Ceftobiprol v léčbě pacientů s akutními bakteriálními infekcemi kůže a kožní struktury
Randomizovaná, dvojitě zaslepená, multicentrická studie ke stanovení bezpečnosti a účinnosti ceftobiprolu medocaril ve srovnání s vancomycinem plus aztreonam při léčbě akutních bakteriálních infekcí kůže a kožní struktury
This was a randomized, double-blind, active-controlled, parallel-group, multicenter study in adult hospitalized patients to establish the safety and efficacy of ceftobiprole medocaril compared with vancomycin plus aztreonam in the treatment of acute bacterial skin and skin structure infections (ABSSSIs).
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
This was a randomized, double-blind, active-controlled, parallel-group, multicenter study in adult hospitalized patients with ABSSSIs. Randomization was stratified by study site and type of ABSSSI (with major cutaneous abscess comprising ≤ 30% of the Intent-to-Treat [ITT] population).
Primary endpoint for FDA: Early clinical response based on the percent reduction in lesion size at 48-72 hours compared to baseline in patients who did not receive rescue therapy and were alive, in the ITT population.
Primary endpoint for EMA: Investigator-assessed clinical success at the test-of-cure (TOC) visit 15-22 days after randomization, in the co-primary ITT and Clinically Evaluable (CE) populations.
Typ studie
Typ studie
Zápis (Aktuální)
Zápis
Fáze
Fáze
- Fáze 3
Kontakty a umístění
Studijní místa
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Pleven, Bulharsko, 5800
- University Multiprofile Hospital for Active Treatment
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Plovdiv, Bulharsko, 4004
- University Multiprofile Hospital for Active Treatment
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Rousse, Bulharsko, 7002
- University Multiprofile Hospital for Active Treatment
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Sofia, Bulharsko, 1606
- "University Multiprofile Hospital for Active Treatment and Emergency Medicine ""N. I. Pirogov"", Clinic of Purulent-Septic Surgery-"N.I. Pirogov""
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Kaposvár, Maďarsko, 7400
- Kaposi Mor Teaching Hospital
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Miskolc, Maďarsko, 3529
- CRU Hungary Ltd.
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Szeged, Maďarsko, 6720
- University of SzegednAlbert Szent-Gyorgyi Clinical Center
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Veszprém, Maďarsko, 8200
- Csolnoky Ferenc Hospital
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California
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Anaheim, California, Spojené státy, 92804
- Saint Joseph's Clinical Research
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Anaheim, California, Spojené státy, 92804
- Physician Alliance Research Center
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Chula Vista, California, Spojené státy, 91911
- eStudySite - Chula Vista - PPDS
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Fresno, California, Spojené státy, 93721
- Central Valley Research LLC
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Huntington Beach, California, Spojené státy, 92647
- Marvel Clinical Research
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La Mesa, California, Spojené státy, 91942
- eStudySite - La Mesa - PPDS
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La Palma, California, Spojené státy, 90623
- Omnibus Clinical Research
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Long Beach, California, Spojené státy, 90813
- Alliance Research LLC
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Long Beach, California, Spojené státy, 90813
- Long Beach Clinical Trials
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Modesto, California, Spojené státy, 95350
- Central Valley Research, LLC
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Florida
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Coral Gables, Florida, Spojené státy, 33134
- Gonzalez MD and Aswad MD Health Services
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Miami, Florida, Spojené státy, 33144
- L&C Professional Medical Research Institute
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Montana
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Butte, Montana, Spojené státy, 59701
- Mercury Street Medical Group
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Nevada
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Las Vegas, Nevada, Spojené státy, 89109
- Excel Clinical Research
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Las Vegas, Nevada, Spojené státy, 89109
- eStudySite - Las Vegas - PPDS
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New Jersey
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Somers Point, New Jersey, Spojené státy, 08244
- South Jersey Infectious Disease
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Dnipro, Ukrajina, 49005
- Dnipropetrovsk I.I. Mechnуkov Regional Clinical Hospital, Surgery Department #2
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Ivano-Frankivsk, Ukrajina, 76008
- Ivano-Frankivsk City Clinical Hospital Surgery 1
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Ivano-Frankivsk, Ukrajina, 76018
- Ivano-Frankivsk City Clinical Hospital General Surgery
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Kyiv, Ukrajina, 03110
- Kyiv City Clinical Hospital
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Lviv, Ukrajina, 79000
- Public City Clinical Hospital of Emergency Medical Care
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Lviv, Ukrajina, 79059
- Lviv Regional Clinical Hospital
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Uzhhorod, Ukrajina, 88000
- Central City Clinical Hospital
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Vinnytsia, Ukrajina, 21018
- Vinnytsia M.I. Pyrohov Regional Clinical Hospital
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Zaporizhia, Ukrajina, 69000
- Zaporizhia City Clinical Hospital of Urgent and Emergency Medical Care
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Zhytomyr, Ukrajina, 12430
- Central District Hospital
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Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
INCLUSION CRITERIA
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Male or female, aged ≥18 years.
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Diagnosis of ABSSSI, meeting at least one of the definitions in (a) to (c) below. Local symptoms must have started within the 7 days prior to the Screening visit:
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Cellulitis/erysipelas, defined as a diffuse skin infection characterized by all of the following within 24 hours:
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i. Rapidly spreading areas of erythema, edema, and/or induration with a minimum total lesion surface area of 75cm^2
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ii. No collection of pus apparent upon visual examination
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iii. At least two of the following local signs of infection:
- erythema
- induration
- localized warmth
- pain or tenderness on palpation
- swelling/edema
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Major cutaneous abscess, defined as infection characterized by a collection of pus within the dermis or deeper that is apparent upon visual examination before or after therapeutic intervention and is accompanied by all of the following within 24 hours:
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i. Erythema, edema and/or induration with a minimum total lesion surface area of 75 cm^2.
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ii. At least two of the following local signs of infection:
- fluctuance
- incision and drainage required
- purulent or seropurulent drainage
- localized warmth
- pain or tenderness on palpation
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Wound infection, defined as infection of any apparent break in the skin characterized by at least one of the following:
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i. Superficial incision/surgical site infection meeting all of the following criteria:
- involves only the skin or subcutaneous tissue around the incision (does not involve fascia).
- occurs within 30 days of procedure.
- purulent drainage (spontaneous or therapeutic) with surrounding erythema, edema and/ or induration with a minimum total lesion surface area of 75cm^2.
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ii. Post-traumatic wound (including penetrating trauma, e.g., needle, nail, knife, insect and spider bites) meeting the following criterion within 24 hours:
- Purulent drainage (spontaneous or therapeutic) with surrounding erythema, edema and/or induration with a minimum total lesion surface area of 75cm^2.
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At least one of the following regional or systemic signs of infection at the Screening visit:
- Lymph node tenderness and volume increase, or palpable lymph node proximal to the primary ABSSSI.
- Fever > 38 °C/100.4 °F measured orally, > 38.5 °C / 101.3 °F measured tympanically, > 37.5 °C / 99.5 °F measured by the axillary method, or > 39 °C / 102.2 °F measured rectally.
- White blood cell (WBC) count > 10.0 × 10^9/L or < 4.0 × 10^9/L.
- > 10% immature neutrophils (band forms).
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Requirement for IV antibacterial treatment.
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Willing and able to adhere to study procedures (including prohibitions and restrictions) as specified in this protocol.
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Willing and able to remain hospitalized (in a hospital or equivalent medical confinement or clinical research unit) until completion of the early-clinical-response assessment for the primary endpoint.
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Informed consent signed by the patient, or their legally acceptable representative if appropriate, indicating that they understand the purpose of, and procedures required for, the study, and are willing to participate.
EXCLUSION CRITERIA
Patients meeting any one of the following:
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Use of any systemic antibacterial treatment within 14 days, or topical antibacterial administration on the primary lesion within 96 hours, before first infusion of study drug.
Exception: Receipt of a single dose of a short acting (half-life ≤ 12 hours) antibacterial therapy (e.g., for surgical prophylaxis) within > 3 days before randomization (i.e., patients cannot have received any antibacterial treatment within 72 hours of randomization).
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Contraindication to the administration of either of the study treatments, including known clinically-relevant hypersensitivity to related antibacterial treatments (e.g., beta-lactam and glycopeptide antibiotics), or to metronidazole if required as adjunctive therapy.
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Participation in any other clinical study within the 30 days prior to randomization, or any prior participation in this study.
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The primary ABSSSI is an uncomplicated skin and skin structure infection, such as furuncles, minor abscesses (area of suppuration not surrounded by cellulitis/erysipelas), impetiginous lesions, superficial or limited cellulitis/erysipelas, or minor wound infections (e.g., stitch abscesses).
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The primary ABSSSI is due to, or associated with, any of the following:
- Diabetic foot infection, gangrene, or perianal abscess.
- Concomitant infection at another site (e.g., septic arthritis, endocarditis, osteomyelitis), not including a secondary ABSSSI lesion.
- Infected burns.
- Decubitus or chronic skin ulcer, or ischemic ulcer due to peripheral vascular disease (arterial or venous).
- Any evolving necrotizing process (e.g., necrotizing fasciitis).
- Infections at vascular catheter sites, or involving thrombophlebitis.
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The primary ABSSSI is associated with, or in close proximity to, a prosthetic device.
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Patients who are placed in a hyperbaric chamber as adjunctive therapy for the ABSSSI.
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Patients expected to require more than two surgical interventions in the operating room for the ABSSSI.
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Severe sepsis or septic shock.
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Significant or life-threatening condition (e.g., endocarditis, meningitis) that would confound, or interfere with, the assessment of the ABSSSI.
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Another severe, acute or chronic medical condition, psychiatric condition, or laboratory abnormality that may increase the risks associated with study participation or administration of the investigational product, or may interfere with the interpretation of study results, and which, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
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Receiving treatment for active tuberculosis.
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Absolute neutrophil count < 0.5 × 10^9/L.
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Recent history of opportunistic infections (i.e., within 30 days) if the underlying cause of these infections is still active (e.g., leukemia, transplant, acquired immunodeficiency syndrome [AIDS]).
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Patients receiving systemic steroids (> 40 mg per day prednisolone, or equivalent), or receiving immunosuppressant drugs.
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Requirement for peritoneal dialysis, plasmapheresis, hemodialysis, venovenous dialysis, or other forms of renal filtration, or expected to require such treatment before the TOC visit.
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Alanine transaminase (ALT) or aspartate transaminase (AST) levels ≥ 8× the upper limit of normal, OR severe hepatic disease with Child-Pugh class C.
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Women who are pregnant or nursing.
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Women who are of childbearing potential and unwilling to use an acceptable method of birth control during the study: female sterilization (bilateral tubal occlusion or oophorectomy, or hysterectomy) or male partner vasectomy; intrauterine device (IUD); combined (estrogen and progesterone containing) hormonal contraception (oral, vaginal ring, or transdermal patch) with an ethinylestradiol dose of at least 30 µg, plus use of male condoms (preferably with spermicides), female condoms, a female diaphragm or a cervical cap; or total sexual abstinence.
Women are not considered to be of childbearing potential if they are either ≥ 1 year post-menopausal (where menopause is defined as at least 12 months of amenorrhea), or have a serum follicle stimulating hormone (FSH) measurement consistent with post-menopausal status according to local laboratory thresholds. An FSH measurement at Screening is to be obtained for post-menopausal females aged < 50 years, or for those aged ≥ 50 years who have been post-menopausal for < 2 years.
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Inability to start study-drug therapy within 24 hours of Screening.
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Patients with illicit drug use within 12 months of screening, including heroin, other opioids (unless prescribed for medical reasons unrelated to heroin substitution), cocaine / crack cocaine, and amphetamine or methamphetamine. Exception: Cannabis use.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Čtyřnásobek
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
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Experimentální: ceftobiprole medocaril
Patients treated with ceftobiprole medocaril 500 mg q8h (with dose adjustment for renal impairment). |
ceftobiprole 500 mg was to be administered every 8 hours as a 2-hour IV infusion (with dose adjustment for renal impairment). The treatment duration was for a minimum of 5 days and a maximum of 10 days. Treatment could be extended up to 14 days if in the investigator's opinion this was required, and the extension was approved by the sponsor's medical monitor.
Ostatní jména:
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Aktivní komparátor: vancomycin+aztreonam
Patients treated with vancomycin 1000 mg (or 15 mg/kg) q12h plus aztreonam 1000 mg q12h (both with dose adjustment for renal impairment). |
Vancomycin 1000 mg (or 15 mg/kg) was to be administered every 12 hours (with dose adjustment for renal impairment) as 2-hour IV infusion. Vancomycin dose adjustment for morbidly obese and hypermetabolic patients was to be done according to local standard of care. When locally available, vancomycin trough testing (VTT) might have been used by the unblinded pharmacist or delegate to adjust the vancomycin dose. The treatment duration was for a minimum of 5 days and a maximum of 10 days. Treatment could be extended up to 14 days if in the investigator's opinion this was required, and the extension was approved by the sponsor's medical monitor. Aztreonam 1000 mg was to be administered as a 0.5-hour IV infusion every 12 hours. If CLCR was < 30 mL/min (i.e., severe renal impairment), the aztreonam dosage regimen was to be adjusted. The requirement to continue aztreonam therapy beyond Day 3 was to be reassessed at the 72-hour study visit. |
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Early Clinical Response
Časové okno: 48-72 hours after start of study drug treatment
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Comparison of early clinical response, including ≥ 20% reduction from baseline in the primary lesion area (based on ruler measurements), survival for ≥ 72 hours and no rescue therapy in the ITT population |
48-72 hours after start of study drug treatment
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Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Investigator-assessed Clinical Success in the ITT Population
Časové okno: 15-22 days after randomization
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Comparison of investigator-assessed clinical success (based on resolution of baseline signs and symptoms of the primary infection) in the ITT population |
15-22 days after randomization
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Investigator-assessed Clinical Success in the Clinically Evaluable (CE) Population
Časové okno: 15-22 days after randomization
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Comparison of investigator-assessed clinical success (based on resolution of baseline signs and symptoms of the primary infection) in the clinically evaluable (CE) population |
15-22 days after randomization
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Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Spolupracovníci
Spolupracovníci
Vyšetřovatelé
Vyšetřovatelé
- Ředitel studie: Marc Engelhardt, MD, Basilea Pharmaceutica
Publikace a užitečné odkazy
Obecné publikace
- Welte T, Scheeren TW, Overcash JS, Saulay M, Engelhardt M, Hamed K. Efficacy and safety of ceftobiprole in patients aged 65 years or older: a post hoc analysis of three Phase III studies. Future Microbiol. 2021 May;16:543-555. doi: 10.2217/fmb-2021-0042. Epub 2021 May 7.
- Overcash JS, Kim C, Keech R, Gumenchuk I, Ninov B, Gonzalez-Rojas Y, Waters M, Simeonov S, Engelhardt M, Saulay M, Ionescu D, Smart JI, Jones ME, Hamed KA. Ceftobiprole Compared With Vancomycin Plus Aztreonam in the Treatment of Acute Bacterial Skin and Skin Structure Infections: Results of a Phase 3, Randomized, Double-blind Trial (TARGET). Clin Infect Dis. 2021 Oct 5;73(7):e1507-e1517. doi: 10.1093/cid/ciaa974.
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Začátek studia
Primární dokončení (Aktuální)
Primární dokončení
Dokončení studie (Aktuální)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
Další identifikační čísla studie
Další identifikační čísla studie
- BPR-CS-008
- HHSO100201600002C (Jiné číslo grantu/financování: BARDA)
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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