小児UC治験参加者の寛解状態に基づき,トファシチニブの有効性を評価すること。 | |||
3 | |||
2021年08月12日 | |||
2021年08月12日 | |||
2021年08月12日 | |||
2026年12月21日 | |||
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120 | ||
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介入研究 | Interventional | |
Study Design |
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単一群 | single arm study |
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非盲検 | open(masking not used) | |
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非対照 | uncontrolled control | |
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単群比較 | single assignment | |
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治療 | treatment purpose | |
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なし | ||
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なし | ||
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なし | ||
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オーストラリア/カナダ/米国/ベルギー/フィンランド/フランス/ドイツ/ハンガリー/イスラエル/イタリア/オランダ/ポーランド/スロバキア/スペイン/スウェーデン/英国 | Australia/Canada/United States/Belgium/Finland/France/Germany/Hungary/Israel/Italy/Netherlands/Poland/Slovakia/Spain/Sweden/United Kingdom | |
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・同意文書/アセントに署名および日付が記入されていること ・2 歳以上18 歳未満かつ体重が10 kg 以上の男性および女性 ・潰瘍性大腸炎(UC)と一致する大腸の炎症を裏付ける病理報告書を入手でき,ベースラインの12 週間以上前からUC の臨床診断を受けている治験参加者。診断を裏付ける生検報告書が保管されていなければならない。 ・6 歳未満でUC と診断された治験参加者は,超早期発症型炎症性腸疾患(VEO IBD)の検査を受け,VEO IBD に関連する単一遺伝子疾患に罹患していないこととする ・中等症から重症の活動期にあるUC 治験参加者[スクリーニング時の大腸内視鏡検査でMayo スコアの合計が6 点以上,直腸出血スコアが1 点以上および内視鏡サブスコア(Mayo)が2 点以上により定義] ・ベースライン時のPediatric Ulcerative Colitis Activity Index(PUCAI)スコアが35 点以上の治験参加者 ・異形成または結腸癌の既往歴がない治験参加者 ・未治療もしくは治療不十分の活動性もしくは潜在性結核感染の徴候もしくは既往歴がない治験参加者 ・米国以外の国の場合:以下の1 つ以上の治療の効果が不十分であったまたは不耐容であった,あるいは以下の治療が医学的に禁忌である治験参加者: -経口または静脈内ステロイド -アザチオプリンまたは6-メルカプトプリン -抗TNF 薬または抗インテグリン薬 |
Inclusion Criteria: *Evidence of a personally signed and dated informed consent document and assent document. *Males and females 2 to less than18 years old and weighing at least 10 kg. *Having a pathology report that confirms colonic inflammation consistent with UC with a clinical diagnosis of UC for at least 12 weeks prior to baseline, with biopsy report supporting the diagnosis of UC. *Participants diagnosed with UC at age less than 6 years old, must have had testing and be negative for monogenic disorders associated with very early onset IBD. *Moderately to severely active UC as defined (via screening colonoscopy) by a Mayo score of at least 6, with a rectal bleeding score of at least 1 and an endoscopic subscore of at least 2. *Pediatric Ulcerative Colitis Activity Index (PUCAI) score greater or equal to 35 . *No history of dysplasia or colon cancer. *No evidence or history of untreated or inadequately treated active or latent infection with Mycobacterium Tuberculosis. *For participants outside of the United States: have had an inadequate response or been intolerant to at least one prior therapy as listed below or have a medical contraindication to such therapies: *Oral or intravenous (IV) corticosteroids; *Azathioprine or 6-mercaptopurine; *TNF inhibitors or anti integrin therapy. *For participants in the United States: have had an inadequate response or intolerance to TNF inhibitors. *Stable doses of the following therapies for UC: *Oral 5 Aminosalicyclic acids (ASA) or sulfasalazine *Oral corticosteroids equivalent to prednisone at most 1 mg/kg up to a maximum of 20 mg/day or budesonide up to 9 mg/day. *evidence of prior varicella zoster virus exposure based on serological testing. *female participant is eligible if she is not pregnant or breastfeeding, If she is a woman of child bearing potential, she needs to be using a contraceptive method that is highly effective (with a failure rate of <1% per year). |
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・分類不能大腸炎,孤立性直腸炎,顕微鏡的大腸炎,感染性大腸炎,クローン病と診断された治験参加者またはクローン病を示唆する臨床所見が認められる治験参加者 ・症候性閉塞性腸狭窄またはストーマ造設の既往歴がある治験参加者,結腸切除,広範な小腸切除(100 cm 超)または短腸症候群の既往歴がある治験参加者,ベースライン来院前4 週間以内にUC に関連する理由で入院した治験参加者 ・静脈血栓塞栓症のリスクに関連する可能性のある因子または臨床的特徴があり,治験参加または治験薬投与によってリスクが増大する可能性がある,または治験結果の解釈に影響を及ぼす可能性があり,治験責任医師が本治験への参加を不適切と判断した治験参加者 ・トファシチニブまたは他のJAK 阻害剤の投与歴がある治験参加者 ・治験薬の初回投与前6 週間以内に生ワクチンまたは弱毒化ワクチンの接種を受けた治験参加者,または治験薬の投与期間中および治験薬投与中止後6 週間,ワクチンの接種またはワクチン接種を受けた人との家庭内接触が予測される治験参加者 ・ベースライン来院前の規定した期間内に以下のの治療を受けている治験参加者:ベースライン前4 週間以内のAZA,6-MP,メトトレキサート,チオグアニン,インフリキシマブ,アダリムマブ,ゴリムマブ,インターフェロン療法,シクロスポリン,ミコフェノール酸,タクロリムス,ステロイドの静脈内・直腸内投与,ナタリズマブ,ベドリズマブ,他の抗接着分子薬,他の治験薬 ・ベースライン前6 ヵ月以内に,選択的リンパ球,単球または顆粒球吸着除去療法を含む白血球吸着除去療法または血漿交換療法を受けた治験参加者 ・治験薬の初回投与前の規定の期間に中等度から強力なCYP3A 誘導剤もしくは阻害剤などの併用禁止薬の投与を受けている治験参加者,または本治験期間中にこれらの併用禁止薬の投与が予期される治験参加者 ・下痢を抑制するための腸運動抑制薬(ジフェノキシレート塩酸塩とアトロピン硫酸塩の併用またはロペラミド)の長期および頻繁な使用を必要とする治験参加者 ・・ベースライン前6 ヵ月以内に胆嚢切除などの腸の手術歴がある治験参加者,ベースライン前3 ヵ月以内に虫垂切除術の手術歴ある治験参加者,スクリーニング来院前4 週間以内に重大な外傷または大手術を受けた治験参加者 ・スクリーニング時の臨床検査で以下の異常値が認められた治験参加者:ヘモグロビンが9.0 g/dL 未満,絶対白血球数が3000/mm3未満,絶対好中球数が1200/mm3未満,絶対リンパ球数が750/mm3未満,血小板数が100,000/mm3未満と定義される血小板減少症,推算糸球体濾過量が40 mL/min/1.73 m2 以下,総ビリルビン,アスパラギン酸アミノトランスフェラーゼまたはアラニンアミノトランスフェラーゼが基準値上限の1.5 倍超 ・スクリーニング時の便検査で,腸内病原菌,病原寄生虫卵または病原寄生虫またはC. difficile 毒素が陽性であった治験参加者 ・ヒト免疫不全ウイルス,B 型肝炎ウイルスまたはC 型肝炎ウイルスに感染している治験参加者 ・2 回以上の帯状疱疹(HZ)の既往歴,1 回以上の播種性HZ または播種性単純ヘルペスの既往歴がある治験参加者 ・リンパ増殖性疾患の既往歴があるまたは現在症状が認められる治験参加者[例えば,エプスタイン・バーウイルス(EBV)によるリンパ増殖性疾患,リンパ腫,白血病,骨髄増殖性疾患,多発性骨髄腫,または現在のリンパ系疾患を示唆する徴候および症状] ・臨床的に意義のある感染症を現在発症している,もしくはベースライン前3 ヵ月以内に発症した治験参加者(例えば,入院または非経口抗菌薬療法を必要とする治験参加者,もしくは日和見感染症),ベースライン前2 週間以内に抗菌薬療法を必要とする感染症の既往歴を有する治験参加者,または治験責任医師が本治験への参加により悪化する可能性があると判断した感染症の既往歴がある治験参加者 ・何らかの悪性腫瘍(ただし,適切に治療されたか切除された非転移性の皮膚基底細胞癌もしくは皮膚扁平上皮癌を除く)を有する治験参加者またはその既往歴がある治験参加者 ・本治験の実施に直接関わっている治験実施医療機関のスタッフおよびその親類縁者,治験責任医師から指示を受けている治験実施医療機関のスタッフ,あるいは本治験の実施に直接関わっている治験依頼者の社員およびその親類縁者 ・本治験組み入れ前2 ヵ月以内または治験期間中に治験薬を使用する他の治験に参加する者 ・その他の急性または慢性の医学的あるいは精神的状態(直近1 年以内あるいは現時点での自殺念慮あるいは自殺行動を含む)や臨床検査値異常があり,治験参加や治験薬投与により危険性が増す可能性や治験結果の解釈に影響を及ぼす可能性がある治験参加者,あるいは治験責任医師が本治験への参加を不適切と判断した治験参加者 ・妊婦。授乳婦。子供をもうけることができる妊娠可能な女性治験参加者で,治験期間中および電話による追跡調査来院まで,本治験実施計画書で概略を示した1 種類の効果の高い避妊法を使用する意思のない者,または使用することができない者 |
Exclusion Criteria: *Diagnosis of indeterminate colitis, isolated proctitis, microscopic colitis, infectious colitis, Crohn's disease, or clinical findings suggestive of Crohn's disease. *History of symptomatic obstructive intestinal strictures or active ostomy, or history of colectomy, extensive small bowel resection ( greater than100 centimetres) or short bowel syndrome, or hospitalization for UC related reason(s) within 4 weeks of baseline visit. *Any factors or clinical characteristics potentially related to the risk of venous thromboembolism that may increase the risk associated with study participation or study intervention administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the participant inappropriate for entry into this study. *Participants who have previously received tofacitinib or another Janus Kinase inhibitor. *Vaccination or exposure to a live or attenuated vaccine within the 6 weeks prior to the first dose of study drug, or who are expected to be vaccinated or to have household exposure to these vaccines during treatment or during the 6 weeks following discontinuation of study drug. *Participants having received azathioprine, 6-mercaptopurine, methotrexate, thioguanine, infliximab, adalimumab, golimumab, interferon, cyclosporine, mycophenolate, tacrolimus, IV or rectally