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Compare the Effect on Cognitive Functioning of Two Formulations of Seroquel, Seroquel XR and IR in Patients With Stable Schizophrenia

A Phase IV Prospective, Double-blind, Double-dummy, Randomised, Crossover Study to Assess the Impact on Daily Cognitive Functioning of Quetiapine Fumarate Immediate Release (Seroquel IR®) Dosed Twice Daily and Quetiapine Fumarate Extended Release (Seroquel XR®) Dosed Once Daily in the Evening in Patients With Stable Schizophrenia

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01213836
Acronym
eXtRa
Enrollment
75
Registered
2010-10-04
Start date
2010-11-30
Completion date
2011-08-31
Last updated
2012-07-27

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

Conditions

Schizophrenia

Keywords

Stable schizophrenia, cognitive functioning

Brief summary

This will be a phase IV 20 -32 day prospective, double blind, double-dummy, randomised crossover study that will evaluate the effect of quetiapine XR and quetiapine IR on cognitive performance in patients with schizophrenia stabilized on a single antipsychotic medication.

Interventions

DRUGSeroquel XR- quetiapine fumarate extended release

Seroquel XR dose 400-700 mg (in tablet form). The investigator established the dosing schedule for each patient depending on the patient's dose when entering the study. The patients continued on the same dose during the study as they had prior to enrolment. Dose taken once a day for 10-16 days.

DRUGSeroquel IR - quetiapine fumarate

Seroquel IR dose 400-700 mg (in tablet form). The investigator established the dosing schedule for each patient depending on the patient's dose when entering the study. The patients continued on the same dose during the study as they had prior to enrolment. Dose taken twice a day for 10-16 days.

DRUGPlacebo matching Seroquel XR

Placebo matching Seroquel XR dose 400-700 mg (in tablet form). Dose taken once a day for 10-16 days.

DRUGPlacebo matching Seroquel IR

Placebo matching Seroquel IR dose 400-700 mg (in tablet form). Dose taken twice a day for 10-16 days.

Sponsors

AstraZeneca
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No

Inclusion criteria

* Provision of written informed consent prior to any study specific procedures * Documented clinical diagnosis of schizophrenia, paranoid type, for at least 2 years before randomisation meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV, American Psychiatric Association 2000) criteria of schizophrenia (DSM-IV codes 295.3) confirmed by MINI version 5.0 * Outpatient status at enrolment * Dose of quetiapine IR or quetiapine XR unchanged during the last 56 days before randomisation

Exclusion criteria

* Diagnosis of any DSM-IV Axis I disorder other than those included in inclusion criteria above within 6 months before randomisation (e.g., alcohol dependence or psychoactive substance dependence not in full remission, concurrent organic mental disorder, or mental retardation \[axis II diagnosis\]) of a degree that may interfere with the patient's ability to co-operate. * Previous stable use of high dosage of benzodiazepines during one year or more * Significant neurological medical history (complicated head trauma as judged by the investigator, epilepsy, meningo-encephalitis) * Use of the following medication: * other antipsychotic drug than quetiapine within 28 days prior to randomisation * a depot antipsychotic injection within two dosing intervals (for the depot) before randomisation (Visit 2) * other psychoactive drugs within 14 days prior to randomisation (hypnotic or anxiolytic drugs, other than those allowed) * Use of concomitant therapy likely to affect cognition, Medication prohibited 28 days prior to randomisation: benzodiazepines, amphetamines, reboxitin, atomoxinetine, buspiron, donepezil, duloxetine, galantamine, ginko biloba, memantine, methylphenidate, modafinil, rivastigmine, tacrine, smoking cessation therapy varencicline and any dosage form of nicotine replacement therapy. Medication prohibited 14 days prior to randomisation: irreversible monoamine oxidase inhibitors (MAOI), tricyclic antidepressants (TCA), biperiden, antoicholinergic agents (even if the indications are extra pyramidal symptoms or urinary symptoms)

Design outcomes

Primary

MeasureTime frameDescription
Mean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)Period 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.Attentional standardised composite score: Standardised speed of performance score. Higher Score=better performance. Score range minus infinity to plus infinity. Measured at baseline (before study drug administration) and in Period 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. (Last test day not earlier than after 10 days of randomised)and in Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Last test day not earlier than after 10 days of crossover treatment.

Secondary

MeasureTime frameDescription
Mean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingPeriod 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.International Shopping List Task (ISLT): measures reasoning and problem solving. Min=minus infinity, max=plus infinity, higher score=better performance. Groton Maze Learning Test (GMLT): measures reasoning and problem solving. Min=minus infinity, max=plus infinity, lower score=better performance. Lower=better performance. One Back memory task (ONB: measures working memory, min=minus infinity, max=plus infinity, lower score=better performance.
Mean Overall Sedation as Measured by the Modified Bond-Lader Visual Analogue Scale (VAS) When Administered According to LabelPeriod 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.The modified Bond-Lader VAS: The degree of sedation was marked by the patient on a 100 mm VAS ranging between Alert (=0 mm) and Drowsy (=100 mm). The marked length in millimetres. There are 3 assessments made in each period (post 1, 2 and 3 for each period). That is three measurements per patient per treatment. The mean is an overall mean of all the recordings in all patients, one mean value per treatment group.
Mean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Before taking study drug, end of Period 1 and end of Period 2TSQM is a 14-item questionnaire with 4 sub-scales: effectiveness of the medication; treatment side effects; convenience of the medication; global satisfaction with the medication. Scale range 0-100 for each sub-scale, higher=greater satisfaction/milder side effects/greater convenience/greater overall satisfaction. There are 2 measurement, (after the start of taking study drug) one at end of period 1 and one at end of period 2. That is one measurement per patient per treatment. The mean of all the patients is presented, one mean value per treatment group.
Number of Dropouts.Period 1 and Period 2The number of patients who dropped out was counted.
Mean Ratio of Morning Plasma Concentration of Quetiapine and Nor-quetiapine for Quetiapine IR and Quetiapine XR, at Steady-state Conditions in the End of Each Treatment Period 1 and 2.End of Period 1, end of Period 2The ratio was derived as individual plasma concentration of quetiapine divided by the plasma concentration of nor-quetiapine. The mean ratio was derived for each treatment, XR and IR, respectively.
Mean Overall Sedation as Measured by the Stanford Sleepiness Scale When Administered According to LabelPeriod 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.Stanford Sleepiness Scale: The sleepiness was assessed by the patient on a 7 item rating scale ranging from 1 (Feeling active and vital) to 7 (Almost in reverie). There are 3 assessments made in each period (post 1, 2 and 3 for each period). That is three measurements per patient per treatment. The mean is an overall mean of all the recordings in all patients, one mean value per treatment group.

Countries

Austria, Denmark, Germany, Italy, Spain

Participant flow

Recruitment details

Patients were recruited at 20 study centres in 5 countries: Austria (1 site), Denmark (1 site), Germany (6 sites), Italy (9 sites) and Spain (3 sites). Recruitment started 2 November 2010 and was completed 29 June 2011. The last patient completed the study on 3 August 2011.

Pre-assignment details

Screening (0 days to 14 days before enrolment), enrolment at Visit 1 (14 days to 3 days prior to randomisation), randomisation at Visit 2 after confirmation of eligibility. 75 patients were screened/enrolled. Of these, 9 were not randomised; 2 patients due to own decision to discontinue and 7 patients due to eligibility criteria not fulfilled.

Participants by arm

ArmCount
First Seroquel XR Then Seroquel IR
Patients randomised to Seroquel XR will have treatment for 10-16 days and after that cross-over to treatment with Seroquel IR for 10-16 days
34
First Seroquel IR Then Seroquel XR
Patients randomised to Seroquel IR will have treatment for 10-16 days and after that cross-over to treatment with Seroquel XR for 10-16 days
32
Total66

Withdrawals & dropouts

PeriodReasonFG000FG001
Period 1, First InterventionAdverse Event21
Period 1, First InterventionProtocol Violation01
Period 1, First InterventionWithdrawal by Subject11

Baseline characteristics

CharacteristicTotalFirst Seroquel IR Then Seroquel XRFirst Seroquel XR Then Seroquel IR
Age Continuous
>50 years
2 participants0 participants2 participants
Age Continuous
between 18 and 29 years
9 participants3 participants6 participants
Age Continuous
Between 30 and 50 years
54 participants28 participants26 participants
Age Continuous37.8 years
STANDARD_DEVIATION 6.9
37.0 years
STANDARD_DEVIATION 5.2
38.6 years
STANDARD_DEVIATION 8.2
Gender
Female
20 participants9 participants11 participants
Gender
Male
45 participants22 participants23 participants
Region of Enrollment
Austria
3 participants2 participants1 participants
Region of Enrollment
Denmark
2 participants1 participants1 participants
Region of Enrollment
Germany
28 participants10 participants18 participants
Region of Enrollment
Italy
31 participants18 participants13 participants
Region of Enrollment
Spain
2 participants1 participants1 participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
4 / 634 / 62
serious
Total, serious adverse events
0 / 630 / 62

Outcome results

Primary

Mean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)

Attentional standardised composite score: Standardised speed of performance score. Higher Score=better performance. Score range minus infinity to plus infinity. Measured at baseline (before study drug administration) and in Period 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. (Last test day not earlier than after 10 days of randomised)and in Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Last test day not earlier than after 10 days of crossover treatment.

