Zibotentan og Dapagliflozin-kombination, evalueret i levercirrhosis (ZEAL-undersøgelse) (ZEAL)
Et todelt fase IIa/b multicenter, randomiseret, dobbeltblindet, placebokontrolleret, parallel gruppedosisvarierende undersøgelse for at vurdere effektivitet, sikkerhed og tolerabilitet af kombinationen af Zibotentan og Dapagliflozin og Dapagliflozin monoterapi versus placebo hos deltagere med cirrose Med funktioner i Portal Hypertension
This is a two part Phase IIa/b multicentre, randomised, double-blind, placebo-controlled, parallel group dose-ranging study to assess the efficacy, safety, and tolerability of the combination of zibotentan and dapagliflozin, and dapagliflozin monotherapy versus placebo in participants with cirrhosis with features of portal hypertension.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
- Medicin: Part A: Placebo (matching zibotentan capsule & matching dapagliflozin tablet)
- Medicin: Part A: zibotentan (dose B) + dapagliflozin
- Medicin: Part B: Placebo (matching zibotentan capsule & matching dapagliflozin tablet)
- Medicin: Part B: placebo (matching zibotentan capsule) + dapagliflozin
- Medicin: Part B: zibotentan (dose A) + dapagliflozin
- Medicin: Part B: zibotentan (dose B) + dapagliflozin
- Medicin: Part B: zibotentan (dose C) + dapagliflozin
Detaljeret beskrivelse
Part A will assess the efficacy, safety, and tolerability of the combination of B mg zibotentan and 10 mg dapagliflozin versus placebo in participants with Child-Pugh A cirrhosis with features of portal hypertension and with no history of decompensation events.
If the safety profile is determined to be acceptable at the conclusion of Part A, Part B will investigate efficacy, safety, and tolerability of A mg, B mg, or C mg zibotentan combined with 10 mg dapagliflozin and of 10 mg dapagliflozin monotherapy versus placebo in participants with cirrhosis with features of portal hypertension. Part B will include a broader range of Child- Pugh A and Child-Pugh B cirrhosis participants, including those with more severe disease, a history of decompensation events, or current ascites.
The study will be conducted in approximately 30 to 45 study centres in North America, Asia, and Europe.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Fase 2
Kontakter og lokationer
Studiesteder
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Heidelberg, Australien, 3084
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Edegem, Belgien, 2650
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Aarhus N, Danmark, 8200
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Esbjerg, Danmark, 6700
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Hvidovre, Danmark, 2650
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Køge, Danmark, 4600
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Birmingham, Det Forenede Kongerige, B9 5SS
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Cambridge, Det Forenede Kongerige, CB2 0XY
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London, Det Forenede Kongerige, SE5 9RS
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Alabama
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Birmingham, Alabama, Forenede Stater, 35233
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California
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Pasadena, California, Forenede Stater, 91105
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San Francisco, California, Forenede Stater, 94115
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West Hollywood, California, Forenede Stater, 90048
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Minnesota
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Rochester, Minnesota, Forenede Stater, 55905
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New York
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The Bronx, New York, Forenede Stater, 10467
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South Carolina
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Charleston, South Carolina, Forenede Stater, 29425
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Texas
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Dallas, Texas, Forenede Stater, 75246
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Virginia
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Charlottesville, Virginia, Forenede Stater, 22903
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Richmond, Virginia, Forenede Stater, 23249
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Wisconsin
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Milwaukee, Wisconsin, Forenede Stater, 53226
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Angers, Frankrig, 49933
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Clichy, Frankrig, 92110
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Paris, Frankrig, 75651
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Toulouse, Frankrig, 31059
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Amsterdam, Holland, 1081 HV
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Beijing, Kina, 100057
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Chengdu, Kina, 610000
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Guangzhou, Kina, 510515
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Hangzhou, Kina, 310015
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Cluj-Napoca, Rumænien, 400162
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Bern, Schweiz, 3010
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Lucerne, Schweiz, 6000
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Lugano, Schweiz, 6900
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Barcelona, Spanien, 08035
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Barcelona, Spanien, 08036
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Barcelona, Spanien, 08041
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Madrid, Spanien, 28034
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Madrid, Spanien, 28007
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Majadahonda, Spanien, 28222
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Santander, Spanien, 39008
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Taipei, Taiwan, 10002
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Taipei, Taiwan, 112
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Prague, Tjekkiet, 128 00
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Prague, Tjekkiet, 169 02
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Dresden, Tyskland, 01307
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Landshut, Tyskland, 84034
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Mainz, Tyskland, 55131
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Münster, Tyskland, 48149
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Wiesbaden, Tyskland, 65189
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Vienna, Østrig, 1090
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Study principal inclusion criteria For both Part A and Part B
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No current or prior (within 1 month of enrolment) medical treatment with an SGLT2 inhibitor or ERAs.
