- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT03848481
CBDV frente a placebo en niños y adultos de hasta 30 años con síndrome de Prader-Willi (PWS)
Cannabidivarina (CBDV) versus placebo en niños y adultos de hasta 30 años con síndrome de Prader-Willi (PWS)
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
Tipo de estudio
Inscripción (Actual)
Fase
- Fase 2
Contactos y Ubicaciones
Ubicaciones de estudio
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New York
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The Bronx, New York, Estados Unidos, 10467
- Montefiore Medical Center, Albert Einstein College of Medicine
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Descripción
Criterios de inclusión
- Pacientes ambulatorios masculinos o femeninos de 5 a 30 años.
- Diagnóstico de PWS confirmado por pruebas genéticas y registros e historial médico del paciente.
- Intervenciones farmacológicas, educativas, conductuales y/o dietéticas estables durante 4 semanas antes del inicio del estudio y durante la duración del estudio.
- Tener un examen físico y resultados de laboratorio que estén dentro de las normas para PWS
- Presencia de un padre/cuidador/tutor que pueda dar su consentimiento para su participación y evaluaciones completas sobre el desarrollo y el comportamiento del paciente a lo largo del estudio. Se obtendrá el asentimiento del niño si el sujeto tiene 7 años de edad o más y tiene la capacidad mental para comprender y firmar un formulario de asentimiento por escrito y/o dar asentimiento verbal.
- Puntuación en la Gravedad de la escala de impresión clínica global (CGI-S) ≥ 4 (gravedad moderada) al inicio del estudio.
- Puntuación de ≥18 en la lista de verificación de comportamiento aberrante-irritabilidad (ABC-I) al inicio del estudio.
- Aceptar no conducir ni operar maquinaria.
Criterio de exclusión
- Exposición a cualquier agente en investigación en los 30 días anteriores a la aleatorización.
- Tratamiento crónico previo con CBD o CBDV.
- Pruebas positivas de THC u otras drogas de abuso a través de análisis de orina en la visita de selección o visitas de referencia al repetir la prueba de confirmación.
- Antecedentes de trastorno por abuso de drogas, incluido el trastorno por consumo de cannabis
- Un diagnóstico psiquiátrico primario que no sea PWS, incluido el trastorno bipolar, la psicosis, la esquizofrenia, el PTSD o el MDD. Estos pacientes serán excluidos debido a posibles resultados confusos.
- Una condición médica que afecta gravemente la capacidad del sujeto para participar en el estudio, interfiere con la realización del estudio, confunde la interpretación de los resultados del estudio o pone en peligro el bienestar del sujeto (incluidos, entre otros, insuficiencia hepática o renal y enfermedad cardiovascular).
- Alergia conocida o sospechada al CBDV o a los excipientes utilizados en la formulación (es decir, sésamo).
- Indicaciones clínicas de disfunción renal, pancreática o hematológica evidenciada por valores por encima de los límites superiores de lo normal para BUN/creatinina, valores dos veces superiores al límite superior de lo normal para lipasa y amilasa séricas, plaquetas
- Anomalía en el ECG en la selección inicial o descenso postural clínicamente significativo de la presión arterial sistólica en la selección. Si el ECG de detección inicial muestra un QTcB superior a 460 ms, se realizarán 2 ECG adicionales en la misma sesión, con 5 minutos de diferencia. Si no se reconoce en la selección, entonces una repetición completa por triplicado que muestre un QTcB promedio de 460 mseg o menos para cumplir con todos los criterios de inclusión/exclusión
- Las mujeres que estén embarazadas serán excluidas del estudio. Si una mujer puede quedar embarazada, se le realizará una prueba de embarazo antes de ingresar al estudio. Se informará a las mujeres que no queden embarazadas mientras toman CBDV. Las mujeres deben informar al investigador y consultar a un obstetra o especialista materno-fetal si quedan embarazadas durante el estudio.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Cuadruplicar
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
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Experimental: Cannabidivarina (CBDV)
Dosis basada en el peso de 10 mg/kg/día de CBDV durante 12 semanas
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CBDV is obtained from the Cannabis sativa L. plant and contains a negligible quantity (less than 0.2%) of Tetrahydrocannabinol (THC).
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Comparador de placebos: Placebo emparejado
Dosis basada en el peso de 10 mg/kg/día de placebo durante 12 semanas
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La solución oral de placebo contiene excipientes correspondientes.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Irritability Based on Aberrant Behavior Checklist-Irritability (ABC-I) Subscale
Periodo de tiempo: Baseline, Week 4, Week 8, Week 12
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Irritability will be assessed using the Aberrant Behavior Checklist-Irritability Subscale (ABC-I).
