ID

37354

Description

Study ID: 111592 Clinical Study ID: 111592 Study Title: A Randomized, Double-blind, Placebo-controlled, Doseescalation Study to Assess the Anti-inflammatory Activity, Efficacy, and Safety of Intravenous SB-681323 in Subjects at Risk for Development of Acute Lung Injury or ARDS Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00996840 See https://clinicaltrials.gov/ct2/show/NCT00996840 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: Placebo, SB-681323 Trade Name: N/A Study Indication: Lung Injury, Acute The primary objective of this phase 2 trial is to evaluate the safety and tolerability of intravenous dilmapimod/SB-681323 given in escalating dosages and over different intervals for three days in trauma patients at risk for the development of ALI or ARDS. This study consists of Screening, infusion of dilmapimod/SB-681323 on days 1-3, examination/sampling up to early day 5 (denoted as "Day 3 - 48 hrs") and a Follow-up on day 7. There are four cohorts, cohorts 1 and 3 receive the medication (or placebo) infusion over 4 hours, cohorts 2 and 4 over 24 hours. This form contains details on the administration of the investigational product and is to be filled in at Day 1, 2 and 3. Additionally, this form also contains Randomisation information and the assignment of the participant to one of the four cohorts for/prior to the first medication administration.

Link

https://clinicaltrials.gov/ct2/show/NCT00996840

Keywords

Versions (2)
  1. 7/16/19 7/16/19 -
  2. 7/20/19 7/20/19 -
Copyright Holder

GlaxoSmithKline

Uploaded on

July 20, 2019

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

SB-681323 in ALI/ARDS risk patients - NCT00996840

English

Investigational Product - IV Dosing, Randomisation, Cohort Assignment

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Subject ID
Description

Subject ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Date of Visit
Description

please fill in the form for each of the three study days

Data type

integer

Alias
UMLS CUI [1]
C1320303
Which Cohort is the subject enrolled in?
Description

Please ensure the Cohort selected is correct before submitting. Medication is infused over 4 or 24 hours depending on the cohort.

Data type

text

Alias
UMLS CUI [1]
C0599755
Date/Time of Cohort Assignment
Description

Date/Time of Cohort Assignment

Data type

datetime

Alias
UMLS CUI [1,1]
C0599755
UMLS CUI [1,2]
C1516050
UMLS CUI [1,3]
C1264639
First Administration
Description

First Administration

Alias
UMLS CUI-1
C3469597
Dosage Duration (per Protocol)
Description

Cohorts 1/3: 0-4 hrs Cohorts 2/4: 0-24hrs

Data type

integer

Alias
UMLS CUI [1,1]
C0449238
UMLS CUI [1,2]
C3469597
UMLS CUI [1,3]
C0304229
Start Date and Time
Description

Start Date and Time

Data type

datetime

Alias
UMLS CUI [1]
C3897500
Stop Date and Time
Description

Stop Date and Time

Data type

datetime

Alias
UMLS CUI [1]
C3899266
Volume administered (mL)
Description

Volume administered

Data type

float

Measurement units
  • mL
Alias
UMLS CUI [1]
C2349139
mL
Administration post interruption
Description

Administration post interruption

Alias
UMLS CUI-1
C3469597
UMLS CUI-2
C0687676
UMLS CUI-3
C1512900
Dosage Duration (per Protocol)
Description

Cohorts 1/3: 0-4 hrs Cohorts 2/4: 0-24 hrs

Data type

integer

Alias
UMLS CUI [1,1]
C0449238
UMLS CUI [1,2]
C3469597
UMLS CUI [1,3]
C0304229
Start Date and Time
Description

Start Date and Time

Data type

datetime

Alias
UMLS CUI [1]
C3897500
Stop Date and Time
Description

Stop Date and Time

Data type

datetime

Alias
UMLS CUI [1]
C3899266
Volume administered (mL)
Description

Volume administered

Data type

float

Measurement units
  • mL
Alias
UMLS CUI [1]
C2349139
mL
Investigational Product Container Number
Description

Investigational Product Container Number

Alias
UMLS CUI-1
C0304229
UMLS CUI-2
C0180098
UMLS CUI-3
C0600091
Investigational Product Container Number
Description

Record the identifying number from the investigational product container dispensed at this visit

Data type

text

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C0180098
UMLS CUI [1,3]
C0600091
Treatment Confirmation
Description

Treatment Confirmation

Alias
UMLS CUI-1
C0750484
UMLS CUI-2
C0087111
Did the subject receive the correct treatment (e.g., treatment which the subject was assigned to) during this dosing interval?
Description

If no, record reasons

Data type

boolean

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C2349182
Reason incorrect treatment
Description

if applicable

Data type

text

Alias
UMLS CUI [1,1]
C0566251
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C3827420
Randomisation Number
Description

Randomisation Number

Alias
UMLS CUI-1
C0034656
UMLS CUI-2
C0237753
Was the subject able to be randomised?
Description

If yes, provide Randomisation Number and Date/time of randomisation

Data type

boolean

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0332149
Randomisation Number
Description

if applicable

Data type

integer

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0237753
Date/time of randomisation
Description

if applicable

Data type

datetime

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C1264639
Back to the top of the page

Similar models

Investigational Product - IV Dosing, Randomisation, Cohort Assignment

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Subject ID
Item
Subject ID
integer
C2348585 (UMLS CUI [1])
Item
Date of Visit
integer
C1320303 (UMLS CUI [1])
Date of Visit
Code List
Date of Visit
CL Item
Day 1 (1)
CL Item
Day 2 (2)
CL Item
Day 3 (3)
Item
Which Cohort is the subject enrolled in?
text
C0599755 (UMLS CUI [1])
Cohort
Code List
Which Cohort is the subject enrolled in?
CL Item
Cohort 1 (3mg/Placebo IV / 4hrs) (C1)
CL Item
Cohort 2 (7.5mg/Placebo IV / 24hrs) (C2)
CL Item
Cohort 3 (7.5mg/Placebo IV / 4hrs) (C3)
CL Item
Cohort 4 (10mg/Placebo IV / 24hrs) (C4)
Date/Time of Cohort Assignment
Item
Date/Time of Cohort Assignment
datetime
C0599755 (UMLS CUI [1,1])
C1516050 (UMLS CUI [1,2])
C1264639 (UMLS CUI [1,3])
Item Group
First Administration
C3469597 (UMLS CUI-1)
Item
Dosage Duration (per Protocol)
integer
C0449238 (UMLS CUI [1,1])
C3469597 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
Dosage Duration
Code List
Dosage Duration (per Protocol)
CL Item
0-4 hrs (1)
CL Item
0-24 hrs (2)
Start Date and Time
Item
Start Date and Time
datetime
C3897500 (UMLS CUI [1])
Stop Date and Time
Item
Stop Date and Time
datetime
C3899266 (UMLS CUI [1])
Volume administered
Item
Volume administered (mL)
float
C2349139 (UMLS CUI [1])
Item Group
Administration post interruption
C3469597 (UMLS CUI-1)
C0687676 (UMLS CUI-2)
C1512900 (UMLS CUI-3)
Item
Dosage Duration (per Protocol)
integer
C0449238 (UMLS CUI [1,1])
C3469597 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
Dosage Duration
Code List
Dosage Duration (per Protocol)
CL Item
0-4 hrs (1)
CL Item
0-24 hrs (2)
Start Date and Time
Item
Start Date and Time
datetime
C3897500 (UMLS CUI [1])
Stop Date and Time
Item
Stop Date and Time
datetime
C3899266 (UMLS CUI [1])
Volume administered
Item
Volume administered (mL)
float
C2349139 (UMLS CUI [1])
Item Group
Investigational Product Container Number
C0304229 (UMLS CUI-1)
C0180098 (UMLS CUI-2)
C0600091 (UMLS CUI-3)
Investigational Product Container Number
Item
Investigational Product Container Number
text
C0304229 (UMLS CUI [1,1])
C0180098 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
Item Group
Treatment Confirmation
C0750484 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
Correct treatment received
Item
Did the subject receive the correct treatment (e.g., treatment which the subject was assigned to) during this dosing interval?
boolean
C0087111 (UMLS CUI [1,1])
C2349182 (UMLS CUI [1,2])
Reason incorrect treatment
Item
Reason incorrect treatment
text
C0566251 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C3827420 (UMLS CUI [1,3])
Item Group
Randomisation Number
C0034656 (UMLS CUI-1)
C0237753 (UMLS CUI-2)
Randomisation possible
Item
Was the subject able to be randomised?
boolean
C0034656 (UMLS CUI [1,1])
C0332149 (UMLS CUI [1,2])
Randomisation Number
Item
Randomisation Number
integer
C0034656 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Randomisation Date/Time
Item
Date/time of randomisation
datetime
C0034656 (UMLS CUI [1,1])
C1264639 (UMLS CUI [1,2])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial