Momelotinib Versus Ruxolitinib in Subjects With Myelofibrosis (Simplify 1)
Primary Purpose
Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, Post-Essential Thrombocythemia Myelofibrosis
Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Momelotinib
Ruxolitinib
Placebo to match momelotinib
Placebo to match ruxolitinib
Sponsored by
About this trial
This is an interventional treatment trial for Primary Myelofibrosis
Eligibility Criteria
Key Inclusion Criteria:
- Palpable splenomegaly at least 5 cm below the left costal margin
- Confirmed diagnosis of PMF or post-PV/ET MF
- Requires myelofibrosis therapy, in the opinion of the investigator
- Classified as high risk OR intermediate-2 risk as defined by the International Prognostic Scoring System (IPSS) for PMF, or intermediate-1 risk (IPSS) associated with symptomatic splenomegaly, hepatomegaly, anemia (hemoglobin < 10.0 g/dL), and/or unresponsive to available therapy
Acceptable laboratory assessment obtained within 14 days prior to the first dose of study drug:
- Absolute neutrophil count (ANC) ≥ 0.75 x 10^9/L in the absence of growth factor in the prior 7 days
- Platelet Count ≥ 50 x 10^9/L (≥ 100 x 10^9/L if aspartate aminotransferase [AST] or alanine aminotransferase [ALT] is ≥ 2 x the upper limit of the normal range [ULN]) in the absence of platelet transfusion(s) or thrombopoietin mimetics in the prior 7 days
- Peripheral blood blast count < 10%
- AST and ALT ≤ 3 x ULN (≤ 5 x ULN if liver is involved by extramedullary hematopoiesis as judged by the investigator or if related to iron chelator therapy that was started within the prior 60 days)
- Calculated creatinine clearance (CrCL) of ≥ 45 mL/min
- Direct bilirubin ≤ 2.0 x ULN
- Life expectancy of > 24 weeks
- Males and females of childbearing potential must agree to use protocol-specified method(s) of contraception
- Females who are nursing must agree to discontinue nursing before the first dose of study drug
- Able to understand and willing to sign the informed consent form
Key Exclusion Criteria:
- Prior splenectomy
- Splenic irradiation within 3 months prior to the first dose of study drug
- Eligible for allogeneic bone marrow or stem cell transplantation
- Uncontrolled inter-current illness, per protocol.
- Known positive status for human immunodeficiency virus (HIV)
- Chronic active or acute viral hepatitis A, B, or C infection, or a hepatitis B or C carrier
- Prior use of a JAK1 or JAK2 inhibitor
- Use of chemotherapy, immunomodulating therapy, biologic therapy, radiation therapy, or investigational therapy within 4 weeks of the first dose of study drug
- Presence of peripheral neuropathy ≥ Common Terminology Criteria for Adverse Events (CTCAE) Grade 2
- Unwilling or unable to undergo a magnetic resonance imaging (MRI) or computed tomography (CT) scan
Note: Other protocol defined Inclusion/Exclusion criteria may apply.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Momelotinib
Ruxolitinib
Arm Description
Participants will receive momelotinib plus placebo to match ruxolitinib.
Participants will receive ruxolitinib plus placebo to match momelotinib.
Outcomes
Primary Outcome Measures
Splenic Response Rate at Week 24
Splenic response rate at Week 24 is defined as the percentage of participants who achieved a spleen volume reduction of ≥ 35% from baseline at the Week 24 assessment as measured by MRI or CT.
Secondary Outcome Measures
Total Symptom Score (TSS) Response Rate at Week 24
Total symptom score (TSS) is defined as the percentage of participants who achieved a ≥50% reduction in TSS at Week 24 versus baseline as measured by the modified Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) v2.0 diary. Response rate was calculated using the average of the daily TSS from a consecutive 28-day period prior to Week 24, which had ≥20 daily TSS available.
The modified MPN-SAF patient-reported outcome instrument consisted of 8 items assessing worst daily incidence of tiredness, filling up quickly, abdominal discomfort, night sweats, itching, bone pain, pain under ribs on left side, and inactivity. Scoring of the Total Symptom Score (TSS), in this study was based on 7 of these items, (range of 0-70,), excluding inactivity. These items assess the impact experienced by the participant in the 24 hours prior to completing the questionnaire. All items are measured using a 0 to 10 Numeric Rating Scale, with 0 corresponding to "Absent" and 10 being the worse
Rate of Red Blood Cell (RBC) Transfusions in the Double-blind Phase, (the Average Number of RBC Units Transfused Per Month Not Associated With Overt Bleeding)
Rate of RBC transfusion was defined as the average number of RBC units transfused not associated with clinically overt bleeding per subject-month during the double-blind phase.
RBC Transfusion Independence Rate at Week 24, (Defined as Absence of RBC Transfusions and no Hemoglobin Level Below 8 g/dL in the 12 Weeks Prior to Week 24, Excluding Cases Associated With Clinically Overt Bleeding)
RBC transfusion independence is the percentage of participants who are transfusion independent at Week 24, defined as absence of RBC transfusions and no hemoglobin level below 8 g/dL in the 12 weeks prior to Week 24, excluding cases associated with clinically overt bleeding.
RBC Transfusion Dependence Rate at Week 24. (Defined as Having Had at Least 4 Units of RBC Transfusions, or a Hemoglobin Level Below 8 g/dL in 8 Weeks Prior to Week 24 (Excluding Cases Associated With Clinically Overt Bleeding)).
RBC transfusion dependence is the percentage of participants who are transfusion dependent at Week 24, defined as having had at least 4 units of RBC transfusions, or a hemoglobin level below 8 g/dL in 8 weeks prior to Week 24 (excluding cases associated with clinically overt bleeding). Participants with the last double-blind phase participation date prior to Day 162 (ie. missing at Week 24) were considered transfusion dependent at Week 24.
Full Information
NCT ID
NCT01969838
First Posted
October 22, 2013
Last Updated
May 10, 2023
Sponsor
Sierra Oncology LLC - a GSK company
1. Study Identification
Unique Protocol Identification Number
NCT01969838
Brief Title
Momelotinib Versus Ruxolitinib in Subjects With Myelofibrosis
Acronym
Simplify 1
Official Title
A Phase 3, Randomized, Double-blind Active-controlled Study Evaluating Momelotinib vs. Ruxolitinib in Subjects With Primary Myelofibrosis (PMF) or Post-Polycythemia Vera or Post-Essential Thrombocythemia Myelofibrosis (Post-PV/ET MF)
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
December 6, 2013 (Actual)
Primary Completion Date
September 12, 2016 (Actual)
Study Completion Date
May 2, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sierra Oncology LLC - a GSK company
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study is to determine the efficacy of momelotinib (MMB) versus ruxolitinib (RUX) in participants with primary myelofibrosis (PMF) or post-polycythemia vera or post-essential thrombocythemia myelofibrosis (post-PV/ET MF) who have not yet received treatment with a Janus kinase inhibitor (JAK inhibitor).
Participants will be randomized to receive either MMB or ruxolitinib for 24 weeks during a double-blind treatment phase, after which they will be eligible to receive open-label MMB for up to an additional 216 weeks. After discontinuation of study medication, assessments will continue for 12 additional weeks, after which participants will be contacted for survival follow-up approximately every 6 months for up to 5 years from the date of enrollment or until study termination. For those participants planning to continue treatment with MMB following the end of the study, the Early Study Drug Discontinuation (ESDD), 30-day, 12-Week, and survival follow-up visits are not required.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Primary Myelofibrosis, Post-Polycythemia Vera Myelofibrosis, Post-Essential Thrombocythemia Myelofibrosis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
432 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Momelotinib
Arm Type
Experimental
Arm Description
Participants will receive momelotinib plus placebo to match ruxolitinib.
Arm Title
Ruxolitinib
Arm Type
Active Comparator
Arm Description
Participants will receive ruxolitinib plus placebo to match momelotinib.
Intervention Type
Drug
Intervention Name(s)
Momelotinib
Other Intervention Name(s)
GS-0387, CYT387
Intervention Description
Momelotinib tablet administered orally once daily
Intervention Type
Drug
Intervention Name(s)
Ruxolitinib
Intervention Description
Ruxolitinib tablets administered orally twice daily
Intervention Type
Drug
Intervention Name(s)
Placebo to match momelotinib
Intervention Description
Placebo to match momelotinib tablets administered orally once daily
Intervention Type
Drug
Intervention Name(s)
Placebo to match ruxolitinib
Intervention Description
Placebo to match ruxolitinib tablets administered orally twice daily
Primary Outcome Measure Information:
Title
Splenic Response Rate at Week 24
Description
Splenic response rate at Week 24 is defined as the percentage of participants who achieved a spleen volume reduction of ≥ 35% from baseline at the Week 24 assessment as measured by MRI or CT.
Time Frame
Week 24
Secondary Outcome Measure Information:
Title
Total Symptom Score (TSS) Response Rate at Week 24
Description
Total symptom score (TSS) is defined as the percentage of participants who achieved a ≥50% reduction in TSS at Week 24 versus baseline as measured by the modified Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) v2.0 diary. Response rate was calculated using the average of the daily TSS from a consecutive 28-day period prior to Week 24, which had ≥20 daily TSS available.
The modified MPN-SAF patient-reported outcome instrument consisted of 8 items assessing worst daily incidence of tiredness, filling up quickly, abdominal discomfort, night sweats, itching, bone pain, pain under ribs on left side, and inactivity. Scoring of the Total Symptom Score (TSS), in this study was based on 7 of these items, (range of 0-70,), excluding inactivity. These items assess the impact experienced by the participant in the 24 hours prior to completing the questionnaire. All items are measured using a 0 to 10 Numeric Rating Scale, with 0 corresponding to "Absent" and 10 being the worse
Time Frame
Week 24
Title
Rate of Red Blood Cell (RBC) Transfusions in the Double-blind Phase, (the Average Number of RBC Units Transfused Per Month Not Associated With Overt Bleeding)
Description
Rate of RBC transfusion was defined as the average number of RBC units transfused not associated with clinically overt bleeding per subject-month during the double-blind phase.
Time Frame
Baseline to Week 24
Title
RBC Transfusion Independence Rate at Week 24, (Defined as Absence of RBC Transfusions and no Hemoglobin Level Below 8 g/dL in the 12 Weeks Prior to Week 24, Excluding Cases Associated With Clinically Overt Bleeding)
Description
RBC transfusion independence is the percentage of participants who are transfusion independent at Week 24, defined as absence of RBC transfusions and no hemoglobin level below 8 g/dL in the 12 weeks prior to Week 24, excluding cases associated with clinically overt bleeding.
Time Frame
Week 24
Title
RBC Transfusion Dependence Rate at Week 24. (Defined as Having Had at Least 4 Units of RBC Transfusions, or a Hemoglobin Level Below 8 g/dL in 8 Weeks Prior to Week 24 (Excluding Cases Associated With Clinically Overt Bleeding)).
Description
RBC transfusion dependence is the percentage of participants who are transfusion dependent at Week 24, defined as having had at least 4 units of RBC transfusions, or a hemoglobin level below 8 g/dL in 8 weeks prior to Week 24 (excluding cases associated with clinically overt bleeding). Participants with the last double-blind phase participation date prior to Day 162 (ie. missing at Week 24) were considered transfusion dependent at Week 24.
