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    Clinical Trial Results:
    A multinational, multicenter, randomized, parallel-group study performed in subjects with Relapsing-Remitting Multiple Sclerosis (RRMS) to assess the efficacy, safety and tolerability of Glatiramer Acetate (GA) injection 40 mg administered three times a week compared to placebo in a double-blind design.

    Summary
    EudraCT number
    2009-018084-27
    Trial protocol
    HU   DE   EE   CZ   LT   BG   IT   GB  
    Global end of trial date
    12 May 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Nov 2018
    First version publication date
    06 Nov 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    MS-GA-301
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01067521
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Teva Branded Pharmaceutical Products R&D, Inc
    Sponsor organisation address
    12 Hatrufa St., PO Box 8077, Sapir Industrial Zone, Netanya, Israel, 42504
    Public contact
    Senior Director, Clinical Development, Multiple Sclerosis, Teva Pharmaceuticals Industries Ltd., 001 888-483-8279, info.era-clinical@teva.de
    Scientific contact
    Senior Director, Clinical Development, Multiple Sclerosis, Teva Pharmaceuticals Industries Ltd., 001 888-483-8279, info.era-clinical@teva.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    12 Apr 2018
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    12 May 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the efficacy of Glatiramer Acetate (GA) injection 40 mg administered three times a week compared to placebo in subjects with RRMS, as measured by the number of confirmed relapses during the 12 months placebo controlled phase. Assessment of safety and tolerability
    Protection of trial subjects
    This study was conducted in full accordance with the International Council for Harmonisation (ICH) Good Clinical Practice (GCP) Consolidated Guideline (E6) and any applicable national and local laws and regulations. Written and/or oral information about the study was provided to all subjects in a language understandable by the subjects. The information included an adequate explanation of the aims, methods, anticipated benefits, potential hazards, and insurance arrangements in force. Written informed consent was obtained from each subject before any study procedures or assessments were done. It was explained to the subjects that they were free to refuse entry into the study and free to withdraw from the study at any time without prejudice to future treatment. Each subject’s willingness to participate in the study was documented in writing in an informed consent form (ICF) that was signed by the subject with the date of that signature indicated. Each investigator kept the original consent forms, and copies were given to the subjects. Upon confirmed diagnosis of multiple sclerosis (MS) relapse (as defined in the protocol) or an increase in Kurtzke Expanded Disability Status Scale (EDSS) of 1.5 points or more, sustained for at least 3 months during the placebo-controlled (PC) phase of the study, the subjects were reminded of the standard-of-care medications available for the treatment of MS and provided the opportunity to terminate study participation. In these cases, the subjects were requested to sign a re-consent ICF if they chose to continue to participate in the study, in the same treatment assignment. If the subjects did not sign the re-consent form following an MS relapse or an increase in EDSS of 1.5 points or more, sustained for at least 3 months during the PC phase of the study, their participation in the study was terminated.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Jun 2010
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 268
    Country: Number of subjects enrolled
    Romania: 145
    Country: Number of subjects enrolled
    United Kingdom: 6
    Country: Number of subjects enrolled
    Bulgaria: 214
    Country: Number of subjects enrolled
    Czech Republic: 18
    Country: Number of subjects enrolled
    Estonia: 14
    Country: Number of subjects enrolled
    Germany: 40
    Country: Number of subjects enrolled
    Hungary: 12
    Country: Number of subjects enrolled
    Italy: 16
    Country: Number of subjects enrolled
    Lithuania: 26
    Country: Number of subjects enrolled
    Israel: 3
    Country: Number of subjects enrolled
    Russian Federation: 166
    Country: Number of subjects enrolled
    Ukraine: 236
    Country: Number of subjects enrolled
    United States: 86
    Country: Number of subjects enrolled
    Croatia: 111
    Country: Number of subjects enrolled
    Georgia: 25
    Country: Number of subjects enrolled
    South Africa: 18
    Worldwide total number of subjects
    1404
    EEA total number of subjects
    870
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    1404
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 1524 subjects were screened in this study, and 120 (7.9%) subjects failed screening. Of these, 69 did not meet inclusion or exclusion criteria, 30 withdrew from the study and 21 failed screening for other reasons.

    Pre-assignment
    Screening details
    1404 subjects were enrolled and randomized in the placebo-controlled (PC) double-blind period. Participants were randomized 2:1 to the treatment arms

    Period 1
    Period 1 title
    Double-Blind Placebo-Controlled Period
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Assessor
    Blinding implementation details
    The Placebo-Controlled period was double blind. Subjects were randomly assigned to receive treatment with GA 40 mg sc TIW or placebo in a 2:1 ratio. The investigators, sponsor, and any personnel involved in subjects’ assessment, monitoring, analysis, and data management (excluding the designated Clinical Supplies Unit [CSU] personnel), were blinded to the subject assignment. Treatment assignments were not to be recorded in any study documents or source document.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Early Start: GA 40 mg / GA 40 mg
    Arm description
    Participants were administered glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week for 12 months during the double-blind Placebo-Controlled Period, and then continued that treatment in the Open-label Period from Month 13 up to Year 6.5 until the study ended.
    Arm type
    Experimental

    Investigational medicinal product name
    glatiramir acetate
    Investigational medicinal product code
    Other name
    GA, Copaxone
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    GA 40 mg/mL for subcutaneous injection in a pre-filled syringe (PFS) administered three times a week. Each PFS also contained 40 mg of mannitol dissolved in water for injection.

