A Clinical Trial to Compare Etrolizumab with Placebo and Adalimumab in Patients with Moderate to Severe Ulcerative Colitis Who Have not Received Treatment with Tumour Necrosis Factor Inhibitors (Hibiscus II)

A Study Comparing the Efficacy and Safety of Etrolizumab With Adalimumab and Placebo in Participants With Moderate to Severe Ulcerative Colitis (UC) in Participants Naive to Tumor Necrosis Factor (TNF) Inhibitors (Hibiscus II)

  • Autoimmune Disorder
  • Inflammatory Bowel Disease (IBD)
  • Ulcerative Colitis
Please note that the recruitment status of the study at your site may differ from the overall study status because some study sites may recruit earlier than others.
Study Status:

Completed

This study runs in
Cities
  • Adelaide
  • Ankara
  • Auckland
  • Bahia
  • Barnaul
  • Bedford Park
  • Cali
  • Ceará
  • cheras
  • Chernivtsi
  • Concord
  • Daugavpils
  • Dnipro
  • Dunedin
  • Dupnica
  • Fitzroy
  • Footscray
  • Gaziantep
  • Győr
  • Hamilton
  • Hlavní město Praha
  • Iraklio
  • Irkutsk
  • İstanbul
  • Katowice
  • Kaunas
  • Kharkiv
  • Kherson
  • Kocaeli
  • Kota Bharu
  • Královéhradecký kraj
  • Ksawerów
  • Kuantan
  • Kyiv
  • Mar del Plata
  • Medellín
  • Mentor
  • Novosibirsk
  • Nowy Targ
  • olomouc-9
  • Omsk Oblast
  • Orlando
  • Osijek
  • oullins-pierre-benite
  • palanga
  • Paraná
  • Pardubice
  • petaling-jaya
  • Pleven
  • Poltava
  • Riga
  • Rio Grande do Sul
  • Ruse
  • Rzeszów
  • Rīga
  • Saint Petersburg
  • Sankt-Peterburg
  • Sliven
  • Sofia
  • Stara Zagora
  • Stavropol
  • Sumy
  • Szczecin
  • São Paulo
  • Tauranga
  • Topeka
  • Uzhhorod
  • Varna
  • Vilnius
  • Vinnytsia
  • Voronezh
  • Warszawa
  • windermere
  • Wrocław
  • Zagreb
  • Zaporizhzhia
  • Łódź
Trial Identifier:

NCT02171429 2013-004277-27 GA28949

  • "City Clinic UMHAC" EOOD

    1407SofiaBulgaria
  • A.Novak Transcarpathian Regional Clinical Hospital

    88018UzhhorodUkraine
  • Allmedica Badania Kliniczne Sp z o.o. Sp K.

    2A Kowaniec34-400Nowy TargPoland
  • Ankara Diskapi Yildirim Beyazit Training and Research Hospital; Gastroenterology

    No: 1 Dışkapı06190AnkaraTürkiye
  • AppleTreeClinics Sp. z o.o.

    20 ks. bp. Wincentego Tymienieckiego90-349ŁódźPoland
  • BHI of Omsk region Clinical Oncology Dispensary

    644013Omsk OblastRussia
  • Center For Digestive Health

    5151 Winter Garden Vineland Rd34786windermereUnited States
  • Center of Emergency and Radiation Medicine; Pulmonology

    194044Saint PetersburgRussia
  • Central Outpatient Clinic

    5401DaugavpilsLatvia
  • Centre Hospitalier Lyon Sud

    165 Chem. du Grand Revoyet69495oullins-pierre-beniteFrance
  • Centro de Investigaciones Medicas Mar Del Plata

    B7600DHKMar del PlataArgentina
  • Centro Digestivo de Curitiba

    655 Alameda Dr. Carlos de Carvalho80430-180ParanáBrazil
  • Centrum Medyczne Medyk

    1 Szopena35-055RzeszówPoland
  • Centrum Opieki Zdrowotnej Orkan-Med

    3 Orkana95-054KsawerówPoland
  • CI Kherson Afanasii and Olha Tropiny City Clinical Hospital

    73000KhersonUkraine
  • CI of Kyiv RC Kyiv Regional Clinical Hospital

    02000KyivUkraine
  • CI of SRC Sumy RCH Dept of Gasroenterology Sumy SU MI

    40000SumyUkraine
  • Clinical Hospital Centre Osijek

    4 Ul. Josipa Huttlera31000OsijekCroatia
  • Clinical Hospital Sveti Duh

    64 Ul. Sveti Duh10000ZagrebCroatia
  • CNE Kyiv CCH #18

    02000KyivUkraine
  • Concord Repatriation General Hospital

    2139ConcordAustralia
  • Cotton-O'Neil Clinical Research Center, Digestive Health

    66606TopekaUnited States
  • DCC Sv. Pantaleymon OOD

    5800PlevenBulgaria
  • Digestive Diseases Center "Gastro"

    LV-1079RigaLatvia
  • Dunedin Hospital

    201 Great King St9016DunedinNew Zealand
  • Endoterapia PFG Sp. z o.o.

    333 Aleja Wilanowska02-665WarszawaPoland
  • Fakultni nemocnice Hradec Kralove

    581 Sokolská500 05Královéhradecký krajCzechia
  • Flinders Medical Centre

    5042Bedford ParkAustralia
  • Footscray Hospital; Gastroenterology

    160 Gordon St3011FootscrayAustralia
  • FSBEI HE "Stavropol State Medical University" of Ministry of Healthcare of Russian Federation

    355018StavropolRussia
  • FSBI "Scientific Research Institute of Physyology and Basic Medicine" under the SB of RAMS

    630117NovosibirskRussia
  • Gabinet Lekarski, Bartosz Korczowski

    1 aleja Niepodległości35-303RzeszówPoland
  • Gaziantep University Medical Faculty Sahinbey Educational Research Hospital; Medical Oncology

    27410GaziantepTürkiye
  • GI L.T.Malaya Therapy National Institute of the NAMS of Ukraine

    61039KharkivUkraine
  • Great Lakes Gastroenterology Research, LLC

    8877 Mentor Ave44060MentorUnited States
  • Haydarpasa Numune Training and Research Hospital; Gastroenterology

    No:23 Tıbbiye Cd34668İstanbulTürkiye
  • Hepato-Gastroenterologie HK, s.r.o.

    1549 tř. E. Beneše500 12Královéhradecký krajCzechia
  • Hospital Ernesto Dornelles

    1801 Av. Ipiranga90160-092Rio Grande do SulBrazil
  • Hospital of Lithuanian University of Health. Sciences Kaunas Clinics

    2 Eivenių g.50161KaunasLithuania
  • Hospital Raja Perempuan Zainab II; Department of Medicine

    15586Kota BharuMalaysia
  • Hospital Tengku Ampuan Afzan

    25100KuantanMalaysia
  • Hospital Universitario Prof Edgar Santos-Ufba; Ambulatorio Magalhaes Neto 3Andar- Dermatologia

    240 R. Padre Feijó40110-170BahiaBrazil
  • Hospital Universitario Walter Cantidio - UFC

    1290 R. Pastor Samuel Munguba60430-372CearáBrazil
  • Instituto de Coloproctologia ICO S.A.S.

    2A-80 Dg. 75B050002MedellínColombia
  • Internal Medicine Specialists

    3885 Oakwater Cir32806OrlandoUnited States
  • Irkutsk State Medical Academy of Continuing Education

    1 Ulitsa Krasnogo Vosstaniya664003IrkutskRussia
  • ISCARE a.s.

    170 04Hlavní město PrahaCzechia
  • Klaipeda Seamen's Hospital, Public Institution

    45 Liepojos g.92334palangaLithuania
  • Kocaeli Universitesi Tip Fakultesi

    41001KocaeliTürkiye
  • LexMedica Osrodek Badan Klinicznych

    12 Weigla53-114WrocławPoland
  • LLC Diaservis

    69061ZaporizhzhiaUkraine
  • M.V. Sklifosovskyi Poltava RCH Dept of Gastroenterology HSEIU UMSA

    36000PoltavaUkraine
  • MCIC MC LLC Health Clinic

    21000VinnytsiaUkraine
  • Med Center of International Institute of Clinical Trials LLC; Medical Center "OK!Clinic+"

    02000KyivUkraine
  • Medical Center "Nov Rehabilitatsionen Tsentar", EOOD

    6000Stara ZagoraBulgaria
  • Medical center CONVEX EOOD

    11А ul. "Sinanishko ezero"1680SofiaBulgaria
  • Medical center Medconsult Pleven OOD

    5800PlevenBulgaria
  • Medical Centre "Asklepii", OOD

    2600DupnicaBulgaria
  • MHAT - Ruse, AD

    7002RuseBulgaria
  • MHAT 'Sv. Marina', EAD

    1 bul. "Hristo Smirnenski"9010VarnaBulgaria
  • MHAT "Hadzhi Dimitar", OOD

    8806SlivenBulgaria
  • Niepubliczny Zaklad Opieki Zdrowotnej SONOMED

    98 księdza Biskupa Władysława Bandurskiego71-685SzczecinPoland
  • North Shore Hospital

    124 Shakespeare Rd0620AucklandNew Zealand
  • Nzoz All-Medicus

    40-659KatowicePoland
  • Pardubicka krajska nemocnice, a.s.

    532 03PardubiceCzechia
  • Pauls Stradins Clinical University Hospital

    13 Pilsoņu iela1002RīgaLatvia
  • Pavlov First Saint Petersburg State Medical University

    6-8 Ulitsa L'va Tolstogo197022Sankt-PeterburgRussia
  • Pesquisare Saúde Sociedade Simples

    125 Avenida Dom Pedro II09080-001São PauloBrazil
  • Petz Aladar Megyei Oktato Korhaz

    2-4 Vasvári Pál u.9024GyőrHungary
  • PreventaMed, s.r.o.

    2 Domovina779 00olomouc-9Czechia
  • Private Small Enterprise Medical Center Pulse

    21000VinnytsiaUkraine
  • Pro Familia Altera Sp z o.o.

    16A Łętowskiego40-648KatowicePoland
  • Pusat Perubatan Universiti Kebangsaan Malaysia

    56000cherasMalaysia
  • RCNECRCH Dept of Surgery, SHEI Ukr BSMU

    58000ChernivtsiUkraine
  • Royal Adelaide Hospital

    5000AdelaideAustralia
  • RTS - Fundación Valle de Lili

    18-49 Cra. 98760032CaliColombia
  • SBEI HPE Altai State Medical University of MoH and SD; Out-patient Department

    40 Prospekt Lenina656038BarnaulRussia
  • SBIH City Clinical Hospital #31

    3 Prospekt Dinamo197110Sankt-PeterburgRussia
  • Shakespeare Specialist Group

    193 Shakespeare Rd0620AucklandNew Zealand
  • SI inst. of Gastroenterology of NAMSU Dept of Stomach & Duodenum Diseases, D&ThN SI DMA of MoHU

    49000DniproUkraine
  • SPb SHI "City Hospital #9"

    197110Saint PetersburgRussia
  • St Vincent's Hospital Melbourne

    41 Victoria Parade3065FitzroyAustralia
  • Tauranga Hospital

    829 Cameron Rd3112TaurangaNew Zealand
  • University General Hospital of Heraklion

    711 10IraklioGreece
  • University Malaya Medical Centre

    50603petaling-jayaMalaysia
  • Uniwersyteckie Centrum Kliniczne im. prof. K. Gibinskiego SUM

    14 Medyków40-752KatowicePoland
  • Vilnius University Hospital Santariskiu Clinic, Public Institution; Cardiology

    2 Santariškių g.08661VilniusLithuania
  • Voronezh Regional Clinical Hospital #1

    394066VoronezhRussia
  • Waikato Hospital

    183 Pembroke St3204HamiltonNew Zealand
  • Zaporizhzhia SMU

    69061ZaporizhzhiaUkraine
    Show study locations

    The source of the below information is public registry websites such as ClinicalTrials.gov, EuClinicalTrials.eu, ISRCTN.com, etc.. It has been summarised and edited into simpler language. For more information about this clinical study see the For Expert tab on the specific ForPatients page or follow these links to https://clinicaltrials.gov and/or https://euclinicaltrials.eu and/or https://www.isrctn.com.

    The below information is taken directly from public registry websites such as ClinicalTrials.gov, EuClinicalTrials.eu, ISRCTN.com, etc., and has not been edited.

    Results Disclaimer

    Study Summary

    This Phase III, double-blind, placebo and active-comparator controlled, multicenter study will investigate the efficacy and safety of etrolizumab in induction of remission in participants with moderately to severely active ulcerative colitis (UC) who are naIve to tumor necrosis factor (TNF) inhibitors and refractory to or intolerant of prior immunosuppressant and/or corticosteroid treatment. In addition to this study, a second Phase III trial with identical study design (GA28948; NCT02163759) was independently conducted.

