Cystic Fibrosis Clinical Trial
Official title:
A Phase 3, Open-label Study Evaluating the Long Term Safety and Efficacy of VX-659 Combination Therapy in Subjects With Cystic Fibrosis Who Are Homozygous or Heterozygous for the F508del Mutation
Verified date | December 2021 |
Source | Vertex Pharmaceuticals Incorporated |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study will evaluate the long-term safety and tolerability of VX-659 in triple combination (TC) with tezacaftor (TEZ) and ivacaftor (IVA) in subjects with cystic fibrosis (CF) who are homozygous or heterozygous for the F508del mutation.
Status | Terminated |
Enrollment | 484 |
Est. completion date | September 9, 2020 |
Est. primary completion date | September 9, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 12 Years and older |
Eligibility | Inclusion Criteria: - Completed study drug treatment in a parent study; or had study drug interruption(s) in a parent study but completed study visits up to the last scheduled visit of the Treatment Period in the parent study. Exclusion Criteria: - History of drug intolerance in a parent study that would pose an additional risk to the subject in the opinion of the investigator. - Current participation in an investigational drug trial (other than a parent study) Other protocol defined Inclusion/Exclusion criteria may apply. |
Country | Name | City | State |
---|---|---|---|
Australia | Royal Adelaide Hospital | Adelaide | |
Australia | The Prince Charles Hospital | Chermside | |
Australia | Alfred Hospital | Melbourne | |
Australia | Institute for Respiratory Health, Sir Charles Gairdner Hospital | Nedlands | |
Australia | John Hunter Hospital & Hunter Medical Research Institute and John Hunter Children's Hospital | New Lambton | |
Australia | Telethon Kids Institute | Perth | |
Australia | Sydney Children's Hospital | Randwick | |
Australia | Lady Cilento Children's Hospital | South Brisbane | |
Canada | Stollery Children's Hospital | Edmonton | |
Canada | Queen Elizabeth II Health Sciences Center | Halifax | |
Canada | St. Michael's Hospital | Toronto | |
Denmark | Juliane Marie Center, Rigshospitalet | Copenhagen | |
Germany | Charite Paediatric Pulmonology Department | Berlin | |
Germany | Ruhrlandklinik Westdeutsches Lungenzentrum am Klinikum Essen | Essen | |
Germany | Clinic of J.W. Goethe University | Frankfurt | |
Germany | Medizinische Hochschule Hannover | Hannover | |
Germany | Mukeviszidose-Zentrum am Universitatsklinikum Jena, Klinik fuer Kinder- und Jugendmedizin | Jena | |
Germany | Universitaetsklinkum Koeln, CF-Studienzentrum | Koeln | |
Germany | Universitatsklinikum Schleswig-Holstein, Klinik für Kinder- und Jugendmedizin | Lubeck | |
Germany | Pneumologische Praxis Pasing | Muenchen | |
Germany | Klinikum Innenstadt, University of Munich | München | |
Ireland | Cork University Hospital | Cork | |
Ireland | Beaumont Hospital | Dublin | |
Ireland | Our Lady's Children's Hospital | Dublin | |
Ireland | St. Vincent's University Hospital | Dublin | |
Ireland | Temple Street Children's University Hospital | Dublin | |
Ireland | University Hospital Galway | Galway | |
Ireland | University Hospital Limerick | Limerick | |
Israel | Lady Davis Carmel Medical Center | Haifa | |
Israel | Rambam Health Care Campus, Liver Unit | Haifa | |
Israel | Pediatrics Hadassah Medical Center | Jerusalem | |
Israel | Schneider Children's Medical Center | Petah Tikva | |
Israel | Sheba Medical Center | Tel HaShomer | |
Poland | Klinika Mukowiscydozy IMD Oddozial Chorob Pluc Szpzoz IM. Dzieci WarszaWY | Lomianki | |
Spain | Hospital Universitari Vall d Hebron | Barcelona | |
Spain | Hospital Universitari Vall d´Hebron Servicio de Broncoscopia | Barcelona | |
Spain | Hospital Universitario 12 de Octubre | Madrid | |
Spain | Hospital Universitario Infantil La Paz | Madrid | |
Spain | Parc Tauli Sabadell Hospital Universitari | Sabadell | |
Spain | Hospital Universitario Virgen del Rocio | Sevilla | |
Spain | Hospital Universitario y Politecnico La Fe | Valencia | |
Switzerland | Lindenhofspital - Quartier Bleu | Bern | |
Switzerland | Kinderspital Zuerich | Zürich | |
United Kingdom | Papworth Hospital NHS Foundation Trust, Papworth Everard | Cambridge | |
United Kingdom | Clinical Research Facility, Queen Elizabeth University Hospital | Glasgow | |
United Kingdom | St. James University Hospital | Leeds | |
United Kingdom | Liverpool Head and Chest Hospital | Liverpool | |
United Kingdom | Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital | London | |
United Kingdom | Wythenshaw e Hospital | Manchester | |
United Kingdom | The Newcastle upon Tyne Hospitals NHS Foundation Trust, The Royal Victoria Infirmary | Newcastle Upon Tyne | |
United Kingdom | Wolfson Cystic Fibrosis Unit, City Campus | Nottingham | |
United Kingdom | All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough | Penarth | |
United States | Albany Medical College | Albany | New York |
United States | Michigan Medicine | Ann Arbor | Michigan |
United States | Children's Hospital Colorado | Aurora | Colorado |
United States | Johns Hopkins Hospital | Baltimore | Maryland |
United States | University of Alabama at Birmingham | Birmingham | Alabama |
United States | St. Luke's CF Center of Idaho | Boise | Idaho |
United States | Boston Children's Hospital | Boston | Massachusetts |
United States | CF Therapeutics Development Center of Western New York | Buffalo | New York |
United States | Clinical Research of Charlotte | Charlotte | North Carolina |
United States | Cincinnati Children's Hospital | Cincinnati | Ohio |
United States | Duke University Medical Center | Durham | North Carolina |
United States | Cook Children's Medical Center | Fort Worth | Texas |
United States | Cystic Fibrosis Center of Chicago | Glenview | Illinois |
United States | Spectrum Health Medical Group Adult Cystic Fibrosis Care Center | Grand Rapids | Michigan |
United States | Hartford Hospital | Hartford | Connecticut |
United States | Texas Children's Hospital | Houston | Texas |
United States | Indiana Clinical Research Center, IU Health University Hospital | Indianapolis | Indiana |
United States | The University of Iowa Hospitals and Clinics | Iowa City | Iowa |
United States | University of Mississippi Medical Center | Jackson | Mississippi |
United States | The Children's Mercy Hospital | Kansas City | Missouri |
United States | University of Tennessee Medical Center- Adult Cystic Fibrosis Clinic | Knoxville | Tennessee |
United States | University of Kentucky | Lexington | Kentucky |
United States | Kosair Charities Pediatric Clinical Research Unit | Louisville | Kentucky |
United States | Dartmouth Hitchcock, Manchester | Manchester | New Hampshire |
United States | Children's Foundation Research Center / Le Bonheur Children's Hospital | Memphis | Tennessee |
United States | Nicklaus Children's Hospital | Miami | Florida |
United States | University of Miami Miller School of Medicine | Miami | Florida |
United States | University of Minnesota | Minneapolis | Minnesota |
United States | Vanderbilt University Medical Center | Nashville | Tennessee |
United States | Rutgers-Robert Wood Johnson Medical School | New Brunswick | New Jersey |
United States | Yale New Haven Medical Center | New Haven | Connecticut |
United States | Northwell Health, Long Island Jewish Medical Center | New Hyde Park | New York |
United States | Columbia University Medical Center | New York | New York |
United States | Advocate Children's Hospital - Park Ridge / North Suburban Pulmonary and Critical Care Consultants | Niles | Illinois |
United States | Santiago Reyes, M.D. | Oklahoma City | Oklahoma |
United States | Orlando Health, Inc.- Arnold Palmer Hospital for Children (APH) | Orlando | Florida |
United States | Stanford University | Palo Alto | California |
United States | Drexel University College of Medicine / Drexel Adult Cystic Fibrosis Center | Philadelphia | Pennsylvania |
United States | Children's Hospital of Pittsburgh of UPMC | Pittsburgh | Pennsylvania |
United States | Oregon Health & Science University | Portland | Oregon |
United States | Washington University School of Medicine/ St. Louis Children's Hospital | Saint Louis | Missouri |
United States | Johns Hopkins All Children's Hospital Outpatient Care Center | Saint Petersburg | Florida |
United States | University of Utah/ Primary Children's Medical Center | Salt Lake City | Utah |
United States | Seattle Children's Hospital | Seattle | Washington |
United States | Sanford Children's Specialty Clinic | Sioux Falls | South Dakota |
United States | Providence Pediatric Pulmonary & Cystic Fibrosis Clinic | Spokane | Washington |
United States | SUNY Upstate Medical University | Syracuse | New York |
United States | UMass Memorial Medical Center | Worcester | Massachusetts |
Lead Sponsor | Collaborator |
---|---|
Vertex Pharmaceuticals Incorporated |
United States, Australia, Canada, Denmark, Germany, Ireland, Israel, Poland, Spain, Switzerland, United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Safety and Tolerability as Assessed by Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs) | From Day 1 up to 28 Days After Last Dose of Study Drug or to the Completion of Study Participation Date, Whichever Occurs First in the Current Study 659-105 (up to Week 100) | ||
Secondary | Absolute Change in Percent Predicted Forced Expiratory Volume in 1 Second (ppFEV1) for Participants From the Parent Study 659-102 | FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration. The analysis was planned to be reported separately for Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-102 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) | |
Secondary | Absolute Change in ppFEV1 for Participants From the Parent Study 659-103 | FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration. The analysis was planned to be reported separately for TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-103 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) | |
Secondary | Absolute Change in Sweat Chloride (SwCl) for Participants From the Parent Study 659-102 | Sweat samples were collected using an approved collection device. The analysis was planned to be reported separately for Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-102 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 24 (Study 659-105) | |
