ID

26225

Beschrijving

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

Trefwoorden

Versies (1)
  1. 12-10-17 12-10-17 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

12 oktober 2017

DOI

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Licentie

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

Engels

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

1 Formulieren  
Patient continuation / withdrawal
Beschrijving

Patient continuation / withdrawal

Is the patient continuing in the study?
Beschrijving

Is the patient continuing in the study?

Datatype

integer

Reason for withdrawal
Beschrijving

Reason for withdrawal

Datatype

integer

If other reason for withdrawal, please specify
Beschrijving

Specification of other reason for withdrawal

Datatype

text

Date of last dose
Beschrijving

Date of last dose

Datatype

date

Investigator´s signature
Beschrijving

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

Datatype

text

Date
Beschrijving

Date

Datatype

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 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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
Terug naar het begin van de pagina 

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