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NCT05638737: COSMOS

A Study in Participants With Non-cirrhotic NASH With Fibrosis

Completed Phase 2 Results posted Last updated 9 July 2025
What this trial tests

Phase 2 trial testing AZD4831 in Non-Cirrhotic Non-alcoholic Steatohepatitis With Fibrosis in 112 participants. Completed in 4 April 2024.

Timeline
26 October 2022
Primary endpoint
4 April 2024
4 April 2024

Quick facts

Lead sponsorAstraZeneca
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingtriple
Primary purposetreatment
Enrollment112
Start date26 October 2022
Primary completion4 April 2024
Estimated completion4 April 2024
Sites65 locations across Denmark, Italy, Sweden, Mexico, Norway, Argentina, Portugal, United States

Drugs / interventions tested

Conditions studied

Sponsor

AstraZeneca — full company profile →

Who can join

Adults 18 to 75, any sex, with Non-Cirrhotic Non-alcoholic Steatohepatitis With Fibrosis. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Relative to Baseline Alanine Aminotransferase (ALT) Primary · Measurements on Baseline, Week 2, Week 4, Week 8, Week 12 and Week 16. Change reported from Baseline to Week 12.

ALT at 12 weeks relative to baseline. ALT is measured in Units per litre (U/L)

GroupValue95% CI
Mitiperstat (5mg)0.9590.885 – 1.040
Placebo0.8950.824 – 0.972
Relative to Baseline Pro-C3 Secondary · Measurements on Baseline, Week 4 and Week 12

Pro-C3 at 12 weeks relative to baseline. Pro-C3 is measured in nanograms per milliliter (ng/mL).

GroupValue95% CI
Mitiperstat (5mg)1.0090.960 – 1.060
Placebo1.0180.971 – 1.068

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse events was collected from time of first dose throughout the treatment period and including the follow-up period, a planned period of 16 weeks. The only exception is related to the predose orthostatic test at Visit 4: If orthostatic hypotension was confirmed, it would be reported as an AE, and symptoms related to the measurement of orthostatic vitals if present should also be reported as an AE.. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Treatment
Serious: 0/56 (0%)
Deaths: 0/56
Placebo
Serious: 3/56 (5%)
Deaths: 0/56

Serious adverse events (5 terms)

ReactionSystemTreatmentPlacebo
BronchitisInfections and infestations
Herpes zosterInfections and infestations
PneumoniaInfections and infestations
SepsisInfections and infestations
Chronic obstructive pulmonary diseaseRespiratory, thoracic and mediastinal disorders
Other adverse events (87 terms — click to expand)

ReactionSystemTreatmentPlacebo
PruritusSkin and subcutaneous tissue disorders
DiarrhoeaGastrointestinal disorders
InfluenzaInfections and infestations
NasopharyngitisInfections and infestations
Urinary tract infectionInfections and infestations
DizzinessNervous system disorders
Rash maculo-papularSkin and subcutaneous tissue disorders
Dry mouthGastrointestinal disorders
Faeces hardGastrointestinal disorders
NauseaGastrointestinal disorders
ThrombocytopeniaBlood and lymphatic system disorders
Covid-19Infections and infestations
Blood creatine phosphokinase increasedInvestigations
ArthralgiaMusculoskeletal and connective tissue disorders
HeadacheNervous system disorders
Abdominal pain upperGastrointestinal disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
AlopeciaSkin and subcutaneous tissue disorders
RashSkin and subcutaneous tissue disorders
ConstipationGastrointestinal disorders
DyspepsiaGastrointestinal disorders
Food poisoningGastrointestinal disorders
Gastrooesophageal reflux diseaseGastrointestinal disorders
Haemorrhagic erosive gastritisGastrointestinal disorders
HaemorrhoidsGastrointestinal disorders
LeukopeniaBlood and lymphatic system disorders
ToothacheGastrointestinal disorders
VomitingGastrointestinal disorders
IllnessGeneral disorders
Influenza like illnessGeneral disorders
Non-cardiac chest painGeneral disorders
Oedema peripheralGeneral disorders
PyrexiaGeneral disorders
Hepatitis alcoholicHepatobiliary disorders
Allergy to arthropod biteImmune system disorders
Food allergyImmune system disorders
AbscessInfections and infestations
Gastroenteritis viralInfections and infestations
HordeolumInfections and infestations
Oral herpesInfections and infestations

Most-reported serious reactions: Bronchitis, Herpes zoster, Pneumonia, Sepsis, Chronic obstructive pulmonary disease.

Data from ClinicalTrials.gov NCT05638737 adverse events section.

Sponsor's own description

This is a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. Participants will be in the trial for up to 24 weeks, including a screening period lasting up to 8 weeks, a 12-week treatment period, and a 4-week safety follow-up period Participants are not expected to directly benefit from treatment during this trial. Participants will help researchers learn more about and how to develop AZD4831 to treat NASH.

Publications & conference data

3 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Treatment of liver fibrosis: Past, current, and future.
    Zhang CY, Liu S, Yang M. · · 2023 · cited 49× · PMID 37397931 · DOI 10.4254/wjh.v15.i6.755
  2. A Phase 2a Trial of Myeloperoxidase Inhibitor Mitiperstat in Non-Cirrhotic Metabolic Dysfunction-Associated Steatohepatitis.
    Armisen J, Flor A, Eriksson J, Nelander K, et al · · 2025 · cited 3× · PMID 41108609 · DOI 10.1111/liv.70406
  3. Tumor microenvironment-mediated immune evasion and resistance in prostate cancer: mechanisms, cross-talk, and therapeutic opportunities.
    Li M, Kwantwi LB, Wang C, Xiao Q. · · 2025 · cited 2× · PMID 41296089 · DOI 10.1007/s10238-025-01944-0

Verify or expand the search:

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Data sources for this page

Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT05638737.

Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing