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    Clinical Trial Results:
    A RANDOMIZED, OPEN-LABEL, MULTI-CENTRE STUDY TO EVALUATE PATIENT PREFERENCE WITH SUBCUTANEOUS ADMINISTRATION OF RITUXIMAB VERSUS INTRAVENOUS RITUXIMAB IN PREVIOUSLY UNTREATED PATIENTS WITH CD20+ DIFFUSE LARGE B-CELL LYMPHOMA OR CD20+ FOLLICULAR NON-HODGKIN’S LYMPHOMA GRADES 1, 2, OR 3A

    Summary
    EudraCT number
    2012-003230-17
    Trial protocol
    DE   HU   NL   IT   PT   SE   AT   DK   HR  
    Global end of trial date

    Results information
    Results version number
    v2
    This version publication date
    04 Aug 2016
    First version publication date
    19 May 2016
    Other versions
    v1 , v3
    Version creation reason
    • Correction of full data set
    Outcome measures need to be updated.

    Trial information

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    Trial identification
    Sponsor protocol code
    MO28457
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01724021
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Hoffman La-Roche
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland,
    Public contact
    Head of Clin. Ops Italy, Roche S.p.A., +39 039 247 5070, ITALY.INFO_CTA@ROCHE.COM
    Scientific contact
    Head of Clin. Ops Italy, Roche S.p.A., +39 039 247 5070, ITALY.INFO_CTA@ROCHE.COM
    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
    Interim
    Date of interim/final analysis
    03 Dec 2015
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the proportion of subjects indicating an overall preference via a Patient Preference Questionnaire (PPQ) for either the subcutaneous (SC) or the intravenous (IV) route of rituximab administration.
    Protection of trial subjects
    All study subjects were required to read and sign an Informed Consent Form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    20 Dec 2012
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    12 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 12
    Country: Number of subjects enrolled
    Portugal: 10
    Country: Number of subjects enrolled
    Romania: 31
    Country: Number of subjects enrolled
    Sweden: 17
    Country: Number of subjects enrolled
    Croatia: 2
    Country: Number of subjects enrolled
    Austria: 15
    Country: Number of subjects enrolled
    Denmark: 13
    Country: Number of subjects enrolled
    Germany: 201
    Country: Number of subjects enrolled
    Hungary: 24
    Country: Number of subjects enrolled
    Italy: 60
    Country: Number of subjects enrolled
    Argentina: 10
    Country: Number of subjects enrolled
    Australia: 49
    Country: Number of subjects enrolled
    Brazil: 26
    Country: Number of subjects enrolled
    Canada: 20
    Country: Number of subjects enrolled
    Chile: 10
    Country: Number of subjects enrolled
    Colombia: 3
    Country: Number of subjects enrolled
    Dominican Republic: 4
    Country: Number of subjects enrolled
    Egypt: 10
    Country: Number of subjects enrolled
    El Salvador: 11
    Country: Number of subjects enrolled
    Guatemala: 8
    Country: Number of subjects enrolled
    Hong Kong: 8
    Country: Number of subjects enrolled
    Indonesia: 23
    Country: Number of subjects enrolled
    Korea, Republic of: 31
    Country: Number of subjects enrolled
    Malaysia: 20
    Country: Number of subjects enrolled
    New Zealand: 5
    Country: Number of subjects enrolled
    Panama: 22
    Country: Number of subjects enrolled
    Peru: 10
    Country: Number of subjects enrolled
    Philippines: 18
    Country: Number of subjects enrolled
    Taiwan: 16
    Country: Number of subjects enrolled
    Thailand: 30
    Country: Number of subjects enrolled
    Turkey: 15
    Country: Number of subjects enrolled
    Vietnam: 6
    Worldwide total number of subjects
    740
    EEA total number of subjects
    385
    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)
    459
    From 65 to 84 years
    281
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 743 participants were enrolled across all the sites and were included in the intent to treat (ITT) population. Three participants were enrolled but died prior to receiving study medication and were not included in the safety population. The Participant Flow represents the safety population.

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A
    Arm description
    Subjects in Arm A received one cycle of rituximab 375 milligram per metre square (mg/m^2) intravenously (IV), then three cycles of rituximab 1400mg subcutaneously (SC), followed by four cycles of rituximab 375 mg/m^2 IV in combination with a standard chemotherapy of cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone/prednisolone (CHOP), cyclcophosphamie, vincristine, prednisone/prednisolone (CVP), or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.
    Arm type
    Experimental

    Investigational medicinal product name
    Rituximab IV
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Subjects received one cycle of rituximab 375 mg/m^2 IV, and four cycles of rituximab 375 mg/m^2 IV n Day 1 of each treatment cycle. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Investigational medicinal product name
    Rituximab SC
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Subjects received three cycles of rituximab 1400 mg SC on Day 1 of each treament cycle. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Arm title
    Arm B
    Arm description
    Subjects in Arm B received four cycles of rituximab 375 mg/m^2 IV followed by four cycles of rituximab 1400 mg SC in combination with a standard chemotherapy of CHOP, CVP, or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.
    Arm type
    Experimental

    Investigational medicinal product name
    Rituximab IV
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Subjects received four cycles of rituximab 375 mg/m^2 IV n Day 1 of each treatment cycle. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Investigational medicinal product name
    Rituximab SC
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Subjects received four cycles of rituximab 1400 mg SC on Day 1 of each treament cycle. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Number of subjects in period 1
    Arm A Arm B
    Started
    371
    369
    Completed
    323
    309
    Not completed
    48
    60
         Lack of Compliance
    -
    1
         Adverse Event
    5
    4
         Death
    24
    29
         Subject request/ Withdrew consent
    13
    10
         Reason Not Specified
    6
    9
         Lost to follow-up
    -
    7

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Subjects in Arm A received one cycle of rituximab 375 milligram per metre square (mg/m^2) intravenously (IV), then three cycles of rituximab 1400mg subcutaneously (SC), followed by four cycles of rituximab 375 mg/m^2 IV in combination with a standard chemotherapy of cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone/prednisolone (CHOP), cyclcophosphamie, vincristine, prednisone/prednisolone (CVP), or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Reporting group title
    Arm B
    Reporting group description
    Subjects in Arm B received four cycles of rituximab 375 mg/m^2 IV followed by four cycles of rituximab 1400 mg SC in combination with a standard chemotherapy of CHOP, CVP, or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Reporting group values
    Arm A Arm B Total
    Number of subjects
    371 369 740
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    58.2 ( 13.18 ) 59.4 ( 12.64 ) -
    Gender categorical
    Units: Subjects
        Female
    187 180 367
        Male
    184 189 373

    End points

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    End points reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Subjects in Arm A received one cycle of rituximab 375 milligram per metre square (mg/m^2) intravenously (IV), then three cycles of rituximab 1400mg subcutaneously (SC), followed by four cycles of rituximab 375 mg/m^2 IV in combination with a standard chemotherapy of cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone/prednisolone (CHOP), cyclcophosphamie, vincristine, prednisone/prednisolone (CVP), or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Reporting group title
    Arm B
    Reporting group description
    Subjects in Arm B received four cycles of rituximab 375 mg/m^2 IV followed by four cycles of rituximab 1400 mg SC in combination with a standard chemotherapy of CHOP, CVP, or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Subject analysis set title
    Rituximab Intravenous (IV)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Rituximab was administered at a dose of 375 mg/m2 body surface area (BSA) as a single IV infusion, followed by administration of chemotherapy. At Cycle 1, Day 1, the first rituximab dose for both Arms A and B was always administered as a slow IV infusion, according to local standard practice. Faster infusion rates were permitted after Cycle 1, according to local practice. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Subject analysis set title
    Rituximab Subcutaneous (SC)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Each treatment cycle consisted of a single SC injection of rituximab administered at a fixed dose of 1400 mg. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Subject analysis set title
    Arm A (ITT)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Subjects received one cycle of rituximab 375 mg/m^2 IV, then three cycles of rituximab 1400mg SC, followed by four cycles of rituximab 375 mg/m^2 IV in combination with a standard chemotherapy of CHOP, CVP, or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator. The analysed intent-to treat (ITT) population included all subjects who were randomised in the study.

    Subject analysis set title
    Arm B (ITT)
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Subjects received four cycles of rituximab 375 mg/m^2 IV followed by four cycles of rituximab 1400mg SC in combination with a standard chemotherapy of CHOP, CVP, or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator. The analysed ITT population included all subjects who were randomised in the study.

    Primary: Percentage of Subjects Indicating a Preference for Rituximab Subcutaneous (SC) Over Rituximab Intravenously (IV) at Cycle 6

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    End point title
    Percentage of Subjects Indicating a Preference for Rituximab Subcutaneous (SC) Over Rituximab Intravenously (IV) at Cycle 6 [1]
    End point description
    Subjects who preferred rituximab SC over rituximab IV, along with the corresponding 95% confidence interval (CI), were estimated using the patient preference questionnaire (PPQ) after completing cycle 6. Intent-to treat (ITT) population included all subjects who were randomised in the study.
    End point type
    Primary
    End point timeframe
    Cycle 6 (up to 24 weeks)
    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: Only descriptive data was planned to be reported.
    End point values
    Arm A (ITT) Arm B (ITT)
    Number of subjects analysed
    372
    371
    Units: percentage of subjects
        number (confidence interval 95%)
    79.1 (74.2 to 83.5)
    80.6 (75.7 to 84.8)
    No statistical analyses for this end point

    Primary: Percentage of Subjects Indicating a Preference for Rituximab Subcutaneous (SC) Over Rituximab Intravenously (IV) at Cycle 8

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    End point title
    Percentage of Subjects Indicating a Preference for Rituximab Subcutaneous (SC) Over Rituximab Intravenously (IV) at Cycle 8 [2]
    End point description
    Subjects who preferred rituximab SC over rituximab IV, along with the corresponding 95% CI, were estimated using the patient preference questionnaire (PPQ) after completing cycle 8. ITT population included all subjects who were randomised in the study.
    End point type
    Primary
    End point timeframe
    Cycle 8 (up to 32 weeks)
    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: Only descriptive data was planned to be reported.
    End point values
    Arm A (ITT) Arm B (ITT)
    Number of subjects analysed
    372
    371
    Units: percentage of subjects
        number (confidence interval 95%)
    77.1 (71.9 to 81.8)
    84.2 (79.6 to 88.2)
    No statistical analyses for this end point

    Secondary: Number of Subjects With Treatment Emergent Adverse Events (AEs)

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    End point title
    Number of Subjects With Treatment Emergent Adverse Events (AEs)
    End point description
    An AE was defined as any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. The safety population included all subjects who received at least one dose of rituximab.
    End point type
    Secondary
    End point timeframe
    Randomization of first participant to clinical cutoff (approximately 25 months)
    End point values
    Arm A Arm B
    Number of subjects analysed
    371
    369
    Units: subjects
    344
    340
    No statistical analyses for this end point

    Secondary: Time Required for Rituximab Administration (Subcutaneous [SC] or Intravenous [IV])

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    End point title
    Time Required for Rituximab Administration (Subcutaneous [SC] or Intravenous [IV])
    End point description
    Administration time was defined as the time from start to end of the SC injection or from start to end of the IV infusion. ITT population included all subjects who were randomised in the study.
    End point type
    Secondary
    End point timeframe
    Cycle 2-4, cycle 5-8 for both SC and IV (up to 32 weeks)
    End point values
    Rituximab Intravenous (IV) Rituximab Subcutaneous (SC)
    Number of subjects analysed
    740
    687
    Units: minutes
        median (full range (min-max))
    838 (0 to 3967)
    22 (0 to 1242)
    No statistical analyses for this end point

    Secondary: Cancer Therapy Satisfaction Questionnaire (CTQS) Score

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    End point title
    Cancer Therapy Satisfaction Questionnaire (CTQS) Score
    End point description
    CTSQ is a validated 16-item questionnaire that measures three domains related to participants' satisfaction with cancer therapy. These include expectations of therapy, feelings about side effects, and satisfaction with therapy. Each domain is scored on a scale of 0 to 100, with higher scores indicative of more positive feelings toward therapy. The score for each domain was averaged among all participants. ITT population included all subjects who were randomized in the study. Here, n specifies the number of participants who were evaluable at specified time points.
    End point type
    Secondary
    End point timeframe
    During cycle 4, 8 of treatment (up to 32 weeks)
    End point values
    Rituximab Intravenous (IV) Rituximab Subcutaneous (SC)
    Number of subjects analysed
    740
    687
    Units: units on a scale
    arithmetic mean (standard deviation)
        Expectations of therapy domain (n=631, 627)
    80.84 ( 18.365 )
    81.96 ( 17.856 )
        Feelings about side effects domain (n=630, 624)
    60.69 ( 22.266 )
    61.62 ( 22.323 )
        Satisfaction with therapy domain (n=619, 623)
    84.58 ( 12.207 )
    85.38 ( 11.284 )
    No statistical analyses for this end point

    Secondary: Rituximab Administration Satisfaction Questionnaire (RASQ) Score

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    End point title
    Rituximab Administration Satisfaction Questionnaire (RASQ) Score
    End point description
    RASQ is a 20-item questionnaire that measures five domains related to the impact of treatment administration. These include physical impact, psychological impact, impact on activities of daily living (ADLs), convenience, and satisfaction. Each domain is scored on a scale of 0 to 100, with higher scores indicative of more positive feelings toward therapy. The score for each domain was averaged among all participants. ITT population included all subjects who were randomized in the study. Here, n specifies the number of subjects who were evaluable at specified time points.
    End point type
    Secondary
    End point timeframe
    During cycle 4, 8 of treatment (up to 32 weeks)
    End point values
    Rituximab Intravenous (IV) Rituximab Subcutaneous (SC)
    Number of subjects analysed
    740
    687
    Units: units on a scale
    arithmetic mean (standard deviation)
        Physical impact domain (n=622,619)
    82.26 ( 15.584 )
    82.07 ( 15.85 )
        Psychological Impact domain (n=614,612)
    77.7 ( 16.377 )
    84.01 ( 14.356 )
        Impact on activities of daily living (n=433,461)
    57.66 ( 25.148 )
    83.95 ( 16.537 )
        Convenience domain (n=619,599)
    59.03 ( 20.75 )
    81.02 ( 13.119 )
        Satisfaction domain (n=617,624)
    74.86 ( 19.368 )
    87.28 ( 14.964 )
    No statistical analyses for this end point

    Secondary: Complete Response (CR) Rate

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    End point title
    Complete Response (CR) Rate
    End point description
    CR rate was assessed according to the International Working Group (IWG) Response Criteria (CHESON ET AL 1999) and included CR and CR unconfirmed (CRu). CR: complete disappearance of all clinical and radiographic evidence of disease and disease-related symptoms, regression of lymph nodes to normal size, absence of splenomegaly, and absence of bone marrow involvement. Cru: disappearance of clinical and radiographic evidence of disease and absence of splenomegaly, with regression of lymph nodes by > 75 % but still >1.5 cm in size, and indeterminate bone marrow assessment. Assessments were based on CT scans with contrast of the neck, chest, and abdomen or other diagnostic means, if applicable. Other methods (e.g. MRI) were acceptable for subjects in whom contrast CT scans were contraindicated. ITT population included all subjects who were randomised in the study. Here, 99999 indicates median and upper and lower limits of CI (99999 and -99999) since they were not reached for this endpoint.
    End point type
    Secondary
    End point timeframe
    28 (± 3 days) after Day 1 of the last dose of induction treatment
    End point values
    Arm A (ITT) Arm B (ITT)
    Number of subjects analysed
    310 [3]
    315 [4]
    Units: percentage of subjects
        number (confidence interval 95%)
    51.3 (45.6 to 57)
    52.4 (46.7 to 58)
    Notes
    [3] - Number of subjects analysed specifies number of subjects who were evaluable for this endpoint.
    [4] - Number of subjects analysed specifies number of subjects who were evaluable for this endpoint.
    No statistical analyses for this end point

    Secondary: Event-free Survival (EFS)

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    End point title
    Event-free Survival (EFS)
    End point description
    EFS was defined as the time from randomization to first occurrence of progression or relapse according to IWG. IWG criteria uses the following categories: CR: complete disappearance of all clinical and radiographic evidence of disease and disease-related symptoms; partial response (PR): at least 50% decrease in sum of the product of the diameters of up to six of the largest dominant nodes or nodal masses; stable disease (SD): subject fails to attain a CR or PR, but does not reach progressive disease (PD); PD: Lymph nodes considered abnormal if the long axis is more than 1.5 cm regardless of the short axis. Lymph node has a long axis of 1.1 to 1.5 cm, it is considered abnormal if its short axis is more than 1.0. Lymph nodes <= 1.0 × <= 1.0 cm would not be considered as abnormal for PD. ITT population included all subjects who were randomised in the study. Here, 99999 indicates median and upper and lower limits of CI (99999 and -99999) since they were not reached for this endpoint.
    End point type
    Secondary
    End point timeframe
    From the time of randomization until disease progression or 24 months post treatment follow up or which ever occur first (approximately 25 months)
    End point values
    Arm A (ITT) Arm B (ITT)
    Number of subjects analysed
    372
    371
    Units: months
        median (confidence interval 95%)
    99999 (-99999 to 99999)
    99999 (-99999 to 99999)
    No statistical analyses for this end point

    Secondary: Disease-free Survival (DFS)

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    End point title
    Disease-free Survival (DFS)
    End point description
    DFS was defined as the period from the data of the initial CR/CRu until the date of relapse or death from any cause, whichever occurred first. ITT population included all subjects who were randomised in the study. Here, 99999 indicates median and upper and lower limits of CI (99999 and -99999) since they were not reached for this endpoint.
    End point type
    Secondary
    End point timeframe
    From the time of randomization until disease progression or 24 months post treatment follow up or which ever occur first (approximately 25 months)
    End point values
    Arm A (ITT) Arm B (ITT)
    Number of subjects analysed
    372
    371
    Units: months
        median (confidence interval 95%)
    99999 (-99999 to 99999)
    99999 (-99999 to 99999)
    No statistical analyses for this end point

    Secondary: Progression-free Survival (PFS)

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    End point title
    Progression-free Survival (PFS)
    End point description
    PFS was defined as the time from randomization to the first occurrence of progression or relapse, according to the IWG response criteria. IWG criteria uses the following categories: CR: Complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy; PR: At least a 50% decrease in SPD of up to six of the largest dominant nodes or nodal masses; SD: participants fails to attain the criteria needed for a CR or PR, but does not fulfill those for PD; PD: Lymph nodes considered abnormal if the long axis is more than 1.5 cm regardless of the short axis. Lymph node has a long axis of 1.1 to 1.5 cm, it is considered abnormal if its short axis is more than 1.0. Lymph nodes <= 1.0 × <= 1.0 cm would not be considered as abnormal for PD. ITT population included all subjects who were randomised in the study. Here, 99999 indicates median and upper and lower limits of CI (99999 and -99999) since they were not reached for this endpoint.
    End point type
    Secondary
    End point timeframe
    From the time of randomization until disease progression or 24 months post treatment follow up or which ever occur first (approximately 25 months)
    End point values
    Arm A (ITT) Arm B (ITT)
    Number of subjects analysed
    372
    371
    Units: months
        median (confidence interval 95%)
    99999 (-99999 to 99999)
    99999 (-99999 to 99999)
    No statistical analyses for this end point

    Secondary: Overall Survival (OS)

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    End point title
    Overall Survival (OS)
    End point description
    OS was defined as the time from randomization to death from any cause. ITT population included all subjects who were randomised in the study. Here, 99999 indicates median and upper and lower limits of CI (99999 and -99999) since they were not reached for this endpoint.
    End point type
    Secondary
    End point timeframe
    From the time of randomization until disease progression or 24 months post treatment follow up or which ever occur first (approximately 25 months)
    End point values
    Arm A (ITT) Arm B (ITT)
    Number of subjects analysed
    372
    371
    Units: months
        median (confidence interval 95%)
    99999 (-99999 to 99999)
    99999 (-99999 to 99999)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects With Anti-Rituximab Antibodies Over Time

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    End point title
    Percentage of Subjects With Anti-Rituximab Antibodies Over Time
    End point description
    The safety population included all subjects who received at least one dose of rituximab. Here, n specifies the number of subjects who were evaluable at specified time points.
    End point type
    Secondary
    End point timeframe
    pre-dose Cycle 1 to 8, interim staging, final staging, 6, 12 months follow-up, end of study (approximately 25 months)
    End point values
    Arm A Arm B
    Number of subjects analysed
    371
    369
    Units: percentage of subjects
    number (not applicable)
        Cycle 1 (n=332,330)
    2.1
    3
        Cycle 2 (n=324,322)
    2.2
    2.2
        Cycle 3 (n=319,318)
    0.3
    0.3
        Cycle 4 (n=315,315)
    0
    0.3
        Interim staging (n=271,268)
    0
    0
        Cycle 5 (n=234,248)
    0
    0
        Cycle 6 (n=281,281)
    0
    0
        Cycle 7 (n=263,279)
    0
    0
        Cycle 8 (n=247,267)
    0
    0
        Final staging (n=219,234)
    0
    0
        Follow-up, 6 months (n=75,84)
    0
    0
        Follow-up, 12 months (n=16,8)
    0
    0
        End of study/early treatment termination (n=22,17)
    0
    0
    No statistical analyses for this end point

    Secondary: Percentage of Subjects With Anti-Recombinant Human Hyaluronidase (rHuPH20) Antibodies Over Time

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    End point title
    Percentage of Subjects With Anti-Recombinant Human Hyaluronidase (rHuPH20) Antibodies Over Time
    End point description
    The safety population included all subjects who received at least one dose of rituximab. Here, n specifies the number of subjects who were evaluable at specified time points.
    End point type
    Secondary
    End point timeframe
    pre-dose Cycle 2 to 8, interim staging, final staging, 6, 12 months follow-up, end of study (approximately 25 months)
    End point values
    Arm A Arm B
    Number of subjects analysed
    371
    369
    Units: percentage of subjects
    number (not applicable)
        Cycle 2 (n=302,3)
    7
    33.3
        Cycle 3 (n=294,1)
    6.5
    100
        Cycle 4 (n=280,1)
    7.1
    100
        Interim staging (n=240,233)
    9.2
    10.7
        Cycle 5 (n=0,229)
    0
    10
        Cycle 6 (n=2,263)
    0
    11
        Cycle 7 (n=2,260)
    50
    11.2
        Cycle 8 (n=0,253)
    0
    11.5
        Final staging (n=200,221)
    10
    14
        Follow-up, 6 months (n=72,81)
    8.3
    13.6
        Follow-up, 12 months (n=15,8)
    6.7
    0
        End of study/early treatment termination (n=20,19)
    15
    5.3
    No statistical analyses for this end point

    Secondary: Summary of Observed Serum Rituximab Concentration

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    End point title
    Summary of Observed Serum Rituximab Concentration
    End point description
    The safety population included all subjects who received at least one dose of rituximab. Here, n specifies the number of subjects who were evaluable at specified time points.
    End point type
    Secondary
    End point timeframe
    pre-dose Cycle 1 to 8, interim staging, final staging, 6, 12 months follow-up, end of study (approximately 25 months)
    End point values
    Arm A Arm B
    Number of subjects analysed
    371
    369
    Units: microgram per millilitre
    arithmetic mean (standard deviation)
        Cycle 1 (n=283,279)
    3850.3 ( 21522.14 )
    1464.4 ( 9399.08 )
        Cycle 2 (n=282,278)
    25104.2 ( 19533.34 )
    24325.2 ( 18222.16 )
        Cycle 3 (n=279,280)
    63001.4 ( 29726.55 )
    45897.9 ( 31362.32 )
        Cycle 4 (n=281,281)
    88888.5 ( 41266.45 )
    59001.4 ( 59001.4 )
        Interim staging (n=243,245)
    118022.6 ( 51063.31 )
    77004.9 ( 28952.1 )
        Cycle 5 (n=213,228)
    108828 ( 54263.69 )
    69654.5 ( 30207.29 )
        Cycle 6 (n=266,261)
    102664.3 ( 48904.9 )
    98704.6 ( 39910.07 )
        Cycle 7 (n=252,259)
    97646.4 ( 45647.06 )
    116129.7 ( 44374.87 )
        Cycle 8 (n=237,251)
    107452.3 ( 49909.38 )
    136598.4 ( 53529.14 )
        Final staging (n=211,219)
    89052.3 ( 43629.85 )
    121032.9 ( 60682.31 )
        Follow-up, 6 months (n=74,84)
    8153.2 ( 12744.38 )
    9732.2 ( 15570.33 )
        Follow-up, 12 months (n=16,8)
    4458.9 ( 8792.36 )
    5605 ( 12353.68 )
        End of study/early treatment termination (n=23,21)
    53774.7 ( 49446.12 )
    63783.3 ( 57845.33 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Randomization of first participant to clinical cutoff (approximately 25 months)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    15.0
    Reporting groups
    Reporting group title
    Arm B
    Reporting group description
    Subjects in Arm B received four cycles of rituximab 375 mg/m^2 IV followed by four cycles of rituximab 1400 mg SC in combination with a standard chemotherapy of CHOP, CVP, or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Reporting group title
    Arm A
    Reporting group description
    Subjects in Arm A received one cycle of rituximab 375 milligram per metre square (mg/m^2) intravenously (IV), then three cycles of rituximab 1400mg subcutaneously (SC), followed by four cycles of rituximab 375 mg/m^2 IV in combination with a standard chemotherapy of cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone/prednisolone (CHOP), cyclcophosphamie, vincristine, prednisone/prednisolone (CVP), or bendamustine. Rituximab was administered on Day 1 of each treatment cycle followed by administration of the preselected chemotherapy. Cycles were repeated every 14, 21, or 28 days, depending on the combination chemotherapy regimen selected by the investigator.

    Serious adverse events
    Arm B Arm A
    Total subjects affected by serious adverse events
         subjects affected / exposed
    118 / 369 (31.98%)
    126 / 371 (33.96%)
         number of deaths (all causes)
    9
    8
         number of deaths resulting from adverse events
    4
    2
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Papillary thyroid cancer
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal cell cancer
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Circulatory collapse
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    3 / 369 (0.81%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Orthostatic hypotension
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vasculitis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Venous thrombosis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Venous thrombosis limb
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 369 (0.27%)
    4 / 371 (1.08%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Chest pain
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    0 / 369 (0.00%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injection site warmth
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    6 / 369 (1.63%)
    11 / 371 (2.96%)
         occurrences causally related to treatment / all
    1 / 8
    8 / 13
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Anaphylactic reaction
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cytokine release syndrome
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypersensitivity
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute respiratory distress syndrome
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Bronchospasm
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dyspnoea
         subjects affected / exposed
    0 / 369 (0.00%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Interstitial lung disease
         subjects affected / exposed
    0 / 369 (0.00%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonitis
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 369 (0.27%)
    3 / 371 (0.81%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Suicide attempt
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Depression
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    C-reactive protein increased
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lymphocyte count decreased
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutrophil count decreased
         subjects affected / exposed
    9 / 369 (2.44%)
    11 / 371 (2.96%)
         occurrences causally related to treatment / all
    7 / 13
    10 / 14
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    White blood cell count decreased
         subjects affected / exposed
    2 / 369 (0.54%)
    3 / 371 (0.81%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    1 / 369 (0.27%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infusion related reaction
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Overdose
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Radius fracture
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Spinal fracture
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Myocardial Infarction
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Acute coronary syndrome
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Angina pectoris
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 369 (0.27%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bradycardia
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Depressed level of consciousness
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dizziness
         subjects affected / exposed
    0 / 369 (0.00%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Headache
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hemiparesis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypertensive encephalopathy
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Neuropathy peripheral
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Paraparesis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral sensory neuropathy
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 369 (0.27%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vith nerve paralysis
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile Neutropenia
         subjects affected / exposed
    28 / 369 (7.59%)
    29 / 371 (7.82%)
         occurrences causally related to treatment / all
    16 / 36
    16 / 36
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Anaemia
         subjects affected / exposed
    4 / 369 (1.08%)
    3 / 371 (0.81%)
         occurrences causally related to treatment / all
    2 / 4
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Leukopenia
         subjects affected / exposed
    2 / 369 (0.54%)
    3 / 371 (0.81%)
         occurrences causally related to treatment / all
    1 / 2
    4 / 8
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    16 / 369 (4.34%)
    17 / 371 (4.58%)
         occurrences causally related to treatment / all
    7 / 19
    13 / 30
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Pancytopenia
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    1 / 369 (0.27%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal Pain lower
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anal fistula
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Constipation
         subjects affected / exposed
    1 / 369 (0.27%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    3 / 369 (0.81%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Enterocolitis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal obstruction
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ileal perforation
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal wall haematoma
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ileus
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ileus paralytic
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intestinal perforation
         subjects affected / exposed
    2 / 369 (0.54%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intra-abdominal haemorrhage
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Oesophagitis
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Small intestinal perforation
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subileus
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    2 / 369 (0.54%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis Acute
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholestasis
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Angioedema
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Purpura
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rash
         subjects affected / exposed
    1 / 369 (0.27%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Stevens-Johnson syndrome
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Nephropathy toxic
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal failure acute
         subjects affected / exposed
    2 / 369 (0.54%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Urinary tract pain
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Endocrine disorders
    Diabetes insipidus
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperthyroidism
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bone pain
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gouty arthritis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myofascial pain syndrome
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myopathy
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Bronchopneumonia
         subjects affected / exposed
    2 / 369 (0.54%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 1
    1 / 1
    Lung Infection
         subjects affected / exposed
    4 / 369 (1.08%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    3 / 4
    2 / 2
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Oropharyngeal Candidiasis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Septic Shock
         subjects affected / exposed
    2 / 369 (0.54%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 2
         deaths causally related to treatment / all
    1 / 1
    0 / 1
    Anal abscess
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Appendicitis
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Appendicitis Perforated
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atypical pneumonia
         subjects affected / exposed
    2 / 369 (0.54%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    2 / 369 (0.54%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 3
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchopulmonary Aspergillosis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 369 (0.27%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cystitis
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diverticulitis
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Erysipelas
         subjects affected / exposed
    1 / 369 (0.27%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Fungal infection
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    1 / 369 (0.27%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis Bacterial
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Herpes Zoster
         subjects affected / exposed
    3 / 369 (0.81%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    3 / 3
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infection
         subjects affected / exposed
    0 / 369 (0.00%)
    3 / 371 (0.81%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    0 / 369 (0.00%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injection site abscess
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Kidney infection
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Localised infection
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lymph node abscess
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Mucosal infection
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oral fungal infection
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritonsillitis
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumocystis Jirovecii Pneumonia
         subjects affected / exposed
    0 / 369 (0.00%)
    2 / 371 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    5 / 369 (1.36%)
    11 / 371 (2.96%)
         occurrences causally related to treatment / all
    1 / 5
    2 / 11
         deaths causally related to treatment / all
    0 / 0
    0 / 2
    Post procedural infection
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Progressive multifocal leukoencephalopathy
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyoderma
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory Tract Infection
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    6 / 369 (1.63%)
    3 / 371 (0.81%)
         occurrences causally related to treatment / all
    3 / 6
    1 / 3
         deaths causally related to treatment / all
    0 / 1
    0 / 1
    Skin infection
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Soft tissue infection
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Staphylococcal sepsis
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subcutaneous abscess
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tooth infection
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Upper Respiratory Tract Infection
         subjects affected / exposed
    2 / 369 (0.54%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary Tract Infection
         subjects affected / exposed
    2 / 369 (0.54%)
    3 / 371 (0.81%)
         occurrences causally related to treatment / all
    1 / 2
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Viral infection
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenic sepsis
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    2 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia viral
         subjects affected / exposed
    1 / 369 (0.27%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dehydration
         subjects affected / exposed
    1 / 369 (0.27%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gout
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    2 / 369 (0.54%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypernataemia
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyponatraemia
         subjects affected / exposed
    1 / 369 (0.27%)
    0 / 371 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tumor lysis syndrome
         subjects affected / exposed
    0 / 369 (0.00%)
    1 / 371 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Arm B Arm A
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    302 / 369 (81.84%)
    301 / 371 (81.13%)
    Investigations
    Neutrophil count decreased
         subjects affected / exposed
    22 / 369 (5.96%)
    24 / 371 (6.47%)
         occurrences all number
    31
    41
    White blood cell count decreased
         subjects affected / exposed
    18 / 369 (4.88%)
    21 / 371 (5.66%)
         occurrences all number
    37
    43
    Nervous system disorders
    Headache
         subjects affected / exposed
    29 / 369 (7.86%)
    27 / 371 (7.28%)
         occurrences all number
    33
    36
    Neuropathy peripheral
         subjects affected / exposed
    46 / 369 (12.47%)
    36 / 371 (9.70%)
         occurrences all number
    51
    41
    Paraesthesia
         subjects affected / exposed
    34 / 369 (9.21%)
    17 / 371 (4.58%)
         occurrences all number
    38
    18
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    62 / 369 (16.80%)
    67 / 371 (18.06%)
         occurrences all number
    90
    90
    Leukopenia
         subjects affected / exposed
    30 / 369 (8.13%)
    40 / 371 (10.78%)
         occurrences all number
    64
    80
    Neutropenia
         subjects affected / exposed
    90 / 369 (24.39%)
    66 / 371 (17.79%)
         occurrences all number
    175
    131
    General disorders and administration site conditions
    Chills
         subjects affected / exposed
    15 / 369 (4.07%)
    28 / 371 (7.55%)
         occurrences all number
    21
    33
    Fatigue
         subjects affected / exposed
    87 / 369 (23.58%)
    67 / 371 (18.06%)
         occurrences all number
    118
    90
    Mucosal inflammation
         subjects affected / exposed
    26 / 369 (7.05%)
    26 / 371 (7.01%)
         occurrences all number
    34
    32
    Pyrexia
         subjects affected / exposed
    45 / 369 (12.20%)
    52 / 371 (14.02%)
         occurrences all number
    61
    63
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    19 / 369 (5.15%)
    20 / 371 (5.39%)
         occurrences all number
    19
    24
    Abdominal pain upper
         subjects affected / exposed
    22 / 369 (5.96%)
    17 / 371 (4.58%)
         occurrences all number
    22
    18
    Constipation
         subjects affected / exposed
    59 / 369 (15.99%)
    58 / 371 (15.63%)
         occurrences all number
    75
    75
    Diarrhoea
         subjects affected / exposed
    47 / 369 (12.74%)
    42 / 371 (11.32%)
         occurrences all number
    55
    67
    Nausea
         subjects affected / exposed
    99 / 369 (26.83%)
    81 / 371 (21.83%)
         occurrences all number
    144
    119
    Stomatitis
         subjects affected / exposed
    20 / 369 (5.42%)
    21 / 371 (5.66%)
         occurrences all number
    21
    26
    Vomiting
         subjects affected / exposed
    55 / 369 (14.91%)
    40 / 371 (10.78%)
         occurrences all number
    64
    56
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    38 / 369 (10.30%)
    41 / 371 (11.05%)
         occurrences all number
    44
    47
    Dyspnoea
         subjects affected / exposed
    21 / 369 (5.69%)
    19 / 371 (5.12%)
         occurrences all number
    22
    19
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    53 / 369 (14.36%)
    58 / 371 (15.63%)
         occurrences all number
    53
    60
    Pruritus
         subjects affected / exposed
    15 / 369 (4.07%)
    27 / 371 (7.28%)
         occurrences all number
    15
    28
    Rash
         subjects affected / exposed
    20 / 369 (5.42%)
    20 / 371 (5.39%)
         occurrences all number
    27
    20
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    29 / 369 (7.86%)
    24 / 371 (6.47%)
         occurrences all number
    31
    24
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    19 / 369 (5.15%)
    20 / 371 (5.39%)
         occurrences all number
    22
    25
    Upper respiratory tract infection
         subjects affected / exposed
    18 / 369 (4.88%)
    20 / 371 (5.39%)
         occurrences all number
    20
    24
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    31 / 369 (8.40%)
    29 / 371 (7.82%)
         occurrences all number
    38
    38

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    21 Feb 2013
    1. For each anti-rituximab sample taken, drug-concentration analysis was added as a requirement at each scheduled time point. 2. The 30-minute postdose anti-rHuPH20 samples were removed from every cycle. 3. Additional anti-rituximab and anti-rHuPH20 samples were required during the follow up period (i.e., at 6 and 12 months). 4. The screening/baseline anti-rituximab sample was removed (because the Cycle 1 predose sample could also act as the baseline sample). 5. The Schedule of Assessments and applicable footnotes were revised to reflect the above changes and to correct some inconsistencies. Immunogenicity sampling schedules for Treatment Arms A and B were included for ease of reference during the study. 6. The prephase corticosteroid example was increased from 3 days to 5 days in subjects with aggressive NHL. 7. The reporting requirements for SAEs and AEs of special interest after the end of study were revised in alignment with recent global requirements. 8. The needle gauge was revised to include both 25- and 27-gauge needles. 9. The word “MabThera” (trade name) was replaced with the word “rituximab” (generic name) in the PPQ for consistency within the protocol.
    02 Jun 2014
    1. It was originally anticipated that the proportion of subjects preferring rituximab SC would be approximately 60%. In order to have a sample size of 720 subjects for analysis of the primary endpoint, the enrollment target was originally 900. However, a preplanned interim analysis revealed that approximately 80% of subjects preferred rituximab SC. After a discussion with the IDMC, the sample size was recalculated, decreasing the required number of subjects from 720 to 560 subjects and the enrollment target to 700 subjects. 2. Although subjects with active hepatitis B or hepatitis C virus were excluded from the study, some hepatitis-related conditions were permitted. 3. As the blastic variant of mantle cell lymphoma is neither DLBCL nor NHL, this was removed as an exclusion criterion from the study. 4. Subjects receiving prior intrathecal methotrexate for central nervous system prophylaxis in DLBCL were not excluded. 5. For study entry, subjects must have had histologically confirmed, previously untreated CD20+ DLBCL or CD20+ follicular NHL Grade 1, 2, or 3a, according to the World Health Organization (WHO) classification system. The patient’s diagnosis was to be histologically confirmed prior to randomization. It was clarified that fine-needle aspiration samples were not be used as the sole material for pathological diagnosis. Lymph node excision or adequate core biopsy was required for the diagnosis of diffuse large B cell lymphoma or follicular NHL. 6. For assessment of hematologic function for study eligibility criteria, it was clarified that transfusions were not permitted within 2 weeks prior to the start of study drug administration. 7. The acceptable length of a cycle delay was increased from 10 days to 3 weeks, making it consistent with the 3-week window allowed for the treatment of toxicities and/or AEs.
    02 Jun 2014
    8. To allow investigators to decide how best to manage specific hematologic and non-hematologic AEs associated with rituximab-CHOP treatment, the protocol “guidelines” were changed to be considered as “recommendations.” Patient management decisions that did not adhere to these recommendations were no longer to be considered as major protocol violations. 9. To comply with doxorubicin’s prescribing information, subjects receiving rituximab-CHOP treatment who had a bilirubin value in the range of 20–50 micro mol per liter had their dose of doxorubicin reduced by 50%. 10. Corticosteroids could now be given as part of premedication to reduce the incidence and severity of injection-related reactions. 11. It was clarified that long-term treatment (>1 month) with intermittent corticosteroids for prophylaxis (e.g., contrast dye allergy) or for treatment of autoimmune conditions was permitted. 12. To comply with the guidance given in the current rituximab SC Investigator’s Brochure, subjects were now to be observed for at least 15 minutes following rituximab SC administration. A longer period may have been appropriate in subjects with an increased risk of hypersensitivity reactions. 13. To conform to standards of clinical practice, subjects with a high risk of central nervous system involvement could now receive prophylactic intrathecal methotrexate. Intrathecal methotrexate was to be administered according to local standards. 14. To better follow clinical practice, subjects were weighed prior to each treatment so that BSA could be recalculated if necessary. Cyclophosphamide, vincristine, doxorubicin, and bendamustine doses were to be recalculated only if the patient’s weight changed by more than ± 10% from baseline. 15. It was clarified that non-investigational medicinal products given as part of the subject’s chemotherapy must have been approved for this indication.
    02 Jun 2014
    16. Additional chemotherapy regimens of CHOP every 14 days × 8 cycles, CHOP every 28 days × 8 cycles, CVP every 21 days × 6 cycles, and CVP every 28 days × 6 cycles were now permitted. 17. The wording about stability and storage of rituximab SC was updated according to the latest Investigator’s Brochure. 18. It was clarified that the end-of-treatment response assessment, including radiology and imaging report, must have been obtained 28 (± 3) days after Day 1 of the last dose of induction treatment. The protocol previously stated that this must have been obtained between 4 and 8 weeks after Day 1 of the last treatment cycle, which was inconsistent with other parts of the protocol describing the final staging assessment. 19. As some study sites were only able to perform an international normalized ratio test, coagulation tests now included at least one of the following tests: international normalized ratio, prothrombin time, and activated partial thromboplastin time. 20. Lactate dehydrogenase (LDH) was previously only required to be tested at screening. However, as normalization of LDH was part of the response assessment according to the International Working Group (Cheson et al. 1999), subjects with an abnormal LDH at screening also had LDH included as part of their interim and final staging assessments. In addition, subjects with abnormal alkaline phosphatase, albumin, blood urea nitrogen, or C reactive protein at screening had these tests repeated as part of their interim and final staging assessments. 21. Neutrophil and lymphocyte counts were added to hematology tests to better monitor safety and to be consistent with other rituximab clinical trial protocols. 22. It was clarified that it was acceptable for subjects to have an MRI if they had a contraindication to CT scans (e.g., subjects with contrast allergy or impaired renal clearance).
    02 Jun 2014
    23. It was clarified that CT scans of the pelvis need only be done if clinically indicated. CT scans of the neck, chest, and abdomen continued to be required for all study subjects. 24. To minimize discrepancy between the calculation of follow-up visit dates and CT scan intervals, the wording was modified to allow sites to follow the CT frequency according to local standard of care. 25. The follow-up of subjects after induction treatment occurred every 3 months (± 2 weeks). It was clarified that the visit schedule would be calculated based on Visit 9. 26. The wording around the timing of Visit 5 (interim staging) was clarified. All interim staging and Visit 5 must have occurred prior to Visit 6 (initiation of Cycle 5), regardless of whether the CHOP regimen was given every 14 or 21 days. 27. To reduce redundant sampling, if Visit 5 (interim staging) was within 7 days of Visit 6 (initiation of Cycle 5), there was no need to collect the samples for Visit 6, i.e., only Visit 5 samples were to be collected and labeled as Visit 5. 28. During the post-treatment follow-up (observation) period, laboratory assessments and physical examinations were performed only if clinically indicated. 29. In the definition of disease-free and PFS, it was clarified that in terms of the event (relapse, progression, or death as relevant), these outcomes were to be assessed based on the event that occurred first. 30. The protocol wording was updated to reflect the latest Roche protocol template regarding the following: a) If an adverse event worsened in severity and became serious b) If the electronic data capture system was not available and a pregnancy reporting form needed to be submitted c) Investigators were to document and explain any protocol deviations 31. If new anti-lymphoma treatment had been started, any response to therapy was documented in electronic Case Report Form; however, it was clarified that response assessments were not specifically mandated by this study.
    02 Jun 2014
    32. It was clarified that CT scans of the pelvis need only be done if clinically indicated. CT scans of the neck, chest, and abdomen continued to be required for all study subjects. 33. To minimize discrepancy between the calculation of follow-up visit dates and CT scan intervals, the wording was modified to allow sites to follow the CT frequency according to local standard of care. 34. The follow-up of subjects after induction treatment occurred every 3 months (± 2 weeks). It was clarified that the visit schedule would be calculated based on Visit 9. 35. The wording around the timing of Visit 5 (interim staging) was clarified. All interim staging and Visit 5 must have occurred prior to Visit 6 (initiation of Cycle 5), regardless of whether the CHOP regimen was given every 14 or 21 days. 36. To reduce redundant sampling, if Visit 5 (interim staging) was within 7 days of Visit 6 (initiation of Cycle 5), there was no need to collect the samples for Visit 6, i.e., only Visit 5 samples were to be collected and labeled as Visit 5. 37. During the post-treatment follow-up (observation) period, laboratory assessments and physical examinations were performed only if clinically indicated. 38. In the definition of disease-free and PFS, it was clarified that in terms of the event (relapse, progression, or death as relevant), these outcomes were to be assessed based on the event that occurred first. 39. The protocol wording was updated to reflect the latest Roche protocol template regarding the following: a) If an adverse event worsened in severity and became serious b) If the electronic data capture system was not available and a pregnancy reporting form needed to be submitted c) Investigators were to document and explain any protocol deviations 40. If new anti-lymphoma treatment had been started, any response to therapy was documented in electronic Case Report Form; however, it was clarified that response assessments were not specifically mandated by this study.
    02 Jun 2014
    41. After study closure initiation, unrelated AEs/SAEs occurring in an off-study patient who had started a new anti-cancer treatment did not need to be reported. 42. Based on current recruitment rates, the study recruitment period was increased from 12 to 18 months, and the study duration was correspondingly adjusted from 3.5 to 4 years. 43. Additional minor changes were made to improve clarity and consistency.

    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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