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    Clinical Trial Results:
    A Phase 2, Open-label, Multicentre, Extension Safety and Tolerability Study for Transfusionally Iron Overloaded Children, Adolescents and Adults Using SSP-004184 (SPD602)

    Summary
    EudraCT number
    2011-006322-25
    Trial protocol
    GB   IT  
    Global end of trial date
    24 Apr 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Oct 2018
    First version publication date
    26 Jul 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SPD602-301
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01671111
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Shire Development LLC
    Sponsor organisation address
    300 Shire Way, Lexington, Massachusetts, United States, 02421
    Public contact
    Study Physician, Shire, 1 866-842-5335,
    Scientific contact
    Study Physician, Shire, 1 866-842-5335,
    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?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    24 Apr 2014
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Apr 2014
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    1. To measure the extent and durability of SSP-004184AQ (SPD602) treatment effects 2. To assess the safety, tolerability and efficacy of SSP-004184AQ in subjects who received SSP-004184AQ in a prior SSP-004184AQ study 3. To allow access and assess response to SSP-004184AQ in subjects randomized to another chelation therapy in a prior SSP-004184AQ study.
    Protection of trial subjects
    This study was conducted in accordance with the International Conference on Harmonisation (ICH) harmonised tripartite guideline E6(R1): Good Clinical Practice, the principles of the Declaration of Helsinki, as well as other applicable local ethical and legal requirements.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Aug 2012
    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
    Canada: 7
    Country: Number of subjects enrolled
    United Kingdom: 1
    Country: Number of subjects enrolled
    Italy: 14
    Country: Number of subjects enrolled
    Thailand: 5
    Country: Number of subjects enrolled
    United States: 3
    Worldwide total number of subjects
    30
    EEA total number of subjects
    15
    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)
    2
    Adolescents (12-17 years)
    8
    Adults (18-64 years)
    20
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects received SSP-004184AQ with last available data during end of treatment visit in feeder studies SPD602-201(NCT01186419), SPD602-202(NCT01363908) and SPD602-203(NCT01604941), those not transitioned but fulfilled screening criteria in their respective feeder studies, and who had normal liver iron/serum ferritin levels, were included.

    Pre-assignment
    Screening details
    A total of 30 subjects were enrolled to this open-label extension study (24 subjects transferred directly from feeder studies SPD602-201 [NCT01186419], SPD602-202 [NCT01363908], and SPD602-203 [NCT01604941] and 6 subjects did not transfer directly and received a chelator other than SSP-004184 after discontinuation from a feeder study).

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    SSP-004184AQ
    Arm description
    Subjects received SSP-004184AQ (magnesium salt of free acid or active form, that is, SSP-004184 [SPD602, FBS0701]) capsules orally at a total daily dose of 8-75 milligram per kilogram per day (mg/kg/day) (equivalent to SSP-004184 7-68 mg/kg/day) either once daily or twice daily at the discretion of investigator for up to a maximum of 3 years or until the sponsor decided to stop the study.
    Arm type
    Experimental

    Investigational medicinal product name
    SSP-004184AQ
    Investigational medicinal product code
    SPD602
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received SSP-004184AQ (magnesium salt of free acid or active form, that is, SSP-004184 [SPD602, FBS0701]) capsules orally at a total daily dose of 8-75 mg/kg/day (equivalent to SSP-004184 7-68 mg/kg/day) either once daily or twice daily at the discretion of investigator for up to a maximum of 3 years or until the sponsor decided to stop the study.

    Number of subjects in period 1
    SSP-004184AQ
    Started
    30
    Completed
    0
    Not completed
    30
         Consent withdrawn by subject
    2
         Physician decision
    1
         Adverse event, non-fatal
    2
         Unspecified
    24
         Lack of efficacy
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    SSP-004184AQ
    Reporting group description
    Subjects received SSP-004184AQ (magnesium salt of free acid or active form, that is, SSP-004184 [SPD602, FBS0701]) capsules orally at a total daily dose of 8-75 milligram per kilogram per day (mg/kg/day) (equivalent to SSP-004184 7-68 mg/kg/day) either once daily or twice daily at the discretion of investigator for up to a maximum of 3 years or until the sponsor decided to stop the study.

    Reporting group values
    SSP-004184AQ Total
    Number of subjects
    30 30
    Age categorical
    Units: Subjects
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    25.5 ( 11.38 ) -
    Gender
    Units: Subjects
        Female
    17 17
        Male
    13 13

    End points

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    End points reporting groups
    Reporting group title
    SSP-004184AQ
    Reporting group description
    Subjects received SSP-004184AQ (magnesium salt of free acid or active form, that is, SSP-004184 [SPD602, FBS0701]) capsules orally at a total daily dose of 8-75 milligram per kilogram per day (mg/kg/day) (equivalent to SSP-004184 7-68 mg/kg/day) either once daily or twice daily at the discretion of investigator for up to a maximum of 3 years or until the sponsor decided to stop the study.

    Primary: Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 1)

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    End point title
    Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 1) [1]
    End point description
    Efficacy of SSP-004184 was assessed by determining LIC. Abdominal magnetic resonance imaging (MRI) data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. Full analysis set (FAS) included all subjects in the Safety set (all subjects who had taken at least 1 dose of study drug) who had at least 1 post-baseline primary efficacy assessment. Here, 'n' signifies the number of FAS subjects evaluable for the respective time points.
    End point type
    Primary
    End point timeframe
    Baseline, Week 24 (Cycle 1)
    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: EudraCT database does not allow reporting statistical analysis for a single reporting group. Due to this format constraint, charts have been uploaded with the accurate details of statistical analysis for this endpoint. Please find the statistical analysis in the attachment below.
    End point values
    SSP-004184AQ
    Number of subjects analysed
    23
    Units: milligram per gram (mg/g) dry tissue
    arithmetic mean (standard deviation)
        Baseline (n=23)
    9.9 ( 8.1 )
        Change at Week 24 (Cycle 1) (n=13)
    -1.1 ( 1.86 )
    Attachments
    Statistical Analyses_Primary_LIC_W24 (C1)
    No statistical analyses for this end point

    Primary: Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 48 (Cycle 1)

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    End point title
    Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 48 (Cycle 1) [2]
    End point description
    Efficacy of SSP-004184 was assessed by determining LIC. Abdominal MRI data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. FAS subjects evaluable for this outcome.
    End point type
    Primary
    End point timeframe
    Baseline, Week 48 (Cycle 1)
    Notes
    [2] - 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: EudraCT database does not allow reporting statistical analysis for a single reporting group. Due to this format constraint, charts have been uploaded with the accurate details of statistical analysis for this endpoint. Please find the statistical analysis in the attachment below.
    End point values
    SSP-004184AQ
    Number of subjects analysed
    9
    Units: mg/g dry tissue
        arithmetic mean (standard deviation)
    -1 ( 1.68 )
    Attachments
    Statistical Analyses_Primary_LIC_W48 (C1)
    No statistical analyses for this end point

    Primary: Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 2)

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    End point title
    Change From Baseline in Ferriscan® R2 Liver Iron Concentrations (LIC) at Week 24 (Cycle 2) [3]
    End point description
    Efficacy of SSP-004184 was assessed by determining LIC. Abdominal MRI data were collected by using FerriScan R2 standard procedures and used to determine LIC. A negative change from baseline indicates that LIC decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. FAS subjects evaluable for this outcome.
    End point type
    Primary
    End point timeframe
    Baseline, Week 24 (Cycle 2)
    Notes
    [3] - 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: EudraCT database does not allow reporting statistical analysis for a single reporting group. Due to this format constraint, charts have been uploaded with the accurate details of statistical analysis for this endpoint. Please find the statistical analysis in the attachment below.
    End point values
    SSP-004184AQ
    Number of subjects analysed
    7
    Units: mg/g dry tissue
        arithmetic mean (standard deviation)
    -1.5 ( 2.23 )
    Attachments
    Statistical Analyses_Primary_LIC_W24 (C2)
    No statistical analyses for this end point

    Primary: Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 1)

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    End point title
    Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 1) [4]
    End point description
    The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. FAS. Here, 'n' signifies the number of FAS subjects evaluable for the respective time points.
    End point type
    Primary
    End point timeframe
    Baseline, Week 24 (Cycle 1)
    Notes
    [4] - 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: EudraCT database does not allow reporting statistical analysis for a single reporting group. Due to this format constraint, charts have been uploaded with the accurate details of statistical analysis for this endpoint. Please find the statistical analysis in the attachment below.
    End point values
    SSP-004184AQ
    Number of subjects analysed
    23
    Units: milliseconds
    arithmetic mean (standard deviation)
        Baseline (n=23)
    35.14 ( 12.242 )
        Change at Week 24 (Cycle 1) (n=14)
    -0.41 ( 8.069 )
    Attachments
    Statistical Analyses_Primary_Cardiac_W24 (C1)
    No statistical analyses for this end point

    Primary: Change From Baseline in Cardiac T2* Values at Week 48 (Cycle 1)

