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Trial registered on ANZCTR
Registration number
ACTRN12616000839404
Ethics application status
Approved
Date submitted
21/06/2016
Date registered
28/06/2016
Date last updated
31/01/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Beta-blockers in chronic obstructive pulmonary disease (COPD): Feasibility study
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Scientific title
Beta-blockers in COPD: Feasibility of an RCT in stable patients
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Secondary ID [1]
289511
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nil
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Universal Trial Number (UTN)
U1111-1182-7193
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
COPD
299215
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Condition category
Condition code
Respiratory
299223
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0
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Chronic obstructive pulmonary disease
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
A feasibility study to assess whether cardio-selective beta-blockers can be started in patients with stable COPD. If patients can tolerate the drug, this will inform future randomised, placebo-controlled trial.
Oral bisoprolol will be started at a dose of 1.25mg daily, increased to 2.5mg daily after 2 weeks and to a target dose of 5mg daily after a further 4 weeks if tolerated. This dose will be maintained for a further 6 weeks.
Compliance will not be objectively monitored
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Intervention code [1]
295102
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Treatment: Drugs
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Ability to recruit eligible patients - percent of eligible patients screened who are started on the beta-blocker
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Assessment method [1]
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Timepoint [1]
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one year
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Primary outcome [2]
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Proportion of patients who tolerate cardio-selective beta-blockers, judged by the proportion of participants who remain on the beta-blockers at the end of the study (self-report).
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Assessment method [2]
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Timepoint [2]
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3 months after starting drug
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Secondary outcome [1]
325005
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Proportion of patients who reach the target dose of 5mg bisoprolol once daily. Assessed by the number of participants who are dispensed the drug and report taking it.
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Assessment method [1]
325005
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Timepoint [1]
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3 months after starting drug
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Secondary outcome [2]
325006
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Proportion of patients experiencing beta-blocker related adverse events and description of these adverse events.
All adverse events will be noted: these events will be detected by self-report, clinical notes, third-party reports (e.g. other doctors or coroner) and/or clinical observations at follow-up,
Pulse, blood pressure, spirometry, and ECGs will be done at each follow-up visit to record the cardiovascular and airway effects of the drug.
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Assessment method [2]
325006
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Timepoint [2]
325006
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3 months after starting drug
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Eligibility
Key inclusion criteria
Clinical diagnosis of COPD
FEV1/FVC ratio <70% on spirometery
History of COPD exacerbation in previous 2 years
Currently clinically stable
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Minimum age
40
Years
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Maximum age
No limit
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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
Clinical diagnosis of asthma
Contraindication to beta-blockers
Active cancer or terminal illness
Pregnant or breastfeeding
Acute coronary syndrome
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
None
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
not applicable
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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
Single group
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Other design features
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Phase
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Type of endpoint/s
Safety
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Statistical methods / analysis
Descriptive analysis of the proportions of patients able to be recruited, the number who tolerate the beta-blocker drug, and the number experiencing adverse events.
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Recruitment
Recruitment status
Active, not recruiting
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Date of first participant enrolment
Anticipated
1/08/2016
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Actual
29/11/2016
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Date of last participant enrolment
Anticipated
30/06/2017
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Actual
27/11/2017
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Date of last data collection
Anticipated
30/03/2018
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Actual
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Sample size
Target
48
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Accrual to date
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Final
37
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Recruitment outside Australia
Country [1]
7980
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New Zealand
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State/province [1]
7980
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Health Research Council
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Address [1]
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Level 3, 110 Stanley St, Auckland, New Zealand.
1141
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Country [1]
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New Zealand
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Primary sponsor type
Individual
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Name
Robert Hancox
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Address
Dunedin School of Medicine,
University of Otago,
PO Box 913
Dunedin.
New Zealand
9054
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Country
New Zealand
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Secondary sponsor category [1]
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Individual
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Name [1]
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Catherina Chang
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Address [1]
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Department of Respiratory Medicine
Waikato Hospital
Pembroke St
Hamilton
3240
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Country [1]
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New Zealand
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Other collaborator category [1]
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Individual
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Name [1]
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Lutz Beckert
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Address [1]
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Department of Medicine
University of Otago,
PO Box 4345
Christchurch
8140
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Country [1]
279042
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New Zealand
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Other collaborator category [2]
279043
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Individual
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Name [2]
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Richard Beasley
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Address [2]
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Medical Research Institute of New Zealand
Level 7, CSB building,
Riddiford St,
Private Bag 7902
Wellington
6021
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Country [2]
279043
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New Zealand
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Other collaborator category [3]
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Individual
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Name [3]
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Conroy Wong
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Address [3]
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Middlemore Hospital,
100 Hospital Road,
Papatoetoe,
Auckland
2025
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Country [3]
279044
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New Zealand
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Other collaborator category [4]
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Individual
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Name [4]
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Catherina Chang
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Address [4]
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Department of Respiratory Medicine
Waikato Hospital
Pembroke St
Hamilton
3240
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Country [4]
279047
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New Zealand
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
295302
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Southern Health & Disability Ethics Committee
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Ethics committee address [1]
295302
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Ethics committee country [1]
295302
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New Zealand
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Date submitted for ethics approval [1]
295302
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08/06/2016
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Approval date [1]
295302
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03/08/2016
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Ethics approval number [1]
295302
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Summary
Brief summary
Rationale for Research Cardiac diseases are a major cause of death in patients with chronic obstructive pulmonary disease (COPD). Patients with exacerbations of COPD are at risk of cardiac complications and these may be the most important determinant of survival in these patients. In addition, both of the commonly used classes of bronchodilators may increase cardiovascular risk and are used in high doses during exacerbations. Protecting patients with exacerbations of COPD from cardiac complications may have a greater impact on mortality than existing respiratory treatments. Beta-blockers are a valuable class of drug for protecting the heart and retrospective studies suggest that beta-blockers could reduce mortality in COPD. However patients with COPD have been excluded from prospective clinical trials of beta-blockers and continue to be denied treatment with them because of concerns that they may worsen airways disease. Several observational studies suggest that beta-blockers are safe and that they reduce mortality in patients with COPD. However, these studies have been prone to bias and confounding. We recently completed a study to assess the feasibility of conducting an RCT of beta-blockers in patients in hospital with exacerbations of COPD. It became clear that we could not do an RCT in this setting. Our aim now to assess whether it is feasible to do an RCT in stable patients with a history of COPD exacerbations Aims Before we conduct a randomised placebo-controlled trial of the cardio-selective beta-blocker metoprolol in patients with stable COPD, we are doing this feasibility study to explore two practical aspects of the proposed study: 1. Can beta-blockers be safely commenced in patients with a history of exacerbations of COPD? Although some patients with COPD take regular beta-blockers, it is not known what proportion of patients will be able to tolerate them. We aim to recruit 48 patients (12 in 4 centres) to establish whether cardio-selective beta-blockers can be commenced in patients with a history of exacerbations and what proportion of them tolerate the drug. 2. What proportion of patients with a history of exacerbations of COPD will be eligible for recruitment, how many consent to take part, how many will be excluded for reasons such as contra-indications to beta-blocker (e.g. childhood asthma, peripheral vascular disease), pre-existing beta-blocker treatment, or have other medical conditions such as advanced malignancy and would be unlikely to benefit from beta-blockers? This information will be important for planning recruitment to the main study. Protocol This feasibility study will recruit patents with COPD and start them on a low dose of metoprolol increasing to a target dose of 95mg daily over 6 weeks. The study will finish after 3 months - after 6 weeks on the highest dose.
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Trial website
None
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Trial related presentations / publications
None
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Public notes
None
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Contacts
Principal investigator
Name
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A/Prof Bob Hancox
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Address
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Dept of Preventive & Social Medicine
Dunedin School of Medicine
PO Box 913
University of Otago
9054
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Country
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New Zealand
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Phone
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+6434798512
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Bob Hancox
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Address
66819
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Dept of Preventive & Social Medicine
Dunedin School of Medicine
PO Box 913
University of Otago
9054
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Country
66819
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New Zealand
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Phone
66819
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+6434798512
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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
Name
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Bob Hancox
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Address
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Dept of Preventive & Social Medicine
Dunedin School of Medicine
PO Box 913
University of Otago
9054
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Country
66820
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New Zealand
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Phone
66820
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+6434798512
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Fax
66820
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Email
66820
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF