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    Clinical Trial Results:
    A Phase 2, Randomized, Double-Blind, Placebo-Controlled, Multi-Center Clinical Study to Evaluate the Efficacy and Safety of Oral Inhalation of GB002 for the Treatment of WHO Group 1 Pulmonary Arterial Hypertension (PAH)

    Summary
    EudraCT number
    2019-002669-37
    Trial protocol
    GB   FR   DE   AT   CZ   BE  
    Global end of trial date
    01 Nov 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    10 Nov 2023
    First version publication date
    10 Nov 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GB002-2101
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04456998
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    GB002 Inc., a wholly owned subsidiary of Gossamer Bio, Inc.
    Sponsor organisation address
    3013 Science Park Road, San Diego, United States, 92121
    Public contact
    Study Director, GB002, Inc., wholly owned subsidiary of Gossamer Bio Inc., GB002, Inc., +1 866 668-4083, ClinicalTrials@gossamerbio.com
    Scientific contact
    Study Director, GB002, Inc., wholly owned subsidiary of Gossamer Bio Inc., GB002, Inc., +1 866 668-4083, ClinicalTrials@gossamerbio.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    01 Nov 2022
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    01 Nov 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Determine the effect of GB002 on improving pulmonary hemodynamics in subjects with World Health Organization (WHO) Group 1 PAH who are WHO Functional Class (FC) II or III
    Protection of trial subjects
    This study was conducted in accordance with consensus ethical principles derived from international guidelines including the Declaration of Helsinki, Council for International Organizations of Medical Sciences (CIOMS) International Ethical Guidelines and International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines. All applicable local laws and regulations regarding patient safety were also followed.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    12 Nov 2020
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Spain: 8
    Country: Number of subjects enrolled
    United Kingdom: 2
    Country: Number of subjects enrolled
    Belgium: 2
    Country: Number of subjects enrolled
    Czechia: 1
    Country: Number of subjects enrolled
    France: 2
    Country: Number of subjects enrolled
    Germany: 7
    Country: Number of subjects enrolled
    Australia: 5
    Country: Number of subjects enrolled
    United States: 59
    Worldwide total number of subjects
    86
    EEA total number of subjects
    20
    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)
    73
    From 65 to 84 years
    13
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    After signing an informed consent form (ICF), subjects were screened for study eligibility for up to a 5-week screening period. 151 participants were screened, 86 of whom were randomized.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    Placebo inhaled orally twice per day (BID) for 24 weeks
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder, hard capsule
    Routes of administration
    Inhalation use
    Dosage and administration details
    Placebo inhaled orally BID for 24 weeks

    Arm title
    GB002 (Seralutinib)
    Arm description
    GB002 (seralutinib) inhaled orally BID for 24 weeks
    Arm type
    Experimental

    Investigational medicinal product name
    GB002
    Investigational medicinal product code
    GB002
    Other name
    Seralutinib
    Pharmaceutical forms
    Inhalation powder, hard capsule
    Routes of administration
    Inhalation use
    Dosage and administration details
    GB002 (seralutinib) inhaled orally BID for 24 weeks

    Number of subjects in period 1
    Placebo GB002 (Seralutinib)
    Started
    42
    44
    Completed
    42
    38
    Not completed
    0
    6
         Adverse event
    -
    4
         Protocol deviation
    -
    1
         Withdrawal by subject
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Placebo inhaled orally twice per day (BID) for 24 weeks

    Reporting group title
    GB002 (Seralutinib)
    Reporting group description
    GB002 (seralutinib) inhaled orally BID for 24 weeks

    Reporting group values
    Placebo GB002 (Seralutinib) Total
    Number of subjects
    42 44 86
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    49.5 ( 11.81 ) 48.3 ( 12.70 ) -
    Gender categorical
    Units: Subjects
        Female
    38 40 78
        Male
    4 4 8
    Race
    Units: Subjects
        White
    37 37 74
        Black or African American
    1 0 1
        Asian
    2 4 6
        Other, Not Specified
    2 3 5
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    6 8 14
        Not Hispanic or Latino
    34 36 70
        Not Reported
    2 0 2

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Placebo inhaled orally twice per day (BID) for 24 weeks

    Reporting group title
    GB002 (Seralutinib)
    Reporting group description
    GB002 (seralutinib) inhaled orally BID for 24 weeks

    Primary: Change From Baseline to Week 24 in Pulmonary Vascular Resistance (PVR)

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    End point title
    Change From Baseline to Week 24 in Pulmonary Vascular Resistance (PVR)
    End point description
    PVR was evaluated using right heart catheterization (RHC). Intent-to-Treat (ITT) Population: all participants who were randomized.
    End point type
    Primary
    End point timeframe
    Baseline, Week 24
    End point values
    Placebo GB002 (Seralutinib)
    Number of subjects analysed
    42
    44
    Units: dyne•s/cm^5
        least squares mean (confidence interval 95%)
    21.2 (-37.4 to 79.8)
    -74.9 (-139.7 to -10.2)
    Statistical analysis title
    Statistical Analysis 1
    Comparison groups
    Placebo v GB002 (Seralutinib)
    Number of subjects included in analysis
    86
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.031
    Method
    ANCOVA
    Parameter type
    Mean difference (net)
    Point estimate
    -96.1
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -183.5
         upper limit
    -8.8

    Secondary: Change From Baseline to Week 24 in Distance Achieved on the Six-Minute Walk Test (6MWT)

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    End point title
    Change From Baseline to Week 24 in Distance Achieved on the Six-Minute Walk Test (6MWT)
    End point description
    The 6MWT measures the distance a subject is able to walk quickly on a flat, hard surface in a period of 6 minutes. ITT Population: all participants who were randomized. Participants with a baseline and post-baseline value.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 24
    End point values
    Placebo GB002 (Seralutinib)
    Number of subjects analysed
    42
    38
    Units: meters
        least squares mean (confidence interval 95%)
    7.4 (-11.2 to 25.9)
    13.9 (-5.1 to 32.8)
    Statistical analysis title
    Statistical Analysis 1
    Comparison groups
    Placebo v GB002 (Seralutinib)
    Number of subjects included in analysis
    80
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.5972
    Method
    Mixed models analysis
    Parameter type
    Mean difference (net)
    Point estimate
    6.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -17.9
         upper limit
    30.9

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first dose of study drug through Week 28
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24.0
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Placebo inhaled orally twice per day (BID) for 24 weeks

    Reporting group title
    GB002 (Seralutinib)
    Reporting group description
    GB002 (seralutinib) inhaled orally BID for 24 weeks

    Serious adverse events
    Placebo GB002 (Seralutinib)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 42 (14.29%)
    10 / 44 (22.73%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Lymphoma
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Squamous cell carcinoma
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Jugular vein thrombosis
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Orthostatic hypotension
         subjects affected / exposed
    1 / 42 (2.38%)
    0 / 44 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Right ventricular failure
         subjects affected / exposed
    3 / 42 (7.14%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    1 / 42 (2.38%)
    0 / 44 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Enteritis
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Obstructive pancreatitis
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Haemoptysis
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary arterial hypertension
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dyspnoea
         subjects affected / exposed
    1 / 42 (2.38%)
    0 / 44 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Appendicitis
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Staphylococcal bacteraemia
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular device infection
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Product issues
    Device malfunction
         subjects affected / exposed
    0 / 42 (0.00%)
    1 / 44 (2.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hypokalaemia
         subjects affected / exposed
    1 / 42 (2.38%)
    0 / 44 (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: 5%
    Non-serious adverse events
    Placebo GB002 (Seralutinib)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    28 / 42 (66.67%)
    31 / 44 (70.45%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    8 / 42 (19.05%)
    6 / 44 (13.64%)
         occurrences all number
    12
    7
    Dizziness
         subjects affected / exposed
    2 / 42 (4.76%)
    5 / 44 (11.36%)
         occurrences all number
    2
    7
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    3 / 42 (7.14%)
    5 / 44 (11.36%)
         occurrences all number
    3
    5
    Chest discomfort
         subjects affected / exposed
    1 / 42 (2.38%)
    3 / 44 (6.82%)
         occurrences all number
    1
    3
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    3 / 42 (7.14%)
    6 / 44 (13.64%)
         occurrences all number
    3
    6
    Nausea
         subjects affected / exposed
    6 / 42 (14.29%)
    5 / 44 (11.36%)
         occurrences all number
    6
    5
    Abdominal pain lower
         subjects affected / exposed
    0 / 42 (0.00%)
    3 / 44 (6.82%)
         occurrences all number
    0
    3
    Vomiting
         subjects affected / exposed
    3 / 42 (7.14%)
    2 / 44 (4.55%)
         occurrences all number
    3
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    16 / 42 (38.10%)
    19 / 44 (43.18%)
         occurrences all number
    16
    19
    Dyspnoea
         subjects affected / exposed
    4 / 42 (9.52%)
    4 / 44 (9.09%)
         occurrences all number
    4
    5
    Nasal congestion
         subjects affected / exposed
    1 / 42 (2.38%)
    3 / 44 (6.82%)
         occurrences all number
    1
    3
    Throat irritation
         subjects affected / exposed
    0 / 42 (0.00%)
    3 / 44 (6.82%)
         occurrences all number
    0
    3
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    1 / 42 (2.38%)
    3 / 44 (6.82%)
         occurrences all number
    1
    4
    Psychiatric disorders
    Nightmare
         subjects affected / exposed
    1 / 42 (2.38%)
    4 / 44 (9.09%)
         occurrences all number
    1
    4
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    1 / 42 (2.38%)
    3 / 44 (6.82%)
         occurrences all number
    1
    3
    Back pain
         subjects affected / exposed
    2 / 42 (4.76%)
    3 / 44 (6.82%)
         occurrences all number
    2
    3
    Pain in extremity
         subjects affected / exposed
    3 / 42 (7.14%)
    0 / 44 (0.00%)
         occurrences all number
    3
    0
    Infections and infestations
    COVID-19
         subjects affected / exposed
    7 / 42 (16.67%)
    6 / 44 (13.64%)
         occurrences all number
    7
    6
    Nasopharyngitis
         subjects affected / exposed
    0 / 42 (0.00%)
    3 / 44 (6.82%)
         occurrences all number
    0
    4
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 42 (7.14%)
    1 / 44 (2.27%)
         occurrences all number
    3
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Jun 2020
    • Updated seralutinib dose from 90 mg to 60 mg to reduce capsule burden. • Updated visit schedule to occur every 6 weeks (instead of 4 weeks), increased visit windows, changed Week 8 visit to telephone contact, and clarified home-health visit options to reduce patient burden. • Added dispensation and collection of an electronic handheld device to record daily dosing. • Updated inclusion criterion to remove rheumatoid arthritis as a PAH-associated disease. • Expanded exclusion criterion to exclude subjects with a condition limiting 6MWT assessment. • Clarified male fertility assessment was optional, required 36 weeks of study participation. • Added language related to photosafety to match language in Version 5 of the Investigator’s Brochure and to align with a United Kingdom specific amendment.
    15 Jan 2021
    • Version 3.0.1 was issued to correct a typographical error in v3.0.0. Protocol v3.0.1 replaced v3.0.0 and no patients were enrolled under v3.0.0. • Updated seralutinib dose from 60 mg to up to 90 mg (dose range of 45 mg to 90 mg BID) based on on-going safety in Phase 1 studies and projected efficacious exposure range. • Updated visit schedule to occur every 4 weeks through Week 12 for adverse event (AE) monitoring. • Added monthly pregnancy testing for Women of childbearing potential (WOCBP) at-home testing when visits were less frequent. • Added clarification that morning doses of oral PAH disease-specific background medications should be taken immediately prior to GB002 dosing in clinic on pharmacokinetic (PK) sampling days. • Added functional respiratory imaging and heart rate monitoring substudies at select sites. • Updated risk language to include embryo-fetal development as an identified risk. • Reduced maximum age inclusion criterion from 80 years of age to 75 years. • Reduced Left ventricular-end diastolic pressure (LVEDP) inclusion criterion from ≤ 15 mmHg to ≤ 12 mmHg. • Updated to indicate that if historical echocardiogram (ECHO) not available, screening ECHO may be used to establish this criterion. Expanded exclusion criterion to exclude subjects with left-sided heart disease. • Updated exclusion criteria to exclude subjects with documented uncontrolled symptomatic coronary disease and portopulmonary hypertension or Child-Pugh Class A or higher. • Expanded estimated glomerular filtration rate (eGFR) exclusion criterion from < 30 mL/min/1.73m^2 to < 45 mL/min/1.73m^2, including subjects with mild-moderate renal function impairment.
    15 Jan 2021
    (continued) • Updated exclusion criteria to exclude inhaled marijuana product use, subjects with history of alcohol abuse and/or a positive test for drugs of abuse, subjects with milk allergy, and subjects that have any other condition or reason that (in the opinion of the Investigator or Sponsor’s Medical Monitor) would prohibit study participation. • Added stopping rules and in investigational product (IP) interruption instructions for fluid retention, neutropenia, thrombocytopenia, and electrocardiogram (ECG) abnormalities. • Added criteria for clinical worsening and updated exploratory endpoint. • Updated prohibited medications to prohibit use of medications associated with QT interval prolongation, as a cautionary measure, and added exclusionary criterion for subjects with QT corrected for heart rate by Fridericia's cube root formula (QTcF) > 480 ms. • Increased window for Week 24 RHC to up to 8 weeks beyond the Week 24 visit for subjects remaining on IP, to allow for impact of pandemic/global emergencies. • Clarified that an open-label extension study was available. A 28-day safety follow up will not be required for subjects transitioning to OLE. • Added subjects were encouraged to weigh themselves at home as part of standard of care in order to monitor for lower extremity edema. • Updated biomarker collection schedule to remove assays.
    18 Nov 2021
    • Updated prohibited medications due to new data indicating seralutinib was not expected to have clinically significant drug-drug interactions with medications which are inhibitors of P-glycoprotein, Breast Cancer Resistance Protein, or moderate or weak cytochrome P450 isoform 3A inhibitors. • Updated prohibited medications to clarify strong cytochrome P450 isoform 3A inhibitors and washout instructions for anticoagulants. • Updated risk language to include potential risk of female reproductive organs based on nonclinical data and potential risk of bleeding to include hemoptysis. • Updated AE assessments to include review of all system organ classes (SOCs), including reproductive system. • Added clarification for the definition of Worsening Risk Score Category. • Expanded inclusion criterion to include categories of connective tissue disease-associated pulmonary arterial hypertension (CTD-APAH). • Updated inclusion criterion for pulmonary function test (PFTs) to be more informative of disease state. • Clarified exclusion criterion to note portal hypertension due to cirrhosis. • Updated exclusion criterion for alcohol use to align with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) definition. • Removed collection of nasal mucosal fluid samples (protocol clarification letter 12APR2021); based on standard laboratory practices, added assessment of urate and activated partial thromboplastin time (APTT). • Replace measure of forced expiratory volume in 1 second (FEV1) with ratio of FEV1 to forced vital capacity (FVC). Replace requirement for carbon monoxide diffusing capacity (DLCO) with FVC.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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