Time Frame
Week 24
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria:
Palpable splenomegaly at least 5 cm below the left costal margin
Confirmed diagnosis of PMF or post-PV/ET MF
Requires myelofibrosis therapy, in the opinion of the investigator
Classified as high risk OR intermediate-2 risk as defined by the International Prognostic Scoring System (IPSS) for PMF, or intermediate-1 risk (IPSS) associated with symptomatic splenomegaly, hepatomegaly, anemia (hemoglobin < 10.0 g/dL), and/or unresponsive to available therapy
Acceptable laboratory assessment obtained within 14 days prior to the first dose of study drug:
Absolute neutrophil count (ANC) ≥ 0.75 x 10^9/L in the absence of growth factor in the prior 7 days
Platelet Count ≥ 50 x 10^9/L (≥ 100 x 10^9/L if aspartate aminotransferase [AST] or alanine aminotransferase [ALT] is ≥ 2 x the upper limit of the normal range [ULN]) in the absence of platelet transfusion(s) or thrombopoietin mimetics in the prior 7 days
Peripheral blood blast count < 10%
AST and ALT ≤ 3 x ULN (≤ 5 x ULN if liver is involved by extramedullary hematopoiesis as judged by the investigator or if related to iron chelator therapy that was started within the prior 60 days)
Calculated creatinine clearance (CrCL) of ≥ 45 mL/min
Direct bilirubin ≤ 2.0 x ULN
Life expectancy of > 24 weeks
Males and females of childbearing potential must agree to use protocol-specified method(s) of contraception
Females who are nursing must agree to discontinue nursing before the first dose of study drug
Able to understand and willing to sign the informed consent form
Key Exclusion Criteria:
Prior splenectomy
Splenic irradiation within 3 months prior to the first dose of study drug
Eligible for allogeneic bone marrow or stem cell transplantation
Uncontrolled inter-current illness, per protocol.
Known positive status for human immunodeficiency virus (HIV)
Chronic active or acute viral hepatitis A, B, or C infection, or a hepatitis B or C carrier
Prior use of a JAK1 or JAK2 inhibitor
Use of chemotherapy, immunomodulating therapy, biologic therapy, radiation therapy, or investigational therapy within 4 weeks of the first dose of study drug
Presence of peripheral neuropathy ≥ Common Terminology Criteria for Adverse Events (CTCAE) Grade 2
Unwilling or unable to undergo a magnetic resonance imaging (MRI) or computed tomography (CT) scan
Note: Other protocol defined Inclusion/Exclusion criteria may apply.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gilead Study Director
Organizational Affiliation
Gilead Sciences
Official's Role
Study Director
Facility Information:
City
Phoenix
State/Province
Arizona
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United States
City
Escondido
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California
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United States
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Stanford
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California
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United States
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Jacksonville
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Florida
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United States
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Atlanta
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Georgia
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Chicago
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Illinois
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Baltimore
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Maryland
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Boston
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Massachusetts
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Saint Louis
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Missouri
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Durham
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North Carolina
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Seattle
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Washington
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Darlinghurst
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New South Wales
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Australia
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Parkville
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New South Wales
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Australia
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Saint Leonards
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New South Wales
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Australia
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Brisbane
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Queensland
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Australia
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Herston
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Queensland
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Australia
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Adelaide
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South Australia
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Australia
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Bedford Park
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South Australia
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Australia
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Frankston
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Victoria
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Australia
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Melbourne
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Victoria
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Australia
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Perth
State/Province
Western Australia
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Australia
City
Wien
State/Province
Vienna
Country
Austria
City
Charleroi
State/Province
Hainaut
Country
Belgium
City
Antwerp
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Belgium
City
Leuven
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Belgium
City
Liege
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Belgium
City
Pleven
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Bulgaria
City
Plovdiv
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Bulgaria
City
Ruse
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Bulgaria
City
Sofia
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Bulgaria
City
Varna
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Bulgaria
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Edmonton
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Alberta
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Canada
City
Vancouver
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British Columbia
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Canada
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Hamilton
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Ontario
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Canada
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Toronto
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Ontario
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Canada
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Hradec Kralove
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Vychodocesky KRAJ
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Czechia
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Brno
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Czechia
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Ostrava
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Czechia
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Aalborg
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Denmark
City
Herlev
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Denmark
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Toulouse cedex 9
State/Province
Midi-pyrenees
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France
City
Pierre Bénite Cedex
State/Province
Rhone-alpes
Country
France
City
Le Kremlin Bicetre Cedex
Country
France
City
Lens
Country
France
City
Lille Cedex
Country
France
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Marseille Cedex 9
Country
France
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Nantes cedex 1
Country
France
City
Paris
Country
France
City
Pessac Cedex
Country
France
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Villejuif Cedex
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France
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München
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Bayern
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Germany
City
Leipzig
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Sachsen
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Germany
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Dresden
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Germany
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Dusseldorf
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Germany
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Freiburg
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Germany
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Hamburg
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Germany
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Mainz
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Germany
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Mannheim
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Germany
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Budapest
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Hungary
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Debrecen
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Hungary
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Kaposvár
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Hungary
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Afula
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Israel
City
Ashkelon
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Israel
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Haifa
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Israel
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Jerusalem
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Israel
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Tel Aviv
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Israel
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Ogaki City
State/Province
Gifu
Country
Japan
City
Kitaku Sapporo
State/Province
Hokkaido
Country
Japan
City
Osaka Sayama
State/Province
Osaka
Country
Japan
City
Osaka-City
State/Province
Osaka
Country
Japan
City
Bunkyo-ku, Tokyo
Country
Japan
City
Fukushima City
Country
Japan
City
Kumamoto City
Country
Japan
City
Matsuyama
Country
Japan
City
Okayama
Country
Japan
City
Seoul
Country
Korea, Republic of
City
Maastricht
Country
Netherlands
City
Nijmegen
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Netherlands
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Rotterdam
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Netherlands
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Utrecht
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Netherlands
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Lodz
State/Province
Lodzkie
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Poland
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Lublin
State/Province
Lubelskie
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Poland
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Kraków
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Malopolskie
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Poland
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Warszawa
State/Province
Mazowiekie
Country
Poland
City
Gdansk
State/Province
Pomorskie
Country
Poland
City
Poznan
State/Province
Wielkopolskie
Country
Poland
City
Bialystok
Country
Poland
City
Brzozow
Country
Poland
City
Chorzow
Country
Poland
City
Arad
Country
Romania
City
Brasov
Country
Romania
City
Bucuresti
Country
Romania
City
Cluj-Napoca
Country
Romania
City
Iasi
Country
Romania
City
Singapore
Country
Singapore
City
Majadahonda
State/Province
Madrid
Country
Spain
City
Pamplona
State/Province
Navarra
Country
Spain
City
Badalona
Country
Spain
City
Barcelona
Country
Spain
City
Valencia
Country
Spain
City
Zaragoza
Country
Spain
City
Lund
State/Province
Skane
Country
Sweden
City
Stockholm
Country
Sweden
City
Uddevalla
Country
Sweden
City
Örebro
Country
Sweden
City
Kaohsiung
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Taiwan
City
Leicester
State/Province
England
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United Kingdom
City
London
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England
Country
United Kingdom
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Manchester
State/Province
England
Country
United Kingdom
City
Newcastle Upon Tyne
State/Province
England
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United Kingdom
City
Oxford
State/Province
England
Country
United Kingdom
City
Cardiff
State/Province
Wales
Country
United Kingdom
City
Northern Ireland
Country
United Kingdom
City
Nottingham
Country
United Kingdom
12. IPD Sharing Statement
Learn more about this trial
Momelotinib Versus Ruxolitinib in Subjects With Myelofibrosis
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