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Relative Bioavailability of Two Different Batches of a Linagliptin / Metformin Combination Tablet in Healthy Volunteers

Relative Bioavailability of Two Different Batches of a 2.5 mg Linagliptin / 1000 mg Metformin Fixed Dose Combination Tablet (FDC) in Healthy Male and Female Volunteers (an Open-label, Randomised, Single Dose, Two-way Crossover, Phase I Trial)

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01216397
Enrollment
40
Registered
2010-10-07
Start date
2010-09-30
Completion date
Unknown
Last updated
2014-06-27

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

Conditions

Healthy

Brief summary

The objective of the current study is to investigate the relative bioavailability of two different batches of a 2.5 mg linagliptin / 1000 mg metformin fixed dose combination tablet (FDC).

Interventions

DRUGLinagliptin/Metformin (standard batch)

Fixed dose combination tablet

DRUGLinagliptin/Metformin (side batch)

Fixed dose combination tablet

Sponsors

Boehringer Ingelheim
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
21 Years to 50 Years
Healthy volunteers
Yes

Inclusion criteria

1. Healthy males and females according to the following criteria: Based upon a complete medical history, including physical examination, vital signs (blood pressure (BP), pulse rate (PR)), 12-lead electrocardiogram (ECG), clinical laboratory tests 2. Age 21 to 50 years (incl.) 3. Body Mass Index (BMI) 18.5 to 29.9 kg/m2 (incl.) 4. Signed and dated written informed consent prior to admission to the study in accordance with Good Clinical Practice (GCP) and the local legislation

Exclusion criteria

1. Any finding of the medical examination (including BP, PR and ECG) deviating from normal and of clinical relevance 2. Any evidence of a clinically relevant concomitant disease 3. Gastrointestinal, hepatic, renal, respiratory, cardiovascular, metabolic, immunological or hormonal disorders 4. Surgery of the gastrointestinal tract (except appendectomy) 5. Diseases of the central nervous system (such as epilepsy) or psychiatric disorders or neurological disorders 6. History of relevant orthostatic hypotension, fainting spells or blackouts 7. Chronic or relevant acute infections 8. History of relevant allergy or hypersensitivity (including allergy to drug or its excipients) 9. Intake of drugs within one month or less than 10 half-lives of the respective drug prior to first study drug administration 10. Participation in another trial with an investigational drug within 2 months prior to administration or during the trial 11. Smoker (more than 10 cigarettes or 3 cigars 3 pipes daily) 12. Alcohol abuse (average consumption of more than 20 g/day in females and 30 g/day in males) 13. Drug abuse 14. Blood donation (more than 100 mL within four weeks prior to day 1 of visit 2) 15. Any laboratory value outside the reference range that is of clinical relevance 16. Inability to comply with dietary regimen of trial site For female subjects of childbearing potential only: 17. Positive pregnancy test, pregnancy or planning to become pregnant 1 month before study or within 2 months after study completion 18. No adequate contraception 1 month before study and until 2 month after study completion, e.g. not any of the following: implants, injectables, combined hormonal contraceptives, hormonal IUD (intrauterine device), sexual abstinence for at least 1 month prior to first study drug administration, vasectomised partner (vasectomy performed at least 1 year prior to enrolment), or surgical sterilisation (including hysterectomy). Females, who do not have a vasectomised partner, are not sexually abstinent or surgically sterile will be asked to use an additional barrier method (e.g. condom). 19. Lactation

Design outcomes

Primary

MeasureTime frameDescription
Linagliptin: Maximum Measured Concentration (Cmax)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of Cmax of Linagliptin
Area Under the Concentration-time Curve of Linagliptin in Plasma Over the Time Interval 0 to 72 Hours (AUC0-72)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of AUC0-72 of Linagliptin
Metformin: CmaxDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric Mean of Cmax of Metformin
Metformin: AUC0-tzDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric Mean of AUC0-tz of Metformin

Secondary

MeasureTime frameDescription
t1/2 (Terminal Half-life of the Analyte in Plasma)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of the t1/2 of linagliptin
Linagliptin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of the MRTpo of linagliptin
Linagliptin: Apparent Clearance of the Analyte in Plasma After Extravascular Administration (CL/F)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of the CL/F of linagliptin
Linagliptin: Apparent Volume of Distribution During the Terminal Phase Following an Extravascular Dose (Vz/F)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of the Vz/F of linagliptin
Metformin: AUC0-infinityDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric Mean of AUC0-infinity of Metformin
Metformin: Percentage of AUCtz-∞ Obtained by ExtrapolationDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric Mean of the percentage of AUCtz-infinity of Metformin, where percentage is the unit of measurement.
Metformin: TmaxDay 1 to 35 for period 1, and Day 36 to 70 for period 2Median of tmax of metformin
Metformin: λz (Terminal Elimination Rate Constant in Plasma)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of λz of metformin
Linagliptin: AUC0-infinityDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of AUC0-infinity of Linagliptin
Metformin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of MRTpo of metformin
Metformin: CL/FDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of CL/F of metformin
Metformin: Vz/FDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of Vz/F of metformin
Electrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesDay 1 to 4 for period 1, and day 36 to 39 for period 212-lead-Electrocardiogram (ECG), vital sign (blood pressure and pulse rate), physical finding and laboratory abnormalities
Participants With Treatment Emergent Adverse EventsDay 1 to 4 for period 1, and day 36 to 39 for period 2Number of patients with treatment emergent AEs
Participants Who Discontinued the Trial Because of an Adverse EventDay 1 to 4 for period 1, and day 36 to 39 for period 2Number of participants who discontinued the trial because of an adverse event
Assessment of Tolerability by the InvestigatorDay 1 to 4 for period 1, and day 36 to 39 for period 2Qualitative variable assessing the tolerability by the investigator
Metformin: t1/2 (Terminal Half-life of the Analyte in Plasma)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of t1/2 of metformin
Linagliptin: Percentage of AUCtz-∞ Obtained by ExtrapolationDay 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric Mean of percentage of AUCtz-∞ of linagliptin, where percentage is the unit of measurement.
Linagliptin: Time to Maximum Measured Concentration of the Analyte in Plasma (Tmax)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Median of the t\_max of linagliptin
Linagliptin: λz (Terminal Elimination Rate Constant in Plasma)Day 1 to 35 for period 1, and Day 36 to 70 for period 2Geometric mean of the λ\_z of linagliptin

Countries

Germany

Participant flow

Pre-assignment details

This was an open-label, single-dose, randomised, 2-way crossover trial. Subjects were equally randomised to one of two sequences, and in general terms, AB or BA. Hence, 20 subjects were in group AB and 20 in group BA. All 40 subjects received A and B. The numbers presented in the milestones are overall, which is consistent with the trial report.

Participants by arm

ArmCount
All Participants
Treatment with standard batch and side batch
40
Total40

Baseline characteristics

CharacteristicAll Participants
Age, Continuous36.8 Years
STANDARD_DEVIATION 6.8
Body mass index23.74 kg/m^2
STANDARD_DEVIATION 2.74
Sex: Female, Male
Female
20 Participants
Sex: Female, Male
Male
20 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
7 / 4011 / 40
serious
Total, serious adverse events
0 / 400 / 40

Outcome results

Primary

Area Under the Concentration-time Curve of Linagliptin in Plasma Over the Time Interval 0 to 72 Hours (AUC0-72)

Geometric mean of AUC0-72 of Linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchArea Under the Concentration-time Curve of Linagliptin in Plasma Over the Time Interval 0 to 72 Hours (AUC0-72)179 nmol*hr/LGeometric Coefficient of Variation 21.6
Side BatchArea Under the Concentration-time Curve of Linagliptin in Plasma Over the Time Interval 0 to 72 Hours (AUC0-72)179 nmol*hr/LGeometric Coefficient of Variation 20.5
Comparison: Standard batch vs. Side batch90% CI: [96.1, 104.2]ANOVA
Primary

Linagliptin: Maximum Measured Concentration (Cmax)

Geometric mean of Cmax of Linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchLinagliptin: Maximum Measured Concentration (Cmax)5.36 nmol/LGeometric Coefficient of Variation 20.3
Side BatchLinagliptin: Maximum Measured Concentration (Cmax)5.39 nmol/LGeometric Coefficient of Variation 20.3
Comparison: Standard batch vs. Side batch90% CI: [94.2, 105]ANOVA
Primary

Metformin: AUC0-tz

Geometric Mean of AUC0-tz of Metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: AUC0-tz12100 ng*hr/mLGeometric Coefficient of Variation 21.4
Side BatchMetformin: AUC0-tz12100 ng*hr/mLGeometric Coefficient of Variation 19.4
90% CI: [95.7, 105.4]ANOVA
Primary

Metformin: Cmax

Geometric Mean of Cmax of Metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: Cmax1790 ng/mLGeometric Coefficient of Variation 23
Side BatchMetformin: Cmax1820 ng/mLGeometric Coefficient of Variation 25.5
Comparison: Standard batch vs. Side batch90% CI: [92.5, 103.7]ANOVA
Secondary

Assessment of Tolerability by the Investigator

Qualitative variable assessing the tolerability by the investigator

Time frame: Day 1 to 4 for period 1, and day 36 to 39 for period 2

Population: Treated Set

ArmMeasureGroupValue (NUMBER)
Standard BatchAssessment of Tolerability by the InvestigatorGood39 Participants
Standard BatchAssessment of Tolerability by the InvestigatorNot satisfactory1 Participants
Side BatchAssessment of Tolerability by the InvestigatorNot satisfactory0 Participants
Side BatchAssessment of Tolerability by the InvestigatorGood40 Participants
Secondary

Electrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding Abnormalities

12-lead-Electrocardiogram (ECG), vital sign (blood pressure and pulse rate), physical finding and laboratory abnormalities

Time frame: Day 1 to 4 for period 1, and day 36 to 39 for period 2

Population: Treated Set

ArmMeasureGroupValue (NUMBER)
Standard BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesPhysical examination abnormalities0 Participants
Standard BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesVital sign abnormalities0 Participants
Standard BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesECG abnormalities0 Participants
Standard BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesLaboratory finding abnormalities0 Participants
Side BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesLaboratory finding abnormalities0 Participants
Side BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesPhysical examination abnormalities0 Participants
Side BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesECG abnormalities0 Participants
Side BatchElectrocardiogram (ECG), Vital Signs, Physical Finding or Laboratory Finding AbnormalitiesVital sign abnormalities0 Participants
Secondary

Linagliptin: Apparent Clearance of the Analyte in Plasma After Extravascular Administration (CL/F)

Geometric mean of the CL/F of linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchLinagliptin: Apparent Clearance of the Analyte in Plasma After Extravascular Administration (CL/F)330 mL/minGeometric Coefficient of Variation 25.4
Side BatchLinagliptin: Apparent Clearance of the Analyte in Plasma After Extravascular Administration (CL/F)330 mL/minGeometric Coefficient of Variation 23.6
Secondary

Linagliptin: Apparent Volume of Distribution During the Terminal Phase Following an Extravascular Dose (Vz/F)

Geometric mean of the Vz/F of linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchLinagliptin: Apparent Volume of Distribution During the Terminal Phase Following an Extravascular Dose (Vz/F)1300 LiterGeometric Coefficient of Variation 22.8
Side BatchLinagliptin: Apparent Volume of Distribution During the Terminal Phase Following an Extravascular Dose (Vz/F)1300 LiterGeometric Coefficient of Variation 24.6
Secondary

Linagliptin: AUC0-infinity

Geometric mean of AUC0-infinity of Linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchLinagliptin: AUC0-infinity267 nmol*hr/LGeometric Coefficient of Variation 25.4
Side BatchLinagliptin: AUC0-infinity267 nmol*hr/LGeometric Coefficient of Variation 23.6
Comparison: Standard batch vs. Side batch90% CI: [94.7, 105.8]ANOVA
Secondary

Linagliptin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)

Geometric mean of the MRTpo of linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchLinagliptin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)64.6 hrGeometric Coefficient of Variation 15.7
Side BatchLinagliptin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)64.5 hrGeometric Coefficient of Variation 19.5
Secondary

Linagliptin: Percentage of AUCtz-∞ Obtained by Extrapolation

Geometric Mean of percentage of AUCtz-∞ of linagliptin, where percentage is the unit of measurement.

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchLinagliptin: Percentage of AUCtz-∞ Obtained by Extrapolation32.6 percentageGeometric Coefficient of Variation 17.5
Side BatchLinagliptin: Percentage of AUCtz-∞ Obtained by Extrapolation32.1 percentageGeometric Coefficient of Variation 20.3
Secondary

Linagliptin: Time to Maximum Measured Concentration of the Analyte in Plasma (Tmax)

Median of the t\_max of linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (MEDIAN)
Standard BatchLinagliptin: Time to Maximum Measured Concentration of the Analyte in Plasma (Tmax)3.00 hr
Side BatchLinagliptin: Time to Maximum Measured Concentration of the Analyte in Plasma (Tmax)3.00 hr
Secondary

Linagliptin: λz (Terminal Elimination Rate Constant in Plasma)

Geometric mean of the λ\_z of linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchLinagliptin: λz (Terminal Elimination Rate Constant in Plasma)0.0153 1/hrGeometric Coefficient of Variation 17.1
Side BatchLinagliptin: λz (Terminal Elimination Rate Constant in Plasma)0.0152 1/hrGeometric Coefficient of Variation 21.6
Secondary

Metformin: AUC0-infinity

Geometric Mean of AUC0-infinity of Metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: AUC0-infinity12400 ng*h/mLGeometric Coefficient of Variation 21.2
Side BatchMetformin: AUC0-infinity12300 ng*h/mLGeometric Coefficient of Variation 19.9
Comparison: Standard batch vs. Side batch90% CI: [95.7, 105.2]ANOVA
Secondary

Metformin: CL/F

Geometric mean of CL/F of metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: CL/F1350 mL/minGeometric Coefficient of Variation 21.2
Side BatchMetformin: CL/F1350 mL/minGeometric Coefficient of Variation 19.9
Secondary

Metformin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)

Geometric mean of MRTpo of metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)8.27 hrGeometric Coefficient of Variation 31.1
Side BatchMetformin: MRTpo (Mean Residence Time of the Analyte in the Body After Peroral Administration)8.23 hrGeometric Coefficient of Variation 36.9
Secondary

Metformin: Percentage of AUCtz-∞ Obtained by Extrapolation

Geometric Mean of the percentage of AUCtz-infinity of Metformin, where percentage is the unit of measurement.

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: Percentage of AUCtz-∞ Obtained by Extrapolation1.51 percentageGeometric Coefficient of Variation 87.4
Side BatchMetformin: Percentage of AUCtz-∞ Obtained by Extrapolation1.52 percentageGeometric Coefficient of Variation 97
Secondary

Metformin: t1/2 (Terminal Half-life of the Analyte in Plasma)

Geometric mean of t1/2 of metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: t1/2 (Terminal Half-life of the Analyte in Plasma)14.1 hrGeometric Coefficient of Variation 71
Side BatchMetformin: t1/2 (Terminal Half-life of the Analyte in Plasma)13.5 hrGeometric Coefficient of Variation 84.3
Secondary

Metformin: Tmax

Median of tmax of metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (MEDIAN)
Standard BatchMetformin: Tmax1.99 hr
Side BatchMetformin: Tmax2.00 hr
Secondary

Metformin: Vz/F

Geometric mean of Vz/F of metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: Vz/F1640 LiterGeometric Coefficient of Variation 74.3
Side BatchMetformin: Vz/F1580 LiterGeometric Coefficient of Variation 82.4
Secondary

Metformin: λz (Terminal Elimination Rate Constant in Plasma)

Geometric mean of λz of metformin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard BatchMetformin: λz (Terminal Elimination Rate Constant in Plasma)0.0493 1/hrGeometric Coefficient of Variation 71
Side BatchMetformin: λz (Terminal Elimination Rate Constant in Plasma)0.0514 1/hrGeometric Coefficient of Variation 84.3
Secondary

Participants Who Discontinued the Trial Because of an Adverse Event

Number of participants who discontinued the trial because of an adverse event

Time frame: Day 1 to 4 for period 1, and day 36 to 39 for period 2

Population: Treated Set

ArmMeasureValue (NUMBER)
Standard BatchParticipants Who Discontinued the Trial Because of an Adverse Event0 Participants
Side BatchParticipants Who Discontinued the Trial Because of an Adverse Event0 Participants
Secondary

Participants With Treatment Emergent Adverse Events

Number of patients with treatment emergent AEs

Time frame: Day 1 to 4 for period 1, and day 36 to 39 for period 2

Population: Treated Set

ArmMeasureGroupValue (NUMBER)
Standard BatchParticipants With Treatment Emergent Adverse EventsHeadache6 Participants
Standard BatchParticipants With Treatment Emergent Adverse EventsNausea0 Participants
Standard BatchParticipants With Treatment Emergent Adverse EventsVomiting2 Participants
Standard BatchParticipants With Treatment Emergent Adverse EventsFatigue1 Participants
Side BatchParticipants With Treatment Emergent Adverse EventsFatigue0 Participants
Side BatchParticipants With Treatment Emergent Adverse EventsHeadache9 Participants
Side BatchParticipants With Treatment Emergent Adverse EventsVomiting1 Participants
Side BatchParticipants With Treatment Emergent Adverse EventsNausea1 Participants
Secondary

t1/2 (Terminal Half-life of the Analyte in Plasma)

Geometric mean of the t1/2 of linagliptin

Time frame: Day 1 to 35 for period 1, and Day 36 to 70 for period 2

Population: Treated Set

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Standard Batcht1/2 (Terminal Half-life of the Analyte in Plasma)45.4 hrGeometric Coefficient of Variation 17.1
Side Batcht1/2 (Terminal Half-life of the Analyte in Plasma)45.6 hrGeometric Coefficient of Variation 21.6

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026