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    Summary
    EudraCT Number:2016-003897-41
    Sponsor's Protocol Code Number:D1699C00001
    National Competent Authority:Bulgarian Drug Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2017-01-09
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedBulgarian Drug Agency
    A.2EudraCT number2016-003897-41
    A.3Full title of the trial
    Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening
    Heart Failure or Cardiovascular Death in Patients with Chronic Heart
    Failure with Reduced Ejection Fraction
    Клинично изпитване, целящо да установи ефекта на Дапаглифлозин върху честотата на влошаване на сърдечната недостатъчност или сърдечно-съдова смърт, при пациенти с хронична сърдечна недостатъчност и с намалена фракция на изтласкване.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to evaluate if dapagliflozin treatment is effective in patients with heart failure by reducing the number of hospitalizations and urgent visits due to heart failure, and by reducing the risk of death.
    Изпитване, което да оцени дали лечението на сърдечна недостатъчност с дапаглифлозин е ефективно като води до намаляване на броя на: хоспитализациите и спешните визити по повод на сърдечна недостатъчност и намалява риска от смърт.

    A.3.2Name or abbreviated title of the trial where available
    DAPA HF
    ДАПА СН
    A.4.1Sponsor's protocol code numberD1699C00001
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorAstraZeneca AB
    B.1.3.4CountrySweden
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportAstraZeneca AB
    B.4.2CountrySweden
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAstraZeneca
    B.5.2Functional name of contact pointInformation Center
    B.5.3 Address:
    B.5.3.1Street AddressN/A
    B.5.3.2Town/ cityN/A
    B.5.3.3Post codeN/A
    B.5.3.4CountryUnited States
    B.5.6E-mailinformation.center@astrazeneca.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Forxiga
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca AB
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameDapagliflozin
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDAPAGLIFLOZIN PROPANEDIOL
    D.3.9.1CAS number 960404-48-2
    D.3.9.3Other descriptive nameDAPAGLIFLOZIN PROPANEDIOL MONOHYDRATE
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Forxiga
    D.2.1.1.2Name of the Marketing Authorisation holderAstraZeneca AB
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameDapagliflozin
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDAPAGLIFLOZIN PROPANEDIOL
    D.3.9.1CAS number 960404-48-2
    D.3.9.3Other descriptive nameDAPAGLIFLOZIN PROPANEDIOL MONOHYDRATE
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Chronic Heart Failure (HF) with Reduced Ejection Fraction
    Сърдечна недостатъчност с намалена фракция на изтласкване.
    E.1.1.1Medical condition in easily understood language
    Chronic Heart Failure (HF) with reduced pump function to eject blood flow.
    Сърдечна Недостатъчност, състояние, при което помпените възможности на сърцето са намалени и не може да изтласква кръвта в кръвотока.
    E.1.1.2Therapeutic area Diseases [C] - Cardiovascular Diseases [C14]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To determine whether dapagliflozin is superior to placebo, when added to standard of care, in reducing the incidence of CV death or a HF event (hospitalization for HF or equivalent HF event, ie an urgent HF visit).
    Да се определи дали ефекта на Дапаглифлозин , добавен към стандартната терапия, превъзхожда този на плацебо, при намаляване на честотата на сърдечно-съдова смърт или събития свързани със сърдечна недостатъчност (хоспитализация по повод на СН или еквивалентно събитие, напр. спешна визита по повод на сърдечна недостатъчност).
    E.2.2Secondary objectives of the trial
    1) To compare the effect of dapagliflozin versus placebo on CV death or hospitalization for HF.

    2) To compare the effect of dapagliflozin versus placebo on total number of recurrent HF hospitalizations and CV death.

    3) To compare the effect of treatment with dapagliflozin versus placebo on the Kansas City Cardiomiyopathy Questionnaire total symptom score for HF symptoms and physical limitations.

    4) To determine if dapagliflozin compared with placebo reduces the incidence of a worsening renal function composite outcome.

    5) To determine whether dapagliflozin, compared with placebo, reduces the incidence of all cause mortality.