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    End point title
    Change From Baseline in Cardiac T2* Values at Week 48 (Cycle 1) [5]
    End point description
    The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. FAS subjects evaluable for this outcome.
    End point type
    Primary
    End point timeframe
    Baseline, Week 48 (Cycle 1)
    Notes
    [5] - 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: EudraCT database does not allow reporting statistical analysis for a single reporting group. Due to this format constraint, charts have been uploaded with the accurate details of statistical analysis for this endpoint. Please find the statistical analysis in the attachment below.
    End point values
    SSP-004184AQ
    Number of subjects analysed
    9
    Units: milliseconds
        arithmetic mean (standard deviation)
    -3.47 ( 9.619 )
    Attachments
    Statistical Analyses_Primary_Cardiac_W48 (C1)
    No statistical analyses for this end point

    Primary: Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 2)

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    End point title
    Change From Baseline in Cardiac T2* Values at Week 24 (Cycle 2) [6]
    End point description
    The efficacy of SSP-004184 was assessed by determining cardiac iron load. Cardiac MRI data were collected by using T2* standard procedures and used to determine iron load. A negative change from baseline indicates that iron load increased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. FAS subjects evaluable for this outcome.
    End point type
    Primary
    End point timeframe
    Baseline, Week 24 (Cycle 2)
    Notes
    [6] - 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: EudraCT database does not allow reporting statistical analysis for a single reporting group. Due to this format constraint, charts have been uploaded with the accurate details of statistical analysis for this endpoint. Please find the statistical analysis in the attachment below.
    End point values
    SSP-004184AQ
    Number of subjects analysed
    7
    Units: milliseconds
        arithmetic mean (standard deviation)
    -3.91 ( 5.551 )
    Attachments
    Statistical Analyses_Primary_Cardiac_W24 (C2)
    No statistical analyses for this end point

    Secondary: Change from Baseline in Serum Ferritin Values at Specified Visits

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    End point title
    Change from Baseline in Serum Ferritin Values at Specified Visits
    End point description
    A negative change from baseline indicates that serum ferritin decreased. A cycle consisted of 8 standard 6-weekly visits and the cycles were repeated each year for the duration of the study. FAS. Here, 'n' signifies the number of FAS subjects evaluable for the respective time points.
    End point type
    Secondary
    End point timeframe
    Baseline, Weeks 24 and 48 of Cycle 1, Week 24 of Cycle 2
    End point values
    SSP-004184AQ
    Number of subjects analysed
    23
    Units: nanogram per milliliter
    arithmetic mean (standard deviation)
        Baseline (n=23)
    5353.38 ( 4588.423 )
        Change at Week 24 (Cycle 1) (n=12)
    -395.82 ( 569.305 )
        Change at Week 48 (Cycle 1) (n=9)
    -250.87 ( 452.327 )
        Change at Week 24 (Cycle 2) (n=7)
    -384.03 ( 649.99 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From start of study treatment up to the end of study (1 week after the end of treatment)
    Adverse event reporting additional description
    An adverse event (AE) that occurred during the study was considered a treatment-emergent AE (TEAE) if it had a start date and time on or after the study treatment or if it had a start date before the date and time of the study treatment but increased in intensity on or after the date and time of the study treatment.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    12.1
    Reporting groups
    Reporting group title
    SSP-004184AQ
    Reporting group description
    Subjects received SSP-004184AQ (magnesium salt of free acid or active form, that is, SSP-004184 [SPD602, FBS0701]) capsules orally at a total daily dose of 8-75 mg/kg/day (equivalent to SSP-004184 7-68 mg/kg/day) either once daily or twice daily at the discretion of investigator for up to a maximum of 3 years or until the sponsor decided to stop the study.

    Serious adverse events
    SSP-004184AQ
    Total subjects affected by serious adverse events
         subjects affected / exposed
    2 / 30 (6.67%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Congenital, familial and genetic disorders
    Sickle cell anaemia with crisis
         subjects affected / exposed
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Bronchitis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 30 (3.33%)
         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
    SSP-004184AQ
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    25 / 30 (83.33%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    3 / 30 (10.00%)
         occurrences all number
    3
    Paraesthesia
         subjects affected / exposed
    4 / 30 (13.33%)
         occurrences all number
    5
    General disorders and administration site conditions
    Influenza like illness
         subjects affected / exposed
    5 / 30 (16.67%)
         occurrences all number
    6
    Asthenia
         subjects affected / exposed
    4 / 30 (13.33%)
         occurrences all number
    8
    Pyrexia
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    5
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    4 / 30 (13.33%)
         occurrences all number
    6
    Abdominal pain upper
         subjects affected / exposed
    3 / 30 (10.00%)
         occurrences all number
    3
    Constipation
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Diarrhoea
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    3
    Respiratory, thoracic and mediastinal disorders
    Oropharyngeal pain
         subjects affected / exposed
    4 / 30 (13.33%)
         occurrences all number
    6
    Cough
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Psychiatric disorders
    Depression
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    2
    Infections and infestations
    Pharyngitis
         subjects affected / exposed
    3 / 30 (10.00%)
         occurrences all number
    3
    Nasopharyngitis
         subjects affected / exposed
    5 / 30 (16.67%)
         occurrences all number
    6
    Gastroenteritis
         subjects affected / exposed
    2 / 30 (6.67%)
         occurrences all number
    4

