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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT05610085
Registration number
NCT05610085
Ethics application status
Date submitted
27/10/2022
Date registered
9/11/2022
Titles & IDs
Public title
A Dose Escalation Study of Levetiracetam in the Treatment of Neonatal Seizures
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Scientific title
A Phase IIb Dose Escalation Study of Levetiracetam for the Treatment of Neonatal Seizures
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Secondary ID [1]
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FD-R-6335
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Universal Trial Number (UTN)
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Trial acronym
NEOLEV3
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Neonatal Seizure
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Neonatal Encephalopathy
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Hypoxic-Ischemic Encephalopathy
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Seizure Newborn
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Condition category
Condition code
Neurological
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Epilepsy
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Neurological
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0
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Other neurological disorders
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Cardiovascular
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0
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Diseases of the vasculature and circulation including the lymphatic system
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Levetiracetam Injection
Treatment: Drugs - Phenobarbital Sodium Injection
Experimental: Dose escalation with LEV - Additional LEV at a higher dose (30 mg/kg, 60 mg/kg, or 90 mg/kg depending on the stage of the study).
Active comparator: Standard of care Phenobarbital - Treatment with Phenobarbital 20mg/kg IV and if needed a further 20mg/kg totalling 40mg/kg
Treatment: Drugs: Levetiracetam Injection
Neonates will be treated with intravenous levetiracetam 60mg/kg for first line management of seizures, and if seizures persist will be randomized to receive higher dose Levetiracetam or standard of care phenobarbital
Treatment: Drugs: Phenobarbital Sodium Injection
Standard of care for neonatal seizures
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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The primary endpoint is the maximum safe and tolerated dose of Levetiracetam
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Assessment method [1]
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A continual reassessment method will be used to determine the maximal safe and tolerated dose
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Timepoint [1]
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4 years
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Secondary outcome [1]
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Levetiracetam CL
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Assessment method [1]
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Population pharmacokinetic parameters for LEV Clearance (CL)will be calculated
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Timepoint [1]
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4 years
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Secondary outcome [2]
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Levetiracetam Vd
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Assessment method [2]
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Population pharmacokinetic parameters for LEV Volume of distribution (Vd) will be calculated
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Timepoint [2]
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4 years
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Secondary outcome [3]
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Adverse event rates
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Assessment method [3]
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Rates of adverse events seen with high dose LEV treatment will be reported and compared to rates seen in PHB control arm.
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Timepoint [3]
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4 years
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Secondary outcome [4]
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Long-term outcome
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Assessment method [4]
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Rates of adverse long-term outcome ( Death or Disability at 24 months) will be compared between treatment arms
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Timepoint [4]
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8 years
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Secondary outcome [5]
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Seizure burden reduction
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Assessment method [5]
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Number of patients with at least 50% seizure burden reduction post treatment will be compared between randomized treatment arms
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Timepoint [5]
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4 years
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Secondary outcome [6]
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Seizure freedom rates
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Assessment method [6]
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Number of patients who become seizure free for 24 hours post treatment will be compared between the randomized treatment groups in each stage of the study
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Timepoint [6]
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4 years
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Secondary outcome [7]
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Estimate of efficacy of higher dose LEV
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Assessment method [7]
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Assuming no dose limiting toxicity is demonstrated and the study proceeds to completion, 50 subjects will be treated at 120mg/kg or higher dosing level. This sample size will give satisfactory power for estimating additional efficacy of higher doses. For example, if we document an additional response rate of 15%, this sample size will provide a 95% confidence interval (0.051, 0.248) around that estimate.
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Timepoint [7]
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4 years
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Eligibility
Key inclusion criteria
* at risk for seizures or suspected to be having seizures;
* all seizure aetiologies except correctable metabolic abnormalities such as hypoglycaemia and hypocalcaemia;
* Term neonates (corrected gestational age between 35 and 44 weeks, postnatal age less than 28 days);
* weight > 2200g.
* Parental ability to comprehend and provide written informed consent
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Minimum age
No limit
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Maximum age
1
Month
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Cumulative seizure burden of 8 minutes/ hour or more in phases 1 and 2, Cumulative seizure burden of 30 minutes/hour or more in phase 3;
* Renal failure defined as anuria in the first 24 hours of life;
* Subjects in whom death seems imminent;
* Seizures caused by correctable metabolic abnormality, such as hypocalcaemia, hypoglycaemia.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
24/03/2023
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
31/12/2027
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Actual
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Sample size
Target
133
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment outside Australia
Country [1]
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United States of America
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State/province [1]
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California
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Country [2]
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United States of America
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State/province [2]
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Minnesota
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Country [3]
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New Zealand
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State/province [3]
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Auckland
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of California, San Diego
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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University of Minnesota
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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Rady Children's Hospital, San Diego
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Address [2]
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Country [2]
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Other collaborator category [3]
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Government body
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Name [3]
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Auckland City Hospital
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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University of Auckland, New Zealand
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Address [4]
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Country [4]
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Other collaborator category [5]
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Other
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Name [5]
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Middlemore Hospital, New Zealand
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Address [5]
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Country [5]
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Ethics approval
Ethics application status
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Summary
Brief summary
The main purpose of this study is to determine the maximum safe tolerated dose of LEV in the treatment of neonatal seizures. Our hypothesis is that optimal dosing of Levetiracetam (LEV) to treat neonatal seizures is significantly greater than 60mg/kg. This study will be an open label dose-escalation, preliminary safety and efficacy study. There will be a randomized control treatment component. Infants recognized as having neonatal seizures or as being at risk of developing seizures will be recruited and started on continuous video EEG monitoring (CEEG). Eligibility will be confirmed and consent will be obtained. In the first 2 phases of the study, neurologists will identify neonates with mild-moderate seizure burden (less than 8 minutes cumulative seizure activity per hour), appropriate for study with LEV, and exclude patients with higher seizure burden where treatment with PHB is more appropriate. Phase 3 of the dose escalation will only proceed if additional efficacy of LEV has been demonstrated in phases 1 and 2. In Phase 3 we will recruit neonates with seizures of greater severity up to 30 minute seizure burden/hour. This will make the final results of study more generalizable. If seizures are confirmed, enrolled subjects will receive 60mg/kg of LEV. Subjects whose seizures persist or recur 15 minutes after the first infusion is complete, subjects will then be randomized in the dose escalation study. Patients in the dose escalation study will be randomly assigned to receive either higher dose LEV or treatment with the control drug PHB in a 3:1 allocation ratio, stratified by site. Funding Source- FDA OOPD
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Trial website
https://clinicaltrials.gov/study/NCT05610085
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Sonya G Wang, M.D.
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Address
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University of Minnesota
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Sonya G Wang, M.D.
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Address
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Country
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Phone
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612-301-1454
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT05610085