MTD, Safety, and Efficacy of Pomalidomide (CC-4047) Alone or With Low-dose Dexamethasone in Patients With Relapsed and Refractory Multiple Myeloma
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Purpose
The purpose of this study is to determine the maximum tolerated dose and effectiveness of the study drug (CC-4047) as treatment for patients with relapsed and refractory multiple myeloma.
| Condition | Intervention | Phase |
|---|---|---|
|
Multiple Myeloma |
Drug: Pomalidomide Drug: Dexamethasone Drug: Aspirin |
Phase 1 Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Phase 1/2 Multi-center, Randomized, Open-label Dose Escalation Study to Determine the Maximum Tolerated Dose, Safety, and Efficacy of CC-4047 Alone Or in Combination With Low-dose Dexamethasone in Patients With Relapsed and Refractory Multiple Myeloma Who Have Received Prior Treatment That Includes Lenalidomide and Bortezomib |
- Phase 1: Participants With Dose-Limiting Toxicities (DLT) in Cycle 1 [ Time Frame: Up to Day 28 (Cycle 1) ] [ Designated as safety issue: Yes ]
The maximum tolerated dose was defined as the highest dose level at which no more than 1 of 6 participants experiences a DLT within the first 28-day cycle.
DLTs were defined as:
- Grade 4 neutropenia or thrombocytopenia
- Febrile neutropenia
- Grade 3 or 4 nausea, vomiting or diarrhea despite optimal symptomatic treatment
- Serum transaminase > 20 * upper limit of normal (ULN)
- Serum transaminase > 5 * ULN for >= 7 days
- Delay of the start of cycle 2 by >7 days due to pomalidomide-related adverse event
- Phase 2: Kaplan-Meier Estimates of Progression-free Survival (PFS) as of the 01 April 2011 Cut-off [ Time Frame: up to 67 weeks ] [ Designated as safety issue: No ]
Progression free survival (PFS) is the time from randomization to the first documentation of disease progression or death from any cause during study, whichever occurs earlier. Disease progression was assessed by the Independent Response Adjudication Committee (IRAC).
For the primary PFS analysis, participants who withdrew for any reason or received another antimyeloma therapy (except adding dexamethasone to the Phase 2: Pomalidomide arm) without documented PD (as determined by the IRAC review) were censored on the date of their last adequate response assessment, prior to receiving any other anti-myeloma therapy. Subjects who were still active at the time of the data cut-off date without PD (as determined by the IRAC) were censored on the date of their last adequate response assessment.
Data collection is ongoing and future data results will be included as available.
- Phase 2: Percentage of Participants With Progression-Free Survival (PFS) Events as of the 01 April 2011 Cut-off [ Time Frame: up to 67 weeks ] [ Designated as safety issue: No ]
Percentage of participants with the progression-free survival events: disease progression and death. Disease progression was assessed by the Independent Response Adjudication Committee (IRAC).
Data collection is ongoing and future data results will be included as available.
- Phase 1: Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) While on Single-Agent Pomalidomide as of the 01 April 2011 Cut-off [ Time Frame: Up to week 104 ] [ Designated as safety issue: Yes ]
Relation to study drug was assessed by the Investigator as either suspected or not suspected. Counts represent the suspected relationship. Severity was assessed using National Cancer Institute Common Toxicity Terminology Criteria for Adverse Events version 3.0 (NCI CTCAE v3.0): 1= Mild 2= Moderate 3= Severe 4= Life-threatening and 5= Death related to AE. Serious AEs (SAEs) are those that resulted in death, were life-threatening, required or prolonged inpatient hospitalization, resulted in persistent or significant disability/incapacity, congenital anomaly, or resulted in an important medical event that may have jeopardized the patient or required medical or surgical intervention to prevent one of the outcomes listed above.
Data collection is ongoing and future data results will be included as available.
- Phase 1: Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) While on Both Pomalidomide and Dexamethasone as of the 01 April 2011 Cut-off [ Time Frame: Up to week 126 ] [ Designated as safety issue: Yes ]
TEAEs that occurred during Phase 1 after dexamethasone was added to pomalidomide treatment.
Relation to study drug was assessed by the Investigator as either suspected or not suspected. Counts represent the suspected relationship. Severity was assessed using National Cancer Institute Common Toxicity Terminology Criteria for Adverse Events version 3.0 (NCI CTCAE v3.0): 1= Mild 2= Moderate 3= Severe 4= Life-threatening and 5= Death related to AE. Serious AEs (SAEs) are those that resulted in death, were life-threatening, required or prolonged inpatient hospitalization, resulted in persistent or significant disability/incapacity, congenital anomaly, or resulted in an important medical event that may have jeopardized the patient or required medical or surgical intervention to prevent one of the outcomes listed above.
Data collection is ongoing and future data results will be included as available.
- Phase 2: Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) as of the 01 April 2011 Cut-off [ Time Frame: Up to week 70 ] [ Designated as safety issue: Yes ]
Relation to study drug was assessed by the Investigator as either suspected or not suspected. Counts represent the suspected relationship. Severity was assessed using National Cancer Institute Common Toxicity Terminology Criteria for Adverse Events version 3.0 (NCI CTCAE v3.0): 1= Mild 2= Moderate 3= Severe 4= Life-threatening and 5= Death related to AE. Serious AEs (SAEs) are those that resulted in death, were life-threatening, required or prolonged inpatient hospitalization, resulted in persistent or significant disability/incapacity, congenital anomaly, or resulted in an important medical event that may have jeopardized the patient or required medical or surgical intervention to prevent one of the outcomes listed above.
Data collection is ongoing and future data results will be included as available.
- Phase 2: Summary of Best Myeloma Response As Assessed by Independent Response Adjudication Committee (IRAC) Using European Group for Blood and Bone Marrow Transplant (EBMT) Criteria as of the 01 April 2011 Cut-off [ Time Frame: up to 70 weeks ] [ Designated as safety issue: No ]
IRAC used EBMT criteria to assess myeloma response:
- Complete Response (CR)-absence of serum and urine monoclonal paraprotein for 6 weeks, plus no increase in size or number of lytic bone lesions, plus other factors)
- Partial Response (PR)-not all CR criteria, plus >=50% reduction in serum monoclonal paraprotein plus others
- Minimal Response (MR)- 25-49% reduction in serum monoclonal paraprotein plus others
- Stable Disease (SD)- not MR or progressive disease (PD)
- Progressive Disease (PD)- reappearance of monoclonal paraprotein, lytic bone lesions, other
- Not Evaluable (NE).
Data collection is ongoing and future data results will be included as available.
- Phase 2: Kaplan-Meier Estimates of Duration of Response as of the 01 April 2011 Cut-off [ Time Frame: up to 70 weeks ] [ Designated as safety issue: No ]
Duration of myeloma response is defined as the time from when the response criteria are first met for partial response (PR) or better, until the first date the response criteria are met for progressive disease (PD) or until the participant dies from any cause, whichever occurs first. Duration of response for participants last known to be alive with no progression after a complete response (CR) or PR was censored at the date of last adequate response assessment. Participants with confirmed responses that occur after receiving any other anti-myeloma therapy (except for adding dexamethasone to the pomalidomide treatment arm), including radiation therapy initiated after baseline, was censored at the last adequate assessment prior to the initiation of such treatment.
Response was assessed by the Independent Response Adjudication Committee (IRAC) using European Group for Blood and Bone Marrow Transplant (EBMT) criteria as described in the previous outcome.
- Phase 2: Time to Response as of the 01 April 2011 Cut-off [ Time Frame: up to 70 weeks ] [ Designated as safety issue: No ]
Time to myeloma response is defined as the time from randomization to the time the response criteria for complete response (CR) or partial response (PR) are first met.
Response was assessed by the Independent Response Adjudication Committee (IRAC) using European Group for Blood and Bone Marrow Transplant (EBMT) criteria as described previously.
Data collection is ongoing and future data results will be included as available.
- Phase 2: Kaplan-Meier Estimates of Overall Survival as of the 01 April 2011 Cut-off [ Time Frame: up to 70 weeks ] [ Designated as safety issue: No ]
Overall survival was defined as the time between randomization and death. Participants who die, regardless of the cause of the death, were considered to have had an event. All participants who were lost to follow-up prior to the end of the trial or who were withdrawn from the trial were censored at the time of last contact. Participants who were still being treated were censored at the last available date the subject was known to be alive, or clinical cut-off date if it was earlier.
Data collection is ongoing and future data results will be included as available.
| Enrollment: | 259 |
| Study Start Date: | June 2008 |
| Estimated Study Completion Date: | September 2015 |
| Estimated Primary Completion Date: | September 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Phase 1: 2 mg pomalidomide
Pomalidomide 2 mg daily on days 1-21 of each 28-day cycle. Participants with progressive disease (PD) had the option of adding dexamethasone 40 mg on Days 1, 8, 15, 22 of each 28-day cycle to the pomalidomide treatment, or discontinuing study treatment.
|
Drug: Pomalidomide
1 mg, 2 mg, and 5 mg capsules for oral administration packaged in bottles containing a 21-day supply
Other Names:
Drug: Dexamethasone
oral dexamethasone
Other Name: dexamethasone sodium phosphate
Drug: Aspirin
As prophylactic anti-thrombotic treatment, all participants were given aspirin 81-100 mg daily (commercial supply) unless contraindicated. If aspirin was contraindicated, participants were given another form of anti-thrombotic therapy according to hospital guidelines or physician preference.
Other Name: aspirin
|
|
Experimental: Phase 1: 3 mg pomalidomide
Pomalidomide 3 mg daily on days 1-21 of each 28-day cycle. Participants with progressive disease (PD) had the option of adding dexamethasone 40 mg on Days 1, 8, 15, 22 of each 28-day cycle to the pomalidomide treatment, or discontinuing study treatment.
|
Drug: Pomalidomide
1 mg, 2 mg, and 5 mg capsules for oral administration packaged in bottles containing a 21-day supply
Other Names:
Drug: Dexamethasone
oral dexamethasone
Other Name: dexamethasone sodium phosphate
Drug: Aspirin
As prophylactic anti-thrombotic treatment, all participants were given aspirin 81-100 mg daily (commercial supply) unless contraindicated. If aspirin was contraindicated, participants were given another form of anti-thrombotic therapy according to hospital guidelines or physician preference.
Other Name: aspirin
|
|
Experimental: Phase 1: 4 mg pomalidomide
Pomalidomide 4 mg daily on days 1-21 of each 28-day cycle. Participants with progressive disease (PD) had the option of adding dexamethasone 40 mg on Days 1, 8, 15, 22 of each 28-day cycle to the pomalidomide treatment, or discontinuing study treatment.
|
Drug: Pomalidomide
1 mg, 2 mg, and 5 mg capsules for oral administration packaged in bottles containing a 21-day supply
Other Names:
Drug: Dexamethasone
oral dexamethasone
Other Name: dexamethasone sodium phosphate
Drug: Aspirin
As prophylactic anti-thrombotic treatment, all participants were given aspirin 81-100 mg daily (commercial supply) unless contraindicated. If aspirin was contraindicated, participants were given another form of anti-thrombotic therapy according to hospital guidelines or physician preference.
Other Name: aspirin
|
|
Experimental: Phase 1: 5 mg pomalidomide
Pomalidomide 5 mg daily on days 1-21 of each 28-day cycle. Participants with progressive disease (PD) had the option of adding dexamethasone 40 mg on Days 1, 8, 15, 22 of each 28-day cycle to the pomalidomide treatment, or discontinuing study treatment.
|
Drug: Pomalidomide
1 mg, 2 mg, and 5 mg capsules for oral administration packaged in bottles containing a 21-day supply
Other Names:
Drug: Dexamethasone
oral dexamethasone
Other Name: dexamethasone sodium phosphate
Drug: Aspirin
As prophylactic anti-thrombotic treatment, all participants were given aspirin 81-100 mg daily (commercial supply) unless contraindicated. If aspirin was contraindicated, participants were given another form of anti-thrombotic therapy according to hospital guidelines or physician preference.
Other Name: aspirin
|
|
Experimental: Phase 2: pomalidomide + dexamethasone
Combination therapy of 4 mg pomalidomide given once per day on Days 1-21 of each 28-day cycle and the starting dose of dexamethasone (determined by age) on days 1, 8, 15, and 22 of each 28-day cycle. The starting dose of dexamethasone was 40 mg for participants who were ≤ 75 years of age and 20 mg for participants who were > 75 years of age. Dose reduction steps for dexamethasone were provided for drug-related toxicities.
|
Drug: Pomalidomide
1 mg, 2 mg, and 5 mg capsules for oral administration packaged in bottles containing a 21-day supply
Other Names:
Drug: Dexamethasone
oral dexamethasone
Other Name: dexamethasone sodium phosphate
Drug: Aspirin
As prophylactic anti-thrombotic treatment, all participants were given aspirin 81-100 mg daily (commercial supply) unless contraindicated. If aspirin was contraindicated, participants were given another form of anti-thrombotic therapy according to hospital guidelines or physician preference.
Other Name: aspirin
|
|
Experimental: Phase 2: pomalidomide
4 mg pomalidomide was given once per day on Days 1-21 of each 28-day cycle until PD. Participants in the single agent pomalidomide treatment arm who developed confirmed PD at any time had the option to receive oral dexamethasone on days 1, 8, 15, and 22 of each 28-day cycle at the starting dose of 20 or 40 mg depending on age in addition to their current dose of pomalidomide, or to discontinue treatment.
|
Drug: Pomalidomide
1 mg, 2 mg, and 5 mg capsules for oral administration packaged in bottles containing a 21-day supply
Other Names:
Drug: Dexamethasone
oral dexamethasone
Other Name: dexamethasone sodium phosphate
Drug: Aspirin
As prophylactic anti-thrombotic treatment, all participants were given aspirin 81-100 mg daily (commercial supply) unless contraindicated. If aspirin was contraindicated, participants were given another form of anti-thrombotic therapy according to hospital guidelines or physician preference.
Other Name: aspirin
|
Detailed Description:
The Phase 1 segment of the study was designed to determine the maximum tolerated dose (MTD) of single-agent pomalidomide, which was to be determined in the first cycle of treatment. Following completion of the first cycle, participants were allowed to continue the study at their assigned dose of pomalidomide. Participants who developed progressive disease (PD) at any time, or who had not achieved at least a 25% reduction of serum myeloma (M)-protein levels (if measurable) and a 50% reduction of urine M-protein (if measurable) compared with baseline after completion of 4 cycles of pomalidomide, had the option to receive oral dexamethasone 40 mg on days 1, 8, 15, and 22 of each 28-day treatment cycle in addition to their current dose of pomalidomide. Participants with PD who chose not to add dexamethasone to pomalidomide therapy were to be discontinued from the study. Participants who chose to add dexamethasone were allowed to continue study treatment until PD developed again, at which time they were to be discontinued.
Based on results from the phase 1 portion, the Data Monitoring Committee confirmed 4 mg/day as MTD of pomalidomide. Therefore, the recommended starting dose of pomalidomide for Phase 2 was 4 mg/day on Days 1-21 of each 28-day cycle. In the combination treatment arm, the starting dose of dexamethasone was 40 mg once per day on Days 1, 8, 15 and 22 of each 28-day cycle for subjects who were ≤ 75 years of age. For subjects who were > 75 years of age, the starting dose of dexamethasone was 20 mg once per day on Days 1, 8, 15 and 22 of each 28-day cycle. As prophylactic anti-thrombotic treatment, all participants were to be given aspirin 81-100 mg daily (commercial supply) unless contraindicated. If aspirin was contraindicated, participants were to receive another form of anti-thrombotic therapy according to hospital guidelines or physician preference.
Participants in the combination treatment arm could continue study treatment until PD developed, at which time they were to be discontinued. Participants in the single agent pomalidomide treatment arm who developed confirmed PD at any time had the option to receive oral dexamethasone in addition to their current dose of pomalidomide at the starting dose described above. Participants with PD who chose not to add dexamethasone to pomalidomide therapy were discontinued from study treatment. Participants who chose to add dexamethasone to pomalidomide therapy could continue study treatment until PD developed again, at which point they were discontinued.
