A Study Evaluating the Efficacy and Safety of Crovalimab in Adult and Adolescent Patients with atypical Hemolytic Uremic Syndrome (aHUS)

2023-505089-27-00 Protocol BO42353 Therapeutic confirmatory (Phase III) Ongoing, recruitment ended

Start 1 Jul 2021 · Status Ongoing, recruitment ended · 7 EU/EEA countries · 23 sites · Protocol BO42353

Overview

Sponsor-declared trial summary

Phase Therapeutic confirmatory (Phase III)
Status Ongoing, recruitment ended
Participants planned 81
Countries 7
Sites 23

Atypical Hemolytic Uremic Syndrome (aHUS)

To evaluate the effect of crovalimab in complement inhibitor treatment-naive (Naive) patients

Key facts

Sponsor
F. Hoffmann-La Roche AG
Participant type
Pediatric, Patients
Age range
0-17 years, 18-64 years, 65+ years
Gender
Male and Female
Therapeutic area
Diseases [C] - Hemic and Lymphatic Diseases [C15]
Trial duration
1 Jul 2021 → ongoing
Decision date (initial)
2024-03-08
Transition trial
Yes
Low-intervention
No
Rare-disease indication
Yes
Vulnerable population
Yes
Funding sources
F. Hoffmann-La Roche AG

External identifiers

EU CT number
2023-505089-27-00
EudraCT number
2020-002475-35

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy, Pharmacodynamic, Others, Safety, Pharmacokinetic

To evaluate the effect of crovalimab in complement inhibitor treatment-naive (Naive) patients

Secondary objectives 4

  1. To evaluate the effect of crovalimab in patients in the Naive and Switch (switching from an existing complement inhibitor treatment to crovalimab) patients
  2. To evaluate the overall safety and tolerability of crovalimab
  3. To evaluate the pharmacokinetics of crovalimab
  4. To evaluate the immune response to crovalimab

Conditions and MedDRA coding

Atypical Hemolytic Uremic Syndrome (aHUS)

VersionLevelCodeTermSystem organ class
20.1 LLT 10079841 Atypical hemolytic uremic syndrome 10005329

Study design 1 period

#TitleAllocationBlindingRoles blindedArms
1 Treatment
This single-arm, uncontrolled, multicenter, 3 Cohorts: Niave, Switch & C5 SNP.
2 None

Regulatory references

Scientific advice from competent authorities
European Medicines Agency
Plan to share IPD
No
IPD plan description
n/a

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 6

  1. Vaccination against Neisseria meningitidis < 3 years prior to initiation of study treatment in accordance with current local guidelines or standard of care, as applicable in patients with complement deficiency (for ALL cohorts)
  2. Adequate hepatic function, AST and ALT ≤ 3×ULN at the time of screening; no clinical signs or known laboratory/radiographic evidence consistent with cirrhosis (for ALL cohorts)
  3. For female patients of childbearing potential, an agreement to remain abstinent (refrain from heterosexual intercourse) or use contraception (for ALL cohorts)
  4. Onset of initial TMA presentation, within 28 days prior to the first dose of crovalimab (For naïve cohort only)
  5. Clinical evidence of response to either eculizumab or ravulizumab, as documented by a platelet count ≥LLN, LDH ≤ULN, and stable (decrease or increase of ≤20%) or improving creatinine at two consecutive measurements at least 4 weeks apart prior to Week 1 Day 1 of crovalimab treatment. (For switch cohort only)
  6. Known C5 polymorphism (e.g., Arg885) (For C5SNP cohort only)

Exclusion criteria 6

  1. TMA associated with non-aHUS-related renal disease
  2. History of a kidney disease other than aHUS, affecting renal function
  3. Known systemic sclerosis (scleroderma), systemic lupus erythematosus, or antiphospholipid antibody positivity or syndrome
  4. Active systemic bacterial, viral, or fungal infection within 14 days before first crovalimab administration
  5. History of Neisseria meningitidis infection within 6 months of study enrollment
  6. History of malignancy within 5 years prior to screening and up to the first crovalimab administration

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

  1. 1. Proportion of patients with complete TMA response (cTMAr)

Secondary endpoints 18

  1. 1. Dialysis requirement status (yes/no) change
  2. 2. Observed value and change from baseline in estimated glomerular filtration rate (eGFR)
  3. 3. Proportion of patients with change from baseline in chronic kidney disease stage
  4. 4. Observed value and change from baseline in hematologic parameters
  5. 5. In adults (≥ 18 years), change from baseline in fatigue as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire
  6. 6. Incidence and severity of adverse events
  7. 7. Change in targeted vital signs and clinical laboratory test results
  8. 8. Incidence and severity of injection-site reactions, infusion-related reactions, hypersensitivity, malignant hypertension, and infections
  9. 9. Incidence of adverse events leading to study drug discontinuation
  10. 10. Serum concentrations of crovalimab
  11. 11. Prevalence and incidence of anti-drug antibodies (ADAs) to crovalimab
  12. 12. Proportion of patients with platelet count ≥ LLN
  13. 13. Proportion of patients with normalization of LDH
  14. 14. Proportion of patients with ≥ 25% decrease in serum creatinine from baseline
  15. 15. Time to cTMAr
  16. 16. Duration of cTMAr
  17. 17. Proportion of patients with cTMAr
  18. 18. Proportion of patients with maintained TMA control (mTMAc)

Investigational products

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

Test 1

Crovalimab

PRD9871077 · Product

Active substance
Crovalimab
Pharmaceutical form
SOLUTION FOR INJECTION/INFUSION
Route of administration
SUBCUTANEOUS AND INTRAVENOUS USE
Max daily dose
1500 mg milligram(s)
Max total dose
94500 mg milligram(s)
Max treatment duration
60 Month(s)
Authorisation status
Not Authorised
MA holder
F. HOFFMANN-LA ROCHE LTD
Paediatric formulation
No
Orphan designation
No

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

F. Hoffmann-La Roche AG

Sponsor organisation
F. Hoffmann-La Roche AG
Address
Grenzacherstrasse 124
City
Basel
Postcode
4058
Country
Switzerland

Scientific contact point

Organisation
F. Hoffmann-La Roche AG
Contact name
Trial Information System - TISL

Public contact point

Organisation
F. Hoffmann-La Roche AG
Contact name
Trial Information System - TISL

Third parties 13

OrganisationCity, countryDuties
Yprime LLC
ORG-100042888
Malvern, United States Other
Cmic Pharma Science Co. Ltd.
ORG-100040871
Nishiwaki, Japan Other
Perceptive Informatics Inc.
ORG-100013171
Billerica, United States Interactive response technologies (IRT)
Labcorp
ORG-100011514
Burlington, United States Other
Fulgent Genetics Inc.
ORG-100047477
El Monte, United States Other
IQVIA Limited
ORG-100008655
Reading, United Kingdom Other
Labcorp Early Development Laboratories Inc.
ORG-100012865
Greenfield, United States Other
Teckro Limited
ORG-100041454
Limerick, Ireland Other
Labcorp Central Laboratory Services LP
ORG-100032236
Indianapolis, United States Other
Fortrea Inc.
ORG-100012602
Princeton, United States Other
Q Squared Solutions Limited
ORG-100042527
Reading, United Kingdom Other
Secugen S.L.
ORG-100050094
Madrid, Spain Other
Icon Development Solutions LLC
ORG-100012400
Whitesboro, United States Other

Locations

7 EU/EEA countries · 23 investigational sites

By country

CountryMS statusPlanned subjectsSites
Belgium Ongoing, recruitment ended 2 1
France Ongoing, recruitment ended 3 5
Germany Ongoing, recruitment ended 6 4
Hungary Ongoing, recruitment ended 1 1
Italy Ongoing, recruitment ended 3 4
Poland Ongoing, recruitment ended 2 4
Spain Ended 2 4
Rest of world
India, Japan, Peru, Turkey, Thailand, Mexico, South Africa, New Zealand, Israel, Brazil, United States, China, United Kingdom, Switzerland, Canada
62

Investigational sites

Belgium

1 site · Ongoing, recruitment ended
UZ Leuven
Nephrology, Herestraat 49, 3000, Leuven

France

5 sites · Ongoing, recruitment ended
Assistance Publique Hopitaux De Paris
GH NECKER - enfants malades - néphrologie, 149 Rue De Sevres, 75015, Paris
Assistance Publique Hopitaux De Paris
CHU ROBERT DEBRE - néphrologie pédiatrique, 48 Boulevard Serurier, 75019, Paris
Centre Hospitalier Universitaire De Montpellier
Hôpital LAPEYRONIE - néphrologie, 191 Avenue Du Doyen Gaston Giraud, 34090, Montpellier
Centre Hospitalier Universitaire De Montpellier
Hôpital Arnaud de Villeneuve - néphrologie, 371 Avenue Du Doyen Gaston Giraud, 34090, Montpellier
Assistance Publique Hopitaux De Paris
TENON - Service SINRA, 4 Rue De La Chine, 75020, Paris

Germany

4 sites · Ongoing, recruitment ended
Universitaetsklinikum Essen AöR
Klinik für Kinder- und Jugendmedizin, Pädiatrie II, Hufelandstrasse 55, Holsterhausen, Essen
Universitaetsklinikum Essen AöR
Klinik für Nephrologie, Klinik für Infektiologie, Medizinisches Forschungszentrum (MFZ), Hufelandstrasse 55, Holsterhausen, Essen
University Hospital Cologne AöR
Klinik II für Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin, Kerpener Strasse 62, Lindenthal, Cologne
Medizinische Hochschule Hannover
Klinik für Nieren- und Hochdruckerkrankungen, Carl-Neuberg-Strasse 1, Gross Buchholz, Hanover

Hungary

1 site · Ongoing, recruitment ended
Del-Pesti Centrumkorhaz Orszagos Hematologiai Es Infektologiai Intezet
Hematologia, Albert Florian Ut 5-7, 1097, Budapest IX

Italy

4 sites · Ongoing, recruitment ended
Careggi University Hospital
Nefrologia, Largo Giovanni Alessandro Brambilla 3, 50134, Florence
IRCCS Ospedale Policlinico San Martino
Clinica Nefrologica Dialisi e Trapianto, Largo Rosanna Benzi 10, 16132, Genoa
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
UOC Nefrologia, Largo Francesco Vito 1, 00168, Rome
Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico
Nefrologia, Dialisi e Trapianto Renale, Via Francesco Sforza 28, 20122, Milan

Poland

4 sites · Ongoing, recruitment ended
Uniwersyteckie Centrum Kliniczne
Klinika Chorób Nerek i Nadciśnienia Dzieci i Młodzieży, Ul. Debinki 7, 80-211, Gdansk
Samodzielny Publiczny Szpital Kliniczny Nr 1 Im.Prof.Stanislawa Szyszko Slaskiego Uniwersytetu Medycznego W Katowicach
Oddział Nefrologii Dzieci z Pododdziałem Dializoterapii, Ul. 3 Maja 13/15, 41-800, Zabrze
Instytut Centrum Zdrowia Matki Polki
Klinika Pediatrii i Immunologii i Nefrologii, Ul. Rzgowska 281/289, 93-338, Lodz
Uniwersyteckie Centrum Kliniczne Warszawskiego Uniwersytetu Medycznego
Klinika Nefrologii, Dializoterapii i Chorób Wewnętrznych, Ul. Ulica Stefana Banacha 1a, 02-097, Warsaw

Spain

4 sites · Ended
Complexo Hospitalario Universitario A Coruna
Nephrology, Lugar Jubias De Arriba 84, 15006, A Coruna
University Hospital Virgen Del Rocio S.L.
Nephrology, Avenida De Manuel Siurot S/n, 41013, Sevilla
Hospital Clinic De Barcelona
Nephrology, Calle Villarroel 170, 08036, Barcelona
Hospital Universitario 12 De Octubre
Nephrology, Bloque D, Avenida De Cordoba Sn, Madrid

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 2021-07-30 2023-12-11 2025-04-30
France 2021-11-09 2023-01-04 2025-04-30
Germany 2021-08-06 2022-06-22 2025-04-30
Hungary 2021-07-21 2021-10-22 2025-04-30
Italy 2021-11-12 2022-05-03 2025-04-30
Poland 2021-08-26 2023-05-05 2025-04-30
Spain 2021-07-01 2025-10-23 2022-01-12 2025-04-30

Results and documents

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

Documents 130 files

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

TypeTitleVersion
Protocol (for publication) D1_Protocol 2023-505089-27-00_Redacted.pdf 7
Protocol (for publication) d4_patient-facing-documents_-ecoa-patient-preference-screen-report_en_redacted 2
Protocol (for publication) d4_patient-facing-documents_ecoa-pedsql_en_redacted 3.0
Protocol (for publication) d4_patient-facing-documents_ecoa-pedsql-mfs_en_redacted 3
Protocol (for publication) d4_patient-facing-documents_ecoa-qlq-c30_en_redacted 1
Protocol (for publication) d4_patient-facing-documents_facit_en_redacted 1
Protocol (for publication) d4_patient-facing-documents_kdqol-screen-report_en_redacted 1
Protocol (for publication) d4_patient-facing-documents_lost-days-missed-school-screen-report_en_redacted 2
Protocol (for publication) d4_patient-facing-documents_lost-days-missed-work-screen-report_en_redacted 2
Protocol (for publication) d4_patient-facing-documents_screen-report_en_redacted 2
Protocol (for publication) d4_patient-facing-documents-ecoa-tsqm-9_en_redacted 2
Protocol (for publication) d4_patient-facing-documents-other-subject_en_redacted 2
Recruitment arrangements (for publication) K_Recruitment arrangements 1
Recruitment arrangements (for publication) K0_ Document additionnel CTR 1
Recruitment arrangements (for publication) K1 Recruitment arrangement 1
Recruitment arrangements (for publication) K1_ Recruitment arrangements 1
Recruitment arrangements (for publication) K1_BO42353_DEU_Recruitment Arrangement 1
Recruitment arrangements (for publication) K1_Recruitment Arrangement 1.0
Recruitment arrangements (for publication) K1_Recruitment_arrangement 1
Recruitment arrangements (for publication) K1_Recruitment_arrangement_form_Hungary_doc 1
Recruitment arrangements (for publication) K2_ Recruitment material _ Brochure Info Patient 1
Recruitment arrangements (for publication) K2_Patient information brochure 1
Recruitment arrangements (for publication) K2_Recruitment material_Brochure 1
Recruitment arrangements (for publication) K2_Recruitment material_Clinical Trial Leaflet 1
Recruitment arrangements (for publication) K2_Recruitment material_Patient Information Brochure 1
Recruitment arrangements (for publication) K2_Recruitment material_Patient Information Brochure 1
Recruitment arrangements (for publication) K2_Recruitment material_Patient Information Brochure_BO42353 1
Recruitment arrangements (for publication) K3_Referral Letter 2
Subject information and informed consent form (for publication) L1 SIS and ICF_Assent12-17 8
Subject information and informed consent form (for publication) L1 SIS and ICF_General 8
Subject information and informed consent form (for publication) L1 SIS and ICF_ICF_COVID-19_Addendum 2
Subject information and informed consent form (for publication) L1 SIS and ICF_infant authorization 2
Subject information and informed consent form (for publication) L1 SIS and ICF_Mobile nursing 3
Subject information and informed consent form (for publication) L1 SIS and ICF_RBR samples 1
Subject information and informed consent form (for publication) L1_ SIS and Infant Authorization form 3.0
Subject information and informed consent form (for publication) L1_BO42353_DEU_ICF_MAIN_Adult 10
Subject information and informed consent form (for publication) L1_BO42353_DEU_ICF_MAIN_Parents 10
Subject information and informed consent form (for publication) L1_BO42353_DEU_ICF_MAIN_Youth 9
Subject information and informed consent form (for publication) L1_BO42353_DEU_ICF_Pregnant Patient 3
Subject information and informed consent form (for publication) L1_BO42353_DEU_ICF_RBR 1
Subject information and informed consent form (for publication) L1_ICF_adolescent 6
Subject information and informed consent form (for publication) L1_ICF_adolescent addendum 2
Subject information and informed consent form (for publication) L1_ICF_infant 2
Subject information and informed consent form (for publication) L1_ICF_Main addendum 2
Subject information and informed consent form (for publication) L1_ICF_Mobile nursing 3
Subject information and informed consent form (for publication) L1_ICF_Mobile nursing adolescent 3
Subject information and informed consent form (for publication) L1_ICF_RBR 1
Subject information and informed consent form (for publication) L1_ICF_RBR adolescent 1
Subject information and informed consent form (for publication) L1_ICF_restart 1
Subject information and informed consent form (for publication) L1_ICF_restart adolescent 1
Subject information and informed consent form (for publication) L1_Privacy consent form other subjects 3.0
Subject information and informed consent form (for publication) L1_SIS Ages 12-17 and ICF Ages 13-17 7
Subject information and informed consent form (for publication) L1_SIS Ages 12-17 and ICF Ages 13-17 Mobile nursing 4
Subject information and informed consent form (for publication) L1_SIS Ages 12-17 and ICF Ages 13-17 RBR 2
Subject information and informed consent form (for publication) L1_SIS Ages 12-17 and ICF Ages 13-17 Restart after TM recurrence 2
Subject information and informed consent form (for publication) L1_SIS and ICF 12-17 yr 7.1
Subject information and informed consent form (for publication) L1_SIS and ICF Assent Form Ages 12 to 17 years_EN 7.0
Subject information and informed consent form (for publication) L1_SIS and ICF Assent Form Ages 12 to 17 years_FR 7.0
Subject information and informed consent form (for publication) L1_SIS and ICF Assent Form Ages 12 to 17 years_NL 7.0
Subject information and informed consent form (for publication) L1_SIS and ICF COVID-19 ICF Addendum 1_EN 1.0
Subject information and informed consent form (for publication) L1_SIS and ICF COVID-19 ICF Addendum 1_FR 1.0
Subject information and informed consent form (for publication) L1_SIS and ICF COVID-19 ICF Addendum 1_NL 1.0
Subject information and informed consent form (for publication) L1_SIS and ICF COVID19 addendum Ages 12-17_note to file N/A
Subject information and informed consent form (for publication) L1_SIS and ICF COVID19 addendum_note to file N/A
Subject information and informed consent form (for publication) L1_SIS and ICF IAF_EN 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF IAF_FR 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF IAF_NL 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF Infant 1
Subject information and informed consent form (for publication) L1_SIS and ICF Main 7.1
Subject information and informed consent form (for publication) L1_SIS and ICF Main 6
Subject information and informed consent form (for publication) L1_SIS and ICF Main_EN 7.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main_FR 7.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main_NL 7.0
Subject information and informed consent form (for publication) L1_SIS and ICF Mobile nursing 3
Subject information and informed consent form (for publication) L1_SIS and ICF Mobile Nursing_EN 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Mobile Nursing_FR 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Mobile Nursing_NL 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Parents 7.1
Subject information and informed consent form (for publication) L1_SIS and ICF pregnant partner 4.0
Subject information and informed consent form (for publication) L1_SIS and ICF RBR 1
Subject information and informed consent form (for publication) L1_SIS and ICF RBR_EN 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF RBR_FR 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF RBR_NL 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF Restart after TM 1
Subject information and informed consent form (for publication) L1_SIS and ICF_ 12-17 yr 7
Subject information and informed consent form (for publication) L1_SIS and ICF_ 12-17 yr _addendum 1
Subject information and informed consent form (for publication) L1_SIS and ICF_ infant born 3
Subject information and informed consent form (for publication) L1_SIS and ICF_ main _addendum 1
Subject information and informed consent form (for publication) L1_SIS and ICF_ Main (adults) 7
Subject information and informed consent form (for publication) L1_SIS and ICF_ parents 7
Subject information and informed consent form (for publication) L1_SIS and ICF_ parents _addendum 1
Subject information and informed consent form (for publication) L1_SIS and ICF_ RBR 12-17 yr 1
Subject information and informed consent form (for publication) L1_SIS and ICF_ RBR main 1
Subject information and informed consent form (for publication) L1_SIS and ICF_ RBR Parents 1
Subject information and informed consent form (for publication) L1_SIS_adolescent 5
Subject information and informed consent form (for publication) L1_SIS_adolescent covid addendum 2
Subject information and informed consent form (for publication) L1_SIS_ICF_ Main 6
Subject information and informed consent form (for publication) L1_SIS_Infant 2
Subject information and informed consent form (for publication) L1_SIS_main addendum 2
Subject information and informed consent form (for publication) L1_SIS_Main_redacted 5
Subject information and informed consent form (for publication) L1_SIS_Mobile nursing 3
Subject information and informed consent form (for publication) L1_SIS_Mobile nursing adolescent 3
Subject information and informed consent form (for publication) L1_SIS_RBR 1
Subject information and informed consent form (for publication) L1_SIS_RBR adolescent 1
Subject information and informed consent form (for publication) L1_SIS_restart 1
Subject information and informed consent form (for publication) L1_SIS_restart adolescent 1
Subject information and informed consent form (for publication) L2_Informed Consent Form Procedure 1
Subject information and informed consent form (for publication) L2_Lay CTD_EN 7.0
Subject information and informed consent form (for publication) L2_Lay CTD_FR 7.0
Subject information and informed consent form (for publication) L2_Lay CTD_NL 7.0
Subject information and informed consent form (for publication) L2_other subject material_GDPR 7
Subject information and informed consent form (for publication) L2_Patient card 2
Subject information and informed consent form (for publication) L2_Patient Information Brochure_EN 1
Subject information and informed consent form (for publication) L2_Patient Information Brochure_FR 1
Subject information and informed consent form (for publication) L2_Patient Information Brochure_NL 1
Subject information and informed consent form (for publication) L2_Sponsor Statement On Use Of ICF Model 1
Subject information and informed consent form (for publication) L3_Visit guide 2
Subject information and informed consent form (for publication) L4_IFU 2
Subject information and informed consent form (for publication) Summary for patient materials_Clean 1
Synopsis of the protocol (for publication) D1_Protocol synopsis_ENG 2023-505089-27-00 n/a
Synopsis of the protocol (for publication) d1_protocol-synopsis_be-de-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_be-fr-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_be-nl-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_de-de-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_eng-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_es-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_fr-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_hu-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_it-2023-505089-27-00 1
Synopsis of the protocol (for publication) d1_protocol-synopsis_pl-2023-505089-27-00 1

Application history

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

#TypeCodeSubmittedReference MSConclusionDecision date
1 INITIAL IN 2024-01-25 Germany Acceptable
2024-02-29
2024-02-29
2 SUBSTANTIAL MODIFICATION SM-1 2024-08-20 Germany Acceptable
2024-11-25
2024-11-25
3 SUBSTANTIAL MODIFICATION SM-2 2025-07-07 Germany Acceptable
2025-08-22
2025-08-22
4 SUBSTANTIAL MODIFICATION SM-3 2025-11-06 Germany Acceptable
2026-01-19
2026-01-19