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    Summary
    EudraCT Number:2019-003520-20
    Sponsor's Protocol Code Number:R668-BP-1902
    National Competent Authority:France - ANSM
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2020-03-25
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedFrance - ANSM
    A.2EudraCT number2019-003520-20
    A.3Full title of the trial
    A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to Evaluate the Efficacy and Safety of Dupilumab in Adult Patients with Bullous Pemphigoid
    ÉTUDE MULTICENTRIQUE, RANDOMISÉE, EN DOUBLE AVEUGLE, CONTROLÉE CONTRE PLACEBO, EN GROUPES PARALLÈLES, VISANT A ÉVALUER L'EFFICACITÉ ET LA SÉCURITÉ DU DUPILUMAB CHEZ DES PATIENTS ADULTES ATTEINTS DE PEMPHIGOÏDE BULLEUSE
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study to Evaluate the Efficacy and Safety of Dupilumab in Adult Patients with Bullous Pemphigoid
    Étude visant à évaluer l’efficacité et la sécurité du dupilumab chez des patients adultes atteints de pemphigoïde bulleuse
    A.3.2Name or abbreviated title of the trial where available
    LIBERTY-BP ADEPT
    A.4.1Sponsor's protocol code numberR668-BP-1902
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorRegeneron Pharmaceuticals, Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportRegeneron Pharmaceuticals, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationRegeneron Pharmaceuticals, Inc.
    B.5.2Functional name of contact pointClinical Trial Information
    B.5.3 Address:
    B.5.3.1Street Address777 Old Saw Mill River Road
    B.5.3.2Town/ cityTarrytown, NY
    B.5.3.3Post code10591
    B.5.3.4CountryUnited States
    B.5.6E-mailclinicaltrials@regeneron.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Dupixent
    D.2.1.1.2Name of the Marketing Authorisation holderSanofi-Aventis Research & Development
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namedupilumab
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNdupilumab
    D.3.9.2Current sponsor codeREGN668
    D.3.9.3Other descriptive nameDUPILUMAB
    D.3.9.4EV Substance CodeSUB130625
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for injection
    D.8.4Route of administration of the placeboSubcutaneous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Bullous pemphigoid (BP)
    E.1.1.1Medical condition in easily understood language
    Bullous pemphigoid is a rare, autoimmune skin condition that causes large, fluid-filled blisters
    La pemphigoïde bulleuse est une maladie cutanée rare d’origine auto-immune qui se caractérise par l’apparition de bulles de grande taille remplies de liquide
    E.1.1.2Therapeutic area Diseases [C] - Immune System Diseases [C20]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10034277
    E.1.2Term Pemphigoid
    E.1.2System Organ Class 10040785 - Skin and subcutaneous tissue disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of the study is to demonstrate that dupilumab is superior to placebo in achieving sustained remission off oral corticosteroids (OCS) in patients with bullous pemphigoid (BP).
    Démontrer que le dupilumab est supérieur au placebo pour parvenir à une rémission durable après diminution progressive des corticoïdes oraux (CO) chez des patients atteints de pemphigoïde bulleuse (PB).
    E.2.2Secondary objectives of the trial
    -To evaluate the OCS-sparing effects of dupilumab in patients with BP
    -To evaluate the effect of dupilumab on itch in patients with BP
    -To evaluate the effects of dupilumab on health-related quality of life measures in patients with BP
    -To evaluate the effect of dupilumab in circulating BP180 and BP230 autoantibody titers
    -To assess the safety and tolerability of dupilumab administered to patients with BP
    -To characterize the trough concentrations of functional dupilumab over time following administration of dupilumab in patients with BP
    -To assess the immunogenicity of dupilumab in patients with BP over time
    •Évaluer les effets du dupilumab comme stratégie d’épargne cortisonique chez des patients atteints de PB
    •Évaluer l’effet du dupilumab sur les démangeaisons des patients atteints de PB
    •Évaluer l’effet du dupilumab sur les mesures de la qualité de vie liée à la santé des patients atteints de PB
    •Évaluer l’effet du dupilumab sur le titrage des auto-anticorps circulants dirigés contre les auto-antigènes BP180 et BP230
    •Évaluer la sécurité et la tolérance du dupilumab administré aux patients atteints de PB
    •Caractériser les concentrations minimales de dupilumab fonctionnel à long terme après son administration chez des patients atteints de PB
    •Évaluer l’immunogénicité à long terme du dupilumab chez des patients atteints de PB
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Optional genomics sub-study
    E.3Principal inclusion criteria
    1. Patients must have clinical features of BP (eg, urticarial or eczematous or erythematous plaques, bullae, pruritus) at the screening and baseline visits.
    2. Study participants are required to have histological and serological confirmation of BP by the baseline visit.
    3. Bullous Pemphigoid Disease Area Index (BPDAI) activity score ≥24 at baseline and screening visits.
    4. Baseline peak pruritus NRS score for maximum itch intensity ≥4
    5. Male or female, age 18 to 90 at the screening visit
    6. Karnofsky performance status score ≥50% at the screening visit.

    NOTE: Other protocol defined inclusion criteria apply
    1.Les patients doivent présenter des signes cliniques de PB (p. ex., plaques d’urticaire, d’eczéma ou d’érythèmes, des bulles, du prurit) aux visites de sélection et d’inclusion.
    2.Les participants à l’étude doivent présenter des signes histologiques et sérologiques confirmés de PB à la visite d’inclusion
    3.Score BPDAI (Bullous Pemphigoid Disease Area Index) ≥ 24 aux visites d’inclusion et de sélection.
    4.CCN du pic de prurit avec intensité maximale des démangeaisons ≥ 4 à l’inclusion.
    5.Homme ou femme, âgés de 18 à 90 ans à la visite de sélection.
    6.Indice de performance de Karnofsky ≥ 50% à la visite de sélection.

    REMARQUE: d'autres critères d'inclusion définis par le protocole s'appliquent
    E.4Principal exclusion criteria
    1. Forms of pemphigoid other than classic BP (eg, mucous membrane-dominant BP, Brunsting Perry cicatrial pemphigoid, anti-p200 pemphigoid, epidermolysis bullosa acquisita, or BP with concomitant pemphigus vulgaris)
    2. Patients who are receiving treatments known to cause or exacerbate BP (eg, angiotensin converting enzyme inhibitors, penicillamine, furosemide, phenacetin, dipeptidyl peptidase 4 inhibitor) who have not been on a stable dose of these medications for at least 4 weeks prior to the screening visit
    3. Have ever received treatment with an IL-4 or IL-13 antagonist such as dupilumab, tralokinumab, or lebrikizumab.
    4. Treatment with systemic corticosteroids within 2 weeks before the baseline visit
    5. Treatment with topical corticosteroids of medium potency or higher, topical calcineurin inhibitor, or topical crisaborole within 1 week before the baseline visit
    6. Treatment with non-steroidal immunosuppressive/immunomodulating drug(s) (eg, mycophenolate mofetil, azathioprine, or methotrexate) within 4 weeks before the baseline visit.
    7. Treatment with BP-directed biologics as follows:
    a. Any cell-depleting agents including but not limited to rituximab: within 12 months before the baseline visit, or until lymphocyte and CD 19+ lymphocyte count returns to normal, whichever is longer
    b. Other biologics: within 5 half-lives (if known) or 16 weeks prior to the baseline visit, whichever is longer
    c. Intravenous immunoglobulin within 16 weeks prior to the baseline visit

    NOTE: Other protocol defined exclusion criteria apply
    1.Formes de pemphigoïde autre que la PB classique (PB des muqueuses, pemphigoïde cicatricielle de Brunsting-Perry, pemphigoïde anti-p200, épidermolyse bulleuse acquise ou PB avec pemphigus vulgaire concomitant)
    2.Patients recevant des traitements connus pour causer ou exacerber la PB (p. ex., inhibiteurs de l’enzyme de conversion de l’angiotensine, pénicillamine, furosémide, phénacétine, inhibiteur de l’enzyme dipeptidyl peptidase 4) qui ne prennent pas une dose stable de ces médicaments depuis quatre semaines au moins avant la visite de sélection.
    3.Patients ayant reçu un traitement comprenant un antagoniste IL-4 ou IL-13, comme le dupilumab, le tralokinumab ou le lébrikizumab.
