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Long-Term Immune Persistence of GlaxoSmithKline Biologicals' Inactivated Hepatitis A Vaccine Injected According to a 0, 12-month Schedule

Double-blind Randomized Study to Evaluate the Immunogenicity and Reactogenicity of Two Different Lots of GlaxoSmithKline Biologicals' Inactivated Hepatitis A Vaccine Containing 1440 EL.U of Antigen Per mL and Injected According to a 0, 12 Month Schedule in Healthy Adult Volunteers

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00291876
Enrollment
135
Registered
2006-02-15
Start date
2004-01-01
Completion date
2013-03-01
Last updated
2017-11-29

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hepatitis A

Keywords

HAVRIX™, Hepatitis A

Brief summary

The aim of this study is to evaluate the persistence of hepatitis A antibodies at 138, 150, 162, 174,186, 198, 210, 222, 234 and 246 months after subjects received their first dose of a 2 dose vaccination schedule of hepatitis A vaccine. This protocol posting deals with objectives & outcome measures of the extension phase at year 11 to 20. No additional subjects will be recruited during this long-term follow-up.

Detailed description

This is a long-term follow-up study at Years 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20 after primary vaccination with GSK Biologicals' hepatitis A vaccine (two-dose schedule). To evaluate the long-term antibody persistence, volunteers will donate a blood sample at Years 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20 after the first vaccine dose of the primary vaccination course to determine their anti-hepatitis A (anti-HAV) antibody concentrations. If a subject has become seronegative for anti-HAV antibodies during any of the long-term blood sampling time point (i.e. Months 138, 150, 162, 174,186, 198, 210, 222, 234 and 246), he/ she will be offered an additional vaccine dose. A blood sample will be taken on the day of the additional vaccination 14 days and one month after additional vaccination to evaluate the immune response following this vaccination. The Protocol Posting has been updated in order to comply with the FDA Amendment Act, Sep 2007 and to extend the follow up until Year 20. The study has 10 phases: 100571, 100572, 100573, 100574, 100575, 110677, 110678, 110679, 110680, 110681.

Interventions

BIOLOGICALHavrix™

2 doses at 12 months interval

Sponsors

GlaxoSmithKline
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
29 Years to 60 Years
Healthy volunteers
Yes

Inclusion criteria

* Subjects who had received at least one dose of the study vaccine in the primary study * Written informed consent will have been obtained from the subjects before the blood sampling visit of each year.

Design outcomes

Primary

MeasureTime frameDescription
Anti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationAt Months 138, 150, 162, 174, 186, 198, 210, 222, 234 and 246Concentrations given as geometric mean concentration (GMC) expressed as milli-international unit per millilitre (mIU/mL). \*\* = Regarding Month 234 data, please note that there were 5 subjects for whom serum sample tube was broken and thus due to risk of contamination the test were not performed. Hence these subjects were not included in the LT-ATP cohort for immunogenicity analysis at Month 234. $ = Regarding Month 246 data, please note there was 1 subject for whom serum sample tube was broken and hence scrapped by laboratory. Hence this subject was not included in the LT-ATP cohort for immunogenicity analysis at Month 246.
Number of Seropositive Subjects Against Hepatitis A VirusAt Months 138, 150, 162, 174, 186, 198, 210, 222, 234 and 246A seropositive subject was a vaccinated subject whose concentrations for antibodies against hepatitis A virus (anti-HAV) were equal or above (\>=) the assay cut-off for seropositivity of 15 milli-international units per milliliter (mIU/mL). \*\* = Regarding Month 234 data, please note that there were 5 subjects for whom serum sample tube was broken and thus due to risk of contamination the test were not performed. Hence these subjects were not included in the LT-ATP cohort for immunogenicity analysis at Month 234. $ = Regarding Month 246 data, please note there was 1 subject for whom serum sample tube was broken and hence scrapped by laboratory. Hence this subject was not included in the LT-ATP cohort for immunogenicity analysis at Month 246.

Secondary

MeasureTime frameDescription
Number of Subjects Reporting Solicited General SymptomsDuring the 4-day (Days 0-3) follow-up period after additional vaccinationSolicited general symptoms assessed include fatigue, fever, gastrointestinal symptoms and headache. 4 subjects received additional vaccination at Month 186 and 1 subject at Month 198.
Number of Subjects Reporting Unsolicited Adverse Events (AE)During the 30-day follow-up period after additional vaccinationAn AE is any untoward medical occurrence in a clinical investigation subject, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. 4 subjects received additional vaccination at Month 186 and 1 at Month 198.
Anti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationBefore additional vaccination, 14 days after additional vaccination and 30 days after additional vaccinationConcentrations given as GMC expressed as mIU/mL. 4 subjects received additional vaccination at Month 186 and 1 subject at Month 198. Please note that value 14.9 means \<15.
Number of Subjects Reporting Serious Adverse Events (SAE) After Additional VaccinationDuring the 30-day follow-up period after additional vaccinationAn SAE is any untoward medical occurrence that: results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, is a congenital anomaly/birth defect in the offspring of a study subject, or may evolve into one of the outcomes listed above. 4 subjects received additional vaccination at Month 186 and 1 at Month 198.
Number of Subjects Reporting Pregnancies After Additional VaccinationAt Months 186 and 198The number of subjects with outcome of pregnancies reported among subjects who had received the additional vaccination was tabulated. 4 subjects received additional vaccination at Month 186 and 1 subject at Month 198.
Number of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyAt Months 138, 150, 162, 174, 186, 198, 210, 222, 234 and 246An SAE is any untoward medical occurrence that: results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, is a congenital anomaly/birth defect in the offspring of a study subject, or may evolve into one of the outcomes listed above
Number of Subjects Reporting Solicited Local SymptomsDuring the 4-day (Days 0-3) follow-up period after additional vaccinationSolicited local symptoms assessed include pain, redness and swelling. Additional vaccination was given to 4 subjects at the Month 186 timepoint and to 1 subject at the Month 198 timepoint.

Countries

Belgium

Participant flow

Recruitment details

Participant Flow and Baseline Measures are given for each of the follow-up time points- Months 138, 150, 162, 174, 186, 198, 210, 222, 234 and 246. Note that not all subjects returned and participated in each of the intermediate follow-up time points.

Pre-assignment details

The Long-Term (LT) Total Cohort included all subjects who returned for the follow-up and who belonged to the Total Cohort in the primary study. The Long Term According-to-Protocol (LT-ATP) cohort for immunogenicity included subjects who returned for the follow-up and who were included in the ATP cohort for immunogenicity of the primary study.

Participants by arm

ArmCount
Havrix Group
Subjects who received during the primary study 2 doses of Havrix™ at Day 0 and at Month 12.
135
Total135

Baseline characteristics

CharacteristicHavrix Group
Age, Continuous46.3 Years
STANDARD_DEVIATION 5.35
Sex: Female, Male
Female
98 Participants
Sex: Female, Male
Male
29 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
2 / 5
serious
Total, serious adverse events
0 / 135

Outcome results

Primary

Anti-hepatitis A Virus (Anti-HAV) Antibody Concentration

Concentrations given as geometric mean concentration (GMC) expressed as milli-international unit per millilitre (mIU/mL). \*\* = Regarding Month 234 data, please note that there were 5 subjects for whom serum sample tube was broken and thus due to risk of contamination the test were not performed. Hence these subjects were not included in the LT-ATP cohort for immunogenicity analysis at Month 234. $ = Regarding Month 246 data, please note there was 1 subject for whom serum sample tube was broken and hence scrapped by laboratory. Hence this subject was not included in the LT-ATP cohort for immunogenicity analysis at Month 246.

Time frame: At Months 138, 150, 162, 174, 186, 198, 210, 222, 234 and 246

Population: Analysis was performed on the Long Term According-to-Protocol (LT-ATP) cohort for analysis of immunogenicity, on subjects with available data for the defined timepoint.~\* The laboratory assay was changed at Month 138, thus the blood samples were re-tested with the old assay for the sake of bridging.

ArmMeasureGroupValue (GEOMETRIC_MEAN)
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 138 (N=79)748.1 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 138 (N=85)*378.6 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 150 (N=93)419.3 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 162 (N=101)342.2 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 174 (N=102)318.9 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 186 (N=98)353.1 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 198 (N=101)339.9 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 210 (N=91)369.3 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 222 (N=86)340.1 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 234 (N=79)**283.3 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationMonth 246 (N=85)$317.3 mIU/mL
Primary

Number of Seropositive Subjects Against Hepatitis A Virus

A seropositive subject was a vaccinated subject whose concentrations for antibodies against hepatitis A virus (anti-HAV) were equal or above (\>=) the assay cut-off for seropositivity of 15 milli-international units per milliliter (mIU/mL). \*\* = Regarding Month 234 data, please note that there were 5 subjects for whom serum sample tube was broken and thus due to risk of contamination the test were not performed. Hence these subjects were not included in the LT-ATP cohort for immunogenicity analysis at Month 234. $ = Regarding Month 246 data, please note there was 1 subject for whom serum sample tube was broken and hence scrapped by laboratory. Hence this subject was not included in the LT-ATP cohort for immunogenicity analysis at Month 246.

