FibromyalgiaPhase 4NCT01038323
Drug and Talk Therapy for Fibromyalgia
A Phase 4 study testing CBT and milnacipran and Educational with milnacipran in people with Fibromyalgia, run by Indiana University at 1 site in United States.
Trial summary
Fibromyalgia Syndrome (FMS) afflicts 2% of the U.S. population and have huge individual and societal costs in terms of quality of life, social and work functioning, health care use, and lost productivity. Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Fibromyalgia
- What is being tested?
- CBT and milnacipran and Educational with milnacipran
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 58 participants
- Where
- 1 siteUnited States
- Study dates
- Dec 2009to Sep 2012
- Phase
- Phase 4
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Must be between the ages of 18 to 65 years of age
- Must have been diagnosed with fibromyalgia by a rheumatologist
- Must have an overall body pain average score ≥ 4
- Must be on stable doses of your current medication for at least past four weeks
- Must report all medication including herbal supplements and over-the-counter medications that you are currently taking to a member of the research team.
- Must limit any changes in your medication(s)during the 21-week study time period unless medically necessary
Show all 33Show fewer
- Must be willing to maintain a medication diary provided to you during the 21-week study period
- Must be willing to abstain (not take) any fibromyalgia related medication (including over-the-counter)for at least 6-hours prior to each of the three testing visits. (Otherwise, you may take these medication immediately after pain sensitivity testing has been completed and as prescribed in-between visits)
- Must experience the symptoms of fibromyalgia syndrome (FMS) that decreases (limits) your ability to perform daily activities.
- Exclusions Criteria:
- You have uncontrolled hypertension(high blood pressure) systolic >160 mm Hg or diastolic blood pressure > 100 mm Hg)
- If you have a history of: heart disease, glaucoma, or hepatitis
- You have been diagnosed with any type of peripheral neuropathy
- You have a body mass index (BMI) of more than 34
- You currently or frequently have thoughts of harming yourself or committing suicide.
- You are in the process of filing, or plan to file for disability benefits within the study timeline.
- You plan to undergo an elective surgery within the study timeline.
- You have been diagnosed with another major rheumatic conditions (i.e. rheumatoid arthritis, systemic lupus erythematosus, scleroderma and other connective tissue diseases)
- You are currently pregnant, are planning to become pregnant, or are breastfeeding
- You have been diagnosed with schizophrenia or manic-depressive.
- You are currently taking any of the following medications:
- fluoxetine, Brand Names: Prozac, Prozac Weekly, Rapiflux, Sarafem
- sertraline, Brand Name: Zoloft
- paroxetine, Brand Names: Paxil, Paxil CR, Pexeva
- citalopram, Brand Name: Celexa
- escitalopram, Brand Names: Lexapro
- venlafaxine, Brand Names: Effexor, Effexor XR
- mirtazapine, Brand Names: Remeron, Remeron SolTab
- duloxetine, Brand Name: Cymbalta NOTE: If you are taking any of the medication(s) listed above and are willing to discontinue its use for the duration of this study, you must first discuss your decision with your primary care physician (or prescribing doctor)regarding the appropriate regimen to wean off your current medication and receive his/her written consent before proceeding with enrollment. We will provide you a "Dear Doctor" letter that explains the study details.
- If you are currently taking or have ever taken Savella® (milnacipran)
- You are currently participating in other pain research study or have previously been enrolled in any study or class in which cognitive behavioral therapy or educational formats were used to help control pain or stress related to fibromyalgia
- You are unwilling or unable to comply with the study guidelines
- Note: If you have ever experienced an adverse event while taking any type of antidepressant, please alert the research team, while it may not exclude you from participating in the study, it is important that we are aware of the incident in order to keep you safe.
Who cannot join
None listed.
Trial locations and contacts
1 site in 1 country.
United States1 site
Clinical Research Center for Pain, 250 University Blvd
Indianapolis, Indiana, 46202
About this study
Official title: A Pilot Study on the Combined Use of Cognitive Behavioral Therapy (CBT) and Milnacipran
Fibromyalgia Syndrome (FMS) afflicts 2% of the U.S. population and have huge individual and societal costs in terms of quality of life, social and work functioning, health care use, and lost productivity. Although single therapy approaches such as medication, graduated exercise, and Cognitive Behavioral Therapy (CBT) are well-established treatment approaches, the majority of FMS continue to report significant levels of pain and pain-related disability. Testing the efficacy of using combination therapies such and CBT with medication has considerable potential to maximize treatment response. Also, exploring the biological and psychological mechanisms underlying combination treatment may pave the way for developing new treatments for FMS sufferers.
We chose to study drug and CBT for several reasons: 1) the scarcity of trials that manipulate medications along with CBT in FMS, 2) the prohibitive nature of adding an exercise treatment arm in a study that has both time and budgetary constraints, 3) the complexity in understanding the mechanism of actions of 3 different modes of intervention in one clinical trial, and 4) the desire to explore mechanisms in this program of research, in particular the potential effects of a biological intervention (drug) on what is traditionally considered a psychological outcome (pain-related attributions and cognition) and the potential effects of a psychological intervention (CBT) on what is traditionally considered a physiological outcome (pain sensitivity).
Read the detailed description
Qualified participants will take part in a 21-week clinical research study entitled, "Drug and Talk Therapy for Fibromyalgia". We are doing this study to better understand how talk therapies, such as education and cognitive behavioral therapy (CBT), can improve the therapeutic benefits of drug for fibromyalgia.
Savella ®, (milnacipran) is an FDA approved drug for fibromyalgia. The safety and efficacy of Savella has been established in two US-based clinical studies involving over 2,000 patients with fibromyalgia. Because Savella has already been shown to be effective when used in isolation to treat fibromyalgia, we are conducting the study to determine whether combination treatment (Savella + talk therapy) is more efficacious than just Savella alone or talk therapy alone.
Volunteers will be randomized (like flipping a coin) on two different levels:
- Each participate will be randomized into one of two groups for medication: One group will receive Savella and the other group will receive a placebo (no medicinal value). Both the medication and the placebo will look identical and subjects will not be told into which group they have been placed until the completion of the study. Each participants has 66% chance of receiving Savella and 34% chance of getting the placebo.
- The second level of randomization will be to determine which type of talk therapies you will be assigned to. Subjects will be randomly assigned to receive educational instruction relevant to fibromyalgia, OR cognitive behavioral therapy which includes a workbook. Both talk therapies will be provided over the phone once a week for 8 weeks. Each phone session may last for 30 minutes. Importantly, both talk therapies can provide coping tools and information designed to help manage fibromyalgia symptoms.
Study Overview:
Subjects will be asked to visit the Fibromyalgia Clinical Research Center on five separate occasions: Initial Screening (today's visit), Week 1, Week 2, Week 9, and Week 21.
VISIT 1:
- Informed consent and initial screening questionnaire,physical assessment
- Issue a 'pain score' wrist monitor with instructions to record current pain level three times a day for one week
VISIT 2:
- Submit your pain recording
- Complete the self-assessment questionnaires via computer
- Vital signs check
- Undergo pain sensitivity testing
- If qualified, subjects be randomized to receive Savella or placebo AND to receive education or cognitive behavioral therapy
VISIT 3:
- We will assess the subject's willingness to continue participation.
- Review medication diary and medication side-effect checklist.
- Schedule PHONE Therapy sessions: 8 thirty minute calls
VISIT 4:
- One week prior to this visit, subjects will receive a 'pain score' monitor in order to enter current pain levels three times a day for one week. Then report for this visit.
- Review side effect checklist, medication diary.
- Completion of self-assessment questionnaires via computer
- Undergo pain sensitivity testing
VISIT 5:
- One week prior to this visit, subjects will receive a 'pain score' monitor in order to enter current pain levels three times a day for one week. Then report for this visit.
- Review side effect checklist, medication diary.
- Completion of self-assessment questionnaires via computer
- Undergo pain sensitivity testing
- Upon visit completion, participants will receive a reduced dose regimen of the medication along with written and verbal instructions to safely discontinue the study medication.
- Conditions
- Fibromyalgia
- Being tested
- CBT and milnacipran, CBT with a placebo, Educational with milnacipran
- Keywords
- Fibromyalgia, FMS
- Medical subject headings
- Fibromyalgia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CBT and milnacipranOther
Also called milnacipran, Savella, Cognitive Behavioral Therapy, CBT
Participants will receive a series of eight telephone sessions of CBT along with a 21-week regimen of milnacipran. Dosing for milnacipran begins with a one week "starter pack". Dosage:12.5 mg on day 1,12.5 mg twice daily on days 2 and 3, then 25 mg twice daily on days 4,5,6,and 7. On day 8 participants will begin taking 50 mg twice daily for the balance of the study.
CBT with a placeboBehavioural
Also called placebo, sugar pills, Cognitive Behavioral Therapy, CBT
Participants will receive a series of eight telephone sessions of CBT along with a 21-week regimen of a placebo. Dosing for the placebo begins with a one week "starter pack". Dosage: 12.5 mg on day 1,12.5 mg twice daily on days 2 and 3, then 25 mg twice daily on days 4,5,6,and 7. On day 8 participants will begin taking 50 mg twice daily for the balance of the study.
Educational with milnacipranDrug
Also called fibromyalgia, fibromyalgia education, milnacipran, Savella
Participants will receive a series of eight telephone sessions of fibromyalgia related education along with a 21-week regimen of milnacipran. Dosing for milnacipran begins with a one week "starter pack". Dosage:12.5 mg on day 1,12.5 mg twice daily on days 2 and 3, then 25 mg twice daily on days 4,5,6,and 7. On day 8 participants will begin taking 50 mg twice daily for the balance of the study.
| Study group | Role | What they receive |
|---|---|---|
| CBT and milnacipran | Experimental | Subjects randomized to this group will receive a combination of eight telephone sessions of Cognitive Behavior Therapy (CBT) and a 21-week regimen of milnacipran. Receives: Other: CBT and milnacipran |
| CBT and placebo | Placebo comparator | Subjects randomized to this arm will receive a series of eight telephone sessions of Cognitive Behavioral Therapy (CBT) along with a 21-week regimen of a placebo(sugar pill)medication. Receives: Behavioral: CBT with a placebo |
| Educational with milnacipran | Active comparator | Subjects randomized to this group will receive a series of eight educational phone calls regarding fibromyalgia along with a 21-week regimen of milnacipran. Receives: Drug: Educational with milnacipran |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Weekly Average Pain Intensity
Change in weekly average pain intensity score from baseline to week 21 (scale from -10 to +10; the more negative the value, the better in terms of pain reduction)
Measured: Baseline and Week 21clinic visits
Secondary outcomes (2)
Change in Evoked Pain Scores
0 to 20 pain scale, with higher pain score representing greater sensitivity to pressure pain stimuli
Measured: Baseline and Week 21 clinic visits
Identification of Group Assignment
Subjects identifying group assignment correctly
Measured: week 21
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Dec 2009 (estimated)
- Study startDec 2009
- Primary completionSep 2012
- Study completionSep 2012
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for FibromyalgiaStudies of the same condition, open and under way.
- More trials run by Indiana UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 58 participants (actual)
Sponsor and investigators
- Lead sponsor
- Indiana University
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- Responsible party
- Sponsor
- Investigators
- Dennis C. Ang, MD, Principal investigator, Indiana University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01038323
- Sponsor's protocol ID
- IU 0904-08
- Other IDs
- 1R21AR056046-01A2
- Status last verified
- Jan 2017
- First submitted
- 18 Dec 2009
- Last updated
- 6 Mar 2017
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Publications
Ang DC, Jensen MP, Steiner JL, Hilligoss J, Gracely RH, Saha C. Combining cognitive-behavioral therapy and milnacipran for fibromyalgia: a feasibility randomized-controlled trial. Clin J Pain. 2013 Sep;29(9):747-54. doi: 10.1097/AJP.0b013e31827a784e.
