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Trial registered on ANZCTR
Registration number
ACTRN12612000216819
Ethics application status
Approved
Date submitted
13/02/2012
Date registered
21/02/2012
Date last updated
21/02/2012
Type of registration
Retrospectively registered
Titles & IDs
Public title
Botulinum Toxin A (BTXA) versus Hydrodistension for Refractory Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)- a Multicentre, Prospective, Randomized, Double Blind Study
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Scientific title
Botulinum Toxin A (BTXA) versus Hydrodistension for Refractory Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)- a Multicentre, Prospective, Randomized, Double Blind Study
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Secondary ID [1]
279874
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nil
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Universal Trial Number (UTN)
U1111-1127-9192
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
interstitial cystitis/painful bladder syndrome
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Condition category
Condition code
Renal and Urogenital
285955
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0
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Other renal and urogenital disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Injection of Botulinum A toxin; Dysport 500U diluted in 30 mls of saline and injected into the bladder wall, submucosally. It occurs once. Hydrodistension involves stretching the bladder with infusd saline using 120 cm of hydrostatic pressure for 4 minutes .
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Intervention code [1]
284198
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Treatment: Drugs
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Intervention code [2]
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Treatment: Other
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Comparator / control treatment
Injection of saline plus hydrodistension
Injection of Saline, 30 mls into the bladder wall, submucosally. It occurs once. Hydrodistension involves stretching the bladder with infusd saline using 120 cm of hydrostatic pressure for 4 minutes .
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Control group
Placebo
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Outcomes
Primary outcome [1]
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improvement in Oleary Sant scores problem and symptom. O'leary Sant scoring is a validated , well recognized measure of the impact upon a patient of Interstitial cystitis symptoms and problems that they experience
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Assessment method [1]
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Timepoint [1]
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3 months
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Secondary outcome [1]
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diary data. This data asseses patient maximum voided volume, patient averaged voided volume. Frequency of voiding during the day, frequency of voiding at night
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Assessment method [1]
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Timepoint [1]
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3 months
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Secondary outcome [2]
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patient global impression improvement. This is a standardised, validated questionnaire patients will complete
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Assessment method [2]
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Timepoint [2]
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3 months
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Secondary outcome [3]
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patient global impression severity. This is a standardised, validated questionnaire patients will complete
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Assessment method [3]
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Timepoint [3]
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3 months
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Secondary outcome [4]
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urodynamic data. This is a standardised test that will collect the following information; peak flow rate,voided volume, residual post void volume left in bladder, maximum filling capacity, bladder compliance (pressure rise in cm H20 for a volume of fluid instilled) . Incontinence if it occurs.
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Assessment method [4]
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Timepoint [4]
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3 months
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Secondary outcome [5]
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urge incontinence impact questionnaire data. This is a standardised, validated questionnaire patients will complete measuring specifically symptoms of urinary urgency
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Assessment method [5]
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Timepoint [5]
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3 months
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Eligibility
Key inclusion criteria
Female, chronic, refractory interstitial cystitis, painful bladder syndrome
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Minimum age
18
Years
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Maximum age
100
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
urinary tract infection
pregnancy
systemic steroid use
cancer
voiding impairment
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
enrolment ; existing patients from 3 specialist referral centres invited to participate. Urinary tract infection tested for.
Subjects were randomised to receive, under general anaesthetic, either a 4 minute hydrodistension with injection of 30 mls of normal saline into the bladder wall, or hydrodistension with injection of 500 Units of BTXA Dysport (registered trademark) diluted in 30 mls of normal saline. Both were injected through a 30 cm Bard 23 gauge needle at 30 sites in 1 ml aliquots, sparing the trigone and avoiding ureters. A bladder biopsy was obtained if not already available.
Urodynamic studies were repeated upon recruitment if not recently done. A free urinary flow rate with post void residual was performed at 1 week post treatment.
Approval for the study was obtained from the Research and Ethics Committees of all 3 hospitals. There was no public trial registry enrolment in 2003.