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    30 Jul 2012
    Due to an error in the study phase numbering, the study phase was amended from Phase 3 to Phase 2.
    30 Apr 2013
    1. SPD602-301 replaces FBS0701-CTP-15 2. Updated selection of study population, study assessments 3. Updated the description of the study design to allow entry (further to meeting all qualification criteria) of subjects who were unable to transition directly into this extension study due to administrative reasons, and who had initiated treatment with a chelator other than SSP-004184 4. Replaced glucose intolerance test with fasting glucose test 5. Added pharmacokinetic parameters to the study objectives 6. Updated the description of the study period and timelines 7. Added information regarding adverse events (AEs) of particular interest including paresthesia and hypoesthesia and extended neurological examinations 8. Updated Inclusion and exclusion criteria for subjects who did not transition directly from their feeder protocol 9. Updated the description of the study period and timelines to include timelines for qualification for subjects who did not transition directly from their feeder protocol and who had initiated treatment with a chelator other than SSP-004184 10. Qualified that the measurable data demonstrating qualification into the extension study were to be taken from the end of treatment visit from the feeder protocol for those subjects who transitioned directly from their feeder protocol only 11. Updated the follow-up period from 30 days to 7 days 12. Added withdrawal criteria: Cardiac left ventricular ejection fraction (LVEF) <50% 13. Updated the management of study toxicities section 14. Inserted endocrine laboratory tests for subjects 10 years and over who enrolled in their feeder protocol <18-years old, visual acuity test and eye examination for all subjects 15. Amended the timing of AE and serious AE collection to detail that AEs were to be recorded from the time of signed informed consent until 7 days after the last dosing 16. Added data monitoring committee
    22 Oct 2013
    1. Clarified that echocardiography was acceptable for LVEF if MRI information was not available 2. To replace extended neurological examinations with total neuropathy score nurse (TNSn) assessments at Qualification and Enrolment, Visits 4, 8, and end of treatment/early discontinuation 3. Subjects who had either completed 1 of the previous feeder studies or who discontinued (with agreement from the investigator and Shire physician) and who met qualification criteria were permitted to enrol subjects who had either completed a previous SSP-004184AQ study or prematurely discontinued 1 of the SSP-004184AQ studies (with agreement from the investigator and Shire physician) were permitted to enrol 4. Subjects who had either completed a previous SSP-004184AQ study or prematurely discontinued 1 of the SSP-004184AQ studies (with agreement from the investigator and Shire physician) were permitted to enrol 5. Excluded subjects with cardiac T2* MRI <10.0 milliseconds (from <8msec), LVEF below the locally determined normal range or LVEF <50% at baseline testing by MRI or echocardiography 6. “Chronic cholecystitis” was no longer exclusionary 7. Subjects were to be withdrawn from the study and classified as treatment failures if they continued to accumulate iron based on cardiac iron concentration determined by MRI 8. Replaced previous AE severity assessment with those reflecting National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 criteria 9. Added statement indicating that Qualification and Enrollment physical examination, TNSn and ECG are required if assessment was not completed at the last feeder study visit (as well as for subjects who did not transition directly from their feeder protocol)

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    01 Mar 2014
    The SPD-602 development program was placed on clinical hold in March 2014. This clinical hold was a result of data from a 104-week rat carcinogenicity study that demonstrated an increased incidence of renal tubular adenomas and carcinomas in male rats. The relevance of these finding to humans, if any, was unknown. However, Shire continued to take appropriate measures to further assess these results. Investigators and relevant regulatory authorities were informed and a comprehensive surveillance program was implemented to monitor safety in subjects who participated in SPD602 studies. Because of the interruption in treatment with SPD602 and the inability at the time to draw definitive conclusions regarding the relevance of the rat findings to humans, ongoing clinical studies were terminated in July 2014.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    This study was terminated early due to non-clinical safety results. Not all subjects completed the study. The available efficacy data were analyzed as specified in the statistical analysis plan; however, no efficacy conclusions were drawn.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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