Secondary | Absolute Change in SwCl for Participants From the Parent Study 659-103 | Sweat samples were collected using an approved collection device. The analysis was planned to be reported separately for TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-103 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 24 (Study 659-105) | |
Secondary | Number of Pulmonary Exacerbations (PEx) for Participants From the Parent Study 659-102 | PEx was defined as treatment with new or changed antibiotic therapy (intravenous, inhaled, or oral) for at least 4 sinopulmonary signs/symptoms. The analysis was planned to be reported separately for Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in the parent study 659-102 or/and VX-659/TEZ/IVA in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline except for Placebo - VX-659/TEZ/IVA category, for which the baseline was defined as study 659-105 baseline. | From Baseline up to Week 96 (Study 659-105) | |
Secondary | Number of PEx for Participants From the Parent Study 659-103 | PEx was defined as treatment with new or changed antibiotic therapy (intravenous, inhaled, or oral) for at least 4 sinopulmonary signs/symptoms. The analysis was planned to be reported for overall participants from the parent study 659-103, that is combined for TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in the parent study 659-103 or/and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline except for TEZ/IVA - VX-659/TEZ/IVA category, for which the baseline was defined as study 659-105 baseline. | From Baseline up to Week 96 (Study 659-105) | |
Secondary | Number of Participants With at Least One PEx for Participants From the Parent Study 659-102 | PEx was defined as treatment with new or changed antibiotic therapy (intravenous, inhaled, or oral) for at least 4 sinopulmonary signs/symptoms. The time-to-first-PEx data were planned to be estimated using the Kaplan-Meier (KM) method. However, because way less than 50% of participants had events, median time-to-first event data were not estimable. Instead, the number of participants with at least one PEx event was assessed and reported separately for those in Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and the VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in the parent study 659-102 or/and VX-659/TEZ/IVA in the current study 659-105). Baseline was defined as the parent study baseline except for Placebo - VX-659/TEZ/IVA category, for which the baseline was defined as study 659-105 baseline. | From Baseline up to Week 96 (Study 659-105) | |
Secondary | Number of Participants With at Least One PEx for Participants From the Parent Study 659-103 | PEx was defined as treatment with new or changed antibiotic therapy (intravenous, inhaled, or oral) for at least 4 sinopulmonary signs/symptoms. The time-to-first-PEx data were planned to be estimated using the KM method. However, because way less than 50% of participants had events, median time-to-first-event data were not estimable. Instead, the number of participants with at least one PEx event was assessed and reported for all participants from the parent study 659-103, that is combined for those in the TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and the VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in the parent study 659-103 or/and in the current study 659-105). Baseline was defined as the parent study baseline except for TEZ/IVA - VX-659/TEZ/IVA category, for which the baseline was defined as study 659-105 baseline. | From Baseline up to Week 96 (Study 659-105) | |
Secondary | Absolute Change in Body Mass Index (BMI) for Participants From the Parent Study 659-102 | BMI was defined as weight in kilograms (kg) divided by squared height in meters (m^2). The analysis was planned to be reported separately for Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-102 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) | |
Secondary | Absolute Change in BMI for Participants From the Parent Study 659-103 | BMI was defined as weight in kg divided by squared height in meters (m^2). The analysis was planned to be reported separately for TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-103 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) | |
Secondary | Absolute Change in BMI Z-score for Participants From the Parent Study 659-102 (Participants <=20 Years Old at Parent Study Baseline) | BMI was defined as weight in kg divided by squared height in meters (m^2). The z-score is a statistical measure to describe whether a value was above or below the standard. A z-score of 0 is equal to the standard. Lower numbers indicate values lower than the standard and higher numbers indicate values higher than the standard. The analysis was planned to be reported separately for Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-102 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 60 (Study 659-105) | |
Secondary | Absolute Change in BMI Z-score for Participants From The Parent Study 659-103 (Participants <=20 Years Old at Parent Study Baseline) | BMI was defined as weight in kg divided by squared height in meters (m^2). The z-score is a statistical measure to describe whether a value was above or below the standard. A z-score of 0 is equal to the standard. Lower numbers indicate values lower than the standard and higher numbers indicate values higher than the standard. The analysis was planned to be reported separately for TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-103 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 60 (Study 659-105) | |
Secondary | Absolute Change in Body Weight for Participants From the Parent Study 659-102 | The analysis was planned to be reported separately for Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-102 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) | |
Secondary | Absolute Change in Body Weight for Participants From the Parent Study 659-103 | The analysis was planned to be reported separately for TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-103 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) | |
Secondary | Absolute Change in Cystic Fibrosis Questionnaire-Revised (CFQ-R) Respiratory Domain Score for Participants From the Parent Study 659-102 | The CFQ-R is a validated participant-reported outcome measuring health-related quality of life for participants with cystic fibrosis. Respiratory domain assessed respiratory symptoms, score range: 0-100; higher scores indicating fewer symptoms and better health-related quality of life. The analysis was planned to be reported separately for Placebo - VX-659/TEZ/IVA category (participants who received placebo in the parent study 659-102 and VX-659/TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-102 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) | |
Secondary | Absolute Change in CFQ-R Respiratory Domain Score for Participants From the Parent Study 659-103 | The CFQ-R is a validated participant-reported outcome measuring health-related quality of life for participants with cystic fibrosis. Respiratory domain assessed respiratory symptoms, score range: 0-100; higher scores indicating fewer symptoms and better health-related quality of life. The analysis was planned to be reported separately for TEZ/IVA - VX-659/TEZ/IVA category (participants who received TEZ/IVA in the parent study 659-103 and VX-659-TEZ/IVA in the current study 659-105) and VX-659/TEZ/IVA - VX-659/TEZ/IVA category (participants who received VX-659/TEZ/IVA in both the parent study 659-103 and in the current study 659-105) as pre-specified in analysis plan. Baseline was defined as the parent study baseline. | From Baseline at Week 72 (Study 659-105) |
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT04696198 -
Thoracic Mobility in Cystic Fibrosis Care
|
N/A | |
Completed |
NCT00803205 -
Study of Ataluren (PTC124™) in Cystic Fibrosis
|
Phase 3 | |
Terminated |
NCT04921332 -
Bright Light Therapy for Depression Symptoms in Adults With Cystic Fibrosis (CF) and COPD
|
N/A | |
Completed |
NCT03601637 -
Safety and Pharmacokinetic Study of Lumacaftor/Ivacaftor in Participants 1 to Less Than 2 Years of Age With Cystic Fibrosis, Homozygous for F508del
|
Phase 3 | |
Terminated |
NCT02769637 -
Effect of Acid Blockade on Microbiota and Inflammation in Cystic Fibrosis (CF)
|
||
Recruiting |
NCT06012084 -
The Development and Evaluation of iCF-PWR for Healthy Siblings of Individuals With Cystic Fibrosis
|
N/A | |
Recruiting |
NCT06030206 -
Lung Transplant READY CF 2: A Multi-site RCT
|
N/A | |
Recruiting |
NCT06032273 -
Lung Transplant READY CF 2: CARING CF Ancillary RCT
|
N/A | |
Recruiting |
NCT05392855 -
Symptom Based Performance of Airway Clearance After Starting Highly Effective Modulators for Cystic Fibrosis (SPACE-CF)
|
N/A | |
Recruiting |
NCT06088485 -
The Effect of Bone Mineral Density in Patients With Adult Cystic Fibrosis
|
||
Recruiting |
NCT04039087 -
Sildenafil Exercise: Role of PDE5 Inhibition
|
Phase 2/Phase 3 | |
Recruiting |
NCT04056702 -
Impact of Triple Combination CFTR Therapy on Sinus Disease.
|
||
Completed |
NCT04038710 -
Clinical Outcomes of Triple Combination Therapy in Severe Cystic Fibrosis Disease.
|
||
Completed |
NCT04058548 -
Clinical Utility of the 1-minute Sit to Stand Test as a Measure of Submaximal Exercise Tolerance in Patients With Cystic Fibrosis During Acute Pulmonary Exacerbation
|
N/A | |
Completed |
NCT03637504 -
Feasibility of a Mobile Medication Plan Application in CF Patient Care
|
N/A | |
Recruiting |
NCT03506061 -
Trikafta in Cystic Fibrosis Patients
|
Phase 2 | |
Completed |
NCT03566550 -
Gut Imaging for Function & Transit in Cystic Fibrosis Study 1
|
||
Recruiting |
NCT04828382 -
Prospective Study of Pregnancy in Women With Cystic Fibrosis
|
||
Completed |
NCT04568980 -
Assessment of Contraceptive Safety and Effectiveness in Cystic Fibrosis
|
||
Recruiting |
NCT04010253 -
Impact of Bronchial Drainage Technique by the Medical Device Simeox® on Respiratory Function and Symptoms in Adult Patients With Cystic Fibrosis
|
N/A |