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Pharmacokinetic, Efficacy and Safety of BT524 in Patients With Congenital Fibrinogen Deficiency

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02065882
Recruitment Status : Completed
First Posted : February 19, 2014
Last Update Posted : July 27, 2022
Sponsor:
Collaborators:
ICON plc
SYNLAB Analytics and Services Germany GmbH
Phoenix Clinical Research
Accovion GmbH
Pharmetheus AB
Information provided by (Responsible Party):
Biotest

Tracking Information
First Submitted Date  ICMJE February 3, 2014
First Posted Date  ICMJE February 19, 2014
Last Update Posted Date July 27, 2022
Actual Study Start Date  ICMJE March 2013
Actual Primary Completion Date May 18, 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: July 25, 2022)
  • Single-dose Pharmacokinetics (PK) of BT524: Terminal Elimination Half-life (t1/2) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    T1/2 of fibrinogen antigen was determined from samples taken at several time points during the 14 day sampling period. T1/2 was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-dose Pharmacokinetics (PK) of BT524: Time to Maximum Concentration (Tmax) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Time of occurence of Cmax relative to dosing (Tmax) for fibrinogen antigen was determined from samples taken at several time points during the 14 day sampling period. Tmax was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Maximum Concentration (Cmax) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Maximum observed plasma concentration (Cmax) for fibrinogen antigen was determined from samples taken at several time points during the 14 day sampling period. Cmax was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Area Under the Curve (AUC) Calculated to the Last Measured Concentration (AUC0-tz) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    AUC0-tz: Area under the time course of the plasma concentrations calculated from time zero up to the last quantifiable plasma concentration for fibrinogen antigen, was determined from samples taken at several time points during the 14 day sampling period. AUC0-tz was derived from time-concentration profiles using adapted methodology (noncompartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Extent of Area Under the Curve (AUC) Extrapolation Beyond Last Concentration (AUCextr) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    AUCextr: extent of AUC extrapolation beyond last concentration for fibrinogen antigen, was determined from samples taken at several time points during the 14 day sampling period. AUCextr was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Area Under the Curve (AUC) From Time 0 to Infinity (AUC0-∞) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    AUC0-∞: AUC from time 0 to infinity for fibrinogen antigen, was determined from samples taken at several time points during the 14 day sampling period. AUC0-∞ was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Mean Residence Time (MRT) Extrapolated to Infinity (MRT0-∞) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    MRT0-∞: Mean Residence Time (MRT) extrapolated to infinity for fibrinogen antigen was determined from samples taken at several time points during the 14 day sampling period. MRT0-∞ was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Clearance (CL) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    CL: Total clearance (CL) for fibrinogen antigen was determined from samples taken at several time points during the 14 day sampling period. CL was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Volume of Distribution at Presumed Steady-state (Vdss) for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Vdss: Volume of distribution at presumed steady-state for fibrinogen antigen was determined from samples taken at several time points during the 14 day sampling period. Vdss was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Volume of Distribution at Presumed Steady-state (Vdss) per kg BW for Fibrinogen Antigen [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Vdss per kg BW: Volume of distribution at presumed steady-state per kg bodyweight for fibrinogen antigen was determined from samples taken at several time points during the 14 day sampling period. Vdss per kg BW was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacokinetics (PK) for BT524: Incremental Recovery (IR) for Fibrinogen Antigen [ Time Frame: Between pre-dose and 4 hours post-dose ]
    IR is the dose-adjusted maximum fibrinogen increase in plasma within 4 hours after the end of infusion.
  • Single-Dose Pharmacokinetics (PK) for BT524: Classical in Vivo Recovery (CIR) for Fibrinogen Antigen [ Time Frame: Between pre-dose and 4 hours post-dose ]
    CIR: maximum fibrinogen increase in plasma within 4 hours after the end of infusion divided by the maximum theoretical fibrinogen increase
Original Primary Outcome Measures  ICMJE
 (submitted: February 17, 2014)
Terminal Elimination Half-life (t1/2) for fibrinogen antigen, [ Time Frame: Prior to the initial dose on day 1, at the end of the infusion and 0.5, 1, 2, 4, 8 hours post dose, 24, 48,96, 168, 240h and 336 hours post-dose ]
The primary objective of this study is to investigate the 14 day single-dose pharmacokinetics of BT524 following intravenous (IV) infusion in patients with congenital afibrinogenemia or severe congenital hypofibrinogenemia (part I).
