive heart failure (15 or 30 mg orally once daily; if tolerated, increase by 15 mg increments up to a maximum of 45 mg orally once daily for additional glycemic control

  • FARXIGA/dapagliflozinDrug

    Label dosing recommendations indicated for glycemic control in type 2 diabetes (5 mg orally once daily; if tolerated, increase to 10 mg orally once daily for additional glycemic control)

Study groups in NCT07848191
Study groupRoleWhat they receive
Actos (pioglitazone) [Ongoing] | Resmetirom [New]OtherExperienced Actos/Pioglitazone + Resmetirom Naive (A1)
Receives: Drug: Resmetirom; Drug: ACTOS/pioglitazone
Farxiga (dapagliflozin) [Ongoing] | Resmetirom [New]OtherExperienced Farxiga/Dapagliflozin + Resmetirom Naive (A2)
Receives: Drug: Resmetirom; Drug: FARXIGA/dapagliflozin
REZDIFFRA [Ongoing] | Actos (pioglitazone) [New]OtherExperienced REZDIFFRA + Actos/Pioglitazone Naive (B1)
Receives: Drug: Rezdiffra; Drug: ACTOS/pioglitazone
REZDIFFRA [Ongoing] | Farxiga (dapagliflozin) [New]OtherExperienced REZDIFFRA + Farxiga/Dapagliflozin Naive (B2)
Receives: Drug: Rezdiffra; Drug: FARXIGA/dapagliflozin
Actos (pioglitazone) [New] | Resmetirom [New]OtherNaive Actos/Pioglitazone + Resmetirom Naive (C2)
Receives: Drug: Resmetirom; Drug: ACTOS/pioglitazone
Farxiga (dapagliflozin) [New] | Resmetirom [New]OtherNaïve Farxiga/dapagliflozin + Resmetirom Naïve (C2)
Receives: Drug: Resmetirom; Drug: FARXIGA/dapagliflozin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number and Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs)

    The total number of TEAEs and the number and percentage of participants with at least 1 TEAE will be summarized by study group. TEAEs will also be summarized by System Organ Class and Preferred Term.

    Measured: From First Dose of newly introduced medication up to 28 weeks

  2. Number and Percentage of Participants With TEAEs by Maximum Severity

    The number and percentage of participants with TEAEs will be summarized by maximum severity using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 5.0.

    Measured: From First Dose of newly introduced medication up to 28 weeks

  3. Number and Percentage of Participants With TEAEs by Relationship to Study Medication

    The number and percentage of participants with TEAEs assessed as Related or Not Related to each applicable study medication (REZDIFFRA/resmetirom, ACTOS/pioglitazone, or FARXIGA/dapagliflozin) will be summarized by study group.

    Measured: From First Dose of newly introduced medication up to 28 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Sep 2026
  2. Study start7 Oct 2026
  3. Primary completionNov 2027 (estimated)
  4. Study completionNov 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
150 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07848191
Sponsor's protocol ID
MGL-3196-33
Status last verified
Oct 2026
First submitted
25 Aug 2026
Last updated
16 Oct 2026
Results posted
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Rezdiffra, Resmetirom and ACTOS/pioglitazone in people with MASH - Metabolic Dysfunction-Associated Steatohepatitis, run by Madrigal Pharmaceuticals, Inc. at 16 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 16 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Tom Hare (267-406-0611, info@madrigalpharma.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number and Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) (time frame: From First Dose of newly introduced medication up to 28 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Oct 2026.

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