Mycophenolatmofetil bei systemischer Sklerose mit subklinischer interstitieller Lungenerkrankung (SSc-mILD)
Randomisierte, doppelblinde, placebokontrollierte klinische Studie zur Bewertung der Wirksamkeit von Mycophenolatmofetil bei subklinischer interstitieller Lungenerkrankung im Zusammenhang mit systemischer Sklerose: eine Machbarkeitsstudie
The goal of this pilot study is to assess the feasibility of a larger study on the efficacy of mycophenolate mofetil in people diagnosed with systemic sclerosis with mild lung involvement. Participants will be recruited over 12 months at 3 academic centers and assigned randomly to receive either mycophenolate mofetil or placebo, a look-alike substance that contains no active drug, for 96 weeks.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Background: Systemic sclerosis (SSc, scleroderma) is a rare but life-threatening systemic autoimmune disease characterized by microvasculopathy, serum autoantibodies, inflammation and fibrosis of the skin and internal organs. Early rapidly progressive SSc remains the most lethal autoimmune rheumatic disease, with over 60% mortality at 5 years in high-risk patients. Interstitial lung disease (ILD) is the leading cause of SSc-related mortality and affects over half of SSc patients. SSc-ILD is currently treated with immunosuppressive and anti-fibrotic drugs, with the first-line treatment being mycophenolate mofetil (MMF), although treatments have modest benefits when initiated in advanced stages of disease. Emerging data suggest that earlier treatment, when lung function is still normal despite evidence of ILD on computed tomography scan ("subclinical SSc-ILD"), may lead to improved outcomes, suggesting a window of treatment opportunity.
Research Aims: The goal of the proposed pilot RCT is to establish the feasibility of a phase III RCT that will assess the efficacy of MMF in subclinical SSc-ILD. Specifically, we aim to:
- Determine the rate of patient recruitment at three centers over one year, and identify barriers and solutions to recruitment;
- Determine the proportion of participants receiving the allocated treatment and with complete primary efficacy outcome data at 48 and 96 weeks; and
- Generate preliminary data on clinical efficacy outcomes that will contribute information to the analysis of the phase III trial through a Bayesian inference framework.
Methods: Participants will be adults with SSc, ILD diagnosed within the past 3 years and a normal forced vital capacity (≥ 80%). Participants will be recruited over 12 months at 3 academic centers affiliated to the Canadian Scleroderma Research Group. Eligible participants will be assigned using stratified randomization to receive either MMF (up to 2 grams daily) or placebo for 96 weeks. The primary feasibility outcome will be the rate of recruitment per site over 12 months. A Bayesian approach will be used to estimate the probability of reaching the target sample size based on observed recruitment rates, with decision rules to continue, adapt, or stop the trial. Data collected on the primary clinical efficacy outcome (annual rate of decline in forced vital capacity over 96 weeks) will be used to inform the analysis of the phase III trial (as an informative prior) through a Bayesian inference framework.
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Phase 2
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Sabrina Hoa, MD MSc
- Telefonnummer: 514-890-8000
- E-Mail: sabrina.anh-tu.hoa.med@ssss.gouv.qc.ca
Studieren Sie die Kontaktsicherung
- Name: Unité d'innovation thérapeutique, CHUM
- E-Mail: uit.eligibilite.chum@ssss.gouv.qc.ca
Studienorte
-
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Quebec
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Montreal, Quebec, Kanada, H2X 3E4
- Rekrutierung
- Centre hospitalier de l'Université de Montréal (CHUM)
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Kontakt:
- Unité d'innovation thérapeutique, CHUM
- Telefonnummer: 5148908000
- E-Mail: uit.eligibilite.chum@ssss.gouv.qc.ca
-
Hauptermittler:
- Sabrina Hoa, MD MSc
-
Montreal, Quebec, Kanada, H3T 1E2
- Noch keine Rekrutierung
- Jewish General Hospital - CIUSSS-COMTL
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Kontakt:
- Marie Hudson, MD
-
Hauptermittler:
- Marie Hudson, MD
-
Québec, Quebec, Kanada
- Noch keine Rekrutierung
- Institut Universitaire de Cardiologie et Pneumologie de Québec