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On no or a stable dose of beta blockers, with no major dose changes within 1 month prior to the first dose of study intervention.
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Provision of signed and dated, written ICF prior to any mandatory study-specific procedures, sampling, and analyses.
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Female participants of non-childbearing potential confirmed at screening by fulfilling one of the following criteria:
- Post-menopausal: defined as amenorrhoea for at least 12 months or more following cessation of all exogenous hormonal treatments; and also, FSH levels in the post-menopausal range by central laboratory.
- Documentation of irreversible surgical sterilisation by hysterectomy, bilateral oophorectomy or bilateral salpingectomy but not tubal ligation.
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Female participants must have a negative pregnancy test at screening and must not be lactating
Part A participants who have the following:
- Clinical and/or histological diagnosis of cirrhosis with either (i) features of portal hypertension or (ii) liver stiffness ≥ 21 kPa.
- MELD score < 15.
- Child-Pugh score ≤ 6.
- No clinically evident ascites.
- No evidence of worsening of hepatic function (eg, no clinically significant change in signs, symptoms, or laboratory parameters of hepatic disease status) within the last month prior to dosing, as determined by the investigator or usual practitioner.
- HVPG recording of good enough quality as judged by a central reader.
Part B participants who have the following:
- Clinical and/or histological diagnosis of cirrhosis and either history of decompensation or compensated cirrhosis with signs of clinically significant portal hypertension.
- HVPG recording of good enough quality and HVPG > 10 mmHg, as judged by a central reader.
- MELD score < 15.
- Child-Pugh score < 10.
- No ascites or ascites up to grade 2 without change in diuretic treatment within the last month prior to first dose and no paracentesis within the last month or planned paracentesis in the next 4 months at screening.
- No evidence of worsening of hepatic function (eg, no clinically significant change in signs, symptoms, or laboratory parameters of hepatic disease status) within the last month prior to dosing, as determined by the investigator or usual practitioner.
Study principal exclusion criteria:
- Any evidence of a clinically significant disease which in the investigator's opinion makes it undesirable for the participant to participate in the study.
- Liver cirrhosis caused by chronic cholestatic liver disease
- ALT or AST ≥ 150 U/L and/or total bilirubin ≥ 3 × ULN
- Acute liver injury caused by drug toxicity or by an infection.
- Any history of hepatocellular carcinoma.
- Liver transplant or expected liver transplantation within 6 months of screening.
- History of TIPS or a planned TIPS within 6 months from enrolment into the study.
- Active treatment for HCV within the last 1 year or HBV antiviral therapy for less than 1 year.
- Participants with T1DM.
Medical Conditions (Part A only)
- INR > 1.5.
- Serum/plasma levels of albumin ≤ 35 g/L.
- Platelet count < 75 × 109/L.
- History of ascites
- History of hepatic hydrothorax
- History of portopulmonary syndrome
- History of hepatic encephalopathy
- History of variceal haemorrhage
- History of acute kidney injury
- History of heart failure, including high output heart failure (eg, due to hyperthyroidism or Paget's disease)
Medical Conditions (Part B only)
- INR > 1.7.
- Serum/plasma levels of albumin ≤ 28 g/L.
- Platelet count < 50 × /109L.
- Acute kidney injury within 3 months of screening.
- History of encephalopathy of West Haven grade 2 or higher within 6 months prior to screening.
- History of variceal haemorrhage within 6 months prior to screening.
- NYHA functional heart failure class III or IV or with unstable heart failure requiring hospitalisation for optimisation of heart failure treatment and who are not yet stable on heart failure therapy within 6 months prior to screening.
- Heart failure due to cardiomyopathies that would primarily require specific other treatment: eg, cardiomyopathy due to pericardial disease, amyloidosis or other infiltrative diseases, cardiomyopathy related to congenital heart disease, primary hypertrophic cardiomyopathy, cardiomyopathy related to toxic or infective conditions (ie, chemotherapy, infective myocarditis, septic cardiomyopathy).
- High output heart failure (eg, due to hyperthyroidism or Paget's disease).
