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    Clinical Trial Results:
    AZD1656 in Transplantation with Diabetes tO PromoTe Immune TOleraNce

    Summary
    EudraCT number
    2019-001587-30
    Trial protocol
    GB  
    Global end of trial date
    11 Sep 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    05 Dec 2024
    First version publication date
    05 Dec 2024
    Other versions
    Summary report(s)
    Early termination

    Trial information

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    Trial identification
    Sponsor protocol code
    012657
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT05216172
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    IRAS: 252155, REC: 19/EE/0209
    Sponsors
    Sponsor organisation name
    Queen Mary University of London
    Sponsor organisation address
    Mile End Road, London, United Kingdom, E1 4NS
    Public contact
    Dr Kieran McCafferty, Diabetic Kidney Disease Centre, kieran.mccafferty4@nhs.net
    Scientific contact
    Dr Kieran McCafferty, Diabetic Kidney Disease Centre, research.governance@qmul.ac.uk
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    20 Aug 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    11 Sep 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    11 Sep 2023
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    Will treating post-transplant patients with glucokinase activator (AZD1656) compared to placebo for 3 months improve the function of their transplant kidney via a change in the levels of immune cells (regulatory T cells)? We will measure this by measuring the number of regulatory T cells in blood samples taken from the patients.
    Protection of trial subjects
    All subjects were under regular clinical and research monitoring. Trial conduct supervised by regular joint trial steering and data monitoring committee. All subject data stored as pseudonymised records in either locked research facility or saved on secure servers.
    Background therapy
    Standard of care for renal transplant recipients at the site stratifies them into standard and high immunological risk, based on multiple factors. Patients deemed to be at high immunological risk are given antithymocyte globulin (ATG) as induction; patients with standard immunological risk or unsuitable for ATG are given basiliximab (anti-IL-2 receptor mAb). Living donor recipients are pre-loaded with tacrolimus. All recipients receive induction therapy of either basiliximab or ATG on the day of transplant, in addition to intravenous methylprednisolone, with a second dose of basiliximab or AGT on day 4 post-transplant. Patients receiving ATG are given hydrocortisone and chlorphenamine to mitigate against infusion reactions. After transplant, all patients are maintained on tacrolimus (Adoport), mycophenolate mofetil and a reducing course of prednisolone. Prednisolone is gradually weaned from 20mg OD to 5mg OD over a period of 12 weeks. Target trough levels are reduced from 8-12 mcg/L after the first 3 months to 5-10mcg/L for the rest of the first year post-transplant. Immunosuppression regimes are individually “fine tuned” depending on renal function, incidence of infection, patient tolerance and any other drug side-effects. Patients receive antimicrobial prophylaxis for the first 3-6 months: PCP prophylaxis for all patients; CMV prophylaxis for antibody negative recipients who have received an antibody positive graft; and TB prophylaxis for high risk or IGRA positive patients. All patients receive aspirin and atorvastatin as cardiovascular protection, and either proton pump inhibitors or histamine H2 receptor antagonists as gastroprotection. Patients are reviewed in clinic 2-3 times per week within the first 3 months of transplant; subsequently, monitoring decreases to weekly or fortnightly before moving to monthly to 3 monthly visits at around 6 months post-transplant. Monitoring frequency can be adjusted according to individual circumstances.
    Evidence for comparator
    Glucokinase activators (GKA) have been recognised as effective and safe glucose-lowering agents. However, they has not been licensed for clinical use due to their lack of long-term efficacy. AZD1656 is a GKA which has been given to around 960 subjects in phase I-IIB studies. It has recently been shown to increase glucokinase activity in regulatory T cells (Tregs), which switches them from a resting to migratory phenotype, with subsequent migration into sites of injury. Conversely, inhibition of glucokinase resulting in less Treg motility led to increased rejection in a skin transplant model. Tregs have been suggested to mediate tolerance in human renal transplantation. It was therefore proposed to use AZD1656 in patients undergoing renal transplant with pre-existing Type 2 diabetes in order to both mobilise Tregs as a tolerogenic therapy and to improve glycemic control.
    Actual start date of recruitment
    30 Dec 2019
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy, Ethical reason, Regulatory reason, Scientific research
    Long term follow-up duration
    1 Years
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 26
    Worldwide total number of subjects
    26
    EEA total number of subjects
    0
    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)
    22
    From 65 to 84 years
    4
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients were recruited exclusively from patients undergoing renal transplantation at the Royal London Hospital.

    Pre-assignment
    Screening details
    Once possible participants were identified by their clinical team, their eligibility was determined by the CI or sub-I: they had to meet all of the inclusion criteria and none of the exclusion criteria.

    Period 1
    Period 1 title
    Study period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer
    Blinding implementation details
    Treatment codes were created via an online generator using a 2:2 block randomisation sequence and written on cards; these were allocated at random into envelopes with 1-50 printed on them. These sealed envelopes were randomly chosen to associate a study ID to the treatment code inside. The linked study ID and treatment code were sent to pharmacy on a prescription to dispense the study drug. The dispensing pharmacist would refer to the spreadsheet which linked treatment code with allocation.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    -
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    100mg twice daily with or after a meal for 3 months (two 50mg tablets twice daily)

    Arm title
    AZD1656
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    AZD1656
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    100mg twice daily with or after a meal for 3 months (two 50mg tablets twice daily)

    Number of subjects in period 1
    Placebo AZD1656
    Started
    13
    13
    Completed
    13
    13

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group title
    AZD1656
    Reporting group description
    -

    Reporting group values
    Placebo AZD1656 Total
    Number of subjects
    13 13 26
    Age categorical
    Units: Subjects
        Adults
    13 13 26
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    56.5 ( 10.4 ) 57.7 ( 6.6 ) -
    Gender categorical
    Units: Subjects
        Female
    5 3 8
        Male
    8 10 18
    Ethnicity
    participant ethnicity
    Units: Subjects
        Asian/Asian British
    8 3 11
        Black/Black British
    4 6 10
        White British
    0 3 3
        Other
    1 1 2
    Smoking status
    current/ex-smoker
    Units: Subjects
        Yes
    0 2 2
        No
    13 11 24
    Family history of diabetes
    Family history of diabetes
    Units: Subjects
        Yes
    10 11 21
        No
    3 2 5
    Previous transplant
    previous renal transplant
    Units: Subjects
        First graft
    13 11 24
        Second graft
    0 2 2
    Cause of renal failure
    primary renal diagnosis
    Units: Subjects
        Diabetes
    11 10 21
        Vascular (HTN)
    1 1 2
        Glomerular
    0 1 1
        Obstruction
    0 1 1
        Unknown
    1 0 1
    Dialysis modality
    renal replacement modality prior to transplant
    Units: Subjects
        Peritoneal dialysis
    2 6 8
        Haemodialysis
    8 6 14
        Transplant
    0 1 1
        Pre-emptive
    3 0 3
    Transplant type
    Units: Subjects
        DBD
    7 9 16
        DCD
    5 2 7
        Live unrelated
    1 1 2
        Live related
    0 1 1
        ECD
    0 0 0
    HLA mismatch
    Units: Subjects
        total 1
    1 0 1
        total 2
    2 1 3
        total 3
    4 5 9
        total 4
    1 1 2
        total 5
    4 5 9
        total 6
    1 1 2
    Donor sex
    Units: Subjects
        Female
    9 10 19
        Male
    4 3 7
    Donor cause of death
    Units: Subjects
        Vascular
    8 10 18
        Hypoxia
    4 0 4
        Other
    0 1 1
        NA: live donor
    1 2 3
    CMV status
    Units: Subjects
        -/-
    0 1 1
        -/+
    4 2 6
        +/-
    1 3 4
        +/+
    8 7 15
    Induction agent
    Units: Subjects
        IL-2 (basiliximab)
    12 12 24
        ATG
    1 1 2
    Timing of baseline blood sampling
    Units: Subjects
        Pre-induction
    5 6 11
        Pre-induction but loaded with tacrolimus
    1 2 3
        Post-induction
    7 5 12
    Immunosuppression ciclosporin/Azathioprine
    Units: Subjects
        Yes
    0 0 0
        No
    13 13 26
    Number of anti diabetic medications per patient
    Units: Subjects
        0 ADMs
    2 7 9
        1 ADM
    7 4 11
        2 ADMs
    1 2 3
        3 ADMs
    3 0 3
    immunosupression Tacrolimus
    Units: Subjects
        Yes
    11 12 23
        No
    2 1 3
    immunosupression: MMF
    Units: Subjects
        Yes
    11 10 21
        No
    2 3 5
    immunosupression: Prednisolone
    Units: Subjects
        yes
    11 10 21
        no
    2 3 5
    peripheral arterial disease
    Units: Subjects
        Yes
    2 1 3
        No
    11 12 23
    Cardiovascular disease
    Units: Subjects
        Yes
    3 2 5
        No
    10 11 21
    hypertension
    Units: Subjects
        yes
    8 7 15
        no
    5 6 11
    Medication: metformin
    Units: Subjects
        yes
    0 0 0
        no
    13 13 26
    medication gliclazide
    Units: Subjects
        yes
    3 1 4
        no
    10 12 22
    medication linaglyptin
    Units: Subjects
        yes
    5 5 10
        no
    8 8 16
    medication: insulin
    Units: Subjects
        yes
    8 2 10
        no
    5 11 16
    comorbidity: respiratory
    Units: Subjects
        yes
    2 3 5
        no
    11 10 21
    medication: GLP1RA
    Units: Subjects
        yes
    0 0 0
        no
    13 13 26
    comorbidity: urinary
    Units: Subjects
        yes
    3 3 6
        no
    10 10 20
    comorbidity: gastrointestinal
    Units: Subjects
        yes
    2 4 6
        no
    11 9 20
    comorbidity:endocrine
    Units: Subjects
        yes
    0 1 1
        no
    13 12 25
    comorbidity:neurological
    Units: Subjects
        yes
