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This study will evaluate safety and efficacy of d-Amphetamine Transdermal System for the treatment of Attention Deficit Hyperactivity Disorder in children and adolescents.
The study will consist of a four-week screening period, a 3-day wash-out period (if applicable), a five-week open-label, step-wise dose optimization period and two-week double blind randomized crossover treatment period with weekly classroom assessments and a safety follow-up by telephone 7 - 10 days after last dose of study drug.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| d-Amphetamine Transdermal patch | Active Comparator | The study was conducted in 2 parts: a 5-week, open-label, step-wise Dose Optimization Period and a 2-week, randomized, cross-over Double-Blind Treatment Period. Subjects who reached the optimal dose by end of dose optimization treatment period were randomized to receive double-blind treatment. Participants first received study patches everyday for one week, then subjects were crossed-over to receive the placebo treatment. d-Amphetamine Transdermal System: Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. |
|
| Placebo patch | Placebo Comparator | The study was conducted in 2 parts: a 5-week, open-label, step-wise Dose Optimization Period and a 2-week, randomized, cross-over Double-Blind Treatment Period. Subjects who reached the optimal dose by end of dose optimization treatment period were randomized to receive double-blind treatment. Participants first received placebo patches everyday for one week, then subjects were crossed-over to receive the study treatment. Placebo patch: Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| d-Amphetamine Transdermal Patch | Drug | The study was conducted in 2 parts: a 5 week, open-label, step-wise Dose Optimization Period and a 2-week, randomized, cross-over Double-Blind Treatment Period. Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. |
| Measure | Description | Time Frame |
|---|---|---|
| Mean Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Total Score During the Double-Blind Treatment Period | The SKAMP total score comprises all 13 items. The SKAMP was designed for independent observers to rate 13 items representing 2 factors of classroom behavior: attention (SKAMP-A) and deportment (SKAMP-D), as well as quality of work. Items are specific to place (classroom setting) & time (during a typical classroom period), & the scale is used to assess multiple ratings taken within a day. The SKAMP-D subscale evaluates deportment, including interacting with other children, interacting with adults, remaining quiet according to classroom rules, & staying seated according to classroom rules. The SKAMP-A subscale is a measure of attention & evaluates getting started on assignments, sticking with tasks, attending to an activity, and making activity transitions. The SKAMP quality of work subscale includes 3 items: completing assigned work, performing work accurately, and being careful and neat while writing or drawing. Scores range from 0-78 with higher scores indicating worse impairment. | Mean SKAMP Total Score of SKAMP Total Scores from 9 different time points including (1, 2, 3, 4.5, 6, 7, 9, 10, 12 hours post-dose) |
| Measure | Description | Time Frame |
|---|---|---|
| Onset of Efficacy Measured by Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Total Score | Onset of efficacy defined as the time of the first assessment time showing statistical significance between d-ATS and placebo. The time point for the reported data are SKAMP scores (LS mean) from 2 hours post-dose. The SKAMP total score comprises all 13 items. The SKAMP was designed for independent observers to rate 13 items representing 2 factors of classroom behavior: attention (SKAMP-A) and deportment (SKAMP-D), as well as quality of work. Items are specific to place (classroom setting) & time (during a typical classroom period), & the scale is used to assess multiple ratings taken within a day. Scores range from 0-78 with higher scores indicating worse impairment. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| James Waxmonsky, MD | Not Affiliated | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California - Irvine | Irvine | California | 92612 | United States | ||
| Florida International University Center for Children and Families |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37339441 | Derived | Cutler AJ, Suzuki K, Starling B, Balakrishnan K, Komaroff M, Meeves S, Castelli M, Childress A. d-Amphetamine Transdermal System in Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Secondary Endpoint Results and Post Hoc Effect Size Analyses from a Pivotal Trial. J Child Adolesc Psychopharmacol. 2023 Jun;33(5):176-182. doi: 10.1089/cap.2023.0005. | |
| 35020462 |
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The study consisted of 2 study periods. Period 1 is a 5-week open-label Dose Optimization Study with only one arm, Period 2 is a randomized, cross-over, double-blind treatment study (2 weeks).
A total of 110 subjects were enrolled into the Dose Optimization Treatment (Period 1). 4 subjects did not complete the Dose Optimization Period. 106 subjects were randomized into the Double-Blind Treatment Period (Period 2).
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| ID | Title | Description |
|---|---|---|
| FG000 | d-Amphetamine Transdermal Patch | The study consisted of 2 study periods. Period 1 is a 5-week open-label Dose Optimization Study with only one arm, Period 2 is a randomized, cross-over, double-blind treatment study (2 weeks). A total of 110 subjects were enrolled into the Dose Optimization Treatment (Period 1). 4 subjects did not complete the Dose Optimization Period. 106 subjects were randomized into the Double-Blind Treatment Period (Period 2). Arm Titles are defined for Period 2 (Open-Label Dose Optimization Treatment). For Period 1 study, there is only 1 arm. All participants started with the lowest dose of d-Amphetamine Transdermal System. Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. Patients return for a visit every week to evaluate whether to increase the dose next week for 5 weeks until an optimized dose was identified. For Period 2 study, participants first received study patches everyday for one week, then subjects were crossed-over to receive the placebo treatment. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Open-Label Dose Optimization Period |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | May 8, 2013 | Apr 21, 2022 |
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| Placebo patch | Drug | The study was conducted in 2 parts: a 5 week, open-label, step-wise Dose Optimization Period and a 2-week, randomized, cross-over Double-Blind Treatment Period. Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. |
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| Onset of efficacy defined as the time of the first assessment time showing statistical significance between d-ATS and placebo. 2 hours post-dose in Double-Blind Treatment Period |
| Duration of Effect for d-Amphetamine and Placebo Treatment | Duration of Effect is the difference between the End of Effect and Onset of Effect in hours, where End of Effect is the first time point after Onset of Effect at which the 50% reduction in SKAMP total score from pre-dose is not observed. | Duration of Effect was from onset (2 hours post-dose) and up to 12 hours post-dose (p<0.001) |
| Permanent Product Measure of Performance (PERMP) Scores Including PREMP-C and PREMP-A From Different Timepoints Post-dose | To assess efficacy of d-ATS compared to placebo as measured by the PERMP-C (number of correct answers) and PERMP-A (number of attempted answers) score. The PERMP is an age-adjusted written math test, of 10 minutes' duration administered at multiple time points. Subjects are given 5 pages of 80 math problems (400 total problems) and are instructed to work at their desks and to complete as many problems as possible in 10 minutes. Performance is measured as the number of problems attempted (PERMP-A) and the number of problems worked correctly (PERMP-C). The scores range from 0-800 with higher scores indicating better performance. | 1,2, 3, 4.5,6,7,9,10 and 12 hours post-dose from double-blind treatment period |
| Change in the Clinician-rated Scale of ADHD Symptoms Based on DSM-IV-TR Criteria (ADHD-RS-IV). | The ADHD-RS-IV is based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria to assess efficacy of d-ATS compared to placebo. The ADHD-RS-IV scale was developed to measure the behaviors of children with ADHD, and it consists of 18 items designed to reflect current symptomatology of ADHD based on DSM-IV criteria. Each item is scored from a range of 0 (reflecting no symptoms) to 3 (reflecting severe symptoms) with total scores ranging from 0 to 54. Note: Week 6 is the first week of the double-blind treatment period, week 7 is the second week of the double-blind treatment period. | Averaged from week 6 and week 7 results during the Double-Blind Cross-Over treatment period. |
| Conners Parent Rating Scale Revised Short Form (CPRS-R:S) Total Scores From Week 6 and Week 7 | The CPRS-R:S evaluates problem behaviors as reported by the parent or alternative caregivers. The CPRS-R:S total score comprises 27 items and covers a subset of the subscales and items on the long parent form. The score ranges from 0-81 calculated from summed subscales scores. Higher score is considered a worse outcome for ADHD patients. Note: Week 6 is the first week of the double-blind treatment period, week 7 is the second week of the double-blind treatment period. | Combined analysis by treatment groups from week 6 and week 7 (averaged) |
| Number of Responders Evaluated by Clinical Global Impression (CGI-I) Scale by Treatments From the Double-blind Treatment Period | The CGI scale permits a global evaluation of the subject's improvement over time. During the Dose Optimization Period and the Double-Blind Treatment Period, the investigator assessed the subject's improvement relative to symptoms prior to dosing, using the CGI-I Scale. For CGI-I scale, the responders are defined as subjects achieving a score of