administered corticosteroids, natalizumab, vedolizumab, other antiadhesion molecules, or investigational drugs during the specified time periods prior to baseline whereby they may still have pharmacokinetic and/or pharmacodynamic effect in the body of the participant. *Previous treatment by leukocyte apheresis including selective lymphocyte, monocyte, or granulocyte apheresis, or plasma exchange within 6 months prior to baseline. *Treatment by specified prohibited concomitant medications, including moderate to potent CYP3A inducers or inhibitors in the specified time periods prior to the first dose of study drug or are expected to receive any of these medications during the study period. *Chronic and frequent use of antimotility agents for control of diarrhea (ie, diphenoxylate hydrochloride with atropine sulfate or loperamide). *History of bowel surgery, including cholecystectomy within 6 months prior to baseline, history of appendectomy within 3 months prior to baseline, or significant trauma or major surgery within 4 weeks of screening visit are excluded. *Participants with the following laboratory values at screening: *Hemoglobin level lower than 9.0 g/Dl. *Absolute white blood cell (WBC) count lower than 3000/mm3. *Absolute neutrophil count lower than 1200/mm3. *Absolute lymphocyte count lower than 750/mm3. *Thrombocytopenia as defined by a platelet count lower than 100,000/mm3. *Estimated bedside Schwartz Glomerular filtration rate (GFR) lower or equal to 40 mL/min/1.73 m2. *Total bilirubin, aspartate aminostransferase (AST) or alanine aminotransferase (ALT) more than 1.5 times the upper limit of normal. *Positive stool examinations for enteric pathogens, pathogenic ova or parasites, or C. difficile toxin at screening. *Participants infected with human immunodeficiency virus (HIV) or hepatitis B or C viruses. *History of more than one episode of HZ, a history of disseminated HZ or disseminated herpes simplex. *History or current symptoms of any lymphoproliferative disorder (eg, Epstein Barr Virus (EBV) related lymphoproliferative disorder, lymphoma, leukemia, myeloproliferative disorders, multiple myeloma, or signs and symptoms suggestive of currently lymphatic disease). *Clinically significant infections currently or within 3 months prior to baseline (eg, those requiring hospitalization or parenteral antimicrobial therapy or opportunistic infections), a history of any infection requiring antimicrobial therapy within 2 weeks of baseline, or a history of any infection otherwise judged by the investigator to have the potential for exacerbation by participation in the study. *Any malignancies or with a history of malignancies, with the exception of adequately treated or excised nonmetastatic basal cell or squamous cell cancer of the skin. *Investigator site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the investigator, or participants who are employees of the Sponsor, including their family members, directly involved in the conduct of the study. *Participation in other studies involving investigational drug(s) within 2 months prior to study entry and/or during study participation. *Other acute or chronic medical or psychiatric condition including recent (within the past year) or active suicidal ideation or behavior or laboratory abnormality that may increase the risk associated with study participation or study intervention administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the participant inappropriate for entry into this study. *Pregnant female participants; breastfeeding female participants; fertile female participants of childbearing potential who are unwilling or unable to use a highly effective method of contraception as outlined in this protocol for the duration of the study and through the telephone follow up visit. |
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2歳 以上 | 2age old over | |
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17歳 以下 | 17age old under | |
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男性・女性 | Both | |
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潰瘍性大腸炎 | Ulcerative Colitis | |
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あり | ||
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トファシチニブ トファシチニブ5 mg 1日2回(BID)の投与を受けた成人に観察された全身曝露量に相当する全身曝露量が得られると予想される用量で開始し,用量増量基準を満たす場合,10 mg BID に増量することができる。 |
Drug: tofacitinib Open label tofacitinib 5 mg BID weight based adult equivalent with the option for individual dose increase to 10 mg BID weight based adult equivalent for a limited time if dose escalation criteria are met, prior to returning to 5 mg BID. |
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・維持期の第44週時における中央判読による内視鏡サブスコアを用いたMayoスコアに基づく寛解:Mayo スコアが2 点以下で,個々のサブスコアが1 点を超えておらず,直腸出血サブスコアが0 点の状態と定義する。 | Primary Outcome Measures : 1.Remission by central read Mayo score following 44 weeks in the maintenance phase. [ Time Frame: Outcome measured at the end of the 44 weeks of the maintenance phase. ] Remission is defined by central endoscopy read Mayo score of 2 points or lower, with no individual subscore exceeding 1 point and a rectal bleeding subscore of 0. The primary outcome Mayo score is the summation of 4 subscores as listed below : *patient reported stool frequency (scored 0 to 3) *patient reported rectal bleeding (scored 0 to 3) *central read findings on endoscopy (scored 0 to 3) *physician's global assessment (scored 0 to 3) The Mayo score has a scale from 0 to 12 points, with the lower score indicating lower ulcerative colitis (UC) disease activity. |
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・Mayo スコアによる反応(寛解導入期の第8 週時または第16 週時,維持期の第44 週時): Mayo スコアがベースラインから3 点以上,30%以上低下し,かつ直腸出血サブスコアが1 点以上低下したかまたは直腸出血サブスコアの絶対値が0 点または1 点である状態と定義する。 ・Mayo スコアによる寛解(寛解導入期の第8週時または第16 週時,維持期の第44 週時) 治験実施医療機関および中央での判読に基づくMayo スコアによる寛解(寛解導入期の第8週時または第16 週時),治験実施医療機関での判読に基づくMayo スコアによる寛解(維持期の第44 週時) ・Mayo スコアのベースラインからの変化量(寛解導入期の第8 週時または第16 週時,維持期の第44 週時) ・部分Mayo スコアによる反応:部分Mayo スコアがベースラインから2 点以上低下した状態と定義する。 ・部分Mayo スコアのベースラインからの変化量 ・PUCAI スコアによる反応:PUCAI スコアが20 点以上低下した状態と定義する。 ・PUCAI スコアによる寛解:PUCAI スコアが10 点未満の状態と定義する。 ・PUCAI スコアのベースラインからの変化量 ・内視鏡的改善(寛解導入期の第8 週時または第16 週時,維持期の第44 週時):Mayo 内視鏡サブスコアが0 点または1 点である状態と定義する。 ・内視鏡的寛解(寛解導入期の第8 週時または第16 週時,維持期の第44 週時):Mayo 内視鏡サブスコアが0 点である状態と定義する。 ・再燃までの時間(維持期および継続投与期) ・便中カルプロテクチン値のベースラインからの変化量 ・高感度C 反応性蛋白(hs-CRP)値のベースラインからの変化量 ・部分Mayo スコアによるステロイドフリー寛解:来院前4 週間以上,ステロイドによる治療を必要としない寛解状態と定義する。 ・血漿中濃度(ベースライン,寛解導入期の第8 週時または第16 週時,維持期の第16 週時,維持期の第44 週時) ・トファシチニブ経口液剤の味の許容性およびトファシチニブフィルムコーティング錠の味の許容性評価(第2 週時) |
Secondary Outcome Measures : 1.Response by Mayo score [ Time Frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44 ] Response by Mayo score is defined by a decrease from baseline in Mayo score of at least 3 points and at least 30%, with an accompanying decrease in the subscore for rectal bleeding of at least 1 point or absolute subscore for rectal bleeding of 0 or 1. 2.Remission by Mayo score [ Time Frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44 ] Remission by Mayo score with local and central endoscopy read (induction Week 8, induction Week 16), and with local endoscopy read only (maintenance week 44). 3.Change from baseline in Mayo score. [ Time Frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44 ] 4.Response measured by Partial Mayo Score [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] Response is defined by a partial Mayo score decrease of 2 points or more from baseline. This score is based on the summation of the following subscores : *stool frequency (scored 0 to 3) *rectal bleeding (scored 0 to 3) *physician global assessment (PGA) (scored 0 to 3) The partial Mayo score has a scale from 0 to 9, with the lower score indicating lower ulcerative colitis (UC) disease activity. 5.Change from baseline in Partial Mayo score [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] Change in partial Mayo score. This score is the summation of 3 distinct dimensions as listed below : *stool frequency (scored 0 to 3) *rectal bleeding (scored 0 to 3) *physician global assessment (PGA) (scored 0 to 3) The partial Mayo score has a scale from 0 to 9, with the lower score indicating lower ulcerative colitis (UC) disease activity. 6.Response by PUCAI score [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] The Pediatric Ulcerative Colitis Activity Index (PUCAI) score is the summation of 6 dimensions that are all reported by the investigator. The PUCAI score varies from 0 to 85 points, with the lower score indicating lower ulcerative colitis (UC) disease activity. The 6 dimensions of the PUCAI score are as follows : *abdominal pain *rectal bleeding *stool consistency of most stools *number of stools per 24 hours *nocturnal stools *activity level Response is defined by a PUCAI score decrease of 20 points or more. 7.Change from baseline in PUCAI score [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] The Pediatric Ulcerative Colitis Activity Index (PUCAI) score is the summation of 6 dimensions that are all reported by the investigator *abdominal pain *rectal bleeding *stool consistency of most stools *number of stools per 24 hours *nocturnal stools *activity level The PUCAI score varies from 0 to 85 points, with the lower score indicating lower ulcerative colitis (UC) disease activity. 8.Percentage of Participants Achieving Endoscopic Improvement at Week 8, 16, and 44 [ Time Frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44 ] Endoscopic improvement is defined by Mayo endoscopic sub-score of 0 or 1. The Mayo endoscopic sub-score is used to assess ulcerative colitis activity, and ranges from 0 to 3, and is based on the findings during endoscopy. A lower score is indicative of a lower ulcerative colitis (UC) disease activity. 9.Time to flare [ Time Frame: Outcome measured from 2 to 4 months in the study, through study completion, an average of 3 and a half years ] 10.Change from baseline in fecal calprotectin levels [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] 11.Change from baseline in serum high sensitivity C-Reactive Protein (hsCRP) levels [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] 12.Corticosteroid free remission by Partial Mayo Score [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] Remission is defined by a partial Mayo score of 2 points or lower, with no individual subscore exceeding 1 point and rectal bleeding subscore of 0. The subscores of the partial Mayo score are: *stool frequency (scored 0 to 3) *rectal bleeding (scored 0 to 3) *physician global assessment (PGA) (scored 0 to 3) 13.Average plasma concentration of tofacitinib (Cavg) [ Time Frame: Outcome measured at baseline, induction Week 8, induction Week 16, maintenance Week 16, maintenance Week 44 ] 14.Evaluation of taste acceptability of tofacitinib oral solution, and acceptability of film coated tablet by choosing one of 5 choices [ Time Frame: Outcome measured at induction week 2 ] Taste acceptability will be assessed by asking the participant to select one of 5 choices which most adequately reflects the participant's response to taste. Age appropriate tools (using wording and/or graphic facial expressions) will be used to assess taste acceptability. 15.Peak (maximum) plasma concentration of tofacitinib (Cmax) [ Time Frame: Outcome measured at baseline, induction Week 8, induction Week 16, maintenance Week 16, maintenance Week 44 ] 16.Percentage of Participants Achieving Endoscopic Remission at Week 8, 16, and 44 [ Time Frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44 ] Endoscopic remission is defined by a Mayo endoscopic subscore of 0, out of a maximum of 3 points. The Mayo endoscopic sub-score is used to assess ulcerative colitis activity, and ranges from 0 to 3, and is based on the findings during endoscopy. A lower score is indicative of a lower ulcerative colitis (UC) disease activity. 17.Remission by PUCAI score [ Time Frame: Outcome measured through study completion, an average of 3 and a half years ] The Pediatric Ulcerative Colitis Activity Index (PUCAI) score is the summation of 6 dimensions that are all reported by the investigator. The PUCAI score varies from 0 to 85 points, with the lower score indicating lower ulcerative colitis (UC) disease activity. The 6 dimensions of the PUCAI score are as follows : *abdominal pain *rectal bleeding *stool consistency of most stools *number of stools per 24 hours *nocturnal stools *activity level Remission is defined by a PUCAI score of less than 10 points. |
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トファシチニブ |
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ゼルヤンツ錠5mg | ||
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22500AMX00869 | ||
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募集中 |
Recruiting |
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ファイザー株式会社 |
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Pfizer Japan Inc. |
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なし | |
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久留米大学臨床試験審査委員会 | Kurume University IRB |
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福岡県久留米市旭町67 | 67 Asahi-machi Kurume-shi, Fukuoka |
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0942-31-7200 | |
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kcrc_jimu@kurume-u.ac.jp | |
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承認 |
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NCT04624230 |
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ClinicalTrials.gov |
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ClinicalTrials.gov |
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有 | Yes |
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ファイザーは,ある基準,条件,特例により適格とされる研究者からの要請に応じて、匿名化された個別治験参加者のデータおよび関連文書(治験実施計画書,統計解析計画書,総括報告書など)に研究者がアクセスできる環境を提供しています。当社の臨床試験データの共有に関する基準およびアクセス申請の詳細は,https://www.pfizer.com/science/clinical_trials/trial_data_and_results/data_requestsに掲載されています。 | Pfizer will provide access to individual de-identified participant data and related study documents (e.g. protocol, Statistical Analysis Plan (SAP), Clinical Study Report (CSR)) upon request from qualified researchers, and subject to certain criteria, conditions, and exceptions. Further details on Pfizer's data sharing criteria and process for requesting access can be found at: https://www.pfizer.com/science/clinical_trials/trial_data_and_results/data_requests. |
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(1)試験等の目的及び内容の「実施予定被験者数」は、日本の被験者数ではなく、試験全体の被験者数である。 |
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設定されていません |
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設定されていません |