A Study to Assess the Effectiveness of BOTOX (Botulinum Toxin Type A) Injections for the Change of Masseter Muscle Prominence in Adult Participants

2022-500568-37-00 Protocol M23-123 Therapeutic confirmatory (Phase III) Ended

Start 11 Oct 2023 · End 29 Oct 2025 · Status Ended · 7 EU/EEA countries · 26 sites · Protocol M23-123

Overview

Sponsor-declared trial summary

Phase Therapeutic confirmatory (Phase III)
Status Ended
Participants planned 248
Countries 7
Sites 26

Masseter Muscle Prominence

To compare the efficacy and safety of BOTOX with placebo for treatment in subjects with masseter muscle prominence (MMP)

Key facts

Sponsor
Abbvie Deutschland GmbH & Co. KG
Participant type
Patients
Age range
18-64 years, 65+ years
Gender
Male and Female
Therapeutic area
Not possible to specify
Trial duration
11 Oct 2023 → 29 Oct 2025
Decision date (initial)
2023-02-06
Transition trial
No
Low-intervention
No
Rare-disease indication
No
Vulnerable population
Yes

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Safety, Efficacy

To compare the efficacy and safety of BOTOX with placebo for treatment in subjects with masseter muscle prominence (MMP)

Conditions and MedDRA coding

Masseter Muscle Prominence

Study design 2 periods

#TitleAllocationBlindingRoles blindedArms
1 Period 1 (Days 1 through 180)
Period 1 is a double-blind, randomized, placebo-controlled, single treatment design, which will assess the safety and efficacy of BOTOX treatment of MMP. On Day 180 visit, the final Period 1 assessments will be collected, after which all eligible subjects who are willing to undergo retreatment will continue into Period 2
Randomised Controlled Double [{"id":158179,"code":2,"name":"Investigator"},{"id":158178,"code":1,"name":"Subject"}] Period 1 Arm 1: Eligible subjects will be randomized to receive BOTOX 48 U
Period 1 Arm 2: Eligible subjects will be randomized to receive placebo
2 Period 2 (Days 180 through 360)
Period 2 is an open-label treatment and safety follow up period which, comprises of 1 retreatment at the Day 180 visit, if the subject meets retreatment criteria and is willing to undergo retreatment, and 6 months of safety follow-up post retreatment. In this study, the term "retreatment" indicates that subjects randomized to BOTOX in Period 1 receive BOTOX retreatment and for subjects randomized to placebo in Period 1 receive first BOTOX treatment
Not Applicable None Period 2 Arm 1: Eligible subjects will be randomized to receive Botox

Regulatory references

Scientific advice from competent authorities
European Medicines Agency
Plan to share IPD
Yes
IPD plan description
AbbVie is committed to responsible clinical trial data sharing. This includes access to anonymized, individual and trial-level data (analysis data sets), as well as other information. To learn more about the process, or to submit a request, visit the following link https://www.abbvieclinicaltrials.com/hcp/data-sharing/ For details on when studies are available for sharing visit https://vivli.org/ourmember/abbvie/

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 2

  1. Body mass index using the calculation: BMI = weight (kg)/height (m)2, rounded to the nearest whole number.
  2. • Bilateral MMP (identical grades for left and right sides of the face), as determined at screening and at the Day 1 visit by the investigator. • Bilateral MMP (identical grades for left and right sides of the face), as determined at the Day 1 visit by the subject. • MMP grades, as assessed by investigator and subject, with bilateral symmetry at Day 1.

