ID
38670
Description
Study ID: 101468/205 Clinical Study ID: 101468/205 Study Title:A 12-Week, Double-Blind, Placebo Controlled, Parallel Group Study to Assess the Efficacy and Safety of Ropinirole XR (Extended Release) in Patients with Restless Legs Syndrome Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00197080 Sponsor: GlaxoSmithKline Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Modutab,ZIPEREVE,ZEPREVE,REPREVE,ADARTREL,REQUIP,Zygara; Zygara,ZIPEREVE,ZEPREVE,Requip Depot,REQUIP,REPREVE,Modutab,ADARTREL Study Indication: Restless Legs Syndrome
Keywords
Versions (2)
- 2/18/19 2/18/19 -
- 10/30/19 10/30/19 - Sarah Riepenhausen
Copyright Holder
GlaxoSmithKline
Uploaded on
October 30, 2019
DOI
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License
Creative Commons BY-NC 3.0
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Efficacy and Safety of Ropinirole XR (Extended Release) in Patients with Restless Legs Syndrome NCT00197080
Investigational Product; Status of Treatment Blind; Pharmacogenetic Research; Concomitant Medication; Non-Serious Adverse Events; Serious Adverse Events
Description
Investigational Product
Alias
- UMLS CUI-1
- C0304229
Description
e.g., 1
Data type
text
Alias
- UMLS CUI [1,1]
- C0178602
- UMLS CUI [1,2]
- C0304229
Description
Investigational Product Start Date
Data type
date
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0808070
Description
Investigational Product Stop Date
Data type
date
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0806020
Description
Has the subject missed investigational product for >2 consecutive days?
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0457454
- UMLS CUI [1,3]
- C0439228
- UMLS CUI [1,4]
- C1707491
Description
Investigational Product Container Number
Data type
integer
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0180098
- UMLS CUI [1,3]
- C0600091
Description
Investigational Product Container Number
Data type
integer
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0180098
- UMLS CUI [1,3]
- C0600091
Description
Status of Treatment Blind
Alias
- UMLS CUI-1
- C0749659
- UMLS CUI-2
- C2347038
Description
If Yes, complete the following
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0749659
- UMLS CUI [1,2]
- C2347038
Description
Date blind broken
Data type
date
Alias
- UMLS CUI [1,1]
- C3897431
- UMLS CUI [1,2]
- C0011008
Description
Complete Non-Serious Adverse Events or Serious Adverse Event pages, as appropriate.
Data type
integer
Alias
- UMLS CUI [1,1]
- C3897431
- UMLS CUI [1,2]
- C0392360
Description
If other reason for blind broken, specify.
Data type
text
Alias
- UMLS CUI [1,1]
- C3897431
- UMLS CUI [1,2]
- C0392360
- UMLS CUI [1,3]
- C0205394
- UMLS CUI [1,4]
- C2348235
Description
Consent for Pharmacogenetic Research
Alias
- UMLS CUI-1
- C0021430
- UMLS CUI-2
- C2347500
Description
If Yes, record the date informed consent obtained for PGx-Pharmacogenetic research If No, check one reason
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0021430
- UMLS CUI [1,2]
- C2347500
Description
Date informed consent obtained for PGx-Pharmacogenetic research
Data type
date
Alias
- UMLS CUI [1,1]
- C0021430
- UMLS CUI [1,2]
- C2347500
- UMLS CUI [1,3]
- C0011008
Description
Reason for informed consent for PGx-Pharmacogenetic research not obtained
Data type
integer
Alias
- UMLS CUI [1,1]
- C0021430
- UMLS CUI [1,2]
- C2347500
- UMLS CUI [1,3]
- C1882120
- UMLS CUI [1,4]
- C0392360
Description
Other reason for informed consent for PGx-Pharmacogenetic research not obtained
Data type
text
Alias
- UMLS CUI [1,1]
- C0021430
- UMLS CUI [1,2]
- C2347500
- UMLS CUI [1,3]
- C1882120
- UMLS CUI [1,4]
- C0392360
- UMLS CUI [1,5]
- C0205394
- UMLS CUI [1,6]
- C2348235
Description
PGx - Blood Sample Collection (DNA)
Alias
- UMLS CUI-1
- C0031325
- UMLS CUI-2
- C0005834
- UMLS CUI-3
- C0012854
Description
PGx - Withdrawal of Consent
Alias
- UMLS CUI-1
- C2347500
- UMLS CUI-2
- C0021430
- UMLS CUI-3
- C2349954
Description
PGx - Blood Sample Destruction
Alias
- UMLS CUI-1
- C0031325
- UMLS CUI-2
- C0370003
- UMLS CUI-3
- C1948029
Description
If Yes, check one reason
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0031325
- UMLS CUI [1,2]
- C0370003
- UMLS CUI [1,3]
- C1948029
- UMLS CUI [1,4]
- C1272683
Description
Reason for sample destruction
Data type
integer
Alias
- UMLS CUI [1,1]
- C1948029
- UMLS CUI [1,2]
- C0178913
- UMLS CUI [1,3]
- C0392360
Description
If other Reason for sample destruction, specify
Data type
text
Alias
- UMLS CUI [1,1]
- C1948029
- UMLS CUI [1,2]
- C0178913
- UMLS CUI [1,3]
- C0392360
- UMLS CUI [1,4]
- C0205394
- UMLS CUI [1,5]
- C2348235
Description
Concomitant Medications
Alias
- UMLS CUI-1
- C2347852
Description
If Yes, record each medication on a separate line using Trade Names where possible. If the medication is related to a Non-Serious Adverse Event or Serious Adverse Event, details should be expressed using the same terminology.
Data type
boolean
Alias
- UMLS CUI [1]
- C2347852
Description
Concomitant Medications
Alias
- UMLS CUI-1
- C2347852
Description
(Trade Name preferred) e.g., Aspirin
Data type
text
Alias
- UMLS CUI [1]
- C2360065
Description
Total Daily Dose
Data type
integer
Alias
- UMLS CUI [1,1]
- C2348070
- UMLS CUI [1,2]
- C0439810
Description
Units
Data type
text
Alias
- UMLS CUI [1]
- C1519795
Description
Reason for Medication
Data type
text
Alias
- UMLS CUI [1,1]
- C0392360
- UMLS CUI [1,2]
- C0013227
Description
Start Date
Data type
date
Alias
- UMLS CUI [1]
- C2826734
Description
Medication Taken Prior to Study?
Data type
boolean
Alias
- UMLS CUI [1]
- C2826667
Description
Concomitant Medication Stop Date
Data type
date
Alias
- UMLS CUI [1]
- C2826744
Description
Ongoing Medication?
Data type
boolean
Alias
- UMLS CUI [1]
- C2826666
Description
Non-Serious Adverse Events
Alias
- UMLS CUI-1
- C1518404
Description
Non-Serious Adverse Events
Alias
- UMLS CUI-1
- C1518404
Description
Diagnosis Only (if known), Otherwise Sign/Symptom
Data type
text
Alias
- UMLS CUI [1]
- C0877248
Description
Non-Serious Adverse Event Start Date
Data type
date
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C2697888
Description
Non-Serious Adverse Event Start Time
Data type
time
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1301880
Description
Non-Serious Adverse Event Outcome
Data type
integer
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C1705586
Description
Non-Serious Adverse Event End Date
Data type
date
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C0806020
Description
Non-Serious Adverse Event End Time
Data type
time
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C1522314
Description
Non-Serious Adverse Event Frequency
Data type
integer
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C0439603
Description
Non-Serious Adverse Event Maximum Intensity
Data type
integer
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C0518690
- UMLS CUI [1,3]
- C0806909
Description
Action Taken with Investigational Product(s) as a Result of the Non-Serious AE
Data type
integer
Alias
- UMLS CUI [1,1]
- C1704758
- UMLS CUI [1,2]
- C1518404
Description
Withdrawal
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1710677
- UMLS CUI [1,2]
- C1518404
Description
Relationship to Investigational Product(s)
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C0013230
- UMLS CUI [1,3]
- C0439849
Description
Time to Onset Since Last Dose
Data type
time
Measurement units
- Hr(s):Min(s)
Alias
- UMLS CUI [1,1]
- C0449244
- UMLS CUI [1,2]
- C1762893
Description
Serious Adverse Events
Alias
- UMLS CUI-1
- C1519255
Description
If Yes, record details below.
Data type
boolean
Alias
- UMLS CUI [1]
- C1519255
Description
Subject Identifier
Data type
integer
Alias
- UMLS CUI [1]
- C2348585
Description
Centre Number
Data type
integer
Alias
- UMLS CUI [1,1]
- C0600091
- UMLS CUI [1,2]
- C0019994
Description
Randomisation Number
Data type
integer
Alias
- UMLS CUI [1,1]
- C0034656
- UMLS CUI [1,2]
- C0237753
Description
Serious Adverse Events - Section 1
Alias
- UMLS CUI-1
- C1519255
Description
Diagnosis Only (if known) Otherwise Sign/Symptom
Data type
text
Alias
- UMLS CUI [1]
- C0877248
Description
Serious Adverse Event Start Date
Data type
date
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0808070
Description
Serious Adverse Event Start Time
Data type
time
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1301880
Description
Serious Adverse Event Outcome
Data type
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1705586
Description
If fatal, record date of death.
Data type
date
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0806020
Description
Serious Adverse Event End Time
Data type
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1522314
Description
Serious Adverse Event Maximum Intensity
Data type
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0518690
- UMLS CUI [1,3]
- C0806909
Description
Action Taken with Investigational Product(s) as a Result of the SAE
Data type
integer
Alias
- UMLS CUI [1,1]
- C1704758
- UMLS CUI [1,2]
- C1519255
Description
If yes, Complete Study Conclusion page and check Adverse event as reason for withdrawal.
Data type
boolean
Alias
- UMLS CUI [1,1]
- C2349954
- UMLS CUI [1,2]
- C1519255
Description
Relationship to Investigational Product(s)
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1519255
Description
Time to Onset Since Last Dose
Data type
time
Measurement units
- Hr(s):Min(s)
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0946444
- UMLS CUI [1,3]
- C0449244
Description
If Yes, summarise findings in Section 11 Narrative Remarks of this SAE form.
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0004398
- UMLS CUI [1,2]
- C1519255
Description
Serious Adverse Events - Section 2 (Seriousness)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C1710056
Description
Seriousness
Data type
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1710056
Description
If other Reason for considering this a SAE, please specify.
Data type
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1710056
- UMLS CUI [1,3]
- C0205394
- UMLS CUI [1,4]
- C2348235
Description
Serious Adverse Events - Section 3 (Demography Data)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0011298
Description
Serious Adverse Events - Section 4
Alias
- UMLS CUI-1
- C1519255
Description
If Investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further Investigational Product(s) were Administered?
Data type
integer
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0457454
- UMLS CUI [2,1]
- C1519255
- UMLS CUI [2,2]
- C0034897
Description
Serious Adverse Events - Section 5 (Possible Cause of SAE)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0085978
Description
Check all that apply:
Data type
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [2,1]
- C0304229
- UMLS CUI [2,2]
- C0205394
Description
If other cause, specify
Data type
text
Alias
- UMLS CUI [1,1]
- C0085978
- UMLS CUI [1,2]
- C1519255
- UMLS CUI [1,3]
- C0205394
- UMLS CUI [1,4]
- C2348235
Description
Serious Adverse Events - Medical Conditions
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0012634
Description
Specify any RELEVANT past or current medical disorders, allergies, surgeries, etc. that can help explain the SAE
Data type
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0521116
- UMLS CUI [1,3]
- C2347946
- UMLS CUI [2]
- C0020517
- UMLS CUI [3]
- C0543467
Description
Medical Condition Date of Onset
Data type
date
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0574845
Description
Condition Present at Time of the SAE?
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C1519255
Description
If No, Date of Last Occurrence
Data type
date
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0011008
- UMLS CUI [1,3]
- C2745955
Description
Serious Adverse Events - Section 7 (Other relevant Risk Factors)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0035648
- UMLS CUI-3
- C2347946
Description
Serious Adverse Events - Section 8 (Relevant Concomitant Medication)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C2347852
Description
Trade Name preferred
Data type
text
Alias
- UMLS CUI [1]
- C0013227
Description
Medication Dose
Data type
integer
Alias
- UMLS CUI [1]
- C3174092
Description
Medication Unit
Data type
text
Alias
- UMLS CUI [1]
- C2826646
Description
Medication Frequency
Data type
text
Alias
- UMLS CUI [1]
- C3476109
Description
Medication Route
Data type
text
Alias
- UMLS CUI [1]
- C0013153
Description
Taken Prior to Study?
Data type
boolean
Alias
- UMLS CUI [1]
- C2826667
Description
Medication Start Date
Data type
date
Alias
- UMLS CUI [1]
- C2826734
Description
Medication Stop Date
Data type
date
Alias
- UMLS CUI [1]
- C2826744
Description
Ongoing Medication?
Data type
boolean
Alias
- UMLS CUI [1]
- C2826666
Description
Reason for Medication
Data type
text
Alias
- UMLS CUI [1]
- C2826696
Description
Serious Adverse Events - Section 9 (Details of Investigational Product(s))
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0304229
Description
Investigational Product Start Date
Data type
date
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0808070
Description
Investigational Product Start Time
Data type
time
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C1301880
Description
Start Date of Most Recent Titration to SAE
Data type
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C0162621
- UMLS CUI [1,3]
- C1519255
- UMLS CUI [1,4]
- C1513491
Description
Start Time of Most Recent Titration to SAE
Data type
time
Alias
- UMLS CUI [1,1]
- C1301880
- UMLS CUI [1,2]
- C0162621
- UMLS CUI [1,3]
- C1519255
- UMLS CUI [1,4]
- C1513491
Description
Dose of Most Recent Titration
Data type
text
Alias
- UMLS CUI [1,1]
- C3174092
- UMLS CUI [1,2]
- C0162621
- UMLS CUI [1,3]
- C1513491
Description
Was treatment blind broken at investigational site?
Data type
integer
Alias
- UMLS CUI [1]
- C3897431
Description
Serious Adverse Events - Section 10 ( Details of relevant Assessments)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0220825
- UMLS CUI-3
- C2347946
Description
Serious Adverse Events - Section 11 (Narrative Remarks)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0947611
Description
Serious Adverse Events - Investigator's signature
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C2346576
Similar models
Investigational Product; Status of Treatment Blind; Pharmacogenetic Research; Concomitant Medication; Non-Serious Adverse Events; Serious Adverse Events
C0304229 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0457454 (UMLS CUI [1,2])
C0439228 (UMLS CUI [1,3])
C1707491 (UMLS CUI [1,4])
C0180098 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
C0180098 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
C2347038 (UMLS CUI-2)
C2347038 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
C2347500 (UMLS CUI-2)
C2347500 (UMLS CUI [1,2])
C2347500 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C2347500 (UMLS CUI [1,2])
C1882120 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
C2347500 (UMLS CUI [1,2])
C1882120 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
C0205394 (UMLS CUI [1,5])
C2348235 (UMLS CUI [1,6])
C0005834 (UMLS CUI-2)
C0012854 (UMLS CUI-3)
C0005834 (UMLS CUI [1,2])
C0021430 (UMLS CUI-2)
C2349954 (UMLS CUI-3)
C0021430 (UMLS CUI [1,2])
C2349954 (UMLS CUI [1,3])
C0370003 (UMLS CUI-2)
C1948029 (UMLS CUI-3)
C0370003 (UMLS CUI [1,2])
C1948029 (UMLS CUI [1,3])
C1272683 (UMLS CUI [1,4])
C0178913 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
C0178913 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,4])
C2348235 (UMLS CUI [1,5])
C0439810 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C2697888 (UMLS CUI [1,2])
C1301880 (UMLS CUI [1,2])
C1705586 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C1522314 (UMLS CUI [1,2])
C0439603 (UMLS CUI [1,2])
C0518690 (UMLS CUI [1,2])
C0806909 (UMLS CUI [1,3])
C1518404 (UMLS CUI [1,2])
C1518404 (UMLS CUI [1,2])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
C1762893 (UMLS CUI [1,2])
C0019994 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C1301880 (UMLS CUI [1,2])
C1705586 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C1522314 (UMLS CUI [1,2])
C0518690 (UMLS CUI [1,2])
C0806909 (UMLS CUI [1,3])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C0085978 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C0946444 (UMLS CUI [1,2])
C0449244 (UMLS CUI [1,3])
C1519255 (UMLS CUI [1,2])
C1710056 (UMLS CUI-2)
C1710056 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
C0011298 (UMLS CUI-2)
C0457454 (UMLS CUI [1,2])
C1519255 (UMLS CUI [2,1])
C0034897 (UMLS CUI [2,2])
C0085978 (UMLS CUI-2)
C0085978 (UMLS CUI [1,2])
C0304229 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C1519255 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
C0012634 (UMLS CUI-2)
C0521116 (UMLS CUI [1,2])
C2347946 (UMLS CUI [1,3])
C0020517 (UMLS CUI [2])
C0543467 (UMLS CUI [3])
C0574845 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0035648 (UMLS CUI-2)
C2347946 (UMLS CUI-3)
C0035648 (UMLS CUI [1,2])
C2347946 (UMLS CUI [1,3])
C2347852 (UMLS CUI-2)
C0304229 (UMLS CUI-2)
C0808070 (UMLS CUI [1,2])
C1301880 (UMLS CUI [1,2])
C0162621 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1513491 (UMLS CUI [1,4])
C0162621 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1513491 (UMLS CUI [1,4])
C0162621 (UMLS CUI [1,2])
C1513491 (UMLS CUI [1,3])
C0220825 (UMLS CUI-2)
C2347946 (UMLS CUI-3)
C2347946 (UMLS CUI [1,2])
C0947611 (UMLS CUI-2)
C2346576 (UMLS CUI-2)