Subjects and treating doctors were blinded to treatment allocation, which was prepared in the hospital pharmacy according to a series of computer generated randomization numbers, held confidentially by pharmacy. Unlabelled drug was then delivered to theatre
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
randomization numbers-computer generated by statistician from Dept mathematics local university
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
Blinding maintained when all allowed access to active treatment-Botulinum A toxin at 3 months
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Phase
Phase 2
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/01/2004
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
50
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment postcode(s) [1]
4940
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2291
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Recruitment postcode(s) [2]
4941
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3189
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Recruitment postcode(s) [3]
4942
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2305
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Recruitment postcode(s) [4]
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3800
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Jane Manning
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Address [1]
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PO Box 648
The Junction 2291 NSW
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Country [1]
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Australia
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Funding source category [2]
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Commercial sector/Industry
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Name [2]
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Ibsen pharmaceuticals, Bard, and the Principal investigator
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Address [2]
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Ibsen
suite 6
40 Montclair Ave
Glen Waverly
Victoria 3150
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Country [2]
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Australia
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Funding source category [3]
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Commercial sector/Industry
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Name [3]
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Bard
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Address [3]
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Bard Australia
69-71 Waterloo Road
North Ryde NSW, Australia
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Country [3]
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Australia
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Funding source category [4]
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Self funded/Unfunded
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Name [4]
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Jane Manning
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Address [4]
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PO Box 648
The Junction
2291 NSW
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Country [4]
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Australia
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Primary sponsor type
Hospital
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Name
John Hunter Hospital
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Address
Lookout Road
New Lambton NSW 2305
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
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Other collaborator category [1]
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Hospital
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Name [1]
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Mercy Hospital
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Address [1]
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Mercy Hospital for Women
63 Studley Road, Heidelberg 3084
Melbourne, Victoria
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Country [1]
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Australia
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Other collaborator category [2]
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Hospital
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Name [2]
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Monash Medical Centre
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Address [2]
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Monash Medical Centre
246 Clayton Road
Clayton 3168
Melbourne, Victoria
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Country [2]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Hunter New England Area Research Ethics and Governance Unit
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Ethics committee address [1]
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Locked Bag 1 New Lambton NSW 2305
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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01/01/2004
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Ethics approval number [1]
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03/09/10/3.10
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Summary
Brief summary
Background IC/PBS requires effective treatment options. Objective Is BTXA effective for the treatment of IC/PBS? Design, Setting and Participants: 2003-2009, 55 severe, refractory female subjects from 3 referral centres invited. UTI, malignancy, steroid use excluded. Intervention Double blind design, random allocation to treatment with hydrodistension and bladder wall injection of normal saline, or else hydrodistension with injection of BTXA. Outcome measures and statistical Analysis O’Leary Sant (OLS) problem (PI) and Symptom (SI), UIIQ, compared between BTXA and controls. Repeated measures ANOVA tested whether BTXA subjects performed better than control subjects (group effect) for changes from baseline to 3 months (time effect) by assessing significance of group by time interaction. Multivariate modelling analyzed effect over time of other possible confounders. Measurements made beyond 3 months, but no further randomized comparisons possible, as majority subjects then chose active BTXA injection. Withdrawal; 4 subjects completed questionnaires too poorly, 1 withdrawn pre treatment with bladder cancer, leaving 50. Results and limitations: In both groups, the OLS, bladder diary, UIIQ scores showed improvement over 3 months. But no difference detected during initial analysis between the BTXA and control subjects for any outcome measure except OLS PI, where improvement noted at 3 months (P=0.04). 12 had UTI treated during the study. This significantly confounded, with greater improvement seen in the control group treated for UTI. Multivariate modelling accounted for effect of UTI showing improvement in the total OLS score (P=0.02), the OLS SI for the BTXA (P=0.008) group, pain (Q4 of OLS PI) (P=0.015) for the BTXA group at 3 months. 24% request continuing periodic BTXA treatment. Conclusions BTXA treatment improves OLS score at 3 months when compared to hydrodistension and saline injection alone, for a minority women. Consideration of the significant confounding effect of UTI, strengthened this improvement.
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Trial website
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Trial related presentations / publications
IUGA Lake Como 2009
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Jane Manning
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Address
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PO Box 648
The Junction 2291 NSW
Australia
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Country
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Australia
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Phone
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61 02 4940869
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Fax
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61 02 49610599
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Email
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[email protected]
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Contact person for scientific queries
Name
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Jane Manning
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Address
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PO Box 648
The Junction 2291 NSW
Australia
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Country
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Australia
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Phone
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61 02 4940869
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Fax
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Email
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61 02 49610599
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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