    Arm title
    Delayed Start: Placebo / GA 40 mg
    Arm description
    Participants were administered placebo subcutaneous injections three times a week for 12 months during the double-blind Placebo-Controlled Period. Participants were then switched to glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week during the Open-Label Period from Month 13 up to Year 6.5 until the study ended.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Matching placebo for subcutaneous injection (40 mg of mannitol dissolved in 1 mL of water for injection) in a pre-filled syringe (PFS) administered three times a week for 12 months during the Placebo-Controlled period.

    Investigational medicinal product name
    glatiramir acetate
    Investigational medicinal product code
    Other name
    GA, Copaxone
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    GA 40 mg/mL for subcutaneous injection in a pre-filled syringe (PFS) administered three times a week during the Open-Label period which started at Month 13 and continued up to Year 6.5 until the study ended. Each PFS also contained 40 mg of mannitol dissolved in water for injection.

    Number of subjects in period 1
    Early Start: GA 40 mg / GA 40 mg Delayed Start: Placebo / GA 40 mg
    Started
    943
    461
    Completed
    859
    430
    Not completed
    84
    31
         Adverse event, serious fatal
    -
    1
         Consent withdrawn by subject
    34
    17
         Physician decision
    1
    1
         Adverse event, non-fatal
    29
    6
         Refuse to sign informed consent
    4
    1
         Pregnancy
    7
    4
         Non-compliance with study drug
    2
    -
         Lost to follow-up
    5
    1
         Protocol deviation
    2
    -
    Period 2
    Period 2 title
    Open-Label Period
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Early Start: GA 40 mg / GA 40 mg
    Arm description
    Participants were administered glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week for 12 months during the double-blind Placebo-Controlled Period, and then continued that treatment in the Open-Label Period from Month 13 up to Year 6.5 until the study ended.
    Arm type
    Experimental

    Investigational medicinal product name
    glatiramir acetate
    Investigational medicinal product code
    Other name
    GA, Copaxone
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    GA 40 mg/mL for subcutaneous injection in a pre-filled syringe (PFS) administered three times a week. Each PFS also contained 40 mg of mannitol dissolved in water for injection.

    Arm title
    Delayed Start: Placebo / GA 40 mg
    Arm description
    Participants were administered placebo subcutaneous injections three times a week for 12 months during the double-blind Placebo-Controlled Period. Participants were then switched to glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week during the Open-Label Period from Month 13 up to Year 6.5 until the study ended.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Matching placebo for subcutaneous injection (40 mg of mannitol dissolved in 1 mL of water for injection) in a pre-filled syringe (PFS) administered three times a week for 12 months during the Placebo-Controlled period.

    Investigational medicinal product name
    glatiramir acetate
    Investigational medicinal product code
    Other name
    GA, Copaxone
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    GA 40 mg/mL for subcutaneous injection in a pre-filled syringe (PFS) administered three times a week during the Open-Label period which started at Month 13 and continued up to Year 6.5 until the study ended. Each PFS also contained 40 mg of mannitol dissolved in water for injection.

    Number of subjects in period 2 [1]
    Early Start: GA 40 mg / GA 40 mg Delayed Start: Placebo / GA 40 mg
    Started
    834
    419
    Completed
    580
    261
    Not completed
    254
    158
         Adverse event, serious fatal
    3
    1
         Consent withdrawn by subject
    160
    88
         Physician decision
    13
    11
         Adverse event, non-fatal
    30
    28
         Pregnancy
    14
    8
         Non-compliance with study drug
    5
    -
         Lost to follow-up
    21
    20
         Teva requested subject to be withdrawn
    5
    2
         Protocol deviation
    3
    -
    Notes
    [1] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period.
    Justification: Some participants did not continue into the open-label period.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Early Start: GA 40 mg / GA 40 mg
    Reporting group description
    Participants were administered glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week for 12 months during the double-blind Placebo-Controlled Period, and then continued that treatment in the Open-label Period from Month 13 up to Year 6.5 until the study ended.

    Reporting group title
    Delayed Start: Placebo / GA 40 mg
    Reporting group description
    Participants were administered placebo subcutaneous injections three times a week for 12 months during the double-blind Placebo-Controlled Period. Participants were then switched to glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week during the Open-Label Period from Month 13 up to Year 6.5 until the study ended.

    Reporting group values
    Early Start: GA 40 mg / GA 40 mg Delayed Start: Placebo / GA 40 mg Total
    Number of subjects
    943 461 1404
    Age categorical
    Units: Subjects
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    943 461 1404
        From 65-84 years
    0 0 0
        85 years and over
    0 0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    37.36 ( 9.401 ) 38.12 ( 9.222 ) -
    Gender categorical
    Units: Subjects
        Female
    641 313 954
        Male
    302 148 450
    Race
    Units: Subjects
        American Indian or Alaska Native
    1 0 1
        Asian
    2 0 2
        Black or African American
    12 3 15
        Other
    12 3 15
        White
    916 455 1371
    Ethnicity
    Units: Subjects
        Not Hispanic or Latino
    934 460 1394
        Hispanic or Latino
    9 1 10
    Body Mass Index
    Units: kg/m^2
        arithmetic mean (standard deviation)
    24.38 ( 4.709 ) 24.44 ( 4.804 ) -
    Time from First Symptom
    Units: years
        arithmetic mean (standard deviation)
    7.68 ( 6.748 ) 7.61 ( 6.360 ) -
    Time from Multiple Sclerosis (MS) Diagnosis
    Units: years
        arithmetic mean (standard deviation)
    3.70 ( 4.982 ) 3.88 ( 4.744 ) -
    Number of T1 Gadolinium (Gd)- Enhanced Lesions per Participant at Baseline
    Units: lesions
        arithmetic mean (standard deviation)
    1.7 ( 4.70 ) 1.4 ( 3.69 ) -
    Number of T2 Lesions Per Participant at Baseline
    Units: lesions
        arithmetic mean (standard deviation)
    38.9 ( 26.34 ) 36.7 ( 26.68 ) -
    Sienax Normalized Brain Volume at Baseline
    Sienax estimates total brain tissue volume, from a single image, normalised for skull size. One participant in the GA40 mg ("Early Start') arm was missing the Sienax normalized brain volume baseline measure.
    Units: mL
        arithmetic mean (standard deviation)
    1533.888 ( 110.6107 ) 1537.899 ( 110.7549 ) -

    End points

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    End points reporting groups
    Reporting group title
    Early Start: GA 40 mg / GA 40 mg
    Reporting group description
    Participants were administered glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week for 12 months during the double-blind Placebo-Controlled Period, and then continued that treatment in the Open-label Period from Month 13 up to Year 6.5 until the study ended.

    Reporting group title
    Delayed Start: Placebo / GA 40 mg
    Reporting group description
    Participants were administered placebo subcutaneous injections three times a week for 12 months during the double-blind Placebo-Controlled Period. Participants were then switched to glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week during the Open-Label Period from Month 13 up to Year 6.5 until the study ended.
    Reporting group title
    Early Start: GA 40 mg / GA 40 mg
    Reporting group description
    Participants were administered glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week for 12 months during the double-blind Placebo-Controlled Period, and then continued that treatment in the Open-Label Period from Month 13 up to Year 6.5 until the study ended.

    Reporting group title
    Delayed Start: Placebo / GA 40 mg
    Reporting group description
    Participants were administered placebo subcutaneous injections three times a week for 12 months during the double-blind Placebo-Controlled Period. Participants were then switched to glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week during the Open-Label Period from Month 13 up to Year 6.5 until the study ended.

    Subject analysis set title
    Entire Study: Early Start: GA 40 mg / GA 40 mg
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Participants were administered glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week for 12 months during the double-blind Placebo-Controlled Period, and then continued that treatment in the Open-label Period from Month 13 up to Year 6.5 until the study ended.

    Subject analysis set title
    Entire Study: Delayed Start: Placebo / GA 40 mg
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Participants were administered placebo subcutaneous injections three times a week for 12 months during the double-blind Placebo-Controlled Period. Participants were then switched to glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week during the Open-Label Period from Month 13 up to Year 6.5 until the study ended.

    Subject analysis set title
    OL Period - Delayed Start: GA 40 mg
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    After completing the double-blind Placebo-Controlled Period, participants had the option of continuing in the study on open-label glatiramer acetate (GA) 40 mg/ml by subcutaneous injection three times a week until the study ended. This 'Delayed Start' treatment began at Month 13 and continued until the study ended (up to about 6.5 years).

    Subject analysis set title
    PC Period-Delayed Start: Placebo
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Participants were administered placebo subcutaneous injections three times a week from Day 1 to Month 12 during the double-blind Placebo-Controlled Period.

    Primary: Total Number of Confirmed Relapses During the Placebo Controlled (PC) Treatment Period Estimated by Negative Binomial Regression

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    End point title
    Total Number of Confirmed Relapses During the Placebo Controlled (PC) Treatment Period Estimated by Negative Binomial Regression
    End point description
    Relapses were monitored throughout the study. During the PC Period, two neurologists/physicians assessed subjects’ general medical and neurological evaluations separately. A relapse was defined as the appearance of 1+ new neurological abnormalities or the reappearance of 1+ previously observed neurological abnormalities lasting >= 48 hours and immediately preceded by an improving neurological state of at >=30 days from onset of previous relapse. An event was counted as a relapse only when the subject's symptoms were accompanied by observed objective neurological changes, consistent with >= one of the following: - An increase of >= 0.5 in the Expanded Disability Status Scale (EDSS) score as compared to previous evaluation. - An increase of one grade in the actual score of >=2 of the 7 functional systems (FS), as compared to previous evaluation. - An increase of 2 grades in the actual score of one FS as compared to the previous evaluation. Adjusted mean values are displayed.
    End point type
    Primary
    End point timeframe
    Day 1 to 12 months
    End point values
    Early Start: GA 40 mg / GA 40 mg Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    943 [1]
    461 [2]
    Units: confirmed relapses
        arithmetic mean (standard error)
    0.331 ( 0.028 )
    0.505 ( 0.049 )
    Notes
    [1] - Intent To Treat (ITT) Analysis Population
    [2] - Intent To Treat (ITT) Analysis Population
    Statistical analysis title
    Number of Confirmed Relapses During PC Period
    Statistical analysis description
    Relapses were estimated by a baseline-adjusted, Negative Binomial Regression with an “offset” based on the log of subject’s exposure to treatment. The model included the following covariates: - Baseline EDSS score. - Log of the prior 2-year number of relapses. - Volume of T2 lesions at baseliner. - Status of Gd-enhancing T1 activity at baseline (=0 no Gd-enhancing T1 at baseline; =1 at least one Gd-enhancing T1 at baseline). - CGR.
    Comparison groups
    Delayed Start: Placebo / GA 40 mg v Early Start: GA 40 mg / GA 40 mg
    Number of subjects included in analysis
    1404
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [3]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.656
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.539
         upper limit
    0.799
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.066
    Notes
    [3] - The overall significance level for this study is 5%.

