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GRACE: A Study to Compare the Effectiveness, Safety and Tolerability of PREZISTA (Darunavir)/Ritonavir by Gender and Race When Administered With Other Antiretroviral Medications in Human Immunodeficiency Virus (HIV) Positive Women and Men.

GRACE: An Open-label, Multicenter Trial to Compare the Efficacy, Safety, and Tolerability of PREZISTA (Darunavir)/Ritonavir by Gender and Race, When Administered in Combination With an Individually Optimized Background Regimen Over a 48-week Treatment Period.

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00381303
Enrollment
429
Registered
2006-09-27
Start date
2006-11-30
Completion date
2008-12-31
Last updated
2014-04-21

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

Conditions

HIV, Infectious

Keywords

HIV, AIDS, Immunodeficiency Virus, Human, Females, Women, PREZISTA, darunavir, TMC114, Protease Inhibitor

Brief summary

The purpose of this study is to evaluate any differences in the effectiveness, safety, and tolerability of PREZISTA (darunavir; DRV) 600 mg, administered with ritonavir (RTV) 100 mg twice a day on virologic response (defined as a viral load (VL) of \< 50 copies/mL) over a 48-week treatment period in HIV-positive women and men. Additional antiretroviral (ARV) agents will also be administered and will be chosen by the Investigator based on resistance testing and prior treatment history (referred to as the Optimized Background Regimen (OBR)).

Detailed description

This is a multi-center, open-label (doctors and patients know which drug is being administered), Phase IIIb clinical trial to evaluate differences in effectiveness, safety, and tolerability of darunavir/ritonavir by sex and/or race over a 48-week treatment period. This study will be conducted in HIV positive women and men who have been treated previously with antiretroviral therapy. This study will enroll 70% women and will be conducted in the U.S., Puerto Rico, Mexico and Canada in approximately 420 patients who will receive darunavir 600 mg and ritonavir 100 mg twice daily. The primary objective of this study is to determine the percentage of patients who achieve virologic response, defined as a viral load (VL) of \<50 copies/mL at week 48. Secondary study objectives include comparisons of endpoints between women and men as well as race across multiple parameters including but not limited to change in CD4 count from baseline to week 48, time to loss of virologic response (TLOVR), changes in metabolic parameters (blood chemistry), etc. Within 4 weeks after the Screening Visit (initial visit with investigator to determine eligibility), the Investigator should have received all data required to determine the patient's eligibility and will construct the individual Optimized Background Regimen (OBR) that will be used during the treatment period in combination with darunavir/ritonavir for those patients enrolled in the study. The OBR will consist of additional antiretroviral (ARV) agents that will also be administered during the study chosen by the Investigator and based on resistance testing and prior treatment history. The study Sponsor will provide the following ARV agents, that may be used as options for the OBR: TMC 125 (investigational non-nucleoside reverse transcriptase inhibitor; NNRTI); Truvada (tenofovir/emtricitabine); Viread (tenofovir); Emtriva (emtricitabine); Zidovudine. Other NRTIs (nucleoside reverse transcriptase inhibitors) or NNRTIs may be used at the discretion of the Investigator, but will not be provided by the Sponsor. The Baseline Visit (Day 1) will be followed by a 48-week treatment period during which patients will be evaluated at Weeks 4, 8, 12, 16, 24, 36, 48 and at a final Follow-Up Visit during Week 52. (total of 10 visits from Screening to final visit). At a number of visits throughout the study, blood samples will be obtained to assess defined laboratory values, safety parameters and to determine concentrations of study drugs darunavir, TMC125 (if applicable) and ritonavir). Patients will be assessed for change in CD4 count and HIV-RNA throughout the study. At each visit, vital signs will be assessed and patients will be asked about any untoward medical occurrences and these will be recorded as adverse events (AEs) and/or HIV-related events. Detailed definitions and reporting procedures for AEs will be provided as part of the protocol. Study patients will receive PREZISTA (darunavir) 600 mg boosted with 100 mg of ritonavir orally (by mouth) twice a day in combination with other antiretroviral drugs for 48 weeks.

