ID
33376
Description
Study ID: 107806 Clinical Study ID: RA3107806 Study Title: An open label study to determine the safety, tolerability, excretion balance and pharmacokinetics of Losmapimod, administered as a single dose of an oral solution to healthy adult male subjects Patient Level Data: Clinicaltrials.gov Identifier: NCT00599612 https://clinicaltrials.gov/ct2/show/NCT00599612 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: losmapimod Trade Name: losmapimod Study Indication: Pulmonary Disease, Chronic Obstructive The study consists of a screening, study visit and follow-up. The protocol identifier for all: RA3107806 This document contains the liver events form. It has to be filled in if a liver event occurs during study (including screening and study visit).
Link
https://clinicaltrials.gov/ct2/show/NCT00599612
Keywords
Versions (2)
- 12/4/18 12/4/18 -
- 12/7/18 12/7/18 -
Copyright Holder
GlaxoSmithKline
Uploaded on
December 7, 2018
DOI
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License
Creative Commons BY-NC 3.0
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Safety, tolerability, excretion balance and pharmacokinetics of Losmapimod in healthy males, NCT00599612
Liver events
- StudyEvent: ODM
Description
Liver events
Alias
- UMLS CUI-1
- C0023884
- UMLS CUI-2
- C0877248
- UMLS CUI-3
- C0220825
Description
day month year
Data type
boolean
Alias
- UMLS CUI [1]
- C2985720
Description
Time period to the onset of ALT ≥ 2xUpper Limit Normal (ULN). Note: Although stopping criteria is ALT 3x ULN, GSK are interested in capturing ALT≥2x ULNto assess the probability of drug relatedness of liver event
Data type
boolean
Alias
- UMLS CUI [1]
- C0201836
Description
AST
Data type
boolean
Alias
- UMLS CUI [1]
- C0201899
Description
Total bilirubin
Data type
boolean
Alias
- UMLS CUI [1]
- C0201913
Description
Alkaline phosphatase
Data type
boolean
Alias
- UMLS CUI [1]
- C0201850
Description
Other
Data type
boolean
Alias
- UMLS CUI [1]
- C0205394
Description
Liver events assessment
Alias
- UMLS CUI-1
- C0023884
- UMLS CUI-2
- C0877248
- UMLS CUI-3
- C0220825
Description
If Yes, stop investigational product, complete date stopped on lnvestigational Product form, contact GSK within 24 hours of occurrence, complete Liver Events Form and obtain the following tests: PK blood sample within 24 hours of last dose (or 3x the investigational product half-life or t1/2). Hepatitis A: Hepatitis A lgM antibody. Hepatitis B: Hepatitis B surface antigen and Hepatitis B Core Antibody (/gM). Hepatitis C: Hepatitis C RNA. Hepatitis E /gM antibody (if subject resides or hastravelled in past 3 months outside the USA or Canada). Cytomegalovirus lgM antibody (CMV) EBV (Epstein Barr viral capsid antigen /gM antibody) or if unavailable, obtain heterophile antibody or monospot testing. CPK (serum creatine phosphokinase) LDH (factate dehydrogenase) Bilirubin fractionation, if bilirubin ≥ 1,5xULN The following are only needed when ALT ≥ 3xULN and bilirubin ≥ 1,5xULN (>35% direct): Anti-nuclear antibody Anti-smooth muscle antibody Type 1 anti-liver kidney microsomal antibodies (if available) Liver Imaging (ultrasound, magnetic resonance, or computerised tomography
Data type
text
Alias
- UMLS CUI [1,1]
- C0023884
- UMLS CUI [1,2]
- C0008000
- UMLS CUI [1,3]
- C1254595
- UMLS CUI [1,4]
- C2746065
- UMLS CUI [1,5]
- C0243161
Description
Treatment periods applicable to the onset of ALT≥2x ULN
Alias
- UMLS CUI-1
- C0087111
- UMLS CUI-2
- C1948053
- UMLS CUI-3
- C0201836
Description
If the liver event occurred during treatment period record start and stop date of investigational product for that treatment period. If the liver event occurred after treatment period record start and stop date of investigational product for the most recent period prior to the liver event. Tick for each period/event
Data type
integer
Alias
- UMLS CUI [1,1]
- C0439564
- UMLS CUI [1,2]
- C0023884
- UMLS CUI [1,3]
- C0877248
Description
Start Date lnvestigational Date
Data type
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C0304229
Description
End Date lnvestigational Product
Data type
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C0304229
Description
Liver events, Diagnositics
Alias
- UMLS CUI-1
- C0023884
- UMLS CUI-2
- C0877248
- UMLS CUI-3
- C0430022
Description
Age of subject
Data type
text
Alias
- UMLS CUI [1]
- C0001779
Description
If Yes, ensure Pregnancy Notification Form has been completed.
