A Phase 2 interventional study of levothyroxine sodium in Hypothyroidism, sponsored by Xeris Pharmaceuticals. Completed at 6 sites in United States. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2025-07-03.
Sponsored by Xeris Pharmaceuticals · Phase 2, Interventional, and Treatment
This is a non-randomized, open-label, single arm, self-controlled study of XP-8121 (levothyroxine sodium) to determine a target dose conversion factor from stably dosed oral levothyroxine to XP-8121 (levothyroxine sodium) in patients with hypothyroidism and to assess the safety and tolerability of XP-8121(levothyroxine sodium) after once weekly subcutaneous injections. This study includes the following periods: Screening, Titration Period, and Maintenance Period. The study will conclude with an End of Maintenance Visit or Early Termination (ET) Visit.
This is a non-randomized, open-label, single arm, self-controlled study of XP-8121 (levothyroxine sodium) to determine a target dose conversion factor from stably dosed oral levothyroxine to XP-8121 (levothyroxine sodium) in patients with hypothyroidism and to assess the safety and tolerability of XP-8121 (levothyroxine sodium) after once weekly subcutaneous injections. This study includes the following periods: Screening, Titration Period (2 to 8 weeks), and Maintenance Period (4 weeks). A pharmacokinetic substudy will be conducted for a subset of participants during the Maintenance Period. The study will conclude with an End of Maintenance Visit or Early Termination (ET) Visit.
Exclusion Criteria:
XP-8121 100 to 1500 μg subcutaneous injection
Drug: levothyroxine sodium
Levothyroxine sodium 10 mg/mL
Also known as: XP-8121
Dose Conversion Factor
Geometric mean ratio of the weekly dose of XP-8121 to the daily dose of oral levothyroxine (aka dose conversion factor), where the XP-8121 dose corresponds to the administration immediately preceding collection of blood TSH used to determine normalization at the end of Maintenance Period. The dose conversion factor was assessed by comparing the natural log-transformed final XP-8121 dose in μg that maintained normalized TSH throughout the Maintenance Period to the natural log-transformed daily oral levothyroxine dose the participant was taking before the study, using a linear mixed effects model with treatment as the fixed effect and subject as the random effect. Geometric least square means (LSMs) were calculated by exponentiating the LSM from the ANOVA. The geometric mean ratio and the corresponding 90% CI was found by exponentiating the differences of log-transformed LSM and 90% confidence interval (CI) of the difference.
Time frame: Day 29 of the Maintenance Period
Tolerability Assessment: Modified Draize Scale - Erythema
The Modified Draize Scale assessment of erythema and edema was conducted 30 (+/-5) minutes after each dosing. The Modified Draize Scale is a 5-point scale: 0-none, 1-very slight, 2-slight, 3-moderate, 4-severe.
Time frame: Week 1 Dosing in Titration Period through Day 22 Dosing in Maintenance Period
Tolerability Assessment: Modified Draize Scale - Edema
The Modified Draize Scale assessment of erythema and edema was conducted 30 (+/-5) minutes after each dosing. The Modified Draize Scale is a 5-point scale: 0-none, 1-very slight, 2-slight, 3-moderate, 4-severe.
Time frame: Week 1 Dosing in Titration Period through Day 22 Dosing in Maintenance Period
Tolerability Assessments: Injection Site Discomfort Evaluation
Injection site discomfort was assessed by each participant at 10 (+/-2) minutes post-injection.
Time frame: Week 1 dosing in the Titration Period through Day 22 dosing in the Maintenance Period
Proportion of Participants With Normalized TSH Throughout the Maintenance Period
Proportion of participants enrolled with normalized TSH throughout the Maintenance Period
Time frame: Day 29 of the Maintenance Period
Proportion of Participants With Normalized TSH at End of Maintenance Period
Proportion of participants enrolled with normalized TSH at the end of the Maintenance Period.
Time frame: Day 29 of the Maintenance Period
Thyroid Hormone Concentrations: Total Thyroxine
Thyroid hormone concentrations (total thyroxine, free protein-unbound thyroxine (fT4), and TSH) following the first dose of XP-8121 during the Titration Period and Maintenance Periods
Time frame: Up to Day 29 of the Maintenance Period
Thyroid Hormone Concentrations: Free Thyroxine (fT4)
Thyroid hormone concentrations (total thyroxine, free protein-unbound thyroxine (fT4), and TSH) following the first dose of XP-8121 during the Titration Period and Maintenance Periods
Time frame: Up to Day 29 of the Maintenance Period
Thyroid Hormone Concentrations: Thyroid Stimulating Hormone (TSH)
Thyroid hormone concentrations (total thyroxine, free protein-unbound thyroxine (fT4), and TSH) following the first dose of XP-8121 during the Titration Period and Maintenance Periods
Time frame: Up to Day 29 of the Maintenance Period
Participants were recruited over an approximate 7.5 month period at medical research centers with experience in hypothyroidism.
| Milestone | XP-8121 |
|---|---|
| Started | 46 |
| Completed | 42 |
| Not completed | 4 |
| Withdrew: Adverse event | 1 |
| Withdrew: Inability to achieve a tolerable replacement dosage | 3 |
| Milestone | XP-8121 |
|---|---|
| Started | 42 |
| Completed | 39 |
| Not completed | 3 |
| Withdrew: Adverse event | 1 |
| Withdrew: Inability to achieve a tolerable replacement dosage | 1 |
| Withdrew: Inability to achieve an adequate replacement dosage | 1 |
Geometric mean ratio of the weekly dose of XP-8121 to the daily dose of oral levothyroxine (aka dose conversion factor), where the XP-8121 dose corresponds to the administration immediately preceding collection of blood TSH used to determine normalization at the end of Maintenance Period. The dose conversion factor was assessed by comparing the natural log-transformed final XP-8121 dose in μg that maintained normalized TSH throughout the Maintenance Period to the natural log-transformed daily oral levothyroxine dose the participant was taking before the study, using a linear mixed effects model with treatment as the fixed effect and subject as the random effect. Geometric least square means (LSMs) were calculated by exponentiating the LSM from the ANOVA. The geometric mean ratio and the corresponding 90% CI was found by exponentiating the differences of log-transformed LSM and 90% confidence interval (CI) of the difference.
| Ratio | XP-8121 |
|---|---|
| Dose Conversion Factor | 4.24 (4.06 to 4.42) |
The Modified Draize Scale assessment of erythema and edema was conducted 30 (+/-5) minutes after each dosing. The Modified Draize Scale is a 5-point scale: 0-none, 1-very slight, 2-slight, 3-moderate, 4-severe.
| Participants | XP-8121 |
|---|---|
| Titration Period: Week 1 Dosing — 0 - None | 43 |
| Titration Period: Week 1 Dosing — 1 - Very Slight | 3 |
| Titration Period: Week 1 Dosing — 2 - Slight | 0 |
| Titration Period: Week 1 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 1 Dosing — 4 - Severe | 0 |
| Titration Period: Week 2 Dosing — 0 - None | 41 |
| Titration Period: Week 2 Dosing — 1 - Very Slight | 2 |
| Titration Period: Week 2 Dosing — 2 - Slight | 0 |
| Titration Period: Week 2 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 2 Dosing — 4 - Severe | 0 |
| Titration Period: Week 3 Dosing — 0 - None | 41 |
| Titration Period: Week 3 Dosing — 1 - Very Slight | 2 |
| Titration Period: Week 3 Dosing — 2 - Slight | 0 |
| Titration Period: Week 3 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 3 Dosing — 4 - Severe | 0 |
| Titration Period: Week 4 Dosing — 0 - None | 37 |
| Titration Period: Week 4 Dosing — 1 - Very Slight | 5 |
| Titration Period: Week 4 Dosing — 2 - Slight | 0 |
| Titration Period: Week 4 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 4 Dosing — 4 - Severe | 0 |
| Titration Period: Week 5 Dosing — 0 - None | 38 |
| Titration Period: Week 5 Dosing — 1 - Very Slight | 4 |
| Titration Period: Week 5 Dosing — 2 - Slight | 0 |
| Titration Period: Week 5 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 5 Dosing — 4 - Severe | 0 |
| Titration Period: Week 6 Dosing — 0 - None | 38 |
| Titration Period: Week 6 Dosing — 1 - Very Slight | 3 |
| Titration Period: Week 6 Dosing — 2 - Slight | 0 |
| Titration Period: Week 6 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 6 Dosing — 4 - Severe | 0 |
| Titration Period: Week 7 Dosing — 0 - None | 12 |
| Titration Period: Week 7 Dosing — 1 - Very Slight | 1 |
| Titration Period: Week 7 Dosing — 2 - Slight | 0 |
| Titration Period: Week 7 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 7 Dosing — 4 - Severe | 0 |
| Titration Period: Week 8 Dosing — 0 - None | 12 |
| Titration Period: Week 8 Dosing — 1 - Very Slight | 0 |
| Titration Period: Week 8 Dosing — 2 - Slight | 0 |
| Titration Period: Week 8 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 8 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 1 Dosing — 0 - None | 40 |
| Maintenance Period: Day 1 Dosing — 1 - Very Slight | 2 |
| Maintenance Period: Day 1 Dosing — 2 - Slight | 0 |
| Maintenance Period: Day 1 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 1 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 8 Dosing — 0 - None | 40 |
| Maintenance Period: Day 8 Dosing — 1 - Very Slight | 2 |
| Maintenance Period: Day 8 Dosing — 2 - Slight | 0 |
| Maintenance Period: Day 8 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 8 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 15 Dosing — 0 - None | 39 |
| Maintenance Period: Day 15 Dosing — 1 - Very Slight | 1 |
| Maintenance Period: Day 15 Dosing — 2 - Slight | 1 |
| Maintenance Period: Day 15 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 15 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 22 Dosing — 0 - None | 37 |
| Maintenance Period: Day 22 Dosing — 1 - Very Slight | 2 |
| Maintenance Period: Day 22 Dosing — 2 - Slight | 0 |
| Maintenance Period: Day 22 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 22 Dosing — 4 - Severe | 0 |
The Modified Draize Scale assessment of erythema and edema was conducted 30 (+/-5) minutes after each dosing. The Modified Draize Scale is a 5-point scale: 0-none, 1-very slight, 2-slight, 3-moderate, 4-severe.
| Participants | XP-8121 |
|---|---|
| Titration Period: Week 1 Dosing — 0 - None | 44 |
| Titration Period: Week 1 Dosing — 1 - Very Slight | 2 |
| Titration Period: Week 1 Dosing — 2 - Slight | 0 |
| Titration Period: Week 1 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 1 Dosing — 4 - Severe | 0 |
| Titration Period: Week 2 Dosing — 0 - None | 43 |
| Titration Period: Week 2 Dosing — 1 - Very Slight | 0 |
| Titration Period: Week 2 Dosing — 2 - Slight | 0 |
| Titration Period: Week 2 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 2 Dosing — 4 - Severe | 0 |
| Titration Period: Week 3 Dosing — 0 - None | 43 |
| Titration Period: Week 3 Dosing — 1 - Very Slight | 0 |
| Titration Period: Week 3 Dosing — 2 - Slight | 0 |
| Titration Period: Week 3 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 3 Dosing — 4 - Severe | 0 |
| Titration Period: Week 4 Dosing — 0 - None | 41 |
| Titration Period: Week 4 Dosing — 1 - Very Slight | 1 |
| Titration Period: Week 4 Dosing — 2 - Slight | 0 |
| Titration Period: Week 4 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 4 Dosing — 4 - Severe | 0 |
| Titration Period: Week 5 Dosing — 0 - None | 42 |
| Titration Period: Week 5 Dosing — 1 - Very Slight | 0 |
| Titration Period: Week 5 Dosing — 2 - Slight | 0 |
| Titration Period: Week 5 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 5 Dosing — 4 - Severe | 0 |
| Titration Period: Week 6 Dosing — 0 - None | 41 |
| Titration Period: Week 6 Dosing — 1 - Very Slight | 0 |
| Titration Period: Week 6 Dosing — 2 - Slight | 0 |
| Titration Period: Week 6 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 6 Dosing — 4 - Severe | 0 |
| Titration Period: Week 7 Dosing — 0 - None | 11 |
| Titration Period: Week 7 Dosing — 1 - Very Slight | 1 |
| Titration Period: Week 7 Dosing — 2 - Slight | 1 |
| Titration Period: Week 7 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 7 Dosing — 4 - Severe | 0 |
| Titration Period: Week 8 Dosing — 0 - None | 12 |
| Titration Period: Week 8 Dosing — 1 - Very Slight | 0 |
| Titration Period: Week 8 Dosing — 2 - Slight | 0 |
| Titration Period: Week 8 Dosing — 3 - Moderate | 0 |
| Titration Period: Week 8 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 1 Dosing — 0 - None | 42 |
| Maintenance Period: Day 1 Dosing — 1 - Very Slight | 0 |
| Maintenance Period: Day 1 Dosing — 2 - Slight | 0 |
| Maintenance Period: Day 1 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 1 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 8 Dosing — 0 - None | 42 |
| Maintenance Period: Day 8 Dosing — 1 - Very Slight | 0 |
| Maintenance Period: Day 8 Dosing — 2 - Slight | 0 |
| Maintenance Period: Day 8 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 8 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 15 Dosing — 0 - None | 40 |
| Maintenance Period: Day 15 Dosing — 1 - Very Slight | 0 |
| Maintenance Period: Day 15 Dosing — 2 - Slight | 1 |
| Maintenance Period: Day 15 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 15 Dosing — 4 - Severe | 0 |
| Maintenance Period: Day 22 Dosing — 0 - None | 39 |
| Maintenance Period: Day 22 Dosing — 1 - Very Slight | 0 |
| Maintenance Period: Day 22 Dosing — 2 - Slight | 0 |
| Maintenance Period: Day 22 Dosing — 3 - Moderate | 0 |
| Maintenance Period: Day 22 Dosing — 4 - Severe | 0 |
Injection site discomfort was assessed by each participant at 10 (+/-2) minutes post-injection.