Then the number of responders are calculated by treatment arms. Note: Week 6 is the first week of the double-blind treatment period, week 7 is the second week of the double-blind treatment period. | the double-blind treatment period |
| Miami |
| Florida |
| 33199 |
| United States |
| Center for Psychiatry and Behavioral Medicine Inc. | Las Vegas | Nevada | 89128 | United States |
| Derived |
| Cutler AJ, Suzuki K, Starling B, Balakrishnan K, Komaroff M, Castelli M, Meeves S, Childress AC. Efficacy and Safety of Dextroamphetamine Transdermal System for the Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Results from a Pivotal Phase 2 Study. J Child Adolesc Psychopharmacol. 2022 Mar;32(2):89-97. doi: 10.1089/cap.2021.0107. Epub 2022 Jan 11. |
| FG001 | Placebo Patch | Period 1 is open-label, Dose Optimization Treatment Period and has only one treatment arm. No placebo patch were used. Placebo Patch was used in Double-Blind Treatment Period, which has 2 arms. |
| COMPLETED |
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| NOT COMPLETED |
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| Double-blind Cross-Over Treatment Period |
|
A total of 110 subjects entered the Dose Optimization Period. The optimized dose achieved by a subject during this period was then utilized in the Double-Blind Treatment Period of the study. The Demographic and Baseline Characteristics are presented as one arm for all subjects enrolled.
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| ID | Title | Description |
|---|---|---|
| BG000 | Baseline Characteristics for All Subjects Enrolled | Baseline Characteristics are presented for all subjects that were enrolled (n=110). |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Age, Continuous | Mean | Standard Deviation | years |
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| Age, Customized | Median | Full Range | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||||||
| BMI | Mean | Standard Deviation | kg/m^2 |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Mean Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Total Score During the Double-Blind Treatment Period | The SKAMP total score comprises all 13 items. The SKAMP was designed for independent observers to rate 13 items representing 2 factors of classroom behavior: attention (SKAMP-A) and deportment (SKAMP-D), as well as quality of work. Items are specific to place (classroom setting) & time (during a typical classroom period), & the scale is used to assess multiple ratings taken within a day. The SKAMP-D subscale evaluates deportment, including interacting with other children, interacting with adults, remaining quiet according to classroom rules, & staying seated according to classroom rules. The SKAMP-A subscale is a measure of attention & evaluates getting started on assignments, sticking with tasks, attending to an activity, and making activity transitions. The SKAMP quality of work subscale includes 3 items: completing assigned work, performing work accurately, and being careful and neat while writing or drawing. Scores range from 0-78 with higher scores indicating worse impairment. | Full Analysis Set: included all consented and randomized subjects who took at least 1 dose of study of medication | Posted | Least Squares Mean | Standard Error | score on a scale | Mean SKAMP Total Score of SKAMP Total Scores from 9 different time points including (1, 2, 3, 4.5, 6, 7, 9, 10, 12 hours post-dose) |
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| Secondary | Onset of Efficacy Measured by Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Total Score | Onset of efficacy defined as the time of the first assessment time showing statistical significance between d-ATS and placebo. The time point for the reported data are SKAMP scores (LS mean) from 2 hours post-dose. The SKAMP total score comprises all 13 items. The SKAMP was designed for independent observers to rate 13 items representing 2 factors of classroom behavior: attention (SKAMP-A) and deportment (SKAMP-D), as well as quality of work. Items are specific to place (classroom setting) & time (during a typical classroom period), & the scale is used to assess multiple ratings taken within a day. Scores range from 0-78 with higher scores indicating worse impairment. | Full Analysis Set: included all consented and randomized subjects who took at least 1 dose of study of medication. | Posted | Least Squares Mean | Standard Error | score on a scale | Onset of efficacy defined as the time of the first assessment time showing statistical significance between d-ATS and placebo. 2 hours post-dose in Double-Blind Treatment Period |
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| Secondary | Duration of Effect for d-Amphetamine and Placebo Treatment | Duration of Effect is the difference between the End of Effect and Onset of Effect in hours, where End of Effect is the first time point after Onset of Effect at which the 50% reduction in SKAMP total score from pre-dose is not observed. | Full Analysis Set: included all consented and randomized subjects who took at least 1 dose of study of medication. | Posted | Least Squares Mean | Standard Error | Hours | Duration of Effect was from onset (2 hours post-dose) and up to 12 hours post-dose (p<0.001) |
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| Secondary | Permanent Product Measure of Performance (PERMP) Scores Including PREMP-C and PREMP-A From Different Timepoints Post-dose | To assess efficacy of d-ATS compared to placebo as measured by the PERMP-C (number of correct answers) and PERMP-A (number of attempted answers) score. The PERMP is an age-adjusted written math test, of 10 minutes' duration administered at multiple time points. Subjects are given 5 pages of 80 math problems (400 total problems) and are instructed to work at their desks and to complete as many problems as possible in 10 minutes. Performance is measured as the number of problems attempted (PERMP-A) and the number of problems worked correctly (PERMP-C). The scores range from 0-800 with higher scores indicating better performance. | Full Analysis Set: included all consented and randomized subjects who took at least 1 dose of study of medication | Posted | Least Squares Mean | Standard Error | score on a scale | 1,2, 3, 4.5,6,7,9,10 and 12 hours post-dose from double-blind treatment period |
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| Secondary | Change in the Clinician-rated Scale of ADHD Symptoms Based on DSM-IV-TR Criteria (ADHD-RS-IV). | The ADHD-RS-IV is based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria to assess efficacy of d-ATS compared to placebo. The ADHD-RS-IV scale was developed to measure the behaviors of children with ADHD, and it consists of 18 items designed to reflect current symptomatology of ADHD based on DSM-IV criteria. Each item is scored from a range of 0 (reflecting no symptoms) to 3 (reflecting severe symptoms) with total scores ranging from 0 to 54. Note: Week 6 is the first week of the double-blind treatment period, week 7 is the second week of the double-blind treatment period. | Full Analysis Set | Posted | Least Squares Mean | Standard Deviation | score on a scale | Averaged from week 6 and week 7 results during the Double-Blind Cross-Over treatment period. |
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| Secondary | Conners Parent Rating Scale Revised Short Form (CPRS-R:S) Total Scores From Week 6 and Week 7 | The CPRS-R:S evaluates problem behaviors as reported by the parent or alternative caregivers. The CPRS-R:S total score comprises 27 items and covers a subset of the subscales and items on the long parent form. The score ranges from 0-81 calculated from summed subscales scores. Higher score is considered a worse outcome for ADHD patients. Note: Week 6 is the first week of the double-blind treatment period, week 7 is the second week of the double-blind treatment period. | Full Analysis Set Double-Blind period Week 6 and Week 7 | Posted | Least Squares Mean | Standard Error | score on a scale | Combined analysis by treatment groups from week 6 and week 7 (averaged) |
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| Secondary | Number of Responders Evaluated by Clinical Global Impression (CGI-I) Scale by Treatments From the Double-blind Treatment Period | The CGI scale permits a global evaluation of the subject's improvement over time. During the Dose Optimization Period and the Double-Blind Treatment Period, the investigator assessed the subject's improvement relative to symptoms prior to dosing, using the CGI-I Scale. For CGI-I scale, the responders are defined as subjects achieving a score of
Then the number of responders are calculated by treatment arms. Note: Week 6 is the first week of the double-blind treatment period, week 7 is the second week of the double-blind treatment period. | Responder includes the categories "Very Much Improved" and "Much Improved"; "Non-Responder" includes all other categories, with the exception of "not assessed" which has been considered missing data. Note: the Full Analysis Set is 106 (N) | Posted | Count of Participants | Participants | the double-blind treatment period |
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From beginning of Dose-Optimization Phase (5-week) through double blind treatment phase (2-week), up to 7 weeks total.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | All d-ATS Treatment During the Dose-Optimization Phase | This includes subjects that started the one arm Dose-Optimization Study in Period 1 and continued into Double-Blind, Cross-Over, Placebo-Controlled Treatment study in Period 2. The adverse events are reported for adverse events including all d-ATS doses during Dose-Optimization Study Phase (Period 1). | 0 | 110 | 0 | 110 | 108 | 110 |
| EG001 | d-ATS Patch Treated Arm During the Double Blind Phase | This includes subjects that started the one arm Dose-Optimization Study in Period 1 and continued into Double-Blind, Cross-Over, Placebo-Controlled Treatment study in Period 2. The adverse events are reported from subjects who received d-ATS patch treatment during the double blind phase. | 0 | 106 | 0 | 106 | 44 | 106 |
| EG002 | Placebo Treated Arm During the Double Blind Phase | This includes subjects that started the one arm Dose-Optimization Study in Period 1 and continued into Double-Blind, Cross-Over, Placebo-Controlled Treatment study in Period 2. The adverse events are reported from subjects who received placebo patch treatment. | 0 | 106 | 0 | 106 | 32 | 106 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Decreased appetite | Metabolism and nutrition disorders | Systematic Assessment |
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| Hyperkalemia | Metabolism and nutrition disorders | 9 | Systematic Assessment |
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| Insomnia | Psychiatric disorders | Systematic Assessment |
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| Affect lability | Psychiatric disorders | Systematic Assessment |
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| Initial insomnia | Psychiatric disorders | Systematic Assessment |
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| Irritability | General disorders | Systematic Assessment |
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| Application site pain | General disorders | Systematic Assessment |
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| Fatigue | General disorders | Systematic Assessment |
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| Application site pruritis | General disorders | Systematic Assessment |
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| Pyrexia | General disorders | Systematic Assessment |
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| Headache | Nervous system disorders | Systematic Assessment |
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| Dizziness | Nervous system disorders | Systematic Assessment |
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| Upper respiratory tract infection | Infections and infestations | Systematic Assessment |
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| Nasopharyngitis | Infections and infestations | Systematic Assessment |
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| Cough | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
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| Nasal congestion | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
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| Abdominal upper pain | Gastrointestinal disorders | Systematic Assessment |
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| Nausea | Gastrointestinal disorders | Systematic Assessment |
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| Vomiting | Gastrointestinal disorders | Systematic Assessment |
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| Abdominal Pain | Gastrointestinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Study Director | Noven Pharmaceuticals, Inc. | (305) 253-5099 | ClinicalTrials@noven.com |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Jun 26, 2013 | Apr 21, 2022 | SAP_001.pdf |
| ID | Term |
|---|---|
| D001289 | Attention Deficit Disorder with Hyperactivity |
| ID | Term |
|---|---|
| D019958 | Attention Deficit and Disruptive Behavior Disorders |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D003913 | Dextroamphetamine |
| D000661 | Amphetamine |
| ID | Term |
|---|---|
| D000662 | Amphetamines |
| D010627 | Phenethylamines |
| D005021 | Ethylamines |
| D000588 | Amines |
| D009930 | Organic Chemicals |
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| Unknown or Not Reported |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
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| Unknown or Not Reported |
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| OG001 |
| Placebo Patch |
Subjects who reached the optimal dose by end of dose optimization treatment period were randomized to receive double-blind treatment. Participants first received placebo patches everyday for one week, then subjects were crossed-over to receive the study treatment. Placebo patch: Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. |
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Subjects who reached the optimal dose by end of dose optimization treatment period were randomized to receive double-blind treatment. Participants first received placebo patches everyday for one week, then subjects were crossed-over to receive the study treatment. Placebo patch: Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. |
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| OG001 | Placebo Patch | Subjects who reached the optimal dose by end of dose optimization treatment period were randomized to receive double-blind treatment. Participants first received placebo patches everyday for one week, then subjects were crossed-over to receive the study treatment. Placebo patch: Patches will be worn for 9 hours every day. After 9 hours the patch will be removed. Every day a new patch will be applied. |
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