Clinical Trial Results:
Pen-Administered Low-Dose Dasiglucagon for Prevention and Treatment of Hypoglycemia in People with Type 1 Diabetes: A Randomized, Open-Label, Two-Period Crossover Outpatient Study
Summary
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EudraCT number |
2020-005745-16 |
Trial protocol |
DK |
Global end of trial date |
28 Jan 2022
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Results information
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Results version number |
v1(current) |
This version publication date |
24 Feb 2023
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First version publication date |
24 Feb 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 |
77119
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT04764968 | ||
WHO universal trial number (UTN) |
- | ||
Other trial identifiers |
Regional Scientific Ethics Committee: H-21000002 | ||
Sponsors
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Sponsor organisation name |
Steno Diabetes Center Copenhagen
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Sponsor organisation address |
Borgmester Ib Juuls Vej 83, Herlev, Denmark, 2730
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Public contact |
Christian Laugesen, Steno Diabetes Center Copenhagen, +45 51642387, christian.laugesen@regionh.dk
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Scientific contact |
Christian Laugesen, Steno Diabetes Center Copenhagen, +45 51642387, christian.laugesen@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 |
14 Nov 2022
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
30 Dec 2021
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Global end of trial reached? |
Yes
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Global end of trial date |
28 Jan 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 |
The primary objective of the study is to evaluate the efficacy, safety and feasibility of outpatient-utilization of low-dose (80 μg) dasiglucagon administered via an investigational trial device (a multi-dose reusable pen injector) in preventing and treating mild hypoglycemia in insulin pump-treated people type 1 diabetes
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Protection of trial subjects |
N/A
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Background therapy |
All participants used their regular treatment modality (insulin pump therapy including stand-alone CGM). | ||
Evidence for comparator |
N/A | ||
Actual start date of recruitment |
27 Apr 2021
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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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: 24
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Worldwide total number of subjects |
24
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EEA total number of subjects |
24
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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) |
20
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From 65 to 84 years |
4
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85 years and over |
0
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Recruitment
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Recruitment details |
Participants were recruited from the outpatient diabetes clinic at Steno Diabetes Center Copenhagen from May 2021 to November 2021. | |||||||||
Pre-assignment
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Screening details |
After providing oral and written informed consent, participants completed a screening visit for assessment of the eligibility criteria. Procedures included routine blood sampling, physical examination, review of medical history and medications as well as registration of baseline characteristics. | |||||||||
Period 1
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Period 1 title |
Study period (overall period)
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Is this the baseline period? |
Yes | |||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Not blinded | |||||||||
Arms
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Are arms mutually exclusive |
No
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Arm title
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Dasiglucagon period | |||||||||
Arm description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with pen-administered low-dose (80 μg) s.c. dasiglucagon using a multi-dose reusable pen injector. | |||||||||
Arm type |
Experimental | |||||||||
Investigational medicinal product name |
dasiglucagon
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Investigational medicinal product code |
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Other name |
CAS15 number: 1544300-84-6, EV Substance code: SUB193123
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Pharmaceutical forms |
Solution for injection
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Administration of s.c. dasiglucagon (80 ug) using a multi-dose reusable pen injector.
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Arm title
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Usual care period | |||||||||
Arm description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with usual care (i.e. consumption of carbohydrates) | |||||||||
Arm type |
Usual care | |||||||||
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 |
Study period
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Reporting group description |
All 24 participants included in the study | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Dasiglucagon period
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Subject analysis set type |
Full analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with pen-administered low-dose (80 μg) s.c. dasiglucagon using a multi-dose reusable pen injector.
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Subject analysis set title |
Usual care period
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Subject analysis set type |
Full analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with usual care (i.e. consumption of carbohydrates)
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End points reporting groups
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Reporting group title |
Dasiglucagon period
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Reporting group description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with pen-administered low-dose (80 μg) s.c. dasiglucagon using a multi-dose reusable pen injector. | ||
Reporting group title |
Usual care period
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Reporting group description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with usual care (i.e. consumption of carbohydrates) | ||
Subject analysis set title |
Dasiglucagon period
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with pen-administered low-dose (80 μg) s.c. dasiglucagon using a multi-dose reusable pen injector.
