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Safety and Tolerability Study of V501 in Japanese Boys (V501-200)

A Phase III, Open-Label, Clinical Trial to Study the Safety and Immunogenicity of the Quadrivalent HPV (Types 6, 11, 16, 18) L1 VLP Particle (VLP) Vaccine in 9- to 15-Year-Old Japanese Boys

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02576054
Enrollment
101
Registered
2015-10-15
Start date
2015-11-20
Completion date
2018-08-08
Last updated
2019-11-25

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

Conditions

Anogenital Human Papilloma Virus Infection, Condyloma Acuminata

Brief summary

This is a study of V501 \[quadrivalent Human Papillomavirus (HPV) (Type 6, 11, 16 and 18) L1 virus-like particle (VLP) vaccine\] in healthy Japanese boys. This study will consist of two periods. Period I of the study is to evaluate the immunogenicity and tolerability of V501 up to Month 7. Period II of the study is to evaluate the long-term immunogenicity and safety from Month 7 to Month 30. Two analyses are planned. The first analysis will be conducted when all subjects have completed their Month 7 visit or have been discontinued before that time. The second analysis will be conducted at the end of study. The primary hypothesis tested in this study is that seroconversion rates for the vaccine HPV types will be \>90% at 4 weeks postdose 3.

Interventions

BIOLOGICALV501

Quadrivalent HPV \[Type 6, 11, 16 and 18\] L1 VLP vaccine), 0.5 mL intramuscular injection on Day 1, Month 2, and Month 6

Sponsors

Merck Sharp & Dohme LLC
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE

Eligibility

Sex/Gender
MALE
Age
9 Years to 15 Years
Healthy volunteers
Yes

Inclusion criteria

* Healthy Japanese male * Have a legal representative who provides written informed consent for the trial on the participant's behalf * Have a legal representative who is able to read, understand, and complete the vaccine report card * Has not yet had coitarche and does not plan on becoming sexually active from Day 1 through Month 7 of the study * Other inclusion criteria will be discussed with the investigator during screening

Exclusion criteria

* Currently enrolled in clinical studies of investigational agents * History of known prior vaccination with an HPV vaccine or plans to receive one outside the study * History of severe allergic reaction that required medical intervention * Allergic to any vaccine component, including aluminum, yeast, or BENZONASE™ * Received immune globulin or blood-derived products in the past 6 months or plans to receive any before Month 7 of the study * History of splenectomy, is currently immunocompromised, or has been diagnosed with immunodeficiency, Human Immunodeficiency Virus (HIV) infection, lymphoma, leukemia, systemic lupus erythematosus, rheumatoid arthritis, juvenile rheumatoid arthritis, inflammatory bowel disease, or other autoimmune condition * Received immunosuppressive therapy in the past year, excluding inhaled, nasal, or topical corticosteroids * Known thrombocytopenia or coagulation disorder that would contraindicate intramuscular injections * Ongoing alcohol or drug abuse within the past 12 months * History of genital warts or a positive test for HPV

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants With a Vaccine-related Serious Adverse EventUp to 30 monthsAn AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the sponsor's product, whether or not considered related to the use of the product. A serious adverse event (SAE) is an AE that results in death, is life threatening, results in a persistent or significant disability or incapacity, results in or prolongs an existing hospitalization, is a congenital anomaly or birth defect, is a cancer, is an overdose, or is another important medical event. The percentage of participants that experienced 1 or more SAEs that were considered at least possibly related to the study vaccine was summarized.
Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18Four weeks postdose 3 (Month 7)Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay 4 weeks after 3rd vaccination (Month 7). Antibody titers were expressed as milli Merck units/mL (mMU/mL). Seroconversion was defined as an anti-HPV 6 titer ≥20 mMU/mL, an anti-HPV 11 titer ≥16 mMU/mL, an anti-HPV 16 titer of ≥20 mMU/mL and an anti-HPV 18 titer of ≥24 mMU/mL.
Percentage of Participants With Elevated Oral Temperature (>=37.5° C)Up to Day 5 after any vaccinationThe parent/guardian of the participant was to record the participant's oral temperature in the evening after each study vaccination and daily for 4 days after each study vaccination. Elevated temperature was defined as ≥99.5°F (≥37.5ºC). The percentage of participants that had an elevated temperature was summarized.
Percentage of Participants With an Injection-site Adverse EventUp to Day 5 after any vaccinationAn adverse event (AE) is defined as any untoward medical occurrence in a participant which does not necessarily have a causal relationship with study drug. An AE can therefore be any unfavourable and unintended sign, symptom, or disease temporally associated with the use of study drug or a protocol-specified procedure, whether or not considered related to the study drug or protocol-specified procedure. Any worsening of a preexisting condition that is temporally associated with the study drug or protocol-specified procedure is also an AE. The parent/guardian of the participant was to record the presence of any vaccination report card (VRC)-prompted injection-site AEs that occurred in the 5 days after any vaccination. The percentage of participants with an injection-site AE prompted on the VRC (erythema, pain, and swelling) was summarized.
Percentage of Participants With a Systemic Adverse EventUp to Day 15 after any vaccinationAn adverse event (AE) is defined as any untoward medical occurrence in a participant which does not necessarily have a causal relationship with study drug. An AE can therefore be any unfavourable and unintended sign, symptom, or disease temporally associated with the use of study drug or a protocol-specified procedure, whether or not considered related to the study drug or protocol-specified procedure. Any worsening of a preexisting condition that is temporally associated with the study drug or protocol-specified procedure is also an AE. The parent/guardian of the participant was to record the presence of any VRC-prompted systemic AEs that occurred in the 5 days after any vaccination. The percentage of participants with a systemic AE was summarized.
Percentage of Participants With a Serious Adverse EventUp to Day 15 after any vaccinationAn AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the sponsor's product, whether or not considered related to the use of the product. A serious adverse event (SAE) is an AE that results in death, is life threatening, results in a persistent or significant disability or incapacity, results in or prolongs an existing hospitalization, is a congenital anomaly or birth defect, is a cancer, is an overdose, or is another important medical event. The percentage of participants that experienced 1 or more SAEs was summarized.

Secondary

MeasureTime frameDescription
Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 18 Months12 months postdose 3 (18 months)Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay. Antibody titers were expressed as mMU/mL.
Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 30 Months24 months postdose 3 (30 months)Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay. Antibody titers were expressed as mMU/mL.
Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 18 Months12 months postdose 3 (18 months)Serum antibodies to HPV types were measured with a competitive luminex immunoassay. The serostatus cutoffs (mMU/mL) for HPV types were as follows: HPV Type 6: ≥20; HPV Type 11: ≥16; HPV Type 16: ≥20; HPV Type 18: ≥24
Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 30 Months24 months postdose 3 (30 months)Serum antibodies to HPV types were measured with a competitive luminex immunoassay. The serostatus cutoffs (mMU/mL) for HPV types were as follows: HPV Type 6: ≥20; HPV Type 11: ≥16; HPV Type 16: ≥20; HPV Type 18: ≥24.
Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsFour weeks postdose 3 (Month 7)Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay. Antibody titers were expressed mMU/mL. GMTs obtained for each anti-HPV from this study were compared to each of the ant-HPV GMTs obtained in study V501-122 (NCT NCT01862874) in which Japanese males 16 to 26 years received V501 in the same 3 dose regimen, to test a hypothesis that would demonstrate non-inferiority.

Countries

Japan

Participant flow

Participants by arm

ArmCount
V501
0.5 mL intramuscular injection on Day 1, Month 2, and Month 6
101
Total101

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyWithdrawal by Subject1

Baseline characteristics

CharacteristicV501
Age, Continuous12.2 years
STANDARD_DEVIATION 2
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
101 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
101 Participants
Race (NIH/OMB)
Black or African American
0 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
White
0 Participants
Sex: Female, Male
Female
0 Participants
Sex: Female, Male
Male
101 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 100
other
Total, other adverse events
67 / 100
serious
Total, serious adverse events
0 / 100

Outcome results

Primary

Percentage of Participants With an Injection-site Adverse Event

An adverse event (AE) is defined as any untoward medical occurrence in a participant which does not necessarily have a causal relationship with study drug. An AE can therefore be any unfavourable and unintended sign, symptom, or disease temporally associated with the use of study drug or a protocol-specified procedure, whether or not considered related to the study drug or protocol-specified procedure. Any worsening of a preexisting condition that is temporally associated with the study drug or protocol-specified procedure is also an AE. The parent/guardian of the participant was to record the presence of any vaccination report card (VRC)-prompted injection-site AEs that occurred in the 5 days after any vaccination. The percentage of participants with an injection-site AE prompted on the VRC (erythema, pain, and swelling) was summarized.

Time frame: Up to Day 5 after any vaccination

Population: All participants who received at least 1 study vaccination and had follow-up safety data.

ArmMeasureValue (NUMBER)
V501Percentage of Participants With an Injection-site Adverse Event64.0 Percentage of Participants
Primary

Percentage of Participants With a Serious Adverse Event

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the sponsor's product, whether or not considered related to the use of the product. A serious adverse event (SAE) is an AE that results in death, is life threatening, results in a persistent or significant disability or incapacity, results in or prolongs an existing hospitalization, is a congenital anomaly or birth defect, is a cancer, is an overdose, or is another important medical event. The percentage of participants that experienced 1 or more SAEs was summarized.

Time frame: Up to Day 15 after any vaccination

Population: All participants who received at least 1 study vaccination and had follow-up safety data.

ArmMeasureValue (NUMBER)
V501Percentage of Participants With a Serious Adverse Event0.0 Percentage of Participants
Primary

Percentage of Participants With a Systemic Adverse Event

An adverse event (AE) is defined as any untoward medical occurrence in a participant which does not necessarily have a causal relationship with study drug. An AE can therefore be any unfavourable and unintended sign, symptom, or disease temporally associated with the use of study drug or a protocol-specified procedure, whether or not considered related to the study drug or protocol-specified procedure. Any worsening of a preexisting condition that is temporally associated with the study drug or protocol-specified procedure is also an AE. The parent/guardian of the participant was to record the presence of any VRC-prompted systemic AEs that occurred in the 5 days after any vaccination. The percentage of participants with a systemic AE was summarized.

Time frame: Up to Day 15 after any vaccination

Population: All participants who received at least 1 study vaccination and had follow-up safety data.

ArmMeasureValue (NUMBER)
V501Percentage of Participants With a Systemic Adverse Event21.0 Percentage of Participants
Primary

Percentage of Participants With a Vaccine-related Serious Adverse Event

An AE is defined as any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the sponsor's product, whether or not considered related to the use of the product. A serious adverse event (SAE) is an AE that results in death, is life threatening, results in a persistent or significant disability or incapacity, results in or prolongs an existing hospitalization, is a congenital anomaly or birth defect, is a cancer, is an overdose, or is another important medical event. The percentage of participants that experienced 1 or more SAEs that were considered at least possibly related to the study vaccine was summarized.

Time frame: Up to 30 months

Population: All participants who received at least 1 study vaccination and had follow-up safety data.

ArmMeasureValue (NUMBER)
V501Percentage of Participants With a Vaccine-related Serious Adverse Event0.0 Percentage of Participants
Primary

Percentage of Participants With Elevated Oral Temperature (>=37.5° C)

The parent/guardian of the participant was to record the participant's oral temperature in the evening after each study vaccination and daily for 4 days after each study vaccination. Elevated temperature was defined as ≥99.5°F (≥37.5ºC). The percentage of participants that had an elevated temperature was summarized.

Time frame: Up to Day 5 after any vaccination

Population: All participants who received at least 1 study vaccination and had follow-up safety data.

ArmMeasureGroupValue (NUMBER)
V501Percentage of Participants With Elevated Oral Temperature (>=37.5° C)≥ 37.5 °C (99.5 °F) and < 38.0 °C (100.4 °F)3.0 Percentage of Participants
V501Percentage of Participants With Elevated Oral Temperature (>=37.5° C)≥ 38.0 °C (100.4 °F) and < 38.5 °C (101.3 °F)1.0 Percentage of Participants
V501Percentage of Participants With Elevated Oral Temperature (>=37.5° C)≥ 38.5 °C (101.3 °F)2.0 Percentage of Participants
Primary

Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18

Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay 4 weeks after 3rd vaccination (Month 7). Antibody titers were expressed as milli Merck units/mL (mMU/mL). Seroconversion was defined as an anti-HPV 6 titer ≥20 mMU/mL, an anti-HPV 11 titer ≥16 mMU/mL, an anti-HPV 16 titer of ≥20 mMU/mL and an anti-HPV 18 titer of ≥24 mMU/mL.

Time frame: Four weeks postdose 3 (Month 7)

Population: All participants that received all 3 vaccinations within acceptable day ranges, were seronegative to the relevant HPV type at Day 1, did not have protocol violations that could interfere with evaluation of the immune response, and provided Month 7 serology result within 21 to 49 days post dose 3.

ArmMeasureGroupValue (MEAN)
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18Anti HPV 1699.0 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18Anti HPV 694.9 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18Anti HPV 1199.0 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18Anti HPV 1899.0 Percentage of Participants
Secondary

Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 Years

Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay. Antibody titers were expressed mMU/mL. GMTs obtained for each anti-HPV from this study were compared to each of the ant-HPV GMTs obtained in study V501-122 (NCT NCT01862874) in which Japanese males 16 to 26 years received V501 in the same 3 dose regimen, to test a hypothesis that would demonstrate non-inferiority.

Time frame: Four weeks postdose 3 (Month 7)

Population: Participants 9 to 15 years old (PN200) or 16 to 26 years old (PN122) that received all 3 vaccinations within acceptable day ranges, were seronegative to the relevant HPV type at Day 1, did not have protocol violations that could interfere with evaluation of the immune response, and provided Month 7 serology result within 21 to 49 days post dose 3.

ArmMeasureGroupValue (GEOMETRIC_MEAN)
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 111052.8 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 163878.3 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 181114.5 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 6482.9 mMU/mL
Participants Aged 16 to 26 Years (PN122)Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 18365.4 mMU/mL
Participants Aged 16 to 26 Years (PN122)Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 11458.4 mMU/mL
Participants Aged 16 to 26 Years (PN122)Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 162294.8 mMU/mL
Participants Aged 16 to 26 Years (PN122)Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18 Participants Aged 9 to 15 Years Versus Participants Aged 16 to 26 YearsAnti-HPV 6385.0 mMU/mL
Comparison: Anti-HPV 6p-value: <0.00195% CI: [1, 1.57]ANOVA
Comparison: Anti-HPV 11p-value: <0.00195% CI: [1.89, 2.78]ANOVA
Comparison: Anti-HPV 16p-value: <0.00195% CI: [1.35, 2.11]ANOVA
Comparison: Anti-HPV 18p-value: <0.00195% CI: [2.33, 3.99]ANOVA
Secondary

Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 18 Months

Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay. Antibody titers were expressed as mMU/mL.

Time frame: 12 months postdose 3 (18 months)

Population: All participants that received all 3 vaccinations within acceptable day ranges, were seronegative to the relevant HPV type at Day 1, did not have protocol violations that could interfere with evaluation of the immune response, and provided Month 18 data within an acceptable date range of 12 months postdose 3.

ArmMeasureGroupValue (GEOMETRIC_MEAN)
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 6222.0 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 11259.9 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 161154.1 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 18212.1 mMU/mL
Secondary

Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 30 Months

Antibodies to HPV Types 6, 11, 16, and 18 were measured using a competitive luminex immunoassay. Antibody titers were expressed as mMU/mL.

Time frame: 24 months postdose 3 (30 months)

Population: All participants that received all 3 vaccinations within acceptable day ranges, were seronegative to the relevant HPV type at Day 1, did not have protocol violations that could interfere with evaluation of the immune response, and provided Month 30 data within an acceptable date range of 24 months postdose 3.

ArmMeasureGroupValue (GEOMETRIC_MEAN)
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 6177.5 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 11181.5 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 16831.3 mMU/mL
V501Geometric Mean Titers for Serum Anti-HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 18144.2 mMU/mL
Secondary

Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 18 Months

Serum antibodies to HPV types were measured with a competitive luminex immunoassay. The serostatus cutoffs (mMU/mL) for HPV types were as follows: HPV Type 6: ≥20; HPV Type 11: ≥16; HPV Type 16: ≥20; HPV Type 18: ≥24

Time frame: 12 months postdose 3 (18 months)

Population: All participants that received all 3 vaccinations within acceptable day ranges, were seronegative to the relevant HPV type at Day 1, did not have protocol violations that could interfere with evaluation of the immune response, and provided Month 18 data within an acceptable date range of 12 months postdose 3.

ArmMeasureGroupValue (NUMBER)
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 697.9 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 11100.0 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 1699.0 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 18 MonthsAnti-HPV 1894.8 Percentage of Participants
Secondary

Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 30 Months

Serum antibodies to HPV types were measured with a competitive luminex immunoassay. The serostatus cutoffs (mMU/mL) for HPV types were as follows: HPV Type 6: ≥20; HPV Type 11: ≥16; HPV Type 16: ≥20; HPV Type 18: ≥24.

Time frame: 24 months postdose 3 (30 months)

Population: All participants that received all 3 vaccinations within acceptable day ranges, were seronegative to the relevant HPV type at Day 1, did not have protocol violations that could interfere with evaluation of the immune response, and provided Month 30 data within an acceptable date range of 24 months postdose 3.

ArmMeasureGroupValue (NUMBER)
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 698.0 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 1198.0 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 1699.0 Percentage of Participants
V501Percentage of Participants With Seroconversion for HPV Types 6, 11, 16, and 18: Persistence at 30 MonthsAnti-HPV 1893.9 Percentage of Participants

Source: ClinicalTrials.gov · Data processed: Feb 22, 2026