ID

39066

Beskrivning

Study ID: 108062 Clinical Study ID: 108062 Study Title: A three part, staggered cohort, open-label and double blind, randomized, placebo controlled study to investigate the efficacy, safety, tolerability and pharmacokinetics of eltrombopag, a thrombopoietin receptor agonist, in previously treated pediatric patients with chronic idiopathic thrombocytopenic purpura (ITP). Eltrombopag PETIT: Eltrombopag in PEdiatric patients with Thrombocytopenia from ITP Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00908037 https://clinicaltrials.gov/ct2/show/NCT00908037 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: eltrombopag, Placebo Trade Name: N/A Study Indication: Purpura, Thrombocytopaenic, Idiopathic The study consists of a screening, Day 1 and three parts. All subjects were supposed to receive 24 weeks (6 months) of eltrombopag treatment during Part 2/3. Screening period: Up to 28 days prior to Day 1 of treatment. Day 1 Part 1 (Dose Finding Phase): A 24-week (6 months) open label treatment period for 5 subjects in each age cohort. (short: P1W1-P1W7, P1W8-23, P1W24/EW). A safety, PK and platelet count review took place after 12 weeks (3 months) of treatment. Subjects in the Dose Finding Phase did not participate in the Randomized Period. Part 2 (Randomized Period): A 7-week randomized, double-blind, placebo-controlled period involving 18 subjects per cohort (short: P2W1-P2W7). Part 3: An open-label treatment period where subjects randomized to eltrombopag in Part 2 received an additional 17 weeks of eltrombopag in Part 3 and subjects randomized to placebo in Part 2 received 24 weeks of eltrombopag in Part 3 (short: P3W8-P3W23, P3W24/EW, P3W8-30, P3W31/EW). Follow-up: 4 weeks following the last dose of eltrombopag (short: FUW1- FUW4). Additional ocular examinations were performed at 12 and 24 weeks (3 and 6 months) after the last dose of eltrombopag (short: FUM3, FUM6). The subjects were enrolled in 3 cohorts: Cohort 1: Subjects between 12 and 17 years old (<18 years of age at Day 1). Cohort 2: Subjects between 6 and 11 years old (<12 years of age at Day 1). Cohort 3: Subjects between 1 and 5 years old (<6 years of age at Day 1). The enrollment was started with the oldest cohort (Cohort 1). The younger cohorts were not enrolled until safety, PK and platelet counts had been reviewed in the older cohort(s). This document contains the Ocular history form. It has to be filled in for screening and for Day 1.

Länk

https://clinicaltrials.gov/ct2/show/NCT00908037

Nyckelord

  1. 2019-10-17 2019-10-17 -
  2. 2019-11-26 2019-11-26 - Sarah Riepenhausen
Rättsinnehavare

GlaxoSmithKline

Uppladdad den

26 november 2019

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0

Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

Effects of eltrombopag in children with chronic idiopathic thrombocytopenic purpura, NCT00908037

Ocular history

  1. StudyEvent: ODM
    1. Ocular history
Administrative Data
Beskrivning

Administrative Data

Alias
UMLS CUI-1
C1320722
Subject number
Beskrivning

Subject number

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Date of Visit
Beskrivning

day month year

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Visit type
Beskrivning

Please note for which visit you'll fill in this document.

Datatyp

integer

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0332307
Ocular history and risk factors
Beskrivning

Ocular history and risk factors

Alias
UMLS CUI-1
C1299003
UMLS CUI-2
C0262926
UMLS CUI-3
C1299003
UMLS CUI-4
C0035648
Actual Date of Assessment
Beskrivning

day month year

Datatyp

date

Alias
UMLS CUI [1]
C2985720
Subject has visually significant cataracts
Beskrivning

Visually significant cataracts

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C3665347
Subject has the following cataract risk factors
Beskrivning

Subject has the following cataract risk factors

Alias
UMLS CUI-1
C0086543
UMLS CUI-2
C0035648
Cataract risk factors: Chronic steroid use
Beskrivning

Cataract risk factors: Chronic steroid use

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2,1]
C0281991
UMLS CUI [2,2]
C0205191
Cataract risk factors: Family history of cataract at a young (<60 yo) age
Beskrivning

Cataract risk factors: Family history of cataract

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2,1]
C0241889
UMLS CUI [2,2]
C0086543
UMLS CUI [2,3]
C1833334
Cataract risk factors: History of radiation treatment to the head or orbit
Beskrivning

Cataract risk factors: History of radiation treatment to the head or orbit

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C1522449
UMLS CUI [2,3]
C0018670
UMLS CUI [3,1]
C0262926
UMLS CUI [3,2]
C1522449
UMLS CUI [3,3]
C0029180
Cataract risk factors: Diabetes mellitus
Beskrivning

Cataract risk factors: Diabetes mellitus

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2]
C0011849
Cataract risk factors: History of intraocular surgery
Beskrivning

Cataract risk factors: History of intraocular surgery

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C0543467
UMLS CUI [2,3]
C3282905
Cataract risk factors: History of ocular disease requiring medical treatment
Beskrivning

Cataract risk factors: History of ocular disease requiring medical treatment

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C0015397
UMLS CUI [2,3]
C1514873
UMLS CUI [2,4]
C0087111
Cataract risk factors: Serious eye trauma
Beskrivning

Cataract risk factors: Serious eye trauma

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2,1]
C0205404
UMLS CUI [2,2]
C0015408
Cataract risk factors: Chronic exposure to UV light
Beskrivning

Cataract risk factors: Chronic exposure to UV light

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2,1]
C0205191
UMLS CUI [2,2]
C0332157
UMLS CUI [2,3]
C0041625
Cataract risk factors: Gout
Beskrivning

Cataract risk factors: Gout

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2]
C0018099
Cataract risk factors: Cigarette use
Beskrivning

Cataract risk factors: Cigarette use

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2]
C0694535
Cataract risk factors: Alcohol abuse
Beskrivning

Cataract risk factors: Alcohol abuse

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [2]
C0085762
Cataract risk factors: Other
Beskrivning

Cataract risk factors: Other

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [1,3]
C0205394
If other cataract risk factors, please specify
Beskrivning

Other cataract risk factors, specification

Datatyp

text

Alias
UMLS CUI [1,1]
C0086543
UMLS CUI [1,2]
C0035648
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2348235

Similar models

Ocular history

  1. StudyEvent: ODM
    1. Ocular history
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Date of Visit
Item
Date of Visit
date
C1320303 (UMLS CUI [1])
Item
Visit type
integer
C0545082 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
Visit type
CL Item
Screening (1)
CL Item
Day 1 (2)
Item Group
Ocular history and risk factors
C1299003 (UMLS CUI-1)
C0262926 (UMLS CUI-2)
C1299003 (UMLS CUI-3)
C0035648 (UMLS CUI-4)
Actual Date of Assessment
Item
Actual Date of Assessment
date
C2985720 (UMLS CUI [1])
Item
Subject has visually significant cataracts
text
C0086543 (UMLS CUI [1,1])
C3665347 (UMLS CUI [1,2])
Code List
Subject has visually significant cataracts
CL Item
No (N)
CL Item
OD (Right Eye) (OD)
CL Item
OS (Left Eye) (OS)
CL Item
OU (Both Eyes) (OU)
Item Group
Subject has the following cataract risk factors
C0086543 (UMLS CUI-1)
C0035648 (UMLS CUI-2)
Item
Cataract risk factors: Chronic steroid use
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0281991 (UMLS CUI [2,1])
C0205191 (UMLS CUI [2,2])
Code List
Cataract risk factors: Chronic steroid use
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Family history of cataract at a young (<60 yo) age
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0241889 (UMLS CUI [2,1])
C0086543 (UMLS CUI [2,2])
C1833334 (UMLS CUI [2,3])
Code List
Cataract risk factors: Family history of cataract at a young (<60 yo) age
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: History of radiation treatment to the head or orbit
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0262926 (UMLS CUI [2,1])
C1522449 (UMLS CUI [2,2])
C0018670 (UMLS CUI [2,3])
C0262926 (UMLS CUI [3,1])
C1522449 (UMLS CUI [3,2])
C0029180 (UMLS CUI [3,3])
Code List
Cataract risk factors: History of radiation treatment to the head or orbit
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Diabetes mellitus
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0011849 (UMLS CUI [2])
Code List
Cataract risk factors: Diabetes mellitus
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: History of intraocular surgery
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0262926 (UMLS CUI [2,1])
C0543467 (UMLS CUI [2,2])
C3282905 (UMLS CUI [2,3])
Code List
Cataract risk factors: History of intraocular surgery
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: History of ocular disease requiring medical treatment
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0262926 (UMLS CUI [2,1])
C0015397 (UMLS CUI [2,2])
C1514873 (UMLS CUI [2,3])
C0087111 (UMLS CUI [2,4])
Code List
Cataract risk factors: History of ocular disease requiring medical treatment
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Serious eye trauma
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0205404 (UMLS CUI [2,1])
C0015408 (UMLS CUI [2,2])
Code List
Cataract risk factors: Serious eye trauma
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Chronic exposure to UV light
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0205191 (UMLS CUI [2,1])
C0332157 (UMLS CUI [2,2])
C0041625 (UMLS CUI [2,3])
Code List
Cataract risk factors: Chronic exposure to UV light
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Gout
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0018099 (UMLS CUI [2])
Code List
Cataract risk factors: Gout
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Cigarette use
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0694535 (UMLS CUI [2])
Code List
Cataract risk factors: Cigarette use
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Alcohol abuse
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0085762 (UMLS CUI [2])
Code List
Cataract risk factors: Alcohol abuse
CL Item
Yes (Y)
CL Item
No (N)
Item
Cataract risk factors: Other
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Code List
Cataract risk factors: Other
CL Item
Yes (Y)
CL Item
No (N)
Other cataract risk factors, specification
Item
If other cataract risk factors, please specify
text
C0086543 (UMLS CUI [1,1])
C0035648 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

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