The ABC-I is a well-characterized outcome that is accepted by the FDA for the purpose of labeling and is one of the best and most validated outcome measures in the developmental disabilities.
The ABC-Irritability subscale consists of 15 questions that address the presence of irritability, aggression, tantrums and/or self-injury.
Each item is rated on a scale ranging from 0 ("Not at all a problem") to 3 ("Severe problem"), resulting in a total score range of 0-45, such that higher ABC-I scores are indicative of more severe behavioral problems.
Subjects must score an 18 or higher at screening to be included in the study.
ABC-I scores for Week 4, Week 8, and Week 12 are summarized in the table by study arm using descriptive statistics.
Baseline results for this outcome can be found in the Baseline Characteristics module.
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Baseline, Week 4, Week 8, Week 12
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Repetitive Behavior Based on the Repetitive Behavior Scale-Revised (RBS-R).
Periodo de tiempo: Baseline, Week 4, Week 8, Week 12
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Repetitive behavior will be evaluated using the RBS-R.
RBS-R is a 43-item self-report questionnaire used to measure the breadth or repetitive behaviors in children, adolescents, and adults with ASD.
The RBS-R consists of 6 subscales: Stereotyped Behavior, Self-injurious Behavior, Compulsive Behavior, Ritualistic Behavior, Sameness Behavior, and Restricted Behavior that have no overlap of item content.
Each of the 43 items are rated on a 4-point Likert scale ranging from 0 ("Behavior does not occur") to 3 ("Behavior occurs and is a severe problem"), yielding an overall scoring range of 0-129, such that higher scores are associated with increased severity of the problem behavior.
RBS-R scores for Week 4, Week 8, and Week 12 are summarized in the table by study arm using descriptive statistics.
Baseline results for this outcome can be found in the Baseline Characteristics module.
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Baseline, Week 4, Week 8, Week 12
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Repetitive Behaviors Based on Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
Periodo de tiempo: Baseline, Week 4, Week 8, Week 12
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Obsessive-compulsive symptoms will be assessed using the CY-BOCS.
The CY-BOCS is 10-item clinician-rated measure designed to assess the severity of obsessive-compulsive symptoms in children/adolescents over the prior week.
It consists of 5 primary sections: Time, Distress, Interference, Resistance, and Control of Symptoms.
The 10 items are rated on a scale from 0 ("No symptoms") to 4 ("Extreme symptoms"), for an overall possible range of 0-40, with higher scores indicative of greater severity of symptoms.
CY-BOCS scores for Week 4, Week 8, and Week 12 are summarized by study arm using descriptive statistics.
Baseline results for this outcome can be found in the Baseline Characteristics module.
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Baseline, Week 4, Week 8, Week 12
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Hyperphagia
Periodo de tiempo: Baseline, Week 4, Week 8, Week 12
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Hyperphagia will be assessed using the Hyperphagia Questionnaire for Clinical Trials (HQ-CT).
The HQ-CT is a 9-item caregiver-reported measure of the frequency and intensity of food-seeking behaviors in participants with Prader-Willi Syndrome (PWS) over the prior two-week period.
The 9 items are graded on a Likert scale ranging from 0 ("No Hyperphagia") to 4 ("Most severe hyperphagia"), yielding an overall possible scoring range of 0-36, with higher scores indicating greater, more severe hyperphagia.
HQ-CT scores for Week 4, Week 8, and Week 12 are summarized by study arm using descriptive statistics.
Baseline results for this outcome can be found in the Baseline Characteristics module.
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Baseline, Week 4, Week 8, Week 12
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Global Functioning
Periodo de tiempo: Week 4, Week 8, Week 12
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Global Functioning will be assessed using the Clinical Global Impression Scale - Improvement (CGI-I).
The CGI-I is a global assessment which measures the change in a participant's illness severity, relative to a baseline, considering all symptoms, behaviors, and functional impairment.
It consists of a 7-point clinician-rated scale as follows: 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change, 5 = minimally worse, 6 = much worse, 7 = very much worse.
such that higher scores are indicative of worsening global function.
CGI-I scores for Week 4, Week 8, and Week 12 are summarized by study arm using basic descriptive statistics.
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Week 4, Week 8, Week 12
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Caregiver Strain
Periodo de tiempo: Baseline, Week 4, Week 8, Week 12
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Caregiver Strain will be evaluated using the Caregiver Strain Questionnaire (CSQ).
The CSQ is a 21-item self-report questionnaire, consisting of 3 subscales, developed to assess caregiver strain/stress for families with a child living with an emotional or behavioral disorder.
Items 1-11 assess Objective Strain.
Items 12, 16-18, and 20-21 assess Subjective Internalized Strain.
Items 13-15, and 19 assess Subjective Externalize Strain.
All CSQ items are rated from 1 ("Not at all a problem") to 5 ("Very much a problem").
Scores are calculated by averaging items within each subscale to handle missing data and calculating a Global Score by summing the 3 subscale means for a total possible scale range of 3-15.
Higher Global Scores are associated with increased Caregiver Strain.
Global results scores for Week 4, Week 8, and Week 12 are summarized by study arm using descriptive statistics.
Baseline results for this outcome can be found in the Baseline Characteristics module.
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Baseline, Week 4, Week 8, Week 12
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Rigid Behavior - Based on the Montefiore-Einstein Rigidity Scale-Revised-Prader-Willi Syndrome Scale (MERS-R-PWS)
Periodo de tiempo: Week 12
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Rigid behavior will be assessed based using the MERS-R-PWS. The MERS-R-PWS is a clinician-rated scale designed to assess 3 domains of rigid behavior in individuals with PWS: Behavioral Rigidity (e.g., Insistence on sameness, things must be done in his/her way, etc.) Cognitive Rigidity (e.g., Special interests, inflexible adherence to rules, etc.) Protest (in response to deviation from rigidity; e.g., tantrum, irritability, arguing) Each domain consists of 4 items rated on a 5-point scale ranging from 0 ("No/None/Not difficult") to 4 ("Extreme/Extremely Difficult"), yielding a range of 0-16. Scores at Week 12 will only be completed for subjects who display rigid behaviors at baseline, week 4, week 8 and week 12. A total MERS-R-PWS score (0-48) is obtained by summing subscale score. Individual subscale scores (0-16) are also summarized. Higher MERS-R-PWS scores are indicative of greater rigidity within each domain and overall rigidity. |
Week 12
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Aberrant Behavior
Periodo de tiempo: Baseline, Week 4, Week 8, Week 12
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Aberrant Behavior will be assessed using the Aberrant Behavior Checklist (ABC).
The ABC is a 58-item informative rating instrument used to measure maladaptive behaviors in individuals with developmental disabilities and ASD which resolves into 5 subscales: Irritability (15 items); Lethargy/Social withdrawal (16 items); Stereotypic behavior (7 items); Hyperactivity/noncompliance (16 items); and Inappropriate speech (4 items).
The ABC is completed by a parent/caregiver who knows the participant well.
The ABC measures behavior on a 4-point Likert severity scale: (0 = "Not all a problem," 1 = "Slight problem," 2 = "Moderately serious problem," and 3 = "Severe problem").
Scores for 4 of the 5 subscales are reported below (ABC-I results reported as part of the primary outcome).
Higher ABC subscale scores indicate greater behavioral severity/dysfunction of that subscale.
Week 4, Week 8, and Week 12 scores are summarized by study arm.
See Baseline Characteristics module for baseline data.
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Baseline, Week 4, Week 8, Week 12
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Sleep Quality
Periodo de tiempo: Baseline through Week 12
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Sleep quality will be assessed using ActiGraph GT9X-BT® activity monitors.
Successfully screened patients will receive the actigraphy device prior to the onsite baseline visit and will record a minimum of three days of baseline activity data prior to study initiation.
The ActiGraph GT9X-BT activity monitors are a well validated activity and sleep monitoring device widely utilized in clinical trials and health research.
For this study the ActiGraph monitors will measure: Sleep Latency (the time it takes to fall asleep), Total Sleep Time (the total amount of time spent asleep), and sleep efficiency (percentage of time in bed actually spent sleeping).
Sleep data is captured automatically via cloud service.
All parameters will be reported in hours/minutes and summarized by study arm.
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Baseline through Week 12
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Eric Hollander, MD, Montefiore Medical Center/Albert Einstein College of Medicine
Publicaciones y enlaces útiles
Publicaciones Generales
- Kalsner L, Chamberlain SJ. Prader-Willi, Angelman, and 15q11-q13 Duplication Syndromes. Pediatr Clin North Am. 2015;62(3):587-606.
- Angulo MA, Butler MG, Cataletto ME. Prader-Willi syndrome: a review of clinical, genetic, and endocrine findings. J Endocrinol Invest. 2015;38(12):1249-1263.
- Miller J, Wagner M. Prader-Willi syndrome and sleep-disordered breathing. Pediatr Ann. 2013;42(10):200-204.
- Butler MG, Hossain W, Sulsona C, Driscoll DJ, Manzardo AM. Increased plasma chemokine levels in children with Prader-Willi syndrome. Am J Med Genet A. 2015;167A(3):563-571.
- Viardot A, Sze L, Purtell L, et al. Prader-Willi syndrome is associated with activation of the innate immune system independently of central adiposity and insulin resistance. J Clin Endocrinol Metab. 2010;95(7):3392-3399.
- Irizarry KA, Miller M, Freemark M, Haqq AM. Prader Willi Syndrome: Genetics, Metabolomics, Hormonal Function, and New Approaches to Therapy. Adv Pediatr. 2016;63(1):47-77.
- Rout U, Abdul-Rahman OA, Dhossche DM. An immunological basis of hyperphagia driven by GABAergic dysfunction in Prader-Willi Syndrome. Med Hypotheses. 2012;78(4):462-464.
- Knuesel I, Chicha L, Britschgi M, et al. Maternal immune activation and abnormal brain development across CNS disorders. Nat Rev Neurol. 2014;10(11):643-660.
- Blackmon K. Structural MRI biomarkers of shared pathogenesis in autism spectrum disorder and epilepsy. Epilepsy Behav. 2015;47:172-182.
- Washington J, 3rd, Kumar U, Medel-Matus JS, Shin D, Sankar R, Mazarati A. Cytokinedependent bidirectional connection between impaired social behavior and susceptibility to seizures associated with maternal immune activation in mice. Epilepsy Behav. 2015;50:40- 45.
- Basavarajappa BS, Nixon RA, Arancio O. Endocannabinoid system: emerging role from neurodevelopment to neurodegeneration. Mini Rev Med Chem. 2009;9(4):448-462.
- Kerr DM, Downey L, Conboy M, Finn DP, Roche M. Alterations in the endocannabinoid system in the rat valproic acid model of autism. Behav Brain Res. 2013;249:124-132.
- Klein TW, Cabral GA. Cannabinoid-induced immune suppression and modulation of antigen-presenting cells. J Neuroimmune Pharmacol. 2006;1(1):50-64.
- Devinsky O, Cilio MR, Cross H, et al. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 2014;55(6):791-802.
- Siniscalco D, Bradstreet JJ, Cirillo A, Antonucci N. The in vitro GcMAF effects on endocannabinoid system transcriptionomics, receptor formation, and cell activity of autism-derived macrophages. J Neuroinflammation. 2014;11:78.
- Jean-Gilles L, Gran B, Constantinescu CS. Interaction between cytokines, cannabinoids and the nervous system. Immunobiology. 2010;215(8):606-610.
- Anavi-Goffer S, Baillie G, Irving AJ, et al. Modulation of L-alpha-lysophosphatidylinositol/GPR55 mitogen-activated protein kinase (MAPK) signaling by cannabinoids. J Biol Chem. 2012;287(1):91-104.
- Rock EM, Sticht MA, Duncan M, Stott C, Parker LA. Evaluation of the potential of the phytocannabinoids, cannabidivarin (CBDV) and Delta(9) -tetrahydrocannabivarin (THCV), to produce CB1 receptor inverse agonism symptoms of nausea in rats. Br J Pharmacol. 2013;170(3):671-678.
- Pagano E, Romano B, Iannotti FA, et al. The non-euphoric phytocannabinoid cannabidivarin counteracts intestinal inflammation in mice and cytokine expression in biopsies from UC pediatric patients. Pharmacol Res. 2019;149:104464.
- De Petrocellis L, Ligresti A, Moriello AS, et al. Effects of cannabinoids and cannabinoidenriched Cannabis extracts on TRP channels and endocannabinoid metabolic enzymes. Br J Pharmacol. 2011;163(7):1479-1494.
- Deiana S, Watanabe A, Yamasaki Y, et al. Plasma and brain pharmacokinetic profile of cannabidiol (CBD), cannabidivarine (CBDV), Delta(9)-tetrahydrocannabivarin (THCV) and cannabigerol (CBG) in rats and mice following oral and intraperitoneal administration and CBD action on obsessive-compulsive behaviour. Psychopharmacology (Berl). 2012;219(3):859-873.
- Olah A, Markovics A, Szabo-Papp J, et al. Differential effectiveness of selected nonpsychotropic phytocannabinoids on human sebocyte functions implicates their introduction in dry/seborrhoeic skin and acne treatment. Exp Dermatol. 2016;25(9):701-707.
- Coiro P, Padmashri R, Suresh A, et al. Impaired synaptic development in a maternal immune activation mouse model of neurodevelopmental disorders. Brain Behav Immun. 2015;50:249-258.
- Uzunova G, Pallanti S, Hollander E. Excitatory/inhibitory imbalance in autism spectrum disorders: Implications for interventions and therapeutics. World J Biol Psychiatry. 2016;17(3):174-186.
- Hill AJ, Mercier MS, Hill TD, et al. Cannabidivarin is anticonvulsant in mouse and rat. Br J Pharmacol. 2012;167(8):1629-1642.
- Hill TD, Cascio MG, Romano B, et al. Cannabidivarin-rich cannabis extracts are anticonvulsant in mouse and rat via a CB1 receptor-independent mechanism. Br J Pharmacol. 2013;170(3):679-692.
- Burstein S. Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorg Med Chem. 2015;23(7):1377-1385.
- Murillo-Rodriguez E, Sarro-Ramirez A, Sanchez D, et al. Potential effects of cannabidiol as a wake-promoting agent. Curr Neuropharmacol. 2014;12(3):269-272.
- Scopinho AA, Guimaraes FS, Correa FM, Resstel LB. Cannabidiol inhibits the hyperphagia induced by cannabinoid-1 or serotonin-1A receptor agonists. Pharmacol Biochem Behav. 2011;98(2):268-272.
- Kuo HY, Liu FC. Molecular Pathology and Pharmacological Treatment of Autism Spectrum Disorder-Like Phenotypes Using Rodent Models. Front Cell Neurosci. 2018;12:422.
- McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems. N Engl J Med. 2002;347(5):314-321.
- Marcus RN, Owen R, Kamen L, et al. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry. 2009;48(11):1110-1119.
- Lam KS, Aman MG. The Repetitive Behavior Scale-Revised: independent validation in individuals with autism spectrum disorders. J Autism Dev Disord. 2007;37(5):855-866.
- Schertz HH, Odom SL, Baggett KM, Sideris JH. Parent-Reported Repetitive Behavior in Toddlers on the Autism Spectrum. J Autism Dev Disord. 2016;46(10):3308-3316.
- Ventola PE, Yang D, Abdullahi SM, Paisley CA, Braconnier ML, Sukhodolsky DG. Brief Report: Reduced Restricted and Repetitive Behaviors after Pivotal Response Treatment. J Autism Dev Disord. 2016;46(8):2813-2820.
- Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006-1011.
- McCandless SE, Yanovski JA, Miller J, et al. Effects of MetAP2 inhibition on hyperphagia and body weight in Prader-Willi syndrome: A randomized, double-blind, placebocontrolled trial. Diabetes Obes Metab. 2017;19(12):1751-1761.
- Arora T, Broglia E, Pushpakumar D, Lodhi T, Taheri S. An investigation into the strength of the association and agreement levels between subjective and objective sleep duration in adolescents. PLoS One. 2013;8(8):e72406.
- Baum KT, Shear PK, Howe SR, Bishop SL. A comparison of WISC-IV and SB-5 intelligence scores in adolescents with autism spectrum disorder. Autism. 2015;19(6):736745.
- Roid GB, R. . Essentials of Stanford-Binet Intelligence Scales (SB5) Assessment. Hoboken, New Jersey: John Wiley & Sons, Inc; 2004.
- Luther K, Fung GM, Khorassani F. Cost Comparison of Atypical Antipsychotics: Paliperidone ER and Risperidone. Hosp Pharm. 2019;54(6):389-392.
- Al Saabi A, Allorge D, Sauvage FL, et al. Involvement of UDP-glucuronosyltransferases UGT1A9 and UGT2B7 in ethanol glucuronidation, and interactions with common drugs of abuse. Drug Metab Dispos. 2013;41(3):568-574.
Enlaces Útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Trastornos de impronta
- Manifestaciones neurológicas
- Enfermedades del Sistema Nervioso
- Trastornos Nutricionales
- Enfermedades Genéticas Congénitas
- Sobrenutrición
- Manifestaciones neuroconductuales
- Anomalías congénitas
- Anomalías Múltiples
- Exceso de peso
- Discapacidad intelectual
- Obesidad
- Trastornos cromosómicos
- Enfermedades y anomalías congénitas, hereditarias y neonatales
- Enfermedades Nutricionales y Metabólicas
- Síndrome de Prader-Willi
- cannabidivarina
Otros números de identificación del estudio
- 2019-9914
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Descripción del plan IPD
Marco de tiempo para compartir IPD
Criterios de acceso compartido de IPD
Tipo de información de apoyo para compartir IPD
- PROTOCOLO DE ESTUDIO
- SAVIA
- CIF
- RSC
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .