Clinical trial • Phase III • Haematology
CROVALIMAB for Paroxysmal nocturnal hemoglobinuria (PNH)
Phase III trial of CROVALIMAB for Paroxysmal nocturnal hemoglobinuria (PNH).
Overview
- Trial Therapeutic Area
- Haematology
- Trial Disease
- Paroxysmal nocturnal hemoglobinuria (PNH)
- Trial Stage
- Phase III
- Drug Modality
- Monoclonal antibody
- Paediatric Trial
- Yes
Key dates
- Initial CTIS Submission Date
- 08-05-2024
- First CTIS Authorization Date
- 11-06-2024
Trial design
Randomised, open-label, eculizumab (eculizumab) - concentrate for solution for infusion; comparator (dosing per approved dosing recommended for pnh; specific dose/schedule not specified in the record)-controlled Phase III trial in Ireland, Sweden, Netherlands and others.
- Randomised
- Yes
- Open Label
- Yes
- Comparator
- Eculizumab (ECULIZUMAB) - CONCENTRATE FOR SOLUTION FOR INFUSION; comparator (dosing per approved dosing recommended for PNH; specific dose/schedule not specified in the record)
- Target Sample Size
- 84
- Trial Duration For Participant
- 175
Eligibility
Recruits 84 paediatric patients.
- Pregnancy Exclusion
- Pregnant or breastfeeding, or intending to become pregnant during the study or within 46 weeks (approximately 10.5 months) after the final dose of crovalimab, or 3 months after the final dose of eculizumab (or longer if required by the local product label) Note: In France and Czech republic female patients of childbearing potential are not eligible to participate in the study.
- Vulnerable Population
- Vulnerable populations include pediatric participants (age ranges include infants/children/adolescents). Consent/assent procedures are specified: parental/legal guardian informed consent required for minors; age‑appropriate assent forms are provided (documents listed for age groups e.g. 7-11 years, 12-15/12-17 years); infant/parental authorization forms are provided for youngest participants. Note: in France and Czech Republic patients under 18 years are not eligible.
Inclusion criteria
- {"criterion_text":"- General Inclusion Criteria (All Patients) Body weight >= 40 kg at screening (pediatric patients with body weight <40 kg)\n- General Inclusion Criteria (All Patients) Documented diagnosis of PNH, confirmed by high sensitivity flow cytometry evaluation of WBCs\n- General Inclusion Criteria (All Patients) Platelet count >= 30,000/mm3 at screening without transfusion support within 7 days of lab testing\n- For Patients in Randomized Arms (Arm A and B) Age >= 18 years Documented treatment with eculizumab according to the approved dosing recommended for PNH and completion of a minimum of 24 weeks of treatment prior to Day 1\n- For Patients in Randomized Arms (Arm A and B) Lactate dehydrogenase (LDH) <= 1.5 × ULN at screening\n- For Patients in Non-Randomized Arm (Arm C) - Age ≥2 to <18 years with a body weight ≥ 5 kg, currently treated with eculizumab OR - Currently treated with ravulizumab OR - Currently treated with eculizumab at higher-than-approved doses OR - Patients with known C5 polymorphism and poorly controlled hemolysis by eculizumab or ravulizumab - For adult patients currently treated with approved doses of eculizumab Note: In France and Czech Republic patients under 18 years of age are not eligible to participate in the study."}
Exclusion criteria
- {"criterion_text":"- Major Adverse Vascular Event within 6 months prior to first drug administration (Day 1)\n- History of allogeneic bone marrow transplantation\n- Neisseria meningitidis infection within 6 months prior to screening and up to first study drug administration\n- History of myelodysplastic syndrome with Revised International Prognostic Scoring System (IPSS-R) prognostic risk categories of intermediate, high and very high\n- Pregnant or breastfeeding, or intending to become pregnant during the study or within 46 weeks (approximately 10.5 months) after the final dose of crovalimab, or 3 months after the final dose of eculizumab (or longer if required by the local product label) Note: In France and Czech republic female patients of childbearing potential are not eligible to participate in the study.\n- Concurrent disease, treatment, procedure, or surgery or abnormality in clinical laboratory tests that could interfere with the conduct of the study, may pose any additional risk for the patient, or would, in the opinion of the Investigator, preclude the patient’s safe participation in and completion of the study"}
Endpoints
Primary endpoints
- {"endpoint_text":"- 1. Incidence and severity of adverse events","definition_or_measurement_approach":""}
- {"endpoint_text":"- 2. Change from baseline in targeted vital signs","definition_or_measurement_approach":""}
- {"endpoint_text":"- 3. Change from baseline in targeted clinical laboratory test results","definition_or_measurement_approach":""}
- {"endpoint_text":"- 4. Incidence and severity of injection-site reactions, infusion-related reactions, hypersensitivity, and infections","definition_or_measurement_approach":""}
- {"endpoint_text":"- 5. Incidence of adverse events leading to study drug discontinuation","definition_or_measurement_approach":""}
- {"endpoint_text":"- 6. Incidence and severity of clinical manifestations of drug-target-drug complex formation in patients who switched to crovalimab treatment from eculizumab or ravulizumab treatment","definition_or_measurement_approach":""}
Secondary endpoints
- {"endpoint_text":"- 1. Serum concentration of crovalimab or eculizumab","definition_or_measurement_approach":"Serum concentration measurement (pharmacokinetic assessments)"}
- {"endpoint_text":"- 2. Serum concentration of ravulizumab","definition_or_measurement_approach":"Serum concentration measurement (pharmacokinetic assessments)"}
- {"endpoint_text":"- 3. Prevalence and incidence of anti-drug antibodies (ADAs) to crovalimab","definition_or_measurement_approach":"Detection and quantification of anti-drug antibodies using ADA assays"}
- {"endpoint_text":"- 4. Change over time in pharmacodynamic biomarkers","definition_or_measurement_approach":""}
- {"endpoint_text":"- 5. Change over time in free C5 concentration in crovalimab-treated patients","definition_or_measurement_approach":""}
- {"endpoint_text":"- 6. Observed value and absolute change in parameters reflecting hemolysis","definition_or_measurement_approach":""}
- {"endpoint_text":"- 7. Percent change from baseline in LDH levels averaged over Weeks 21, 23, and 25 based on central laboratory LDH measurements","definition_or_measurement_approach":"Based on central laboratory LDH measurements averaged across Weeks 21, 23 and 25"}
- {"endpoint_text":"- 8. Proportion of patients who achieve TA from baseline through Week 25 (after 24 weeks on treatment)","definition_or_measurement_approach":""}
- {"endpoint_text":"- 9. Proportion of patients with BTH from baseline through Week 25","definition_or_measurement_approach":""}
- {"endpoint_text":"- 10. Proportion of patients with stabilization of hemoglobin from baseline through Week 25","definition_or_measurement_approach":""}
- {"endpoint_text":"- 11. Proportion of patients with central LDH ≤ 1.5 X ULN from baseline through Week 25","definition_or_measurement_approach":"Central laboratory LDH measurements"}
- {"endpoint_text":"- 12. Proportion of patients with central LDH ≤ 1 X ULN from baseline through Week 25","definition_or_measurement_approach":"Central laboratory LDH measurements"}
- {"endpoint_text":"- 13. Total number of units (based on local equivalent) of pRBCs transfused per patient by Week 25","definition_or_measurement_approach":""}
- {"endpoint_text":"- 14. Proportion of patients who have experienced a MAVE from baseline through Week 25","definition_or_measurement_approach":""}
- {"endpoint_text":"- 15. Proportion of patients who reach or maintain a hemoglobin level of at least 10 g/dL, without subsequent decrease below 9 g/dL, in the absence of a transfusion","definition_or_measurement_approach":""}
- {"endpoint_text":"- 16. Mean change from baseline to Week 25 in fatigue, as assessed by the Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue] (for adults aged ≥ 18 years)","definition_or_measurement_approach":"Assessed by FACIT-Fatigue questionnaire (adults ≥ 18 years)"}
- {"endpoint_text":"- 17. Mean change from baseline to Week 25 in Physical Functioning, Role Functioning, and Global Health Status (GHS)/Quality of Life (QoL) scales of the EORTC QLQ-C30, and select disease-related symptoms (abdominal pain, headaches, dyspnea, dysphagia, chest pain, and erectile dysfunction) of the EORTC Item Library (for patients aged ≥ 18 years)","definition_or_measurement_approach":"Assessed by EORTC QLQ-C30 scales and selected EORTC Item Library items (patients ≥ 18 years)"}
- {"endpoint_text":"- 18. Mean change from baseline to Week 25 in Pediatric Quality of Life Inventory™ (PedsQL™) Multidimensional Fatigue Scale (MFS), and the Physical Functioning scale of the PedsQL Core (for patients aged 8-17 years)","definition_or_measurement_approach":"Assessed by PedsQL Multidimensional Fatigue Scale and PedsQL Core (patients 8-17 years)"}
- {"endpoint_text":"- 19. Proportion of patients with preference for crovalimab after switching from eculizumab or ravulizumab at Week 17 (Arms A and C), as assessed through use of a Patient Preference Questionnaire developed by the Sponsor (for patients aged ≥ 12 years)","definition_or_measurement_approach":"Assessed using a sponsor-developed Patient Preference Questionnaire (patients ≥ 12 years)"}
- {"endpoint_text":"- 20. Mean treatment satisfaction with crovalimab or eculizumab at Week 25, as assessed by the Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) (for patients aged ≥ 18 years)","definition_or_measurement_approach":"Assessed by TSQM-9 (patients ≥ 18 years)"}
Recruitment
- Planned Sample Size
- 84
- Recruitment Window Months
- 113
- Consent Approach
- Informed consent is obtained from adult participants; for minors parental/legal guardian informed consent is required. Age-appropriate assent forms are provided (documents for age groups such as 7-11 years, 12-15/12-17 years are included). Infant authorization / parental ICF documents are present for the youngest participants. Consent and ICF materials are available in multiple country/language versions per participating Member State (multiple language-specific ICFs and assent/parental forms listed in the trial documents). Note: in France and Czech Republic patients under 18 years are not eligible.
Geography
- Total Number Of Sites
- 32
- Total Number Of Participants
- 77
Ireland
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 09-09-2025
- Processing Time Days
- 473
- Number Of Sites
- 1
- Number Of Participants
- 2
Sites
- Site Name
- St James's Hospital
- Department Name
- Haematology
- Contact Person Name
- Catherine Flynn
- Contact Person Email
- cmflynn@stjames.ie
Sweden
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 10-09-2025
- Processing Time Days
- 474
- Number Of Sites
- 1
- Number Of Participants
- 2
Sites
- Site Name
- Uppsala University Hospital
- Department Name
- Dept. of Hematology
- Contact Person Name
- Martin Hoglund
- Contact Person Email
- martin.hoglund@medsci.uu.se
Netherlands
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 27-11-2024
- Processing Time Days
- 187
- Number Of Sites
- 1
- Number Of Participants
- 6
Sites
- Site Name
- Amsterdam UMC Stichting
- Department Name
- Department of Hematology
- Contact Person Name
- Erfan Nur
- Contact Person Email
- e.nur@amsterdamumc.nl
Germany
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 02-12-2024
- Processing Time Days
- 192
- Number Of Sites
- 2
- Number Of Participants
- 5
Sites
- Site Name
- ELBLANDKLINIKEN Stiftung & Co. KG
- Department Name
- Klinik fuer Innere Medizin III
- Contact Person Name
- Joerg Schubert
- Contact Person Email
- joerg.schubert@elblandkliniken.de
- Site Name
- Universitaetsklinikum Aachen AöR
- Department Name
- Medizinische Klinik IV
- Contact Person Name
- Jens Panse
- Contact Person Email
- jpanse@ukaachen.de
Czechia
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 27-11-2024
- Processing Time Days
- 187
- Number Of Sites
- 1
- Number Of Participants
- 2
Sites
- Site Name
- Institute Of Hematology And Blood Transfusion
- Department Name
- Hematology
- Contact Person Name
- Jaroslav Čermák
- Contact Person Email
- jaroslav.cermak@uhkt.cz
Estonia
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 12-09-2025
- Processing Time Days
- 476
- Number Of Sites
- 1
- Number Of Participants
- 2
Sites
- Site Name
- North Estonia Medical Centre Foundation
- Department Name
- Hematology
- Contact Person Name
- Iige Viigimaa
- Contact Person Email
- iige.viigimaa@regionaalhaigla.ee
France
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 12-09-2025
- Processing Time Days
- 476
- Number Of Sites
- 3
- Number Of Participants
- 3
Sites
- Site Name
- Centre Hospitalier Universitaire De Lille
- Department Name
- Hematology
- Contact Person Name
- Louis TERRIOU
- Contact Person Email
- louis.terriou@chru-lille.fr
- Site Name
- Institut Paoli Calmettes
- Department Name
- Hematology
- Contact Person Name
- Yosr HICHERI
- Contact Person Email
- HICHERIY@ipc.unicancer.fr
- Site Name
- Centre Hospitalier Universitaire De Rennes
- Department Name
- Hematology
- Contact Person Name
- Sophie DE GUIBERT
- Contact Person Email
- sophie.de.guibert@chu-rennes.fr
Italy
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 10-09-2025
- Processing Time Days
- 474
- Number Of Sites
- 4
- Number Of Participants
- 10
Sites
- Site Name
- Azienda Unita Sanitaria Locale Della Romagna
- Department Name
- Hematology
- Contact Person Name
- Francesco Lanza
- Contact Person Email
- francesco.lanza@auslromagna.it
- Site Name
- Azienda Ospedaliera Universitaria Citta Della Salute E Della Scienza Di Torino
- Department Name
- Hematology
- Contact Person Name
- Valentina Giai
- Contact Person Email
- vgiai@cittadellasalute.to.it
- Site Name
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico
- Department Name
- Hematology
- Contact Person Name
- Bruno Fattizzo
- Contact Person Email
- bruno.fattizzo@policlinico.mi.it
- Site Name
- Careggi University Hospital
- Department Name
- Hematology
- Contact Person Name
- Barbara Scappini
- Contact Person Email
- scappinib@aou-careggi.toscana.it
Portugal
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 14-05-2025
- Processing Time Days
- 355
- Number Of Sites
- 2
- Number Of Participants
- 8
Sites
- Site Name
- Unidade Local De Saude Da Regiao De Aveiro E.P.E.
- Department Name
- Serviço de Hematologia
- Contact Person Name
- Fernando Silva
- Contact Person Email
- Fernando.Silva.70836@chbv.min-saude.pt
- Site Name
- Unidade Local De Saude De Santo Antonio E.P.E.
- Department Name
- Serviço de Hematologia Clínica
- Contact Person Name
- Patrícia Seabra
- Contact Person Email
- pseabra.hematologiaclinica@chporto.min-saude.pt
Belgium
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 11-09-2025
- Processing Time Days
- 475
- Number Of Sites
- 3
- Number Of Participants
- 5
Sites
- Site Name
- Algemeen Ziekenhuis Delta
- Department Name
- Hematology
- Contact Person Name
- Dries Deeren
- Contact Person Email
- dries.deeren@azdelta.be
- Site Name
- Centre Hospitalier Universitaire Dinant Godinne Sainte-Elisabeth-UCL-Namur
- Department Name
- Hematology
- Contact Person Name
- Berangere Devalet
- Contact Person Email
- berangere.devalet@chuuclnamur.uclouvain.be
- Site Name
- Cliniques Universitaires Saint-Luc
- Department Name
- Hematology
- Contact Person Name
- Xavier Poiré
- Contact Person Email
- Xavier.Poire@saintluc.uclouvain.be
Spain
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 11-09-2025
- Processing Time Days
- 475
- Number Of Sites
- 10
- Number Of Participants
- 17
Sites
- Site Name
- Hospital Clinico San Carlos
- Department Name
- Hematology
- Contact Person Name
- Fernando Ataulfo Gonzalez Fernandez
- Contact Person Email
- fernandoataulfo.gonzalez@salud.madrid.org
- Site Name
- El Hospital Universitario De Gran Canaria Dr. Negrin
- Department Name
- Hematology
- Contact Person Name
- Silvia Narcisa de la Iglesia Iñigo
- Contact Person Email
- siglini@gmail.com
- Site Name
- University Hospital Virgen Del Rocio S.L.
- Department Name
- Hematology
- Contact Person Name
- Ramiro Nuñez Vazquez
- Contact Person Email
- ramirojosenv@gmail.com
- Site Name
- Hospital Universitario De Salamanca
- Department Name
- Hematology
- Contact Person Name
- Maria Belen Vidriales Vicente
- Contact Person Email
- mbvidriales@saludcastillayleon.es
- Site Name
- Hospital Universitario De Toledo
- Department Name
- Hematology
- Contact Person Name
- Jorge Cuesta Tovar
- Contact Person Email
- jorgecuestatovar@gmail.com
- Site Name
- Hospital Unviersitario Miguel Servet
- Department Name
- Hematology
- Contact Person Name
- Maria del Valle Recasens Flores
- Contact Person Email
- vrecasens@salud.aragon.es
- Site Name
- Hospital General Universitario Gregorio Maranon
- Department Name
- Hematology
- Contact Person Name
- Mónica Ballesteros Andres
- Contact Person Email
- monicabandres@hotmail.com
- Site Name
- Hospital Universitario Regional De Malaga
- Department Name
- Hematology
- Contact Person Name
- Alejandro Contento Gonzalo
- Contact Person Email
- dralejandrocontento@yahoo.com.ar
- Site Name
- Hospital Universitario Basurto
- Department Name
- Hematology
- Contact Person Name
- Cristina de Barrenetxea Lekue
- Contact Person Email
- cristina.barrene@gmail.com
- Site Name
- Complexo Hospitalario Universitario De Santiago
- Department Name
- Hematology
- Contact Person Name
- Ana Maria Fernandez Villar
- Contact Person Email
- ana.fernandez.villar@gmail.com
Poland
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 12-09-2025
- Processing Time Days
- 476
- Number Of Sites
- 4
- Number Of Participants
- 11
Sites
- Site Name
- Szpital Uniwersytecki Nr 2 Im Dr Jana Biziela W Bydgoszczy
- Department Name
- Klinika Hematologii
- Contact Person Name
- Marta Sobas
- Contact Person Email
- marta.sobas@gmail.com
- Site Name
- Uniwersyteckie Centrum Kliniczne
- Department Name
- Klinika Hematologii i Transplantologii
- Contact Person Name
- Agnieszka Piekarska
- Contact Person Email
- babajaga@gumed.edu.pl
- Site Name
- Mtz Clinical Research Powered By Pratia
- Contact Person Name
- Joanna Drozd-Sokołowska
- Contact Person Email
- badacz@pratia.com
- Site Name
- Uniwersytecki Szpital Kliniczny Nr 1 W Lublinie
- Department Name
- Klinika Hematoonkologii i Transplantacji Szpiku
- Contact Person Name
- Justyna Kozińska
- Contact Person Email
- justynakozinska@vp.pl
Greece
- Earliest CTIS Part Ii Submission Date
- 24-05-2024
- Latest Decision Or Authorization Date
- 26-09-2025
- Processing Time Days
- 490
- Number Of Sites
- 3
- Number Of Participants
- 4
Sites
- Site Name
- Laiko General Hospital Of Athens
- Department Name
- Hematology Clinic and Bone Marrow Τransplantation Unit
- Contact Person Name
- Panayiotis Panayiotidis
- Contact Person Email
- ppanayi@med.uoa.gr
- Site Name
- University General Hospital Attikon
- Department Name
- B Department of Propaedeutic Internal Medicine Clinic
- Contact Person Name
- Vassiliki Pappa
- Contact Person Email
- vas_pappa@yahoo.com
- Site Name
- Geniko Nosokomeio Thessalonikis George Papanikolaou
- Department Name
- Hematology Clinic
- Contact Person Name
- Chrysavgi – Elissavet Lalagianni
- Contact Person Email
- luizana6@gmail.com
Sponsor
Primary sponsor
- Full Name
- F. Hoffmann-La Roche AG
- Organisation Type
- Pharmaceutical company
- Country Of Registered Address
- Switzerland
Contract research organisations
- Name
- IQVIA Limited
- Responsibilities
- Global CRO; FSP monitoring
- Name
- Parexel International Limited
- Responsibilities
- Randomization
- Name
- Icon Clinical Research Limited
- Responsibilities
- Patient Reported Outcomes
- Name
- Iqvia Inc.
- Responsibilities
- Patient Reported Outcomes
- Name
- Fortrea Inc.
- Responsibilities
- Mobile Clinical Services
Third parties
- {"country":"United Kingdom","full_name":"IQVIA Limited","duties_or_roles":"FSP monitoring","organisation_type":"Pharmaceutical company"}
- {"country":"United Kingdom","full_name":"Parexel International Limited","duties_or_roles":"Randomization","organisation_type":"Pharmaceutical company"}
- {"country":"United States","full_name":"FACIT.Org Inc.","duties_or_roles":"Patient Reported Outcomes","organisation_type":"Pharmaceutical company"}
- {"country":"Belgium","full_name":"MEDPACE LABORATORIES","duties_or_roles":"Analytical Laboratory","organisation_type":"Laboratory/Research/Testing facility"}
- {"country":"United States","full_name":"Iqvia Inc.","duties_or_roles":"Patient Reported Outcomes","organisation_type":"Pharmaceutical company"}
- {"country":"Japan","full_name":"Cmic Pharma Science Co. Ltd.","duties_or_roles":"Analytical Laboratory","organisation_type":"Pharmaceutical company"}
- {"country":"United Kingdom","full_name":"IQVIA Limited","duties_or_roles":"Global CRO","organisation_type":"Pharmaceutical company"}
- {"country":"United Kingdom","full_name":"Q Squared Solutions Limited","duties_or_roles":"Analytical Laboratory","organisation_type":"Non-Pharmaceutical company"}
- {"country":"United States","full_name":"Fortrea Inc.","duties_or_roles":"Mobile Clinical Services","organisation_type":"Pharmaceutical company"}
- {"country":"Belgium","full_name":"Europese Organisatie Voor Onderzoek En Behandeling Van Kanker Organisation Europeenne Pour La Recherche Et Le Traitement Du Cancer European Organi","duties_or_roles":"Patient Reported Outcomes","organisation_type":"Patient organisation/association"}
- {"country":"United States","full_name":"Icon Development Solutions LLC","duties_or_roles":"Analytical Laboratory","organisation_type":"Pharmaceutical company"}
- {"country":"Switzerland","full_name":"Labcorp Central Laboratory Services SARL","duties_or_roles":"Central lab","organisation_type":"Pharmaceutical company"}
- {"country":"Ireland","full_name":"Icon Clinical Research Limited","duties_or_roles":"Patient Reported Outcomes","organisation_type":"Pharmaceutical company"}
- {"country":"United Kingdom","full_name":"Publicis Healthcare Communications Group Limited","duties_or_roles":"Patient and site materials","organisation_type":"Non-Pharmaceutical company"}
Investigational products
- Investigational Product Name
- Crovalimab
- Active Substance
- CROVALIMAB
- Modality
- Monoclonal antibody
- Routes Of Administration
- Intravenous
- Route
- Intravenous
- Maximum Dose
- 1500 mg
- Investigational Product Name
- Eculizumab
- Active Substance
- ECULIZUMAB
- Modality
- Monoclonal antibody
- Routes Of Administration
- Intravenous
- Route
- Intravenous
- Maximum Dose
- 900 mg
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