A Phase 1/2/3 Study to Evaluate the Safety, Tolerability, and Efficacy of VX- 880 in Subjects Who Have Type 1 Diabetes Mellitus With Impaired Hypoglycemic Awareness and Severe Hypoglycemia

2024-513929-23-00 Protocol VX20-880-101 Phase II and Phase III (Integrated) Ongoing, recruiting

Start 26 May 2023 · Status Ongoing, recruiting · 5 EU/EEA countries · 6 sites · Protocol VX20-880-101

Overview

Sponsor-declared trial summary

Phase Phase II and Phase III (Integrated)
Status Ongoing, recruiting
Participants planned 44
Countries 5
Sites 6

Type 1 Diabetes Mellitus with Impaired Hypoglycemic Awareness and Severe Hypoglycemia

Evaluate the efficacy of VX-880 infusion in subjects who have T1D with impaired hypoglycemic awareness (IAH) and severe hypoglycemia

Key facts

Sponsor
Vertex Pharmaceuticals Inc.
Participant type
Patients
Age range
18-64 years, 65+ years
Gender
Male and Female
Therapeutic area
Diseases [C] - Nutritional and Metabolic Diseases [C18]
Trial duration
26 May 2023 → ongoing
Decision date (initial)
2024-10-07
Transition trial
Yes
Low-intervention
No
Rare-disease indication
No
Vulnerable population
Yes

External identifiers

EU CT number
2024-513929-23-00
EudraCT number
2022-002292-11
ClinicalTrials.gov
NCT04786262

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy, Safety, Therapy

Evaluate the efficacy of VX-880 infusion in subjects who have T1D with impaired hypoglycemic awareness (IAH) and severe hypoglycemia

Secondary objectives 2

  1. Evaluate the efficacy of VX-880 infusion on metabolic control
  2. Evaluate the safety and tolerability of VX-880 infusion in subjects who have T1D with IAH and severe hypoglycemia

Conditions and MedDRA coding

Type 1 Diabetes Mellitus with Impaired Hypoglycemic Awareness and Severe Hypoglycemia

VersionLevelCodeTermSystem organ class
21.1 LLT 10081605 Severe hypoglycemia 10027433
20.0 PT 10012601 Diabetes mellitus 100000004861

Study design 1 period

#TitleAllocationBlindingRoles blindedArms
1 Phase 1/2 Study
Phase 1/2 Study
2 None

Regulatory references

Plan to share IPD
No
IPD plan description
Details on Vertex data sharing criteria and process for requesting access can be found at: https://www.vrtx.com/independent-research/clinical-trial-data-sharing
EU CT numberTitleSponsor
2022-002292-11 A Phase 1/2 Study to Evaluate the Safety, Tolerability, and Efficacy of VX-880 in Subjects Who Have Type 1 Diabetes Mellitus With Impaired Hypoglycemic Awareness and Severe Hypoglycemia, Studio di fase 1/2 per valutare la sicurezza, la tollerabilità e l’efficacia di VX-880 in soggetti affetti da diabete mellito di tipo 1 con alterata sensibilità all’ipoglicemia e ipoglicemia grave

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 5

  1. Clinical history and laboratory evidence of T1D
  2. At least 2 episodes of severe hypoglycemia (confirmed by independent adjudication for subjects in Parts B and C) in the 12 months prior to signing of informed consent at Screening.
  3. Reduced awareness of hypoglycemia at Screening
  4. Consistent use of continuous glucose monitor (CGM) for at least 3 months before Screening. In regions where CGM is not standard of care for T1D, subjects are exempted from the requirement for use of CGM before Screening.
  5. Compatible blood group (A or AB)

Exclusion criteria 5

  1. Prior islet cell transplant, organ transplant, or cell therapy
  2. Advanced complications associated with diabetes including untreated proliferative retinopathy, skin ulcers, or amputations attributable to diabetes.
  3. Subjects who have any 1 of the following criteria: o Insulin requirements: >0.8 U/(kg*day), >55 U/day, or <10 U/day; o HbA1c: <6.0% or >9.5%
  4. Clinically significant active infection or chronic infection such as hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and/or tuberculosis (TB); or invasive aspergillus, histoplasmosis, or coccidioidomycosis infection within 1 year prior to signing of informed consent at Screening.
  5. Negative screen for Epstein-Barr virus (EBV) by immunoglobulin G (IgG) determination

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 2

  1. Part A - Safety and tolerability based on treatment-emergent adverse events (TEAEs; including incidence and severity of adverse events [AEs] and serious adverse events [SAEs]), clinical laboratory values, vital signs, standard 12-lead ECGs, and imaging findings
  2. Part B and C - The following endpoints apply to the analysis of all infused subjects who intended to receive 0.8 × 10E9 total SC-islet cells with 1 infusion: •Proportion of subjects who are insulin independent at Day 365 after VX-880 infusion