| Participants | XP-8121 |
|---|---|
| Titration Period: Week 1 Dosing — Yes | 14 |
| Titration Period: Week 1 Dosing — No | 32 |
| Titration Period: Week 2 Dosing — Yes | 9 |
| Titration Period: Week 2 Dosing — No | 34 |
| Titration Period: Week 3 Dosing — Yes | 12 |
| Titration Period: Week 3 Dosing — No | 31 |
| Titration Period: Week 4 Dosing — Yes | 10 |
| Titration Period: Week 4 Dosing — No | 32 |
| Titration Period: Week 5 Dosing — Yes | 12 |
| Titration Period: Week 5 Dosing — No | 30 |
| Titration Period: Week 6 Dosing — Yes | 9 |
| Titration Period: Week 6 Dosing — No | 32 |
| Titration Period: Week 7 Dosing — Yes | 6 |
| Titration Period: Week 7 Dosing — No | 7 |
| Titration Period: Week 8 Dosing — Yes | 2 |
| Titration Period: Week 8 Dosing — No | 10 |
| Maintenance Period: Day 1 Dosing — Yes | 13 |
| Maintenance Period: Day 1 Dosing — No | 29 |
| Maintenance Period: Day 8 Dosing — Yes | 12 |
| Maintenance Period: Day 8 Dosing — No | 30 |
| Maintenance Period: Day 15 Dosing — Yes | 8 |
| Maintenance Period: Day 15 Dosing — No | 33 |
| Maintenance Period: Day 22 Dosing — Yes | 6 |
| Maintenance Period: Day 22 Dosing — No | 33 |
Proportion of participants enrolled with normalized TSH throughout the Maintenance Period
| Participants | All Participants | Participants Who Entered the Maintenance Period |
|---|---|---|
| Proportion of Participants With Normalized TSH Throughout the Maintenance Period | 27 | 27 |
Proportion of participants enrolled with normalized TSH at the end of the Maintenance Period.
| Participants | All Participants | Participants Who Entered Maintenance Period |
|---|---|---|
| Proportion of Participants With Normalized TSH at End of Maintenance Period | 31 | 31 |
Thyroid hormone concentrations (total thyroxine, free protein-unbound thyroxine (fT4), and TSH) following the first dose of XP-8121 during the Titration Period and Maintenance Periods
| nmol/L | XP-8121 |
|---|---|
| Titration Period: Baseline | 103.68 ± 27.278 |
| Titration Period: Week 2 Dosing | 88.17 ± 23.019 |
| Titration Period: Week 3 Dosing | 89.68 ± 23.019 |
| Titration Period: Week 4 Dosing | 92.44 ± 24.104 |
| Titration Period: Week 5 Dosing | 94.26 ± 22.059 |
| Titration Period: Week 6 Dosing | 97.38 ± 22.056 |
| Titration Period: Week 7 Dosing | 90.29 ± 18.867 |
| Titration Period: Week 8 Dosing | 88.58 ± 25.032 |
| Maintenance Period: Day 1 Dosing (Baseline) | 103.45 ± 24.970 |
| Maintenance Period: Day 8 Dosing | 102.24 ± 23.704 |
| Maintenance Period: Day 15 Dosing | 103.35 ± 23.508 |
| Maintenance Period: Day 22 Dosing | 104.67 ± 19.389 |
| Maintenance Period: Day 29 | 101.97 ± 24.532 |
Thyroid hormone concentrations (total thyroxine, free protein-unbound thyroxine (fT4), and TSH) following the first dose of XP-8121 during the Titration Period and Maintenance Periods
| pmol/L | XP-8121 |
|---|---|
| Titration Period: Baseline | 14.60 ± 2.713 |
| Titration Period: Week 2 Dosing | 12.09 ± 2.209 |
| Titration Period: Week 3 Dosing | 11.69 ± 2.494 |
| Titration Period: Week 4 Dosing | 12.47 ± 2.668 |
| Titration Period: Week 5 Dosing | 12.84 ± 2.417 |
| Titration Period: Week 6 Dosing | 12.88 ± 1.977 |
| Titration Period: Week 7 Dosing | 12.32 ± 1.814 |
| Titration Period: Week 8 Dosing | 13.26 ± 1.840 |
| Maintenance Period: Day 1 Dosing (Baseline) | 14.50 ± 2.411 |
| Maintenance Period: Day 8 Dosing | 14.36 ± 2.319 |
| Maintenance Period: Day 15 Dosing | 14.24 ± 2.147 |
| Maintenance Period: Day 22 Dosing | 14.27 ± 1.917 |
| Maintenance Period: Day 29 | 14.14 ± 1.796 |
Thyroid hormone concentrations (total thyroxine, free protein-unbound thyroxine (fT4), and TSH) following the first dose of XP-8121 during the Titration Period and Maintenance Periods
| mIU/L | XP-8121 |
|---|---|
| Titration Period: Baseline | 1.958 ± 1.0778 |
| Titration Period: Week 2 Dosing | 3.942 ± 2.8299 |
| Titration Period: Week 3 Dosing | 6.534 ± 8.2589 |
| Titration Period: Week 4 Dosing | 6.162 ± 8.8632 |
| Titration Period: Week 5 Dosing | 6.397 ± 9.8016 |
| Titration Period: Week 6 Dosing | 5.506 ± 7.1427 |
| Titration Period: Week 7 Dosing | 8.326 ± 8.5120 |
| Titration Period: Week 8 Dosing | 5.752 ± 5.3967 |
| Maintenance Period: Day 1 Dosing (Baseline) | 2.967 ± 2.1827 |
| Maintenance Period: Day 8 Dosing | 2.920 ± 2.7009 |
| Maintenance Period: Day 15 Dosing | 2.739 ± 2.8858 |
| Maintenance Period: Day 22 Dosing | 2.494 ± 2.0766 |
| Maintenance Period: Day 29 | 2.493 ± 1.5087 |
Collected over From Screening through the End of Maintenance Visit (Day 29) or up to 14 (+/-2 days) after last dose of XP-8121 for participants who withdrew prematurely. Non-serious events are listed at a 3% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Titration Period | 0/46 (0%) | 0/46 (0%) | 19/46 (41.3%) |
| Maintenance Period | 0/42 (0%) | 0/42 (0%) | 4/42 (9.5%) |
| Overall | 0/46 (0%) | 0/46 (0%) | 22/46 (47.8%) |
| Event | Titration Period | Maintenance Period | Overall |
|---|---|---|---|
| FatigueGeneral disorders | 10/46 | 0/42 | 10/46 |
| Injection site painGeneral disorders | 3/46 | 2/42 | 5/46 |
| HeadacheNervous system disorders | 4/46 | 0/42 | 4/46 |
| Urinary tract infectionInfections and infestations | 3/46 | 0/42 | 3/46 |
| Temperature intoleranceGeneral disorders | 2/46 | 0/42 | 2/46 |
| Weight increasedInvestigations | 1/46 | 1/42 | 2/46 |
| AnxietyPsychiatric disorders | 1/46 | 1/42 | 2/46 |
| EcchymosisSkin and subcutaneous tissue disorders | 1/46 | 1/42 | 2/46 |
| PruritisSkin and subcutaneous tissue disorders | 2/46 | 0/42 | 2/46 |
| Age, Continuous(years) | XP-8121 |
|---|---|
| Median | 54.5 (33 to 65) |
| Sex: Female, Male(Participants) | XP-8121 |
|---|---|
| Female | 37 |
| Male | 9 |
| Race (NIH/OMB)(Participants) | XP-8121 |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 1 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 0 |
| White | 44 |
| More than one race | 1 |
| Unknown or Not Reported | 0 |
| Ethnicity (NIH/OMB)(Participants) | XP-8121 |
|---|---|
| Hispanic or Latino | 29 |
| Not Hispanic or Latino | 17 |
| Unknown or Not Reported | 0 |
| Baseline Body Mass Index(kg/m^2) | XP-8121 |
|---|---|
| Median | 29.50 (23.1 to 39.9) |
| Primary Hypothyroidism History(Participants) | XP-8121 |
|---|---|
| Count of participants | 46 |
| Prior Daily Oral Levothyroxine Brand(Participants) | XP-8121 |
|---|---|
| Synthroid | 9 |
| Other Brand or Generic | 37 |
| Prior Daily Oral Levothyroxine Dose(Participants) | XP-8121 |
|---|---|
| 50 micrograms | 14 |
| 75 micrograms | 12 |
| 88 micrograms | 3 |
| 100 micrograms | 8 |
| 112 micrograms | 3 |
| 125 micrograms | 3 |
| 150 micrograms | 2 |
| 175 micrograms | 1 |
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Xeris Pharmaceuticals