CClinicalTrials.gg
CompletedNCT01582711iAdhereUpdated Mar 13, 2025Results posted

Study 33: Adherence to Latent Tuberculosis Infection Treatment 3HP SAT Versus 3HP DOT

A Phase 3 interventional study of Self Administered Therapy (SAT) and SMS reminders in Latent Tuberculosis Infection, sponsored by Centers for Disease Control and Prevention. Completed at 12 sites in 4 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-03-13.

Sponsored by Centers for Disease Control and Prevention · Phase 3, Interventional, and Prevention

Phase
Phase 3
Study type
Interventional
Enrollment
1,002
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The study is an open label, multicenter, randomized (three arms: DOT (standard control), SAT, SAT with SMS reminders) controlled clinical trial. The trial is conducted in patients diagnosed with latent tuberculosis infection (LTBI) who are recommended for treatment. The primary objective is to evaluate adherence to a three-month (12-dose) regimen of weekly rifapentine and isoniazid (3RPT/INH) given by directly observed therapy (DOT) compared to self-administered therapy (SAT). The secondary objectives:

  • To compare the treatment completion rates between participants randomized to SAT without reminders versus SAT with weekly SMS reminders
  • To evaluate the timing of doses and patterns of adherence to once weekly RPT/INH among participants who complete treatment and those who discontinue therapy prior to completion.
  • To determine the availability and acceptability of using SMS reminders among all patients consenting to participate in the study.
  • To determine the toxicity and tolerability by comparing the rates of any drug-related grade 3 or 4 adverse events or death between the DOT arm and the SAT arms (both combined and individually)
  • To compare the frequency, timing, and causes for failure to complete treatment between the DOT arm and the SAT arms
  • To collect patient-specific cost data related to the 3 treatment arms
  • To describe the pattern of antituberculosis drug resistance among Mycobacterium tuberculosis strains cultured from participants who develop active TB.
Read the detailed description

The World Health Organization (WHO) estimates that approximately 2.3 billion people are infected with Mycobacterium tuberculosis. Approximately 1.7 million people die of TB each year, the second most common infectious cause of death in the world. In order to improve TB control worldwide, an affordable, effective, short course treatment for latent TB infection (LTBI) is a global priority.

Candidates for LTBI treatment are those persons with a positive TST or IGRA, particularly if they also have risk factors for progressing to active TB, including individuals likely to be recently infected. The Prevent TB Study (TBTC Study 26) was an open-label, randomized, phase III controlled clinical trial with over 8,000 high risk TST reactors enrolled. The study compared rifapentine and INH (3RPT/INH) given once-weekly by directly observed treatment (DOT) for 3 months (12 doses) compared with 9 months of daily, self-administered INH. The results demonstrated the safety and efficacy of the shorter regimen. Moreover, the once weekly therapy had significantly higher treatment completion rates than the standard 9 INH regimen.

One of the most effective strategies for assuring adherence with therapy is to have each dose of medication directly administered by a health care worker who observes and records the ingestion of the drugs. DOT for active TB has been successfully used in many settings to improve treatment completion, however cost and logistical constraints of DOT remain. The estimated cost of giving 12 weekly DOT doses to all LTBI patients is likely prohibitive for TB control programs worldwide. This may lead to a decreased uptake of the new regimen or implementation using SAT where adherence has not been studied. Therefore, to apply the Prevent TB study results more broadly, a new study evaluating treatment completion of 3 RPT/INH given as SAT is conducted.

Medication adherence is defined by whether patients take a treatment as prescribed. The effectiveness of any treatment is determined largely by adherence. In clinical practice and research, indirect measures of adherence are commonly used. Indirect measures of adherence include patient self-report, evaluation of pharmacy dispensation records, pill counts, and the use of electronic prescription bottle monitors. Patient self-reported adherence is accurate when non-adherence is reported but tends to overestimate true adherence. Self-report is not discerning enough to be utilized as a sole measure of adherence in research settings where adherence is the primary outcome. Pill counts have been utilized successfully in research and clinical settings for real-time assessment but also tend to overestimate adherence. Electronic drug monitors such as the Medication Event Monitoring System (MEMS) are the best available tools to assess the timing and patterns of adherence. This study uses a combination of indirect measures including MEMS, pill counts, and self-report to provide the most accurate assessment of adherence to once weekly, self-administered RPT/INH.

The number of cellular phone users globally has increased dramatically in the last decade. Cell phones and SMS reminders have been used successfully in randomized controlled clinical trials to improve adherence to vaccines, HIV medications, and asthma treatment. SMS appear to be cost-effective ways to reach patients in remote locations. This study examines effect of SMS on medication adherence.

The goal of this open label clinical trial is to compare the adherence to 3RPT/INH given by DOT versus SAT or SAT with a weekly SMS reminder. The primary assessment of adherence will be treatment completion which is defined as taking at least 90% of the doses (11/12 doses of each drug) within 16 weeks of initiation. Secondary objectives include evaluating the patterns of adherence in participants who fail to complete, determining the feasibility and impact of using SMS reminders on treatment completion with SAT, evaluating the tolerability and any adverse events associated with each treatment arm, monitoring for the development of active TB, determining the drug susceptibility for participants who develop active TB, and measuring important patient-related expenditures associated with each study arm. The trial will be conducted in patients diagnosed with LTBI and recommended for treatment.

02

Conditions studied

  • Latent Tuberculosis Infection

Keywords

  • LTBI
  • LTB
  • Latent TB
  • TB infection
03

In context

Infections

6,687 studies on the registry are indexed under Infections; 807 are open to participants now.

This study's enrollment of 1,002 is above the median of 120 across 4,200 interventional studies indexed under Infections.

Browse Infections studies →

Lead sponsor

Centers for Disease Control and Prevention is the lead sponsor of 273 studies on the registry; 2 are open to participants now.

Of its 11 completed or terminated interventional studies of FDA-regulated products, 8 (73%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Males and non-pregnant, non-nursing females
  • Age > 18 years
  • Weight > 45kg and considered appropriate to receive RPT 900mg and INH 900mg once weekly by the local site investigator
  • Willingness to provide signed informed consent.
  • Clinical indication for LTBI treatment such as: 1) persons with a positive tuberculin skin test (TST) as defined by CDC criteria or a positive interferon-gamma release assay (IGRA) defined per the manufacturers' guidelines AND one of the following: close contact to someone with culture confirmed TB, HIV infection, or > 2 cm2 of pulmonary parenchymal fibrosis on chest X-ray and no prior history of TB treatment; 2) TST or IGRA converters defined as a documented change from negative to positive within a two-year period; 3) Persons with any other clinical indication for LTBI treatment as locally defined including persons with a negative TST and/or IGRA (e.g. HIV-infected close contacts to an active pulmonary TB cases)

Exclusion criteria

Exclusion Criteria:

  • Confirmed or suspected active TB
  • Contacts to a source case with known resistance to isoniazid or rifampin
  • Persons with a history (by written documentation or self-report) of ever receiving > 1 week of treatment for active or latent TB, regardless of whether the course was completed, because adherence may be different in people who previously took TB treatment
  • Persons who are not considered candidates for SAT by the local investigator
  • History of sensitivity or intolerance to isoniazid or rifamycins
  • Serum alanine aminotransferase (ALT, SGPT) > 5x upper limit of normal among persons in whom an ALT is determined
  • Persons with HIV-infection who 1) have a CD4 \< 350 or 2) are currently receiving or planning to receive antiretroviral therapy in the first 120 days after study initiation (e.g., HIV-1 protease inhibitors, nucleoside or non-nucleoside reverse transcriptase inhibitors, CCR5 inhibitors or integrase inhibitors)
05

Study design

Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
1,002 participants (actual)

Study arms

  • Active comparator
    3HP Directly Observed Therapy (DOT)

    900mg of isoniazid plus 900mg of rifapentine given weekly for 3 months (12 weeks, 12 doses) under Directly Observed Therapy (DOT)

    Drug: isoniazid and rifapentine

  • Experimental
    3HP Self Administered Therapy (SAT)

    900mg of isoniazid plus 900mg of rifapentine given weekly for 3 months (12 weeks, 12 doses) as patient Self Administered Therapy (SAT)

    Behavioral: Self Administered Therapy (SAT) · Drug: isoniazid and rifapentine

  • Experimental
    3HP SAT with SMS Reminders

    900mg of isoniazid plus 900mg of rifapentine given weekly for 3 months (12 weeks, 12 doses) as patient Self Administered Therapy (SAT). In addition, patient receives phone Short Message Service (SMS) reminders weekly.

    Behavioral: Self Administered Therapy (SAT) · Behavioral: SMS reminders · Drug: isoniazid and rifapentine

Interventions

  • BehavioralSelf Administered Therapy (SAT)

    Self Administered Therapy (SAT)

    Also known as: SAT

  • BehavioralSMS reminders

    Short Message Service (SMS) text reminders

    Also known as: SMS, phone text reminder

  • Drugisoniazid and rifapentine

    rifapentine (PRIFTIN, RPT) 900 mg and isoniazid (INH) 900mg, once-weekly, for 12 weeks (12 doses)

    Also known as: PRIFTIN, RPT, P, INH, I

06

What researchers measure

Primary outcomes

  1. Treatment Completion Rate.

    To compare the treatment completion rates between participants randomized to DOT vs SAT without reminders and DOT versus SAT with weekly SMS reminders. Treatment completion is defined as taking at least 90% of the doses (11/12 doses of each drug) within 16 weeks of treatment initiation.

    Time frame: Up to 16 weeks from start of treatment.

Secondary outcomes

  1. Treatment Completion Rates Between Participants Randomized to SAT Without Reminders Versus SAT With Weekly SMS Reminders

    To compare the treatment completion rates between participants randomized to SAT without reminders versus SAT with weekly SMS reminders

    Time frame: Up to 16 weeks from start of treatment.

  2. The Percentage of Participants Who Completed Treatment Based on SOC vs SOC Plus MEMS

    The number and proportion of participants who adhered (completed treatment) based on pill count and self-report, considered to be standard of care (SOC) vs. the number of participants who completed treatment based on SOC plus MEMS cap.

    Time frame: Up to 16 weeks from start of treatment.

  3. Availability and Acceptability

    To determine the availability and acceptability of using SMS reminders among all patients consenting to participate in the study.

    Time frame: Up to 16 weeks from start of treatment.

  4. Number and Percentage of Participants With Drug-related Grade 3 or 4 Adverse Events or Death

    To determine the toxicity and tolerability by comparing the rates of any drug-related grade 3 or 4 adverse events or death between the DOT arm and the SAT arms (both combined and individually)

    Time frame: Up to 16 weeks from start of treatment.

  5. Number and Percentage of Participants Reason for Failure to Complete Treatment

    To compare the frequency, timing, and causes for failure to complete treatment between the DOT arm and the SAT arms (both combined and individually) including discontinuation due to: * non-adherence * any adverse event (AE) * a diagnosis of active TB * other reasons

    Time frame: Up to 16 weeks from start of treatment.

  6. Patient-specific Cost

    To collect patient-specific cost data related to the DOT and SAT arms

    Time frame: Up to 20 weeks from start of treatment.

  7. Antituberculosis Drug Resistance

    To describe the pattern of antituberculosis drug resistance among Mycobacterium tuberculosis strains cultured from participants who develop active TB.

    Time frame: Up to 16 weeks from start of treatment.

07

Results

Posted Mar 13, 2025

Participant flow

Participant flow — Overall Study
Milestone3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
Started337337328
Completed337337328
Not completed000

Outcome measures

PrimaryTreatment Completion Rate.

To compare the treatment completion rates between participants randomized to DOT vs SAT without reminders and DOT versus SAT with weekly SMS reminders. Treatment completion is defined as taking at least 90% of the doses (11/12 doses of each drug) within 16 weeks of treatment initiation.

Time frame:
Up to 16 weeks from start of treatment.
Reported as:
Count of participants · Participants
Treatment Completion Rate.
Participants3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
Treatment Completion Rate.294248250
SecondaryTreatment Completion Rates Between Participants Randomized to SAT Without Reminders Versus SAT With Weekly SMS Reminders

To compare the treatment completion rates between participants randomized to SAT without reminders versus SAT with weekly SMS reminders

Time frame:
Up to 16 weeks from start of treatment.
Reported as:
Count of participants · Participants
Treatment Completion Rates Between Participants Randomized to SAT Without Reminders Versus SAT With Weekly SMS Reminders
Participants3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
Treatment Completion Rates Between Participants Randomized to SAT Without Reminders Versus SAT With Weekly SMS Reminders248250
SecondaryThe Percentage of Participants Who Completed Treatment Based on SOC vs SOC Plus MEMS

The number and proportion of participants who adhered (completed treatment) based on pill count and self-report, considered to be standard of care (SOC) vs. the number of participants who completed treatment based on SOC plus MEMS cap.

Time frame:
Up to 16 weeks from start of treatment.
Reported as:
Count of participants · Participants
The Percentage of Participants Who Completed Treatment Based on SOC vs SOC Plus MEMS
Participants3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
Treatment completion proportion based on pill count/self-report294271266
Treatment completion proportion based on pill count/self-report and MEMS cap294248249
SecondaryAvailability and Acceptability

To determine the availability and acceptability of using SMS reminders among all patients consenting to participate in the study.

Time frame:
Up to 16 weeks from start of treatment.
Reported as:
Count of participants · Participants
Availability and Acceptability
Participants3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders3HP Directly Observed Therapy (DOT)
Proportion of Participants have cell SMS phone (Availability)342928
Proportion of Participants willing to use SMS (Acceptability) (eSAT arm ONLY)02290
SecondaryNumber and Percentage of Participants With Drug-related Grade 3 or 4 Adverse Events or Death

To determine the toxicity and tolerability by comparing the rates of any drug-related grade 3 or 4 adverse events or death between the DOT arm and the SAT arms (both combined and individually)

Time frame:
Up to 16 weeks from start of treatment.
Reported as:
Count of participants · Participants
Number and Percentage of Participants With Drug-related Grade 3 or 4 Adverse Events or Death
Participants3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
Number and Percentage of Participants With Drug-related Grade 3 or 4 Adverse Events or Death232329
SecondaryNumber and Percentage of Participants Reason for Failure to Complete Treatment

To compare the frequency, timing, and causes for failure to complete treatment between the DOT arm and the SAT arms (both combined and individually) including discontinuation due to: * non-adherence * any adverse event (AE) * a diagnosis of active TB * other reasons

Time frame:
Up to 16 weeks from start of treatment.
Reported as:
Count of participants · Participants
Number and Percentage of Participants Reason for Failure to Complete Treatment
Participants3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
Study therapy not started374
Drug toxicities causing permanent discontinuation121814
Failure to complete minimum number of PP doses479
Not advisable to continue study drugs252
Refused further study therapy6711
Patient became pregnant212
Other91211
Unknown/Missing266
SecondaryPatient-specific Cost

To collect patient-specific cost data related to the DOT and SAT arms

Time frame:
Up to 20 weeks from start of treatment.
Reported as:
Median · U.S. Dollar
Patient-specific Cost
U.S. Dollar3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (Combined SAT and SAT With Reminders)
Patient-specific Cost361.50 (125 to 425)257.82 (90 to 340)
SecondaryAntituberculosis Drug Resistance

To describe the pattern of antituberculosis drug resistance among Mycobacterium tuberculosis strains cultured from participants who develop active TB.

Time frame:
Up to 16 weeks from start of treatment.
Reported as:
Count of participants · Participants
Antituberculosis Drug Resistance
Participants3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
Developed TB but not drug resistant001
Antituberculosis Drug Resistant000

Adverse events

Collected over Adverse event data were collected for the duration of study treatment (up to 16 weeks) + 14 days (for late toxicity). Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
3HP Directly Observed Therapy (DOT)0/337 (0%)11/337 (3.3%)42/337 (12.5%)
3HP Self Administered Therapy (SAT)0/337 (0%)5/337 (1.5%)54/337 (16%)
3HP SAT With SMS Reminders1/328 (0.3%)6/328 (1.8%)56/328 (17.1%)
Most frequent serious events
Most frequent serious events
Event3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
unrelated to study drugGeneral disorders8/3375/3374/328
Acute gastroenteritisGastrointestinal disorders1/3370/3371/328
fatigueGeneral disorders0/3370/3371/328
Systemic Drug ReactionGeneral disorders1/3370/3370/328
rheumatoid arthritis flareGeneral disorders1/3370/3370/328
Most frequent other events
Most frequent other events
Event3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS Reminders
OtherGeneral disorders27/33736/33750/328
Systemic Drug ReactionGeneral disorders13/33715/33714/328
HepatitisGeneral disorders1/3373/3375/328
ThrombocytopeniaGeneral disorders0/3370/3371/328
NeutropeniaGeneral disorders1/3370/3370/328

Baseline characteristics

Age, Continuous
Age, Continuous(years)3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS RemindersTotal
Median36 (27 to 48)36 (27 to 48)38 (27 to 49)36 (27 to 49)
Sex: Female, Male
Sex: Female, Male(Participants)3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS RemindersTotal
Female153161168482
Male184176160520
Race (NIH/OMB)
Race (NIH/OMB)(Participants)3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS RemindersTotal
American Indian or Alaska Native0000
Asian686270200
Native Hawaiian or Other Pacific Islander0000
Black or African American849175250
White171175172518
More than one race1491134
Unknown or Not Reported0000
Region of Enrollment
Region of Enrollment(participants)3HP Directly Observed Therapy (DOT)3HP Self Administered Therapy (SAT)3HP SAT With SMS RemindersTotal
United States261262251774
China15141645
South Africa26292883
Spain353233100
08

Study locations

12 sites
  • University of California, San Francisco
    San Francisco, California 94110, United States
  • Denver Public Health Department
    Denver, Colorado 80204, United States
  • Washington DC Veterans Affairs Medical Center
    Washington, District of Columbia 20422, United States
  • Columbia University College of Physicians and Surgeons and New York City Department of Health
    New York, New York 10032, United States
  • Duke University
    Durham, North Carolina 27713, United States
  • Vanderbilt University Medical Center and Nashville Metro Public Health Department
    Nashville, Tennessee 37232-0146, United States
  • University of North Texas Health Science Center at Fort Worth
    Fort Worth, Texas 76104-4802, United States
  • Audie L. Murphy VA Hospital
    San Antonio, Texas 78229-4404, United States
  • South Texas - Department of State Health Services
    San Antonio, Texas 78229-4404, United States
  • TB and Chest service of Hong Kong
    Hong Kong, China
  • Wits Health Consortium
    Soweto, South Africa
  • Agencia de Salut Publica - Barcelona, Spain and UNTHSC
    Barcelona, 08023, Spain
09

References and documents

Publications

  • Sterling TR, Villarino ME, Borisov AS, Shang N, Gordin F, Bliven-Sizemore E, Hackman J, Hamilton CD, Menzies D, Kerrigan A, Weis SE, Weiner M, Wing D, Conde MB, Bozeman L, Horsburgh CR Jr, Chaisson RE; TB Trials Consortium PREVENT TB Study Team. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011 Dec 8;365(23):2155-66. doi: 10.1056/NEJMoa1104875. PubMed 22150035 ↗
  • Centers for Disease Control and Prevention (CDC). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep. 2011 Dec 9;60(48):1650-3. PubMed 22157884 ↗
  • Shepardson D, Marks SM, Chesson H, Kerrigan A, Holland DP, Scott N, Tian X, Borisov AS, Shang N, Heilig CM, Sterling TR, Villarino ME, Mac Kenzie WR. Cost-effectiveness of a 12-dose regimen for treating latent tuberculous infection in the United States. Int J Tuberc Lung Dis. 2013 Dec;17(12):1531-7. doi: 10.5588/ijtld.13.0423. PubMed 24200264 ↗
  • Sterling TR, Moro RN, Borisov AS, Phillips E, Shepherd G, Adkinson NF, Weis S, Ho C, Villarino ME; Tuberculosis Trials Consortium. Flu-like and Other Systemic Drug Reactions Among Persons Receiving Weekly Rifapentine Plus Isoniazid or Daily Isoniazid for Treatment of Latent Tuberculosis Infection in the PREVENT Tuberculosis Study. Clin Infect Dis. 2015 Aug 15;61(4):527-35. doi: 10.1093/cid/civ323. Epub 2015 Apr 22. PubMed 25904367 ↗
  • Moro RN, Scott NA, Vernon A, Tepper NK, Goldberg SV, Schwartzman K, Leung CC, Schluger NW, Belknap RW, Chaisson RE, Narita M, Machado ES, Lopez M, Sanchez J, Villarino ME, Sterling TR. Exposure to Latent Tuberculosis Treatment during Pregnancy. The PREVENT TB and the iAdhere Trials. Ann Am Thorac Soc. 2018 May;15(5):570-580. doi: 10.1513/AnnalsATS.201704-326OC. PubMed 29393655 ↗
  • Belknap R, Holland D, Feng PJ, Millet JP, Cayla JA, Martinson NA, Wright A, Chen MP, Moro RN, Scott NA, Arevalo B, Miro JM, Villarino ME, Weiner M, Borisov AS; TB Trials Consortium iAdhere Study Team. Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine Treatment of Latent Tuberculosis Infection: A Randomized Trial. Ann Intern Med. 2017 Nov 21;167(10):689-697. doi: 10.7326/M17-1150. Epub 2017 Nov 7. PubMed 29114781 ↗
10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Mar 13, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT01582711
Lead sponsor
Centers for Disease Control and Prevention
Responsible party
Sponsor
First posted
Apr 23, 2012
Start date
Sep 2012
Primary completion
Oct 2014
Completion
Oct 2014
Results posted
Mar 13, 2025
Last update
Mar 13, 2025

Study contacts

Andrey S Borisov, MD, MPH
study director · U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA.
Robert Belknap, MD
study chair · Division of Infectious Diseases, University of Colorado, Denver, USA.
Robert Belknap, MD
principal investigator · Division of Infectious Diseases, University of Colorado, Denver, USA.

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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