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: July 25, 2022)
  • Single-dose Pharmacodynamics (PD) of BT524: Terminal Elimination Half-life (t1/2) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    T1/2 of fibrinogen activity was determined from samples taken at several time points during the 14 day sampling period. T1/2 was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-dose Pharmacodynamics (PD) of BT524: Time to Maximum Concentration (Tmax) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Time of occurence of Cmax relative to dosing (Tmax) for fibrinogen activity was determined from samples taken at several time points during the 14 day sampling period. Tmax was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/required).
  • Single-dose Pharmacodynamics (PD) of BT524: Maximum Concentration (Cmax) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Maximum observed plasma concentration (Cmax) for fibrinogen activity was determined from samples taken at several time points during the 14 day sampling period. Cmax was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-dose Pharmacodynamics (PD) of BT524: Area Under the Curve (AUC) Calculated to the Last Measured Concentration (AUC0-tz) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    AUC0-tz: Area under the time course of the plasma concentrations calculated from time zero up to the last quantifiable plasma concentration for fibrinogen activity, was determined from samples taken at several time points during the 14 day sampling period. AUC0-tz was derived from time-concentration profiles using adapted methodology (noncompartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-dose Pharmacodynamics (PD) of BT524: Extent of Area Under the Curve (AUC) Extrapolation Beyond Last Concentration (AUCextr) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    AUCextr: extent of AUC extrapolation beyond last concentration for fibrinogen activity, was determined from samples taken at several time points during the 14 day sampling period. AUCextr was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-dose Pharmacodynamics (PD) of BT524: Area Under the Curve (AUC) From Time 0 to Infinity (AUC0-∞) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    AUC0-∞: AUC from time 0 to infinity for fibrinogen activity, was determined from samples taken at several time points during the 14 day sampling period. AUC0-∞ was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-dose Pharmacodynamics (PD) of BT524: Mean Residence Time (MRT) Extrapolated to Infinity (MRT0-∞) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    MRT0-∞: Mean Residence Time (MRT) extrapolated to infinity for fibrinogen activity was determined from samples taken at several time points during the 14 day sampling period. MRT0-∞ was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacodynamics (PD) for BT524: Clearance (CL) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    CL: Total clearance (CL) for fibrinogen activity was determined from samples taken at several time points during the 14 day sampling period. CL was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacodynamics (PD) for BT524: Volume of Distribution at Presumed Steady-state (Vdss) for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Vdss: Volume of distribution at presumed steady-state for fibrinogen activity was determined from samples taken at several time points during the 14 day sampling period. Vdss was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacodynamics (PD) for BT524: Volume of Distribution at Presumed Steady-state (Vdss) per kg BW for Fibrinogen Activity [ Time Frame: Pre-dose on Dosing Day 0, at the end of the infusion and 0.5, 1, 2, 4, 8, 24, 48, 96, 168, 240 and 336 hours post-dose ]
    Vdss per kg BW: Volume of distribution at presumed steady-state per kg bodyweight for fibrinogen activity was determined from samples taken at several time points during the 14 day sampling period. Vdss per kg BW was derived from time-concentration profiles using adapted methodology (non-compartmental analysis, compartment analysis, or population modeling, as appropriate/ required).
  • Single-Dose Pharmacodynamics (PD) for BT524: Incremental Recovery (IR) for Fibrinogen Activity [ Time Frame: Between pre-dose and 4 hours post-dose ]
    IR is the dose-adjusted maximum fibrinogen increase in plasma within 4 hours after the end of infusion.
  • Single-Dose Pharmacodynamics (PD) for BT524: Classical in Vivo Recovery (CIR) for Fibrinogen Activity [ Time Frame: Between pre-dose and 4 hours post-dose ]
    CIR: maximum fibrinogen increase in plasma within 4 hours after the end of infusion divided by the maximum theoretical fibrinogen increase
  • Surrogate Efficacy for BT524: Maximum Clot Firmness (MCF) [ Time Frame: Part I: pre-dose and at 1 and 8 hours post-end of IV infusion. Part II: pre-dose and at 1 hour post-end of each IV infusion. ]
    MCF measured by rotational thromboelastometry (ROTEM) was assessed as surrogate efficacy marker for haemostatic efficacy of single (part I) and/or repetitive (part II) administrations of BT524. Part I: Comparison of MCF pre-dose and at 1 and 8 hours post-end of IV infusion. Correlation between MCF and fibrinogen activity at these timepoints. Part II: Comparison of MCF pre-dose and at 1 hour post-end of each IV infusion. Correlation between MCF and fibrinogen activity at these timepoints.
