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XRP6258 Plus Prednisone Compared to Mitoxantrone Plus Prednisone in Hormone Refractory Metastatic Prostate Cancer (TROPIC)

This study has been completed.
Sponsor:
Information provided by:
Sanofi
ClinicalTrials.gov Identifier:
NCT00417079
First received: December 28, 2006
Last updated: March 4, 2011
Last verified: March 2011
Results First Received: September 20, 2010  
Study Type: Interventional
Study Design: Allocation: Randomized;   Endpoint Classification: Efficacy Study;   Intervention Model: Parallel Assignment;   Masking: Open Label;   Primary Purpose: Treatment
Conditions: Neoplasms
Prostatic Neoplasms
Interventions: Drug: cabazitaxel (XRP6258) (RPR116258)
Drug: mitoxantrone
Drug: prednisone

  Participant Flow
  Hide Participant Flow

Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
Multicenter study: 146 actives sites from 26 countries in Europe, USA, South America and Asia Pacific region. Study initiation date: January 2nd, 2007; study completion date/study cut off date: September 25th, 2009.

Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment

165 patients signed informed consent but were not randomized and considered as screen failure.

Intention to Treat Population (ITT or randomized patients): 755 patients (377 mitoxantrone, 378 cabazitaxel).

Safety population (treated patients): 742 patients (371 mitoxantrone, 371 cabazitaxel) (Patients not treated: 6 mitoxantrone, 7 cabazitaxel).


Reporting Groups
  Description
Mitoxantrone + Prednisone mitoxantrone 12 mg/m^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily
Cabazitaxel + Prednisone cabazitaxel 25 mg/m^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily

Participant Flow:   Overall Study
    Mitoxantrone + Prednisone   Cabazitaxel + Prednisone
STARTED   377 [1]   378 [1] 
COMPLETED   46 [1]   105 [1] 
NOT COMPLETED   331   273 
Disease progression                267                180 
Adverse Event                32                67 
Non-compliance to protocol                0                1 
Lost to Follow-up                2                0 
Withdrawal by Subject                17                8 
Not treated                6                7 
Screened failure                2                1 
Investigator's decision                1                4 
Non-confirmed Disease progression                1                1 
Clinical deterioration                1                0 
Screening error                2                1 
Withdrawal by subject's family                0                1 
Patient unable to come to the clinic                0                1 
abnormal liver function tests                0                1 
[1] Randomized patients



  Baseline Characteristics
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Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
No text entered.

Reporting Groups
  Description
Mitoxantrone + Prednisone mitoxantrone 12 mg/m^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily
Cabazitaxel + Prednisone cabazitaxel 25 mg/m^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily
Total Total of all reporting groups

Baseline Measures
   Mitoxantrone + Prednisone   Cabazitaxel + Prednisone   Total 
Overall Participants Analyzed 
[Units: Participants]
 377   378   755 
Age 
[Units: Years]
Median (Full Range)
 67.0 
 (47 to 89) 
 68.0 
 (46 to 92) 
 67 
 (46 to 92) 
Gender, Customized 
[Units: Participants]
     
Male   377   378   755 
Region of Enrollment 
[Units: Participants]
     
United States   106   97   203 
Taiwan   4   7   11 
Slovakia   1   1   2 
Spain   10   9   19 
Chile   9   12   21 
Russian Federation   6   4   10 
Italy   17   18   35 
India   11   9   20 
France   44   46   90 
Denmark   19   26   45 
South Africa   7   9   16 
Netherlands   8   9   17 
Korea, Republic of   8   7   15 
Finland   4   1   5 
Turkey   17   19   36 
United Kingdom   17   20   37 
Hungary   8   7   15 
Czech Republic   10   12   22 
Mexico   2   3   5 
Canada   16   16   32 
Argentina   7   3   10 
Brazil   7   4   11 
Belgium   16   15   31 
Singapore   6   3   9 
Germany   6   11   17 
Sweden   11   10   21 
Eastern Cooperative Oncology Group (ECOG) Performance Status 
[Units: Participants]
     
0 - Fully Active   120   141   261 
1 - Ambulatory, Restricted Activity   224   209   433 
2 - Ambulatory, No Work Activities   33   28   61 
Prostatic Specific Antigen PSA 
[Units: ng/mL]
Median (Full Range)
 127.5 
 (2 to 11220) 
 143.9 
 (2 to 7842) 
 135.00 
 (2 to 11220) 
Measurable disease [1] 
[Units: Participants]
     
Measurable disease   204   201   405 
Not Measurable disease   173   177   350 
[1]

Measurability of the disease per Response Evaluation Criteria in Solid Tumors (RECIST) criteria:

Patients with measurable disease have at least one visceral or soft tissue metastatic lesion (including new lesion).

Patient with non-measurable disease have documented rising PSA levels or appearance of new lesion.

Extent of disease [1] 
[Units: Participants]
     
Metastatic   356   364   720 
Locoregional Recurrence   20   14   34 
Missing   1   0   1 
[1]

Extent of the disease at screening stage:

  • Metastatic: bone or visceral metastases.
  • Locoregional recurrence includes local recurrent tumor at the primary site, along the draining lymphatic channels, or within the draining lymphatic nodal basin.
Tumor Location: number of sites involved 
[Units: Participants]
     
 134   146   280 
 117   112   229 
 78   73   151 
4 or more   43   44   87 
Missing   5   3   8 


  Outcome Measures
  Show All Outcome Measures

1.  Primary:   Overall Survival   [ Time Frame: From the date of randomization up to 104 weeks (study cut-off) ]

2.  Secondary:   Time to Progression Free Survival (PFS)   [ Time Frame: From the date of randomization up to 104 weeks (study cut-off) ]

3.  Secondary:   Overall Tumor Response   [ Time Frame: From the date of randomization up to 104 weeks (study cut-off) ]

4.  Secondary:   Time to Tumor Progression   [ Time Frame: From the date of randomization up to 104 weeks (study cut-off) ]

5.  Secondary:   Time to Prostatic Specific Antigen (PSA) Progression   [ Time Frame: at screening, day 1 of every treatment cycle, up to 104 weeks (study cut-off) ]

6.  Secondary:   PSA (Prostate-Specific Antigen) Response   [ Time Frame: from baseline up to 104 weeks (study cut-off) ]

7.  Secondary:   Time to Pain Progression   [ Time Frame: from baseline up to 104 weeks (study cut-off) ]

8.  Secondary:   Pain Response   [ Time Frame: from baseline up to 104 weeks (study cut-off) ]


  Serious Adverse Events
  Hide Serious Adverse Events

Time Frame Adverse events are collected from the time to the first patient signed an informed consent form until 30 days after the administration of the last cycle of the study treatment to the last patient (i.e. 104 weeks).
Additional Description The safety analyses are performed on the safety population which includes all randomized patients who received at least part of one dose of the study drug.

Reporting Groups
  Description
Mitoxantrone + Prednisone mitoxantrone 12 mg/m^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily
Cabazitaxel + Prednisone cabazitaxel 25 mg/m^2 (Day 1) by intravenous (IV) every 3 weeks, and prednisone 10 mg orally given daily