    Hoffmann-La Roche Sponsor
    Phase 3 Phase
    NCT02171429, GA28949, 2013-004277-27 Study Identifier
    All Gender
    ≥ 18 Years & ≤ 80 Years Age
    No Healthy Volunteers

    How does the Hibiscus II clinical trial work?
    This clinical trial is recruiting people who have ‘ulcerative colitis’, a condition that results in inflammation and ulcers in the large intestine or bowel (‘colon’) or back passage (‘rectum’). It is for people whose ulcerative colitis is categorised as moderately to severely active.

    How do I take part in this clinical trial?
    To be able to take part in this clinical trial, you must not have already been given a type of medicine called a ‘tumour necrosis factor inhibitor’ for your ulcerative colitis and you must have been diagnosed with ulcerative colitis at least 3 months before the start of this trial.

    If you think this clinical trial may be suitable for you and would like to take part, please talk to your doctor.

    If your doctor thinks that you might be able to take part in this clinical trial, he/she may refer you to the closest clinical trial doctor who will give you all the information you need to make your decision about taking part in the clinical trial. You will also find the clinical trial locations at the top of this page.

    You will have some further tests to make sure you will be able to take the treatments given in this clinical trial. Some of these tests and procedures may be part of your regular medical care and may be done even if you do not take part in the clinical trial. If you have had some of the tests recently, they may not need to be done again.

    This clinical trial is divided into three parts or ‘phases’. These parts are called the:

    • ‘Screening phase’ where the clinical trial doctor will check your suitability for the trial, this lasts for up to 5 weeks.
    • ‘Treatment phase’ where you will be given the trial medicine, this lasts for up to 14 weeks. After the treatment phase, if you are eligible you may be asked if you would like to take part in an additional trial called the COTTONWOOD trial (also known as the ‘Open Label Extension Trial’) to receive the etrolizumab drug. If you do not qualify or choose not to join, then you would continue onto the next ‘Safety Monitoring’ phase.
    • ‘Safety monitoring follow-up phase’ where the clinical trial doctor will check if you are having any side effects, this lasts for 12 weeks.

    The maximum length of time you will be in this trial is 31 weeks.

    What happens during the screening phase?
    During the screening phase, you will be told about any risks and benefits of taking part in the trial and what other treatments are available so that you may decide if you still want to take part. While taking part in the clinical trial, both men and women (if you are not currently pregnant but can become pregnant) will need to either not have heterosexual intercourse or take effective contraceptive medications while taking part in the trial for safety reasons.

    What treatment will I be given if I join this clinical trial?
    Everyone who joins this clinical trial will be split into three groups randomly (like flipping a coin) and given one of three different treatments in a blinded fashion.

    This is a ‘placebo-controlled’ clinical trial, which means that one of the groups will be given only injections with no active drug (also known as a placebo). At the start of the treatment phase, a computer will randomly choose your treatment group. This will be one of:

    • Treatment with active etrolizumab (and an adalimumab placebo).
    • Treatment with active adalimumab (and an etrolizumab placebo).
    • Treatment with placebo only (an etrolizumab placebo and an adalimumab placebo).

    You will have a 2 in 5 chance of being given etrolizumab and the placebo, a 2 in 5 chance of being given adalimumab and the placebo, and a 1 in 5 chance of being given only placebo treatment.

    To allow a fair comparison between etrolizumab and adalimumab, you and your clinical trial doctor will be ‘blinded’ to treatment. This means that neither you nor your clinical trial doctor will know which treatments you are taking. If your safety is at risk, your clinical trial doctor can find out which drug you are being given.

    How often will I be seen in follow-up appointments, and for how long?
    During the treatment phase, you will be asked to keep an electronic diary at home to record how you are feeling and managing with day-to-day activities. You will also come to the hospital every 2 weeks to be given your medicine. The clinical trial doctor will ask you about how your ulcerative colitis is responding to the treatment and about any side effects that you may be having.

    At the Week 10 visit, you will be assessed by the clinical trial doctor to see if your ulcerative colitis has responded to treatment.

