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The rationale for the interventional, open-label, single-arm design of JZP258-401 is to evaluate the clinical experience in participants with narcolepsy transitioning treatment from Xyrem to XYWAV.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Open-Label Conversion and Treatment Optimization | Experimental | Conversion from Xyrem to XYWAV, maintaining the dose and regimen of any concomitant anticataplectics or stimulants unchanged throughout study. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| JZP-258 | Drug | Maximum nightly dosage of 9 grams, administered once, twice or thrice nightly, with no single dose > 6 g |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Weekly Rate of Cataplexy Attacks | Mean weekly rate of cataplexy attack = (total number of cataplexy attacks reported during the period/number of days during the period where a diary was completed) x 7. | Baseline to Week 8 |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in the Nausea Visual Analog Scale (NVAS) | Tolerability associated with Xyrem and XYWAV was measured based on an NVAS assessment administered electronically. NVAS was captured daily during the last 7 days of the Baseline (Xyrem-stable dose and regimen) period and the last 7 days of the Intervention period (on XYWAV) prior to the ET visit or prior to the E/D visit, if possible. For participants with at least one day of NVAS data, the NVAS for that week was the average daily score from days with non-missing data within the week, then multiplied by 7. The NVAS ranges 0-100 mm, with higher scores representing more severe/intense nausea. |
Inclusion Criteria:
Age
Participant must be 18 to 80 years of age (inclusive), at the time of signing the informed consent. Type of Participant and Disease Characteristics
Participants who have a primary diagnosis of Type 1 or Type 2 narcolepsy that meets ICSD-3 criteria or DSM-5 criteria (Ruoff and Rye 2016), and are being currently treated with Xyrem, with or without additional anticataplectics or stimulants.
Participants who have been taking Xyrem (with or without additional anticataplectics or stimulants eg, TCA, SNRI, SSRI, atomoxetine) in a stable dose and regimen for at least two months prior to screening, with evidence of clinical improvement on their current regimen, per the investigator's judgement. Only Xyrem will be substituted with XYWAV, with dose and regimen of any concomitant anticataplectics or stimulants remaining unchanged throughout the study.
Sex and Contraceptive/Barrier Requirements
Participant is male or female
A female participant is eligible to participate if she is not pregnant or breastfeeding, and one of the following conditions applies:
A WOCBP must have a negative highly sensitive pregnancy test (serum) during screening.
The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
Informed Consent
Capable of giving signed informed consent, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
Exclusion Criteria:
Medical Conditions
Have a diagnosis of narcolepsy, secondary to another medical condition (eg, central nervous system injury or lesion)
Are currently prescribed a Xyrem regimen exceeding a dose of 9 grams nightly, or any single dose in excess of 6 grams.
Have been diagnosed with restless leg syndrome (RLS) requiring treatment other than iron supplements
Exhibit succinic semi-aldehyde dehydrogenase deficiency (SSADH)
Have uncontrolled hypothyroidism
Have a history of seizures, excluding early childhood non-pathological febrile seizures
Have a history of head trauma associated with loss of consciousness in the past 5 years, or if the event occurred more than 5 years prior to screening and the participant experiences sequelae due to the event
Show evidence of untreated or inadequately treated sleep-disordered breathing including:
Experience parasomnias (eg, sleep walking, REM Sleep Behavior Disorder, etc.) considered by the investigator to negatively impact the conduct of the study. Parasomnia events associated with physical injury to the participant (or others) shall be discussed with the sponsor Medical Monitor.
Meet criteria for current major depression based on clinical interview
Have any clinically relevant medical, behavioral, or psychiatric disorder (other than narcolepsy) that is associated with excessive sleepiness
Have a history or presence of bipolar disorder, bipolar related disorders, schizophrenia, schizophrenia spectrum disorders, or other psychotic disorders according to DSM-5 criteria
Have a history or presence of any unstable or clinically significant medical condition, behavioral or psychiatric disorder (including active suicidal ideation), or history or presence of another neurological disorder or surgical history that might affect the participant's safety and/or interfere with the conduct of the study, in the opinion of the investigator
Display relevant suicidality as indicated by Columbia Suicide Severity Rating Scale (C-SSRS) evaluation at screening
Display moderate to severe depression as indicated by the Participant Health Questionnaire - 9 (PHQ-9) at screening
Are a female participant who is pregnant or breastfeeding
Prior/Concomitant Therapy
Have undergone treatment with any prohibited central nervous system (CNS) agents, including but not limited to benzodiazepines, non-benzodiazepine anxiolytics/ hypnotics/sedatives, neuroleptics, opioids, barbiturates, phenytoin, ethosuximide, or MCT inhibitors, eg, diclofenac, valproate, ibuprofen, within 2 weeks prior to enrollment. Discontinuation for the purpose of study enrollment is permitted only if considered safe by the investigator and approved by the Medical Monitors.
Prior/Concurrent Clinical Study Experience
Received any other investigational drug within 30 days or five half-lives (whichever is longer) prior to screening, or plan to use an investigational drug (other than the study intervention) during the study.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Wright Clinical Research, LLC | Alabaster | Alabama | 35007 | United States | ||
| Sleep Disorders Center of Alabama |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38652499 | Derived | Macfadden W, Leary EB, Fuller DS, Kirby MT, Roy A. Effectiveness and optimization of low-sodium oxybate in participants with narcolepsy switching from a high-sodium oxybate: data from the Substitution of Equal Grams of Uninterrupted Xyrem to Xywav study. J Clin Sleep Med. 2024 Sep 1;20(9):1467-1477. doi: 10.5664/jcsm.11182. |
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A total of 62 participants were enrolled in trial sites across the United States.
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| ID | Title | Description |
|---|---|---|
| FG000 | Overall | Participants received JZP258 (XYWAV) at a maximum nightly dosage of 9 g administered orally 1 to 3 times nightly, with no single dose exceeding 6 g. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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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 | Dec 8, 2020 | Nov 15, 2023 |
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|
| Baseline to Week 8 |
| Number of Participants With Patient Global Impression of Change (PGIc) Values | The PGIc is a 7-point Likert-type rating based on a 7-point scale ranging from 1 (very much improved) to 7 (very much worse). PGIc values were measured at the ET or E/D, as applicable. | Week 8 |
| Change in Epworth Sleepiness Scale (ESS) | The ESS questionnaire included a set of 8 questions regarding how likely the participant would be to doze off or fall asleep in different situations. The ESS measures EDS or average sleep propensity in daily life. Responses range from 0 = would never doze (better outcome) to 3 = high chance of dozing (worse outcome). Changes in ESS scores were assessed between the Baseline period and ET or E/D, as applicable | Baseline to Week 8 |
| Time to Achieve Optimized Dose and Regimen | Defined as the time from the first dose and regimen to the optimized dose and regimen of XYWAV, where the optimized dose and regimen indicates the final dose and regimen that remains unchanged throughout the remainder of the Intervention period. | Baseline to Week 8 |
| Number of Changes From the First Dose and Regimen to Optimized Dose and Regimen | The amount of times the dose and regimen were changed before an optimized dose and regimen were achieved. | Baseline to Week 8 |
| Number of Participants Dosing Fasted Versus Dosing Without Consideration of Food | Once the participant reached an optimized dose and regimen, the investigator could decide to instruct the participant to dose without regard to food. | Baseline to Week 8 |
| Duration of Time Between the Last Meal Relative to Dosing | The difference between the time of day that participants ate their last meal and the time of day participants take their first dose. | Baseline to Week 8 |
| Characterization of Meals Relative to Dosing | Types of meals consumed before dosing. | Baseline to Week 8 |
| Birmingham |
| Alabama |
| 35213 |
| United States |
| Pulmonary Associates of the Southeast, PC | Birmingham | Alabama | 35254 | United States |
| Santa Monica Clinical Trials | Los Angeles | California | 90025 | United States |
| Southern California Institute For Respiratory Diseases, Inc./ Tower Sleep Medicine | Los Angeles | California | 90048 | United States |
| Southern California Institute For Respiratory Diseases, Inc. | Los Angeles | California | 90048 | United States |
| Stanford University- Sleep Medicine | Redwood City | California | 94063 | United States |
| SDS Clinical Trials, Inc | Santa Ana | California | 92705 | United States |
| Delta Waves, Inc. | Colorado Springs | Colorado | 80918 | United States |
| Pulmonary Disease Specialists, PA d/b/a PDS Research | Kissimmee | Florida | 34741 | United States |
| Clinical Research of West Florida, Inc | Tampa | Florida | 33606 | United States |
| Florida Pediatric Research Institute, LLC | Winter Park | Florida | 32789 | United States |
| Sleep Practitioners LLC | Macon | Georgia | 31210 | United States |
| Clinical Research Institute | Stockbridge | Georgia | 30281 | United States |
| The Center for Sleep & Wake Disorders | Chevy Chase | Maryland | 20815 | United States |
| WMed Center for Clinical Research | Kalamazoo | Michigan | 49008 | United States |
| Minnesota Lung Center | Edina | Minnesota | 55435 | United States |
| Clayton Sleep Institute, LLC | St Louis | Missouri | 63123 | United States |
| Clinical Research of Gastonia | Gastonia | North Carolina | 28054 | United States |
| Intrepid Research LLC | Cincinnati | Ohio | 45245 | United States |
| Cleveland Clinic, Sleep Disorders Center | Cleveland | Ohio | 44195 | United States |
| Ohio Sleep Medicine Institute | Dublin | Ohio | 43017 | United States |
| Geisinger Clinic | Danville | Pennsylvania | 17822 | United States |
| Bogan Sleep Consultants, LLC | Columbia | South Carolina | 29201 | United States |
| Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences | North Charleston | South Carolina | 29425 | United States |
| Clinical Research of Rock Hill | Rock Hill | South Carolina | 29732 | United States |
| FutureSearch Trials of Neurology | Austin | Texas | 78731 | United States |
| Sleep Therapy & Research Center | San Antonio | Texas | 78229 | United States |
| Baseline Period |
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| Intervention (XYWAV) Period |
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| Safety Follow-Up Period |
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| COMPLETED |
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| NOT COMPLETED |
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Baseline characteristics were assessed using the Safety Analysis Set, which included all participants in the Enrolled Analysis set who received at least 1 dose of Xyrem after providing informed consent.
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| ID | Title | Description |
|---|---|---|
| BG000 | Overall | Participants received JZP258 (XYWAV) at a maximum nightly dosage of 9 g administered orally 1 to 3 times nightly, with no single dose exceeding 6 g. |
| 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, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||||
| 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 |
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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 | Change in Weekly Rate of Cataplexy Attacks | Mean weekly rate of cataplexy attack = (total number of cataplexy attacks reported during the period/number of days during the period where a diary was completed) x 7. | The weekly rate of cataplexy attacks was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. Includes Narcolepsy type 1 participants with a mean weekly rate of cataplexy attack at both the first 7 days of the baseline period and the week 8 visit. | Posted | Mean | Standard Deviation | cataplexy attacks per week | Baseline to Week 8 |
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| Other Pre-specified | Change in the Nausea Visual Analog Scale (NVAS) | Tolerability associated with Xyrem and XYWAV was measured based on an NVAS assessment administered electronically. NVAS was captured daily during the last 7 days of the Baseline (Xyrem-stable dose and regimen) period and the last 7 days of the Intervention period (on XYWAV) prior to the ET visit or prior to the E/D visit, if possible. For participants with at least one day of NVAS data, the NVAS for that week was the average daily score from days with non-missing data within the week, then multiplied by 7. The NVAS ranges 0-100 mm, with higher scores representing more severe/intense nausea. | NVAS was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. Includes participants with a baseline value and a post-baseline value at the end of treatment (ET) or early discontinuation ( E/D). | Posted | Mean | Standard Deviation | score on a scale | Baseline to Week 8 |
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| Other Pre-specified | Number of Participants With Patient Global Impression of Change (PGIc) Values | The PGIc is a 7-point Likert-type rating based on a 7-point scale ranging from 1 (very much improved) to 7 (very much worse). PGIc values were measured at the ET or E/D, as applicable. | PGIC was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. Includes participants who have at least one PGIc assessment performed at the end of the intervention period or early discontinuation (E/D) visit. | Posted | Count of Participants | Participants | Week 8 |
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| Other Pre-specified | Change in Epworth Sleepiness Scale (ESS) | The ESS questionnaire included a set of 8 questions regarding how likely the participant would be to doze off or fall asleep in different situations. The ESS measures EDS or average sleep propensity in daily life. Responses range from 0 = would never doze (better outcome) to 3 = high chance of dozing (worse outcome). Changes in ESS scores were assessed between the Baseline period and ET or E/D, as applicable | ESS was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. Includes participants with Epworth Sleeping Scale assessments at both Baseline and ET or E/D visits. | Posted | Mean | Standard Deviation | units on a scale | Baseline to Week 8 |
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| Other Pre-specified | Time to Achieve Optimized Dose and Regimen | Defined as the time from the first dose and regimen to the optimized dose and regimen of XYWAV, where the optimized dose and regimen indicates the final dose and regimen that remains unchanged throughout the remainder of the Intervention period. | The time to achieve an optimized dose and regimen was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. | Posted | Mean | Standard Deviation | day | Baseline to Week 8 |
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| Other Pre-specified | Number of Changes From the First Dose and Regimen to Optimized Dose and Regimen | The amount of times the dose and regimen were changed before an optimized dose and regimen were achieved. | The number of changes from the first dose and regimen to the optimized was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. | Posted | Count of Participants | Participants | Baseline to Week 8 |
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| Other Pre-specified | Number of Participants Dosing Fasted Versus Dosing Without Consideration of Food | Once the participant reached an optimized dose and regimen, the investigator could decide to instruct the participant to dose without regard to food. | The number of participants who dosed fasted versus without food consideration was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. | Posted | Count of Participants | Participants | Baseline to Week 8 |
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| Other Pre-specified | Duration of Time Between the Last Meal Relative to Dosing | The difference between the time of day that participants ate their last meal and the time of day participants take their first dose. | The duration of time between the last meal and dosing was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. | Posted | Mean | Standard Deviation | minute | Baseline to Week 8 |
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| Other Pre-specified | Characterization of Meals Relative to Dosing | Types of meals consumed before dosing. | Characterization of meals was assessed using the XYWAV Efficacy Analysis Set, which included all participants in the XYWAV Safety Analysis Set who finished the course of study. | Posted | Count of Participants | Participants | Baseline to Week 8 |
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Treatment-emergent adverse event (TEAE) data were collected from up to 30 days before Day 1 up to week 10 + 3 days.
A TEAE is defined as an AE that either began or worsened after administration of the first dose of study intervention (XYWAV) to End of Treatment Period (prior to the Safety Follow-up Period). Adverse events were assessed using the XYWAV Safety Analysis set, which included all participants in the Safety Analysis Set who received at least 1 dose of XYWAV.
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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 | Overall | Overall XYWAV safety analysis set. | 0 | 60 | 2 | 60 | 18 | 60 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hyperkalaemia | Metabolism and nutrition disorders | MedDRA24.0 | Systematic Assessment |
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| Fall | Injury, poisoning and procedural complications | MedDRA24.0 | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Diarrhoea | Gastrointestinal disorders | MedDRA24.0 | Systematic Assessment |
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| Nausea | Gastrointestinal disorders | MedDRA24.0 | Systematic Assessment |
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| Haemorrhoids | Gastrointestinal disorders | MedDRA24.0 | Systematic Assessment |
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| Chills | General disorders | MedDRA24.0 | Systematic Assessment |
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| Oedema peripheral | General disorders | MedDRA24.0 | Systematic Assessment |
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| COVID-19 | Infections and infestations | MedDRA24.0 | Systematic Assessment |
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| Nasopharyngitis | Infections and infestations | MedDRA24.0 | Systematic Assessment |
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| Conjunctivitis | Infections and infestations | MedDRA24.0 | Systematic Assessment |
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| Sinusitis | Infections and infestations | MedDRA24.0 | Systematic Assessment |
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| Arthropod bite | Injury, poisoning and procedural complications | MedDRA24.0 | Systematic Assessment |
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| Intentional overdose | Injury, poisoning and procedural complications | MedDRA24.0 | Systematic Assessment |
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| Sedation complication | Injury, poisoning and procedural complications | MedDRA24.0 | Systematic Assessment |
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| Urobilinogen urine increased | Investigations | MedDRA24.0 | Systematic Assessment |
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| Hyperkalaemia | Metabolism and nutrition disorders | MedDRA24.0 | Systematic Assessment |
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| Exostosis | Musculoskeletal and connective tissue disorders | MedDRA24.0 | Systematic Assessment |
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| Headache | Nervous system disorders | MedDRA24.0 | Systematic Assessment |
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| Migraine | Nervous system disorders | MedDRA24.0 | Systematic Assessment |
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| Paraesthesia | Nervous system disorders | MedDRA24.0 | Systematic Assessment |
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| Somnolence | Nervous system disorders | MedDRA24.0 | Systematic Assessment |
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| Initial insomnia | Psychiatric disorders | MedDRA24.0 | Systematic Assessment |
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| Suicidal ideation | Psychiatric disorders | MedDRA24.0 | Systematic Assessment |
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| Urine abnormality | Renal and urinary disorders | MedDRA24.0 | Systematic Assessment |
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| Night sweats | Skin and subcutaneous tissue disorders | MedDRA24.0 | Systematic Assessment |
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| Rash | Skin and subcutaneous tissue disorders | MedDRA24.0 | Systematic Assessment |
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| Hot flush | Vascular disorders | MedDRA24.0 | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Clinical Trial Disclosure & Transparency | Jazz Pharmaceuticals | 215-832-3750 | ClinicalTrialDisclosure@jazzpharma.com |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Dec 12, 2022 | Nov 15, 2023 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D009290 | Narcolepsy |
| ID | Term |
|---|---|
| D006970 | Disorders of Excessive Somnolence |
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
| D001523 | Mental Disorders |
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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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