    4 2 6
        no
    9 11 20
    comorbidity:musculoskeletal
    Units: Subjects
        yes
    4 2 6
        no
    9 11 20
    comorbidity: other
    Units: Subjects
        yes
    4 5 9
        no
    9 8 17
    Medication: RAASI
    Units: Subjects
        yes
    2 1 3
        no
    11 12 23
    Medication: statin
    Units: Subjects
        yes
    5 5 10
        no
    8 8 16
    Medication:antiplatelet
    Units: Subjects
        yes
    5 3 8
        no
    8 10 18
    Medication: beta-blocker
    Units: Subjects
        yes
    3 5 8
        no
    10 8 18
    Medication:: diuretic
    Units: Subjects
        yes
    1 0 1
        no
    12 13 25
    Medication: other anthypertensive
    Units: Subjects
        yes
    2 3 5
        no
    11 10 21
    Medication:mineral bone medications
    Units: Subjects
        yes
    2 4 6
        no
    11 9 20
    Medication:: PPI
    Units: Subjects
        yes
    11 10 21
        no
    2 3 5
    Medication:prophylaxis
    Units: Subjects
        yes
    11 10 21
        no
    2 3 5
    Medication:antibiotics
    Units: Subjects
        yes
    0 1 1
        no
    13 12 25
    Medication:valganciclovir
    Units: Subjects
        yes
    4 1 5
        no
    9 12 21
    Medication: other
    Units: Subjects
        yes
    6 8 14
        no
    7 5 12
    diabetes comorbidity: retinopathy
    Units: Subjects
        yes
    6 5 11
        no
    7 8 15
    diabetic complications: neuropathy
    Units: Subjects
        yes
    2 1 3
        no
    11 12 23
    sBP
    Units: mmHg
        arithmetic mean (standard deviation)
    128.4 ( 17.8 ) 128.8 ( 22.2 ) -
    BMI
    Units: kg/m2
        median (inter-quartile range (Q1-Q3))
    27.9 (26.7 to 34.4) 30.3 (25.1 to 32.7) -
    Weight
    weight (kg)
    Units: kg
        median (inter-quartile range (Q1-Q3))
    80 (71.1 to 91.6) 87.3 (79.6 to 90.8) -
    dBP
    Units: mmHg
        arithmetic mean (standard deviation)
    70.0 ( 12.0 ) 67.6 ( 12.9 ) -
    Dialysis vintage
    Units: days
        arithmetic mean (standard deviation)
    1280.5 ( 902.5 ) 1230.6 ( 783.2 ) -
    Duration of diabetes
    Units: years
        arithmetic mean (standard deviation)
    19.3 ( 11.3 ) 17.5 ( 8.5 ) -
    Units of alcohol/week
    Units: units
        median (inter-quartile range (Q1-Q3))
    0 (0 to 0) 0 (0 to 2) -
    Time on waitlist
    Units: days
        arithmetic mean (standard deviation)
    413.3 ( 287.3 ) 714.2 ( 441.6 ) -
    Warm ischaemic time (secondary)
    Units: minutes
        arithmetic mean (standard deviation)
    40.9 ( 11.8 ) 43.4 ( 11.2 ) -
    Cold ischaemia time
    Units: minutes
        arithmetic mean (standard deviation)
    930.3 ( 353 ) 786.0 ( 363.8 ) -
    Donor age
    Units: years
        median (inter-quartile range (Q1-Q3))
    45 (44 to 52) 51 (40.5 to 58.5) -
    Platelets
    Units: x10^9/L
        arithmetic mean (standard deviation)
    185.1 ( 47.7 ) 169.9 ( 65.1 ) -
    WBC
    Units: x10^9/L
        arithmetic mean (standard deviation)
    11.3 ( 5.4 ) 9.6 ( 4.3 ) -
    Hb
    Units: g/L
        arithmetic mean (standard deviation)
    97.7 ( 21.1 ) 100.8 ( 20.3 ) -
    Sodium
    Units: mmol/L
        median (inter-quartile range (Q1-Q3))
    137 (134 to 138) 136 (134.5 to 139.5) -
    Potassium
    Units: mmol/L
        arithmetic mean (standard deviation)
    5.1 ( 0.7 ) 5.1 ( 1.0 ) -
    Bicarbonate
    Units: mmol/L
        arithmetic mean (standard deviation)
    21.7 ( 2.1 ) 23.6 ( 3.3 ) -
    Urea
    Units: mmol/L
        median (inter-quartile range (Q1-Q3))
    19.4 (18.6 to 22) 15.0 (10.7 to 22.4) -
    Creatinine
    Units: umol/L
        median (inter-quartile range (Q1-Q3))
    578 (453 to 850) 654 (534.5 to 755.5) -
    eGFR
    Units: ml/min/1.73m2
        median (inter-quartile range (Q1-Q3))
    6 (4.5 to 10.5) 7 (6 to 8) -
    PO4
    Units: mmol/L
        arithmetic mean (standard deviation)
    1.60 ( 0.37 ) 1.50 ( 0.38 ) -
    cCa
    Units: mmol/L
        arithmetic mean (standard deviation)
    2.23 ( 0.13 ) 2.17 ( 0.25 ) -
    albumin
    Units: g/L
        arithmetic mean (standard deviation)
    36.3 ( 6.4 ) 34.5 ( 6.4 ) -
    ALP
    Units: unit/L
        arithmetic mean (standard deviation)
    91.8 ( 42.9 ) 108.7 ( 55.6 ) -
    ALT
    Units: unit/L
        median (inter-quartile range (Q1-Q3))
    20 (14.5 to 26.5) 15 (12 to 17) -
    Bilirubin
    Units: umol/L
        median (inter-quartile range (Q1-Q3))
    4 (2 to 6) 7 (4 to 10) -
    Mg
    Units: mmol/L
        arithmetic mean (standard deviation)
    1.0 ( 0.1 ) 1.0 ( 0.2 ) -
    C-peptide
    Units: pmol/L
        arithmetic mean (standard deviation)
    1748.4 ( 837.6 ) 2857.8 ( 859.4 ) -
    HbA1c
    Units: mmol/mol
        arithmetic mean (standard deviation)
    62 ( 12.9 ) 57.4 ( 22.3 ) -
    glucose
    Units: mmol/L
        arithmetic mean (standard deviation)
    11.5 ( 6.0 ) 12.1 ( 4.4 ) -
    triglycerides
    Units: mmol/L
        median (inter-quartile range (Q1-Q3))
    1.72 (1.06 to 2.02) 1.20 (0.89 to 1.93) -
    total cholesterol
    Units: mmol/L
        arithmetic mean (standard deviation)
    3.5 ( 0.9 ) 3.4 ( 1.4 ) -
    CRP
    Units: mg/L
        median (inter-quartile range (Q1-Q3))
    10 (4.5 to 40.5) 6 (4 to 17) -
    HOMA-IR
    Units: standard units
        median (inter-quartile range (Q1-Q3))
    5.40 (2.9 to 7.3) 7.70 (6.6 to 10.5) -

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group title
    AZD1656
    Reporting group description
    -

    Primary: Change in pTregs between month 3 and baseline

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    End point title
    Change in pTregs between month 3 and baseline
    End point description
    change in number of peripheral Tregs between week 12 and randomisation (ie number of Tregs at week 12 - number of Tregs at baseline)
    End point type
    Primary
    End point timeframe
    12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: cells
        arithmetic mean (standard deviation)
    56.5 ( 91.4 )
    -50.2 ( 129.9 )
    Statistical analysis title
    student t-test (unpaired)
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    < 0.05 [1]
    Method
    t-test, 2-sided
    Confidence interval
    Notes
    [1] - p value 0.023

    Primary: Treg count at baseline

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    End point title
    Treg count at baseline
    End point description
    number of Treg cells at baseline
    End point type
    Primary
    End point timeframe
    at baseline
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: cells
        arithmetic mean (standard deviation)
    116.2 ( 99.7 )
    155.1 ( 135.4 )
    Statistical analysis title
    student t test (unpaired)
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.412
    Method
    t-test, 2-sided
    Confidence interval

    Primary: Treg count at week 12

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    End point title
    Treg count at week 12
    End point description
    End point type
    Primary
    End point timeframe
    at week 12
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: ce
        arithmetic mean (standard deviation)
    172.6 ( 113.6 )
    104.9 ( 71.9 )
    Statistical analysis title
    ANOVA
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    > 0.05
    Method
    ANOVA
    Confidence interval
    Statistical analysis title
    student t-test (unpaired)
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.082
    Method
    t-test, 2-sided
    Confidence interval

    Secondary: Delayed graft function

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    End point title
    Delayed graft function
    End point description
    need for dialysis within 1 week post-transplant
    End point type
    Secondary
    End point timeframe
    1 week post-transplant
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: number of patients
        No
    10
    11
        Yes
    3
    2
    Statistical analysis title
    Fisher exact
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 1
    Method
    Fisher exact
    Confidence interval

    Secondary: eGFR at month 3

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    End point title
    eGFR at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: ml/min/1.73m2
        median (inter-quartile range (Q1-Q3))
    47 (33 to 62)
    28 (19 to 48)
    Statistical analysis title
    Mann-Whitney U
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    < 0.005 [2]
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [2] - p value 0.039

    Secondary: Creatinine at month 3

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    End point title
    Creatinine at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: umol/L
        arithmetic mean (standard deviation)
    133.6 ( 40.1 )
    198.2 ( 74.6 )
    Statistical analysis title
    t-test
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    < 0.05 [3]
    Method
    t-test, 2-sided
    Confidence interval
    Notes
    [3] - p value 0.011

    Secondary: Urea at month 3

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    End point title
    Urea at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: mmol/L
        median (inter-quartile range (Q1-Q3))
    8.0 (6.7 to 11.5)
    10.7 (8.7 to 13.7)
    Statistical analysis title
    Mann Whitney U
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.091
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval

    Secondary: Incidence of hypoglycaemic episodes at month 3

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    End point title
    Incidence of hypoglycaemic episodes at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: episodes
        No
    4
    3
        Yes
    9
    10
    Statistical analysis title
    Fisher exact
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 1
    Method
    Fisher exact
    Confidence interval

    Secondary: Number of hypoglycaemic episodes at month 3

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    End point title
    Number of hypoglycaemic episodes at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: no. of episodes
        1 episode
    4
    4
        2 episodes
    4
    4
        3 episodes
    1
    1
        4 episodes
    0
    1
    Statistical analysis title
    Chi square
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.813
    Method
    Chi-squared
    Confidence interval

    Secondary: Incidence of episodes of rejection at month 3

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    End point title
    Incidence of episodes of rejection at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: episodes
        No
    13
    11
        Yes
    0
    2
    Statistical analysis title
    Fisher exact
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.48
    Method
    Fisher exact
    Confidence interval

    Secondary: Number of episodes of rejection at month 3

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    End point title
    Number of episodes of rejection at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: episodes
        0 episodes
    13
    11
        1 episode
    0
    1
        2 episodes
    0
    1
    Statistical analysis title
    Chi square
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    > 0.05 [4]
    Method
    Chi-squared
    Confidence interval
    Notes
    [4] - n/a

    Secondary: Incidence of episodes of infection at month 3

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    End point title
    Incidence of episodes of infection at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: episodes
        No
    3
    2
        Yes
    10
    11
    Statistical analysis title
    Fisher exact
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 1
    Method
    Fisher exact
    Confidence interval

    Secondary: Number of episodes of infection at month 3

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    End point title
    Number of episodes of infection at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: episodes
        1 episode
    4
    2
        2 episodes
    6
    2
        3 episodes
    0
    2
        4 episodes
    0
    1
        5 episodes
    0
    2
        8 episodes
    0
    1
        12 episodes
    0
    1
    Statistical analysis title
    Chi square
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.141
    Method
    Chi-squared
    Confidence interval

    Secondary: Delta HbA1c at month 3

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    End point title
    Delta HbA1c at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: mmol/mol
        arithmetic mean (standard deviation)
    9.8 ( 19.2 )
    8.4 ( 31.9 )
    Statistical analysis title
    t-test
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.903
    Method
    t-test, 2-sided
    Confidence interval

    Secondary: HbA1c at month 3

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    End point title
    HbA1c at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: mmol/mol
        arithmetic mean (standard deviation)
    69.5 ( 17.3 )
    62.9 ( 20.4 )
    Statistical analysis title
    t-test
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.418
    Method
    t-test, 2-sided
    Confidence interval

    Secondary: HOMA-IR at month 3

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    End point title
    HOMA-IR at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13
    Units: standard units
        median (inter-quartile range (Q1-Q3))
    1.40 (1.1 to 2.0)
    2.30 (1.2 to 3.1)
    Statistical analysis title
    Mann Whitney U
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.302
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval

    Secondary: Number of anti diabetic medications at month 3

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    End point title
    Number of anti diabetic medications at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13 [5]
    Units: number of medications
        1 ADM
    4
    2
        2 ADMs
    4
    8
        3 ADMs
    4
    2
        4 ADMs
    1
    0
    Notes
    [5] - 1 patient MV as on HDx
    Statistical analysis title
    Chi square
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.304
    Method
    Chi-squared
    Confidence interval

    Secondary: Antidiabetic medications at month 3

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    End point title
    Antidiabetic medications at month 3
    End point description
    End point type
    Secondary
    End point timeframe
    3 months/12 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    13
    13 [6]
    Units: type of medication
        Metformin
    3
    0
        Gliclazide
    1
    1
        Linagliptin
    7
    7
        Insulin
    12
    10
        GLP1RA
    0
    2
    Notes
    [6] - 1 patient MV as on HDx at month 3
    Statistical analysis title
    Fisher exact
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    26
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    > 0.05 [7]
    Method
    Fisher exact
    Confidence interval
    Notes
    [7] - metformin 0.220 gliclazide 1.000 linagliptin 1.000 insulin 0.593 GLP1RA 0.220

    Other pre-specified: ANOVA AZ Bx data

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    End point title
    ANOVA AZ Bx data
    End point description
    End point type
    Other pre-specified
    End point timeframe
    as needed (100 days)
    End point values
    Placebo AZD1656
    Number of subjects analysed
    3 [8]
    6 [9]
    Units: %Treg cells
        arithmetic mean (standard deviation)
    0.32 ( 0.46 )
    0.22 ( 0.20 )
    Notes
    [8] - not all subjects had paired biopsies
    [9] - not all subjects had paired biopsies
    Statistical analysis title
    repeated 2 way ANOVA
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    9
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    > 0.05
    Method
    ANOVA
    Confidence interval

    Other pre-specified: ANOVA migration Tregs

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    End point title
    ANOVA migration Tregs
    End point description
    End point type
    Other pre-specified
    End point timeframe
    14 weeks
    End point values
    Placebo AZD1656
    Number of subjects analysed
    8 [10]
    6 [11]
    Units: delta Treg cells
        arithmetic mean (standard deviation)
    0.38 ( 13.5 )
    7.00 ( 14.3 )
    Notes
    [10] - not all subjects had complete data for additional assay
    [11] - not all subjects had complete data for additional assay
    Statistical analysis title
    ANOVA repeated 2 way
    Comparison groups
    Placebo v AZD1656
    Number of subjects included in analysis
    14
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    > 0.05
    Method
    ANOVA
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    12 months
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26
    Reporting groups
    Reporting group title
    AZD1656
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    AZD1656 Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    9 / 13 (69.23%)
    6 / 13 (46.15%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    1
    0
    Investigations
    Biopsy kidney
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Post transplant lymphoproliferative disorder
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Delayed graft function
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Toxicity to various agents
    Additional description: IP admission
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Atrial flutter
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Nephrostomy
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vesicoureteral reflux surgery
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Physical deconditioning
    Additional description: Prolonged IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malaise
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Transplant rejection
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Haematemesis
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Perinephric collection
    Additional description: IP admissions
         subjects affected / exposed
    2 / 13 (15.38%)
    2 / 13 (15.38%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Confusion
    Additional description: IP admission
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Escherichia bacteraemia
    Additional description: IP admission
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Emphysematous pyelonephritis
    Additional description: IP admission - graft nephrectomy Possible SUSAR
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    COVID-19 pneumonia
    Additional description: IP admission
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cytomegalovirus viraemia
    Additional description: IP admissions
         subjects affected / exposed
    3 / 13 (23.08%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pseudomonal sepsis
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (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
    Additional description: Prolonged IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal graft infection
    Additional description: Prolonged IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary mucormycosis
    Additional description: IP admission and death Reported as possible SUSAR
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Urosepsis
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyperkalaemia
    Additional description: IP admission
         subjects affected / exposed
    2 / 13 (15.38%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyperglycaemia
    Additional description: IP admission
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    AZD1656 Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    13 / 13 (100.00%)
    13 / 13 (100.00%)
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Diastolic hypertension
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Hot flush
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Hypotension
         subjects affected / exposed
    7 / 13 (53.85%)
    1 / 13 (7.69%)
         occurrences all number
    8
    1
    Hypertension
         subjects affected / exposed
    12 / 13 (92.31%)
    10 / 13 (76.92%)
         occurrences all number
    17
    15
    Orthostatic hypotension
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Superficial vein thrombosis
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Thrombophlebitis
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Surgical and medical procedures
    Bladder catheter temporary
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Enteral nutrition
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Nephrostomy
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Renal transplant
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    Catheter site pain
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Chest pain
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 13 (15.38%)
         occurrences all number
    0
    2
    Fatigue
         subjects affected / exposed
    6 / 13 (46.15%)
    6 / 13 (46.15%)
         occurrences all number
    6
    6
    Impaired healing
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Peripheral swelling
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Oedema
         subjects affected / exposed
    5 / 13 (38.46%)
    4 / 13 (30.77%)
         occurrences all number
    5
    4
    Oedema peripheral
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Pyrexia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Swelling face
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Thirst
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Immune system disorders
    Transplant rejection
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Reproductive system and breast disorders
    Menstruation irregular
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Penile oedema
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Penile swelling
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Prostatism
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Pruritus genital
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Scrotal swelling
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Dysphonia
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Dyspnoea
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Dyspnoea exertional
         subjects affected / exposed
    2 / 13 (15.38%)
    5 / 13 (38.46%)
         occurrences all number
    2
    5
    Epistaxis
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Oropharyngeal pain
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Rhinorrhoea
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Pulmonary embolism
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Pulmonary mass
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Rales
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Psychiatric disorders
    Confusion
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Depressed mood
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Insomnia
         subjects affected / exposed
    1 / 13 (7.69%)
    3 / 13 (23.08%)
         occurrences all number
    1
    3
    Investigations
    Blood magnesium decreased
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Blood bicarbonate decreased
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 13 (15.38%)
         occurrences all number
    0
    2
    Blood bicarbonate increased
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Blood calcium decreased
         subjects affected / exposed
    3 / 13 (23.08%)
    1 / 13 (7.69%)
         occurrences all number
    3
    1
    Blood cholesterol increased
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Blood creatinine increased
         subjects affected / exposed
    7 / 13 (53.85%)
    4 / 13 (30.77%)
         occurrences all number
    8
    4
    Blood folate decreased
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Blood iron decreased
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Blood lactic acid increased
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Blood phosphorus decreased
         subjects affected / exposed
    2 / 13 (15.38%)
    4 / 13 (30.77%)
         occurrences all number
    2
    5
    Candida test positive
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Culture positive
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Culture urine positive
         subjects affected / exposed
    4 / 13 (30.77%)
    8 / 13 (61.54%)
         occurrences all number
    12
    18
    Blood potassium increased
         subjects affected / exposed
    4 / 13 (30.77%)
    4 / 13 (30.77%)
         occurrences all number
    6
    5
    Fluid balance negative
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Liver function test abnormal
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Occult blood positive
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Staphylococcus test positive
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Stress echocardiogram abnormal
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Strongyloides test positive
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Troponin T increased
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Urine output decreased
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Weight increased
         subjects affected / exposed
    1 / 13 (7.69%)
    4 / 13 (30.77%)
         occurrences all number
    1
    4
    White blood cell count decreased
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Tracheal aspirate culture
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Injury, poisoning and procedural complications
    Abdominal wound dehiscence
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Arteriovenous fistula maturation failure
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Complications of transplant surgery
         subjects affected / exposed
    2 / 13 (15.38%)
    2 / 13 (15.38%)
         occurrences all number
    2
    2
    Contusion
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Delayed graft function
         subjects affected / exposed
    3 / 13 (23.08%)
    5 / 13 (38.46%)
         occurrences all number
    3
    5
    Endotracheal intubation complication
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Post procedural persistent drain fluid
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Postoperative ileus
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Procedural pain
         subjects affected / exposed
    3 / 13 (23.08%)
    3 / 13 (23.08%)
         occurrences all number
    5
    3
    Product dose omission in error
         subjects affected / exposed
    3 / 13 (23.08%)
    0 / 13 (0.00%)
         occurrences all number
    3
    0
    Product prescribing error
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Post procedural haematoma
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Skin abrasion
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Spinal compression fracture
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    1
    Wrong drug
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Transplant dysfunction
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Wound complication
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Wound dehiscence
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Palpitations
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Sinus tachycardia
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 13 (15.38%)
         occurrences all number
    0
    2
    Supraventricular tachycardia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Tricuspid valve incompetence
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Nervous system disorders
    Amnesia
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Dizziness
         subjects affected / exposed
    2 / 13 (15.38%)
    1 / 13 (7.69%)
         occurrences all number
    2
    1
    Headache
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 13 (15.38%)
         occurrences all number
    1
    2
    Hypoaesthesia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Lethargy
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Paraesthesia
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Parosmia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Sciatica
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Somnolence
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Syncope
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Tremor
         subjects affected / exposed
    1 / 13 (7.69%)
    4 / 13 (30.77%)
         occurrences all number
    1
    5
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    9 / 13 (69.23%)
    8 / 13 (61.54%)
         occurrences all number
    12
    9
    Iron deficiency anaemia
         subjects affected / exposed
    2 / 13 (15.38%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Lymphopenia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Polycythaemia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Thrombocytopenia
         subjects affected / exposed
    2 / 13 (15.38%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Eye disorders
    Blepharitis
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Diabetic retinopathy
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Macular oedema
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Ocular hyperaemia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Vision blurred
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Visual acuity reduced
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Visual impairment
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Abdominal discomfort
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Abdominal distension
         subjects affected / exposed
    3 / 13 (23.08%)
    2 / 13 (15.38%)
         occurrences all number
    3
    2
    Abdominal pain
         subjects affected / exposed
    2 / 13 (15.38%)
    1 / 13 (7.69%)
         occurrences all number
    2
    1
    Abdominal pain upper
         subjects affected / exposed
    2 / 13 (15.38%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Anal fissure
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Constipation
         subjects affected / exposed
    1 / 13 (7.69%)
    7 / 13 (53.85%)
         occurrences all number
    2
    7
    Dry mouth
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Dyspepsia
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Epigastric discomfort
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal motility disorder
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Gastrooesophageal reflux disease
         subjects affected / exposed
    3 / 13 (23.08%)
    3 / 13 (23.08%)
         occurrences all number
    3
    3
    Diarrhoea
         subjects affected / exposed
    5 / 13 (38.46%)
    6 / 13 (46.15%)
         occurrences all number
    6
    7
    Nausea
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Odynophagia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Tongue ulceration
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Vomiting
         subjects affected / exposed
    2 / 13 (15.38%)
    2 / 13 (15.38%)
         occurrences all number
    2
    2
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Blister
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Night sweats
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Pruritus
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Skin hyperpigmentation
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Skin hypopigmentation
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Skin plaque
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Skin ulcer
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Anuria
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Bladder spasm
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Haematuria
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Hydronephrosis
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Hypertonic bladder
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Perinephric collection
         subjects affected / exposed
    1 / 13 (7.69%)
    3 / 13 (23.08%)
         occurrences all number
    1
    3
    Pollakiuria
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Nocturia
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 13 (15.38%)
         occurrences all number
    1
    2
    Polyuria
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Proteinuria
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Renal artery stenosis
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Renal impairment
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Renal mass
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Renal pain
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Urine abnormality
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Endocrine disorders
    Hyperthyroid
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Hypothyroidism
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Thyroid mass
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 13 (0.00%)
    3 / 13 (23.08%)
         occurrences all number
    0
    3
    Back pain
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Joint swelling
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Muscle atrophy
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Muscle spasms
         subjects affected / exposed
    2 / 13 (15.38%)
    4 / 13 (30.77%)
         occurrences all number
    2
    4
    Musculoskeletal discomfort
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Pain in extremity
         subjects affected / exposed
    3 / 13 (23.08%)
    2 / 13 (15.38%)
         occurrences all number
    3
    3
    Infections and infestations
    Asymptomatic COVID-19
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    COVID-19
         subjects affected / exposed
    2 / 13 (15.38%)
    3 / 13 (23.08%)
         occurrences all number
    2
    3
    Cystitis
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 13 (15.38%)
         occurrences all number
    1
    2
    Cystitis escherichia
         subjects affected / exposed
    3 / 13 (23.08%)
    1 / 13 (7.69%)
         occurrences all number
    6
    1
    Cystitis klebsiella
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Cystitis pseudomonal
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Cytomegalovirus viraemia
         subjects affected / exposed
    7 / 13 (53.85%)
    3 / 13 (23.08%)
         occurrences all number
    8
    3
    Herpes simplex
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Polyomavirus viraemia
         subjects affected / exposed
    2 / 13 (15.38%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Oesophageal candidiasis
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Oral candidiasis
         subjects affected / exposed
    3 / 13 (23.08%)
    1 / 13 (7.69%)
         occurrences all number
    5
    1
    Pseudomonal sepsis
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Rhinitis
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Staphylococcal bacteraemia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Transmission of an infectious agent via transplant
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Urinary tract infection
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Wound infection
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Wound infection staphylococcal
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Metabolism and nutrition disorders
    Abnormal loss of weight
         subjects affected / exposed
    3 / 13 (23.08%)
    1 / 13 (7.69%)
         occurrences all number
    3
    1
    Diabetes mellitus inadequate control
         subjects affected / exposed
    3 / 13 (23.08%)
    0 / 13 (0.00%)
         occurrences all number
    3
    0
    Decreased appetite
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Hyperglycaemia
         subjects affected / exposed
    13 / 13 (100.00%)
    12 / 13 (92.31%)
         occurrences all number
    17
    18
    Hyperkalaemia
         subjects affected / exposed
    2 / 13 (15.38%)
    2 / 13 (15.38%)
         occurrences all number
    2
    2
    Hypervolaemia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Hypoglycaemia
         subjects affected / exposed
    10 / 13 (76.92%)
    9 / 13 (69.23%)
         occurrences all number
    19
    15
    Hypokalaemia
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    19 May 2020
    Update PIS for study contact details; leeway for follow-up visits; change in location of sample processing for primary endpoint; clarification of EOT definition; trial will contribute to PhD of sub-I. PI is academic supervisor.
    20 Nov 2020
    update definition of acceptable methods of highly effective contraception to remove abstinence also updated latest version of IB and drug label
    01 Nov 2022
    Extension of EOT period duration to allow for sample processing; transfer of samples to external laboratory for processing; potential exploratory end-points.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    02 Mar 2020
    Halt to study recruitment due to COVID-19
    20 Aug 2020
    05 Jan 2021
    Halt to study recruitment due to COVID-19
    06 Apr 2021

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    192 PD recorded: none sig impacted trial no protocol Bx - due to COVID 3 patients had IMP held for 9/10/12 days; another 3 not compliant at wk12 1 patient took IMP OD (not BD) for 7 days from day 18-25. see appendix for early termination note
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