Exclusion criteria 9

  1. Subject has current intraoral infection, including infection of the mouth or gums, or facial skin infection requiring medical treatment in the opinion of the investigator.
  2. Prior exposure to botulinum toxin of any serotype to any part of the body (not including masseter muscle) within the 3 months prior to Day 1.
  3. History of or current TMJD, or presence of signs/symptoms of possible TMJD in the opinion of the investigator.
  4. Subject has weakness of the masseter, pterygoid, or temporalis muscles due to trauma, facial nerve injury, or other condition that could interfere with normal chewing and jaw clenching, as determined by the investigator.
  5. Excess lower facial fat, jowling, loose or lax skin in lower face, or parotid gland prominence that could interfere with MMPS or MMPS-P grading, as determined by the investigator.
  6. Medical condition that may put the subject at increased medical risk with exposure to BOTOX, including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other condition that might interfere with neuromuscular function.
  7. History of dental or surgical procedure for lower facial shaping or masseter muscle reduction.
  8. No history of any permanent soft tissue fillers in the jawline.
  9. No history of any semi-permanent soft tissue fillers, HA fillers, or autologous fat in the jawline within 24 months prior to Day 1.

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 2

  1. Achievement of MMPS ≥ 2-grade improvement from baseline at Day 90, per investigator assessment of MMP
  2. Achievement of MMPS-P ≥ 2-grade improvement from baseline at Day 90, per subject assessment of MMP

Secondary endpoints 8

  1. Response on the LFSQ-TXSAT follow-up version at Day 90
  2. Response of on the BIA-MMP at Day 90
  3. Change from baseline in lower facial volume (cm3) at Day 90, calculated from standardized images
  4. Change from baseline in lower facial width (mm) at Day 90, calculated from standardized images
  5. Change from baseline in Lower Facial Shape Questionnaire - Impact Assessment (LFSQ-IA) summary score at Day 90
  6. Response of on the LFSQ-TXSAT follow-up version
  7. Response on the BIA-MMP
  8. Change from baseline in LFSQ-IA summary score

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 1

BOTOX 100 Allergan Units Powder for Solution for Injection

PRD9814936 · Product

Active substance
Botulinum Toxin Type A
Substance synonyms
Onaclostox, Botulinum toxin, type A, purified neurotoxin component, OnabotulinumtoxinA, BOTULINUM TOXIN A, BOTULIN TOXIN A
Pharmaceutical form
SOLUTION FOR INJECTION
Route of administration
INTRAMUSCULAR INJECTION
Max daily dose
48 IU international unit(s)
Max total dose
48 IU international unit(s)
Max treatment duration
12 Month(s)
Authorisation status
Authorised
ATC code
M03AX01 — BOTULINUM TOXIN
Marketing authorisation
PA 1824/17/1
MA holder
ABBVIE LIMITED
MA country
Ireland
Paediatric formulation
No
Orphan designation
No
Modified vs. Marketing Authorisation
Yes
Modification description
Botox will be packaged in a masked/blinded manner to look similar to the placebo packaging

Placebo 1

Placebo for Botox - Solution for Injection

N/A · Product

Other product name
N/A
Pharmaceutical form
N/A
ATC code
N/A — N/A
Marketing authorisation
N/A
MA holder
N/A
MA country
Iceland
Paediatric formulation
No

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Abbvie Deutschland GmbH & Co. KG

Sponsor organisation
Abbvie Deutschland GmbH & Co. KG
Address
Knollstrasse
City
Ludwigshafen Am Rhein
Postcode
67061
Country
Germany

Scientific contact point

Organisation
Abbvie Deutschland GmbH & Co. KG
Contact name
Global Clinial Trial Helpdesk

Public contact point

Organisation
Abbvie Deutschland GmbH & Co. KG
Contact name
Global Clinial Trial Helpdesk

Third parties 3

OrganisationCity, countryDuties
Canfield Scientific Inc.
ORG-100042834
Parsippany, United States Other
Labcorp Endpoint Clinical Inc.
ORG-100040567
Wakefield, United States Interactive response technologies (IRT)
Medidata Solutions Inc.
ORG-100016256
New York, United States Other, E-data capture

Locations

7 EU/EEA countries · 26 investigational sites

By country

CountryMS statusPlanned subjectsSites
Belgium Ended 30 4
Bulgaria Ended 26 3
France Ended 38 5
Germany Ended 42 6
Italy Ended 23 3
Netherlands Ended 11 1
Spain Ended 29 4
Rest of world
United Kingdom
49

Investigational sites

Belgium

4 sites · Ended
Estheticare
Evolve Clinic, Turnhoutsebaan 210, 2970, Schilde
UZ Brussel
Dermatology, Laarbeeklaan 101, 1090, Jette
Dermatologie Kempenland
Davinciclinic, Kempenlaan 36, 2340, Beerse
Aesthics
Lightfalls Clinic, Regenboog 1, 9090, Melle

Bulgaria

3 sites · Ended
Medical Center Derma Vita EOOD
Medical Center Derma Vita EOOD, Ulitsa Akad. Ivan Buresh 8, 1407, Sofiya
Medical Center Dermatologia D-R Denkova EOOD
Medical Center Dermatology Dr. Denkova EOOD, Bulevard Simeonovsko Shose 62, Fl. 2, Sofiya
Dermavist Group Practice For Specialized Medical Aid For Skin Diseases Ltd.
Dermavist Group Practice For Specialized Medical Aid For Skin Diseases Ltd., Bulevard Maritsa 25, 4000, Plovdiv

France

5 sites · Ended
Docteur Belhaouari
Cabinet de Chirurgie Plastique et Esthetique, 3 Allees Jules Guesde, 31000, Toulouse
Bodokh Isaac
Cabinet Dermatologie, 109 Rue D Antibes, 06400, Cannes
Selarl Du Dr Laurence Benouaiche
Cabinet medical de Chirurgie Plastique et Esthetique, 8 Rue De Solferino, 75007, Paris
Global Esthetic
Centre médical de médecine esthétique, 56 Avenue Victor Hugo, 75116, Paris
Mediti S.A.S.
Chirurgie esthétique, 90 Boulevard Francis Meilland, 06160, Antibes

Germany

6 sites · Ended
Privatpraxis Dr. Hilton & Partner
Privatpraxis Dr. Hilton & Partner, Huschbergerstrasse 20, 40212, Duesseldorf
Hautzentrum Köln
Hautzentrum Köln, Schillingsrotter Strasse 39-41, 50996, Cologne
Privatpraxis Dr. Hilton & Partner
Privatpraxis Dr. Hilton & Partner, Gruenstrasse 6, 40212, Duesseldorf
Hautok and Hautok-Cosmetics
Hautok and Hautok-Cosmetics, Residenzstrasse 7, 80333, Munich
Hamburg University
Department of Chemistry - Institute for Biochemistry and Molecular Biology, Papendamm 21, Rotherbaum, Hamburg
Studienzentrum Theatiner46
Studienzentrum Theatiner46, Theatinerstrasse 46, 80333, Munich

Italy

3 sites · Ended
ASL Di Latina
Ospedale A. Florini di Terracina, Dermatologia, Girasoli, Via P. Nervi Torre 2, Latina
Centro Ricerche Cliniche Di Verona S.r.l.
Centro Ricerche Cliniche Di Versona S.r.l., Piazzale Ludovico Antonio Scuro 10, 37134, Verona
Fondazione Policlinico Universitario Campus Bio-Medico
U.O.C. di Chirurgia Plastica Ricostruttiva ed Estetica e Dermatologia, Via Alvaro Del Portillo N 200, 00128, Rome

Netherlands

1 site · Ended
Doctors at Soap B.V.
Doctors at Soap B.V., Van Baerlestraat 122, 1071 BD, Amsterdam