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Subject analysis set title |
Usual care period
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
2-week period where participants managed impending and manifested episodes of hypoglycaemia with usual care (i.e. consumption of carbohydrates)
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End point title |
Percentage of time in range (3.9-10 mmol/L) | ||||||||||||
End point description |
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End point type |
Primary
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End point timeframe |
2-week 'usual care' period and 2-week 'dasiglucagon' period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.1286 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
2.4
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-0.7 | ||||||||||||
upper limit |
5.5 |
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End point title |
Percentage of time below range (<3.9 mmol/L) | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
2-week usual care period and 2-week dasiglucagon period
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Statistical analysis title |
Difference between intervenstions | ||||||||||||
Statistical analysis description |
The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.1622 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-0.5
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-1.2 | ||||||||||||
upper limit |
0.2 |
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End point title |
Percentage of time above range (>10 mmol/L) | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
2-week usual care period and 2-week dasiglucagon period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other [1] | ||||||||||||
P-value |
= 0.2772 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-1.9
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-5.4 | ||||||||||||
upper limit |
1.6 | ||||||||||||
Notes [1] - The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect. |
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End point title |
Coefficient of variation | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
2-week usual care period and 2-week dasiglucagon period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other [2] | ||||||||||||
P-value |
= 0.5503 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
0.4
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-1 | ||||||||||||
upper limit |
1.8 | ||||||||||||
Notes [2] - The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect. |
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End point title |
Successful cases (%) of hypoglycemia treatment | ||||||||||||
End point description |
Initial sensor glucose level ≥ 2.2 mmol/l and ≤ 3.9 mmol/l AND sensor glucose level > 3.9 mmol/l 30 minutes post-treatment
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End point type |
Secondary
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End point timeframe |
2-week 'usual care' period and 2-week 'dasiglucagon' period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The endpoint was evaluated using a logistic regression model with random subject effect using sequence, period, and event baseline sensor glucose value as a covariate.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.1597 | ||||||||||||
Method |
Regression, Logistic | ||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||
Point estimate |
1.55
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
0.84 | ||||||||||||
upper limit |
2.86 |
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End point title |
Successful cases (%) of hypoglycemia treatment without subsequent hyperglycemia | ||||||||||||
End point description |
Initial sensor glucose level ≥ 2.2 mmol/l and ≤ 3.9 mmol/l AND sensor glucose level > 3.9 mmol/l 30 minutes post-treatment AND sensor glucose level ≤ 10 mmol/l during the first two hours post-treatment
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End point type |
Secondary
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End point timeframe |
2-week 'usual care' period and 2-week 'dasiglucagon' period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The endpoint was evaluated using a logistic regression model with random subject effect using sequence, period, and event baseline sensor glucose value as a covariate.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.3215 | ||||||||||||
Method |
Regression, Logistic | ||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||
Point estimate |
0.79
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
0.49 | ||||||||||||
upper limit |
1.27 |
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End point title |
Successful cases (%) of hypoglycemia prevention | ||||||||||||
End point description |
Initial sensor glucose level > 3.9 mmol/l AND sensor glucose level < 3.9 for ≤ 15 consecutive minutes during the first two hours post-treatment
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End point type |
Secondary
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End point timeframe |
2-week 'usual care' period and 2-week 'dasiglucagon' period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The endpoint was evaluated using a logistic regression model with random subject effect using sequence, period, and event baseline sensor glucose value as a covariate.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.0177 | ||||||||||||
Method |
Regression, Logistic | ||||||||||||
Parameter type |
Odds ratio (OR) | ||||||||||||
Point estimate |
3
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
1.21 | ||||||||||||
upper limit |
7.41 |
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End point title |
Time (in minutes) from hypoglycemia treatment to euglycemia | ||||||||||||
End point description |
Minutes from initial sensor glucose level ≥ 2.2 mmol/l and ≤ 3.9 mmol/l to sensor glucose level ≥ 3.9 mmol/l
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End point type |
Secondary
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End point timeframe |
2-week 'usual care' period and 2-week 'dasiglucagon' period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The endpoint was evaluated using a proportional hazards regression model with gamma-distributed random effect using sequence, period, and event baseline sensor glucose value as a covariate.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.0064 | ||||||||||||
Method |
Regression, Cox | ||||||||||||
Parameter type |
Rate ratio (RR) | ||||||||||||
Point estimate |
1.44
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
1.11 | ||||||||||||
upper limit |
1.87 |
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End point title |
Incidence rate of supplement carbohydrate administration during the first hour following dasiglucagon administration | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
2-week 'dasiglucagon' period
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No statistical analyses for this end point |
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End point title |
Total daily insulin dose | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
2-week 'usual care' period and 2-week 'dasiglucagon' period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
= 0.5148 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
0.7
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-1.5 | ||||||||||||
upper limit |
2.9 |
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End point title |
Total daily carbohydrate intake | ||||||||||||
End point description |
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End point type |
Secondary
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End point timeframe |
2-week 'dasiglucagon' period
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Statistical analysis title |
Difference between interventions | ||||||||||||
Statistical analysis description |
The treatment effect was evaluated by comparing treatment groups using a linear mixed model that included the factors treatment (2 levels), sequence (2 levels), period (2 levels), and a random subject effect.
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Comparison groups |
Dasiglucagon period v Usual care period
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Number of subjects included in analysis |
48
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-20
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-34 | ||||||||||||
upper limit |
-6 |
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End point title |
Patient-reported outcome | ||||||||
End point description |
Percentage of participants scoring a favorable outcome on the patient-reported outcome questionnaire ("How likely is it that you, given the option, would use dasiglucagon as part of your diabetes management?" (Answer options: Very unlikely, unlikely, likely, very likely).
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End point type |
Secondary
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End point timeframe |
At the end-of-study visit
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
2-week 'usual care' period and 2-week 'dasiglucagon' period
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
N/A | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
N/A
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Reporting groups
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Reporting group title |
Dasiglucagon period
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Usual care period
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 0% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? No | |||
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. | |||
None reported |