- Heart failure due to primary cardiac valvular disease/dysfunction, severe functional mitral or tricuspid valve insufficiency, or planned cardiac valve repair/replacement.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Screening
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Tredobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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Eksperimentel: Part A: Treatment Group 1
Participants will receive once daily dose of placebo matching zibotentan capsule + placebo matching dapagliflozin tablet for 6 weeks. |
placebo capsule (matching zibotentan capsule) placebo tablet (matching dapagliflozin tablet) |
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Eksperimentel: Part A: Treatment Group 2
Participants will receive once daily dose of zibotentan capsule + dapagliflozin tablet for 6 weeks. |
zibotentan capsule dapagliflozin tablet |
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Eksperimentel: Part B: Treatment Group 1
Participants will receive once daily dose of placebo matching zibotentan capsule + placebo matching dapagliflozin tablet for 16 weeks. |
placebo capsule (matching zibotentan capsule) placebo tablet (matching dapagliflozin tablet) |
|
Eksperimentel: Part B: Treatment Group 2
Participants will receive once daily dose of placebo matching zibotentan capsule + dapagliflozin tablet for 16 weeks. |
placebo capsule (matching zibotentan capsule) dapagliflozin tablet |
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Eksperimentel: Part B: Treatment Group 3
Participants will receive once daily dose of zibotentan capsule + dapagliflozin tablet for 16 weeks. |
zibotentan capsule dapagliflozin tablet |
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Eksperimentel: Part B: Treatment Group 4
Participants will receive once daily dose of zibotentan capsule + dapagliflozin tablet for 16 weeks. |
zibotentan capsule dapagliflozin tablet |
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Eksperimentel: Part B: Treatment Group 5
Participants will receive once daily dose of zibotentan capsule + dapagliflozin tablet for 16 weeks. |
zibotentan capsule dapagliflozin tablet |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Absolute Change in HVPG From Baseline to Week 6, Part A
Tidsramme: From Baseline to Week 6
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Absolute change in Hepatic venous pressure gradient from baseline to week 6. |
From Baseline to Week 6
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Absolute Change in HVPG From Baseline to Week 6, Part B
Tidsramme: From Baseline to Week 6
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Absolute change in Hepatic venous pressure gradient from baseline to week 6. |
From Baseline to Week 6
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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HVPG Percentage Change From Baseline to Week 6, Part A
Tidsramme: From Baseline to Week 6
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Hepatic venous pressure gradient percentage change from baseline to week 6, Part A. |
From Baseline to Week 6
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HVPG Percentage Change From Baseline to Week 6, Part B
Tidsramme: From baseline to week 6
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Hepatic venous pressure gradient percentage change from baseline to week 6, Part B. |
From baseline to week 6
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Number of Participants With HVPG Response at Week 6, Part A
Tidsramme: From baseline to week 6
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A HVPG responder is defined as a subject having <10 mmHg at week 6 if baseline HVPG >=10 or a reduction of >=1.5 mmHg from baseline to week 6. n: Number of subjects in analysis. N: Number of subjects per treatment group. |
From baseline to week 6
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Number of Participants With HVPG Response at Week 6, Part B
Tidsramme: From baseline to Week 6
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A HVPG responder in Part B is defined as a subject having at least 20% decrease or a reduction to or below 12 mmHg if baseline HVPG > 12 mmHG from baseline to Week 6. |
From baseline to Week 6
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Change in Body Weight (kg) Over Time Course of Study, Part A
Tidsramme: From baseline to Week 6
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The analysis is performed using MMRM. The model includes the continuous covariate of the Baseline measurements as the fixed effect covariate and fixed categorical effects of treatment group, visit, and treatmentby-visit interaction. |
From baseline to Week 6
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Change in Body Weight (kg) Over Time Course of Study, Part B
Tidsramme: From baseline to Week 6 and Week 16
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The analysis is performed using MMRM. The model includes the continuous covariate of the Baseline measurements as the fixed effect covariate and fixed categorical effects of treatment group, visit, and treatmentby-visit interaction. |
From baseline to Week 6 and Week 16
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Change in Total Dosage of Loop-diuretic Equivalents Use From Baseline to Week 6, Part A
Tidsramme: From baseline to Week 6
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Change in total dosage of loop-diuretic equivalents use from baseline to Week 6, Part A. A loop-diuretic equivalent is based on 40 mg furosemide = 1 mg bumetanide = 20 mg torsemide = 50 mg ethacrynic acid. |
From baseline to Week 6
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Change in Total Dosage of Loop-diuretic Equivalents Use From Baseline to Week 6 and Week 16, Part B