    If, at Week 10 your ulcerative colitis has responded to treatment, you will continue for another 4 weeks and be given one more dose of etrolizumab or placebo at the Week 12 visit. No more doses of adalimumab will be given after Week 8. You will be assessed at Week 14 to see if you are still responding to treatment. After this assessment, you will either enter the safety monitoring follow-up phase of this clinical trial or your doctor will talk to you about entering the Open Label Extension Trial COTTONWOOD where you will be given long-term treatment with etrolizumab. The clinical trial doctor will give you all the information you need to make your decision about taking part in this other clinical trial.

    If you have not met the required response at the Week 10 visit, you will either enter the 12-week safety monitoring follow-up phase, or if suitable, your doctor will talk to you about entering the Open Label Extension Trial COTTONWOOD where you will be given long-term treatment with etrolizumab. The clinical trial doctor will give you all the information you need to make your decision about taking part in this other clinical trial.

    What happens during the safety monitoring follow-up phase?
    All patients who leave this trial and do not enter the other clinical trial of long-term treatment with etrolizumab will be asked to complete a 12‑week safety monitoring follow-up phase. This will include one safety monitoring telephone call at Week 6 and one clinic visit at Week 12.

    What happens if I’m unable to take part in this clinical trial?
    If this clinical trial is not suitable for you, you will not be able to take part. Your doctor will suggest other treatments for you that you can be given or other clinical trials that you may be able to take part in. You will not lose access to any of your regular care.

    For more information about this clinical trial see the For Expert tab on this page or follow this link to ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02171429  

    Trial-identifier: NCT02171429

    Study Summary

    This Phase III, double-blind, placebo and active-comparator controlled, multicenter study will investigate the efficacy and safety of etrolizumab in induction of remission in participants with moderately to severely active ulcerative colitis (UC) who are naIve to tumor necrosis factor (TNF) inhibitors and refractory to or intolerant of prior immunosuppressant and/or corticosteroid treatment. In addition to this study, a second Phase III trial with identical study design (GA28948; NCT02163759) was independently conducted.

    Hoffmann-La Roche Sponsor
    Phase 3 Phase
    NCT02171429, GA28949, 2013-004277-27 Trial Identifier
    Adalimumab, Adalimumab Placebo, Etrolizumab, Etrolizumab Placebo Treatments
    Ulcerative Colitis Condition
    Official Title

    Phase III, Randomized, Double-Blind, Double-Dummy, Placebo-Controlled, Multicenter Study to Evaluate the Efficacy (Induction of Remission) and Safety of Etrolizumab Compared With Adalimumab and Placebo in Patients With Moderate to Severe Ulcerative Colitis Who Are Naive to TNF Inhibitors

    Eligibility Criteria

    All Gender
    ≥ 18 Years & ≤ 80 Years Age
    No Healthy Volunteers
    Inclusion Criteria
    • Diagnosis of ulcerative colitis (UC) established at least 3 months prior to randomization (Day 1)
    • Moderately to severely active UC as determined by the MCS
    • Naive to treatment with TNF inhibitor therapy
    • An inadequate response, loss of response, or intolerance to prior corticosteroid and/or immunosuppressant treatment
    • Background UC therapy may include oral 5-aminosalisylate (5-ASA), budesonide, oral corticosteroids, probiotics, azathioprine (AZA), 6-mercaptopurine (6MP), or methotrexate (MTX) if doses have been stable for:
    • AZA, 6-MP, MTX: 8 weeks immediately prior to randomization
    • 5-ASA: 4 weeks immediately prior to randomization
    • Corticosteroids: 4 weeks immediately prior to randomization; if corticosteroids are being tapered, dose has to be stable for at least 2 weeks prior to randomization
    • Use of highly effective contraception method as defined by the protocol
    • Have received a colonoscopy within the past year or be willing to undergo a colonoscopy in lieu of a flexible sigmoidoscopy at screening
    Exclusion Criteria

    Exclusion Criteria Related to Inflammatory Bowel Disease:

    • Prior extensive colonic resection, subtotal or total colectomy, or planned surgery for UC
    • Past or present ileostomy or colostomy
    • Diagnosis of indeterminate colitis
    • Suspicion of ischemic colitis, radiation colitis, or microscopic colitis
    • Diagnosis of toxic megacolon within 12 months of initial screening visit
    • Any diagnosis of Crohn's disease
    • Past or present fistula or abdominal abscess
    • A history or current evidence of colonic mucosal dysplasia
    • Patients with any stricture (stenosis) of the colon
    • Patients with history or evidence of adenomatous colonic polyps that have not been removed

    Exclusion Criteria Related to Prior or Concomitant Therapy:

    • Prior treatment with TNF-alpha antagonists
    • Any prior treatment with etrolizumab or other anti-integrin agents
    • Any prior treatment with rituximab
    • Any treatment with tofacitinib during screening
    • Any prior treatment with anti-adhesion molecules
    • Use of intravenous (IV) steroids within 30 days prior to screening with the exception of a single administration of IV steroid
    • Use of agents that deplete B or T cells
    • Use of anakinra, abatacept, cyclosporine, sirolimus, or mycophenolate mofetil (MMF) within 4 weeks prior to randomization
    • Chronic nonsteroidal anti‑inflammatory drug (NSAID) use
    • Patients who are currently using anticoagulants including, but not limited to, warfarin, heparin, enoxaparin, dabigatran, apixaban, rivaroxaban
    • Patients who have received treatment with corticosteroid enemas/suppositories and/or topical (rectal) 5-ASA preparations within 2 weeks prior to randomization
    • Apheresis (i.e., Adacolumn apheresis) within 2 weeks prior to randomization
    • Received any investigational treatment including investigational vaccines within 5 half lives of the investigational product or 28 days after the last dose, whichever is greater, prior to randomization
    • History of moderate or severe allergic or anaphylactic/anaphylactoid reactions to chimeric, human, or humanized antibodies, fusion proteins, or murine proteins or hypersensitivity to etrolizumab (active drug substance) or any of the excipients (L histidine, L-arginine, succinic acid, polysorbate 20)
    • Patients administered tube feeding, defined formula diets, or parenteral alimentation/nutrition who have not discontinued these treatments within 3 weeks prior to randomization

    Exclusion Criteria Related to General Safety:

    • Pregnant or lactating
    • Lack of peripheral venous access
    • Hospitalization (other than for elective reasons) during the screening period
    • Significant uncontrolled comorbidity, such as cardiac (e.g., moderate to severe heart failure New York Heart Association Class III/IV), pulmonary, renal, hepatic, endocrine, or gastrointestinal disorders
    • Neurological conditions or diseases that may interfere with monitoring for PML
    • History of demyelinating disease
    • Clinically significant abnormalities on screening neurologic examination (PML Objective Checklist)
    • Clinically significant abnormalities on the screening PML Subjective Checklist
    • History of alcohol, drug, or chemical abuse less than 6 months prior to screening
    • Conditions other than UC that could require treatment with >10 mg/day of prednisone (or equivalent) during the course of the study
    • History of cancer, including hematologic malignancy, solid tumors, and carcinoma in situ, within 5 years before screening

    Exclusion Criteria Related to Infection Risk

    • Congenital or acquired immune deficiency
    • Patients must undergo screening for HIV and test positive for preliminary and confirmatory tests
    • Positive hepatitis C virus (HCV) antibody test result
    • Positive hepatitis B virus (HBV) antibody test result
    • Evidence of or treatment for Clostridium difficile (as assessed by C. difficile toxin testing) within 60 days prior to randomization or other intestinal pathogens (as assessed by stool culture and ova and parasite evaluation) within 30 days prior to randomization
    • Evidence of or treatment for clinically significant cytomegalovirus (CMV) colitis (based on the investigator's judgment) within 60 days prior to randomization
    • History of active or latent TB
    • History of recurrent opportunistic infections and/or history of severe disseminated viral infections
    • Any serious opportunistic infection within the last 6 months prior to screening
    • Any current or recent signs or symptoms (within 4 weeks before screening and during screening) of infection
    • Any major episode of infection requiring treatment with IV antibiotics within 8 weeks prior to screening or oral antibiotics within 4 weeks prior to screening
    • Received a live attenuated vaccine within 4 weeks prior to randomization
    • History of organ transplant

    Exclusion Criteria Related to Laboratory Abnormalities (at Screening)

    • Serum creatinine >2 x upper limit of normal (ULN)
    • ALT or AST >3 x ULN or alkaline phosphatase >3 x ULN or total bilirubin >2.5 x ULN
    • Platelet count <100,000/uL
    • Hemoglobin <8 g/dL
    • Absolute neutrophil count <1500/uL
    • Absolute lymphocyte count <500/uL

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