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NCT00655824

Long-term Efficacy and Safety of Repeated Ofatumumab Treatment Courses in RA Patients Who Previously Received Ofatumumab or Placebo in Trial Hx-CD20-403

Terminated Phase 2 Results posted Last updated 5 December 2017
What this trial tests

Phase 2 trial testing ofatumumab in Arthritis, Rheumatoid in 124 participants. Terminated before completion.

Timeline
1 January 2008
Primary endpoint
25 May 2011
19 March 2013

Quick facts

Lead sponsorGlaxoSmithKline
PhasePhase 2
StatusTerminated
Study typeINTERVENTIONAL
Allocationna
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment124
Start date1 January 2008
Primary completion25 May 2011
Estimated completion19 March 2013
Sites10 locations across Denmark, United Kingdom, Poland, Hungary, United States

Drugs / interventions tested

Conditions studied

Sponsor

GlaxoSmithKline — full company profile →

Who can join

18 and older, any sex, with Arthritis, Rheumatoid. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Minimum Change From Baseline in Disease Activity Score Based on 28 Joints (DAS28) Over the Course of Weeks (Wk) 1 to 24 in Each Treatment Course (TC), Assessed by Erythrocyte Sedimentation Rate (ESR; Rate at Which Red Blood Cells Sediment in 1 Hour) Secondary · Baseline (last visit prior to dosing in each TC) and last visit of each TC (8 wk post infusion, then every 4 wk until Wk 24; up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

DAS28(ESR) is a numeric outcome that measures RA activity based on the ESR (a non-specific general indicator of inflammation), tender joint count (JC), swollen JC, and participant's global assessment of disease activity on a 100 millimeter Visual Analog Scale. DAS28 values range from 0 (no activity) and upwards; increasing values indicate increasing activity (there is no upper limit on the scale). Change from baseline (CFB) was calculated at all visits; however, minimum CFB was calculated as the minimum CFB obtained over the course of weeks 1-24 of each treatment cycle.

Treatment Course 1, n=91
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.92± 0.918
Treatment Course 2, n=71
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.58± 0.824
Treatment Course 3, n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.52± 0.849
Treatment Course 4, n=20
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.65± 1.110
Treatment Course 5, n=8
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-2.16± 1.114
Treatment Course 6, n=4
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-0.87± 0.771
Treatment Course 7, n=2
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-2.10± 2.146
Minimum Change From Baseline in DAS28 Over the Course of Weeks 1 to 24 in Each Treatment Course, Based on C-reactive Protein (CRP) Secondary · Baseline (last visit prior to dosing in each TC) and last visit of each TC (8 wk post infusion, then every 4 wk until Wk 24; up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

DAS28(CRP) is a numeric outcome that measures RA activity based on the CRP (used to monitor acute inflammatory phases of RA), tender JC, swollen JC, and participant's global assessment of disease activity on a 100 millimeter Visual Analog Scale. DAS28 values range from 0 (no activity) and upwards; increasing values indicate increasing activity (there is no upper limit on the scale). Change from baseline (CFB) was calculated at all visits; however, minimum CFB was calculated as the minimum CFB obtained over the course of weeks 1-24 of each treatment cycle.

Treatment Course 1, n=91
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.79± 0.906
Treatment Course 2, n=71
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.32± 0.771
Treatment Course 3, n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.27± 0.793
Treatment Course 4, n=20
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.55± 0.970
Treatment Course 5, n=8
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-1.88± 1.181
Treatment Course 6, n=4
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-0.88± 0.572
Treatment Course 7, n=2
GroupValue95% CI
Ofatumumab 700 mg IV Infusion-2.14± 1.893
Time to Re-treatment in Each Treatment Course Secondary · Week 16 to Week 104 of each treatment course (up to 125 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Time to re-treatment in each treatment course (TC) is defined as the time from the first infusion of ofatumumab until the date of the first infusion of the first re-treatment course. The data presented reflect the time to re-treatment, which is defined as the time in days between the first infusion of each TC and the first infusion of the following TC. For TC 1, time to re-treatment is defined as the time between the first infusion in TC 1 and the first infusion in TC 2; similarly, for TC 2 it is the time between the first infusion of TC 2 and the first infusion of TC 3. The study was terminat

