- ICH GCP
- Реестр клинических исследований США
- Клиническое испытание NCT03371667
Сравнить эффективность добавления метотрексата (MTX) к текущему стандарту лечения острой реакции «трансплантат против хозяина» (РТПХ) первой линии кортикостероидами (MTX-aGVHD)
Многоцентровое рандомизированное двойное слепое исследование фазы III, в котором сравнивали стандартную терапию отдельно с кортикостероидами и низкими дозами метотрексата (MTX) для лечения первой линии острой реакции «трансплантат против хозяина» после аллогенной трансплантации стволовых клеток
Phase III randomized double-blinded trial designed to compare the efficacy of the addition of MTX to current standard acute GVHD first-line treatment with corticosteroids. The protocol will use a novel endpoint for benchmarking interventions based on a composite primary endpoint of GVHD-free and corticosteroids-free survival.
The primary endpoint of the trial will be the assessment of a composite endpoint of graft-versus-host disease-free and corticosteroids-free survival at 12 months after randomization
Обзор исследования
Статус
Условия
Вмешательство/лечение
Подробное описание
This is a phase III randomized, multicenter, double blinded controlled study. Patients who develop clinically meaningful acute GVHD and who meet all other entry criteria will be randomized 1:1 to receive either corticosteroids and placebo ("standard of care", control arm) or the combination of low-dose MTX with corticosteroids as first-line therapy for acute GVHD (MTX; "experimental arm").
The primary analysis of this hypothesis generation study is to estimate the composite endpoint of GVHD-free and corticosteroids-free survival at 12 months after randomization in both treatment arms. In fact, it is more and more established that such composite endpoint is a clinically very relevant one because it represents ideal recovery from allo-SCT (Stem Cell transplantation) (at 1 year after acute GVHD diagnosis) and a measure of cure without ongoing morbidity.
Тип исследования
Регистрация (Действительный)
Фаза
- Фаза 3
Контакты и местонахождение
Места учебы
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Paris, Франция, 75012
- Saint Antoine Hospital - Hematology Department
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Критерии участия
Критерии приемлемости
Возраст, подходящий для обучения
Принимает здоровых добровольцев
Полы, имеющие право на обучение
Описание
Inclusion Criteria:
- Adults patients (>=18 years old) with hematological diseases, who develop a first episode of acute GVHD (grade II-IV) requiring systemic therapy
- First allo-SCT, with any type of donor, stem cell source, GVHD prophylaxis or conditioning regimen
- Biopsy of acute GVHD target organ is recommended, but not required. Enrollment should not be delayed awaiting biopsy or pathology results
- The patient must have received no previous systemic immune suppressive therapy for treatment of acute GVHD, except for a maximum 72 hours of prior corticosteroid therapy
- Absolute neutrophil count (ANC) greater than 0.5 G/L
- Platelets count greater than 20 G/L
- Signed informed consent
- Affiliation to a social security system (recipient or assign)
- Women who are of childbearing potential must have a negative serum pregnancy test and agree to use a medically acceptable method of contraception until 6 months after the end of treatment.
Men with a partner of childbearing potential must agree to use a medically acceptable method of contraception until 6 months after the end of treatment.
Exclusion Criteria:
- Hyper-acute GVHD as defined by the MD Anderson's criteria (Saliba, de Lima et al. 2007)
- Flare of GVHD in a patient already on corticosteroid treatment
- Overlap chronic GVHD as defined by the NIH Consensus Criteria (Jagasia, Greinix et al. 2015)
- MTX given within 7 days of enrollment
- Active uncontrolled infection
- Relapsed/persistent malignancy requiring rapid immune suppression withdrawal
- Acute GVHD after donor lymphocytes infusion (DLI)
- Other systemic drugs for GVHD treatment (including extra-corporeal photopheresis)
- If any prior steroid therapy (for indication other than GVHD), treatment at doses > 0.5 mg/kg/day methyl-prednisolone within 7 days prior to onset of acute GVHD
- Patients who are pregnant, breast feeding, or if sexually active, unwilling to use effective birth control for the duration of the study
- Patient on dialysis
- Patients with veno-occlusive disease of the liver or with significant liver abnormalities who in the judgment of the treating physician cannot receive MTX
- Patients requiring after inclusion in the protocol the continuation of one or more of the following medication: probenecide, trimethoprime (alone or in combination with sulfametoxazole), phenylbutazone or yellow fever vaccine
- Patients with a history of intolerance/allergy to MTX
- Hypersensitivity to the active substance or to any of the excipients
Учебный план
Как устроено исследование?
Детали дизайна
- Основная цель: Уход
- Распределение: Рандомизированный
- Интервенционная модель: Параллельное назначение
- Маскировка: Двойной
Оружие и интервенции
Группа участников / Армия |
Вмешательство/лечение |
|---|---|
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Экспериментальный: Methotrexate
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Methotrexate 3 mg/m2 will be given once week for 4 weeks, then 3 mg/m2 every two weeks for 12 weeks. Body surface area will be capped at 2 m2. Methotrexate will be given as an IV infusion over 15 minutes. All patients will received prednisone 2 mg/kg.day PO (or methylprednisolone 1.6 mg/Kg/day) for 3 days. For responding patients between day 4 and 28, the dose of prednisone must be at least 0.25 mg/kg/day prednisone (or 0.2 mg/kg/day methylprednisolone). All patients should receive a folinic acid supplementation 24 hours after each MTX/placebo administration. Lederfoldin 10 mg po or iv will be administered on days 2, 9, 16 and 23. Lederfoldin 10 mg po or iv will be administered on days 37, 51, 65, 79, 93 and 103. |
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Плацебо Компаратор: Placebo
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Placebo 3 mg/m2 will be given once week for 4 weeks, then 3 mg/m2 every two weeks for 12 weeks. Body surface area will be capped at 2 m2. Placebo will be given as an IV infusion over 15 minutes. All patients will received prednisone 2 mg/kg.day PO (or methylprednisolone 1.6 mg/Kg/day) for 3 days. For responding patients between day 4 and 28, the dose of prednisone must be at least 0.25 mg/kg/day prednisone (or 0.2 mg/kg/day methylprednisolone). All patients should receive a folinic acid supplementation 24 hours after each MTX/placebo administration. Lederfoldin 10 mg po or iv will be administered on days 2, 9, 16 and 23. Lederfoldin 10 mg po or iv will be administered on days 37, 51, 65, 79, 93 and 103. |
Что измеряет исследование?
Первичные показатели результатов
Мера результата |
Мера Описание |
Временное ограничение |
|---|---|---|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization.
Временное ограничение: Evaluation will be performed at time of inclusion
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at time of inclusion
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (1).
Временное ограничение: Evaluation will be performed before start of MTX at the randomization.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed before start of MTX at the randomization.
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (2).
Временное ограничение: Evaluation will be performed at Day 8
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 8
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (3).
Временное ограничение: Evaluation will be performed at Day 15
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GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 15
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (4).
Временное ограничение: Evaluation will be performed at Day 22
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GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 22
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (5).
Временное ограничение: Evaluation will be performed at Day 28
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 28
|
|
Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (6).
Временное ограничение: Evaluation will be performed at Day 36
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 36
|
|
Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (7).
Временное ограничение: Evaluation will be performed at Day 50
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 50
|
|
Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (8).
Временное ограничение: Evaluation will be performed at Day 56
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 56
|
|
Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (9).
Временное ограничение: Evaluation will be performed at Day 64
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 64
|
|
Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (10)
Временное ограничение: Evaluation will be performed at Day 78
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 78
|
|
Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (11).
Временное ограничение: Evaluation will be performed at Day 92
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 92
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (12).
Временное ограничение: Evaluation will be performed at Day 102
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 102
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (13).
Временное ограничение: Evaluation will be performed at 5 months after randomization.
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GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 5 months after randomization.
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (14).
Временное ограничение: Evaluation will be performed at 6 months after randomization.
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GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 6 months after randomization.
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (17).
Временное ограничение: Evaluation will be performed at 9 months after randomization .
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GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 9 months after randomization .
|
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Assessment of a composite endpoint of graft-versus-host disease-free at 12 months after randomization (18).
Временное ограничение: Evaluation will be performed at 12 months after randomization.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 12 months after randomization.
|
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Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (19).
Временное ограничение: Evaluation will be performed at time of inclusion.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at time of inclusion.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (20).
Временное ограничение: Evaluation will be performed before start of MTX at the randomization.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed before start of MTX at the randomization.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (21).
Временное ограничение: Evaluation will be performed at Day 8.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 8.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (20).
Временное ограничение: Evaluation will be performed at Day 15.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 15.
|
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Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (21).
Временное ограничение: Evaluation will be performed at Day 22.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 22.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (22).
Временное ограничение: Evaluation will be performed at Day 28.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 28.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (23).
Временное ограничение: Evaluation will be performed at Day 36
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 36
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (24).
Временное ограничение: Evaluation will be performed at Day 50.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 50.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (25).
Временное ограничение: Evaluation will be performed at Day 56.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 56.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (26).
Временное ограничение: Evaluation will be performed at Day 64.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 64.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (27).
Временное ограничение: Evaluation will be performed at Day 78.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 78.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (28).
Временное ограничение: Evaluation will be performed at D92.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at D92.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (29).
Временное ограничение: Evaluation will be performed at Day 102.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at Day 102.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (30).
Временное ограничение: Evaluation will be performed at 5 months after randomization.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 5 months after randomization.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (31).