  • Clinical Efficacy for BT524: Overall Hemostatic Response (OHR) to Treatment With BT524 in Study Part II [ Time Frame: Part II: Overall assessment after each bleeding event at the day of hospital discharge (if applicable) or at the end of the treated bleeding event. ]
    Overall hemostatic response (OHR) to treatment with BT524 for each surgical procedure and each treated bleed was rated on a 4-point scale ("none", "moderate", "good" or "excellent"). The sum of good and excellent ratings was defined as "success" in the analysis. Frequencies and percentages of OHR on event level (Success rate in % = number of successfully treated bleeding events / total number of bleeding events).
  • Clinical Efficacy for BT524: Total Loss of Blood for Surgical Bleeding Events in Study Part II [ Time Frame: Part II: Total loss of blood after each surgical bleeding event ]
    Total loss of blood was rated by the investigator per surgical bleeding events (eg, intra- and post-operatively, rebleedings) using the classifications of "lower than expected", "within the expected range", and "higher than expected". The ratings were analyzed descriptively (frequencies and percentages) on event level for the FBE.
  • Clinical Efficacy for BT524: Units of Other Fibrinogen-containing Products (FCP) Infused Besides BT524 in Study Part II [ Time Frame: Part II: FCP assessed after each surgical bleeding event on BT524 dosing Day 0 or 1 day after ]
    Units of other fibrinogen-containing products (FCP) infused besides BT524 eg, fresh frozen plasma (FFP) or cryoprecipitate or alternative commercially available fibrinogen concentrates given to counteract hemodynamic instability were documented and analyzed descriptively on event level for the FBE.
Original Secondary Outcome Measures  ICMJE
 (submitted: February 17, 2014)
Terminal Elimination Half-life (t1/2) for fibrinogen activity [ Time Frame: Prior to the initial dose on day 1, at the end of the infusion and 0.5, 1, 2, 4, 8 hours post dose, 24, 48,96, 168, 240 and 336 hours post-dose ]
Secondary objectives are to investigate the 14 day single-dose pharmacodynamics of BT524, and the surrogate efficacy and safety of BT524 in part I of the study. In addition, the hemostatic efficacy, surrogate efficacy, and safety of single and/or repetitive administrations for on-demand prophylaxis (ODP) and/or on-demand treatment (ODT) of bleeding events will be investigated.
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Pharmacokinetic, Efficacy and Safety of BT524 in Patients With Congenital Fibrinogen Deficiency
Official Title  ICMJE A Prospective, Open-label, Phase I/III Study Investigating Pharmacokinetic Properties of BT524 and Efficacy and Safety of BT524 in the Treatment and Prophylaxis of Bleeding in Patients With Congenital Fibrinogen Deficiency
Brief Summary The purpose of the study is to investigate pharmacokinetics, efficacy and safety of BT524 in patients with congenital fibrinogen deficiency.
Detailed Description The present study is designed as a prospective, open-label, multicentre, phase I/III study investigating the 14 day single-dose pharmacokinetic properties, efficacy and safety of BT524 following intravenous administration in the treatment or prophylaxis of bleeding in patients with congenital afibrinogenemia or severe congenital hypofibrinogenemia.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 3
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • Congenital Afibrinogenemia
  • Congenital Hypofibrinogenemia
Intervention  ICMJE Biological: BT524 (fibrinogen concentrate from human plasma)
single intravenous infusion
Study Arms  ICMJE Experimental: BT524
Single intravenous infusion of a fixed dose of 70 mg BT524 per kilogram body weight (BW)
Intervention: Biological: BT524 (fibrinogen concentrate from human plasma)
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: July 24, 2019)
36
Original Estimated Enrollment  ICMJE
 (submitted: February 17, 2014)
20
Actual Study Completion Date  ICMJE November 18, 2020
Actual Primary Completion Date May 18, 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Known congenital afibrinogenemia or severe congenital hypofibrinogenemia
  • Plasma fibrinogen activity ≤ 0.5 g/l and antigen ≤ 0.5 g/l
  • Male or female
  • Age 0 to 75 years, with the first ten patients will be 18 years or
  • Presumed to be compliant with the study procedures and to terminate the study as scheduled
  • Willing and able to be hospitalized for 3 days for the pharmacokinetic assessment (if applicable)
  • Willing and able to be hospitalized - if required - in case of interventions (e.g., surgical procedures, major bleeds)
  • Written informed consent by the patient, his/her parents or by the patient's legal / authorized representative as applicable

Exclusion Criteria:

  • Known congenital dysfibrinogenemia
  • Known bleeding disorder other than congenital fibrinogen deficiency
  • History of esophageal variceal bleeding
  • Known presence or history of venous/arterial thrombosis or thromboembolic event in the preceding 6 months
  • Known presence or history of fibrinogen inhibitory antibodies
  • Known presence or history of hypersensitivity to human fibrinogen or human plasma proteins e.g., immunoglobulins, vaccines or hypersensitivity to any of the excipients
  • Known positive serology for HIV-1 and HIV-2
  • Clinically relevant biochemical or hematological findings (except due to underlying disease or emergency bleeding) outside the normal range (at the investigator's discretion)
  • Clinically relevant pathological findings in physical examination including electrocardiogram (ECG)
  • Treatment with any fibrinogen concentrate and/or fibrinogen-containing product within 2 weeks prior to infusion of BT524
  • Concomitant medication interacting relevantly with the coagulation system (e.g., low molecular weight heparin, unfractioned heparin, factor Xa inhibitors, factor IIa inhibitors or PY12 inhibitors) within 2 weeks prior to infusion of BT524
  • Recent vaccination (within 3 weeks prior to infusion)
  • Body weight (BW) below 22 kg for patients ≥ 6 years; BW below the 5th percentile of the normal range for children < 6 years (refers to local standard)
  • End stage disease
  • Abuse of drugs
  • Unable to understand and follow the study requirements
  • Participation in another interventional clinical study within 30 days before entering the study or during the study
  • Pregnant/ nursing woman, or woman of childbearing potential not using reliable/ effective contraceptive method(s) during the study and at least one month after the last administration of study drug (e.g., oral/ injectable/ implantable/ insertable/ topical hormonal contraceptives, intrauterine devices, female sterilization, partner's vasectomy or condoms)
  • Any other condition that, to the investigator's judgment, could have an impact on patient's safety or the study results
  • Elective surgery during the 14 day PK blood sampling period
  • Acute infection
  • Clinically relevant increase or decrease in body temperature
  • Actively bleeding or anticipated bleeding (including female menorrhea) at the time point of or within 7 days prior to infusion of BT524
  • Surgery within 7 days prior to infusion of BT524
  • Immobilization within 7 days prior to infusion of BT524
  • Intake of alcohol or significantly increased intake of caffeine containing products within 24 hours prior to infusion of BT524
  • Blood donation or comparable blood loss within 60 days prior to infusion of BT524
  • Excessive physical exercise (extreme sports activities, sauna) within 72 hours prior to infusion of BT524
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 0 Years to 75 Years   (Child, Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Bulgaria,   Egypt,   Germany,   Lebanon,   Tunisia
Removed Location Countries Italy
 
Administrative Information
NCT Number  ICMJE NCT02065882
Other Study ID Numbers  ICMJE Biotest 984
2011-004154-25 ( EudraCT Number )
Has Data Monitoring Committee No
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Current Responsible Party Biotest
Original Responsible Party Same as current
Current Study Sponsor  ICMJE Biotest
Original Study Sponsor  ICMJE Same as current
Collaborators  ICMJE
  • ICON plc
  • SYNLAB Analytics and Services Germany GmbH
  • Phoenix Clinical Research
  • Accovion GmbH
  • Pharmetheus AB
Investigators  ICMJE
Principal Investigator: Claudia Djambas Khayat, MD Hôtel Dieu de France, Dept. of Pediatrics
PRS Account Biotest
Verification Date July 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP