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This study evaluates the efficacy, safety and tolerability of NER1006 versus MOVIPREP in adult patients requiring bowel cleansing prior to any procedure that requires a clean bowel, using a 2-Day evening/morning Split-Dosing and 1-Day morning only Split-Dosing regimens. Approximately 810 patients will be randomised with the aim of achieving a minimum of 245 patients in each of the 3 groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NER1006, 2-Day Split-Dosing | Experimental | NER1006: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). |
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| NER1006,1-Day Morning Split-Dosing | Experimental | NER1006: 1-Day Morning Split-Dosing Regimen (to commence in the morning of the day of colonoscopy). |
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| MOVIPREP, 2-Day Split-Dosing | Active Comparator | MOVIPREP®: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NER1006, 2-Day Split-Dosing | Drug | The subject will self-administer the first dose of the assigned investigational product in the evening prior to the scheduled colonoscopy and take mandatory additional clear fluid. Subject will take the second dose together with mandatory additional clear fluids on the morning of the colonoscopy. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Patients With Successful Bowel Cleansing (Overall Colon) | The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). A final HCS grading of A, B, C or D was derived. Grades A and B are classified as successful (i.e. all mucosa could be visualized) and C and D are classified as unsuccessful. Comparison of overall success of cleansing with NER1006 2-Day and 1-Day versus MOVIPREP was evaluated using a non-inferiority study design. | Up to 2 days (from day of first dosing to day of colonoscopy) |
| Number of Patients With 'Excellent Plus Good' (Highly Effective) Bowel Cleansing (Colon Ascendens) | The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). Highly effective cleansing in the colon ascendens corresponded to scores 3 (Good) or 4 (Excellent) of the HCS. Adequate plus failure of cleansing corresponded to score 0-2. Comparison of 'Excellent plus good' cleansing of the colon ascendens using NER1006 2-Day and 1-Day versus MOVIPREP was evaluated using a non-inferiority study design. | Up to 2 days (from day of first dosing to day of colonoscopy) |
| Measure | Description | Time Frame |
|---|---|---|
| Adenoma Detection Rate (Colon Ascendens) | Comparison of the number of patients with at least one adenoma detected in the colon ascendens when NER1006 2-Day and 1-Day is used for bowel cleansing versus MOVIPREP. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the colon ascendens. | Up to 2 days (from day of first dosing to day of colonoscopy) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Raf Bisschops, MD | UZ Leuven | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| AZ Sint-Lucas | Bruges | Belgium | ||||
| UZ Ghent |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36064325 | Derived | Cash BD, Allen C, Poppers DM. Transient alterations in plasma sodium concentrations with NER1006 bowel preparation: an analysis of three phase III, randomized clinical trials. BMC Gastroenterol. 2022 Sep 5;22(1):412. doi: 10.1186/s12876-022-02484-7. | |
| 30025414 | Derived | Bisschops R, Manning J, Clayton LB, Ng Kwet Shing R, Alvarez-Gonzalez M; MORA Study Group. Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial. Endoscopy. 2019 Jan;51(1):60-72. doi: 10.1055/a-0638-8125. Epub 2018 Jul 19. |
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The trial recruited out/in-patients at 29 medical centres in Europe, from October 2014 to June 2015.
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| ID | Title | Description |
|---|---|---|
| FG000 | MOVIPREP, 2-Day Split-Dosing | MOVIPREP®: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). |
| FG001 | NER1006, 2-Day Split-Dosing | NER1006: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| NER1006,1-Day Morning Split-Dosing | Drug | The subject will self-administer the first dose of the investigational product on the morning of the colonoscopy and take mandatory additional clear fluid. After a 1-2 hour break the subject will self-administer the second dose plus additional clear mandatory fluid. |
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| MOVIPREP, 2-Day Split-Dosing | Drug | The subject will self-administer the first dose of the assigned investigational product in the evening prior to the scheduled colonoscopy and take recommended additional clear fluid. Subject will take the second dose together with recommended additional clear fluids on the morning of the colonoscopy. |
|
| Adenoma Detection Rate (Overall Colon) | Comparison of the number of patients with at least one adenoma detected in the overall colon when NER1006 2-Day and 1-Day is used for bowel cleansing versus MOVIPREP. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the overall colon. | Up to 2 days (from day of first dosing to day of colonoscopy) |
| Polyp Detection Rate (Colon Ascendens) | Comparison of the number of patients with at least one polyp detected in the colon ascendens when NER1006 2-Day and 1-Day is used for bowel cleansing versus MOVIPREP. Polyp detection rate (PDR) defined as the number of patients with at least one polyp in the colon ascendens. | Up to 2 days (from day of first dosing to day of colonoscopy) |
| Polyp Detection Rate (Overall Colon) | Comparison of the number of patients with at least one polyp detected in the overall colon when NER1006 is used for bowel cleansing versus number detected when MOVIPREP is used. PDR defined as the number of patients with at least one polyp in the overall colon. | Up to 2 days (from day of first dosing to day of colonoscopy) |
| Ghent |
| Belgium |
| UZ Leuven | Leuven | 3000 Leuven | Belgium |
| CHC- Clinique Saint-Joseph | Liège | Belgium |
| Hôpital Avicenne- Service de Gastro-Entérologie | Bobigny | France |
| Hôpital Hotel-Dieu | Nantes | France |
| Kliniken Essen-Mitte; Abteilung für Gastroenterologie | Essen | Germany |
| Klinikum der Friedrich Schiller Universität Jena | Jena | Germany |
| Praxis für Innere Medizin, Gastroenterologie und Allg. Medizin | Ludwigshafen | Germany |
| A.O.U. di Bologna - Policlinico S. Orsola-Malpighi | Bologna | Italy |
| Ospedale Valduce U.O. Gastroenterologia e Endoscopia | Como | Italy |
| P.O. Maresca OORR Area Vesuviana ASL | Naples | Italy |
| Centro di Riferimento Oncologico (C.R.O.) S.O.C Gastroenterologia | Pordenone | Italy |
| Pol. Univ. A. Gemelli U.O. di Endoscopia Digestiva Chirurgica | Roma | Italy |
| Uniwersytecki Szpital Kliniczny w Bialymstoku | Bialystok | Poland |
| Gabinet Internistyczny dr n. med. Krzysztof Janik | Częstochowa | Poland |
| NZOZ Centrum Medyczne-Szpital Swietej Rodziny | Lodz | Poland |
| Centralny Szpital Kliniczny Ministerstwa Spraw Wewnetrznych | Warsaw | Poland |
| Robert Petryka Gabinet Internistyczny | Warsaw | Poland |
| Lexmedica Durbajlo Hanna | Wroclaw | Poland |
| Hospital General Universitario de Alicante | Alicante | Spain |
| Hospital del Mar | Barcelona | Spain |
| Hospital Universitari Germans Trias i Pujol | Barcelona | Spain |
| Hospital ClÃnico San Carlos | Madrid | Spain |
| Hospital Ramon y Cajal - Ctra. De Colmenar km. 9, 100 | Madrid | Spain |
| Lothian Health Board | Edinburgh | United Kingdom |
| Borders General Hospital | Melrose | United Kingdom |
| Royal Shrewsbury Hospital | Shrewsbury | United Kingdom |
| Royal Albert Edward Infirmary Department | Wigan | United Kingdom |
| FG002 | NER1006,1-Day Morning Split-Dosing | NER1006: 1-Day Morning Split-Dosing Regimen (to commence in the morning of the day of colonoscopy). |
| COMPLETED |
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| NOT COMPLETED |
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The number of participants for analysis, 245 per arm, was based on assumed overall cleansing success rates of 90% for both MOVIPREP and NER1006, a non-inferiority margin of 10%, and at least 90% power to demonstrate non-inferiority. The overall number of participants analyzed was based on the modified full analysis set (mFAS).
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| ID | Title | Description |
|---|---|---|
| BG000 | MOVIPREP, 2-Day Split-Dosing | MOVIPREP®: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). |
| BG001 | NER1006, 2-Day Split-Dosing | NER1006: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). |
| BG002 | NER1006,1-Day Morning Split-Dosing | NER1006: 1-Day Morning Split-Dosing Regimen (to commence in the morning of the day of colonoscopy). |
| BG003 | Total | Total of all reporting groups |
| 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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| Sex: Female, Male | Count of Participants | Participants |
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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 | Number of Patients With Successful Bowel Cleansing (Overall Colon) | The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). A final HCS grading of A, B, C or D was derived. Grades A and B are classified as successful (i.e. all mucosa could be visualized) and C and D are classified as unsuccessful. Comparison of overall success of cleansing with NER1006 2-Day and 1-Day versus MOVIPREP was evaluated using a non-inferiority study design. | The overall number of participants analyzed was based on the mFAS. This included all randomized patients, except any patient who (i) was randomized but subsequently failed to meet entry criteria and (ii) in whom it was confirmed (from their patient diary) that the same patient did not receive any study drug. | Posted | Count of Participants | Participants | Up to 2 days (from day of first dosing to day of colonoscopy) |
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| Primary | Number of Patients With 'Excellent Plus Good' (Highly Effective) Bowel Cleansing (Colon Ascendens) | The overall quality of bowel cleansing was assessed by a blinded central reader (an experienced and trained colonoscopist) using the segmental scores of the Harefield Cleansing Scale (HCS). Highly effective cleansing in the colon ascendens corresponded to scores 3 (Good) or 4 (Excellent) of the HCS. Adequate plus failure of cleansing corresponded to score 0-2. Comparison of 'Excellent plus good' cleansing of the colon ascendens using NER1006 2-Day and 1-Day versus MOVIPREP was evaluated using a non-inferiority study design. | The overall number of participants analyzed was based on the mFAS. This included all randomized patients, except any patient who (i) was randomized but subsequently failed to meet entry criteria and (ii) in whom it was confirmed (from their patient diary) that the same patient did not receive any study drug. | Posted | Count of Participants | Participants | Up to 2 days (from day of first dosing to day of colonoscopy) |
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| Secondary | Adenoma Detection Rate (Colon Ascendens) | Comparison of the number of patients with at least one adenoma detected in the colon ascendens when NER1006 2-Day and 1-Day is used for bowel cleansing versus MOVIPREP. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the colon ascendens. | The overall number of participants analyzed was based on the mFAS. This included all randomized patients, except any patient who (i) was randomized but subsequently failed to meet entry criteria and (ii) in whom it was confirmed (from their patient diary) that the same patient did not receive any study drug. | Posted | Count of Participants | Participants | Up to 2 days (from day of first dosing to day of colonoscopy) |
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| Secondary | Adenoma Detection Rate (Overall Colon) | Comparison of the number of patients with at least one adenoma detected in the overall colon when NER1006 2-Day and 1-Day is used for bowel cleansing versus MOVIPREP. Adenoma detection rate (ADR) defined as the number of patients with at least one adenoma in the overall colon. | The overall number of participants analyzed was based on the mFAS. This included all randomized patients, except any patient who (i) was randomized but subsequently failed to meet entry criteria and (ii) in whom it was confirmed (from their patient diary) that the same patient did not receive any study drug. | Posted | Count of Participants | Participants | Up to 2 days (from day of first dosing to day of colonoscopy) |
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| Secondary | Polyp Detection Rate (Colon Ascendens) | Comparison of the number of patients with at least one polyp detected in the colon ascendens when NER1006 2-Day and 1-Day is used for bowel cleansing versus MOVIPREP. Polyp detection rate (PDR) defined as the number of patients with at least one polyp in the colon ascendens. | The overall number of participants analyzed was based on the mFAS. This included all randomized patients, except any patient who (i) was randomized but subsequently failed to meet entry criteria and (ii) in whom it was confirmed (from their patient diary) that the same patient did not receive any study drug | Posted | Count of Participants | Participants | Up to 2 days (from day of first dosing to day of colonoscopy) |
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| Secondary | Polyp Detection Rate (Overall Colon) | Comparison of the number of patients with at least one polyp detected in the overall colon when NER1006 is used for bowel cleansing versus number detected when MOVIPREP is used. PDR defined as the number of patients with at least one polyp in the overall colon. | The overall number of participants analysed is based on the mFAS. This included all randomized patients except those patients who (i) were randomized but subsequently failed to meet entry criteria and (ii) in whom it was confirmed (from their patient diary) that the same patient did not receive any study drug (n=822). | Posted | Number | Participants | Up to 2 days (from day of first dosing to day of colonoscopy) |
|
Afternoon of Day 1 (first dose) to Day 9 (final clinic visit)
Treatment Emergent AEs. Safety analyses were based on the safety population, which included all randomized patients whom it could not be ruled out (from their patient diary) that they received study drug at least once (n=794).
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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 | MOVIPREP, 2-Day Split-Dosing | MOVIPREP®: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). | 0 | 263 | 31 | 263 | ||
| EG001 | NER1006, 2-Day Split-Dosing | NER1006: 2-Day Split-Dosing Regimen (to commence in the evening of the day before colonoscopy). | 2 | 262 | 41 | 262 | ||
| EG002 | NER1006,1-Day Morning Split-Dosing | NER1006: 1-Day Morning Split-Dosing Regimen (to commence in the morning of the day of colonoscopy). | 0 | 269 | 49 | 269 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Procedural intestinal perforation | Injury, poisoning and procedural complications | MedDRA (18.0) | Non-systematic Assessment |
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| Alcohol abuse | Psychiatric disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abdominal pain | Gastrointestinal disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Abdominal pain lower | Gastrointestinal disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Dry mouth | Gastrointestinal disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Nausea | Gastrointestinal disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Vomiting | Gastrointestinal disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Fatigue | General disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Feeling cold | General disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Thirst | General disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Headache | Nervous system disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Dehydration | Metabolism and nutrition disorders | MedDRA (18.0) | Non-systematic Assessment |
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| Hypertension | Vascular disorders | MedDRA (18.0) | Non-systematic Assessment |
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Imputation of failure occurred in 4% of patients. This strict analytical approach reduced the cleansing success rates for both treatments.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Lucy Clayton | Norgine Ltd | +44-1895-826669 | LClayton@norgine.com |
| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| ID | Term |
|---|---|
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |
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| ID | Term |
|---|---|
| C520497 | MoviPrep |
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| Between 18 and 65 years |
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| >=65 years |
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| Male |
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| Title | Measurements |
|---|---|
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| Non-Inferiority or Equivalence |
The confidence limits (CL) were adjusted for multiple comparisons (two alternative primary endpoints): To be declared non-inferior, the primary endpoint must show a difference in success rates of no greater than 10% in favour of MOVIPREP using lower 1-sided 97.5% CL. Calculated using exact Clopper-Pearson CLs. To accommodate the comparison of 2 NER1006 regimens a hierarchical testing approach was used whereby NER1006 2-Day was assessed first and, if successful, then NER1006 1-Day was evaluated. |
| The hypothesis was to demonstrate NI of NER1006 1-Day to MOVIPREP (10% margin). Success rate was number of patients with successful overall bowel cleansing as proportion of number of patients in each group. Treatment effect was NER1006 1-Day success rate - MOVIPREP success rate. A Hochberg procedure was used to control Type I error since there were two alternative primary endpoints. An alpha level of 1.25% 1-sided was used. A closed testing procedure used to evaluate superiority if NI was met. | Fisher Exact | 0.328 | The p-value was adjusted for multiple comparisons (two alternative primary endpoints): To be declared superior, primary endpoint must demonstrate non-inferiority with 1-sided p-value <0.025, the threshold for statistical significance. | Difference in success rate | 1.59 | 1-Sided | 97.5 | -6.91 | Non-Inferiority or Equivalence | The CLs were adjusted for multiple comparisons (2 alternative primary endpoints): To be declared non-inferior, the primary endpoint must show a difference in success rates of no greater than 10% in favour of MOVIPREP using lower 1-sided 97.5% CLs. Calculated using exact Clopper-Pearson confidences limits. To accommodate the comparison of two NER1006 regimens a hierarchical testing approach will be used whereby NER1006 2-Day was assessed first and, if successful, then NER1006 1-Day was evaluated. |
| NER1006,1-Day Morning Split-Dosing |
NER1006: 1-Day Morning Split-Dosing Regimen (to commence in the morning of the day of colonoscopy). |
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