Trial Outcomes & Findings for The TRAfermin in Neuropathic Diabetic Foot Ulcer Study - Northern Europe The TRANS-North Study (NCT NCT01217476)

NCT ID: NCT01217476

Last Updated: 2014-08-05

Results Overview

wound closure is defined as 100% reepithelialization of the target DFU, without exudates.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

207 participants

Primary outcome timeframe

12 weeks

Results posted on

2014-08-05

Participant Flow

Participant milestones

Participant milestones
Measure
Trafermin
Trafermin 0.01% spray: For ulcers with a maximum diameter (longest axis) of less or equal to 6 cm, the daily dose of trafermin 0.01% spray is 5 puffs (30 microgram) sprayed onto the wound surface. If the maximum diameter (longest axis) of the ulcer is \>6 cm, the ulcer should be sprayed in two parts, i.e. 5 puffs (30 microgram) sprayed onto each half of the wound surface
Placebo
Matching placebo spray: For ulcers with a maximum diameter (longest axis) of less or equal to 6 cm, the daily dose of trafermin 0.01% spray is 5 puffs (30 microgram) sprayed onto the wound surface. If the maximum diameter (longest axis) of the ulcer is \>6 cm, the ulcer should be sprayed in two parts, i.e. 5 puffs (30 microgram) sprayed onto each half of the wound surface
Overall Study
STARTED
105
102
Overall Study
COMPLETED
93
95
Overall Study
NOT COMPLETED
12
7

Reasons for withdrawal

Reasons for withdrawal
Measure
Trafermin
Trafermin 0.01% spray: For ulcers with a maximum diameter (longest axis) of less or equal to 6 cm, the daily dose of trafermin 0.01% spray is 5 puffs (30 microgram) sprayed onto the wound surface. If the maximum diameter (longest axis) of the ulcer is \>6 cm, the ulcer should be sprayed in two parts, i.e. 5 puffs (30 microgram) sprayed onto each half of the wound surface
Placebo
Matching placebo spray: For ulcers with a maximum diameter (longest axis) of less or equal to 6 cm, the daily dose of trafermin 0.01% spray is 5 puffs (30 microgram) sprayed onto the wound surface. If the maximum diameter (longest axis) of the ulcer is \>6 cm, the ulcer should be sprayed in two parts, i.e. 5 puffs (30 microgram) sprayed onto each half of the wound surface
Overall Study
Adverse Event
6
1
Overall Study
Physician Decision
0
1
Overall Study
Withdrawal by Subject
3
3
Overall Study
Surgery on the Target Limb
0
2
Overall Study
Protocol Deviation
1
0
Overall Study
Other
2
0

Baseline Characteristics

The TRAfermin in Neuropathic Diabetic Foot Ulcer Study - Northern Europe The TRANS-North Study

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Trafermin
n=105 Participants
Trafermin 0.01% spray
Placebo
n=102 Participants
Matching placebo spray
Total
n=207 Participants
Total of all reporting groups
Age, Continuous
60.1 years
STANDARD_DEVIATION 9.0 • n=99 Participants
59.4 years
STANDARD_DEVIATION 10.4 • n=107 Participants
59.8 years
STANDARD_DEVIATION 9.7 • n=206 Participants
Sex: Female, Male
Female
24 Participants
n=99 Participants
14 Participants
n=107 Participants
38 Participants
n=206 Participants
Sex: Female, Male
Male
81 Participants
n=99 Participants
88 Participants
n=107 Participants
169 Participants
n=206 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Asian
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Black or African American
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
White
104 Participants
n=99 Participants
102 Participants
n=107 Participants
206 Participants
n=206 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants
n=99 Participants
0 Participants
n=107 Participants
1 Participants
n=206 Participants
Wound size ≤5cm^2
81 participants
n=99 Participants
80 participants
n=107 Participants
161 participants
n=206 Participants
Wound size >5cm^2
24 participants
n=99 Participants
22 participants
n=107 Participants
46 participants
n=206 Participants
Peripheral blood perfusion Impaired
17 participants
n=99 Participants
16 participants
n=107 Participants
33 participants
n=206 Participants
Peripheral blood perfusion Normal
88 participants
n=99 Participants
86 participants
n=107 Participants
174 participants
n=206 Participants
BMI
30.19 kg/m2
STANDARD_DEVIATION 5.15 • n=99 Participants
30.31 kg/m2
STANDARD_DEVIATION 4.92 • n=107 Participants
30.25 kg/m2
STANDARD_DEVIATION 5.02 • n=206 Participants

PRIMARY outcome

Timeframe: 12 weeks

Population: The primary analysis of the efficacy criteria was conducted on the ITT population.

wound closure is defined as 100% reepithelialization of the target DFU, without exudates.

Outcome measures

Outcome measures
Measure
Trafermin
n=105 Participants
Trafermin 0.01% spray
Placebo
n=102 Participants
Matching placebo spray
Wound Closure Rate of Diabetic Foot Ulcers (DFUs) of Neuropathic Origin After a Maximum of 12 Weeks Topical Daily Application of Trafermin 0.01% Spray Compared With Placebo, in Addition to Best Local Cares
21.0 percentage of participants
16.7 percentage of participants

SECONDARY outcome

Timeframe: 6 weeks

Population: The analysis of the efficacy criteria was conducted on the ITT population.

The incidence of wound area regression of at least 40% at week 6 was considered as an important exploratory secondary efficacy variable. The wound area regression was calculated as percentage change from inclusion at week 6 using centralized wound area data.

Outcome measures

Outcome measures
Measure
Trafermin
n=105 Participants
Trafermin 0.01% spray
Placebo
n=102 Participants
Matching placebo spray
Relative Wound Area Regression of 40% or More at 6 Week
53.3 percentage of participants
55.9 percentage of participants

Adverse Events

Trafermin

Serious events: 20 serious events
Other events: 40 other events
Deaths: 0 deaths

Placebo

Serious events: 26 serious events
Other events: 40 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Trafermin
n=105 participants at risk
Trafermin 0.01% spray
Placebo
n=102 participants at risk
Matching placebo spray
Cardiac disorders
Atrial fibrillation
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Cardiac disorders
Myocardial infarction
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Gastrointestinal disorders
Inguinal hernia
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
General disorders
Sudden death
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Hepatobiliary disorders
Biliary colic
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Cellulitis
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Cystitis
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Diabetic foot infection
3.8%
4/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
7.8%
8/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Erysipelas
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Gastroenteritis
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Infective exacerbation of chronic obstructive airways disease
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Liver abscess
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Osteomyelitis
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
3.9%
4/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Pneumonia
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Sepsis
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Urinary tract infection
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Injury, poisoning and procedural complications
Femoral neck fracture
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Injury, poisoning and procedural complications
Humerus fracture
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Injury, poisoning and procedural complications
Limb injury
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Investigations
Glycosylated hemoglobin increased
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Metabolism and nutrition disorders
Diabetic foot
2.9%
3/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
2.0%
2/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Metabolism and nutrition disorders
Diabetic ketoacidosis
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Metabolism and nutrition disorders
Neuroglycopenia
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Metabolism and nutrition disorders
Type 2 diabetes mellitus
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Musculoskeletal and connective tissue disorders
Osteonecrosis
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Nervous system disorders
Cerebrovascular accident
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Nervous system disorders
Transient ischemic attack
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Renal and urinary disorders
Renal colic
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Renal and urinary disorders
Renal failure acute
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Renal and urinary disorders
Renal failure chronic
0.95%
1/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.00%
0/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Renal and urinary disorders
Urinary tract inflammation
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Vascular disorders
Arteriovenous fistula
0.00%
0/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
0.98%
1/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.

Other adverse events

Other adverse events
Measure
Trafermin
n=105 participants at risk
Trafermin 0.01% spray
Placebo
n=102 participants at risk
Matching placebo spray
General disorders
Edema peripheral
6.7%
7/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
10.8%
11/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Infections and infestations
Diabetic foot infection
8.6%
9/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
11.8%
12/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
Metabolism and nutrition disorders
Diabetic foot
22.9%
24/105 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.
16.7%
17/102 • Primary Treatment Emergent Adverse Event: adverse events that occurred after starting the treatment with the study medication until the end of primary follow up period up to 24 weeks.
The safety population included all patients who were randomized and exposed to the study treatment.

Additional Information

Mr. Akira Kondo, Manager, Clinical R&D

Olympus France S.A.S

Phone: +33-1-4560-6849

Results disclosure agreements

  • Principal investigator is a sponsor employee PI have no implicit or explicit rights to publish study data and results of their services.
  • Publication restrictions are in place

Restriction type: OTHER