Time frame: Period 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.

Population: The per protocol set (PPS) is a subset of the FAS consisting of patients who fulfilled all inclusion criteria but none of the exclusion criteria, complied with study medication dosing scheme, did not violate any of the study restrictions and completed the study without protocol violation.

ArmMeasureGroupValue (MEAN)Dispersion
Seroquel XRMean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)Post 10.002 standardised unitsStandard Deviation 0.856
Seroquel XRMean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)Post 2-0.201 standardised unitsStandard Deviation 1.054
Seroquel XRMean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)Post 3-0.194 standardised unitsStandard Deviation 1.04
Seroquel IRMean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)Post 1-0.098 standardised unitsStandard Deviation 0.983
Seroquel IRMean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)Post 2-0.131 standardised unitsStandard Deviation 1.053
Seroquel IRMean for Attentional Standardised Composite Score Based on Performance Scores From the CogState Test Battery Domains Detection (Speed of Processing)and Identification (Attention/Vigilance)Post 3-0.120 standardised unitsStandard Deviation 1.1
Secondary

Mean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem Solving

International Shopping List Task (ISLT): measures reasoning and problem solving. Min=minus infinity, max=plus infinity, higher score=better performance. Groton Maze Learning Test (GMLT): measures reasoning and problem solving. Min=minus infinity, max=plus infinity, lower score=better performance. Lower=better performance. One Back memory task (ONB: measures working memory, min=minus infinity, max=plus infinity, lower score=better performance.

Time frame: Period 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.

Population: Per Protocol (PPS), subset of the FAS consisting of patients who fulfilled all of inclusion but none of exclusion criteria, complied with study medication dosing, did not violate any of the restrictions and completed the study without protocol violation.

ArmMeasureGroupValue (MEAN)Dispersion
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingISLT post 223.551 Units on a scaleStandard Deviation 4.899
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingGMLT post 357.229 Units on a scaleStandard Deviation 24.162
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingGMLT post 164.180 Units on a scaleStandard Deviation 29.822
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingONB post 12.875 Units on a scaleStandard Deviation 0.143
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingISLT post 323.216 Units on a scaleStandard Deviation 5.36
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingONB post 22.896 Units on a scaleStandard Deviation 0.151
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingGMLT post 259.021 Units on a scaleStandard Deviation 21.257
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingONB post 32.894 Units on a scaleStandard Deviation 0.161
Seroquel XRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingISLT post 124.020 Units on a scaleStandard Deviation 5.746
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingONB post 32.893 Units on a scaleStandard Deviation 0.154
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingISLT post 123.588 Units on a scaleStandard Deviation 5.787
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingISLT post 223.152 Units on a scaleStandard Deviation 5.562
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingISLT post 322.920 Units on a scaleStandard Deviation 4.944
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingGMLT post 161.040 Units on a scaleStandard Deviation 28.721
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingGMLT post 256.956 Units on a scaleStandard Deviation 21.798
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingGMLT post 357.300 Units on a scaleStandard Deviation 22.307
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingONB post 12.897 Units on a scaleStandard Deviation 0.134
Seroquel IRMean Daytime Cognitive Performance Using CogState: - Working Memory - Verbal Learning) -Reasoning and Problem SolvingONB post 22.896 Units on a scaleStandard Deviation 0.169
Secondary

Mean Overall Sedation as Measured by the Modified Bond-Lader Visual Analogue Scale (VAS) When Administered According to Label

The modified Bond-Lader VAS: The degree of sedation was marked by the patient on a 100 mm VAS ranging between Alert (=0 mm) and Drowsy (=100 mm). The marked length in millimetres. There are 3 assessments made in each period (post 1, 2 and 3 for each period). That is three measurements per patient per treatment. The mean is an overall mean of all the recordings in all patients, one mean value per treatment group.

Time frame: Period 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.

Population: The full analysis set (FAS) used for analysis of efficacy included all patients who, in both study periods, received at least one dose of investigational product and for whom post-dose efficacy data are available in both periods.

ArmMeasureValue (MEAN)Dispersion
Seroquel XRMean Overall Sedation as Measured by the Modified Bond-Lader Visual Analogue Scale (VAS) When Administered According to Label23.5 units on a scaleStandard Deviation 19
Seroquel IRMean Overall Sedation as Measured by the Modified Bond-Lader Visual Analogue Scale (VAS) When Administered According to Label28.6 units on a scaleStandard Deviation 21.4
Secondary

Mean Overall Sedation as Measured by the Stanford Sleepiness Scale When Administered According to Label

Stanford Sleepiness Scale: The sleepiness was assessed by the patient on a 7 item rating scale ranging from 1 (Feeling active and vital) to 7 (Almost in reverie). There are 3 assessments made in each period (post 1, 2 and 3 for each period). That is three measurements per patient per treatment. The mean is an overall mean of all the recordings in all patients, one mean value per treatment group.

