Trial Outcomes & Findings for N-acetylcysteine in Non-Acetaminophen Pediatric Acute Liver Failure (NCT NCT00248625)

NCT ID: NCT00248625

Last Updated: 2016-07-28

Results Overview

Spontaneous survival without transplant plus survival following transplantation

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

184 participants

Primary outcome timeframe

One year following randomization

Results posted on

2016-07-28

Participant Flow

Participants were from an established registry of children with acute liver failure. Entry criteria: children \<18 years, absence of a known chronic liver disease, biochemical evidence of acute liver injury, and a liver-based coagulopathy. Evidence of hepatic encephalopathy was required if the prothrombin time (PT) was between 15-19.9 seconds

Participant milestones

Participant milestones
Measure
Placebo
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to placebo consisting of D5W alone. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications. Treatment was stopped earlier than 7 days in the case of hospital discharge, liver transplantation, or death within 7 days of randomization. Dextrose in water: Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive N-acetylcysteine (150 mg/kg/d) in 5% dextrose (D5W) and water or placebo consisting of an equal volume of D5W alone. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications.
N-acetylcysteine (NAC)
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) and water. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications. Treatment was stopped earlier than 7 days in the case of hospital discharge, LTx, or death within 7 days of randomization. N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study. The infusion is discontinued at the time of death, liver transplant or discharge.
Overall Study
STARTED
92
92
Overall Study
COMPLETED
92
90
Overall Study
NOT COMPLETED
0
2

Reasons for withdrawal

Reasons for withdrawal
Measure
Placebo
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to placebo consisting of D5W alone. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications. Treatment was stopped earlier than 7 days in the case of hospital discharge, liver transplantation, or death within 7 days of randomization. Dextrose in water: Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive N-acetylcysteine (150 mg/kg/d) in 5% dextrose (D5W) and water or placebo consisting of an equal volume of D5W alone. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications.
N-acetylcysteine (NAC)
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) and water. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications. Treatment was stopped earlier than 7 days in the case of hospital discharge, LTx, or death within 7 days of randomization. N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study. The infusion is discontinued at the time of death, liver transplant or discharge.
Overall Study
Withdrawal by Subject
0
2

Baseline Characteristics

N-acetylcysteine in Non-Acetaminophen Pediatric Acute Liver Failure

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
N-acetylcysteine (NAC)
n=92 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=92 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Total
n=184 Participants
Total of all reporting groups
Age, Categorical
<=18 years
92 Participants
n=5 Participants
92 Participants
n=7 Participants
184 Participants
n=5 Participants
Age, Categorical
Between 18 and 65 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Age, Categorical
>=65 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Age, Continuous
3.7 years
n=5 Participants
4.5 years
n=7 Participants
4.1 years
n=5 Participants
Sex: Female, Male
Female
45 Participants
n=5 Participants
38 Participants
n=7 Participants
83 Participants
n=5 Participants
Sex: Female, Male
Male
47 Participants
n=5 Participants
54 Participants
n=7 Participants
101 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
1 Participants
n=7 Participants
1 Participants
n=5 Participants
Race (NIH/OMB)
Asian
3 Participants
n=5 Participants
5 Participants
n=7 Participants
8 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
15 Participants
n=5 Participants
15 Participants
n=7 Participants
30 Participants
n=5 Participants
Race (NIH/OMB)
White
68 Participants
n=5 Participants
65 Participants
n=7 Participants
133 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
3 Participants
n=5 Participants
4 Participants
n=7 Participants
7 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
3 Participants
n=5 Participants
2 Participants
n=7 Participants
5 Participants
n=5 Participants
Region of Enrollment
Canada
2 participants
n=5 Participants
3 participants
n=7 Participants
5 participants
n=5 Participants
Region of Enrollment
United States
61 participants
n=5 Participants
68 participants
n=7 Participants
129 participants
n=5 Participants
Region of Enrollment
United Kingdom
29 participants
n=5 Participants
21 participants
n=7 Participants
50 participants
n=5 Participants
Coma Grade of Hepatic Encephalopathy
0-1
65 participants
n=5 Participants
68 participants
n=7 Participants
133 participants
n=5 Participants
Coma Grade of Hepatic Encephalopathy
2-4
27 participants
n=5 Participants
24 participants
n=7 Participants
51 participants
n=5 Participants

PRIMARY outcome

Timeframe: One year following randomization

Population: All participants who were enrolled in the study were included in the survival analysis

Spontaneous survival without transplant plus survival following transplantation

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=92 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=92 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Survival
68 Participants
76 Participants

SECONDARY outcome

Timeframe: One year following randomization

Population: All participants enrolled in study

Survival without liver transplantation

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=92 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=92 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Spontaneous Recovery
33 participants
49 participants

SECONDARY outcome

Timeframe: Within 1 year of randomization

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=92 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=92 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Cumulative Percent Incidence of Transplantation by 1 Year
45 percentage of participants
35 percentage of participants

SECONDARY outcome

Timeframe: Randomization to hospital discharge

Population: All participants enrolled in study with hospital stay information, 2 participants (1 in each arm) did not have hospital discharge information.

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=91 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=91 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Length of Hospital Stay
103 days
Interval 13.0 to 103.0
21 days
Interval 9.0 to 103.0

SECONDARY outcome

Timeframe: Within 7 days of randomization

The length of ICU stay was categorized as number of days in ICU within 7 days of randomization, unless participant either died or received an LTx within this time period. Special categories were created for these cases.

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=92 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=92 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Categorized Length of ICU Stay
1 day
3 participants
4 participants
Categorized Length of ICU Stay
0 days
29 participants
34 participants
Categorized Length of ICU Stay
2 days
3 participants
4 participants
Categorized Length of ICU Stay
3 days
2 participants
0 participants
Categorized Length of ICU Stay
4 days
1 participants
3 participants
Categorized Length of ICU Stay
5 days
4 participants
3 participants
Categorized Length of ICU Stay
6 days
5 participants
3 participants
Categorized Length of ICU Stay
7 days
9 participants
14 participants
Categorized Length of ICU Stay
underwent LTx w/i 7 days of randomization
28 participants
22 participants
Categorized Length of ICU Stay
died w/o LTx w/i 7 days of randomization
8 participants
5 participants

SECONDARY outcome

Timeframe: Within 7 days of randomization

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=92 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=92 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Number of Organ Systems Failing
0
44 participants
46 participants
Number of Organ Systems Failing
1
21 participants
23 participants
Number of Organ Systems Failing
2
15 participants
12 participants
Number of Organ Systems Failing
3
11 participants
8 participants
Number of Organ Systems Failing
4
1 participants
3 participants

SECONDARY outcome

Timeframe: Within 7 days of randomization

Population: All enrolled participants where coma grade could be assessed. Four participants (two in each randomization arm) could not have coma grade assessed during the 7 days after randomization.

West Haven Criteria for hepatic encephalopathy (Grade 0 - IV ) is used for participants \> 3 year of age. Coma grade IV indicates a participant who is comatose , with no reflexes, is decerebrate and has abnormal EEG changes with very slow delta activity. For participants less than 3 years the Whittington Scale was used. The Whittington scale does not use EEG changes and has only 3 levels, early (grades I and II), Mid (III) with somnolence, stupor, combativeness and Late (IV) for participants who are comatose with absent reflexes and decerebrate or decorticate posturing.

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=90 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=90 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Highest Coma Grade of Hepatic Encephalopathy
0
28 participants
27 participants
Highest Coma Grade of Hepatic Encephalopathy
I
16 participants
21 participants
Highest Coma Grade of Hepatic Encephalopathy
II
20 participants
19 participants
Highest Coma Grade of Hepatic Encephalopathy
III
15 participants
17 participants
Highest Coma Grade of Hepatic Encephalopathy
IV
11 participants
6 participants

SECONDARY outcome

Timeframe: Within 7 days of randomization

Outcome measures

Outcome measures
Measure
N-acetylcysteine (NAC)
n=92 Participants
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study.
Placebo
n=92 Participants
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: placebo consisting of an equal volume of D5W alone for up to 7 days following entry into the study
Infectious Complication
20 Participants
21 Participants

Adverse Events

N-acetylcysteine (NAC)

Serious events: 5 serious events
Other events: 19 other events
Deaths: 0 deaths

Placebo

Serious events: 4 serious events
Other events: 16 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
N-acetylcysteine (NAC)
n=92 participants at risk
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study. The infusion is discontinued at the time of death, liver transplant or discharge.
Placebo
n=92 participants at risk
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) and water or placebo consisting of an equal volume of D5W alone. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications. Treatment was stopped earlier than 7 days in the case of hospital discharge, LTx, or death within 7 days of randomization.
Respiratory, thoracic and mediastinal disorders
Respiratory distress
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Infections and infestations
Bacteremia
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Cardiac disorders
Bradycardiac episode
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Endocrine disorders
Hypoglycemia
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Blood and lymphatic system disorders
Aplastic Anemia
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Infections and infestations
Epstein-Barr virus
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Infections and infestations
Fever, chills, sinusitis
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Gastrointestinal disorders
Small intestine ulcerations
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
General disorders
Fever
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
Ear and labyrinth disorders
Hearing loss
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
Cardiac disorders
Bigeminy
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment

Other adverse events

Other adverse events
Measure
N-acetylcysteine (NAC)
n=92 participants at risk
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days N-acetylcysteine: The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study. The infusion is discontinued at the time of death, liver transplant or discharge.
Placebo
n=92 participants at risk
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive Dextrose in water: Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and HE (grade 0-1 or 2-4) to receive NAC (150 mg/kg/d) in 5% dextrose (D5W) and water or placebo consisting of an equal volume of D5W alone. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications. Treatment was stopped earlier than 7 days in the case of hospital discharge, LTx, or death within 7 days of randomization.
Infections and infestations
Infection
12.0%
11/92 • Seven day randomization treatment period
Regular investigator assessment
8.7%
8/92 • Seven day randomization treatment period
Regular investigator assessment
Skin and subcutaneous tissue disorders
Rash
4.3%
4/92 • Seven day randomization treatment period
Regular investigator assessment
2.2%
2/92 • Seven day randomization treatment period
Regular investigator assessment
Respiratory, thoracic and mediastinal disorders
Bronchospasm
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Cardiac disorders
Arrhythmia
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
4.3%
4/92 • Seven day randomization treatment period
Regular investigator assessment
Respiratory, thoracic and mediastinal disorders
Aspiration
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Eye disorders
Dilated and fixed pupils
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Vascular disorders
Hypertension
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
Respiratory, thoracic and mediastinal disorders
Pleural effusion
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
0.00%
0/92 • Seven day randomization treatment period
Regular investigator assessment
General disorders
Sleepiness
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
Cardiac disorders
Bradycardia
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
General disorders
High Fever
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment
1.1%
1/92 • Seven day randomization treatment period
Regular investigator assessment

Additional Information

Robert H. Squires, Jr.

University of Pittsburgh

Phone: 412-692-8648

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place