Secondary endpoints 5

  1. Part B and C: Secondary Endpoints - Proportion of subjects free of SHEs from Day 90 through Day 365 (inclusive) and HbA1c <7.0% at Day 365 after VX 880 infusion
  2. Part B and C: Secondary Endpoints - Change from baseline in HbA1c at Day 365 after VX-880 infusion
  3. Part B and C: Secondary Endpoints- Proportion of subjects who achieve insulin independence and are insulin independent 12 months later, with absence of SHEs
  4. Part B and C: Secondary Endpoints- Proportion of subjects who maintain insulin independence for at least 1 year
  5. Part B and C: afety and tolerability based on TEAEs (including incidence and severity of AEs and SAEs), clinical laboratory values, vital signs, standard 12-lead ECGs, and imaging findings

Investigational products

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

Test 1

VX-880 solution for infusion

PRD8501686 · Product

Active substance
Zimislecel
Substance synonyms
VX-880, Allogeneic human stem cell-derived fully differentiated pancreatic islet cells, STx-02
Other product name
zimislecel
Pharmaceutical form
SOLUTION FOR INFUSION
Route of administration
INTRAPORTAL USE
Max daily dose
8000000000 Other
Max total dose
8000000000 Other
Max treatment duration
1 Day(s)
Authorisation status
Not Authorised
MA holder
VERTEX PHARMACEUTICALS, INCORPORATED
Paediatric formulation
No
Orphan designation
No

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Vertex Pharmaceuticals Inc.

Sponsor organisation
Vertex Pharmaceuticals Inc.
Address
50 Northern Avenue
City
Boston
Postcode
02210-1862
Country
United States

Scientific contact point

Organisation
Vertex Pharmaceuticals Inc.
Contact name
Clinical Trials and Medical Info

Public contact point

Organisation
Vertex Pharmaceuticals Inc.
Contact name
Clinical Trials and Medical Info

Locations

5 EU/EEA countries · 6 investigational sites

By country

CountryMS statusPlanned subjectsSites
France Ongoing, recruiting 1 2
Germany Ongoing, recruiting 1 1
Italy Ongoing, recruiting 1 1
Netherlands Ongoing, recruiting 1 1
Norway Ongoing, recruiting 4 1
Rest of world
United States, Canada, United Kingdom, Switzerland
36

Investigational sites

France

2 sites · Ongoing, recruiting
Les Hopitaux Universitaires De Strasbourg
Service Endocrinologie-Diabète-Nutrition, 1 Avenue Moliere, Bp 49, Strasbourg Cedex 2
Centre Hospitalier Universitaire De Lille
Sce Chir Generale & Endocrinienne, Rue Michel Polonovski, 59037, Lille Cedex

Germany

1 site · Ongoing, recruiting
Universitaetsklinikum Carl Gustav Carus Dresden an der Technischen Universitaet Dresden AöR
Medizinische Klinik und Poliklinik III/Klinik und Poliklinik f. Viszeral-,Thorax- und Gefäßchirurgie, Fetscherstrasse 74, Johannstadt-Nord, Dresden

Italy

1 site · Ongoing, recruiting
Ospedale San Raffaele S.r.l.
Department of Regenerative Medicine and Transplantation, Via Olgettina 60, 20132, Milan

Netherlands

1 site · Ongoing, recruiting
Leiden University Medical Center
Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden

Norway

1 site · Ongoing, recruiting
Oslo University Hospital HF
NA, Klaus Torgardsvei 3, 0371, Oslo

Country notifications

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

Country Trial startTrial end Recruitment startRecruitment end Early termination
France 2023-07-31 2023-10-30
Germany 2023-08-18 2023-10-17
Italy 2023-09-15 2023-09-18
Netherlands 2023-05-26 2023-07-26
Norway 2023-06-21 2024-06-17