-
Kontakt:
- Geneviève Dion, MD
- E-Mail: genevieve.dion.med@ssss.gouv.qc.ca
-
Hauptermittler:
- Geneviève Dion, MD
-
-
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
- Able and willing to provide informed consent and adhere to study protocol;
- Women and men of all race/ethnicity, aged 18 years and older;
- SSc based on 2013 ACR-EULAR classification criteria;
- Presence of interstitial lung disease on HRCT scan, obtained within 12 months before screening, that shows fibrosis affecting less than 20% of the lungs, as confirmed by an expert radiologist;
- Diagnosis of ILD within 7 years before screening;
- Forced vital capacity of 80% predicted and above, on pulmonary function tests obtained within 6 months before screening;
- Able to communicate in French or English;
Exclusion Criteria:
-
Progressive pulmonary fibrosis, defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation, as defined by the 2022 ATS/ERS/JRS/ALAT Clinical Practice Guideline;
-
Use of medications with putative lung disease-modifying properties:
- Current use of MMF, mycophenolic acid, azathioprine, calcineurin inhibitors (e.g. tacrolimus, cyclosporin A), tocilizumab, nintedanib, pirfenidone or corticosteroids (Prednisone equivalent dose >10 mg/day) at time of screening
- Cyclophosphamide within one year prior to screening
- Rituximab within 6 months prior to screening
- Cell therapies (including stem cell transplantation) within one year prior to screening
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Current use of other biological, targeted synthetic or investigational products with immunosuppressive effects (e.g. TNF inhibitors, abatacept, tofacitinib) at time of screening
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Any contraindication to MMF, including:
- Pregnancy and/or breastfeeding
- Female of childbearing potential not using reliable method of contraception
- Persistent leucopenia (white blood cell count <3.0 x103/μL)
- Persistent thrombocytopenia (platelet count <100 x103/μL)
- Persistent anemia (hemoglobin <100 g/L)
- Baseline liver enzymes (alanine transaminase (ALT) or aspartate transaminase (AST)) or bilirubin >1.5 times the upper limit of normal, other than due to Gilbert's disease
- Uncontrolled congestive heart failure
- Active infection (lung or elsewhere)
- Active solid or hematological malignancy (other than basal cell cancer of the skin or cervical carcinoma in situ removed entirely by biopsy)
- Active peptic ulcer disease
- Other serious concomitant medical illness, unreliability or drug abuse that might compromise the patient's ability to safely take MMF
- Use of drugs or products with significant interactions with MMF
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Sonstiges
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Vervierfachen
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Experimental: Mycophenolate mofetil
2 to 4 capsules of mycophenolate mofetil twice daily. |
The participant will receive 500 mg to 1000 mg twice daily of mycophenolate mofetil administered orally for 96 weeks. The dose scheduling will be as follow: Weeks 1 and 2: 500 mg twice a day Weeks 3 and 4: 750 mg twice a day Weeks 5 to 96: 1000 mg twice a day |
|
Placebo-Komparator: Placebo
2 to 4 capsules of placebo twice daily. |
The participant will receive 500 mg to 1000 mg twice daily of placebo administered orally for 96 weeks. The dose scheduling will be as follow: Weeks 1 and 2: 500 mg twice a day Weeks 3 and 4: 750 mg twice a day Weeks 5 to 96: 1000 mg twice a day |
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Zeitfenster |
|---|---|
|
Gesamtzahl potenziell in Frage kommender Patienten, die pro Standort identifiziert wurden
Zeitfenster: Über ein Jahr
|
Über ein Jahr
|
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Anteil potenziell in Frage kommender Patienten, die pro Standort ihre Einwilligung geben
Zeitfenster: Über ein Jahr
|
Über ein Jahr
|
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Anteil der zugelassenen Teilnehmer, die die Zulassungskriterien pro Standort erfüllen
Zeitfenster: Über ein Jahr
|
Über ein Jahr
|
|
Monatliche Rate randomisierter Teilnehmer pro Standort
Zeitfenster: Über ein Jahr
|
Über ein Jahr
|
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Einhaltung der Behandlung gemäß Bewertung durch die Dosierungstagebücher der Teilnehmer
Zeitfenster: Von der ersten Dosis bis zur letzten Dosis, die für jeden Teilnehmer eingenommen wurde, bis zu 96 Wochen
|
Von der ersten Dosis bis zur letzten Dosis, die für jeden Teilnehmer eingenommen wurde, bis zu 96 Wochen
|
|
Rate der Arzneimitteladhärenz, wie anhand von Pharmacy Accountability Logs bewertet
Zeitfenster: Von der ersten Dosis bis zur letzten Dosis, die für jeden Teilnehmer eingenommen wurde, bis zu 96 Wochen
|
Von der ersten Dosis bis zur letzten Dosis, die für jeden Teilnehmer eingenommen wurde, bis zu 96 Wochen
|
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Einhaltung des Studienprotokolls gemessen an der Anzahl der Protokollabweichungen
Zeitfenster: Über den gesamten Studienzeitraum (bis zu 96 Wochen pro Teilnehmer)
|
Über den gesamten Studienzeitraum (bis zu 96 Wochen pro Teilnehmer)
|
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Anteil der Teilnehmer, die das Studienmedikament nicht vertragen und die Studienbehandlung abbrechen
Zeitfenster: Über den gesamten Studienzeitraum (bis zu 96 Wochen pro Teilnehmer)
|
Über den gesamten Studienzeitraum (bis zu 96 Wochen pro Teilnehmer)
|
|
Anteil der Teilnehmer, die die zugewiesene Behandlung nach 48 Wochen erhalten
Zeitfenster: Mit 48 Wochen
|
Mit 48 Wochen
|
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Anteil der Teilnehmer, die die zugewiesene Behandlung nach 96 Wochen erhielten
Zeitfenster: Mit 96 Wochen
|
Mit 96 Wochen
|
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Anteil der Teilnehmer mit vollständigen primären Wirksamkeitsdaten nach 48 Wochen
Zeitfenster: Mit 48 Wochen
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Mit 48 Wochen
|
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Anteil der Teilnehmer mit vollständigen Daten zum primären Wirksamkeitsergebnis nach 96 Wochen
Zeitfenster: Mit 96 Wochen
|
Mit 96 Wochen
|
|
Anteil der Teilnehmer, die durch Follow-up verloren gegangen sind
Zeitfenster: Über den gesamten Studienzeitraum (bis zu 96 Wochen pro Teilnehmer)
|
Über den gesamten Studienzeitraum (bis zu 96 Wochen pro Teilnehmer)
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Frequency of treatment-related adverse events
Zeitfenster: Over total study period (up to 96 weeks per participant)
|
Incidence and severity of AEs, with severity determined according to National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0) |
Over total study period (up to 96 weeks per participant)
|
Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Jährliche Abnahmerate in Prozent (%) der prognostizierten forcierten Vitalkapazität (FVC) über 48 Wochen
Zeitfenster: Über 48 Wochen
|
Über 48 Wochen
|
|
|
Jährliche Abnahmerate in Prozent (%) der prognostizierten forcierten Vitalkapazität (FVC) über 96 Wochen
Zeitfenster: Über 96 Wochen
|
Über 96 Wochen
|
|
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Jährliche Abnahmerate in Prozent (%) der prognostizierten Gesamtlungenkapazität über 48 Wochen
Zeitfenster: Über 48 Wochen
|
Über 48 Wochen
|
|
|
Jährliche Abnahmerate in Prozent (%) der prognostizierten Gesamtlungenkapazität über 96 Wochen
Zeitfenster: Über 96 Wochen
|
Über 96 Wochen
|
|
|
Jährliche Abnahmerate in Prozent (%) vorhergesagte Diffusionskapazität für Kohlenmonoxid (DLCO) über 48 Wochen
Zeitfenster: Über 48 Wochen
|
Über 48 Wochen
|
|
|
Jährliche Abnahmerate in Prozent (%) prognostizierter DLCO über 96 Wochen
Zeitfenster: Über 96 Wochen
|
Über 96 Wochen
|
|
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Veränderung der quantitativen SSc-Autoantikörpertiter gegenüber dem Ausgangswert nach 48 Wochen
Zeitfenster: Mit 48 Wochen
|
Mit 48 Wochen
|
|
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Veränderung der quantitativen SSc-Autoantikörpertiter gegenüber dem Ausgangswert nach 96 Wochen
Zeitfenster: Mit 96 Wochen
|
Mit 96 Wochen
|
|
|
Veränderung der Titer von Krebs von Lungen 6 (KL-6) gegenüber dem Ausgangswert nach 48 Wochen
Zeitfenster: Mit 48 Wochen
|
Mit 48 Wochen
|
|
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Veränderung der Titer von Krebs von Lungen 6 (KL-6) gegenüber dem Ausgangswert nach 96 Wochen
Zeitfenster: Mit 96 Wochen
|
Mit 96 Wochen
|
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Proportion of participants having clinically meaningful progression
Zeitfenster: Over total study period (up to 96 weeks per participant)
|
