Clinical Trial Results:
An investigation of postoperative pain, why still in hospital and days alive and out of hospital following transoral robotic surgery for squamous cell carcinoma of unknown primary and obstructive sleep apnea
Summary
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EudraCT number |
2019-004610-34 |
Trial protocol |
DK |
Global end of trial date |
09 Nov 2022
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Results information
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Results version number |
v1(current) |
This version publication date |
28 Oct 2023
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First version publication date |
28 Oct 2023
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
DexaCup
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT04189107 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Rigshospitalet
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Sponsor organisation address |
Inge Lehmanns vej, Copenhagen, Denmark,
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Public contact |
Mikkel Larsen, Rigshospitalet, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, 45 35452071, mikkel.hjordt.holm.larsen@regionh.dk
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Scientific contact |
Mikkel Larsen, Rigshospitalet, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, 45 35452071, mikkel.hjordt.holm.larsen@regionh.dk
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
02 Jun 2023
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
09 Nov 2022
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Global end of trial reached? |
Yes
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Global end of trial date |
09 Nov 2022
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To investigate the effect of high dose steroids on the postoperative pain level measured by self-assessed VAS during rest and swallowing following transoral robotic surgery
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Protection of trial subjects |
Dexamethasone is a commonly used and safe drug used to reduce PONV. The analgesic effect of dexamethasone has previously only been sparsely studied in patients undergoing transoral robotic surgery. In this RCT we compared the effect of high vs low dose dexamethasone on patient reported pain. All adverse effects were monitored and reported. patients with contraindications for dexamethasone therapy were not included. The trial was monitored by the local GCP unit.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
30 Jun 2020
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Denmark: 18
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Worldwide total number of subjects |
18
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EEA total number of subjects |
18
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
13
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From 65 to 84 years |
5
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85 years and over |
0
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Recruitment
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Recruitment details |
The first patient was included and randomized 17th of August 2020 and the last patient was included and randomized 13th of October 2022. A total of 18 patients were included and randomized with 9 patients in each arm | |||||||||
Pre-assignment
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Screening details |
a total of 22 patients were screened. 4 patients were excluded as they declined participation or fulfilled a exclusion criteria | |||||||||
Period 1
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | |||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||
Roles blinded |
Investigator, Monitor, Assessor, Subject | |||||||||
Blinding implementation details |
Dexamethasone was delivered in blinded packages from a pharmacy. thus the treatment was blinded to all involved personnel and subjects.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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High dose | |||||||||
Arm description |
Patients undergoing transoral robotic resection lingual tonsillectomy as part of the diagnostic workup for carcinoma of unknown primary or in the treatment of obstructive sleep apnea were randomized to either 24 mg dexamethasone intraoperatively vs 8 mg intraoperatively followed by either 12mg on pod2 and pod 4 vs placebo on pod2 and pod4. | |||||||||
Arm type |
Experimental | |||||||||
Investigational medicinal product name |
Dexamethasone
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for injection
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Routes of administration |
Intravenous use
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Dosage and administration details |
the solution was delivered in 4mg/ml dexamethasone. Patient in the high dose group thus received 6mL intraoperatively and 3mL on POD2 and 4. patients in the low dose group received 2mL intraoperatively and placebo (sodium chloride) 4mL followed by 3 mL of sodium chloride on POD2 and 4
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Arm title
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low dose | |||||||||
Arm description |
Patients undergoing transoral robotic resection lingual tonsillectomy as part of the diagnostic workup for carcinoma of unknown primary or in the treatment of obstructive sleep apnea were randomized to either 24 mg dexamethasone intraoperatively vs 8 mg intraoperatively followed by either 12mg on pod2 and pod 4 vs placebo on pod2 and pod4. | |||||||||
Arm type |
No intervention | |||||||||
Investigational medicinal product name |
No investigational medicinal product assigned in this arm
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Baseline characteristics reporting groups
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Reporting group title |
High dose
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Reporting group description |
Patients undergoing transoral robotic resection lingual tonsillectomy as part of the diagnostic workup for carcinoma of unknown primary or in the treatment of obstructive sleep apnea were randomized to either 24 mg dexamethasone intraoperatively vs 8 mg intraoperatively followed by either 12mg on pod2 and pod 4 vs placebo on pod2 and pod4. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
low dose
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Reporting group description |
Patients undergoing transoral robotic resection lingual tonsillectomy as part of the diagnostic workup for carcinoma of unknown primary or in the treatment of obstructive sleep apnea were randomized to either 24 mg dexamethasone intraoperatively vs 8 mg intraoperatively followed by either 12mg on pod2 and pod 4 vs placebo on pod2 and pod4. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
High dose
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Reporting group description |
Patients undergoing transoral robotic resection lingual tonsillectomy as part of the diagnostic workup for carcinoma of unknown primary or in the treatment of obstructive sleep apnea were randomized to either 24 mg dexamethasone intraoperatively vs 8 mg intraoperatively followed by either 12mg on pod2 and pod 4 vs placebo on pod2 and pod4. | ||
Reporting group title |
low dose
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Reporting group description |
Patients undergoing transoral robotic resection lingual tonsillectomy as part of the diagnostic workup for carcinoma of unknown primary or in the treatment of obstructive sleep apnea were randomized to either 24 mg dexamethasone intraoperatively vs 8 mg intraoperatively followed by either 12mg on pod2 and pod 4 vs placebo on pod2 and pod4. |
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End point title |
VAS [1] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
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End point type |
Primary
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End point timeframe |
Until postoperative day 14
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Notes [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: The median VAS for each group at measure point was compared with Mann Whitney U-test. no statistical analyses has been added in the result section, as only one p value can be reported. |
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No statistical analyses for this end point |
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End point title |
Length of stay | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
from day of surgery until discharge
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No statistical analyses for this end point |
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End point title |
Rescue opioid use, during primary admission | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
from day of surgery until discharge
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No statistical analyses for this end point |
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End point title |
rescue opioid use, day of surgery until postoperative day 14 | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
from day of surgery until postoperative day 14
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No statistical analyses for this end point |
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End point title |
mortality | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
thirty day mortality
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No statistical analyses for this end point |
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End point title |
Postoperative hemorrhage | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
from day of surgery until followup
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No statistical analyses for this end point |
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End point title |
postoperative nausea and vomitting | ||||||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
Postoperative day 1-14
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No statistical analyses for this end point |
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End point title |
Postoperative infection | ||||||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From day of surgery until follow-up
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No statistical analyses for this end point |
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End point title |
Blood glucose level | ||||||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
Postoperative day 2 and 4
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No statistical analyses for this end point |
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End point title |
Tracheotomy placement | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
Day of surgery until postoperative day 30
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No statistical analyses for this end point |
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End point title |
Unplanned readmission | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
Thirty day unplanned readmission rate
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No statistical analyses for this end point |
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End point title |
Naso gastic tube placement | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From day of surgery until removal
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No statistical analyses for this end point |
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End point title |
Feeding tube re-insertion | |||||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
thirty day feeding tube re-insertion rate
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No statistical analyses for this end point |
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End point title |
Days until oral dietary intake | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
from day of surgery until oral dietary intake
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No statistical analyses for this end point |
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End point title |
Patient reported Food consistency | |||||||||
End point description |
Patient reported Food consistency
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End point type |
Secondary
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End point timeframe |
POD1 until POD 14
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Attachments |
Untitled (Filename: figure3.pdf) |
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No statistical analyses for this end point |
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Adverse events information [1]
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Timeframe for reporting adverse events |
until 60 hours after last administration of study drug. SAE/SAR until postoperative day 14
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Assessment type |
Systematic | ||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
none | ||||||||||
Dictionary version |
0
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Reporting groups
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Reporting group title |
ALL adverse events/reactions and SAE/SAR
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Reporting group description |
- | ||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||
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Notes [1] - There are no non-serious adverse events recorded for these results. It is expected that there will be at least one non-serious adverse event reported. Justification: There were no Adverse events or reactions or SAE/SAR in the cohort. The trial has a limited sample size, which can explain no adverse events |
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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14 Oct 2022 |
Sample size changed from 34 in total to 18 patients in total |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
All patients in the CUP group were HPV+. |