    Primary: Annualized Rate of Confirmed Relapses Comparing Early Starters to Delayed Starters Estimated by Negative Binomial Regression

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    End point title
    Annualized Rate of Confirmed Relapses Comparing Early Starters to Delayed Starters Estimated by Negative Binomial Regression
    End point description
    The annualized relapse rate (ARR) was calculated for the study by dividing the cumulative number of confirmed relapses by the number of person-years of exposure to treatment. The analysis of the annualized relapse rate is based on estimating a contrast (early start vs delayed start) derived from a baseline-adjusted, Negative Binomial Regression model to the number of confirmed relapses observed during study (post randomization) with an “offset” based on the log of exposure to treatment.
    End point type
    Primary
    End point timeframe
    Day 1 up to 6.5 years
    End point values
    Entire Study: Early Start: GA 40 mg / GA 40 mg Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    943
    461
    Units: relapses per year
        arithmetic mean (standard error)
    0.2621 ( 0.0189 )
    0.3146 ( 0.0279 )
    Statistical analysis title
    Annualized Rate of Relapse
    Statistical analysis description
    Entire Study The Negative Binomial Regression model covariates: • treatment group • PCBL (Placebo-Controlled Baseline) Kurtzke’s Expanded Disability Status Scale (EDSS) score as 1 degree of freedom variable • Log of the # of relapses in the 2 years prior to PCBL • Volume of T2 lesions at PCBL • Status of Gd-enhancing T1 lesion activity at PCBL (=0 if no Gd-enhancing T1 lesions at PCBL; =1 if at least one Gd-enhancing T1 lesion at PCBL) • Country or Geographical Region (CGR)
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1404
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0409 [4]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.8332
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.6995
         upper limit
    0.9925
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.0744
    Notes
    [4] - not adjusted for multiplicity

    Secondary: The Cumulative Number of New/Enlarging T2 Lesions Taken at Month 6 and Month 12 During the Placebo Controlled (PC) Treatment Period Estimated by Negative Binomial Regression

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    End point title
    The Cumulative Number of New/Enlarging T2 Lesions Taken at Month 6 and Month 12 During the Placebo Controlled (PC) Treatment Period Estimated by Negative Binomial Regression
    End point description
    T2 lesions are hyperintense brain lesions that show on magnetic resonance imaging (MRI) and are associated with multiple sclerosis. The cumulative number of T2 lesions at Months 6 and 12 that are new or enlarged as compared to the baseline MRI are offered. Note that the two timeframes (Months 6 and 12) are combined. Adjusted mean is based on negative binomial regression, adjusted for baseline number of T2 lesions and country or geographical region as covariates. When a subject had both Month 6 and Month 12 scans missing, the subject was excluded from the analysis. When the Month 12 scan was missing, data from Month 6 was used and an offset of log (0.5) introduced. When the Month 6 scan was missing, data from Month 12 was used with an offset of 0.
    End point type
    Secondary
    End point timeframe
    Baseline (Day -7), Month 6, Month 12
    End point values
    Early Start: GA 40 mg / GA 40 mg Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    884 [5]
    441 [6]
    Units: lesions
        arithmetic mean (standard error)
    3.650 ( 0.259 )
    5.592 ( 0.490 )
    Notes
    [5] - ITT. See outcome description for how missing data was handled.
    [6] - ITT. See outcome description for how missing data was handled.
    Statistical analysis title
    Cumulative # New-Enlarged T2 Lesions
    Statistical analysis description
    Negative binomial regression
    Comparison groups
    Early Start: GA 40 mg / GA 40 mg v Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1325
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [7]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.653
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.546
         upper limit
    0.78
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.059
    Notes
    [7] - The overall significance level for this study is 5%

    Secondary: The Cumulative Number of Gadolinium (Gd)-Enhanced Lesions on T1-Weighted Images At Month 6 and Month 12 of the Placebo-Controlled (PC) Treatment Period Estimated by Negative Binomial Regression

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    End point title
    The Cumulative Number of Gadolinium (Gd)-Enhanced Lesions on T1-Weighted Images At Month 6 and Month 12 of the Placebo-Controlled (PC) Treatment Period Estimated by Negative Binomial Regression
    End point description
    The cumulative number of gadolinium (Gd)-enhanced lesions on T1-weighted images at Months 6 and 12 as compared to the baseline MRI are offered. Note that the two timeframes (Months 6 and 12) are combined. Adjusted mean is based on negative binomial regression with an “offset” employing the log of the proportion of the number of the available post-baseline scans to adjust for missing MRI scans (if any), adjusted for baseline number of enhancing lesions on T1-weighted images and country or geographical region as covariates. When a subject had both Month 6 and Month 12 scans missing, the subject was excluded from the analysis.
    End point type
    Secondary
    End point timeframe
    Baseline (Day -7), Month 6, Month 12
    End point values
    Early Start: GA 40 mg / GA 40 mg Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    884 [8]
    441 [9]
    Units: lesions
        arithmetic mean (standard error)
    0.905 ( 0.087 )
    1.639 ( 0.194 )
    Notes
    [8] - ITT. See outcome description for how missing data was handled.
    [9] - ITT. See outcome description for how missing data was handled.
    Statistical analysis title
    Cumulative # of Enhanced T1 Lesions
    Comparison groups
    Delayed Start: Placebo / GA 40 mg v Early Start: GA 40 mg / GA 40 mg
    Number of subjects included in analysis
    1325
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [10]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.552
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.436
         upper limit
    0.699
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.066
    Notes
    [10] - The overall significance level for this study is 5%

    Secondary: Brain Atrophy As Defined by the Percent of Change in Normalized Brain Volume From Baseline to Month 12 During the Placebo Controlled (PC) Treatment Period

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    End point title
    Brain Atrophy As Defined by the Percent of Change in Normalized Brain Volume From Baseline to Month 12 During the Placebo Controlled (PC) Treatment Period
    End point description
    The analysis of brain atrophy as defined by the percentage change in normalized brain volume from baseline to Month 12 was based on the outcome of a contrast (GA 40 mg TIW vs. placebo) derived from a baseline-adjusted ANCOVA. In addition to the treatment group, the model included the following covariates: - SIENAX normalized brain volume at baseline. - The number of enhancing lesions on T1-weighted images at baseline. - country or geographical region. Sienax estimates total brain tissue volume, from a single image, normalised for skull size.
    End point type
    Secondary
    End point timeframe
    Baseline (Day -7), Month 12
    End point values
    Early Start: GA 40 mg / GA 40 mg Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    840 [11]
    423 [12]
    Units: percentage change
        arithmetic mean (standard error)
    -0.706 ( 0.037 )
    -0.645 ( 0.047 )
    Notes
    [11] - ITT population of participants who had SIENEX brain volume estimates at both baseline and Month 12.
    [12] - ITT population of participants who had SIENEX brain volume estimates at both baseline and Month 12.
    Statistical analysis title
    % Change in Normalized Brain Volume
    Comparison groups
    Early Start: GA 40 mg / GA 40 mg v Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1263
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2058 [13]
    Method
    ANCOVA
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.061
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.154
         upper limit
    0.033
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.048
    Notes
    [13] - The overall significance level for this study is 5%

    Secondary: The Number of New/Enlarging T2 Lesions at Months 6, 12 and 36 Estimated by Negative Binomial Regression

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    End point title
    The Number of New/Enlarging T2 Lesions at Months 6, 12 and 36 Estimated by Negative Binomial Regression
    End point description
    All data accumulated from screening, the PC Treatment period up to the end of the Open Label (OL) period are combined and referred to as the Long Term Period. T2 lesions are hyperintense brain lesions that show on magnetic resonance imaging (MRI) and are associated with multiple sclerosis. The number of T2 lesions at Months 6, 12 and 36 that are new or enlarged as compared to the baseline MRI are offered. Adjusted mean is based on negative binomial regression, adjusted for baseline number of T2 lesions and country or geographical region as covariates. An “offset” employing the log of the proportion of the number of the available post-placebo-controlled baseline (PCBL) scans was used to adjust for missing MRI scans.
    End point type
    Secondary
    End point timeframe
    Baseline (Day -7), Month 6, Month 12, Month 36
    End point values
    Entire Study: Early Start: GA 40 mg / GA 40 mg Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    883 [14]
    440 [15]
    Units: lesions
    arithmetic mean (standard error)
        Month 6 (n=883, 440)
    2.872 ( 0.214 )
    3.902 ( 0.43 )
        Month 12 (n=854, 425)
    4.484 ( 0.318 )
    7.086 ( 0.699 )
        Month 36 (n=571, 263)
    5.836 ( 0.41 )
    8.759 ( 0.82 )
    Notes
    [14] - ITT population of participants with MRIs at both baseline and the designated timeframes.
    [15] - ITT population of participants with MRIs at both baseline and the designated timeframes.
    Statistical analysis title
    Month 6
    Statistical analysis description
    Negative binomial regression n=1323
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1323
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0056 [16]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.736
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.592
         upper limit
    0.914
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.081
    Notes
    [16] - not adjusted for multiplicity
    Statistical analysis title
    Month 12
    Statistical analysis description
    Negative binomial regression n=1279
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1323
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [17]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.633
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.524
         upper limit
    0.765
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.061
    Notes
    [17] - not adjusted for multiplicity
    Statistical analysis title
    Month 36
    Statistical analysis description
    Negative binomial regression n=834
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1323
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [18]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.666
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.557
         upper limit
    0.797
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.061
    Notes
    [18] - not adjusted for multiplicity

    Secondary: The Cumulative Number of Gadolinium (Gd)-Enhanced Lesions on T1-Weighted Images At Months 6, 12 and 36 Estimated by Negative Binomial Regression

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    End point title
    The Cumulative Number of Gadolinium (Gd)-Enhanced Lesions on T1-Weighted Images At Months 6, 12 and 36 Estimated by Negative Binomial Regression
    End point description
    All data accumulated from screening, the PC Treatment period up to the end of the Open Label (OL) period are combined and referred to as the Long Term Period. The cumulative number of gadolinium (Gd)-enhanced lesions on T1-weighted images at Months 6, 12 and 36 as compared to the baseline MRI are offered. Adjusted mean is based on negative binomial regression The model was fit using an autoregressive covariance structure. Covariates used: number of enhancing lesions on T1-weighted images at placebo-controlled baseline and country or geographical region. The cumulative number is derived from all the data points before it. For example, if the participant skipped one time point in between the baseline and 36 months, then it cannot be calculated.
    End point type
    Secondary
    End point timeframe
    Baseline (Day -7), Month 6, Month 12, Month 36
    End point values
    Entire Study: Early Start: GA 40 mg / GA 40 mg Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    883 [19]
    440 [20]
    Units: lesions
    arithmetic mean (standard error)
        Month 6 (n=883, 440)
    0.629 ( 0.072 )
    1.131 ( 0.186 )
        Month 12 (n=854, 425)
    1.054 ( 0.115 )
    2.051 ( 0.282 )
        Month 36 (n=570, 263)
    1.501 ( 0.168 )
    2.265 ( 0.278 )
    Notes
    [19] - ITT; participants with MRIs at baseline + timeframes, inclusive of proceeding post-baseline times.
    [20] - ITT; participants with MRIs at baseline + timeframes, inclusive of proceeding post-baseline times.
    Statistical analysis title
    Month 6
    Statistical analysis description
    n=1323
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1323
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0005 [21]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.556
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4
         upper limit
    0.773
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.093
    Notes
    [21] - not adjusted for multiplicity
    Statistical analysis title
    Month 12
    Statistical analysis description
    n=1279
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1323
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001 [22]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.514
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.388
         upper limit
    0.679
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.073
    Notes
    [22] - not adjusted for multiplicity
    Statistical analysis title
    Month 36
    Statistical analysis description
    n=833
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1323
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0015 [23]
    Method
    Negative binomial regression model
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.663
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.514
         upper limit
    0.854
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.086
    Notes
    [23] - not adjusted for multiplicity

    Secondary: Brain Atrophy As Defined by the Percent of Change in Brain Volume From Baseline to Months 6, 12 and 36 Estimated by a Mixed Model for Repeated Measures

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    End point title
    Brain Atrophy As Defined by the Percent of Change in Brain Volume From Baseline to Months 6, 12 and 36 Estimated by a Mixed Model for Repeated Measures
    End point description
    The analysis of brain atrophy as defined by the percentage change in brain volume from baseline to Months 6, 12 and 36 was performed using mixed model for repeated measures (MMRM) with SIENAX normalized brain volume at baseline, number of Gd-enhancing lesions at baseline, and country or geographical region as fixed effects. Sienax estimates total brain tissue volume, from a single image, normalised for skull size.
    End point type
    Secondary
    End point timeframe
    Baseline (Day -7), Month 6, Month 12, Month 36
    End point values
    Entire Study: Early Start: GA 40 mg / GA 40 mg Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects analysed
    872 [24]
    436 [25]
    Units: percentage change
    arithmetic mean (standard error)
        Month 6 (n=872, 436)
    -0.429 ( 0.032 )
    -0.345 ( 0.04 )
        Month 12 (n=846, 423)
    -0.739 ( 0.035 )
    -0.653 ( 0.046 )
        Month 36 (n=543, 250)
    -1.935 ( 0.063 )
    -1.952 ( 0.09 )
    Notes
    [24] - ITT population; participants with SIENEX brain scans at both baseline and the designated timeframes.
    [25] - ITT population; participants with SIENEX brain scans at both baseline and the designated timeframes.
    Statistical analysis title
    Month 6
    Statistical analysis description
    n=1308
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1308
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0425 [26]
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.084
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.166
         upper limit
    -0.003
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.041
    Notes
    [26] - not adjusted for multiplicity
    Statistical analysis title
    Month 12
    Statistical analysis description
    n=1269
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1308
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0844 [27]
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.086
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.184
         upper limit
    0.012
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.05
    Notes
    [27] - not adjusted for multiplicity
    Statistical analysis title
    Month 36
    Statistical analysis description
    n=793
    Comparison groups
    Entire Study: Early Start: GA 40 mg / GA 40 mg v Entire Study: Delayed Start: Placebo / GA 40 mg
    Number of subjects included in analysis
    1308
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.8701 [28]
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.017
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.191
         upper limit
    0.225
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.106
    Notes
    [28] - not adjusted for multiplicity

    Secondary: Participants With Treatment-Emergent Adverse Events (TEAEs)

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    End point title
    Participants With Treatment-Emergent Adverse Events (TEAEs)
    End point description
    Adverse events (AEs) summarized in this table are those that began or worsened after treatment with study drug (treatment-emergent AEs). An adverse event was defined in the protocol as any untoward medical occurrence that develops or worsens in severity during the conduct of a clinical study and does not necessarily have a causal relationship to the study drug. Severity was rated by the investigator on a scale of mild, moderate and severe, with severe= an AE which prevents normal daily activities. Relation of AE to treatment was determined by the investigator. Serious AEs include death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, a congenital anomaly or birth defect, OR an important medical event that jeopardized the patient and required medical intervention to prevent the previously listed serious outcomes.
    End point type
    Secondary
    End point timeframe
    Early Start: Day 1 up to 6.5 years Delayed Start - Placebo: Day 1 up to Month 12 Delayed Start - GA: Month 13 up to 6.5 years
    End point values
    Entire Study: Early Start: GA 40 mg / GA 40 mg OL Period - Delayed Start: GA 40 mg PC Period-Delayed Start: Placebo
    Number of subjects analysed
    943 [29]
    419 [30]
    461 [31]
    Units: participants
        Severity of TEAEs: Mild
    698
    283
    247
        Severity of TEAEs: Moderate
    441
    168
    101
        Severity of TEAEs: Severe
    95
    24
    16
        Treatment-related TEAEs
    501
    189
    73
        Serious TEAEs
    117
    36
    21
        Deaths
    3
    1
    1
        TEAEs leading to treatment discontinuation
    63
    28
    6
    Notes
    [29] - Safety
    [30] - Safety
    [31] - Safety
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Delayed Start (Placebo): Day 1 to Month 12 Delayed Start (GA 40 mg): Month 13 up to 6.5 years Early Start: (GA 40 mg/ GA 40 mg) Day 1 up to 6.5 years
    Adverse event reporting additional description
    Death details: Delayed Start (Placebo): cardiopulmonary failure Delayed Start (GA 40 mg): caused by subarachnoid hemorrhage and brain edema 1027 days after the first dose of GA. Early Start: Three deaths due to acute cardiac failure, cardio-respiratory arrest, and cardiac arrest occurring 488, 1283 and 1682 days after first dose of GA
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Delayed Start: Placebo
    Reporting group description
    Participants were administered placebo subcutaneous injections three times a week from Day 1 to Month 12 during the double-blind Placebo-Controlled Period.

    Reporting group title
    Delayed Start: GA 40 mg
    Reporting group description
    After completing the double-blind Placebo-Controlled Period, participants had the option of continuing in the study on glatiramer acetate (GA) 40 mg/ml by subcutaneous injection three times a week until the study ended. This 'Delayed Start' treatment started at Month 13 and continued until the study ended (up to about 6.5 years).

    Reporting group title
    Early Start: GA 40 mg / GA 40 mg
    Reporting group description
    Participants were administered glatiramer acetate (GA) 40 mg/mL by subcutaneous injection three times a week for 12 months during the double-blind Placebo-Controlled Period, and then continued that treatment in the Open-label Period from Month 13 up to Year 6.5 until the study ended.

    Serious adverse events
    Delayed Start: Placebo Delayed Start: GA 40 mg Early Start: GA 40 mg / GA 40 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    21 / 461 (4.56%)
    36 / 419 (8.59%)
    117 / 943 (12.41%)
         number of deaths (all causes)
    1
    1
    3
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Thyroid cancer
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Seminoma
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal cell carcinoma
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Invasive ductal breast carcinoma
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intraductal papilloma of breast
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Breast neoplasm
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaplastic astrocytoma
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Oesophageal carcinoma
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Follicular thyroid cancer
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Leiomyoma
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Basal cell carcinoma
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Astrocytoma
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine leiomyoma
         subjects affected / exposed
    0 / 461 (0.00%)
    2 / 419 (0.48%)
    4 / 943 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Thrombophlebitis superficial
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peripheral venous disease
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aortic dissection
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypertension
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Surgical and medical procedures
    Inguinal hernia repair
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hysterectomy
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Breast conserving surgery
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ureteric calculus removal
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tonsillectomy
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Toe amputation
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cervix operation
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hip arthroplasty
         subjects affected / exposed
    0 / 461 (0.00%)
    2 / 419 (0.48%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Thyroidectomy
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spinal operation
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nephrectomy
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Mammoplasty
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cataract operation
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Appendicectomy
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Abortion threatened
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abortion incomplete
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abortion spontaneous
         subjects affected / exposed
    1 / 461 (0.22%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immediate post-injection reaction
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Feeling hot
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Oedema
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Chills
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injection site swelling
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injection site erythema
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Asthenia
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune system disorders
    Anaphylactic shock
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaphylactic reaction
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Drug hypersensitivity
         subjects affected / exposed
    0 / 461 (0.00%)
    2 / 419 (0.48%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Metrorrhagia
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine cervical erosion
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ovarian cyst
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Oligomenorrhoea
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fibrocystic breast disease
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Endometrial hyperplasia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cervical dysplasia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Benign prostatic hyperplasia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Adenomyosis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Breast disorder
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine polyp
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory failure
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pharyngeal oedema
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory arrest
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Dyspnoea
         subjects affected / exposed
    0 / 461 (0.00%)
    2 / 419 (0.48%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lung infiltration
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Suicidal ideation
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anxiety
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bipolar I disorder
         subjects affected / exposed
    0 / 461 (0.00%)
    2 / 419 (0.48%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Depression
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Investigations
    Weight decreased
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood pressure increased
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Catheterisation cardiac
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Body temperature increased
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Thermal burn
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Meniscus injury
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tibia fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tendon injury
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Face injury
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Craniocerebral injury
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Clavicle fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Burns second degree
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Laceration
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Multiple injuries
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fractured skull depressed
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Foot fracture
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Contusion
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Brain contusion
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Radius fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Head injury
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Forearm fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skull fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Femur fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Extradural haematoma
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fall
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ankle fracture
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Congenital, familial and genetic disorders
    Congenital hydronephrosis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Cardiac failure acute
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Cardio-respiratory arrest
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Tachycardia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Angina unstable
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Palpitations
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ischaemic cardiomyopathy
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Angina pectoris
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiopulmonary failure
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Nervous system disorders
    Syncope
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Trigeminal neuralgia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Status epilepticus
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sciatica
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Optic neuritis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lumbar radiculopathy
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Loss of consciousness
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Idiopathic generalised epilepsy
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Carpal tunnel syndrome
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Apallic syndrome
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Subarachnoid haemorrhage
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Multiple sclerosis relapse
         subjects affected / exposed
    1 / 461 (0.22%)
    2 / 419 (0.48%)
    5 / 943 (0.53%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 3
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Brain oedema
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Ischaemic stroke
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    3 / 943 (0.32%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    3 / 943 (0.32%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Seizure
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lumbosacral radiculopathy
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Iron deficiency anaemia
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Hypoacusis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vertigo positional
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Macular oedema
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Glaucoma
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Iridocyclitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cataract
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Pancreatitis chronic
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haemorrhoids thrombosed
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abdominal hernia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroduodenitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pancreatitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Swollen tongue
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anal fistula
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Proctitis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Constipation
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Chronic gastritis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastric ulcer haemorrhage
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Inguinal hernia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Hepatitis toxic
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Jaundice cholestatic
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholecystitis chronic
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholecystitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gallbladder polyp
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    1 / 461 (0.22%)
    1 / 419 (0.24%)
    3 / 943 (0.32%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Drug-induced liver injury
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psoriasis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pruritus
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Panniculitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Erythema
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hyperkeratosis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urticaria
         subjects affected / exposed
    1 / 461 (0.22%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Angioedema
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Urinary incontinence
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Stress urinary incontinence
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Perinephritis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ureterolithiasis
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal failure
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal colic
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hydronephrosis
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anuria
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal cyst
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nephrolithiasis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Osteoarthritis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Synovitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spondylolisthesis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Spondylitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myositis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intervertebral disc disorder
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Foot deformity
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Exostosis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Chondropathy
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Osteonecrosis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intervertebral disc protrusion
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Latent tuberculosis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ophthalmic herpes zoster
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Staphylococcal sepsis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyelonephritis chronic
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nail infection
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injection site abscess
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatitis B
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis rotavirus
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gallbladder empyema
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diverticulitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Burn infection
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bone tuberculosis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    2 / 461 (0.43%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vestibular neuronitis
         subjects affected / exposed
    1 / 461 (0.22%)
    0 / 419 (0.00%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peritonitis
         subjects affected / exposed
    0 / 461 (0.00%)
    2 / 419 (0.48%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Appendicitis perforated
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Salpingitis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Helicobacter infection
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Appendiceal abscess
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    0 / 943 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    4 / 943 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyelonephritis acute
         subjects affected / exposed
    0 / 461 (0.00%)
    1 / 419 (0.24%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    3 / 943 (0.32%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sinusitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Viral infection
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    2 / 943 (0.21%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Type 2 diabetes mellitus
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypokalaemia
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Electrolyte imbalance
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diabetes mellitus
         subjects affected / exposed
    0 / 461 (0.00%)
    0 / 419 (0.00%)
    1 / 943 (0.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Delayed Start: Placebo Delayed Start: GA 40 mg Early Start: GA 40 mg / GA 40 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    167 / 461 (36.23%)
    238 / 419 (56.80%)
    609 / 943 (64.58%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    55 / 461 (11.93%)
    39 / 419 (9.31%)
    132 / 943 (14.00%)
         occurrences all number
    71
    83
    316
    Multiple sclerosis relapse
         subjects affected / exposed
    7 / 461 (1.52%)
    10 / 419 (2.39%)
    48 / 943 (5.09%)
         occurrences all number
    9
    12
    63
    General disorders and administration site conditions
    Injection site erythema
         subjects affected / exposed
    8 / 461 (1.74%)
    107 / 419 (25.54%)
    243 / 943 (25.77%)
         occurrences all number
    10
    122
    391
    Injection site pain
         subjects affected / exposed
    10 / 461 (2.17%)
    55 / 419 (13.13%)
    115 / 943 (12.20%)
         occurrences all number
    10
    61
    138
    Injection site pruritus
         subjects affected / exposed
    2 / 461 (0.43%)
    23 / 419 (5.49%)
    68 / 943 (7.21%)
         occurrences all number
    2
    24
    95
    Injection site swelling
         subjects affected / exposed
    3 / 461 (0.65%)
    23 / 419 (5.49%)
    50 / 943 (5.30%)
         occurrences all number
    3
    23
    95
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    20 / 461 (4.34%)
    33 / 419 (7.88%)
    98 / 943 (10.39%)
         occurrences all number
    26
    45
    150
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    39 / 461 (8.46%)
    56 / 419 (13.37%)
    167 / 943 (17.71%)
         occurrences all number
    47
    98
    346
    Urinary tract infection
         subjects affected / exposed
    22 / 461 (4.77%)
    36 / 419 (8.59%)
    103 / 943 (10.92%)
         occurrences all number
    24
    50
    165
    Upper respiratory tract infection
         subjects affected / exposed
    25 / 461 (5.42%)
    32 / 419 (7.64%)
    98 / 943 (10.39%)
         occurrences all number
    30
    54
    158
    Influenza
         subjects affected / exposed
    17 / 461 (3.69%)
    25 / 419 (5.97%)
    67 / 943 (7.10%)
         occurrences all number
    22
    33
    103
    Bronchitis
         subjects affected / exposed
    7 / 461 (1.52%)
    20 / 419 (4.77%)
    50 / 943 (5.30%)
         occurrences all number
    9
    25
    65