Spain

4 sites · Ended
Grupo Dermatologico Y Estetico Pedro Jaen S.A.
Grupo Dermatologico y Estetico Pedro Jaen, Calle De Serrano 143, 28006, Madrid
Gavin Dermatologos Vigo S.L.P.
Gavin Dermatologos, Calle Urzaiz 33, 36201, Vigo
Clinica Robega
Clinica Robega, Calle Ferraz 40 Local, 28008, Madrid
Clinica Alejandria
Clinica Alejandria, Calle Sorni 12 Bajo Interior, 46004, Valencia

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Country Trial startTrial end Recruitment startRecruitment end Early termination
Belgium 2023-12-14 2025-06-27 2024-04-03 2024-12-03
Bulgaria 2023-10-13 2025-11-06 2023-10-17 2024-12-03
France 2024-01-31 2025-10-29 2024-02-23 2024-12-03
Germany 2023-10-17 2025-11-12 2023-10-17 2024-12-03
Italy 2023-11-07 2025-11-13 2023-12-12 2024-12-03
Spain 2023-10-11 2025-11-19 2023-10-25 2024-12-03

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 113 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

TypeTitleVersion
Protocol (for publication) m23-123 protocol_Public_Redacted 7.0
Recruitment arrangements (for publication) 22-123 BG Recruitment and ICF Procedures Public 1.0
Recruitment arrangements (for publication) K2 M23-123 DE Ad and Recruitment German Poster 3_Public 1.0
Recruitment arrangements (for publication) K2 M23-123 DE Ad and Recruitment German Poster 4_Public 1.0
Recruitment arrangements (for publication) K2 M23-123 DE Ad and Recruitment German Poster 5_Public 1.0
Recruitment arrangements (for publication) K2 M23-123 DE Ad and Recruitment German Poster 6_Public 1.0
Recruitment arrangements (for publication) K2 M23-123 IT Recruitment Poster 3 _Public 1
Recruitment arrangements (for publication) K2 M23-123 IT Recruitment Poster 4 _Public 1
Recruitment arrangements (for publication) K2 M23-123 IT Recruitment Poster 5_Public 1
Recruitment arrangements (for publication) K2 M23-123 IT Recruitment Poster 6_Public 1
Recruitment arrangements (for publication) K2_M23-123 BE Poster 3 Dutch Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 3 English Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 3 French Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 4 Dutch Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 4 English Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 4 French Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 5 Dutch Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 5 French Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 6 English Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Poster 6 French Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Recruitment Material - Search Ads Dutch public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Recruitment Material - Search Ads English public 1.0
Recruitment arrangements (for publication) K2_M23-123 BE Recruitment Material - Search Ads French public 1.0
Recruitment arrangements (for publication) K2_M23-123 BG Recruitment Material - Search Ads Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BG Recruitment Poster_3_Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BG Recruitment Poster_4_Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BG Recruitment Poster_5_Public 1.0
Recruitment arrangements (for publication) K2_M23-123 BG Recruitment Poster_6_Public 1.0
Recruitment arrangements (for publication) K2_M23-123 DE Recruitment Material - Search Ads public 1.0
Recruitment arrangements (for publication) K2_M23-123 FR Recruitment Material - Search Ads Public 1.0
Recruitment arrangements (for publication) K2_M23-123 FR Recruitment Poster 3_Public 1
Recruitment arrangements (for publication) K2_M23-123 FR Recruitment Poster 4_Public 1
Recruitment arrangements (for publication) K2_M23-123 FR Recruitment Poster 5_Public 1
Recruitment arrangements (for publication) K2_M23-123 FR Recruitment Poster 6_Public 1
Recruitment arrangements (for publication) K2_M23-123 IT Recruitment Material - Search Ads public 1.0
Recruitment arrangements (for publication) K2_M23-123 Poster 5 English Public 1.0
