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Safety and Efficacy of MK-8457 and Methotrexate (MTX) in Participants With Active Rheumatoid Arthritis Despite MTX Therapy (P08683, MK-8457-008)

2019年3月18日 更新者：Merck Sharp & Dohme LLC

A Phase II, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Multicenter, Worldwide, Dose-Ranging Clinical Trial With a Proof-of-Concept Lead Cohort to Evaluate the Safety, Tolerability, and Efficacy of MK-8457 + MTX in Patients With Active Rheumatoid Arthritis Despite Methotrexate Therapy

The purpose of this study is to assess the safety and efficacy of MK-8457 + Methotrexate (MTX) in participants with active rheumatoid arthritis (RA) despite MTX therapy. The primary hypothesis is that at least 1 dose of MK-8457 + MTX will be superior to placebo + MTX as measured by the percentage of participants who achieve American College of Rheumatology 20 (ACR 20) response after 12 weeks of treatment.

調査の概要

状態

終了しました

条件

介入・治療

詳細な説明

In Base Study Phase IIa, participants were to receive blinded MK-8457 100 mg or matched placebo for up to 24 weeks. At Week 12 and 18 of Phase IIa, efficacy evaluation was conducted to assess eligibility for early escape, defined as <20% reduction in both tender and swollen joint counts. The study plan included Base Study Phase IIb in which dose range finding or dose-response was to be evaluated, depending on the outcome of Phase IIa. Participants who completed Phase IIa or Phase IIb and those eligible for early escape could enroll in Period 3, a 2-year Safety Extension.

All participants must have been treated with MTX for at least 3 months prior to screening and have been receiving a stable dose of MTX for at least 4 weeks prior to screening.

研究の種類

介入

入学 (実際)

82

段階

  • フェーズ2

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

18年歳以上 (大人、高齢者)

健康ボランティアの受け入れ

いいえ

受講資格のある性別

全て

説明

Inclusion Criteria:

  • Diagnosis of rheumatoid arthritis for at least 6 months prior to screening
  • Active rheumatoid arthritis as defined by the presence of >= 6 swollen joints (of 66 count) and >= 6 tender joints (of 68 joint count)
  • C-reactive protein blood level >0.9 mg/dL
  • Anti-citrullinated protein antibody positive and/or rheumatoid factor positive at screening
  • American College of Rheumatology Functional Class I, II, or III
  • Received methotrexate for a minimum of 3 months prior to screening with a regionally appropriate stable weekly dose for at least 4 weeks prior to screening
  • If using oral corticosteroids, the participant must be on a stable dose of 10 mg prednisone
  • No history of either untreated, latent, or active tuberculosis prior to baseline
  • Participants of reproductive potential must agree to remain abstinent or use 2 acceptable methods of birth control

Exclusion Criteria:

  • Presence of inflammatory disease other than rheumatoid arthritis, including but not limited to psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus, or Lyme disease
  • Positive hepatitis B surface antigen or hepatitis C test result or the presence of Human immunodeficiency virus (HIV) infection
  • HIV positive
  • User of recreational or illicit drugs or has had a history (within the previous 2 years) of drug or alcohol abuse or dependence
  • Females of childbearing potential who are pregnant, intend to become pregnant, or are lactating;
  • Severe opportunistic infection within 6 months prior to study start.

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：ダブル

武器と介入

参加者グループ / アーム
介入・治療
実験的：Base Study Phase IIa: MK-8457
Participants received MK-8457 100 mg dosed twice daily (BID) orally with MTX at the stable dose received upon study enrollment. Phase IIa lasted up to 24 weeks.
薬：MK-8457 100mg
MK-8457 100 mg 経口 BID 投与
薬：Methotrexate
MTX dosed at the stable dose receive upon study entry
他の名前：
  • MTX
プラセボコンパレーター：Base Study Phase IIa: Placebo
Participants received placebo dosed BID orally with MTX at the stable dose received upon study enrollment. Phase IIa lasted up to 24 weeks.
薬：Methotrexate
MTX dosed at the stable dose receive upon study entry
他の名前：
  • MTX
薬：Dose-Matched Placebo
Dose-matched placebo dosed orally BID
実験的：Safety Extension Period 3: MK-8457
Participants received MK-8457 100 mg BID orally with MTX at the stable dose received upon study enrollment. Period 3 was to last up to 2 years.
薬：MK-8457 100mg
MK-8457 100 mg 経口 BID 投与
薬：Methotrexate
MTX dosed at the stable dose receive upon study entry
他の名前：
  • MTX

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
12週目に米国リウマチ学会（ACR）20の反応を達成した参加者の割合
時間枠：第12週
ACR 反応は、複数の疾患評価基準における改善を数値的に測定したものです。 ACR20 反応は、1) 腫れた関節数 (66 関節) および圧痛のある関節数 (68 関節) で 20% 以上の改善 (0 = なし、1 = あり)、および 2) 以下のうち 3 つで 20% 以上の改善と定義されます。 5 つの評価: a) 参加者の視覚的アナログスケールによる痛みの全体的な評価 (VAS、痛みなし =0 ～極度の痛み =100)。 b) 患者の疾患活動性の総合評価 VAS (非常に良好 =0 ～ 非常に不良 =100)。 c) 治験責任医師による疾患活動性の総合評価 VAS (非常に良好 =0 から非常に不良 =100 ; d) 健康評価アンケート (HAQ) によって測定された 8 つの機能領域にわたる参加者の機能評価、合計スコアは困難なし =0 から範囲タスクを実行できなくなるまで =24; e) 血清 C 反応性タンパク質 (減少は改善を示します)。 この結果の尺度は、基礎研究の参加者のみに適用されます。
第12週

二次結果の測定

結果測定
メジャーの説明
時間枠
Change From Baseline in Disease Activity Score (DAS28) as Measured by Erythrocyte Sedimentation Rate (ESR) at Week 12
時間枠：Baseline and Week 12
The DAS28-ESR is a continuous parameter based upon a statistically-derived index combining tender joints (28 joints, TEN28), swollen joints (28 joints, SW28), ESR (an inflammatory marker), and Patient's Global Assessment of Disease Activity VAS (GH). It is defined as follows: DAS28-ESR = 0.56 × SQRT(TEN28) + 0.28 × SQRT(SW28) + 0.70 × ln (ESR) + 0.014 × GH. SQRT = square root. The DAS28-ESR is a scale ranging from 0 to 10 with higher values indicating greater rheumatoid arthritis (RA) disease activity. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in DAS28 as Measured by C-Reactive Protein (CRP) at Week 12
時間枠：Baseline and Week 12
The DAS28-CRP is a continuous parameter based upon a statistically-derived index combining tender joints (28 joints, TEN28), swollen joints (28 joints, SW28), CRP (an inflammatory marker), and Patient's Global Assessment of Disease Activity VAS (GH). It is defined as follows: DAS28-CRP = 0.56 × SQRT(TEN28) + 0.28 × SQRT(SW28) + 0.36 × ln (CRP+1) + 0.014 × GH + 0.96. The DAS28-CRP is a scale ranging from 0 to 10 with higher values indicating greater RA disease activity. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Percentage of Participants Achieving an ACR70 Response at Week 12
時間枠：Week 12
ACR responses are numerical measurements of improvement in multiple disease assessment criteria. An ACR70 response is defined as a ≥70% improvement in 1) swollen joint count (66 joints) and tender joint count (68 joints) (0 = Absent; 1 = Present) and 2) ≥70% improvement in 3 of the following 5 assessments: a) a participant's overall assessment of pain on a visual analog scale (VAS, no pain =0 to extreme pain =100); b) Patient's Global Assessment of Disease Activity VAS (doing very well =0 to doing very poor =100); c) Investigator's Global Assessment of Disease Activity VAS (doing very well =0 to doing very poor =100 ; d) participant's assessment of function across 8 functional areas as measured by Health Assessment Questionnaire (HAQ), total scores ranging from no difficulty =0 to inability to perform tasks =24; and e) serum C-Reactive Protein (decrease indicates improvement). This outcome measure applied to Base Study participants only.
Week 12
Percentage of Participants Achieving Hybrid ACR Response at Week 12
時間枠：Week 12
Hybrid ACR Response evaluates the improvement in active RA by combining elements of the ACR20/50/70 with a categorical score of the mean change in the core set measures (tender joint count, swollen joint count, Patient's Global Assessment of Disease Activity, Investigator's Global Assessment of Disease Activity, disability index of the HAQ, and CRP). The mean percentage improvement from Baseline in the core set measures was computed and used with the participant's ACR20, ACR50, and ACR70 status to determine the hybrid ACR response in a lookup table. The range of values was -100 to 100, with a positive change indicating improvement. This outcome measure applied to Base Study participants only.
Week 12
Percentage of Participants Achieving an ACR-N Response at Week 12
時間枠：Week 12
The ACR-N response is the minimum of the following: 1) the percent decrease from Baseline in tender joint counts (68 joints, 0 = absent, 1 = present); 2) the percent decrease from Baseline in swollen joint counts (66 joints, 0 = absent, 1 = present); and 3) the median percent decrease from Baseline for the following: a) Patient's Global Assessment of Pain (VAS, 0 mm = "no pain" and 100 mm = "extreme pain"); b) Patient's Global Assessment of Disease Activity (VAS, 0 mm = doing very well to 100 mm = doing very poor); c) Investigator's Global Assessment of Disease Activity (VAS, 0 mm = doing very well to 100 mm = doing very poor); d. physical function as measured by the HAQ (Likert scale, 0 to 3 with a lower score indicating less disability); and e) CRP. This outcome measure applied to Base Study participants only.
Week 12
Percentage of Participants Achieving a DAS28-ESR Response at Week 12
時間枠：Week 12
The DAS28-ESR is a continuous parameter based upon a statistically-derived index combining tender joints (28 joints, TEN28), swollen joints (28 joints, SW28), ESR, and Patient's Global Assessment of Disease Activity VAS (GH). It is defined as follows: DAS28-ESR = 0.56 × SQRT(TEN28) + 0.28 × SQRT(SW28) + 0.70 × ln (ESR) + 0.014 × GH. SQRT = square root. The DAS28-ESR is a scale ranging from 0 to 10 with higher values indicating greater RA disease activity. Depending upon the DAS28-ESR value for a given visit, change in DAS28-ESR is categorized as follows: No Response (reduction from Baseline ≤0.6), No response or Moderate Response (reduction >0.6 - 1.2), and Moderate or Good Response (reduction >1.2). The percentage of participants with a Moderate or Good change in DAS28-ESR was reported. This outcome measure applied to Base Study participants only.
Week 12
Percentage of Participants Achieving a DAS28-CRP Response at Week 12
時間枠：Week 12
The DAS28-CRP is a continuous parameter based upon a statistically-derived index combining tender joints (28 joints, TEN28), swollen joints (28 joints, SW28), CRP, and Patient's Global Assessment of Disease Activity VAS (GH). It is defined as follows: DAS28-CRP = 0.56 × SQRT(TEN28) + 0.28 × SQRT(SW28) + 0.36 × ln (CRP+1) + 0.014 × GH + 0.96. The DAS28-CRP is a scale ranging from 0 to 10 with higher values indicating greater RA disease activity. Depending upon the DAS28-CRP value for a given visit, change in DAS28-CRP is categorized as follows: No Response (reduction from Baseline ≤0.6), No response or Moderate Response (reduction >0.6 - 1.2), and Moderate or Good Response (reduction >1.2). The percentage of participants with a Moderate or Good change in DAS28-CRP was reported. This outcome measure applied to Base Study participants only.
Week 12
Percentage of Participants Achieving DAS28-ESR Remission at Week 12
時間枠：Week 12
The DAS28-ESR is a continuous parameter based upon a statistically-derived index combining tender joints (28 joints, TEN28), swollen joints (28 joints, SW28), ESR, and Patient's Global Assessment of Disease Activity VAS (GH). It is defined as follows: DAS28-ESR = 0.56 × SQRT(TEN28) + 0.28 × SQRT(SW28) + 0.70 × ln (ESR) + 0.014 × GH. SQRT = square root. The DAS28-ESR is a scale ranging from 0 to 10 with higher values indicating greater RA disease activity. DAS28-ESR remission is defined as a value <2.6 at the visit. This outcome measure applied to Base Study participants only.
Week 12
Percentage of Participants Achieving DAS28-CRP Remission at Week 12
時間枠：Week 12
The DAS28-CRP is a continuous parameter derived from the formula: 0.56 × the square root of the tender joint count (0-28) + 0.28 × the square root of the swelling joint count (0-28) + 0.36 × the C reactive protein value (in mg/L +1) + 0.014 × Patient's Global Assessment of Disease Activity VAS of 0-100 mm + 0.96. The DAS28-CRP is a scale ranging from 0 to 10 with higher values indicating greater RA disease activity. DAS28-CRP remission is defined as a value <2.6 at the visit. This outcome measure applied to Base Study participants only.
Week 12
DAS28-ESR Area Under the Curve (AUC)
時間枠：Up to 12 weeks
DAS28-ESR AUC was to be calculated from the DAS28-ESR score versus time curve, which provided an assessment of changes in disease activity over time. The DAS28-ESR AUC was to be calculated using the trapezoidal rule as the DAS28-ESR multiplied by the duration of the assessment period (in weeks) and was to be expressed as %-weeks. A higher calculated AUC value indicates higher disease activity (worse). This outcome measure applied to Base Study participants only.
Up to 12 weeks
DAS28-CRP Area Under the Curve (AUC)
時間枠：Up to 12 weeks
DAS28-CRP AUC was to be calculated from the DAS28-CRP score versus time curve, which provided an assessment of changes in disease activity over time. The DAS28-CRP AUC was to be calculated using the trapezoidal rule as the DAS28-CRP multiplied by the duration of the assessment period (in weeks) and was to be expressed as %-weeks. A higher calculated AUC value indicates higher disease activity (worse). This outcome measure applied to Base Study participants only.
Up to 12 weeks
Change From Baseline in Tender Joint Count at Week 12
時間枠：Baseline and Week 12
Tender Joint Count was examined on 68 joints of the fingers, elbows, hips, knees, ankles, and toes distal for pain in response to pressure or passive motion at the study time points. Joint pain was scored as 0 = Absent; 1 = Present for each joint. The overall Tender Joint Count ranged from 0 to 68. A higher score indicated greater disease severity. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in Swollen Joint Count at Week 12
時間枠：Baseline and Week 12
Swollen joint count included 66 joints (same joints as for tender joint count except this excluded evaluation of hips) that were assessed for the presence of swelling. Soft tissue swelling was considered to be present if there was palpable or visible evidence of capsular distention considered to be due to either synovial thickening and/or a joint effusion. Bony swelling, nodule formation, and joint deformity were excluded from consideration. A swollen joint was scored as 0 = Absent; 1 = Present for each joint. The overall swollen joint count ranged from 0 to 66. A higher score indicated greater disease severity. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in the Simplified Disease Activity Index (SDAI) at Week 12
時間枠：Baseline and Week 12
SDAI is the simple linear sum of the following parameters: tender joint count (TJC) and swollen joint count (SJC) based on a 28-joint assessment, Patient's Global Assessment of Disease Activity [PGA, VAS 0 to 10 cm], Investigator's Global Assessment of Disease Activity (MDGA, VAS 0 to 10 cm) and CRP levels (mg/dL). SDAI =TJC + SJC + PGA + MDGA + CRP. Overall scores can range from 0.0 to 86.0. A higher score indicated greater disease severity. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in the Short Form Health Survey (SF-36) at Week 12
時間枠：Baseline and Week 12
The SF-36 is a health-related quality of life instrument that consists of 8 multi-item scales: limitations in physical functioning due to health problems, limitations in usual role activities due to physical health problems, bodily pain, general mental health (psychological distress and well-being), limitations in usual role activities due to personal or emotional problems, limitations in social functioning due to physical or mental health problems, vitality (energy and fatigue), and general health perception. Each scale is directly transformed into a 0 to 100 scale on the assumption that each question carries equal weight. The lower the score the greater the disability i.e., a score of 0 corresponds to maximum disability and a score of 100 corresponds to no disability. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) at Week 12
時間枠：Baseline and Week 12
The FACIT-F is a questionnaire that assesses self-reported tiredness, weakness, and difficulty conducting usual activities due to fatigue. FACIT-F is a 13-item questionnaire. Participants scored each item on a 5-point scale: 0 (Not at all) to 4 (Very much). The sum of all responses resulted in the FACIT-Fatigue score for a total possible score of 0 (worse score) to 52 (better score). The higher the participant's response to the questions the greater the participant's fatigue. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in the Patient's Global Assessment of Disease Status/Activity (PGADSA) at Week 12
時間枠：Baseline and Week 12
A participant's overall assessment of pain was assessed from the amount of pain due to arthritis experienced during the past 48 hours on a VAS, where 0 mm = doing very well to 100 mm = doing very poor. A negative change from Baseline indicates improvement. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in the Investigator's Global Assessment of Disease Status/Activity (IGADSA) at Week 12
時間枠：Baseline and Week 12
The Investigator's Global Assessment of Disease Status/Activity (IGADSA) is measured with scores ranging from 0 to 100 mm (VAS, 0 mm = doing very well to 100 mm = doing very poor). A negative change from Baseline indicates improvement. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in the Patient's Global Assessment of Pain (PGAP) at Week 12