Serious Adverse Events
    Mitoxantrone + Prednisone   Cabazitaxel + Prednisone
Total, serious adverse events     
# participants affected / at risk   77/371 (20.75%)   145/371 (39.08%) 
Blood and lymphatic system disorders     
Febrile neutropenia * 1     
# participants affected / at risk   4/371 (1.08%)   25/371 (6.74%) 
Neutropenia * 1     
# participants affected / at risk   3/371 (0.81%)   18/371 (4.85%) 
Leukopenia * 1     
# participants affected / at risk   0/371 (0.00%)   3/371 (0.81%) 
Anaemia * 1     
# participants affected / at risk   2/371 (0.54%)   2/371 (0.54%) 
Thrombocytopenia * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Pancytopenia * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Cardiac disorders     
Atrial fibrillation * 1     
# participants affected / at risk   1/371 (0.27%)   2/371 (0.54%) 
Cardiac arrest * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Cardiac failure * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Ventricular fibrillation * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Cardiotoxicity * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Myocardial infarction * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Gastrointestinal disorders     
Diarrhoea * 1     
# participants affected / at risk   0/371 (0.00%)   9/371 (2.43%) 
Vomiting * 1     
# participants affected / at risk   2/371 (0.54%)   6/371 (1.62%) 
Abdominal pain * 1     
# participants affected / at risk   0/371 (0.00%)   6/371 (1.62%) 
Constipation * 1     
# participants affected / at risk   1/371 (0.27%)   3/371 (0.81%) 
Nausea * 1     
# participants affected / at risk   1/371 (0.27%)   3/371 (0.81%) 
Intestinal obstruction * 1     
# participants affected / at risk   0/371 (0.00%)   3/371 (0.81%) 
Rectal haemorrhage * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Abdominal pain lower * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Caecitis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Duodenal ulcer perforation * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Dysphagia * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Enterocolitis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Enterovesical fistula * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Gastric ulcer * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Haemorrhoidal haemorrhage * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Mesenteric vein thrombosis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Oesophageal ulcer * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Haematemesis * 1     
# participants affected / at risk   2/371 (0.54%)   0/371 (0.00%) 
Pancreatic mass * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Pancreatitis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Proctalgia * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
General disorders     
Pyrexia * 1     
# participants affected / at risk   1/371 (0.27%)   6/371 (1.62%) 
Asthenia * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Chest pain * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Disease progression * 1     
# participants affected / at risk   11/371 (2.96%)   1/371 (0.27%) 
Fatigue * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Influenza like illness * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Oedema peripheral * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Pain * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Sudden death * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Hepatobiliary disorders     
Bile duct stone * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Biliary colic * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Cholecystitis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Cholangitis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Hepatic failure * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Immune system disorders     
Anaphylactic shock * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Infections and infestations     
Pneumonia * 1     
# participants affected / at risk   2/371 (0.54%)   6/371 (1.62%) 
Urinary tract infection * 1     
# participants affected / at risk   3/371 (0.81%)   4/371 (1.08%) 
Sepsis * 1     
# participants affected / at risk   0/371 (0.00%)   4/371 (1.08%) 
Septic shock * 1     
# participants affected / at risk   0/371 (0.00%)   4/371 (1.08%) 
Neutropenic sepsis * 1     
# participants affected / at risk   1/371 (0.27%)   3/371 (0.81%) 
Infection * 1     
# participants affected / at risk   2/371 (0.54%)   2/371 (0.54%) 
Neutropenic infection * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Salmonellosis * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Cellulitis * 1     
# participants affected / at risk   2/371 (0.54%)   1/371 (0.27%) 
Urosepsis * 1     
# participants affected / at risk   2/371 (0.54%)   1/371 (0.27%) 
Cystitis * 1     
# participants affected / at risk   1/371 (0.27%)   1/371 (0.27%) 
Lobar pneumonia * 1     
# participants affected / at risk   1/371 (0.27%)   1/371 (0.27%) 
Bacteraemia * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Bronchopneumonia * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Campylobacter infection * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Fungal sepsis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Groin abscess * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Implant site cellulitis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Oesophageal candidiasis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Pneumonia klebsiella * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Urinary tract infection enterococcal * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Urinary tract infection fungal * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Bacterial sepsis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Febrile infection * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Pneumococcal sepsis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Injury, poisoning and procedural complications     
Hip fracture * 1     
# participants affected / at risk   1/371 (0.27%)   2/371 (0.54%) 
Ankle fracture * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Femur fracture * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Accidental overdose * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Alcohol poisoning * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Fracture * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Multiple fractures * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Tibia fracture * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Investigations     
Eastern cooperative oncology group performance status worsened * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Metabolism and nutrition disorders     
Dehydration * 1     
# participants affected / at risk   1/371 (0.27%)   4/371 (1.08%) 
Electrolyte imbalance * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Hyperglycaemia * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Hyperkalaemia * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Hypoalbuminaemia * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Musculoskeletal and connective tissue disorders     
Back pain * 1     
# participants affected / at risk   4/371 (1.08%)   3/371 (0.81%) 
Pain in extremity * 1     
# participants affected / at risk   2/371 (0.54%)   2/371 (0.54%) 
Osteonecrosis * 1     
# participants affected / at risk   2/371 (0.54%)   1/371 (0.27%) 
Flank pain * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Arthralgia * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Spinal column stenosis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Neoplasms benign, malignant and unspecified (incl cysts and polyps)     
Cancer pain * 1     
# participants affected / at risk   1/371 (0.27%)   1/371 (0.27%) 
Metastatic pain * 1     
# participants affected / at risk   1/371 (0.27%)   1/371 (0.27%) 
Gastric cancer * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Metastases to meninges * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Metastases to spine * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Prostate cancer metastatic * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Nervous system disorders     
Spinal cord compression * 1     
# participants affected / at risk   3/371 (0.81%)   4/371 (1.08%) 
Syncope * 1     
# participants affected / at risk   1/371 (0.27%)   2/371 (0.54%) 
Cerebral haemorrhage * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Grand mal convulsion * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Metabolic encephalopathy * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Neuropathy peripheral * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Presyncope * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Speech disorder * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Vith nerve paralysis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Altered state of consciousness * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Cerebral infarction * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Cerebrovascular accident * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Cranial nerve paralysis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Epiduritis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Peripheral motor neuropathy * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Vestibular nystagmus * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Psychiatric disorders     
Confusional state * 1     
# participants affected / at risk   3/371 (0.81%)   1/371 (0.27%) 
Suicidal ideation * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Psychotic disorder * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Renal and urinary disorders     
Haematuria * 1     
# participants affected / at risk   3/371 (0.81%)   10/371 (2.70%) 
Renal failure * 1     
# participants affected / at risk   0/371 (0.00%)   6/371 (1.62%) 
Renal failure acute * 1     
# participants affected / at risk   0/371 (0.00%)   5/371 (1.35%) 
Hydronephrosis * 1     
# participants affected / at risk   1/371 (0.27%)   4/371 (1.08%) 
Ureteric obstruction * 1     
# participants affected / at risk   0/371 (0.00%)   4/371 (1.08%) 
Urinary retention * 1     
# participants affected / at risk   2/371 (0.54%)   2/371 (0.54%) 
Ureteric stenosis * 1     
# participants affected / at risk   1/371 (0.27%)   1/371 (0.27%) 
Bladder neck obstruction * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Renal colic * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Urethral pain * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Urethral stenosis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Urinary tract obstruction * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Postrenal failure * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Reproductive system and breast disorders     
Penile oedema * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Respiratory, thoracic and mediastinal disorders     
Pulmonary embolism * 1     
# participants affected / at risk   6/371 (1.62%)   5/371 (1.35%) 
Dyspnoea * 1     
# participants affected / at risk   1/371 (0.27%)   3/371 (0.81%) 
Respiratory failure * 1     
# participants affected / at risk   0/371 (0.00%)   2/371 (0.54%) 
Aspiration * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Chylothorax * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Hypoxia * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Pneumonitis * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Chronic obstructive pulmonary disease * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Pleural effusion * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
Vascular disorders     
Deep vein thrombosis * 1     
# participants affected / at risk   2/371 (0.54%)   2/371 (0.54%) 
Haematoma * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Hypotension * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Orthostatic hypotension * 1     
# participants affected / at risk   0/371 (0.00%)   1/371 (0.27%) 
Extremity necrosis * 1     
# participants affected / at risk   1/371 (0.27%)   0/371 (0.00%) 
* Events were collected by non-systematic assessment
1 Term from vocabulary, MedDRA 12.0




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Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
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