Coronary Artery DiseaseBIOFLOW-48NCT06779630
Safety and Effectiveness of the Orsiro Mission 48-mm Sirolimus Eluting Coronary Stent System in Subjects With Coronary Artery Lesions
A study testing Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System in people with Coronary Artery Disease, run by Teleflex at 23 sites in 6 countries.
Trial summary
The purpose of the study is to assess the safety and efficacy of the Orsiro® Mission 48- mm Sirolimus-Eluting Coronary Stent System in the treatment of subjects with atherosclerotic lesion(s) >36 mm and ≤ 44 mm in length (by visual estimate) in the native coronary arteries with a reference vessel diameter of 2.25 mm… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Coronary Artery Disease
- What is being tested?
- Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 150 participants
- Where
- 23 sitesin 6 countries
- Study dates
- 18 Jul 2025to Sep 2031
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Subject is ≥ 18 years of age
- Subject is able to understand the nature of the study and provide written informed consent.
- For sites outside of the United States: Note: For subjects presenting with STEMI and not in a position to read, interpret and sign the informed consent form, oral informed consent is required.
- Subject is an acceptable candidate for percutaneous coronary intervention (PCI) according to the applicable guidelines.
- Subject is an acceptable candidate for CABG.
- Subject is eligible for dual antiplatelet therapy (DAPT) according to guidelines.
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- Subject has clinical evidence of ischemic heart disease, stable or unstable angina pectoris or documented silent ischemia.
- Subject is willing and able to comply with study follow-up requirements.
- Angiographic inclusion criteria:
- Subject has only one target lesion in a native coronary artery to be treated with the investigational device.
- Note: One additional non-target lesion may be treated with a non-investigational treatment (e.g. stent, balloon angioplasty, atherectomy) with the exception of brachytherapy, if it is located in a different coronary artery. The non-target lesion must be treated first and must be deemed an angiographic success. (Angiographic success is defined by a residual diameter stenosis < 30% with TIMI 3 flow, as visually assessed by the physician, without the presence of prolonged chest pain or ECG changes consistent with MI.)
- Note: Multiple focal stenoses will be considered as a single lesion if they are amenable to treatment with a single study device.
- Target lesion must be > 36 mm and ≤ 44 mm in length by operator visual estimate and must be amenable to treatment with a single study device.
- Target vessel must have a reference vessel diameter of 2.25-4.0 mm by operator visual estimate.
- For sites in United States: Target lesion must be de novo or restenotic lesion in native coronary artery; restenotic lesion must have been treated with a standard PTCA only.
- For sites outside of the United States: Target lesion can be de novo, restenotic or in-stent restenotic, and must be located in a native coronary artery.
- Target lesion must have angiographic evidence of ≥ 50% and < 100% stenosis (by operator visual estimate which may be assisted by QCA / IVUS / OCT). Target lesion stenosis < 70% should have clinical justification for treatment as per local standards.
- Target vessel must have a Thrombolysis In Myocardial Infarction (TIMI) flow > 1.
- For sites outside of the United States: Note: For STEMI, TIMI flow > 1 prior to stent implantation (after opening the vessel with a guide wire or a balloon).
Who cannot join
- For sites in United States only: Subject has clinical symptoms and/or electrocardiogram (ECG) changes consistent with acute ST elevation myocardial infarction (STEMI) within 72 hours prior to the index procedure.
- Note: Hemodynamically stable non-STEMI (NSTEMI) subjects are eligible for study enrollment.
- Subject is hemodynamically unstable.
- Subject is pregnant and/or breastfeeding or intends to become pregnant during the duration of the study.
- Subject has a known allergy to contrast medium that cannot be adequately pre-medicated, or any known allergy to thienopyridine, aspirin, both heparin and bivalirudin, L-605 cobalt-chromium (Co-Cr) alloy or one of its major elements (cobalt, chromium, tungsten and nickel), acrylic, fluoropolymers, silicon carbide, PLLA or sirolimus.
- Revascularization of any target vessel within 12 months prior to the index procedure or previous PCI of any non-target vessel within <72 hours prior to the index procedure.
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- Future planned PCI (including staged procedure) or CABG after the index procedure.
- Planned surgery or dental surgical procedure within 6 months of index procedure unless dual antiplatelet therapy can be maintained throughout the peri-surgical period.
- History of a stroke or transient ischemic attack (TIA) within 6 months prior to the index procedure.
- Subjects with active bleeding disorders, active coagulopathy, or any other reason, who are ineligible for DAPT.
- Subject will refuse blood transfusions.
- Subject has a left ventricular ejection fraction (LVEF) < 30% within 6 months prior to or during the index procedure that was documented by any method.
- Subject is dialysis dependent or has impaired renal function (i.e., serum creatinine > 2.5 mg/dL or 221 µmol/L, determined within 7 days prior to the index procedure).
- Subject has a documented white blood cell count < 3,000 white blood cells/mm3 or a documented platelet count < 100,000 platelets/mm3 or > 700,000 platelets/mm3.
- Subject is receiving oral or intravenous immunosuppressive therapy (inhaled steroids are permitted) or has known life-limiting immunosuppressive or autoimmune disease (e.g., human immunodeficiency virus, systemic lupus erythematosus; diabetes mellitus is permitted).
- Subject is receiving or scheduled to receive chemotherapy within 30 days before or after the index procedure or has a malignancy that is not in remission.
- Subjects under oral anticoagulation therapy (OAC) prior to index procedure unless DAPT + OAC (i.e. triple therapy) can be maintained according to guidelines.
- Subject has life expectancy of < 1 year.
- Subject is currently participating or plans to participate in another clinical investigation with an investigational device or an investigational drug.
- In the investigator's opinion, subject will not be able to comply with the follow-up requirements.
- Angiographic exclusion criteria:
- Target lesion is excluded if it meets any of the following criteria:
- Lesion is located within or treated through a saphenous vein graft or arterial graft.
- Lesion location is within the left main coronary artery.
- Lesion location is within 3 mm of the origin of the left anterior descending (LAD) or left circumflex (LCX) coronary arteries.
- Involves a side branch of > 2.0 mm in diameter that requires a two-device strategy after pre-dilatation.
- Lesion is totally occluded (100% stenosis).
- For sites in United States only: Lesion is a restenotic lesion that was previously treated with a bare metal or drug eluting stent (in-stent restenosis).
- Target vessel/lesion is excessively tortuous/angulated or is severely calcified, that would prevent complete inflation of an angioplasty balloon. This assessment should be based on visual estimation.
- Site sites in the United States: Target vessel has angiographic evidence of thrombus.
- For sites outside of the United States: Target vessel has angiographic evidence of unresolved large thrombus burden despite of thrombus aspiration.
- Note: Thrombus aspiration is left at the discretion of the implanting physician.
- Target vessel was treated with brachytherapy any time prior to the index procedure.
- Unsuccessful target lesion pre-dilatation, defined as residual stenosis > 50% (by visual estimation) and/or angiographic complications (e.g., distal embolization, side branch closure, dissection greater than National Heart, Lung, Blood Institute type C), and/or, for sites outside of the United States, coronary aneurysms.
- Non-target lesion is excluded if it meets any of the following criteria:
- Any of the target lesion angiographic exclusion criteria except for 1c
- Lesion is located within the target vessel.
- Lesion is > 36 mm by operator visual estimate.
- Lesion requires additional, unplanned stents to treat a complication.
- Lesion treatment is not deemed an angiographic success. (Angiographic success is defined by a residual diameter stenosis < 30% with TIMI 3 flow, as visually assessed by the physician, without the presence of prolonged chest pain or ECG changes consistent with MI.)
Trial locations and contacts
23 sites in 6 countries. Contact the study team or a site near you to ask about taking part.
23 sites in 6 countries
United States10 sites, 10 recruiting
- Recruiting
Massachusetts General Hospital
Boston, Massachusetts, 02114
- Recruiting
Charleston Area Medical Center
Charleston, West Virginia, 25304
- Recruiting
John Muir Medical Center
Concord, California, 94520
- Recruiting
Baylor Scott & White The Heart Hospital - Dallas
Dallas, Texas, 75226
- Recruiting
Henry Ford Hospital
Detroit, Michigan, 48202
- Recruiting
Ascension Texas Cardiovascular
Kyle, Texas, 78640
- Recruiting
North Shore University Hospital
Manhasset, New York, 11030
- Recruiting
Columbia University Irving Medical Center/New York Presbyterian Hospital
New York, New York, 10032
- Recruiting
Barnes Jewish Hospital
St Louis, Missouri, 63110
- Recruiting
Ascension Via Christi Hospitals Wichita
Wichita, Kansas, 67214
France4 sites
- Active, not recruiting
Clinique Louis Pasteur
Essey-lès-Nancy, Grand Est, 54270
- Active, not recruiting
Hospices Civils de Lyon - CHU de Lyon
Lyon, Auvergne-Rhône-Alpes, 69002
- Active, not recruiting
Hôpital Cochin - Groupe AP-HP
Paris, Île-de-France Region, 75014
- Active, not recruiting
Institut Arnault Tzanck
Saint-Laurent-du-Var, Provence-Alpes-Côte d'Azur Region, 06700
Germany4 sites
- Active, not recruiting
Segeberger Kliniken GmbH
Bad Segeberg, Schleswig-Holstein, 23795
- Active, not recruiting
Klinikum Fürth
Fürth, Bavaria, 90766
- Active, not recruiting
Universitätsklinikum Mannheim, I. Medizinische Klinik
Mannheim, Baden-Wurttemberg, 68167
- Withdrawn
Universitätsklinikum Würzburg
Würzburg, Bavaria, 97080
Austria2 sites
- Active, not recruiting
Klinische Abteilung für Kardiologie, Medizinische Universität Graz
Graz, Styria, 8036
- Active, not recruiting
Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien
Vienna, State of Vienna, 1090
Switzerland2 sites
- Active, not recruiting
University hospital Basel
Basel, Canton of Basel-City, 4031
- Active, not recruiting
Istituto Cardiocentro Ticino
Lugano, Canton Ticino, 6900
Poland1 site
- Active, not recruiting
Miedziowe Centrum Zdrowia SA
Lubin, Lower Silesian Voivodeship, 59-301
About this study
Official title: A Prospective Multicenter Single Arm Study to Assess the Safety and Effectiveness of the Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System for the Treatment of Subjects With Atherosclerotic Lesion(s)
The purpose of the study is to assess the safety and efficacy of the Orsiro® Mission 48- mm Sirolimus-Eluting Coronary Stent System in the treatment of subjects with atherosclerotic lesion(s) >36 mm and ≤ 44 mm in length (by visual estimate) in the native coronary arteries with a reference vessel diameter of 2.25 mm to 4.0 mm.
Patients enrolled in the United States will be followed for 2 years post index procedure with follow-up visits at 1, 6, 12 months and 2 years post index procedure. Patients enrolled outside of the United States will be followed through 5 years post index procedure with additional follow-up visits at 3 and 5 years post index procedure.
- Conditions
- Coronary Artery Disease
- Being tested
- Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System
- Keywords
- Orsiro Mission, Sirolimus-Eluting, Coronary Stent System, coronary artery disease
- Medical subject headings
- Coronary Artery Disease
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent SystemDevice
Orsiro Mission is composed of a device (coronary stent system including a cobalt chromium stent platform) and a drug product (a formulation of sirolimus) contained in a bioabsorbable polymer coating.
| Study group | Role | What they receive |
|---|---|---|
| Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System | Experimental | Not described Receives: Device: Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System |
What is being measured
The primary outcome is the main question the study is designed to answer.
Target Lesion Failure (TLF) rate at 12 months post-index procedure
The primary endpoint will be target lesion failure (TLF) rate at 12 months post-index procedure. TLF is defined as a composite of cardiac death, target vessel Q-wave or non-Q-wave myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR).
Measured: 12 months
Secondary outcomes (11)
Device success
Device success, defined as attainment of < 30% residual stenosis of the target lesion (based on operator visual estimate) using the Orsiro Mission study stent only.
Measured: Hospital Discharge (6-24 hours post-index procedure)
Procedure success
Procedure success, defined as attainment of < 30% residual stenosis of the target lesion (based on operator visual estimate) using the Orsiro Mission study stent only without occurrence of in-hospital major adverse cardiac events (MACE).
Measured: Hospital Discharge (6-24 hours post-index procedure)
All-cause death
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Any myocardial infarction (MI)
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Cardiac death or myocardial infarction (MI)
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Major cardiac adverse events (MACE) and individual MACE components
MACE is defined as a composite of all-cause death, Q-wave or non-Q-wave MI, and any clinically driven target lesion revascularization (TLR).
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target lesion failure (TLF) and individual TLF components
TLF is defined as a composite of cardiac death, target vessel Q-wave or non-Q-wave myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR).
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target vessel failure (TVF) and individual TVF components
TVF is defined as a composite of cardiac death, target vessel Q-wave or non-Q-wave myocardial infarction (TV-MI), and clinically driven target vessel revascularization (CD-TVR).
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target lesion revascularization (TLR)
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target vessel revascularization (TVR)
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Stent thrombosis
Stent thrombosis will be assessed according to Academic Research Consortium - 2 (ARC-2) definitions.
Measured: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Jan 2025
- Study start18 Jul 2025
- Primary completionSep 2027 (estimated)
- Study completionSep 2031 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Coronary Artery DiseaseStudies of the same condition, open and under way.
- 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 N/A
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 150 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Teleflex
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- BIOTRONIK AG (A Teleflex Company)
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06779630
- Sponsor's protocol ID
- G240288
- Acronym
- BIOFLOW-48
- Status last verified
- Jan 2026
- First submitted
- 14 Jan 2025
- Last updated
- 5 Nov 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- Yes
- Individual data sharing
- No: No IPD sharing is planned at this time. This study evaluates an investigational device under an FDA IDE. The sponsor may consider sharing de-identified IPD under controlled access following completion of primary endpoint analysis and regulatory review. Summary results will be reported in scientific publications and public registries.
Study at a glance
From the registry record, last updated by the sponsor on 5 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Prospective Multicenter Single Arm Study to Assess the Safety and Effectiveness of the Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System for the Treatment of Subjects With Atherosclerotic Lesion(s)
- ClinicalTrials.gov ID
- NCT06779630
- Acronym / sponsor ID
- BIOFLOW-48 / G240288
- Conditions
- Coronary Artery Disease
- Keywords
- Orsiro Mission, Sirolimus-Eluting, Coronary Stent System, coronary artery disease
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 150 participants (estimated)
- Lead sponsor
- TeleflexIndustry (pharma, biotech, devices)
- Collaborators
- BIOTRONIK AG (A Teleflex Company)
- Study start
- 18 Jul 2025 (actual)
- Primary completion
- Sep 2027 (estimated)
- Study completion
- Sep 2031 (estimated)
- First posted
- 16 Jan 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of the study is to assess the safety and efficacy of the Orsiro® Mission 48- mm Sirolimus-Eluting Coronary Stent System in the treatment of subjects with atherosclerotic lesion(s) >36 mm and ≤ 44 mm in length (by visual estimate) in the native coronary arteries with a reference vessel diameter of 2.25 mm to 4.0 mm.
Patients enrolled in the United States will be followed for 2 years post index procedure with follow-up visits at 1, 6, 12 months and 2 years post index procedure. Patients enrolled outside of the United States will be followed through 5 years post index procedure with additional follow-up visits at 3 and 5 years post index procedure.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System | Experimental | Device: Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (19 listed)
- Subject is ≥ 18 years of age
- Subject is able to understand the nature of the study and provide written informed consent.
- For sites outside of the United States: Note: For subjects presenting with STEMI and not in a position to read, interpret and sign the informed consent form, oral informed consent is required.
- Subject is an acceptable candidate for percutaneous coronary intervention (PCI) according to the applicable guidelines.
- Subject is an acceptable candidate for CABG.
Key exclusion criteria (40 listed)
- For sites in United States only: Subject has clinical symptoms and/or electrocardiogram (ECG) changes consistent with acute ST elevation myocardial infarction (STEMI) within 72 hours prior to the index procedure.
- Note: Hemodynamically stable non-STEMI (NSTEMI) subjects are eligible for study enrollment.
- Subject is hemodynamically unstable.
- Subject is pregnant and/or breastfeeding or intends to become pregnant during the duration of the study.
- Subject has a known allergy to contrast medium that cannot be adequately pre-medicated, or any known allergy to thienopyridine, aspirin, both heparin and bivalirudin, L-605 cobalt-chromium (Co-Cr) alloy or one of its major elements (cobalt, chromium, tungsten and nickel), acrylic, fluoropolymers, silicon carbide, PLLA or sirolimus.
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 |
|---|---|---|
| Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent SystemOrsiro Mission is composed of a device (coronary stent system including a cobalt chromium stent platform) and a drug product (a formulation of sirolimus) contained in a bioabsorbable polymer coating. | Device | Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System |
Primary outcome
Target Lesion Failure (TLF) rate at 12 months post-index procedure
Time frame: 12 months
The primary endpoint will be target lesion failure (TLF) rate at 12 months post-index procedure. TLF is defined as a composite of cardiac death, target vessel Q-wave or non-Q-wave myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR).
11 secondary outcomes
Device success
Time frame: Hospital Discharge (6-24 hours post-index procedure)
Procedure success
Time frame: Hospital Discharge (6-24 hours post-index procedure)
All-cause death
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Any myocardial infarction (MI)
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Cardiac death or myocardial infarction (MI)
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Major cardiac adverse events (MACE) and individual MACE components
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target lesion failure (TLF) and individual TLF components
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target vessel failure (TVF) and individual TVF components
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target lesion revascularization (TLR)
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Target vessel revascularization (TVR)
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Stent thrombosis
Time frame: 1, 6, 12 months and 2, 3, and 5 years post-index procedure
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Nov 2026.
- Individual participant dataSharing planned: No. No IPD sharing is planned at this time. This study evaluates an investigational device under an FDA IDE. The sponsor may consider sharing de-identified IPD under controlled access following completion of primary endpoint analysis and regulatory review. Summary results will be reported in scientific publications and public registries.
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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.
23 sites in 6 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Orsiro Mission 48-mm Sirolimus-Eluting Coronary Stent System in people with Coronary Artery Disease, run by Teleflex at 23 sites in 6 countries.
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 19 inclusion and 40 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: looking for participants now, as of the sponsor's last update on 5 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 23 sites in United States, France, Germany, Austria, Switzerland and 1 more country. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact BIOFLOW-48 Project Manager (1-866-246-6990, bioflow-48@teleflex.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Target Lesion Failure (TLF) rate at 12 months post-index procedure (time frame: 12 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 5 Nov 2026.