PubMed 23446065
Study at a glance
From the registry record, last updated by the sponsor on 6 Mar 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Pilot Study on the Combined Use of Cognitive Behavioral Therapy (CBT) and Milnacipran
- ClinicalTrials.gov ID
- NCT01038323
- Acronym / sponsor ID
- IU 0904-08
- Conditions
- Fibromyalgia
- Keywords
- Fibromyalgia, FMS
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 58 participants (actual)
- Lead sponsor
- Indiana UniversityUniversity, hospital or other
- Collaborators
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- Study start
- Dec 2009
- Primary completion
- Sep 2012 (actual)
- Study completion
- Sep 2012 (actual)
- First posted
- 23 Dec 2009 (estimated)
- Results
- Posted 21 Jul 2016
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Fibromyalgia Syndrome (FMS) afflicts 2% of the U.S. population and have huge individual and societal costs in terms of quality of life, social and work functioning, health care use, and lost productivity. Although single therapy approaches such as medication, graduated exercise, and Cognitive Behavioral Therapy (CBT) are well-established treatment approaches, the majority of FMS continue to report significant levels of pain and pain-related disability. Testing the efficacy of using combination therapies such and CBT with medication has considerable potential to maximize treatment response. Also, exploring the biological and psychological mechanisms underlying combination treatment may pave the way for developing new treatments for FMS sufferers.
We chose to study drug and CBT for several reasons: 1) the scarcity of trials that manipulate medications along with CBT in FMS, 2) the prohibitive nature of adding an exercise treatment arm in a study that has both time and budgetary constraints, 3) the complexity in understanding the mechanism of actions of 3 different modes of intervention in one clinical trial, and 4) the desire to explore mechanisms in this program of research, in particular the potential effects of a biological intervention (drug) on what is traditionally considered a psychological outcome (pain-related attributions and cognition) and the potential effects of a psychological intervention (CBT) on what is traditionally considered a physiological outcome (pain sensitivity).
Detailed description
Qualified participants will take part in a 21-week clinical research study entitled, "Drug and Talk Therapy for Fibromyalgia". We are doing this study to better understand how talk therapies, such as education and cognitive behavioral therapy (CBT), can improve the therapeutic benefits of drug for fibromyalgia.
Savella ®, (milnacipran) is an FDA approved drug for fibromyalgia. The safety and efficacy of Savella has been established in two US-based clinical studies involving over 2,000 patients with fibromyalgia. Because Savella has already been shown to be effective when used in isolation to treat fibromyalgia, we are conducting the study to determine whether combination treatment (Savella + talk therapy) is more efficacious than just Savella alone or talk therapy alone.
Volunteers will be randomized (like flipping a coin) on two different levels:
- Each participate will be randomized into one of two groups for medication: One group will receive Savella and the other group will receive a placebo (no medicinal value). Both the medication and the placebo will look identical and subjects will not be told into which group they have been placed until the completion of the study. Each participants has 66% chance of receiving Savella and 34% chance of getting the placebo.
- The second level of randomization will be to determine which type of talk therapies you will be assigned to. Subjects will be randomly assigned to receive educational instruction relevant to fibromyalgia, OR cognitive behavioral therapy which includes a workbook. Both talk therapies will be provided over the phone once a week for 8 weeks. Each phone session may last for 30 minutes. Importantly, both talk therapies can provide coping tools and information designed to help manage fibromyalgia symptoms.
Study Overview:
Subjects will be asked to visit the Fibromyalgia Clinical Research Center on five separate occasions: Initial Screening (today's visit), Week 1, Week 2, Week 9, and Week 21.
VISIT 1:
- Informed consent and initial screening questionnaire,physical assessment
- Issue a 'pain score' wrist monitor with instructions to record current pain level three times a day for one week
VISIT 2:
- Submit your pain recording
- Complete the self-assessment questionnaires via computer
- Vital signs check
- Undergo pain sensitivity testing
- If qualified, subjects be randomized to receive Savella or placebo AND to receive education or cognitive behavioral therapy
VISIT 3:
- We will assess the subject's willingness to continue participation.
- Review medication diary and medication side-effect checklist.
- Schedule PHONE Therapy sessions: 8 thirty minute calls
VISIT 4:
- One week prior to this visit, subjects will receive a 'pain score' monitor in order to enter current pain levels three times a day for one week. Then report for this visit.
- Review side effect checklist, medication diary.