Tidsramme: From Baseline to Week 6 and Week 16
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Change in total dosage of loop-diuretic equivalents use from baseline to Week 6, Part B. A loop-diuretic equivalent is based on 40 mg furosemide = 1 mg bumetanide = 20 mg torsemide = 50 mg ethacrynic acid. |
From Baseline to Week 6 and Week 16
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Change in Total Body Water From Baseline to Week 6, Part A
Tidsramme: From Baseline to Week 6
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Change in total body water from baseline to Week 6, Part A. The analysis is performed using MMRM. |
From Baseline to Week 6
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Change in Total Body Water From Baseline to Week 6 and Week 16, Part B
Tidsramme: From Baseline to Week 6 and Week 16
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Change in total body water from baseline to Week 6 and Week 16, Part B. The analysis is performed using MMRM. |
From Baseline to Week 6 and Week 16
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Change in Extracellular Water From Baseline to Week 6, Part A
Tidsramme: From baseline to Week 6
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Change in extracellular water from baseline to Week 6, Part A. The analysis is performed using MMRM. Bioimpedance spectroscopy (BIS) was performed at the study centre to monitor body water volumes and body fat mass. |
From baseline to Week 6
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Change in Extracellular Water From Baseline to Week 6 and Week 16, Part B
Tidsramme: From Baseline to Week 6 and to Week 16
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Change in extracellular water from baseline to Week 6 and Week 16, Part B. The analysis is performed using MMRM. Bioimpedance spectroscopy (BIS) was performed at the study centre to monitor body water volumes and body fat mass. |
From Baseline to Week 6 and to Week 16
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Change in Intracellular Water From Baseline to Week 6, Part A
Tidsramme: From Baseline to Week 6
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Change in intracellular water from Baseline to Week 6, Part A. The analysis is performed using MMRM. Bioimpedance spectroscopy (BIS) was performed at the study centre to monitor body water volumes and body fat mass. |
From Baseline to Week 6
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Change in Intracellular Water From Baseline to Week 6 and Week 16, Part B
Tidsramme: From Baseline to Week 6 and Week 16
|
Change in intracellular water from Baseline to Week 6 and Week 16, Part B. The analysis is performed using MMRM. Bioimpedance spectroscopy (BIS) was performed at the study centre to monitor body water volumes and body fat mass. |
From Baseline to Week 6 and Week 16
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Change in Total Body Fat Mass From Baseline to Week 6, Part A
Tidsramme: From baseline to Week 6
|
Change in total body fat mass from Baseline to Week 6, Part A. The analysis is performed using MMRM. Bioimpedance spectroscopy (BIS) was performed at the study centre to monitor body water volumes and body fat mass. |
From baseline to Week 6
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Change in Total Body Fat Mass From Baseline to Week 6 and Week 16, Part B
Tidsramme: From Baseline to Week 6 and Week 16
|
Change in total body fat mass from Baseline to Week 6 and Week 16, Part B. The analysis is performed using MMRM. Bioimpedance spectroscopy (BIS) was performed at the study centre to monitor body water volumes and body fat mass. |
From Baseline to Week 6 and Week 16
|
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Change in Systolic Blood Pressure From Baseline to Week 6, Part A
Tidsramme: From Baseline to Week 6
|
Change in systolic blood pressure from baseline to Week 6, Part A. The analysis is performed using MMRM. |
From Baseline to Week 6
|
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Change in Systolic Blood Pressure From Baseline to Week 6 and Week 16, Part B
Tidsramme: From baseline to Week 6 and Week 16
|
Change in systolic blood pressure from baseline to Week 6 and Week 16, Part B. The analysis is performed using MMRM. |
From baseline to Week 6 and Week 16
|
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Change in Diastolic Blood Pressure From Baseline to Week 6, Part A
Tidsramme: From Baseline to Week 6
|
Change in diastolic blood pressure from baseline to Week 6, Part A. The analysis is performed using MMRM. |
From Baseline to Week 6
|
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Change in Diastolic Blood Pressure From Baseline to Week 6 and Week 16, Part B
Tidsramme: From baseline to Week 6 and Week 16
|
Change in diastolic blood pressure from baseline to Week 6 and Week 16, Part B. The analysis is performed using MMRM. |
From baseline to Week 6 and Week 16
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- D4326C00003
- 2021-006577-30 (EudraCT nummer)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All request will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure
IPD-delingstidsramme
AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA Pharma Data Sharing Principles. For details of our timelines, please rerefer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
IPD-delingsadgangskriterier
When a request has been approved AstraZeneca will provide access to the de-identified individual patient-level data in an approved sponsored tool . Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure
IPD-deling Understøttende informationstype
- STUDY_PROTOCOL
- SAP
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