    4.Traitement par corticoïdes systémiques au cours des deux semaines précédant la visite d’inclusion.
    5.Traitement par corticoïdes topiques de puissance moyenne ou supérieure, ou par inhibiteur de la calcineurine topique ou crisaborole topique au cours de la semaine précédant la visite d’inclusion.
    6.Traitement par médicaments immunomodulateurs/immunosuppresseurs non stéroïdiens (p. ex., mycophénolate mofétil, azathioprine ou méthotrexate) au cours des quatre semaines précédant la visite d’inclusion.
    7.Traitement par des agents biologiques ciblant la PB, à savoir :
    a.un quelconque agent de déplétion cellulaire, notamment du rituximab : au cours des 12 mois précédant la visite d’inclusion, ou jusqu’à ce que les numérations de lymphocytes et de lymphocytes CD19+ reviennent à la normale, la durée la plus longue étant retenue ;
    b.autres agents biologiques : au cours des cinq demi-vies (si connues) ou des 16 semaines précédant la visite d’inclusion, la période la plus longue étant retenue ;
    c.immunoglobuline par voie intraveineuse au cours des 16 semaines précédant la visite d’inclusion.


    REMARQUE: d'autres critères d'exclusion définis par le protocole s'appliquent
    E.5 End points
    E.5.1Primary end point(s)
    Proportion of patients achieving sustained remission at week 36.
    Le pourcentage de patients en rémission durable à la semaine 36
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 36
    Semaine 36
    E.5.2Secondary end point(s)
    The key secondary efficacy endpoints are:
    (1) Total cumulative dose of OCS from baseline to week 36
    (2) Percent change in weekly average of daily peak pruritus numerical rating score (NRS) from baseline to week 36
    (3) Proportion of patients with improvement (reduction) of weekly average of daily peak pruritus NRS ≥4 from baseline to week 36
    (4) Percent change in BPDAI activity score from baseline to week 36
    Other secondary endpoints for efficacy:
    (5) Duration of complete remission while not requiring OCS (up to week 36)
    (6) Proportion of patients who do not achieve control of disease activity or who relapse after achieving control of disease activity (Note: control of disease activity is defined when new lesions cease to form and existing lesions begin to heal)
    (7) Proportion of patients who achieve a reduction in BPDAI activity score of at least 50%, 75%, and 90% from baseline to week 36
    (8) Change in autoimmune bullous disease quality of life (ABQOL) from baseline to week 36
    (9) Change from baseline to week 36 in percent body surface area (BSA) of BP involvement
    (10) Change in BP180 and BP230 autoantibody (IgG) titers from baseline to week 36
    (11) Proportion of patients in complete remission and off OCS at week 16
    (12) Percent change in BPDAI activity score from baseline to week 16
    (13) Proportion of patients who achieve a reduction in BPDAI activity score of at least 50%, 75%, and 90% from baseline to week 16
    (14) Percent change in weekly average of daily peak pruritus NRS from baseline to week 16
    (15) Proportion of patients with improvement (reduction) of weekly average of daily peak pruritus NRS ≥4 from baseline to week 16
    Other secondary endpoints for safety:
    (16) Incidence of treatment-emergent adverse events (TEAEs) from baseline through end of treatment (up to week 36)
    (17) Incidence of treatment-emergent serious adverse events (SAEs) from baseline through the end of treatment (up to week 36)
    (18) Incidence of adverse events of special interest (AESIs) from baseline through the end of treatment (up to week 36)
    (19) Incidence of TEAEs from baseline through end of study (up to week 48)
    (20) Incidence of treatment-emergent SAEs from baseline through the end of study (up to week 48)
    (21) Incidence of AESIs from baseline through the end of study (up to week 48)
    Other secondary endpoints for clinical pharmacology and immunogenicity:
    (22) Concentrations of functional dupilumab in serum at each scheduled sampling time
    point from baseline to end of study (up to week 48)
    (23) Incidence of treatment-emergent anti-drug antibody (ADA) responses and titer over time (up to week 48)
    Critères d’évaluation secondaires de l’efficacité :
    (1)Dose cumulée totale des CO entre l’inclusion et la semaine 36
    (2)Variation (%) de la CCN moyenne hebdomadaire du pic de prurit quotidien entre l’inclusion et la semaine 36
    (3)Pourcentage de patients présentant une amélioration (diminution) de la CCN moyenne hebdomadaire du pic de prurit quotidien ≥ 4 entre l’inclusion et la semaine 36
    (4)Variation (%) du score BPDAI entre la visite d’inclusion et la semaine 36
    Autres critères d’évaluation secondaires de l’efficacité :
    (5)Durée la rémission complète sans besoin de corticoïdes (jusqu’à la semaine 36)
    (6)Pourcentage de patients qui ne parviennent pas à contrôler l’activité de la maladie ou qui rechutent après avoir contrôlé l’activité de la maladie (remarque : le contrôle de l’activité de la maladie est défini comme la non-apparition de nouvelles lésions et le début de la cicatrisation des lésions existantes)
    (7)Pourcentage de patients affichant une diminution du score BPDAI d’au moins 50 %, 75 % et 90 % entre l’inclusion et la semaine 36
    (8)Variation de la qualité de vie avec une maladie bulleuse auto-immune (ABQOL de l’anglais autoimmune bullous disease quality of life) depuis l’inclusion jusqu’à la semaine 36
    (9)Variation du pourcentage de la surface corporelle atteinte par la PB, entre l’inclusion et la semaine 36
    (10)Variation du titrage (IgG) des auto-anticorps dirigés contre les auto-antigènes BP180 et BP230, entre l’inclusion et la semaine 36
    (11)Pourcentage de patients en rémission complète et sans corticoïdes à la semaine 16
    (12Variation (%) du score BPDAI entre la visite d’inclusion et la semaine 16
    (13)Pourcentage de patients affichant une réduction du score BPDAI d’au moins 50 %, 75 % et 90 % entre l’inclusion et la semaine 16
    (14)Variation (%) de la CCN moyenne hebdomadaire du pic de prurit quotidien entre l’inclusion et la semaine 16
    (15)Pourcentage de patients présentant une amélioration (réduction) de la CCN moyenne hebdomadaire du pic de prurit quotidien ≥ 4 entre l’inclusion et la semaine 16
    Critères secondaires d’évaluation de la sécurité :
    (16)Incidence des événements indésirables survenus sous traitement (EIST) à compter de l’inclusion et jusqu’à la fin du traitement (semaine 36)
    (17)Incidence des événements indésirables graves (EIG) survenus sous traitement à compter de l’inclusion et jusqu’à la fin du traitement (semaine 36)
    (18)Incidence des événements indésirables graves d’intérêt particulier (EIIP) à compter de l’inclusion et jusqu’à la fin du traitement (semaine 36)
    (19)Incidence des EIST à compter de l’inclusion et jusqu’à la fin de l’étude (semaine 48)
    (20)Incidence des EIG survenus sous traitement à compter de l’inclusion et jusqu’à la fin de l’étude (semaine 48)
    (21)Incidence des EIIP à compter de l’inclusion et jusqu’à la fin de l’étude (semaine 48)
    Critères d’évaluation secondaires d’immunogénicité et de pharmacologie clinique :
    (22)Taux de dupilumab fonctionnel sérique à chaque point temps de prélèvement programmé, à compter de l’inclusion et jusqu’à la fin de l’étude (semaine 48)
    (23)Incidence de la réponse des anticorps antimédicament (AAM) sous traitement et titrage au fil du temps (jusqu’à la semaine 48)

    E.5.2.1Timepoint(s) of evaluation of this end point
    (1-10, 16-18) Up to week 36
    (11) At week 16
    (12-15) Up to week 16
    (19-23) Up to week 48
    (1-10, 16-18) Jusqu'à la semaine 36
    (11) À la semaine 16
    (12-15) Jusqu'à la semaine 16
    (19-23) Jusqu'à la semaine 48
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned6
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA22
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    France
    Germany
    Japan
    Spain
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years
    E.8.9.1In the Member State concerned months28
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial months34
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 16
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 64
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state14
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 34
    F.4.2.2In the whole clinical trial 80
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    none
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-05-19
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-05-18
    P. End of Trial
    P.End of Trial StatusOngoing
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