Clinically meaningful progression defined by the Outcome Measures in Rheumatology (OMERACT) for connective tissue disease-associated interstitial lung diseases (CTD-ILD) (defined as a ≥10% relative decline in FVC from baseline, or a ≥5% to <10% relative decline in FVC associated with a ≥15% relative decline in diffusion capacity [DLCO]) |
Over total study period (up to 96 weeks per participant)
|
|
Time to clinically meaningful progression
Zeitfenster: Over total study period (up to 96 weeks per participant)
|
Clinically meaningful progression as defined by Outcome Measures in Rheumatology (OMERACT) for connective tissue disease- associated interstitial lung diseases (CTD-ILD) (defined as a ≥10% relative decline in FVC from baseline, or a ≥5% to <10% relative decline in FVC associated with a ≥15% relative decline in diffusion capacity [DLCO]) |
Over total study period (up to 96 weeks per participant)
|
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Proportion of participants having an absolute decrease in FVC of at least 3.3% predicted
Zeitfenster: Over total study period (up to 96 weeks per participant)
|
An absolute decrease in FVC of at least 3.3% predicted was proposed as the minimal clinically important difference estimate for worsening of FVC in patients with SSc-ILD. |
Over total study period (up to 96 weeks per participant)
|
|
Time to an absolute decrease in FVC of at least 3.3% predicted
Zeitfenster: Over total study period (up to 96 weeks per participant)
|
An absolute decrease in FVC of at least 3.3% predicted was proposed as the minimal clinically important difference estimate for worsening of FVC in patients with SSc-ILD. |
Over total study period (up to 96 weeks per participant)
|
|
Proportion of participants having progressive pulmonary fibrosis
Zeitfenster: Over total study period (up to 96 weeks per participant)
|
Progressive pulmonary fibrosis defined by 2022 ATS/ERS/JRS/ALAT guidelines |
Over total study period (up to 96 weeks per participant)
|
|
Time to progressive pulmonary fibrosis
Zeitfenster: Over total study period (up to 96 weeks per participant)
|
Progressive pulmonary fibrosis defined by 2022 ATS/ERS/JRS/ALAT guidelines |
Over total study period (up to 96 weeks per participant)
|
|
Change from baseline in percent (%) extent of ILD, ground-glass opacities, reticular infiltrates and honeycombing, and in pulmonary vessel volume at 48 weeks
Zeitfenster: At 48 weeks
|
Measured on high-resolution computed tomography chest scan using automated lung texture analysis |
At 48 weeks
|
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Change from baseline in percent (%) extent of ILD, ground-glass opacities, reticular infiltrates and honeycombing, and in pulmonary vessel volume at 96 weeks
Zeitfenster: At 96 weeks
|
Measured on high-resolution computed tomography chest scan using automated lung texture analysis |
At 96 weeks
|
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Change from baseline in St-George Respiratory Questionnaire at 48 weeks
Zeitfenster: At 48 weeks
|
Scores range from 0 to 100, with higher scores indicating more limitations. |
At 48 weeks
|
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Change from baseline in St-George Respiratory Questionnaire at 96 weeks
Zeitfenster: At 96 weeks
|
Scores range from 0 to 100, with higher scores indicating more limitations. |
At 96 weeks
|
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Change from baseline in Leicester Cough Questionnaire at 48 weeks
Zeitfenster: At 48 weeks
|
Scores (total) range from 3 to 21, with higher scores indicating less limitations. |
At 48 weeks
|
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Change from baseline in Leicester Cough Questionnaire at 96 weeks
Zeitfenster: At 96 weeks
|
Scores (total) range from 3 to 21, with higher scores indicating less limitations. |
At 96 weeks
|
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Change from baseline in health assessment questionnaire modified for scleroderma at 48 weeks
Zeitfenster: At 48 weeks
|
The SHAQ consists of the Health assessment questionnaire (HAQ) and visual analogue scales for pain, patient global assessment, vascular, digital ulcers, lung involvement and gastrointestinal involvement. Scores range from 0 to 3, with higher scores indicating more limitations. |
At 48 weeks
|
|
Change from baseline in health assessment questionnaire modified for scleroderma at 96 weeks
Zeitfenster: At 96 weeks
|
The SHAQ consists of the Health assessment questionnaire (HAQ) and visual analogue scales for pain, patient global assessment, vascular, digital ulcers, lung involvement and gastrointestinal involvement. Scores range from 0 to 3, with higher scores indicating more limitations. |
At 96 weeks
|
|
Change from baseline in 36-items short form survey (SF-36) at 48 weeks
Zeitfenster: At 48 weeks
|
Eight scales with scores range from 0 to 100, with higher scores indicating less limitations. |
At 48 weeks
|
|
Change from baseline in 36-items short form survey (SF-36) at 96 weeks
Zeitfenster: At 96 weeks
|
Eight scales with scores ranging from 0 to 100, with higher scores indicating less limitations. |
At 96 weeks
|
|
Change from baseline in EuroQoL five dimensions (EQ-5D-5L) at 48 weeks
Zeitfenster: At 48 weeks
|
The EQ-5D-5L questionnaire possesses 5 levels for each of the five dimensions. The five dimensions are mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with the following possible five responses: no problems, slight problems, moderate problems, severe problems, unable to/extreme problems. Scores are converted into an index value ranging from 0 to 1, with higher scores indicating better health state. |
At 48 weeks
|
|
Change from baseline in EuroQoL five dimensions (EQ-5D-5L) at 96 weeks
Zeitfenster: At 96 weeks
|
The EQ-5D-5L questionnaire possesses 5 levels for each of the five dimensions. The five dimensions are mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with the following possible five responses: no problems, slight problems, moderate problems, severe problems, unable to/extreme problems. Scores are converted into an index value ranging from 0 to 1, with higher scores indicating better health state. |
At 96 weeks
|
|
Change from baseline in patient global assessment at 48 weeks
Zeitfenster: At 48 weeks
|
Visual analogue scale from 0 to 10, with higher scores indicating worse disease. |
At 48 weeks
|
|
Change from baseline in patient global assessment at 96 weeks
Zeitfenster: At 96 weeks
|
Visual analogue scale from 0 to 10, with higher scores indicating worse disease. |
At 96 weeks
|
|
Change from baseline in physician global assessment at 48 weeks
Zeitfenster: At 48 weeks
|
Visual analogue scale from 0 to 10, with higher scores indicating worse disease. |
At 48 weeks
|
|
Change from baseline in physician global assessment at 96 weeks
Zeitfenster: At 96 weeks
|
Visual analogue scale from 0 to 10, with higher scores indicating worse disease. |
At 96 weeks
|
|
Change from baseline in 6-minute walk oxygen saturation at 48 weeks
Zeitfenster: At 48 weeks
|
Oxygen saturation at nadir during the 6-minute walk test |
At 48 weeks
|
|
Change from baseline in 6-minute walk oxygen desaturation at 96 weeks
Zeitfenster: At 96 weeks
|
Oxygen saturation at nadir during the 6-minute walk test |
At 96 weeks
|
|
Change from baseline in modified Rodnan skin score (mRSS) at 48 weeks
Zeitfenster: At 48 weeks
|
Scores range from 0 to 51, with higher scores indicating more skin involvement. |
At 48 weeks
|
|
Change from baseline in modified Rodnan skin score (mRSS) at 96 weeks
Zeitfenster: At 96 weeks
|
Scores range from 0 to 51, with higher scores indicating more skin involvement. |
At 96 weeks
|
|
Change from baseline in nailfold capillary density at 48 weeks
Zeitfenster: At 48 weeks
|
Mean number of capillaries per mm |
At 48 weeks
|
|
Change from baseline in nailfold capillary density at 96 weeks
Zeitfenster: At 96 weeks
|
Mean number of capillaries per mm |
At 96 weeks
|
|
Change from baseline in nailfold capillaroscopy abnormalities and patterns at 48 weeks
Zeitfenster: At 48 weeks
|
Ectasias/megacapillaries are scored using a semi-quantitative scale (0 = no, 1 = ≤33%, 2= 33-66%, and 3 = ≥66% abnormalities/linear mm) |
At 48 weeks
|
|
Change from baseline in nailfold capillaroscopy abnormalities and patterns at 96 weeks
Zeitfenster: At 96 weeks
|
Ectasias/megacapillaries are scored using a semi-quantitative scale (0 = no, 1 = ≤33%, 2= 33-66%, and 3 = ≥66% abnormalities/linear mm) |
At 96 weeks
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Mitarbeiter
Mitarbeiter
Ermittler
Ermittler
- Hauptermittler: Sabrina Hoa, MD, Centre hospitalier de l'Université de Montréal (CHUM)
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- MP-02-2023-11180
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
Produkt, das in den USA hergestellt und aus den USA exportiert wird
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