ID

41732

Beschrijving

The primary objective of this study was to demonstrate bioequivalence between eltrombopag oral film-coated tablets manufactured at Research and Development (R&D) and Commercial sites. The subject participants each went through two dosing periods (Period 1 and Period 2), during each of which they received a single dose of eltrombopag. The dosing periods were separated by a washout of at least 10 days. For each period, subjects had to perform a visit on the day before and one on the day of the administration of the drug. Furthermore, the protocol-defined visits included a screening visit and a follow-up visit. Study ID: 105122 Clinical Study ID: 105122 Study Title: Phase I Bioequivalence Study for SB 497115 GR Phase II and Phase III Tablets Sponsor: GlaxoSmithKline Phase: phase 1 Study Recruitment Status: Completed Generic Name: Eltrombopag Study Indication: Thrombocytopenia This form has to be filled out by all participants to document, whether pharmacogenetic research consent is either given, not given or withdrawn after it had been previously given.

Trefwoorden

Versies (2)
  1. 09-01-21 09-01-21 -
  2. 09-01-21 09-01-21 -
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GlaxoSmithKline

Geüploaded op

9 januari 2021

DOI

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Creative Commons BY-NC 4.0
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GSK Eltrombopag Thrombocytopenia, Clinical Study ID: 105122

Engels

Pharmacogenetic Research

1 Formulieren  
Administrative Data
Beschrijving

Administrative Data

Alias
UMLS CUI-1
C1320722
date of visit/assessment
Beschrijving

date of visit

Datatype

date

Alias
UMLS CUI [1]
C1320303
subject ID
Beschrijving

subject ID

Datatype

text

Alias
UMLS CUI [1]
C2348585
PGx-Pharmacogenetic Research Consent
Beschrijving

PGx-Pharmacogenetic Research Consent

Alias
UMLS CUI-1
C2347500
UMLS CUI-2
C0021430
has informed consent been obtained for PGx-Pharmacogenetic research?
Beschrijving

informed consent for pharmacogenetic research

Datatype

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C2347500
if yes, please provide the date informed consent obtained for PGx-Pharmacogenetic research
Beschrijving

pharmacogenetic research consent, date

Datatype

date

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C2347500
UMLS CUI [1,3]
C0011008
if yes, has a blood sample been collected for PGx-pharmacogenetic (DNA) research?
Beschrijving

pharmacogenetic research, blood sample

Datatype

boolean

Alias
UMLS CUI [1,1]
C1277698
UMLS CUI [1,2]
C2347500
if a blood sample has been taken, please record the date the sample was taken
Beschrijving

date blood sample taken, pharmacogenetic test

Datatype

date

Alias
UMLS CUI [1,1]
C1277698
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C2347500
if no, please check reason:
Beschrijving

pharmacogenetic tests, no consent, reason

Datatype

text

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0332197
UMLS CUI [1,4]
C0566251
if you checked other, please specify:
Beschrijving

pharmacogenetic tests, no consent, other reason

Datatype

text

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0332197
UMLS CUI [1,4]
C3840932
genetics type
Beschrijving

genetics type

Datatype

text

Alias
UMLS CUI [1,1]
C0017399
UMLS CUI [1,2]
C0332307
PGx-Pharmacogenetic Research Withdrawal of Consent
Beschrijving

PGx-Pharmacogenetic Research Withdrawal of Consent

Alias
UMLS CUI-1
C2347500
UMLS CUI-2
C0021430
UMLS CUI-3
C2349954
has subject withdrawn consent for PGx-Pharmacogenetic research?
Beschrijving

withdrawn consent for PGx-Pharmacogenetic research

Datatype

boolean

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C2349954
has a request been made for sample destruction?
Beschrijving

pharmacogenetic research, request for sample destruction

Datatype

boolean

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C1272683
if yes, please check reason:
Beschrijving

pharmacogenetic research, request for sample destruction, reason

Datatype

text

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C1272683
UMLS CUI [1,4]
C0566251
if other, please specify:
Beschrijving

pharmacogenetic research, request for sample destruction, other reason

Datatype

text

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C1272683
UMLS CUI [1,4]
C3840932
genetics type
Beschrijving

pharmacogenetic tests, genetics type

Datatype

text

Alias
UMLS CUI [1,1]
C2347500
UMLS CUI [1,2]
C0017399
UMLS CUI [1,3]
C0332307
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Similar models

Pharmacogenetic Research

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
date of visit
Item
date of visit/assessment
date
C1320303 (UMLS CUI [1])
subject ID
Item
subject ID
text
C2348585 (UMLS CUI [1])
Item Group
PGx-Pharmacogenetic Research Consent
C2347500 (UMLS CUI-1)
C0021430 (UMLS CUI-2)
informed consent for pharmacogenetic research
Item
has informed consent been obtained for PGx-Pharmacogenetic research?
boolean
C0021430 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
pharmacogenetic research consent, date
Item
if yes, please provide the date informed consent obtained for PGx-Pharmacogenetic research
date
C0021430 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
pharmacogenetic research, blood sample
Item
if yes, has a blood sample been collected for PGx-pharmacogenetic (DNA) research?
boolean
C1277698 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
date blood sample taken, pharmacogenetic test
Item
if a blood sample has been taken, please record the date the sample was taken
date
C1277698 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C2347500 (UMLS CUI [1,3])
Item
if no, please check reason:
text
C2347500 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0332197 (UMLS CUI [1,3])
C0566251 (UMLS CUI [1,4])
pharmacogenetic research, no consent, reason
Code List
if no, please check reason:
CL Item
subject declined (1)
CL Item
subject not asked by Investigator (2)
CL Item
other (3)
pharmacogenetic tests, no consent, other reason
Item
if you checked other, please specify:
text
C2347500 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0332197 (UMLS CUI [1,3])
C3840932 (UMLS CUI [1,4])
genetics type
Item
genetics type
text
C0017399 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Item Group
PGx-Pharmacogenetic Research Withdrawal of Consent
C2347500 (UMLS CUI-1)
C0021430 (UMLS CUI-2)
C2349954 (UMLS CUI-3)
withdrawn consent for PGx-Pharmacogenetic research
Item
has subject withdrawn consent for PGx-Pharmacogenetic research?
boolean
C2347500 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C2349954 (UMLS CUI [1,3])
pharmacogenetic research, request for sample destruction
Item
has a request been made for sample destruction?
boolean
C2347500 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
Item
if yes, please check reason:
text
C2347500 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
C0566251 (UMLS CUI [1,4])
pharmacogenetic research, request for sample destruction, reason
Code List
if yes, please check reason:
CL Item
subject requested  (1)
CL Item
screen failure (2)
CL Item
other (3)
pharmacogenetic research, request for sample destruction, other reason
Item
if other, please specify:
text
C2347500 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C1272683 (UMLS CUI [1,3])
C3840932 (UMLS CUI [1,4])
pharmacogenetic tests, genetics type
Item
genetics type
text
C2347500 (UMLS CUI [1,1])
C0017399 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,3])
Terug naar het begin van de pagina 

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