ID

38164

Description

Study ID: 105-123 Clinical Study ID: 105-123 Study Title: Lamotrigine as add-on therapy in patients with clinical diagnosis of a Lennox-Gastaut syndrome (severe generalised epilepsy of childhood onset.) A multicentre, double-blind, placebo controlled parallel group study Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Sponsor: GlaxoSmithKline Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Lamotrigine Study Indication: Seizures

Mots-clés

Versions (1)
  1. 23/09/2019 23/09/2019 -
Détendeur de droits

GlaxoSmithKline

Téléchargé le

23 septembre 2019

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0
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Lamotrigine as add-on therapy in patients with a clinical diagnosis of a Lennox-Gastaut syndrome (105-123)

Anglais

Study Termination Record

1 Formulaires  
Administrative
Description

Administrative

Alias
UMLS CUI-1
C1320722
Patient's initials
Description

Patient's initials

Type de données

text

Alias
UMLS CUI [1]
C2986440
Patient's trial number
Description

Patient's trial number

Type de données

text

Alias
UMLS CUI [1]
C2348585
Centre number
Description

Centre number

Type de données

text

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Date the patient took last full dose of study medication
Description

Date the patient took last full dose of study medication

Type de données

date

Alias
UMLS CUI [1]
C1762893
Date of last assessment
Description

Date of last assessment

Type de données

date

Alias
UMLS CUI [1,1]
C2985720
UMLS CUI [1,2]
C1517741
Study Termination
Description

Study Termination

Alias
UMLS CUI-1
C0008972
UMLS CUI-2
C0013135
Did the patient complete 16 weeks of the study?
Description

Did the patient complete 16 weeks of the study?

Type de données

boolean

Alias
UMLS CUI [1]
C2348577
Did the patient discontinued prematurely?
Description

Did the patient discontinued prematurely?

Type de données

boolean

Alias
UMLS CUI [1]
C2718058
If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?
Description

If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?

Type de données

boolean

Alias
UMLS CUI [1]
C2348577
UMLS CUI [2,1]
C0064636
UMLS CUI [2,2]
C0549178
UMLS CUI [3,1]
C0064636
UMLS CUI [3,2]
C0439659
If the patient completed 16 weeks did he/ she taper off study medication from week 16?
Description

If the patient completed 16 weeks did he/ she taper off study medication from week 16?

Type de données

boolean

Alias
UMLS CUI [1]
C2348577
UMLS CUI [2,1]
C0441640
UMLS CUI [2,2]
C0304229
If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?
Description

If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?

Type de données

boolean

Alias
UMLS CUI [1]
C2718058
UMLS CUI [2]
C0877248
UMLS CUI [3,1]
C0013230
UMLS CUI [3,2]
C0439849
Did the patient die during the study?
Description

Did the patient die during the study?

Type de données

boolean

Alias
UMLS CUI [1,1]
C0011065
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0008976
If patient died, enter date of Death
Description

If patient died, enter date of Death

Type de données

date

Alias
UMLS CUI [1]
C1148348
Cause of Death
Description

Cause of Death

Type de données

text

Alias
UMLS CUI [1]
C0007465
Other reasons for premature discontinuation
Description

Please chek on only.

Type de données

integer

Alias
UMLS CUI [1,1]
C2718058
UMLS CUI [1,2]
C3840932
Investigator's Statement
Description

Investigator's Statement

Alias
UMLS CUI-1
C0008961
UMLS CUI-2
C1710187
Principal Investigator's signature
Description

I confirm that I have carefully examined all entries on the Case Report Forms for this patient. All Information entered by myself or my colleagues is, to the best of my knowledge, correct as of the date below.

Type de données

text

Alias
UMLS CUI [1,1]
C1519316
UMLS CUI [1,2]
C1521895
Prinicpal Investigator's Name
Description

Prinicpal Investigator's Name

Type de données

text

Alias
UMLS CUI [1]
C2826892
Date of Signature
Description

Date of Signature

Type de données

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
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Similar models

Study Termination Record

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Patient's initials
Item
Patient's initials
text
C2986440 (UMLS CUI [1])
Patient's trial number
Item
Patient's trial number
text
C2348585 (UMLS CUI [1])
Centre number
Item
Centre number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Date the patient took last full dose of study medication
Item
Date the patient took last full dose of study medication
date
C1762893 (UMLS CUI [1])
Date of last assessment
Item
Date of last assessment
date
C2985720 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
Item Group
Study Termination
C0008972 (UMLS CUI-1)
C0013135 (UMLS CUI-2)
Did the patient complete 16 weeks of the study?
Item
Did the patient complete 16 weeks of the study?
boolean
C2348577 (UMLS CUI [1])
Did the patient discontinued prematurely?
Item
Did the patient discontinued prematurely?
boolean
C2718058 (UMLS CUI [1])
If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?
Item
If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?
boolean
C2348577 (UMLS CUI [1])
C0064636 (UMLS CUI [2,1])
C0549178 (UMLS CUI [2,2])
C0064636 (UMLS CUI [3,1])
C0439659 (UMLS CUI [3,2])
If the patient completed 16 weeks did he/ she taper off study medication from week 16?
Item
If the patient completed 16 weeks did he/ she taper off study medication from week 16?
boolean
C2348577 (UMLS CUI [1])
C0441640 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?
Item
If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?
boolean
C2718058 (UMLS CUI [1])
C0877248 (UMLS CUI [2])
C0013230 (UMLS CUI [3,1])
C0439849 (UMLS CUI [3,2])
Did the patient die during the study?
Item
Did the patient die during the study?
boolean
C0011065 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
If patient died, enter date of Death
Item
If patient died, enter date of Death
date
C1148348 (UMLS CUI [1])
Cause of Death
Item
Cause of Death
text
C0007465 (UMLS CUI [1])
Item
Other reasons for premature discontinuation
integer
C2718058 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
Other reasons for premature discontinuation
Code List
Other reasons for premature discontinuation
CL Item
Patient failed to return (1)
CL Item
Parent/ guardian withdrew consent (2)
CL Item
Protocol violation (3)
CL Item
General condition deteriorated (4)
CL Item
Clinically significant deterioration of seizure control (5)
Item Group
Investigator's Statement
C0008961 (UMLS CUI-1)
C1710187 (UMLS CUI-2)
Principal Investigator's signature
Item
Principal Investigator's signature
text
C1519316 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
Prinicpal Investigator's Name
Item
Prinicpal Investigator's Name
text
C2826892 (UMLS CUI [1])
Date of Signature
Item
Date of Signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Retour au début de la page 

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