- ICH GCP
- Registro de ensaios clínicos dos EUA
- Ensaio Clínico NCT03848481
CBDV vs Placebo em crianças e adultos até 30 anos com síndrome de Prader-Willi (PWS)
Canabidivarina (CBDV) vs. Placebo em Crianças e Adultos até 30 anos com Síndrome de Prader-Willi (PWS)
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
Tipo de estudo
Inscrição (Real)
Estágio
- Fase 2
Contactos e Locais
Locais de estudo
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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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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Descrição
Critério de inclusão
- Pacientes ambulatoriais masculinos ou femininos de 5 a 30 anos.
- Diagnóstico de PWS confirmado por testes genéticos e registros médicos e histórico do paciente.
- Intervenções farmacológicas, educacionais, comportamentais e/ou dietéticas estáveis por 4 semanas antes do início do estudo e durante o estudo.
- Ter um exame físico e resultados de laboratório dentro das normas para SPW
- Presença de um pai/cuidador/responsável que seja capaz de consentir em sua participação e avaliações completas sobre o desenvolvimento e comportamento do paciente ao longo do estudo. O consentimento da criança será obtido se o sujeito tiver 7 anos de idade ou mais e tiver capacidade mental para entender e assinar um formulário de consentimento por escrito e/ou dar consentimento verbal.
- Pontuação na Gravidade da Escala de Impressão Clínica Global (CGI-S) ≥ 4 (gravidade moderada) no início do estudo.
- Pontuação de ≥18 na lista de verificação de comportamento aberrante-irritabilidade (ABC-I) na linha de base.
- Concorde em não dirigir ou operar máquinas.
Critério de exclusão
- Exposição a qualquer agente experimental nos 30 dias anteriores à randomização.
- Tratamento crônico prévio com CBD ou CBDV.
- Teste positivo para THC ou outras drogas de abuso por meio de teste de urina na visita de triagem ou visitas iniciais após a repetição do teste de confirmação.
- História de Transtorno por Abuso de Drogas, incluindo Transtorno por Uso de Cannabis
- Um diagnóstico psiquiátrico primário diferente de SPW, incluindo transtorno bipolar, psicose, esquizofrenia, PTSD ou MDD. Esses pacientes serão excluídos devido a potenciais resultados de confusão.
- Uma condição médica que afeta gravemente a capacidade do sujeito de participar do estudo, interfere na condução do estudo, confunde a interpretação dos resultados do estudo ou põe em risco o bem-estar do sujeito (incluindo, entre outros, insuficiência hepática ou renal e doença cardiovascular).
- Alergia conhecida ou suspeita ao CBDV ou excipientes usados na formulação (ou seja, sésamo).
- Indicações clínicas de disfunção renal, pancreática ou hematológica, conforme evidenciado por valores acima dos limites superiores do normal para uréia/creatinina, valores duas vezes acima do limite superior do normal para lipase sérica e amilase, plaquetas
- Anormalidade do ECG na triagem inicial ou queda postural clinicamente significativa na pressão arterial sistólica na triagem. Se o ECG de triagem inicial mostrar um QTcB superior a 460 ms, serão realizados 2 ECGs adicionais na mesma sessão, com 5 minutos de intervalo. Se não for reconhecido na triagem, uma repetição triplicada completa mostrando um QTcB médio de 460 ms ou menos para atender a todos os critérios de inclusão/exclusão
- Indivíduos do sexo feminino que estejam grávidas serão excluídos do estudo. Se uma mulher for capaz de engravidar, ela fará um teste de gravidez antes de entrar no estudo. As mulheres serão informadas para não engravidar enquanto estiverem tomando CBDV. As participantes do sexo feminino devem informar o investigador e consultar um obstetra ou especialista materno-fetal se engravidarem durante o estudo.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Quadruplicar
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Experimental: Canabidivarina (CBDV)
Dosagem baseada no peso de 10 mg/kg/dia de CBDV por 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 Placebo: Placebo correspondente
Dosagem baseada no peso de 10 mg/kg/dia de placebo durante 12 semanas
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A solução oral placebo contém excipientes correspondentes.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Irritability Based on Aberrant Behavior Checklist-Irritability (ABC-I) Subscale
Prazo: 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 resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Repetitive Behavior Based on the Repetitive Behavior Scale-Revised (RBS-R).
Prazo: 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)
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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)
Prazo: 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
Prazo: 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
Prazo: 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
Publicações e links úteis
Publicações Gerais
- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Distúrbios de impressão
- Manifestações Neurológicas
- Doenças do Sistema Nervoso
- Distúrbios Nutricionais
- Doenças Genéticas, Congênitas
- Supernutrição
- Manifestações Neurocomportamentais
- Anomalias congénitas
- Anormalidades, Múltiplas
- Excesso de peso
- Deficiência Intelectual
- Obesidade
- Distúrbios cromossômicos
- Doenças e Anormalidades Congênitas, Hereditárias e Neonatais
- Doenças Nutricionais e Metabólicas
- Síndrome de Prader-Willi
- canabidivarina
Outros números de identificação do estudo
- 2019-9914
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
Prazo de Compartilhamento de IPD
Critérios de acesso de compartilhamento IPD
Tipo de informação de suporte de compartilhamento de IPD
- PROTOCOLO DE ESTUDO
- SEIVA
- CIF
- CSR
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