Time frame: Period 1 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period. Period 2 at 3 visits,(post 1),(post 2),(post 3), in a 5-day (maximum 8 day) period.

Population: The full analysis set (FAS) used for analysis of efficacy included all patients who, in both study periods, received at least one dose of investigational product and for whom post-dose efficacy data are available in both periods.

ArmMeasureValue (MEAN)Dispersion
Seroquel XRMean Overall Sedation as Measured by the Stanford Sleepiness Scale When Administered According to Label2.4 units on a scaleStandard Deviation 0.9
Seroquel IRMean Overall Sedation as Measured by the Stanford Sleepiness Scale When Administered According to Label2.6 units on a scaleStandard Deviation 1
Secondary

Mean Ratio of Morning Plasma Concentration of Quetiapine and Nor-quetiapine for Quetiapine IR and Quetiapine XR, at Steady-state Conditions in the End of Each Treatment Period 1 and 2.

The ratio was derived as individual plasma concentration of quetiapine divided by the plasma concentration of nor-quetiapine. The mean ratio was derived for each treatment, XR and IR, respectively.

Time frame: End of Period 1, end of Period 2

Population: 21 patients for the FAS were analysed. This outcome measure was introduced as a protocol amendment after study start and plasma concentration was not measured in all patients. FAS is all patients who, in both study periods, received at least one dose of investigational product and for whom post-dose efficacy data are available in both periods.

ArmMeasureValue (MEAN)Dispersion
Seroquel XRMean Ratio of Morning Plasma Concentration of Quetiapine and Nor-quetiapine for Quetiapine IR and Quetiapine XR, at Steady-state Conditions in the End of Each Treatment Period 1 and 2.1.941 RatioStandard Deviation 1.504
Seroquel IRMean Ratio of Morning Plasma Concentration of Quetiapine and Nor-quetiapine for Quetiapine IR and Quetiapine XR, at Steady-state Conditions in the End of Each Treatment Period 1 and 2.2.128 RatioStandard Deviation 2.369
Secondary

Mean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)

TSQM is a 14-item questionnaire with 4 sub-scales: effectiveness of the medication; treatment side effects; convenience of the medication; global satisfaction with the medication. Scale range 0-100 for each sub-scale, higher=greater satisfaction/milder side effects/greater convenience/greater overall satisfaction. There are 2 measurement, (after the start of taking study drug) one at end of period 1 and one at end of period 2. That is one measurement per patient per treatment. The mean of all the patients is presented, one mean value per treatment group.

Time frame: Before taking study drug, end of Period 1 and end of Period 2

Population: Full Analysis Set (FAS)used for efficacy analysis included all patients who in both study periods, received at least 1 dose of investigational product and for whom post-dose efficacy data was available.

ArmMeasureGroupValue (MEAN)Dispersion
Seroquel XRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Side Effects87.9 units on a scaleStandard Deviation 20.5
Seroquel XRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Effectiveness65.4 units on a scaleStandard Deviation 16.8
Seroquel XRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Convenience66.2 units on a scaleStandard Deviation 19.3
Seroquel XRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Overall Satisfaction63.0 units on a scaleStandard Deviation 19.7
Seroquel IRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Overall Satisfaction58.9 units on a scaleStandard Deviation 21.1
Seroquel IRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Side Effects81.5 units on a scaleStandard Deviation 27.5
Seroquel IRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Convenience63.6 units on a scaleStandard Deviation 19.7
Seroquel IRMean Treatment Satisfaction for Treatment Satisfaction Questionnaire of Medication (TSQM)Effectiveness62.2 units on a scaleStandard Deviation 19.1
Secondary

Number of Dropouts.

The number of patients who dropped out was counted.

Time frame: Period 1 and Period 2

Population: The Safety analysis set was used, that is all patients who received at least one dose of study medication and for whom any post-dose safety data are available were included in the safety set.

ArmMeasureGroupValue (NUMBER)
Seroquel XRNumber of Dropouts.Period 13 participants
Seroquel XRNumber of Dropouts.Period 20 participants
Seroquel IRNumber of Dropouts.Period 12 participants
Seroquel IRNumber of Dropouts.Period 20 participants

Source: ClinicalTrials.gov · Data processed: Mar 18, 2026