    6) Safety Objective; To evaluate the safety and tolerability of dapagliflozin in this patient population.
    Да се сравни ефекта на дапаглифлозин, спрямо този на плацебо, при случаи на сърдечно-съдова смърт или хоспитализация по повод на СН.
    Да сравни ефекта на дапаглифлозин, спрямо този на плацебо, върху общия брой повтарящи се хоспитализации по повод на СН и върху случаите на сърдечно-съдовата смърт.
    Да се сравни ефекта на дапаглифлозин, спрямо този на плацебо, съгласно отговорите от обобщения клиничен резултат относно симптомите във въпросника KCCQ, касаещи сърдечна недостатъчност и физическа ограниченост.
    Да се определи дали Дапаглифлозин сравнен с плацебо, намалява случаите на комбинираната крайна точка от влошена бъбречна функция .
    Да се определи дали Дапаглифлозин сравнен с плацебо, намалява честотата на обща смъртност.
    Цел във връзка с безопасността: Да се оцени безопасността и поносимостта на Дапаглифлозин при пациенти от описаната популация
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    An echocardiographic sub-study is planned to be conducted in a subset of patients (approx. 300 - 400 patients) in the DAPA -HF trial. The sub-study is designed to evaluate the impact of dapagliflozin at a dose of 10 mg daily, compared to placebo, in addition to conventional heart failure treatment, on changes in cardiac structure and function as determined by echocardiography.
    В изпитването ДАПА СН се планира провеждането на ехокардиографско под-изпитване при определен брой пациенти (приблизително 300 - 400).Дизайнът на под-изпитването предвижда да се оцени ехографски ефекта на Дапаглифлозин 10 мг/дневно, сравнен с този на плацебо, и добавен към конвенционалната терапия по повод на СН, върху промените в сърдечната структура и функция.
    E.3Principal inclusion criteria
    • Provision of signed informed consent prior to any study specific procedures

    • Male or female, aged ≥18 years

    • Established documented diagnosis of symptomatic HFrEF (NYHA functional class
    II-IV), which has been present for at least 2 months

    • LVEF≤40%

    • Elevated N-terminal pro b-type natriuretic peptide (NT-proBNP) levels ≥600 pg/ml

    • Patients should receive background standard of care for HFrEF and be treated according to locally recognized guidelines

    • eGFR ≥30 ml/min/1.73 m2 (CKD-EPI formula) at enrolment (visit 1)
    1. Подписано информирано съгласие,преди каквито и да било процедури по изпитването
    2. Жени или мъже на възраст ≥ 18 г.
    3. Доказана и документирана диагноза: симптоматична Сърдечна недостатъчност с намалена фракция на изтласкване (функционален клас по NYHA II-IV), която е с давност от поне два месеца
    - Фракция на изтласкване за лява камера ≤ 40%
    - Повишени нива на N-terminal pro b-type натриуретичен пептид (NT-proBNP) ≥ 600 pg/ml
    - -Пациентите трябва да са на стандартна терапия по повод на СН с намалена фракция на изтласкване и да са лекувани съгласно локално приетите гайдлайни
    - eGFR ≥ 30 ml/min/1.73 m2 измерен съгласно формулата CKD-EPI на включващата визита (визита 1)
    E.4Principal exclusion criteria
    • Receiving therapy with an SGLT2 inhibitor within 8 weeks prior to enrolment or previous intolerance of an SGLT2 inhibitor

    • Type 1 diabetes mellitus

    • Symptomatic hypotension or systolic BP <95 mmHg

    • Current acute decompensated HF or hospitalization due to decompensated HF <4 weeks prior to enrolment

    • MI, unstable angina, stroke or transient ischemic attack within 12 weeks prior to enrolment

    • Coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting) or valvular repair/replacement within 12 weeks prior to enrolment or planned to undergo any of these operations after randomization

    • Implantation of a cardiac CRT within 12 weeks prior to enrolment or intent to implant a CRT device

    • Previous cardiac transplantation or implantation of a ventricular assistance device or similar device, or implantation expected after randomization

    • HF due to restrictive cardiomyopathy, active myocarditis, constrictive pericarditis, hypertrophic (obstructive) cardiomyopathy or uncorrected primary valvular disease

    • Symptomatic bradycardia or second or third degree heart block without a pacemaker