Временное ограничение: Evaluation will be performed at 6 months after randomization.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 6 months after randomization.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (32).
Временное ограничение: Evaluation will be performed at 9 months after randomization.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 9 months after randomization.
|
|
Assessment of a composite endpoint of corticosteroids-free survival at 12 months after randomization (33).
Временное ограничение: Evaluation will be performed at 12 months after randomization.
|
GVHD-free survival is defined as absence of initiation of additional GVHD therapy or development of chronic GVHD requiring systemic therapy, and corticosteroids-free survival as absence of continuation of corticosteroids above a dose of 0.15 mg/Kg day. |
Evaluation will be performed at 12 months after randomization.
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Вторичные показатели результатов
Мера результата |
Мера Описание |
Временное ограничение |
|---|---|---|
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Частота тяжелых нежелательных явлений в течение первых 12 месяцев после рандомизации
Временное ограничение: 12 месяцев после рандомизации
|
12 месяцев после рандомизации
|
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Доля полной ремиссии (CR), очень хорошего частичного ответа (VGPR), частичного ответа (PR), смешанного ответа (MR), отсутствия ответа (NR) и прогрессирования на 28-й день, 56-й день и наилучший ответ в течение первых 12 месяцев после рандомизации.
Временное ограничение: на 28-й день, 56-й день и лучший ответ в течение первых 12 месяцев после рандомизации.
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на 28-й день, 56-й день и лучший ответ в течение первых 12 месяцев после рандомизации.
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Доля обострений РТПХ в течение первых 12 месяцев после рандомизации.
Временное ограничение: 12 месяцев после рандомизации
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12 месяцев после рандомизации
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Кумулятивная заболеваемость общей и тяжелой хронической РТПХ по оценке NIH Consensus Criteria в течение первых 12 месяцев после рандомизации (Jagasia, Greinix et al. 2015, Lee, Wolff et al. 2015).
Временное ограничение: в течение первых 12 месяцев после рандомизации
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в течение первых 12 месяцев после рандомизации
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Частота системной инфекции и реактивации ЦМВ(цитомегаловируса) в течение 3 месяцев после рандомизации
Временное ограничение: в течение 3 месяцев после рандомизации
|
в течение 3 месяцев после рандомизации
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Частота реактивации ВЭБ (вируса Эпштейна-Барр) и посттрансплантационного лимфопролиферативного заболевания в течение 12 месяцев после рандомизации
Временное ограничение: в течение 12 месяцев после рандомизации
|
в течение 12 месяцев после рандомизации
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Кумулятивная частота безрецидивной смертности в течение первых 12 месяцев после рандомизации.
Временное ограничение: 12 месяцев после рандомизации
|
12 месяцев после рандомизации
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Безкортикостероидная, безрецидивная и общая выживаемость в течение первых 12 месяцев после рандомизации.
Временное ограничение: 12 месяцев после рандомизации
|
12 месяцев после рандомизации
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Иммунологическое восстановление и микробиота: количество пациентов с полным восстановлением иммунитета (лимфоцитов и дендритных клеток) и коррекцией дисбактериоза микробиоты в течение первых 12 мес.
Временное ограничение: 12 месяцев после рандомизации
|
12 месяцев после рандомизации
|
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Quality of Life (QoL)-1
Временное ограничение: 12 Months
|
Evaluation by 1 questionnaire: EORTC QLQ-C30 (quality of life questionnaire) (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) |
12 Months
|
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Quality of Life (QoL)-2
Временное ограничение: 12 Months
|
Evaluation by 1 questionnaire: FACT-BMT (Functional Assessment of Cancer Therapy - Bone Marrow Transplant) |
12 Months
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Соавторы и исследователи
Следователи
- Главный следователь: Mohamad Mohty, PU-PH, Assistance Publique - Hôpitaux de Paris
Даты записи исследования
Изучение основных дат
Начало исследования (Действительный)
Первичное завершение (Действительный)
Завершение исследования (Действительный)
Даты регистрации исследования
Первый отправленный
Впервые представлено, что соответствует критериям контроля качества
Первый опубликованный (Действительный)
Обновления учебных записей
Последнее опубликованное обновление (Действительный)
Последнее отправленное обновление, отвечающее критериям контроля качества
Последняя проверка
Дополнительная информация
Термины, связанные с этим исследованием
Ключевые слова
Дополнительные соответствующие термины MeSH
Другие идентификационные номера исследования
- PHRC-K 16-150
- 2017 (Грант/контракт NIH США)
- 2017-002691-98 (Номер EudraCT)
Планирование данных отдельных участников (IPD)
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Информация о лекарствах и устройствах, исследовательские документы
Изучает лекарственный продукт, регулируемый FDA США.
Изучает продукт устройства, регулируемый Управлением по санитарному надзору за качеством пищевых продуктов и медикаментов США.
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