Data type
text
Alias
- UMLS CUI [1]
- C0032961
Description
Performance of diagnostic imaging tests of the liver or hepatobiliary system (liver ultrasound, computerized tomography or CAT scan, magnetic resonance imaging or MRI, or endoscopic retrograde cholangiopancreatography)
Data type
text
Alias
- UMLS CUI [1,1]
- C0011923
- UMLS CUI [1,2]
- C0023884
- UMLS CUI [2,1]
- C0011923
- UMLS CUI [2,2]
- C1711359
- UMLS CUI [3,1]
- C0023884
- UMLS CUI [3,2]
- C0041618
- UMLS CUI [4]
- C0040405
- UMLS CUI [5]
- C0024485
- UMLS CUI [6]
- C0008310
- UMLS CUI [7]
- C0205394
Description
If No, record the details on the Non-Serious Adverse Events form or Serious Adverse Event form.
Data type
text
Alias
- UMLS CUI [1,1]
- C0086143
- UMLS CUI [1,2]
- C0456984
- UMLS CUI [1,3]
- C0205307
Description
If Yes, complete Liver Biopsy form.
Data type
text
Alias
- UMLS CUI [1]
- C0193388
Description
If Yes, record on the appropriate Concomitant Medication form.
Data type
text
Alias
- UMLS CUI [1]
- C2240391
- UMLS CUI [2]
- C0002346
- UMLS CUI [3]
- C0242295
- UMLS CUI [4]
- C0086190
Description
Dietary Change, Fasting
Data type
text
Alias
- UMLS CUI [1]
- C3671772
- UMLS CUI [2]
- C0015663
Description
An unscheduled PK blood sample must be obtained within 24 hours of last dose (or 3x the investigational product half-life or t1!2).
Data type
text
Alias
- UMLS CUI [1,1]
- C0031328
- UMLS CUI [1,2]
- C0005834
Description
day month year
Data type
date
Alias
- UMLS CUI [1,1]
- C0005834
- UMLS CUI [1,2]
- C0011008
Description
00:00-23:59
Data type
time
Alias
- UMLS CUI [1,1]
- C0005834
- UMLS CUI [1,2]
- C0040223
Description
day month year
Data type
date
Alias
- UMLS CUI [1,1]
- C0005834
- UMLS CUI [1,2]
- C0011008
- UMLS CUI [2,1]
- C1517741
- UMLS CUI [2,2]
- C0304229
- UMLS CUI [2,3]
- C0678766
- UMLS CUI [2,4]
- C0332152
- UMLS CUI [2,5]
- C0031327
Description
00:00-23:59
Data type
time
Alias
- UMLS CUI [1,1]
- C0005834
- UMLS CUI [1,2]
- C0040223
- UMLS CUI [2,1]
- C1517741
- UMLS CUI [2,2]
- C0304229
- UMLS CUI [2,3]
- C0678766
- UMLS CUI [2,4]
- C0332152
- UMLS CUI [2,5]
- C0031327
Description
Sample Identifier Label
Data type
text
Alias
- UMLS CUI [1,1]
- C0005834
- UMLS CUI [1,2]
- C0600091
Description
Sample Number
Data type
text
Alias
- UMLS CUI [1]
- C1299222
Description
Alcohol intake
Alias
- UMLS CUI-1
- C0001948
Description
LIVER DISEASE MEDICAL CONDITIONS
Alias
- UMLS CUI-1
- C0023895
Description
Tick only one response for each condition
Data type
integer
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C2348235
Description
Definitions: CURRENT MEDICAL CONDITIONS Conditionsfrom which the subject is currentlysuffering, regardlessof how long they have been present. If the subject has had a recurring condition that is not present at the time of the assessment, it can be classed as current if, in the Investigator's opinion it is likely to recur during the study. PAST MEDICAL CONDITIONS Conditions from which the subject has sufferedin the past, but are no longer present. A past condition may have stoppedas recently as the day prior to being assessed. NO MEDICAL CONDITION No current or past condition.
Data type
integer
Alias
- UMLS CUI [1,1]
- C3854307
- UMLS CUI [1,2]
- C0012634
Description
DRUG RELATED LIVER DISEASE CONDITIONS (All drugs including lnvestigational Product)
Description
OTHER LIVER DISEASE CONDITIONS
Alias
- UMLS CUI-1
- C0023895
- UMLS CUI-2
- C0205394
Description
Other liver disease
Data type
text
Alias
- UMLS CUI [1,1]
- C0023895
- UMLS CUI [1,2]
- C0205394
Description
Definitions: CURRENT MEDICAL CONDITIONS Conditionsfrom which the subject is currentlysuffering, regardlessof how long they have been present. If the subject has had a recurring condition that is not present at the time of the assessment, it can be classed as current if, in the Investigator's opinion it is likely to recur during the study. PAST MEDICAL CONDITIONS Conditions from which the subject has sufferedin the past, but are no longer present. A past condition may have stoppedas recently as the day prior to being assessed.
Data type
integer
Alias
- UMLS CUI [1,1]
- C3854307
- UMLS CUI [1,2]
- C0012634
Description
OTHER MEDICAL CONDITIONS
Alias
- UMLS CUI-1
- C0012634
- UMLS CUI-2
- C0205394
Description
Disease
Data type
integer
Alias
- UMLS CUI [1]
- C0012634
Description
Definitions: CURRENT MEDICAL CONDITIONS Conditionsfrom which the subject is currentlysuffering, regardlessof how long they have been present. If the subject has had a recurring condition that is not present at the time of the assessment, it can be classed as current if, in the Investigator's opinion it is likely to recur during the study. PAST MEDICAL CONDITIONS Conditions from which the subject has sufferedin the past, but are no longer present. A past condition may have stoppedas recently as the day prior to being assessed. NO MEDICAL CONDITION No current or past condition.
Data type
integer
Alias
- UMLS CUI [1,1]
- C3854307
- UMLS CUI [1,2]
- C0012634
Similar models
Liver events
- StudyEvent: ODM
C0877248 (UMLS CUI-2)
C0220825 (UMLS CUI-3)
C0877248 (UMLS CUI-2)
C0220825 (UMLS CUI-3)
C0008000 (UMLS CUI [1,2])
C1254595 (UMLS CUI [1,3])
C2746065 (UMLS CUI [1,4])
C0243161 (UMLS CUI [1,5])
C1948053 (UMLS CUI-2)
C0201836 (UMLS CUI-3)
C0023884 (UMLS CUI [1,2])
C0877248 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,2])
C0877248 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
C0023884 (UMLS CUI [1,2])
C0011923 (UMLS CUI [2,1])
C1711359 (UMLS CUI [2,2])
C0023884 (UMLS CUI [3,1])
C0041618 (UMLS CUI [3,2])
C0040405 (UMLS CUI [4])
C0024485 (UMLS CUI [5])
C0008310 (UMLS CUI [6])
C0205394 (UMLS CUI [7])
C0456984 (UMLS CUI [1,2])
C0205307 (UMLS CUI [1,3])
C0002346 (UMLS CUI [2])
C0242295 (UMLS CUI [3])
C0086190 (UMLS CUI [4])
C0015663 (UMLS CUI [2])
C0005834 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C1517741 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C0678766 (UMLS CUI [2,3])
C0332152 (UMLS CUI [2,4])
C0031327 (UMLS CUI [2,5])
C0040223 (UMLS CUI [1,2])
C1517741 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C0678766 (UMLS CUI [2,3])
C0332152 (UMLS CUI [2,4])
C0031327 (UMLS CUI [2,5])
C0600091 (UMLS CUI [1,2])
C0560579 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,2])
C0012634 (UMLS CUI [1,2])
C0277579 (UMLS CUI [1,2])
C0205394 (UMLS CUI-2)
C0205394 (UMLS CUI [1,2])
C0012634 (UMLS CUI [1,2])
C0205394 (UMLS CUI-2)
C0012634 (UMLS CUI [1,2])