Results and documents

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

Documents 128 files

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

TypeTitleVersion
Protocol (for publication) D1_Protocol _2024-513929-23-00_ Redacted 11.9
Recruitment arrangements (for publication) K1_Addtional document_FR_Fr_redacted 1
Recruitment arrangements (for publication) K1_Recruitment arrangements_FR_Fr 1
Recruitment arrangements (for publication) K1_Recruitment arrangements_Germany_English 1.0
Recruitment arrangements (for publication) K1_Recruitment Arrangements_Italy_English 1
Recruitment arrangements (for publication) K1_Recruitment arrangements_Netherlands_English 1.0
Recruitment arrangements (for publication) K1_Recruitment Arrangements_Norway_English 1
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Flyer_FR_En 1
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Flyer_Germany_English 1
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Flyer_Italy_English 1
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Slide Deck_FR_Fr_redacted 4.0
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Slide Deck_Germany_English_redacted 4
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Slide Deck_Italy_English_redacted 4.0
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Websites_FR_Fr NA
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Websites_Germany_English NA
Recruitment arrangements (for publication) K2_Recruitment Material_HCP Websites_Italy_English NA
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Facebook Advertisements_FR_Fr 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Facebook Advertisements_Germany_German 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Facebook Advertisements_Italy_Italian 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Facebook Advertisements_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Facebook Advertisements_Norway_Norwegian 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Google Advertisements_FR_Fr 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Google Advertisements_Germany_German 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Google Advertisements_Italy_Italian 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Google Advertisements_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Google Advertisements_Norway_Norwegian 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Copy_FR_Fr 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Copy_Germany_German 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Copy_Italy_Italian 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Copy_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Copy_Norway_Norwegian 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Screenshots_FR_Fr 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Screenshots_Germany_German 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Screenshots_Italy_Italian 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Screenshots_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Landing Page Screenshots_Norway_Norwegian 1
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Patient Navigator Scripts_FR_Fr 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Patient Navigator Scripts_Germany_German 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Patient Navigator Scripts_Italy_Italian 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Patient Navigator Scripts_Netherlands_Dutch 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_MyTomorrows Patient Navigator Scripts_Norway_Norwegian 3
Recruitment arrangements (for publication) K2_Recruitment Material_Patient Invitation to Trial Letter_FR_Fr 1
Recruitment arrangements (for publication) K2_Recruitment Material_Patient Invitation to Trial Letter_Germany_German 1
Recruitment arrangements (for publication) K2_Recruitment Material_Patient Invitation to Trial Letter_Italy_Italian 2
Recruitment arrangements (for publication) K2_Recruitment Material_Patient Invitation to Trial Letter_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_Patient Invitation to Trial Letter_Norway_Norwegian 1
Recruitment arrangements (for publication) K2_Recruitment Material_Patient Invitation to Trial Letter_Norway_Norwegian_Superseded 1
Recruitment arrangements (for publication) K2_Recruitment Material_PI to Physician Letter_FR_Fr 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_PI to Physician Letter_Germany_German 1
Recruitment arrangements (for publication) K2_Recruitment Material_PI to Physician Letter_Italy_Italian 3
Recruitment arrangements (for publication) K2_Recruitment Material_PI to Physician Letter_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_Study Specific_FR_Fr 4.0
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_Study Specific_Germany_German 4
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_Study Specific_Italy_Italian 4
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_Study Specific_Netherlands_Dutch 4.0
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_Study Specific_Norway_Norwegian 4
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_T1D Specific_Germany_German 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_T1D Specific_Italy_Italian 1
Recruitment arrangements (for publication) K2_Recruitment Material_Poster_T1D_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_FR_Fr 1
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Germany_German 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Italy_Italian NA
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Netherlands_Dutch 1.0
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Norway_Norwegian_approved under CTD 1
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Study Specific_FR_Fr 1
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Study Specific_Germany_German 1
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Study Specific_Italy_Italian 1
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Study Specific_Netherlands_Dutch 1
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Study Specific_Norway_Norwegian 1
Recruitment arrangements (for publication) K2_Recruitment Material_Press Release Text_Study Specific_Norway_Norwegian_Superseded 1
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Brochure_FR_Fr 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Brochure_Germany_German 3
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Brochure_Italy_Italian 3
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Brochure_Netherlands_Dutch 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Brochure_Norway_Norwegian 3
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Flyer_FR_Fr 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Flyer_Germany_German 3
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Flyer_Italy_Italian 3
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Flyer_Netherlands_Dutch 3.0
Recruitment arrangements (for publication) K2_Recruitment Material_Recruitment Flyer_Norway_Norwegian 4.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult Appendix A_Germany_German 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult Appendix_Norway_Norwegian 4.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult Part C_Netherlands_Dutch_redacted 9.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult Privacy_FR_Fr_redacted 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult Privacy_Italy_Italian_redacted 5.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult_FR_Fr_redacted 9.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult_Germany_German_redacted 10.1
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult_Italy_Italian_redacted 9.1
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult_Norway_Norwegian_Redacted 9.0
Subject information and informed consent form (for publication) L1_SIS and ICF Main Adult_Norway_Norwegian_Superseded_redacted 5
Subject information and informed consent form (for publication) L1_SIS and ICF Pre-Screening_FR_Fr_redacted 4.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pre-Screening_Germany_German_redacted 5.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pre-Screening_Italy_Italian_redacted 4.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pre-Screening_Netherlands_Dutch_redacted 3.1
Subject information and informed consent form (for publication) L1_SIS and ICF Pre-screening_Norway_Norwegian_redacted 4.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pre-Screening_Privacy_Italy_Italian_redacted 4.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pregnancy Adult ICF_FR_Fr 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pregnancy_Germany_German 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pregnancy_Italy_Italian 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pregnancy_Netherlands_Dutch 3.1
Subject information and informed consent form (for publication) L1_SIS and ICF Pregnancy_Norway_Norwegian_redacted 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Pregnancy_Privacy_Italy_Italian 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF Suvoda_Germany_German 3.0
Subject information and informed consent form (for publication) L1_SIS and ICF Suvoda_Netherlands_Dutch 2.0
Subject information and informed consent form (for publication) L1_SIS and ICF Suvoda_Norway_Norwegian 3.0
Subject information and informed consent form (for publication) L2_GP Letter_Italy_Italian 3.0
Subject information and informed consent form (for publication) L2_Other subject information material_ICF tool_FR_Fr 1
Subject information and informed consent form (for publication) L2_Other subject information material_ICF tool_Germany_German 1
Subject information and informed consent form (for publication) L2_Other subject information material_ICF tool_Italy_Italian 1
Subject information and informed consent form (for publication) L2_Other subject information material_ICF tool_Netherlands_Dutch 1.0
Subject information and informed consent form (for publication) L2_Other subject information material_ICF tool_Norway_Norwegian 1
Subject information and informed consent form (for publication) L2_Other subject information material_Study Fact Sheet_FR_Fr 5.0
Subject information and informed consent form (for publication) L2_Other subject information material_Study Fact Sheet_Germany_German 5
Subject information and informed consent form (for publication) L2_Other subject information material_Study Fact Sheet_Italy_Italian 5
Subject information and informed consent form (for publication) L2_Other subject information material_Study Fact Sheet_Netherlands_Dutch 5.0
Subject information and informed consent form (for publication) L2_Other subject information material_Study Fact Sheet_Norway_Norwegian 5
Synopsis of the Protocol - Extract (for publication) D1_Protocol lay summary DE 2024-513929-23-00 11.9
Synopsis of the Protocol - Extract (for publication) D1_Protocol lay summary ENG 2024-513929-23-00 11.9
Synopsis of the Protocol - Extract (for publication) D1_Protocol lay summary FR 2024-513929-23-00 11.9
Synopsis of the Protocol - Extract (for publication) D1_Protocol lay summary IT 2024-513929-23-00 11.9
Synopsis of the Protocol - Extract (for publication) D1_Protocol lay summary NL 2024-513929-23-00 11.9
Synopsis of the Protocol - Extract (for publication) D1_Protocol lay summary NO 2024-513929-23-00 11.9
Synopsis of the protocol (for publication) D1_Protocol synopsis ENG 2024-513929-23-00_Redacted 11.9
Synopsis of the protocol (for publication) D1_Protocol_synopsis DE 2024-513929-23-00_Redacted 11.9
Synopsis of the protocol (for publication) D1_Protocol_synopsis FR 2024-513929-23-00_Redacted 11.9
Synopsis of the protocol (for publication) D1_Protocol_synopsis IT 2024-513929-23-00_Redacted 11.9
Synopsis of the protocol (for publication) D1_Protocol_synopsis NL 2024-513929-23-00_Redacted 11.9
Synopsis of the protocol (for publication) D1_Protocol_synopsis NO 2024-513929-23-00_Redacted 11.9

Application history

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

#TypeCodeSubmittedReference MSConclusionDecision date
1 INITIAL IN 2024-09-05 Netherlands Acceptable with conditions
2024-10-02
2024-10-02
2 SUBSTANTIAL MODIFICATION SM-1 2024-12-11 Netherlands Acceptable
2025-04-04
2025-04-04
3 SUBSTANTIAL MODIFICATION SM-2 2025-06-16 Netherlands Acceptable
2025-09-17
2025-09-17
4 NON SUBSTANTIAL MODIFICATION NSM-1 2025-09-23 Netherlands Acceptable
2025-09-17
2025-09-23
5 SUBSTANTIAL MODIFICATION SM-4 2025-09-24 Acceptable 2025-10-28
6 SUBSTANTIAL MODIFICATION SM-7 2025-09-24 Acceptable 2025-10-01
7 SUBSTANTIAL MODIFICATION SM-5 2025-09-25 Netherlands Acceptable 2025-10-23
8 SUBSTANTIAL MODIFICATION SM-6 2025-09-25 Acceptable 2025-10-23
9 SUBSTANTIAL MODIFICATION SM-3 2025-09-26 Acceptable 2025-11-12
10 SUBSTANTIAL MODIFICATION SM-8 2026-02-09 Netherlands Acceptable
2026-04-21
2026-04-21