Interventions

DRUGdarunavir

600mg bid for 48 wks

DRUGritonavir

100mg bid for 48 wks

Sponsors

Tibotec Therapeutics, a Division of Ortho Biotech Products, L.P., USA
CollaboratorINDUSTRY
Tibotec, Inc
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Documented HIV infection * Plasma HIV-RNA \>= 1000 copies/mL * Must be able to comply with protocol requirements

Exclusion criteria

* No prior use of PREZISTA (darunavir), TMC125, enfuvirtide, or tipranavir * No currently active AIDS defining illness, Category C conditions according to the Center for Disease Control \[CDC\] Classification System for HIV Infection (1993) with the following exceptions, which must be discussed with the Sponsor prior to enrollment: stable cutaneous Kaposi's Sarcoma, Wasting syndrome due to HIV infection * Not currently using an investigational drug * Not pregnant or breastfeeding * No Grade 3 or 4 laboratory abnormality as defined by DAIDS (Division of AIDS, National Institute of Allergy and Infectious Diseases).

Design outcomes

Primary

MeasureTime frameDescription
Number of Viral Load (VL) < 50 HIV-1 RNA Copies/mL (Time to Loss of Virologic Response[TLOVR]) Subjects by SexWeek 48TLOVR - responders/non-responders per FDA TLOVR response algorithm. A subject was considered a responder at that time point and that subsequent. A subject was considered a non-responder at a time point in the following situations: discontinued treatment at that time point, a rebound value at that time point and that subsequent or at that time point and that followed by treatment discontinuation, intermittent missing values were considered a response if the immediately preceding and following visits were a response, rebound at earlier time point, or any new, unplanned ARV except in tolerability
Number of TLOVR Non-virologic Failure (VF) Censored - VL < 50 HIV-1 RNA Subjects by SexWeek 48TLOVR non-virologic failure (VF) censored. This imputation method differs from the TLOVR algorithm, because subjects that dropped out for reasons other than virologic failure were censored from the time of discontinuation onwards.

Secondary

MeasureTime frameDescription
Descriptive Statistics of [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA by RaceWeek 48TLOVR non-virologic failure (VF) censored. This imputation method differs from the TLOVR algorithm, because subjects that dropped out for reasons other than virologic failure were censored from the time of discontinuation onwards.
Descriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNAWeek 48The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR) TLOVR non-virologic failure(VF) censored. This imputation method differs from the TLOVR algorithm, because subjects that dropped out for reasons other than virologic failure were censored from the time of discontinuation onwards.
Descriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed ValuesBaseline, Week 48Observed obsevations have no imputation methods applied.
Number of VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects by RaceWeek 48Intention to Treat population (ITT)
Descriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)Week 48Last Observation Carried Forward (LOCF) imputation method applied.
Descriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCFWeek 48The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR). The Last Observation Carried Forward (LOCF) imputation method was applied.
Descriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed ValuesWeek 48The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR)
Number of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) SubjectsWeek 48The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR)

Countries

Canada, Puerto Rico, United States

Participant flow

Participants by arm

ArmCount
Female
darunavir (DRV) 600 mg bid for 48 weeks administered with ritonavir 100 mg bid for 48 weeks.
287
Male
darunavir (DRV) 600 mg bid for 48 weeks administered with ritonavir 100 mg bid for 48 weeks.
142
Total429

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAE/HIV-related event226
Overall StudyIneligible to continue the trial21
Overall StudyLost to Follow-up259
Overall StudyNon-Adherence136
Overall StudyNo virologic response by week 1210
Overall StudyPhysician Decision10
Overall StudyPhysician's decision to close the site31
Overall StudyPregnancy20
Overall StudySubject did not continue visits10
Overall StudySubject moved out of state20
Overall StudySubject primary physician's decision10
Overall StudySubject taking too many different meds10
Overall StudySubject was too busy for appointments10
Overall StudyVirologic failure64
Overall StudyWithdrawal by Subject136

Baseline characteristics

CharacteristicMaleTotalFemale
Age, Continuous45 years43 years43 years
CD4+ cell count175 cells/L200 cells/L210 cells/L
Plasma log10 copies/mL VL HIV-1 RNA4.73 copies/mL
STANDARD_DEVIATION 0.856
4.67 copies/mL
STANDARD_DEVIATION 0.874
4.65 copies/mL
STANDARD_DEVIATION 0.883
Previous Antiretroviral (ARV) Experience: Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
NNRTI: < 1 drug count
32 participants115 participants83 participants
Previous Antiretroviral (ARV) Experience: Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
NNRTI: >= 1 drug count
110 participants314 participants204 participants
Previous ARV experience: Protease inhibitor (PI)
PI: <2
50 participants169 participants119 participants
Previous ARV experience: Protease inhibitor (PI)
PI: >=2
92 participants260 participants168 participants
Race/Ethnicity, Customized
Asian
2 participants2 participants0 participants
Race/Ethnicity, Customized
Black
73 participants264 participants191 participants
Race/Ethnicity, Customized
Caucasian/White
31 participants65 participants34 participants
Race/Ethnicity, Customized
Hispanic
36 participants96 participants60 participants
Race/Ethnicity, Customized
Other
0 participants2 participants2 participants
Sex: Female, Male
Female
0 Participants287 Participants287 Participants
Sex: Female, Male
Male
142 Participants142 Participants0 Participants
Time since HIV-infection diagnosis11.91 years11.3 years10.78 years

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
73 / 28733 / 142
serious
Total, serious adverse events
47 / 28733 / 142

Outcome results

Primary

Number of TLOVR Non-virologic Failure (VF) Censored - VL < 50 HIV-1 RNA Subjects by Sex

TLOVR non-virologic failure (VF) censored. This imputation method differs from the TLOVR algorithm, because subjects that dropped out for reasons other than virologic failure were censored from the time of discontinuation onwards.

Time frame: Week 48

Population: TLOVR non-virologic failure (VF) censored

ArmMeasureValue (NUMBER)
FemaleNumber of TLOVR Non-virologic Failure (VF) Censored - VL < 50 HIV-1 RNA Subjects by Sex146 participants
MaleNumber of TLOVR Non-virologic Failure (VF) Censored - VL < 50 HIV-1 RNA Subjects by Sex83 participants
Primary

Number of Viral Load (VL) < 50 HIV-1 RNA Copies/mL (Time to Loss of Virologic Response[TLOVR]) Subjects by Sex

TLOVR - responders/non-responders per FDA TLOVR response algorithm. A subject was considered a responder at that time point and that subsequent. A subject was considered a non-responder at a time point in the following situations: discontinued treatment at that time point, a rebound value at that time point and that subsequent or at that time point and that followed by treatment discontinuation, intermittent missing values were considered a response if the immediately preceding and following visits were a response, rebound at earlier time point, or any new, unplanned ARV except in tolerability

Time frame: Week 48

Population: Intention to Treat (ITT)

ArmMeasureValue (NUMBER)
FemaleNumber of Viral Load (VL) < 50 HIV-1 RNA Copies/mL (Time to Loss of Virologic Response[TLOVR]) Subjects by Sex146 participants
MaleNumber of Viral Load (VL) < 50 HIV-1 RNA Copies/mL (Time to Loss of Virologic Response[TLOVR]) Subjects by Sex83 participants
Comparison: Confidence interval of the difference in proportion of response between two sexes estimated by:~* Application of delta method to be obtained Standard Error (SE)~* Calculation of lower and upper bound using normal approximation to the difference in response ratesp-value: 0.395% CI: [-19.85, 0.68]Regression, Logistic
Secondary

Descriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values

Observed obsevations have no imputation methods applied.

Time frame: Baseline, Week 48

Population: ITT

ArmMeasureValue (MEAN)Dispersion
FemaleDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values152 x10^6 cells/LStandard Error 11.2
MaleDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values122 x10^6 cells/LStandard Error 12.3
HispanicDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values143 x10^6 cells/LStandard Error 10.8
AsianDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values151 x10^6 cells/LStandard Error 23.8
OtherDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values133 x10^6 cells/LStandard Error 17
AsianDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values45 x10^6 cells/LStandard Error 24.5
OtherDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using Observed Values179 x10^6 cells/L
Secondary

Descriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)

Last Observation Carried Forward (LOCF) imputation method applied.

Time frame: Week 48

Population: ITT LOCF

ArmMeasureValue (MEAN)Dispersion
FemaleDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)112 x10^6 cells/LStandard Error 8.8
MaleDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)103 x10^6 cells/LStandard Error 11.2
HispanicDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)109 x10^6 cells/LStandard Error 8.9
AsianDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)110 x10^6 cells/LStandard Error 20.4
OtherDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)109 x10^6 cells/LStandard Error 13.5
AsianDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)45 x10^6 cells/LStandard Error 24.5
OtherDescriptive Statistics of Change From Baseline in CD4+ Cell Count Using the Imputation Method of Last Observation Carried Forward (LOCF)138 x10^6 cells/LStandard Error 41
Secondary

Descriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF

The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR). The Last Observation Carried Forward (LOCF) imputation method was applied.

Time frame: Week 48

Population: Etravirine-TMC125 (ETR Subgroup) Intention to Treat population (ITT)

ArmMeasureValue (MEAN)Dispersion
FemaleDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF107 x10^6 Cells/LStandard Error 12.7
MaleDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF98 x10^6 Cells/LStandard Error 14
HispanicDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF113 x10^6 Cells/LStandard Error 12.1
AsianDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF84 x10^6 Cells/LStandard Error 21.7
OtherDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF90 x10^6 Cells/LStandard Error 22.6
AsianDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF45 x10^6 Cells/LStandard Error 24.5
OtherDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Count Using the Imputation Method of LOCF138 x10^6 Cells/LStandard Error 41
Secondary

Descriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values

The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR)

Time frame: Week 48

Population: Etravirine-TMC125 (ETR Subgroup) Intention to Treat population (ITT)

ArmMeasureValue (MEAN)Dispersion
FemaleDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values136 x10^6 cells/LStandard Error 15.8
MaleDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values108 x10^6 cells/LStandard Error 15.1
HispanicDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values135 x10^6 cells/LStandard Error 13.5
AsianDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values111 x10^6 cells/LStandard Error 26.7
OtherDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values98 x10^6 cells/LStandard Error 29.8
AsianDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values45 x10^6 cells/LStandard Error 24.5
OtherDescriptive Statistics of ETR Subgroup - Change From Baseline in CD4+ Cell Using Observed Values179 x10^6 cells/L
Secondary

Descriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA

The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR) TLOVR non-virologic failure(VF) censored. This imputation method differs from the TLOVR algorithm, because subjects that dropped out for reasons other than virologic failure were censored from the time of discontinuation onwards.

Time frame: Week 48

Population: Etravirine-TMC125 (ETR) Subgroup \[TLOVR Non-virologic Failure (VF) Censored\]

ArmMeasureValue (NUMBER)
FemaleDescriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA69 participants
MaleDescriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA54 participants
HispanicDescriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA74 participants
AsianDescriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA21 participants
OtherDescriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA25 participants
AsianDescriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA2 participants
OtherDescriptive Statistics of ETR Subgroup [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA1 participants
Secondary

Descriptive Statistics of [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA by Race

TLOVR non-virologic failure (VF) censored. This imputation method differs from the TLOVR algorithm, because subjects that dropped out for reasons other than virologic failure were censored from the time of discontinuation onwards.

Time frame: Week 48

Population: TLOVR Non-virologic Failure(VF) Censored

ArmMeasureValue (NUMBER)
FemaleDescriptive Statistics of [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA by Race128 participants
MaleDescriptive Statistics of [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA by Race39 participants
HispanicDescriptive Statistics of [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA by Race59 participants
AsianDescriptive Statistics of [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA by Race2 participants
OtherDescriptive Statistics of [TLOVR Non-virologic Failure (VF) Censored] - VL < 50 HIV-1 RNA by Race1 participants
Secondary

Number of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects

The Etravirine-TMC125 (ETR Subgroup population was defined as all ITT subjects who took at least 1 dose of ETR)

Time frame: Week 48

Population: ETR Subgroup- Intention to Treat population (ITT)

ArmMeasureValue (NUMBER)Dispersion
FemaleNumber of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects69 participants 0.088
MaleNumber of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects54 participants 0.131
HispanicNumber of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects74 participants 0.092
AsianNumber of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects21 participants 0.191
OtherNumber of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects25 participants 0.158
AsianNumber of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects2 participants 0.472
OtherNumber of Etravirine-TMC125 (ETR) Subgroup- VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects1 participants -1.73
Secondary

Number of VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects by Race

Intention to Treat population (ITT)

Time frame: Week 48

Population: ITT

ArmMeasureValue (NUMBER)
FemaleNumber of VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects by Race128 participants
MaleNumber of VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects by Race39 participants
HispanicNumber of VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects by Race59 participants
AsianNumber of VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects by Race2 participants
OtherNumber of VL < 50 HIV-1 RNA Copies/mL (TLOVR) Subjects by Race1 participants

Source: ClinicalTrials.gov · Data processed: Mar 30, 2026