ID

26225

Descripción

Study ID: 101468/125 Clinical Study ID: SKF-101468/125 Study Title: A double-blind, multicentre, flexible dose, L-dopa controlled study of ropinirole to investigate A) neuroprotective effect as measured by 3D PET scanning, and B) ophthalmological safety, in patients with early Parkinson’s disease Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: requip Study Indication: Restless Legs Syndrome

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Versiones (1)
  1. 12/10/17 12/10/17 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

12 de octubre de 2017

DOI

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Licencia

Creative Commons BY-NC 3.0
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L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Patient Continuation / Withdrawal

Inglés

L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Patient Continuation / Withdrawal

1 formularios  
Patient continuation / withdrawal
Descripción

Patient continuation / withdrawal

Is the patient continuing in the study?
Descripción

Is the patient continuing in the study?

Tipo de datos

integer

Reason for withdrawal
Descripción

Reason for withdrawal

Tipo de datos

integer

If other reason for withdrawal, please specify
Descripción

Specification of other reason for withdrawal

Tipo de datos

text

Date of last dose
Descripción

Date of last dose

Tipo de datos

date

Investigator´s signature
Descripción

I certify that I have reviewed the data in this module and that all the information is complete and accurate.

Tipo de datos

text

Date
Descripción

Date

Tipo de datos

date

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Similar models

L-dopa controlled study of ropinirole, neuroprotective effect and ophthalmological safety in early Parkinson’s disease 101468/125 Module 1 Patient Continuation / Withdrawal

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Patient continuation / withdrawal
Item
Is the patient continuing in the study?
integer
Is the patient continuing in the study?
Code List
Is the patient continuing in the study?
CL Item
Yes (1)
CL Item
No (If "No" mark the one most appropriate reason below, and record the date the patient last took the study medication) (2)
Item
Reason for withdrawal
integer
Reason for withdrawal
Code List
Reason for withdrawal
CL Item
Adverse experience (complete Adverse Experience section) (1)
CL Item
Lack of Efficacy  (2)
CL Item
Deviation from protocol (including non-compliance/protocol violation) (3)
CL Item
Lost to follow-up (4)
CL Item
Other (please specify below) (5)
Specification of other reason for withdrawal
Item
If other reason for withdrawal, please specify
text
Date of last dose
Item
Date of last dose
date
Investigator´s signature
Item
Investigator´s signature
text
Date
Item
Date
date
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