    • Severe (eGFR <30 mL/min/1.73 m2 by CKD-EPI), unstable or rapidly progressing renal disease at the time of randomization
    1.Пациентът е бил на лечение с SGLT2 инхибитор в рамките на 8 седмици преди включващата визита или е с непоносимост към SGLT2 инхибитор
    2.Диагноза ЗД Тип 1
    3.Симптоматична хипотензия или систолно кръвно налягане < 95 mmHg
    4.Понастоящем с остра декомпенсирана СН или хоспитализация по повод на декомпенсирана СН < 4 седмици преди включващата визита
    5.Прекарани миокарден инфаркт, нестабилна ангина, инсулт или транзиторна исхемична атака в рамките на 12 седмици преди включване
    6.Коронарна реваскуларизация ( PCI или CABG) или операция / смяна на сърдечна клапа в рамките на 12 седмици преди включване или планиране на някои от изброените процедури в следващите 3 месеца след рандомизация
    7.Имплантиране на сърдечно CRT устройство в рамките на 12 седмици преди включваща визита или планиране на такава имплантация
    8.Анамнеза за сърдечна трансплантация или имплантация на камерно асистиращо устройство или подобно устройство, или имплантацията е планувана за периода след рандомизация
    9.СН в резултат на рестриктивна кардиомиопатия, активен миокардит, констриктивен перикардит, хипертрофична (констриктивна) кардиомиопатия или некоригирана първична клапна болест
    10.Симптоматична брадикардия или втора или трета степен сърдечен блок без пейсмейкър
    11.Тежка (eGFR < 30 ml/min/1.73 m2 измерен съгласно формулата CKD-EPI), нестабилна или бързо прогресираща бъбречна болест към момента на рандомизация
    E.5 End points
    E.5.1Primary end point(s)
    Time to the first occurrence of any of the components of this composite:
    1. CV death
    2. Hospitalization for HF
    3. An urgent HF visit
    Сърдечно-съдова смърт
    Хоспитализация по повод на СН
    Спешна визита във връзка със СН
    E.5.1.1Timepoint(s) of evaluation of this end point
    The primary endpoint will be evaluated after at least when 844 primary endpoint events are accrued.
    Първичните крайни точки ще бъдат оценявани когато бъдат събрани поне 844 събития, които са първични крайни точки .
    E.5.2Secondary end point(s)
    1) Time to the first occurrence of either of the components of this composite:
    1. CV death
    2. Hospitalization for HF

    2) Total number of (first and recurrent) HF hospitalizations and CV death.

    3) Change from baseline measured at 8 months in the overall summary score of the KCCQ, a specific HF patient reported outcome questionnaire.

    4) Time to the first occurrence of any of the components of this composite:
    1. ≥50% sustained decline in eGFR
    2. Reaching End Stage Renal Disease (ESRD)
     - Sustained eGFR <15 ml/min/1.73m2 or,
     - Chronic dialysis treatment or,
     - Receiving a renal transplant
    3. Renal death

    5) Time to death from any cause.

    1) Време до първата поява на някои от компонентите:
    Сърдечно-съдова смърт
    Хоспитализация по повод сърдечна недостатъчност
    2) Общ брой на повтарящи се ( първата и последващите) хоспитализации по повод на
    сърдечна недостатъчност и на сърдечно-съдова смърт.
    3) Измерена на осмия месец промяна спрямо изходното ниво в обобщения клиничен резултат от KCCQ. KCCQ е специфичен въпросник, предназначен за пациенти със СН.
    4) Време до първата проява на някои от компонентите на комбинираната крайна точка:
    ≥ 50% продължително намаляване на eGFR
    Достигане на краен стадий на бъбречна недостатъчност
    - Поддържане на eGFR <15 ml/min/1.73m2 или
    - Хронично диализно лечение или,
    - Направена трансплантация на бъбрек
    - Бъбречна смърт
    5) Време до настъпване на смърт, независимо от причината.

    E.5.2.1Timepoint(s) of evaluation of this end point
    Change from baseline of the total symptom score of the KCCQ will be evaluated at 8 months after randomization. All other secondary endpoints will be evaluated after at least 844 primary endpoint events are accrued.
    Промяната спрямо изходното ниво на обобщения клиничен резултат относно симптомите от въпросника KCCQ ще бъде оценена 8 месеца след рандомизация. Всички останали вторични крайни точки ще бъдат оценени, когато бъдат събрани поне 844 първични събития
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic Yes
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Biomarker
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned20
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA132
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Brazil
    Bulgaria
    Canada
    China
    Czech Republic
    Denmark
    Germany
    Hungary
    India
    Japan
    Netherlands
    Poland
    Russian Federation
    Slovakia
    Sweden
    Taiwan
    United Kingdom
    United States
    Vietnam
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    The last visit of the last patient undergoing the study.
    Последна визита на последния пациент, участващ в изпитването.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years3
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 2250
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 2250
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    When applicable a legally representative, together with impartial witness, is allowed to sign the informed consent of behalf of a patient (i.e. illiterate patients).
    Когато се наложи е разрешено законно приемлив представител, заедно с независим свидетел, да подпише информираното съгласие от името на пациента ( напр. когато е неграмотен)
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state250
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 1650
    F.4.2.2In the whole clinical trial 4500
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Няма
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2017-02-21
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-02-22
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2019-07-17
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