時間枠：Baseline and Week 12
A participant's overall assessment of pain was assessed from the amount of pain due to arthritis experienced during the past 48 hours on a VAS where 0 mm = "no pain" and 100 mm = "extreme pain". A negative change from Baseline indicates improvement. This outcome measure applied to Base Study participants only.
Baseline and Week 12
12週目の健康評価アンケート障害（HAQ障害指数）のベースラインからの変化
時間枠：ベースラインと 12 週目
参加者の機能状態は、リッカートスケールで HAQ の障害指数を使用して評価されました。 この 20 の質問ツールは、人が 8 つの機能領域 (着替え、起床、食事、歩行、衛生、手を伸ばす、握る、日常生活動作) におけるタスクを達成する際の難易度を評価します。 各機能領域の応答は、困難がないことを示す 0 から、その領域でタスクを実行できないことを示す 3 までスコア付けされます。 障害指数の全体的なスコアは、8 つの機能領域スコアの平均であり、0 ～ 3 の範囲であり、スコアが低いほど障害が少ないことを示します。 ベースラインからのマイナスの変化は改善を示します。 この結果の尺度は、基礎研究の参加者のみに適用されます。
ベースラインと 12 週目
Change From Baseline in Serum C-Reactive Protein (CRP) at Week 12
時間枠：Baseline and Week 12
C-Reactive Protein is an inflammatory marker with a normal reference range of less than 0.9 mg/dL. Change from Baseline in CRP at Week 12 (Week 12 concentration minus Baseline concentration). This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in Erythrocyte Sedimentation Rate (ESR) at Week 12
時間枠：Baseline and Week 12
The ESR is the rate at which red blood cells sediment in a period of one hour, and is a non-specific measure of inflammation. Change from Baseline is ESR at Week 12 minus ESR at Baseline. This outcome measure applied to Base Study participants only.
Baseline and Week 12
Change From Baseline in Hemoglobin at Week 12
時間枠：Baseline and Week 12
Hemoglobin is the iron-containing oxygen-transport metalloprotein in red blood cells. Change from Baseline is hemoglobin at Week 12 minus hemoglobin at Baseline. This outcome measure applied to Base Study participants only.
Baseline and Week 12
12週目にACR50反応を達成した参加者の割合
時間枠：第12週
ACR 反応は、複数の疾患評価基準における改善を数値的に測定したものです。 ACR50 反応は、1) 腫れた関節数 (66 関節) および圧痛のある関節数 (68 関節) で 50% 以上の改善 (0 = なし、1 = あり)、および 2) 以下のうち 3 つで 50% 以上の改善と定義されます。 5 つの評価: a) 視覚的アナログスケールでの参加者の痛みの全体的な評価 (VAS、痛みなし =0 ～極度の痛み =100)。 b) 患者の疾患活動性の総合評価 VAS (非常に良好 =0 ～ 非常に不良 =100)。 c) 治験責任医師による疾患活動性の総合評価 VAS (非常に良好 =0 から非常に不良 =100 ; d) 健康評価アンケート (HAQ) によって測定された 8 つの機能領域にわたる参加者の機能評価、合計スコアは困難なし =0 から範囲タスクを実行できなくなるまで =24; e) 血清 C 反応性タンパク質 (減少は改善を示します)。 この結果の尺度は、基礎研究の参加者のみに適用されます。
第12週
Percentage of Participants With an ACR20 Response Over Time
時間枠：Week 1, Week 2, Week 4, Week 6, Week 18 and Week 24
ACR responses are numerical measurements of improvement in multiple disease assessment criteria. An ACR20 response is defined as a ≥20% improvement in 1) swollen joint count (66 joints) and tender joint count (68 joints) (0 = Absent; 1 = Present) and 2) ≥20% improvement in 3 of the following 5 assessments: a) a participant's overall assessment of pain on a visual analog scale (VAS, no pain =0 to extreme pain =100); b) Patient's Global Assessment of Disease Activity VAS (doing very well =0 to doing very poor =100); c) Investigator's Global Assessment of Disease Activity VAS (doing very well =0 to doing very poor =100 ; d) participant's assessment of function across 8 functional areas as measured by Health Assessment Questionnaire (HAQ), total scores ranging from no difficulty =0 to inability to perform tasks =24; and e) serum C-Reactive Protein (decrease indicates improvement). This outcome measure applied to Base Study participants only.
Week 1, Week 2, Week 4, Week 6, Week 18 and Week 24

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Merck Sharp & Dohme LLC

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2012年5月22日

一次修了 (実際)

2013年10月3日

研究の完了 (実際)

2013年10月3日

試験登録日

最初に提出

2012年3月30日

QC基準を満たした最初の提出物

2012年3月30日

最初の投稿 (見積もり)

2012年4月2日

学習記録の更新

投稿された最後の更新 (実際)

2019年3月27日

QC基準を満たした最後の更新が送信されました

2019年3月18日

最終確認日

2019年3月1日

詳しくは

本研究に関する用語

追加の関連 MeSH 用語

その他の研究ID番号

  • P08683 (その他の識別子：Merck)
  • MK-8457-008 (その他の識別子：Merck)
  • 2012-000439-17 (EudraCT番号)
  • 132235 (レジストリ識別子：JAPIC-CTI)

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

はい

IPD プランの説明

http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf

この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。

関節リウマチ（RA）の臨床試験

MK-8457 100mgの臨床試験

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