Time frame: At Months 138, 150, 162, 174, 186, 198, 210, 222, 234 and 246

Population: Analysis was performed on the Long Term According-to-Protocol (LT-ATP) cohort for analysis of immunogenicity, on subjects with available data for the defined timepoint. \*The laboratory assay was changed at Month 138, thus the blood samples were re-tested with the old assay for the sake of bridging.

ArmMeasureGroupValue (NUMBER)
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 138 (N=85)*82 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 138 (N=79)77 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 150 (N=93)90 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 162 (N=101)98 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 174 (N=102)100 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 186 (N=98)95 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 198 (N=101)97 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 210 (N=91)88 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 222 (N=86)86 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 234 (N=79)**79 Subjects
Havrix GroupNumber of Seropositive Subjects Against Hepatitis A VirusMonth 246 (N=85)$85 Subjects
Secondary

Anti-hepatitis A Virus (Anti-HAV) Antibody Concentration

Concentrations given as GMC expressed as mIU/mL. 4 subjects received additional vaccination at Month 186 and 1 subject at Month 198. Please note that value 14.9 means \<15.

Time frame: Before additional vaccination, 14 days after additional vaccination and 30 days after additional vaccination

Population: Analysis was performed on the Long Term Total cohort, only on subjects who received an additional vaccine dose during the current long-term follow-up study. If a subject became seronegative (\< 15 mIU/mL) at any of the long-term blood sampling timepoint, he/she was offered an additional vaccine dose.

ArmMeasureGroupValue (NUMBER)
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 4 Month 186 day 141636 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 4 Month 186 day 302051 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 5 Month 198 before16 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 5 Month 198 day 143222 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 1 Month 186 before14.9 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 1 Month 186 day 1415 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 1 Month 186 day 3026 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 2 Month 186 before14.9 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 2 Month 186 day 14453 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 2 Month 186 day 30787 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 3 Month 186 before15 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 3 Month 186 day 143102 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 3 Month 186 day 303819 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 4 Month 186 before16 mIU/mL
Havrix GroupAnti-hepatitis A Virus (Anti-HAV) Antibody ConcentrationSubject 5 Month 198 day 304894 mIU/mL
Secondary

Number of Subjects Reporting Pregnancies After Additional Vaccination

The number of subjects with outcome of pregnancies reported among subjects who had received the additional vaccination was tabulated. 4 subjects received additional vaccination at Month 186 and 1 subject at Month 198.

Time frame: At Months 186 and 198

Population: Analysis was performed on the Long Term Total cohort, only on subjects who received an additional vaccine dose during the current long-term follow-up study. If a subject became seronegative (\< 15 mIU/mL) at any of the long-term blood sampling timepoint, he/she was offered an additional vaccine dose.

ArmMeasureGroupValue (NUMBER)
Havrix GroupNumber of Subjects Reporting Pregnancies After Additional VaccinationSubjects with pregnancy - At Month 186 (N=4)0 Subject
Havrix GroupNumber of Subjects Reporting Pregnancies After Additional VaccinationSubjects with pregnancy - At Month 198 (N=1)0 Subject
Secondary

Number of Subjects Reporting Serious Adverse Events (SAE) After Additional Vaccination

An SAE is any untoward medical occurrence that: results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, is a congenital anomaly/birth defect in the offspring of a study subject, or may evolve into one of the outcomes listed above. 4 subjects received additional vaccination at Month 186 and 1 at Month 198.

Time frame: During the 30-day follow-up period after additional vaccination

Population: Analysis was performed on the Long Term Total cohort, only on subjects who received an additional vaccine dose during the current long-term follow-up study. If a subject became seronegative (\< 15 mIU/mL) at any of the long-term blood sampling timepoint, he/she was offered an additional vaccine dose.

ArmMeasureGroupValue (NUMBER)
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) After Additional VaccinationMonth 186 (N=4)0 subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) After Additional VaccinationMonth 198 (N=1)0 subjects
Secondary

Number of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine Efficacy

An SAE is any untoward medical occurrence that: results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, is a congenital anomaly/birth defect in the offspring of a study subject, or may evolve into one of the outcomes listed above

Time frame: At Months 138, 150, 162, 174, 186, 198, 210, 222, 234 and 246

Population: Analysis was performed on the Long Term Total cohort, on subjects with available data for the defined timepoint.

ArmMeasureGroupValue (NUMBER)
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 150 (N=117)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 162 (N=127)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 174 (N=127)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 186 (N=129)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 246 (N=116)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 138 (N=107)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 198 (N=135)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 210 (N=124)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 222 (N=114)0 Subjects
Havrix GroupNumber of Subjects Reporting Serious Adverse Events (SAE) Assessed by the Investigator as Related to Primary Study Vaccination, Procedures or Lack of Vaccine EfficacyMonth 234 (N=110)0 Subjects
Secondary

Number of Subjects Reporting Solicited General Symptoms

Solicited general symptoms assessed include fatigue, fever, gastrointestinal symptoms and headache. 4 subjects received additional vaccination at Month 186 and 1 subject at Month 198.

Time frame: During the 4-day (Days 0-3) follow-up period after additional vaccination

Population: Analysis was performed on the Long Term Total cohort, only on subjects who received an additional vaccine dose during the current long-term follow-up study. If a subject became seronegative (\< 15 mIU/mL) at any of the long-term blood sampling timepoint, he/she was offered an additional vaccine dose.

ArmMeasureGroupValue (NUMBER)
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsFatigue Month 186 (N=4)2 subjects
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsFever Month 186 (N=4)0 subjects
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsGastrointestinal Month 186 (N=4)1 subjects
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsHeadache Month 186 (N=4)1 subjects
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsFatigue Month 198 (N=1)0 subjects
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsFever Month 198 (N=1)0 subjects
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsGastrointestinal Month 198 (N=1)0 subjects
Havrix GroupNumber of Subjects Reporting Solicited General SymptomsHeadache Month 198 (N=1)0 subjects
Secondary

Number of Subjects Reporting Solicited Local Symptoms

Solicited local symptoms assessed include pain, redness and swelling. Additional vaccination was given to 4 subjects at the Month 186 timepoint and to 1 subject at the Month 198 timepoint.

Time frame: During the 4-day (Days 0-3) follow-up period after additional vaccination

Population: Analysis was performed on the Long Term Total cohort, only on subjects who received an additional vaccine dose during the current long-term follow-up study. If a subject became seronegative (\< 15 mIU/mL) at any of the long-term blood sampling timepoint, he/she was offered an additional vaccine dose.

ArmMeasureGroupValue (NUMBER)
Havrix GroupNumber of Subjects Reporting Solicited Local SymptomsPain Month 198 (N=1)1 subjects
Havrix GroupNumber of Subjects Reporting Solicited Local SymptomsRedness Month 198 (N=1)0 subjects
Havrix GroupNumber of Subjects Reporting Solicited Local SymptomsSwelling Month 198 (N=1)0 subjects
Havrix GroupNumber of Subjects Reporting Solicited Local SymptomsPain Month 186 (N=4)2 subjects
Havrix GroupNumber of Subjects Reporting Solicited Local SymptomsRedness Month 186 (N=4)0 subjects
Havrix GroupNumber of Subjects Reporting Solicited Local SymptomsSwelling Month 186 (N=4)0 subjects
Secondary

Number of Subjects Reporting Unsolicited Adverse Events (AE)

An AE is any untoward medical occurrence in a clinical investigation subject, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. 4 subjects received additional vaccination at Month 186 and 1 at Month 198.

Time frame: During the 30-day follow-up period after additional vaccination

Population: Analysis was performed on the Long Term Total cohort, only on subjects who received an additional vaccine dose during the current long-term follow-up study. If a subject became seronegative (\< 15 mIU/mL) at any of the long-term blood sampling timepoint, he/she was offered an additional vaccine dose.

ArmMeasureGroupValue (NUMBER)
Havrix GroupNumber of Subjects Reporting Unsolicited Adverse Events (AE)Month 186 (N=4)0 subjects
Havrix GroupNumber of Subjects Reporting Unsolicited Adverse Events (AE)Month 198 (N=1)0 subjects

Source: ClinicalTrials.gov · Data processed: Mar 28, 2026