Upon discontinuation from study treatment for PD or any other reason, participants were to be assessed three times per year (April, August and December), up to five years, for survival and subsequent anti-myeloma therapies.
Two analyses were planned during the course of the Phase 2 segment: one interim analysis (at 50% information of progression-free survival (PFS) events) and one final analysis. Data cut-off for the interim analysis was 29 October 2010. For the interim analysis, results using aggregated data were provided by Celgene, and analyses by treatment arm were performed by an independent statistician for the Data Monitoring Committee (DMC). The DMC recommended that Celgene personnel be unblinded based on the strength of the data. Limited Celgene personnel were unblinded and shared that unblinded data during a meeting with the FDA. Subsequently, Celgene decided to file an application based on more current study data; the data cut-off for the application was 1 April 2011. The product was approved by the FDA in February 2013 based on data from the 01 April 2011 data cut-off. Results from the 01 April 2011 data cut-off are reported.
The study continues. A final analysis will be performed when the study is completed and results reported as available.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Must be greater than or equal to 18 years at the time of signing the informed consent form
- Must be able to adhere to the study visit schedule and other protocol requirements
- Have a documented diagnosis of multiple myeloma and have relapsed and refractory disease. Patients must have received at least 2 prior therapies. Patients must have relapsed after having achieved at least stable disease for at least one cycle of treatment to at least one prior regimen and then developed PD. Patients must also have documented evidence of PD during or within 60 days (measured from the end of the last cycle) of completing treatment with the last anti-myeloma drug regimen used just prior to study entry (refractory disease)
- Patients must have also undergone prior treatment with at least 2 cycles of lenalidomide and at least 2 cycles of bortezomib (either in separate regimens or within the same regimen)
- Measurable levels of myeloma paraprotein in serum (greater than or equal to 0.5 g/dL) or urine (greater than or equal 0.2 g/dL excreted in a 24 hour collection sample)
- Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1, or 2
- Females of childbearing potential (FCBP) [An FCBP is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., who has had menses at any time in the preceding 24 consecutive months)] must agree to refrain from becoming pregnant for 28 days prior to initiation of study drug, while on study drug and for 28 days after discontinuation of study drug and must agree to regular pregnancy testing during this timeframe.
- All patients must also agree to refrain from donating blood while on study drug and for 28 days after discontinuation from this study
- Males must agree to use a latex condom during any sexual contact with FCBP while participating in the study and for 28 days following discontinuation from this study even if he has undergone a successful vasectomy. Males must also agree to refrain from donating blood, semen or sperm during the above referenced timeframe.
- All patients must agree not to share medication with another person.
Exclusion Criteria:
- Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from signing the informed consent form.
- Any serious concurrent medical conditions that may make the patient non-evaluable or put the patient's safety at risk.
- Pregnant or lactating females
Any of the following laboratory abnormalities:
- Absolute neutrophil count (ANC) < 1,000 cells/mm3
- Platelet count < 75,000/mm3 for patients in whom < 50% of bone marrow nucleated cells are plasma cells; or a platelet count < 30,000/mm3 for patients in whom ≥ 50% of bone marrow nucleated cells are plasma cells
- Serum creatinine > 3.0 mg/dL
- Serum glutamic oxaloacetic transaminase/Aspartate transaminase (SGOT/AST) or Serum Glutamic Pyruvate Transaminase/Alanine transaminase (SGPT/ALT) > 3.0 X upper limit of normal (ULN)
- Serum total bilirubin > 2.0 mg/dL
Prior history of malignancies, other than multiple myeloma, unless the patient has been free of the disease for ≥ 3 years. Exceptions include the following:
- Basal or squamous cell carcinoma of the skin
- Carcinoma in situ of the cervix or breast
- Incidental histologic finding of prostate cancer (TNM stage of T1a or T1b)
- Known Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and/or Hepatitis C Virus (HCV) infection
- Hypersensitivity to thalidomide, lenalidomide, or dexamethasone
- Peripheral neuropathy ≥ Grade 2
- Use of any anti-myeloma drug therapy within 14 days of the initiation of study drug treatment or use of any experimental non-drug therapy within 28 days of the initiation of study drug treatment
- Radiation therapy within 14 days of initiation of study drug treatment Inability or unwillingness to comply with birth control requirements
Contacts and Locations| United States, Arizona | |
| Mayo Clinic Arizona | |
| Scottsdale, Arizona, United States, 85259 | |
| United States, Colorado | |
| Colorado Blood Cancer Institute HCA-HealthONE/Rocky Mountain Blood and Marrow Transplant Program | |
| Denver, Colorado, United States, 80218 | |
| United States, Florida | |
| H. Lee Moffitt Cancer and Research Institute | |
| Tampa, Florida, United States, 33612 | |
| United States, Georgia | |
| Emory University | |
| Atlanta, Georgia, United States, 30322 | |
| United States, Massachusetts | |
| Dana-Farber Cancer Institute | |
| Boston, Massachusetts, United States, 02115 | |
| Massachusetts General Hospital | |
| Boston, Massachusetts, United States, 02114 | |
| United States, Michigan | |
| University of Michigan Comprehensive Cancer Center | |
| Ann Arbor, Michigan, United States, 48105 | |
| United States, Minnesota | |
| Mayo Clinic Minnesota | |
| Rochester, Minnesota, United States, 55905 | |
| United States, Missouri | |
| Washington University - Siteman Cancer Center | |
| St. Louis, Missouri, United States, 63110 | |
| United States, New Jersey | |
| The Cancer Center Hackensack University Medical Center | |
| Hackensack, New Jersey, United States, 07601 | |
| United States, New York | |
| Mt. Sinai Hospital | |
| New York, New York, United States, 10029 | |
| United States, Ohio | |
| The Ohio State University - James Cancer Hospital | |
| Columbus, Ohio, United States, 43210 | |
| United States, Pennsylvania | |
| University of Pittsburgh Cancer Institute | |
| Pittsburgh, Pennsylvania, United States, 15232 | |
| Canada, Alberta | |
| Cross Cancer Center | |
| Edmonton, Alberta, Canada, T6G 1Z2 | |
| Canada, British Columbia | |
| Vancover General Hospital - Diamond Health Care | |
| Vancouver, British Columbia, Canada, V5Z 1M9 | |
| University of Calgary - Tom Baker Cancer Center | |
| Vancouver, British Columbia, Canada, T2N 4N2 | |
| Canada, Ontario | |
| Princess Margaret Hospital - UHN | |
| Toronto, Ontario, Canada, M5G 2M9 | |
| Canada, Quebec | |
| Royal Victoria Hospital - McGill University | |
| Montreal, Quebec, Canada, H3A 1A1 | |
| Study Director: | Christian J Jacques, MD | Celgene Corporation |
More Information
No publications provided by Celgene Corporation
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Celgene Corporation |
| ClinicalTrials.gov Identifier: | NCT00833833 History of Changes |
| Other Study ID Numbers: | CC-4047-MM-002 |
| Study First Received: | January 30, 2009 |
| Results First Received: | March 8, 2013 |
| Last Updated: | May 1, 2013 |
| Health Authority: | United States: Food and Drug Administration United States: Institutional Review Board |
Additional relevant MeSH terms:
|
Multiple Myeloma Neoplasms, Plasma Cell Neoplasms by Histologic Type Neoplasms Hemostatic Disorders Vascular Diseases Cardiovascular Diseases Paraproteinemias Blood Protein Disorders Hematologic Diseases Hemorrhagic Disorders Lymphoproliferative Disorders Immunoproliferative Disorders Immune System Diseases Aspirin |
Dexamethasone acetate Dexamethasone BB 1101 Dexamethasone 21-phosphate Thalidomide Sodium phosphate Anti-Inflammatory Agents, Non-Steroidal Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Physiological Effects of Drugs Pharmacologic Actions Anti-Inflammatory Agents Therapeutic Uses |
ClinicalTrials.gov processed this record on May 19, 2013