Recruitment arrangements (for publication) K2_M23-123 Poster 6 Dutch Public 1.0
Recruitment arrangements (for publication) K2_M23-123_ES_Recruitment Poster 3_Public 1
Recruitment arrangements (for publication) K2_M23-123_ES_Recruitment Poster 4_Public 1
Recruitment arrangements (for publication) K2_M23-123_ES_Recruitment Poster 5_Public 1
Recruitment arrangements (for publication) K2_M23-123_ES_Recruitment Poster 6_Public 1
Recruitment arrangements (for publication) M23-123 BE Recruitment and ICF procedures public 1.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Digital Ads public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Digital Ads public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Digital Ads public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Pt Messaging public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Pt Messaging public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Pt Messaging public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Recruitment Poster public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Recruitment Poster public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - Recruitment Poster public 2.0
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - WS Prescreener public 2.1
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - WS Prescreener public 2.1
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - WS Prescreener public 2.1
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - WS Script public 2.1
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - WS Script public 2.1
Recruitment arrangements (for publication) M23-123 BE Recruitment Material - WS Script public 2.1
Recruitment arrangements (for publication) M23-123 BG Recruitment Material - Digital Ads Public 2.0
Recruitment arrangements (for publication) M23-123 BG Recruitment Material - Pt Messaging Public 2.0
Recruitment arrangements (for publication) M23-123 BG Recruitment Material - Recruitment Poster Public 2.0
Recruitment arrangements (for publication) M23-123 BG Recruitment Material - WS Prescreener Public 2.0 to 2.1
Recruitment arrangements (for publication) M23-123 BG Recruitment Material - WS Script Public 2.1
Recruitment arrangements (for publication) M23-123 DE Recruitment and ICF Procedures public 2.0
Recruitment arrangements (for publication) M23-123 DE Recruitment Material - Digital Ads public 2.0
Recruitment arrangements (for publication) M23-123 DE Recruitment Material - Pt Messaging public 2.0
Recruitment arrangements (for publication) M23-123 DE Recruitment Material - Recruitment Poster public 2.0
Recruitment arrangements (for publication) M23-123 DE Recruitment Material - WS Prescreener public 2.1
Recruitment arrangements (for publication) M23-123 DE Recruitment Material - WS Script public 2.1
Recruitment arrangements (for publication) M23-123 ES Recruitment and ICF Procedures public 1.1
Recruitment arrangements (for publication) M23-123 ES Recruitment Material - Digital Ads public 2.0
Recruitment arrangements (for publication) M23-123 ES Recruitment Material - Pt Messaging public 2.0
Recruitment arrangements (for publication) M23-123 ES Recruitment Material - Recruitment Poster public 2.0
Recruitment arrangements (for publication) M23-123 ES Recruitment Material - Search Ads public 1.1
Recruitment arrangements (for publication) M23-123 ES Recruitment Material - WS Prescreener public 2.1
Recruitment arrangements (for publication) M23-123 ES Recruitment Material - WS Script public 2.1
Recruitment arrangements (for publication) M23-123 FR Recruitment and ICF Procedures public 1
Recruitment arrangements (for publication) M23-123 FR Recruitment Material - Digital Ads Public 2.0
Recruitment arrangements (for publication) M23-123 FR Recruitment Material - Pt Messaging Public 3.0
Recruitment arrangements (for publication) M23-123 FR Recruitment Material - Recruitment Poster Public 2.0
Recruitment arrangements (for publication) M23-123 FR Recruitment Material - WS Prescreener Public 3.1
Recruitment arrangements (for publication) M23-123 FR Recruitment Material - WS Script Public 3.1
Recruitment arrangements (for publication) M23-123 IT Recruitment and ICF Procedures public 1
Recruitment arrangements (for publication) M23-123 IT Recruitment Material - Digital Ads public 2.0
Recruitment arrangements (for publication) M23-123 IT Recruitment Material - Pt Messaging public 2.0
Recruitment arrangements (for publication) M23-123 IT Recruitment Material - Recruitment Poster public 2.0
Recruitment arrangements (for publication) M23-123 IT Recruitment Material - WS Presceener public 2.1
Recruitment arrangements (for publication) M23-123 IT Recruitment Material - WS Script public 2.1
Subject information and informed consent form (for publication) L1 M23-123 - FR - Addendum ICF _Public 1
Subject information and informed consent form (for publication) L1 M23-123 DE Informed Consent Main_Public 4.0
Subject information and informed consent form (for publication) L1 M23-123 IT Main ICF_Public Redacted 4
Subject information and informed consent form (for publication) L1 M23-123 IT Pregnant Privacy ICF Public 1
Subject information and informed consent form (for publication) L1_M23-123 BE Main ICF Dutch Public 7.0
Subject information and informed consent form (for publication) L1_M23-123 BE Main ICF English Public 7.0
Subject information and informed consent form (for publication) L1_M23-123 BE Main ICF French Public 7.0
Subject information and informed consent form (for publication) L1_M23-123 BG Informed Consent_Public Redacted 4.0
Subject information and informed consent form (for publication) L1_M23-123 BG Informed Consent_Public Redacted 4.0
Subject information and informed consent form (for publication) L1_M23-123 FR Main ICF_Public 5.1
Subject information and informed consent form (for publication) L1_M23-123_ES_ ICF Main_Public 5.0
Summary of Product Characteristics (SmPC) (for publication) botox 100U spc clean common_public 1
Summary of Product Characteristics (SmPC) (for publication) vistabel 50U 100U pil clean common_Public 2
Synopsis of the protocol (for publication) M23-123 BE Protocol Synopsis Dutch public 7.0
Synopsis of the protocol (for publication) M23-123 BG Protocol synopsis Bulgarian public 7.0
Synopsis of the protocol (for publication) M23-123 DE Protocol Synopsis German public 7.0
Synopsis of the protocol (for publication) M23-123 ES Protocol Synopsis Spanish public 7.0
Synopsis of the protocol (for publication) M23-123 IT Protocol Synopsis Italian public 7.0
Synopsis of the protocol (for publication) M23-123 Protocol Lay Summary Protocol Synopsis_English 1
Synopsis of the protocol (for publication) M23-123 Protocol Lay Summary Synopsis_Dutch 1
Synopsis of the protocol (for publication) M23-123 Protocol Lay Summary Synopsis_Dutch_Belgium 1
Synopsis of the protocol (for publication) M23-123 Protocol Lay Summary Synopsis_French_Belgium 1
Synopsis of the protocol (for publication) M23-123 Protocol Lay Summary Synopsis_German_Belgium 1
Synopsis of the protocol (for publication) M23-123 protocol synopsis_Public 7.0
Synopsis of the protocol (for publication) M23-123_Protocol Lay Summary-Synopsis_French 1
Synopsis of the protocol (for publication) M23-123-FR-Protocol Synopsis_public 7.0

Application history

8 submissions — initial application plus substantial / non-substantial modifications

#TypeCodeSubmittedReference MSConclusionDecision date
1 INITIAL IN 2022-10-04 Germany Acceptable
2023-02-06
2023-02-06
2 SUBSTANTIAL MODIFICATION SM-1 2023-06-22 Germany Acceptable
2023-09-26
2023-09-27
3 SUBSTANTIAL MODIFICATION SM-2 2023-12-13 Germany Acceptable
2024-02-28
2024-02-29
4 SUBSTANTIAL MODIFICATION SM-3 2024-07-31 Germany Acceptable
2024-10-30
2024-10-30
5 SUBSTANTIAL MODIFICATION SM-4 2024-11-15 Acceptable 2024-12-10
6 SUBSTANTIAL MODIFICATION SM-5 2025-02-04 Acceptable 2025-03-04
7 SUBSTANTIAL MODIFICATION SM-6 2025-03-21 Germany Acceptable
2025-06-03
2025-06-04
8 NON SUBSTANTIAL MODIFICATION NSM-1 2025-11-20 Acceptable
2025-06-03
2025-11-20