Treatment Course 1, n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion291.01± 127.367
Treatment Course 2, n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion328.83± 122.427
Treatment Course 3, n=20
GroupValue95% CI
Ofatumumab 700 mg IV Infusion235.95± 93.924
Treatment Course 4, n=8
GroupValue95% CI
Ofatumumab 700 mg IV Infusion154.88± 19.172
Treatment Course 5, n=4
GroupValue95% CI
Ofatumumab 700 mg IV Infusion161.75± 22.066
Treatment Course 6, n=2
GroupValue95% CI
Ofatumumab 700 mg IV Infusion120.00± 0.000
Ofatumumab Serum Concentration Secondary · Before infusion and at the end of infusion for each Treatment Course (8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next TC; up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial vi

Blood samples of participants were collected for the measurement of ofatumumab concentration in the blood. The blood samples were collected before infusion (BI) (baseline of that particular treatment course) and at the end of infusion (EI) of ofatumumab.

Treatment Course 1, Baseline (BI); n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion3596.3± 32324.08
Treatment Course 1, Baseline (EI); n=91
GroupValue95% CI
Ofatumumab 700 mg IV Infusion295588.3± 67754.65
Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV InfusionNA± NA
Treatment Course 2, Baseline (BI); n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion837.6± 3102.94
Treatment Course 2, Baseline (EI); n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion292283.5± 87672.90
Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV InfusionNA± NA
Treatment Course 3, Baseline (BI); n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion955.0± 3270.64
Treatment Course 3, Baseline (EI); n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion276719.3± 68620.07
Percentage of Cluster of Differentiation (CD)19+, 4+, 3+, and 8+ B-cell Subsets in the Blood Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaluation of CD19+, CD4+, CD3+, and CD8+ B-cell subsets. These biomarkers are associated with immune functions.

CD19+, Treatment Course 1, Baseline; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion6.4± 4.45
CD19+, Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion4.0± NA
CD19+, Treatment Course 2, Baseline; n=72
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1.9± 3.06
CD19+, Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion2.0± NA
CD19+, Treatment Course 3, Baseline; n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion2.6± 2.99
CD19+, Treatment Course 3, Week 64; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1.0± NA
CD19+, Treatment Course 4, Baseline; n=20
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1.7± 2.68
CD19+, Treatment Course 4, Week 40; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion3.0± NA
CD19+, CD4+, CD3+, and CD8+ Cell Counts, Measured in mm^3 Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaluation of CD19+, CD4+, CD3+, and CD8+ cell counts. These cells are present on white blood cells and are used as markers to associate cells with immune functions.

CD19+, Treatment Course 1, Baseline; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion109.6± 91.12
CD19+, Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion95.0± NA
CD19+, Treatment Course 2, Baseline; n=71
GroupValue95% CI
Ofatumumab 700 mg IV Infusion30.0± 49.36
CD19+, Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion24.0± NA
CD19+, Treatment Course 3, Baseline; n=51
GroupValue95% CI
Ofatumumab 700 mg IV Infusion43.8± 50.11
CD19+, Treatment Course 3, Week 64; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion16.0± NA
CD19+, Treatment Course 4, Baseline; n=20
GroupValue95% CI
Ofatumumab 700 mg IV Infusion27.2± 43.75
CD19+, Treatment Course 4, Week 40; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion54.0± NA
Ratio of CD 4+/CD8+ Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaluation of CD4+ and CD8+ cell counts and the ratio was calculated.

Treatment Course 1, Baseline; n=72
GroupValue95% CI
Ofatumumab 700 mg IV Infusion2.55± 1.295
Treatment Course 1, Week 48; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion5.40± NA
Treatment Course 2, Week 24; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion4.10± NA
Treatment Course 2, Week 56; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion2.60± NA
Treatment Course 3, Baseline; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion2.60± NA
Treatment Course 3, Week 32; n=2
GroupValue95% CI
Ofatumumab 700 mg IV Infusion2.40± 0.424
Treatment Course 4, Baseline; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1.50± NA
Number of Participants With Rheumatoid Factor (RA Factor) >13 International Units Per Milliliter Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaulation of RA factor. RA factor is an antibody found in the blood of participants with rheumatoid arthritis and is used for the diagnosis of rheumatoid arthritis.

Treatment Course 1, Baseline; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion79
Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Treatment Course 1, At any time; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion81
Treatment Course 2, Baseline; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion60
Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Treatment Course 2, At any time; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion63
Treatment Course 3, Baseline; n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion42
Treatment Course 3, Week 64; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Number of Participants With Anti-cyclic Citrullinated Peptide Antibody (CCP) >6.9 International Units Per Liter Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaluation of Anti-CCP. Anti-CCP plays an important role in immune response and helps assess the disease condition.

Treatment Course 1, Baseline; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion80
Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Treatment Course 1, At any time; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion83
Treatment Course 2, Baseline; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion66
Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Treatment Course 2, At any time; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion67
Treatment Course 3, Baseline; n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion48
Treatment Course 3, Week 64; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Number of Participants With B-Lymphocyte Stimulator (BLyS) >2.49 Micrograms Per Liter Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaluation of BLyS. BLyS is a potent co-stimulator of B lymphocytes, and elevated levels of BLyS are observed in automimmune diseases. It regulates the immunnoglobin (antibody produced by B cells that is used by the immune system to indentify bacteria and viruses in the body) secretion of normal B cells (type of cells in the blood).

Treatment Course 1, Baseline; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion12
Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion0
Treatment Course 1, At any time; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion81
Treatment Course 2, Baseline; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion38
Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion0
Treatment Course 2, At any time; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion65
Treatment Course 3, Baseline; n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion32
Treatment Course 3, Week 64; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Number of Participants With Interleukin 6 (IL-6) >11.9 Picograms Per Milliliter Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaluation of IL-6. IL-6 plays an important role in immune response and helps assess the disease condition.

Treatment Course 1, Baseline; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion40
Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion0
Treatment Course 1, At any time; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion47
Treatment Course 2, Baseline; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion12
Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion1
Treatment Course 2, At any time; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion27
Treatment Course 3, Baseline; n=52
GroupValue95% CI
Ofatumumab 700 mg IV Infusion11
Treatment Course 3, Week 64; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion0
Assessment of Sodium, Potassium, Chloride, Bicarbonate, Calcium, and Uric Acid Secondary · Baseline of each TC and 8 wk post infusion, then every 4 wk until Wk 24, then every 8 wk until next treatment course (up to 144 weeks). TCs were individualized based on clinical status and may not correlate to trial visits or study weeks.

Blood samples of participants were collected for the evaluation of uric acid and electrolytes (sodium, potassium, chloride, and calcium), as increased levels may reflect B-cell lysis due to treatment with ofatumumab.

Sodium, Treatment Course 1, Baseline; n=92
GroupValue95% CI
Ofatumumab 700 mg IV Infusion142.1± 2.76
Sodium, Treatment Course 1, Week 104; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion144.0± NA
Sodium, Treatment Course 2, Baseline; n=73
GroupValue95% CI
Ofatumumab 700 mg IV Infusion142.3± 2.25
Sodium, Treatment Course 2, Week 80; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion145.0± NA
Sodium, Treatment Course 3, Baseline; n=53
GroupValue95% CI
Ofatumumab 700 mg IV Infusion143.3± 2.26
Sodium, Treatment Course 3, Week 64; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion147.0± NA
Sodium, Treatment Course 4, Baseline; n=20
GroupValue95% CI
Ofatumumab 700 mg IV Infusion142.8± 2.65
Sodium, Treatment Course 4, Week 40; n=1
GroupValue95% CI
Ofatumumab 700 mg IV Infusion145.0± NA

Adverse events — posted to ClinicalTrials.gov

Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Ofatumumab 700 mg IV Infusion
Serious: 11/92 (12%)
Deaths:

Serious adverse events (16 terms)

ReactionSystemOfatumumab 700 mg IV Infus…
Memory impairmentNervous system disorders
AmnesiaNervous system disorders
AphasiaNervous system disorders
CholecystitisHepatobiliary disorders
CholelithiasisHepatobiliary disorders
Disturbance in attentionNervous system disorders
FallInjury, poisoning and procedural complications
HypertensionVascular disorders
Joint dislocationInjury, poisoning and procedural complications
Myocardial infarctionCardiac disorders
OsteitisMusculoskeletal and connective tissue disorders
PancreatitisGastrointestinal disorders
PneumoniaInfections and infestations
RashSkin and subcutaneous tissue disorders
Rheumatoid arthritisMusculoskeletal and connective tissue disorders
Visual impairmentEye disorders
Other adverse events (158 terms — click to expand)

ReactionSystemOfatumumab 700 mg IV Infus…
RashSkin and subcutaneous tissue disorders
Upper respiratory tract infectionInfections and infestations
CoughRespiratory, thoracic and mediastinal disorders
Throat irritationRespiratory, thoracic and mediastinal disorders
HeadacheNervous system disorders
SneezingRespiratory, thoracic and mediastinal disorders
RhinitisInfections and infestations
Urinary tract infectionInfections and infestations
UrticariaSkin and subcutaneous tissue disorders
DyspneaRespiratory, thoracic and mediastinal disorders
NeutropeniaBlood and lymphatic system disorders
BronchitisInfections and infestations
NasopharyngitisInfections and infestations
Oral herpesInfections and infestations
LeukopeniaBlood and lymphatic system disorders
HypertensionVascular disorders
FatigueGeneral disorders
InfluenzaInfections and infestations
PharyngitisInfections and infestations
Respiratory tract infectionInfections and infestations
SinusitisInfections and infestations
PruritusSkin and subcutaneous tissue disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
AphasiaNervous system disorders
Memory impairmentNervous system disorders
NauseaGastrointestinal disorders
Hepatic enzyme IncreasedInvestigations
AnemiaBlood and lymphatic system disorders
ConjunctivitisEye disorders
Dry eyeEye disorders
FlushingVascular disorders
VertigoEar and labyrinth disorders
AbscessInfections and infestations
CystitisInfections and infestations
Lower respiratory tract infectionInfections and infestations
AlopeciaSkin and subcutaneous tissue disorders
Rash generalizedSkin and subcutaneous tissue disorders
Dry throatRespiratory, thoracic and mediastinal disorders
Throat tightnessRespiratory, thoracic and mediastinal disorders
Back painMusculoskeletal and connective tissue disorders

Most-reported serious reactions: Memory impairment, Amnesia, Aphasia, Cholecystitis, Cholelithiasis, Disturbance in attention, Fall, Hypertension.

Data from ClinicalTrials.gov NCT00655824 adverse events section.

Sponsor's own description

A 3-year open-label trial for patients who previously participated in Trial Hx-CD20-403 and who fulfill the eligibility criteria for this trial (GEN413) . Th e primary purpose of the trial is to evaluate the long-term effectiveness of repeated courses ( a maximum of 9 treatment courses) of ofatumumab in RA patients who previously received ofatumumab or placebo in Trial Hx-CD20-403.

Publications & conference data

5 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Next-generation anti-CD20 monoclonal antibodies in autoimmune disease treatment.
    Du FH, Mills EA, Mao-Draayer Y. · · 2017 · cited 120× · PMID 29143151 · DOI 10.1007/s13317-017-0100-y
  2. B-cell targeted therapeutics in clinical development.
    Blüml S, McKeever K, Ettinger R, Smolen J, et al · · 2013 · cited 74× · PMID 23566679 · DOI 10.1186/ar3906
  3. Ofatumumab.
    Zhang B. · · 2009 · cited 55× · PMID 20068404 · DOI 10.4161/mabs.1.4.8895
  4. Clinical Perspectives on the Molecular and Pharmacological Attributes of Anti-CD20 Therapies for Multiple Sclerosis.
    Bar-Or A, O'Brien SM, Sweeney ML, Fox EJ, et al · · 2021 · cited 37× · PMID 34370283 · DOI 10.1007/s40263-021-00843-8
  5. Safety of Repeated Open-Label Treatment Courses of Intravenous Ofatumumab, a Human Anti-CD20 Monoclonal Antibody, in Rheumatoid Arthritis: Results from Three Clinical Trials.
    Quattrocchi E, Østergaard M, Taylor PC, van Vollenhoven RF, et al · · 2016 · cited 15× · PMID 27336685 · DOI 10.1371/journal.pone.0157961

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Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT00655824.

Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing