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    Clinical Trial Results:
    Phase II, open-label, single-arm, multicenter study to evaluate the efficacy and safety of deferasirox in combination with deferoxamine followed by deferasirox monotherapy in patients with severe cardiac iron overload due to chronic blood transfusion (HYPERION)

    Summary
    EudraCT number
    2010-021062-29
    Trial protocol
    GB   IT   GR  
    Global end of trial date
    18 Nov 2013

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Jul 2016
    First version publication date
    07 Aug 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CICL670A2214
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01254227
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Novartis Pharma AG
    Sponsor organisation address
    CH-4002 , Basel, Switzerland,
    Public contact
    Clinical Disclosure Office, Novartis Pharma AG, 41 613241111 ,
    Scientific contact
    Clinical Disclosure Office, Novartis Pharma AG, 41 613241111 ,
    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?
    Yes
    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
    18 Nov 2013
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Nov 2013
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the effect of DFX-DFO combination therapy followed by DFX monotherapy on myocardial iron content as depicted by change in cardiac T2* at Month 12
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    19 Jan 2011
    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
    United Kingdom: 3
    Country: Number of subjects enrolled
    Greece: 2
    Country: Number of subjects enrolled
    Italy: 14
    Country: Number of subjects enrolled
    Egypt: 15
    Country: Number of subjects enrolled
    Thailand: 7
    Country: Number of subjects enrolled
    Turkey: 18
    Country: Number of subjects enrolled
    Taiwan: 1
    Worldwide total number of subjects
    60
    EEA total number of subjects
    19
    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)
    4
    Adolescents (12-17 years)
    10
    Adults (18-64 years)
    46
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A screening period (up to 50 days) was used to assess eligibility of patients. Patients with confirmed eligibility discontinued any current chelation therapy and underwent a 5-day washout period prior to commencing the treatment with DFX-DFO combination.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Arm title
    All Patients
    Arm description
    The investigational study drugs were the following: • Deferasirox + Deferoxamine = DFX-DFO combination treatment • Deferasirox = DFX monotherapy All patients started on the combination therapy. After 6 months of treatment, patients could be switched to DFX monotherapy depending on cardiac T2* assessment
    Arm type
    Experimental

    Investigational medicinal product name
    Deferasirox
    Investigational medicinal product code
    Other name
    ICL670, Exjade®
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Clinical supplies of Deferasirox consisted of dispersible tablets in strengths of 125 mg, 250 mg and 500 mg. All patients started with a daily dose of 20 mg/kg of DFX. At the end of the 1st month, DFX dose was increased to 30 mg/kg/day, unless the patient met any of the criteria for dose reduction or drug interruption. Further dose increases of DFX to 40 mg/kg/day was done after the 6-month assessment of cardiac T2, evaluation of cardiac function and safety.

    Investigational medicinal product name
    Deferoxamine
    Investigational medicinal product code
    Other name
    DFO, Desferal®
    Pharmaceutical forms
    Powder for dispersion for infusion
    Routes of administration
    Parenteral use
    Dosage and administration details
    Clinical supplies of Deferoxamine vials consisted of a powder formulation in vials of 500 mg and 2000 mg. Concomitantly, 40 mg/kg/day DFO for 5 days/week for at least 8 hours/day was administered. Dose escalation of DFO was not permitted in the study.

    Number of subjects in period 1
    All Patients
    Started
    60
    Completion of 12 months
    39
    Completion of 24 months
    34
    Completed
    34
    Not completed
    26
         Adverse event, serious fatal
    1
         Consent withdrawn by subject
    6
         Adverse event, non-fatal
    5
         Lost to follow-up
    6
         Abnormal test procedure result(s)
    5
         'Administrative problems '
    2
         Protocol deviation
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    All Patients
    Reporting group description
    The investigational study drugs were the following: • Deferasirox + Deferoxamine = DFX-DFO combination treatment • Deferasirox = DFX monotherapy All patients started on the combination therapy. After 6 months of treatment, patients could be switched to DFX monotherapy depending on cardiac T2* assessment

    Reporting group values
    All Patients Total
    Number of subjects
    60 60
    Age categorical
    Units: Subjects
        2 y - <12 y
    4 4
        12 y - <18 y
    10 10
        18 y - <65 y
    46 46
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    22.8 ( 7.33 ) -
    Gender categorical
    Units: Subjects
        Female
    32 32
        Male
    28 28

    End points

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    End points reporting groups
    Reporting group title
    All Patients
    Reporting group description
    The investigational study drugs were the following: • Deferasirox + Deferoxamine = DFX-DFO combination treatment • Deferasirox = DFX monotherapy All patients started on the combination therapy. After 6 months of treatment, patients could be switched to DFX monotherapy depending on cardiac T2* assessment

    Subject analysis set title
    Full Analysis Set (FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS includes all patients to whom study treatment had been assigned. Patients were considered evaluable for the efficacy endpoint if they had received at least one dose of study treatment and had baseline and a post baseline assessment prior to or on the time of the assessment of the corresponding efficacy endpoint. Patients who did not have a baseline value or did not have any post-baseline value of an efficacy endpoint were excluded from the analysis of this endpoint.

    Subject analysis set title
    Per-Protocol Set (PPS)
    Subject analysis set type
    Per protocol
    Subject analysis set description
    All enrolled patients who received at least 6 months of study treatment, had baseline and a postbaseline T2* value before or at Month 12, and without major protocol deviations (including myocardial T2* value < 5 or ≥ 10 ms.

    Primary: The change in cardiac iron content as measured by cardiac T2* at Month 12 divided by the cardiac T2* value at Baseline

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    End point title
    The change in cardiac iron content as measured by cardiac T2* at Month 12 divided by the cardiac T2* value at Baseline [1]
    End point description
    Cardiac T2* is the most sensitive and reproducible test in detecting myocardial iron load. A cardiac T2* value of <10 ms is defined as severe cardiac iron overload. Patients who do not have baseline T2* or do not have any post-baseline T2* are excluded from the analysis.
    End point type
    Primary
    End point timeframe
    Baseline and Month 12
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analyses have not been performed for this primary end point.
    End point values
    Full Analysis Set (FAS) Per-Protocol Set (PPS)
    Number of subjects analysed
    52 [2]
    51 [3]
    Units: ms
    geometric mean (confidence interval 95%)
        Baseline
    7.19 (6.83 to 7.58)
    7.05 (6.65 to 7.46)
        Month 12
    7.68 (7.1 to 8.3)
    7.73 (7.14 to 8.36)
        Change from Baseline
    1.09 (1.04 to 1.15)
    1.1 (1.04 to 1.16)
    Notes
    [2] - Fifty-two patients (86.7%) were evaluable for this endpoint in the FAS.
    [3] - 51 patients (85.0%) in the PPS and were included in the calculation of the primary endpoint.
    No statistical analyses for this end point

    Secondary: Percentage of patients achieving MRI-measured cardiac T2* ≥ 10 ms (but at least 10% relative increase in cardiac T2* from baseline)

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    End point title
    Percentage of patients achieving MRI-measured cardiac T2* ≥ 10 ms (but at least 10% relative increase in cardiac T2* from baseline)
    End point description
    Only evaluable patients at each visit were used as the denominator for the calculation of proportion.
    End point type
    Secondary
    End point timeframe
    Months 6, 12, 18 and 24
    End point values
    Full Analysis Set (FAS)
    Number of subjects analysed
    60
    Units: percentage of patients
    number (confidence interval 95%)
        Month 6 (n=6)
    12.5 (31.99 to 62.99)
        Month 12 (n=10)
    19.23 (5.86 to 24.7)
        Month 18 (n=11)
    33.33 (10.8 to 31.9)
        Month 24 (n=17)
    47.22 (19.75 to 50.39)
    No statistical analyses for this end point

    Secondary: Change in cardiac iron content as measured by T2* divided by baseline T2*

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    End point title
    Change in cardiac iron content as measured by T2* divided by baseline T2*
    End point description
    End point type
    Secondary
    End point timeframe
    Months 6, 18 and 24
    End point values
    Full Analysis Set (FAS)
    Number of subjects analysed
    60
    Units: GM ratio
    geometric mean (confidence interval 95%)
        Month 6 Change from Baseline (n=48)
    1.02 (0.98 to 1.07)
        Month 18 Change from Baseline (n=33)
    1.17 (1.08 to 1.28)
        Month 24 Change from Baseline (n=36)
    1.3 (1.17 to 1.44)
    No statistical analyses for this end point

    Secondary: Change in MRI-measured parameters of the left and right ventricle: ejection fraction (LVEF, RVEF), ventricular volumes, and masses

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    End point title
    Change in MRI-measured parameters of the left and right ventricle: ejection fraction (LVEF, RVEF), ventricular volumes, and masses
    End point description
    End point type
    Secondary
    End point timeframe
    Months 6, 12, 18 and 24
    End point values
    Full Analysis Set (FAS)
    Number of subjects analysed
    60
    Units: percent
    arithmetic mean (standard deviation)
        LVEF Month 6 absolute change from Baseline (n=48)
    0.1 ( 4.62 )
        LVEF Month 12 absolute change from Baseline (n=45)
    -0.2 ( 4.84 )
        LVEF Month 18 absolute change from Baseline (n=33)
    0.6 ( 7.04 )
        LVEF Month 24 absolute change from Baseline (n=36)
    0.9 ( 5.98 )
        RVEF Month 6 absolute change from Baseline (n=47)
    -1.2 ( 5.35 )
        RVEF Month 12 absolute change from Baseline (n=45)
    -1.6 ( 4.4 )
        RVEF Month 18 absolute change from Baseline (n=33)
    -2.1 ( 6.1 )
        RVEF Month 24 absolute change from Baseline (n=36)
    -1.4 ( 4.25 )
    No statistical analyses for this end point

    Secondary: Time to achieve T2* ≥ 10 ms (but at least 10% relative increase from baseline)

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    End point title
    Time to achieve T2* ≥ 10 ms (but at least 10% relative increase from baseline)
    End point description
    End point type
    Secondary
    End point timeframe
    Month 24
    End point values
    Full Analysis Set (FAS)
    Number of subjects analysed
    60 [4]
    Units: ms
        median (confidence interval 95%)
    722 (520 to 999)
    Notes
    [4] - 999.0 = the upper value was not estimable
    No statistical analyses for this end point

    Secondary: Cardiac Iron Concentration Levels During the Study

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    End point title
    Cardiac Iron Concentration Levels During the Study
    End point description
    End point type
    Secondary
    End point timeframe
    Baseline, Month 6, 12, 18 and Month 24
    End point values
    Full Analysis Set (FAS)
    Number of subjects analysed
    60
    Units: mg Fe/g dw
    arithmetic mean (standard deviation)
        Baseline (n=60)
    4.18 ( 1.045 )
        Month 6 (n=48)
    4.31 ( 1.442 )
        Month 12 (n=46)
    3.93 ( 1.429 )
        Month 18 (n=33)
    3.51 ( 1.348 )
        Month 24 (n=36)
    3.14 ( 1.381 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events are collected from First Patient First Visit (FPFV) until Last Patient Last Visit (LPLV).  All Adverse events are reported in this record from First Patient First Treatment until Last Patient Last Visit.
    Adverse event reporting additional description
    Consistent with EudraCT disclosure specifications, Novartis has reported under the Serious adverse events field “number of deaths resulting from adverse events” all those deaths, resulting from serious adverse events that are deemed to be causally related to treatment by the investigator.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.1
    Reporting groups
    Reporting group title
    All patients
    Reporting group description
    All patients

    Serious adverse events
    All patients
    Total subjects affected by serious adverse events
         subjects affected / exposed
    17 / 60 (28.33%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Ovarian germ cell teratoma benign
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Fallopian tube cyst
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ovarian cyst
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Chest injury
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Spinal column injury
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Congenital, familial and genetic disorders
    Dermoid cyst
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Altered state of consciousness
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Ischaemic stroke
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    VIIth nerve paralysis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    2 / 60 (3.33%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Irritable bowel syndrome
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis acute
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Reflux gastritis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Biliary colic
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cholecystitis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Drug reaction with eosinophilia and systemic symptoms
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Costochondritis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myalgia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Abscess neck
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile infection
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infection
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pharyngitis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Calcium deficiency
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypocalcaemia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypoglycaemia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypophosphataemia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Type 1 diabetes mellitus
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    All patients
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    46 / 60 (76.67%)
    Investigations
    Blood creatinine increased
         subjects affected / exposed
    5 / 60 (8.33%)
         occurrences all number
    6
    Electrocardiogram T wave amplitude decreased
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences all number
    4
    Electrocardiogram T wave inversion
         subjects affected / exposed
    4 / 60 (6.67%)
         occurrences all number
    4
    Urine protein/creatinine ratio increased
         subjects affected / exposed
    6 / 60 (10.00%)
         occurrences all number
    8
    Cardiac disorders
    Atrioventricular block first degree
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences all number
    4
    Nervous system disorders
    Headache
         subjects affected / exposed
    9 / 60 (15.00%)
         occurrences all number
    23
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    4 / 60 (6.67%)
         occurrences all number
    6
    Pyrexia
         subjects affected / exposed
    14 / 60 (23.33%)
         occurrences all number
    20
    Ear and labyrinth disorders
    Deafness neurosensory
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences all number
    3
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    8 / 60 (13.33%)
         occurrences all number
    24
    Abdominal pain upper
         subjects affected / exposed
    4 / 60 (6.67%)
         occurrences all number
    8
    Diarrhoea
         subjects affected / exposed
    8 / 60 (13.33%)
         occurrences all number
    14
    Enteritis
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences all number
    3
    Nausea
         subjects affected / exposed
    8 / 60 (13.33%)
         occurrences all number
    19
    Toothache
         subjects affected / exposed
    7 / 60 (11.67%)
         occurrences all number
    11
    Vomiting
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences all number
    4
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    5 / 60 (8.33%)
         occurrences all number
    9
    Oropharyngeal pain
         subjects affected / exposed
    6 / 60 (10.00%)
         occurrences all number
    6
    Renal and urinary disorders
    Proteinuria
         subjects affected / exposed
    6 / 60 (10.00%)
         occurrences all number
    10
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    8 / 60 (13.33%)
         occurrences all number
    11
    Back pain
         subjects affected / exposed
    12 / 60 (20.00%)
         occurrences all number
    20
    Pain in extremity
         subjects affected / exposed
    4 / 60 (6.67%)
         occurrences all number
    4
    Infections and infestations
    Gastroenteritis
         subjects affected / exposed
    4 / 60 (6.67%)
         occurrences all number
    4
    Influenza
         subjects affected / exposed
    8 / 60 (13.33%)
         occurrences all number
    18
    Nasopharyngitis
         subjects affected / exposed
    9 / 60 (15.00%)
         occurrences all number
    11
    Sinusitis
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences all number
    3
    Tonsillitis
         subjects affected / exposed
    4 / 60 (6.67%)
         occurrences all number
    5
    Tooth abscess
         subjects affected / exposed
    5 / 60 (8.33%)
         occurrences all number
    7
    Upper respiratory tract infection
         subjects affected / exposed
    10 / 60 (16.67%)
         occurrences all number
    10
    Metabolism and nutrition disorders
    Hypocalcaemia
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences all number
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    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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