- Completion of self-assessment questionnaires via computer
- Undergo pain sensitivity testing
VISIT 5:
- One week prior to this visit, subjects will receive a 'pain score' monitor in order to enter current pain levels three times a day for one week. Then report for this visit.
- Review side effect checklist, medication diary.
- Completion of self-assessment questionnaires via computer
- Undergo pain sensitivity testing
- Upon visit completion, participants will receive a reduced dose regimen of the medication along with written and verbal instructions to safely discontinue the study medication.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| CBT and milnacipran | Experimental | Other: CBT and milnacipranSubjects randomized to this group will receive a combination of eight telephone sessions of Cognitive Behavior Therapy (CBT) and a 21-week regimen of milnacipran. |
| CBT and placebo | Placebo comparator | Behavioral: CBT with a placeboSubjects randomized to this arm will receive a series of eight telephone sessions of Cognitive Behavioral Therapy (CBT) along with a 21-week regimen of a placebo(sugar pill)medication. |
| Educational with milnacipran | Active comparator | Drug: Educational with milnacipranSubjects randomized to this group will receive a series of eight educational phone calls regarding fibromyalgia along with a 21-week regimen of milnacipran. |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (33 listed)
- Must be between the ages of 18 to 65 years of age
- Must have been diagnosed with fibromyalgia by a rheumatologist
- Must have an overall body pain average score ≥ 4
- Must be on stable doses of your current medication for at least past four weeks
- Must report all medication including herbal supplements and over-the-counter medications that you are currently taking to a member of the research team.
Key exclusion criteria (0 listed)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CBT and milnacipranAlso: milnacipran, Savella, Cognitive Behavioral Therapy, CBTParticipants will receive a series of eight telephone sessions of CBT along with a 21-week regimen of milnacipran. Dosing for milnacipran begins with a one week "starter pack". Dosage:12.5 mg on day 1,12.5 mg twice daily on days 2 and 3, then 25 mg twice daily on days 4,5,6,and 7. On day 8 participants will begin taking 50 mg twice daily for the balance of the study. | Other | CBT and milnacipran |
| CBT with a placeboAlso: placebo, sugar pills, Cognitive Behavioral Therapy, CBTParticipants will receive a series of eight telephone sessions of CBT along with a 21-week regimen of a placebo. Dosing for the placebo begins with a one week "starter pack". Dosage: 12.5 mg on day 1,12.5 mg twice daily on days 2 and 3, then 25 mg twice daily on days 4,5,6,and 7. On day 8 participants will begin taking 50 mg twice daily for the balance of the study. | Behavioural | CBT and placebo |
| Educational with milnacipranAlso: fibromyalgia, fibromyalgia education, milnacipran, SavellaParticipants will receive a series of eight telephone sessions of fibromyalgia related education along with a 21-week regimen of milnacipran. Dosing for milnacipran begins with a one week "starter pack". Dosage:12.5 mg on day 1,12.5 mg twice daily on days 2 and 3, then 25 mg twice daily on days 4,5,6,and 7. On day 8 participants will begin taking 50 mg twice daily for the balance of the study. | Drug | Educational with milnacipran |
Primary outcome
Change in Weekly Average Pain Intensity
Time frame: Baseline and Week 21clinic visits
Change in weekly average pain intensity score from baseline to week 21 (scale from -10 to +10; the more negative the value, the better in terms of pain reduction)
2 secondary outcomes
Change in Evoked Pain Scores
Time frame: Baseline and Week 21 clinic visits
Identification of Group Assignment
Time frame: week 21
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Mar 2017.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 23446065Ang DC, Jensen MP, Steiner JL, Hilligoss J, Gracely RH, Saha C. Combining cognitive-behavioral therapy and milnacipran for fibromyalgia: a feasibility randomized-controlled trial. Clin J Pain. 2013 Sep;29(9):747-54. doi: 10.1097/AJP.0b013e31827a784e.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Dennis C. Ang, MD principal investigator
Indiana University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing CBT and milnacipran and Educational with milnacipran in people with Fibromyalgia, run by Indiana University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 33 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 Mar 2017. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 21 Jul 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Weekly Average Pain Intensity (time frame: Baseline and Week 21clinic visits). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01038323, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Mar 2017.