This is the link to the site to participate in the Clarity Study

 

https://host.veritasmedicine.com/trial/trial_questions.cfm?did=2311&wid=1253&dis=637391

The following is a copy of the study questionnaire:

 

Clinical Research Study Questionnaire    

                                                                                                                                                                                                                                                                                              

             

Could you take part?

Thank you for your interest in The CLARITY Study!

Please answer the questions below to find out if you pre-qualify to take part in the study. If you are not searching for yourself, please answer these questions on behalf of the person for whom you are searching.  All information that you submit through this form will remain private. To learn more about your privacy, read our privacy policy.

           

.       Please enter date of birth:                   

 

  • Note: Please use the MM/DD/YYYY format. (i.e. January 2, 1946 should read 01/02/1946)

2.     Please enter a zip or postal code from which to search:  (click here to search in Canada)

                                                                                                                 

                                                                                                                   

                Please enter zip or postal code                                                   

                                                                                                                   

                                                                                                   

                                                                                                                   

                Please select an acceptable travel distance from this zip or postal code to a study location:                      

                                                                                                                   

                                                                                             

                                                                                                                   

3.    Gender

 

Male

Female

 

4.    Have you been diagnosed with multiple sclerosis (MS)?

 

Yes

No

Do not know

5.    What type of multiple sclerosis (MS) have you been diagnosed with?

 

I have relapsing-remitting multiple sclerosis (RRMS)

I have primary progressive multiple sclerosis (PPMS)

I have secondary progressive multiple sclerosis (SPMS)

I do not have multiple sclerosis (MS)

Do not know

 

6.    Have you EVER used any of the following medications or treatments? (Please select all that apply.)

 

Cladribine (2-CDA, Luestatin)

Disease Modifying Drugs (Avonex, Betaseron, Copaxone, Rebif)

Mitoxantrone (Novantrone)

Alemtuzumab (Campath-1h)

Cyclophosphamide (Cytoxan)

Azathioprine (Imuran)

Methotrexate (Rheumatrex, Trexall)

Natalizumab (Tysabri)

Myelosuppressive Therapy (Doxorubicin, Adriamycin)

Total lymphoid irradiation (Also know as TLI)

None of the above

Do not know

 

7.    Have you used any of the following medications or treatments within the last three months? (Please select all that apply.)

 

Cytokine Therapy (Roferon, Proleukin, Infron-A, Aldesleukin)

Anti-Cytokine Therapy (Etanercept, Infliximab, Adalimumab, and Anakinra)

Intravenous immunoglobulin (IVIG)

Plasmapheresis (also referred to as therapeutic plasma exchange)

None of the above

Do not know

 

8.    Have you used any of the following medications within the last 28 days?

 

Oral or systemic corticoid steroids (Prednisone, Cortisone, Deltasone, Decadron, Solu-Cortef, Solu-Medrol)

Adrenocorticotropic hormone (ACTH)

None of the above

Do not know

 

9.    Do you have any of the following conditions? (Please select all that apply.)

 

Liver disease, such as hepatitis or cirrhosis

Type-I Diabetes (also known as insulin dependent diabetes)

Lyme disease

Heart disease

Kidney disease

Cancer (prior or current) </I?< td>

HIV or HTLV-I

None of the above

Do not know

 

10.  Have you participated in a clinical trial or used any investigational medications or procedures in the last 6 months?

 

Yes

No

Do not know

 

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Screening Results          

                                     

             Thank you for your interest in this clinical research trial and for answering our questions. Based on the information you have provided, you are not eligible for participation in this study.         

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                                   If you would like to be notified about future clinical research trials for relapsing-remitting multiple sclerosis in your area, please enter your email address below.                                     

            Email: 

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