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Jul 2010
    - To clarify the definition of MRI secondary and add exploratory endpoints* (derived from the same outcome measures already defined in the protocol, namely new T2 and new hypointense T1 lesions). *Note: This was a typographical error made in the protocol amendment. Wording in the amendment should actually read: “To clarify the definition of MRI secondary and exploratory endpoints, and to add exploratory endpoints.” - To limit the anti-GA antibody ancillary study to a subset of approximately 400 subjects in total - To remove 4-amino-pyridine from the disallowed medications list - To add an Exclusion Criterion No. 16 to exclude subjects who underwent endovascular treatment for chronic cerebrospinal venous insufficiency (CCSV) - To reduce the pharmacogenetics (PGx) samples to 1 sample instead of 2 during the study - To correct typographical errors, which were discovered following submission of the protocol.
    01 Jan 2012
    - To add new covariates to the list of pre-defined covariates of the primary endpoint and several exploratory endpoints - To redefine the timeframe for the baseline visit activities in the OL extension phase of the study - To redefine activities at visits 4 and 5 (months 9 and 12) of PC phase of the study - To define the study periods in the OL extension phase for neurological/medical assessment activities - To define the Study Neurologist/Physician’s responsibilities - To correct typographical errors that occurred during the previous amendment - To change the title of Clinical Leader to Clinical Project Physician and the name of the responsible person
    01 Jan 2013
    - Addition of MRI at month 36 in the OL extension phase - Correction of typographical errors found in the definition of some MRI exploratory endpoints

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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