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| ID | Type | Description | Link |
|---|---|---|---|
| R33AR077495 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) | NIH |
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People with Down syndrome (DS) display widespread immune dysregulation, including several immune skin conditions. This study hypothesizes that pharmacological inhibition of the increased interferon (IFN) signaling seen in DS is safe and could improve associated skin conditions.
The study evaluates the safety and efficacy treatment with Tofacitinib, an FDA-approved drug known to block IFN signaling, in adolescents and adults with DS and an autoimmune and/or autoinflammatory skin condition. Investigators will also measure the impact of interferon inhibition on a variety of molecular markers, as well as the cognitive abilities and quality of life of participants.
Trisomy 21 (T21) is the most common human chromosomal disorder, occurring in ~1/700 live births, leading to the condition known as Down syndrome (DS). Importantly, people with DS display widespread immune dysregulation and over half of adults with T21 are affected by one or more autoimmune conditions, including several immune skin conditions. The driving hypothesis for this study is that hyperactivation of interferon (IFN) signaling leads to myriad immune-driven diseases and immunological phenotypes in people with DS, and that pharmacological inhibition of IFN signaling could have multidimensional therapeutic benefits in this population.
This study utilizes Tofacitinib, an FDA-approved drug known to block IFN signaling and several accompanying inflammatory pathways, to reduce IFN signaling in DS and to measure its effects via multidimensional endpoints. Previous studies and current clinical trials indicate that Janus kinase (JAK) inhibitors, such as Tofacitinib, can block inflammatory pathways and may have beneficial effects on immune skin conditions. Further, inhibition of chronically active IFN signaling in DS with Tofacitinib may attenuate other core drivers of immune dysregulation, leading to improvements in other immune diseases and conditions common to DS that are potentially driven by inflammation, such as cognitive deficits. Investigators will test these hypotheses using a battery of immune and molecular assessments, as well as cognitive testing and quality of life measures. This clinical trial evaluates adolescent and adult participants with DS during eight study visits over an approximate five month period.
Specific Aims:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| On Treatment | Experimental | Tofacitinib 5mg oral tablets twice daily for 16 weeks |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tofacitinib | Drug | Treatment with oral Tofacitinib for immune mediated skin conditions in adults with Down syndrome |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of Serious Adverse Events (SAE) Definitely Related to Tofacitinib Treatment. | Safety as measured by the number of serious adverse events definitely related to tofacitinib treatment. | Baseline to 16 weeks |
| Change in Whole Blood Transcriptome Interferon (IFN) Score | The Interferon Score is a composite molecular measure used to quantify activation of the interferon signaling pathway. Interferon Scores are calculated by summing standardized expression (i.e. (expression value - mean) / standard deviation) of a predefined panel of 16 interferon-stimulated genes, measured by RNA-sequencing of whole blood samples. The resulting composite value provides an integrated measure of interferon pathway activity, with higher scores indicating greater pathway activation. No clinical relevance threshold has been established. | Baseline and 16 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Investigator's Global Assessment (IGA) | The IGA is used to assess overall changes in severity across five skin conditions (alopecia areata, atopic dermatitis, vitiligo, psoriasis and hidradenitis suppurativa) scored from 0 (clear) to 4 - 5 (very severe). | Baseline and 16 weeks |
| Change in Dermatology Life Quality Index (DLQI) |
Not provided
Inclusion Criteria:
Males or females with DS between 12 and 50 years of age who weigh at least 40 kg.
Diagnosis of at least one active immune skin condition, including but not limited to:
Be willing to avoid pregnancy or fathering children.
Must present with a study partner or legal guardian who can complete, or assist with completing, study materials as appropriate.
Exclusion Criteria
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| Name | Affiliation | Role |
|---|---|---|
| Joaquin Espinosa, PhD | Linda Crnic Institute, University of Colorado Anschutz Medical Campus | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Linda Crnic Institute for Down Syndrome | Aurora | Colorado | 80045 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31008170 | Background | Rachubinski AL, Estrada BE, Norris D, Dunnick CA, Boldrick JC, Espinosa JM. Janus kinase inhibition in Down syndrome: 2 cases of therapeutic benefit for alopecia areata. JAAD Case Rep. 2019 Apr 5;5(4):365-367. doi: 10.1016/j.jdcr.2019.02.007. eCollection 2019 Apr. No abstract available. | |
| 33630031 | Background | Pham AT, Rachubinski AL, Enriquez-Estrada B, Worek K, Griffith M, Espinosa JM. JAK inhibition for treatment of psoriatic arthritis in Down syndrome. Rheumatology (Oxford). 2021 Sep 1;60(9):e309-e311. doi: 10.1093/rheumatology/keab203. No abstract available. |
| Label | URL |
|---|---|
| The Crnic Institute Human Trisome Project | View source |
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De-identified individual participant data will be made available for all primary outcome measures.
Data will be made available upon publication in a peer-reviewed journal.
Data access requests will be reviewed by the sponsor-investigator and collaborators.
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| ID | Title | Description |
|---|---|---|
| FG000 | On Treatment | Tofacitinib 5mg oral tablets twice daily for 16 weeks. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
Total number of participants who completed Baseline visit and were considered to be enrolled (n=47).
All enrolled participants are represented in Safety Outcome Measure.
As the Primary Outcome Measure for Whole Blood Transcriptome Interferon (IFN) Score is based on the change between Baseline and 16 weeks, a Baseline Measure for this Outcome is based on the 39 completed participants analyzed for this Primary Outcome based on medication compliance and sample availability.
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| ID | Title | Description |
|---|---|---|
| BG000 | On Treatment | Tofacitinib 5mg oral tablets twice daily for 16 weeks. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| 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 Serious Adverse Events (SAE) Definitely Related to Tofacitinib Treatment. | Safety as measured by the number of serious adverse events definitely related to tofacitinib treatment. | All participants who attended Baseline appointment. | Posted | Number | Serious Adverse Events | Baseline to 16 weeks |
|
|
Baseline through 16 weeks.
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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 | On Treatment | Tofacitinib 5mg oral tablets twice daily for 16 weeks Tofacitinib: Treatment with oral Tofacitinib for immune-mediated skin conditions in adults with Down syndrome who completed Baseline and 16-week study time points with adequate medication compliance. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Thromboembolic event | Vascular disorders | CTCAE 5.0 | Non-systematic Assessment | This was a Grade 3 thromboembolic event, determined to be possibly related to the IP. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Grade 1 Diarrhea | Gastrointestinal disorders | CTCAE 5.0 | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Joaquin Espinosa | Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz | 303-724-7389 | joaquin.espinosa@cuanschutz.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 26, 2024 | Oct 3, 2025 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | May 15, 2024 | Oct 3, 2025 | ICF_002.pdf |
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| ID | Term |
|---|---|
| D004314 | Down Syndrome |
| D000506 | Alopecia Areata |
| D003876 | Dermatitis, Atopic |
| D004485 | Eczema |
| D017497 | Hidradenitis Suppurativa |
| D014820 | Vitiligo |
| D011565 | Psoriasis |
| D001327 | Autoimmune Diseases |
| D012871 | Skin Diseases |
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D008607 | Intellectual Disability |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| C479163 | tofacitinib |
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All participants will receive the investigational product, Tofacitinib.
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The DLQI is used to assess participant-reported impact of skin conditions on self-image, relationships, and daily activities. Possible total scores range from 0-30, with higher scores indicating a more impaired quality of life. |
| Baseline and 16 weeks |
| Change in Eczema Area and Severity Index (EASI) Score in Participants With Atopic Dermatitis | The EASI is used to assess changes in the extent (area) and severity of atopic dermatitis (eczema). Each of four sites (head, upper limbs, trunk, and lower limbs), are weighted by overall contribution to body surface area and separately scored by using four parameters (erythema, infiltration, excoriations, lichenification), each of which is graded on a severity scale of 0 (none) to 4 (severe), as well as degree of involvement. Possible total scores range from 0-72, with higher scores indicating a more severe involvement. | Baseline and 16 weeks |
| Change in Severity of Alopecia Tool (SALT) Score in Participants With Alopecia | The SALT is used to assess changes in degree and extent (area) of hair loss due to alopecia areata on the head. Each of four scalp sites (left side, right side, top and back) are weighted by overall contribution to scalp surface area and rated for percent involvement. Possible total scores range from 0-72, with higher scores indicating a larger affected area. | Baseline and 16 weeks |
| Change in Modified Sartorius Score (MSS) Score in Participants With Hidradenitis Suppurativa | The MSS is used to assess changes in areas affected by hidradenitis suppurativa. Each of seven sites (right/left axillae, right/left groin, right/left gluteal, other) are scored by number of lesions, distance between lesions, and presence of normal skin between lesions. Possible total scores range up from 0 with no maximum, with higher scores indicating a more severe involvement. | Baseline and 16 weeks |
| Change in Psoriasis Area and Severity Index (PASI) Score in Participants With Psoriasis | The PASI is used to assess changes in extent (area) and severity of psoriasis. Each of four sites (head, upper limbs, trunk, and lower limbs) are weighted by overall contribution to body surface area and separately scored by degree of involvement and three additional parameters (erythema, induration and desquamation), each of which is graded on a severity scale of 0 (Not severe) to 4 (very severe). Possible total scores range from 0-72, with higher scores indicating a more severe involvement. | Baseline and 16 weeks |
| Change in Vitiligo Extent Tensity Index (VETI) in Participants With Vitiligo | The VETI is used to assess changes in extent (area) of skin affected by vitiligo. Each of five sites (head, trunk, upper limbs, lower limbs, genitalia) are weighted by overall contribution to body surface area and rated for degree of de-pigmentation scale of Stage 0 (normal skin) to Stage 5 (complete de-pigmentation plus significant hair whitening) and percent involvement. Possible scores range from 0-55.5, with a higher score indicating a higher degree of involvement. | Baseline and 16 weeks |
| A Composite Cytokine Score Generated Using the Meso Scale Discovery (MSD) Platform Used to Assess Inflammatory Changes in Plasma. | The Cytokine Score is a composite molecular measure used to quantify inflammatory changes. Cytokine Scores are calculated by summing standardized abundance (i.e. (abundance value - mean) / standard deviation) of a predefined panel of four inflammatory cytokines, measured in plasma samples using the Meso Scale Discovery platform. The resulting composite value provides an integrated measure of inflammatory activity, with higher scores indicating a more inflammatory state. No clinical relevance threshold has been established. | Baseline and 16 weeks |
| 39737640 | Derived | Rachubinski AL, Wallace E, Gurnee E, Enriquez-Estrada BA, Worek KR, Smith KP, Araya P, Waugh KA, Granrath RE, Britton E, Lyford HR, Donovan MG, Eduthan NP, Hill AA, Martin B, Sullivan KD, Patel L, Fidler DJ, Galbraith MD, Dunnick CA, Norris DA, Espinosa JM. JAK inhibition decreases the autoimmune burden in Down syndrome. Elife. 2024 Dec 31;13:RP99323. doi: 10.7554/eLife.99323. |
| 38946973 | Derived | Rachubinski AL, Wallace E, Gurnee E, Estrada BAE, Worek KR, Smith KP, Araya P, Waugh KA, Granrath RE, Britton E, Lyford HR, Donovan MG, Eduthan NP, Hill AA, Martin B, Sullivan KD, Patel L, Fidler DJ, Galbraith MD, Dunnick CA, Norris DA, Espinosa JM. JAK inhibition decreases the autoimmune burden in Down syndrome. medRxiv [Preprint]. 2024 Oct 16:2024.06.13.24308783. doi: 10.1101/2024.06.13.24308783. |
| Physician Decision |
|
| Years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Whole Blood Transcriptome Interferon (IFN) Score | The Interferon Score is a composite molecular measure used to quantify activation of the interferon signaling pathway. Interferon Scores are calculated by summing standardized expression (i.e. (expression value - mean) / standard deviation) of a predefined panel of 16 interferon-stimulated genes, measured by RNA-sequencing of whole blood samples. The resulting composite value provides an integrated measure of interferon pathway activity, with higher scores indicating greater pathway activation. No clinical relevance threshold has been established. | Median IFN score with IQR was calculated for 39 participants who completed 16 weeks. | Median | Inter-Quartile Range | IFN score |
|
|
|
| Primary | Change in Whole Blood Transcriptome Interferon (IFN) Score | The Interferon Score is a composite molecular measure used to quantify activation of the interferon signaling pathway. Interferon Scores are calculated by summing standardized expression (i.e. (expression value - mean) / standard deviation) of a predefined panel of 16 interferon-stimulated genes, measured by RNA-sequencing of whole blood samples. The resulting composite value provides an integrated measure of interferon pathway activity, with higher scores indicating greater pathway activation. No clinical relevance threshold has been established. | All participants meeting medication compliance criteria and for whom IFN scores were available at Baseline and 16 weeks. | Posted | Mean | 95% Confidence Interval | Change in IFN score at 16 weeks | Baseline and 16 weeks |
|
|
|
|
| Secondary | Change in Investigator's Global Assessment (IGA) | The IGA is used to assess overall changes in severity across five skin conditions (alopecia areata, atopic dermatitis, vitiligo, psoriasis and hidradenitis suppurativa) scored from 0 (clear) to 4 - 5 (very severe). | All participants meeting medication compliance criteria and for whom IGA scores were collected at Baseline and 16 weeks. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
|
|
| Secondary | Change in Dermatology Life Quality Index (DLQI) | The DLQI is used to assess participant-reported impact of skin conditions on self-image, relationships, and daily activities. Possible total scores range from 0-30, with higher scores indicating a more impaired quality of life. | All participants meeting medication compliance criteria and for whom DLQI scores were collected at Baseline and 16 weeks. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
|
|
| Secondary | Change in Eczema Area and Severity Index (EASI) Score in Participants With Atopic Dermatitis | The EASI is used to assess changes in the extent (area) and severity of atopic dermatitis (eczema). Each of four sites (head, upper limbs, trunk, and lower limbs), are weighted by overall contribution to body surface area and separately scored by using four parameters (erythema, infiltration, excoriations, lichenification), each of which is graded on a severity scale of 0 (none) to 4 (severe), as well as degree of involvement. Possible total scores range from 0-72, with higher scores indicating a more severe involvement. | All participants meeting medication compliance criteria and for whom qualifying EASI scores were collected at Baseline and 16 weeks. None of the completed trial participants had qualifying EASI scores for atopic dermatitis. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
| Secondary | Change in Severity of Alopecia Tool (SALT) Score in Participants With Alopecia | The SALT is used to assess changes in degree and extent (area) of hair loss due to alopecia areata on the head. Each of four scalp sites (left side, right side, top and back) are weighted by overall contribution to scalp surface area and rated for percent involvement. Possible total scores range from 0-72, with higher scores indicating a larger affected area. | All participants meeting medication compliance criteria and for whom qualifying SALT scores were collected at Baseline and 16 weeks. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
|
|
| Secondary | Change in Modified Sartorius Score (MSS) Score in Participants With Hidradenitis Suppurativa | The MSS is used to assess changes in areas affected by hidradenitis suppurativa. Each of seven sites (right/left axillae, right/left groin, right/left gluteal, other) are scored by number of lesions, distance between lesions, and presence of normal skin between lesions. Possible total scores range up from 0 with no maximum, with higher scores indicating a more severe involvement. | All participants meeting medication compliance criteria and for whom qualifying MSS scores were collected at Baseline and 16 weeks. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
|
|
| Secondary | Change in Psoriasis Area and Severity Index (PASI) Score in Participants With Psoriasis | The PASI is used to assess changes in extent (area) and severity of psoriasis. Each of four sites (head, upper limbs, trunk, and lower limbs) are weighted by overall contribution to body surface area and separately scored by degree of involvement and three additional parameters (erythema, induration and desquamation), each of which is graded on a severity scale of 0 (Not severe) to 4 (very severe). Possible total scores range from 0-72, with higher scores indicating a more severe involvement. | All participants meeting medication compliance criteria and for whom qualifying PASI scores were collected at Baseline and 16 weeks. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
|
|
| Secondary | Change in Vitiligo Extent Tensity Index (VETI) in Participants With Vitiligo | The VETI is used to assess changes in extent (area) of skin affected by vitiligo. Each of five sites (head, trunk, upper limbs, lower limbs, genitalia) are weighted by overall contribution to body surface area and rated for degree of de-pigmentation scale of Stage 0 (normal skin) to Stage 5 (complete de-pigmentation plus significant hair whitening) and percent involvement. Possible scores range from 0-55.5, with a higher score indicating a higher degree of involvement. | All participants meeting medication compliance criteria and for whom qualifying VETI scores were collected at Baseline and 16 weeks. None of the completed trial participants had qualifying VETI scores for vitiligo. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
| Secondary | A Composite Cytokine Score Generated Using the Meso Scale Discovery (MSD) Platform Used to Assess Inflammatory Changes in Plasma. | The Cytokine Score is a composite molecular measure used to quantify inflammatory changes. Cytokine Scores are calculated by summing standardized abundance (i.e. (abundance value - mean) / standard deviation) of a predefined panel of four inflammatory cytokines, measured in plasma samples using the Meso Scale Discovery platform. The resulting composite value provides an integrated measure of inflammatory activity, with higher scores indicating a more inflammatory state. No clinical relevance threshold has been established. | All participants meeting medication compliance criteria and for whom Cytokine scores were collected at Baseline and 16 weeks. | Posted | Mean | 95% Confidence Interval | Change in score at 16 weeks | Baseline and 16 weeks |
|
|
|
|
| 0 |
| 47 |
| 1 |
| 47 |
| 45 |
| 47 |
|
| Grade 2 Diarrhea | Gastrointestinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Vomiting | Gastrointestinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Rash acneiform | Skin and subcutaneous tissue disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Skin and subcutaneous tissue disorders | Skin and subcutaneous tissue disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 2 Skin and subcutaneous tissue disorders | Skin and subcutaneous tissue disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 2 Neutrophil count decreased | Investigations | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Weight loss | Investigations | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Weight gain | Investigations | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 2 Weight gain | Investigations | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Cough | Respiratory, thoracic and mediastinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 2 Cough | Respiratory, thoracic and mediastinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Rhinorrhea | Respiratory, thoracic and mediastinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Productive cough | Respiratory, thoracic and mediastinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Nasal congestion | Respiratory, thoracic and mediastinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Sore throat | Respiratory, thoracic and mediastinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Infections and infestations - COVID-19 | Infections and infestations | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 2 Infections and infestations - COVID-19 | Infections and infestations | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Skin infection | Infections and infestations | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Fever | General disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Fatigue | General disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Headache | Nervous system disorders | CTCAE 5.0 | Non-systematic Assessment |
|
| Grade 1 Stomach pain | Gastrointestinal disorders | CTCAE 5.0 | Non-systematic Assessment |
|
Not provided
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| D000015 | Abnormalities, Multiple |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D025063 | Chromosome Disorders |
| D030342 | Genetic Diseases, Inborn |
| D000505 | Alopecia |
| D007039 | Hypotrichosis |
| D006201 | Hair Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D012873 | Skin Diseases, Genetic |
| D003872 | Dermatitis |
| D017443 | Skin Diseases, Eczematous |
| D006969 | Hypersensitivity, Immediate |
| D006967 | Hypersensitivity |
| D007154 | Immune System Diseases |
| D017192 | Skin Diseases, Bacterial |
| D001424 | Bacterial Infections |
| D001423 | Bacterial Infections and Mycoses |
| D007239 | Infections |
| D012874 | Skin Diseases, Infectious |
| D013492 | Suppuration |
| D016575 | Hidradenitis |
| D013543 | Sweat Gland Diseases |
| D017496 | Hypopigmentation |
| D010859 | Pigmentation Disorders |
| D017444 | Skin Diseases, Papulosquamous |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |