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NCT00691678

Glucosamine and Chondroitin for Aromatase Inhibitor Induced Joint Symptoms in Women With Breast Cancer

Version 5 to 6 · Dawn L. Hershman

Patch inspector

Version 5 to 6

24 operations 5 path groups ctgov_internal_history
ClinicalTrials.gov
Severity is deterministic uncalibrated triage metadata, not validated review priority. Operation-level severity is inferred from deterministic path rules. Rule matches shown per operation are approximate previews (they skip the pipeline's suppression passes); the authoritative classification is the stored event record.
Plain-language summary

Manual review pending.

Rules fired
arms_or_interventions_changedesign_info_changeeligibility_criteria_changeprimary_outcome_any_change
Value signals
[
  {
    "path": "/protocolSection/statusModule/startDateStruct/date",
    "signal": "timeline_significant_shift",
    "category": "timeline_significant_shift",
    "new_type": null,
    "old_type": null,
    "severity": "medium",
    "direction": "later",
    "new_value": "2008-10",
    "old_value": "2008-05",
    "delta_days": 153,
    "date_struct": "startDateStruct",
    "new_precision": "month",
    "old_precision": "month"
  },
  {
    "path": "/protocolSection/statusModule/completionDateStruct/date",
    "signal": "timeline_actual_date_correction",
    "category": "timeline_actual_date_correction",
    "new_type": "ACTUAL",
    "old_type": "ACTUAL",
    "severity": "low",
    "direction": "later",
    "new_value": "2012-09",
    "old_value": "2012-07",
    "delta_days": 62,
    "date_struct": "completionDateStruct",
    "new_precision": "month",
    "old_precision": "month"
  }
]
Provenance
Source
ctgov_internal_history
Fetched
2026-06-18 18:59:38+00
Raw hash
62d92bcd09477dd801e1a237920b781226d5a39604b296339c7f60b7c3f4029e
Payload
Source URL
Primary outcomes Outcome measures that define the trial's primary evidence target. Triage: Critical 2 ops
replace /protocolSection/outcomesModule/primaryOutcomes/0/measure
Triage: Critical
Primary Outcome Change Operation 20
Matched rules
  • primary_outcome_any_change Any add/remove/replace under primary outcome measures is critical review priority.
Before
Change in Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria (composite endpoint including pain, function, and the patient's global assessment of disease)
After
Prevalence of reduced knee and/or joint pain and/or stiffness
add /protocolSection/outcomesModule/primaryOutcomes/0/description
Triage: Critical
Primary Outcome Change Operation 21
Matched rules
  • primary_outcome_any_change Any add/remove/replace under primary outcome measures is critical review priority.
After
Using the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria, which provides a combined assessment of changes in pain, function, and the patient's global assessment of disease status.
Design Trial model, phase, allocation, masking, arms, or interventions. Triage: High 10 ops
replace /protocolSection/designModule/designInfo/allocation
Triage: High
Design Change Operation 10
Matched rules
  • design_info_change Design information changes can alter allocation, masking, model, or purpose and need review.
Before
NON_RANDOMIZED
After
NA
replace /protocolSection/armsInterventionsModule/armGroups/0/label
Triage: High
Arm Intervention Change Operation 11
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
Before
I
After
chondroitin and glucosamine
replace /protocolSection/armsInterventionsModule/armGroups/0/description
Triage: High
Arm Intervention Change Operation 12
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
Before
Glucosamine Chondroitin
After
Postmenopausal breast cancer patients that have joint symptoms induced by aromatase inhibitors and are receiving chondroitin and glucosamine.
replace /protocolSection/armsInterventionsModule/armGroups/0/interventionNames/0
Triage: High
Arm Intervention Change Operation 13
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
Before
Drug: Glucosamine Chondroitin
After
Drug: Chondroitin
add /protocolSection/armsInterventionsModule/armGroups/0/interventionNames/1
Triage: High
Arm Intervention Change Operation 14
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
After
Drug: Glucosamine
replace /protocolSection/armsInterventionsModule/interventions/0/name
Triage: High
Arm Intervention Change Operation 15
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
Before
Glucosamine Chondroitin
After
Chondroitin
replace /protocolSection/armsInterventionsModule/interventions/0/description
Triage: High
Arm Intervention Change Operation 16
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
Before
Glucosamine [500mg three times daily (TID) x 24 weeks] plus chondroitin (400mg TID x 24 weeks)
After
400mg chondroitin TID for twenty-four weeks
replace /protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/0
Triage: High
Arm Intervention Change Operation 17
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
Before
I
After
chondroitin and glucosamine
add /protocolSection/armsInterventionsModule/interventions/0/otherNames
Triage: High
Arm Intervention Change Operation 18
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
After
[
  "Chondroitin sulfate"
]
add /protocolSection/armsInterventionsModule/interventions/1
Triage: High
Arm Intervention Change Operation 19
Matched rules
  • arms_or_interventions_change Arms or interventions changes can alter treatment/comparator structure.
After
{
  "name": "Glucosamine",
  "type": "DRUG",
  "otherNames": [
    "Glucosamine sulfate"
  ],
  "description": "500mg glucosamine TID for twenty-four weeks",
  "armGroupLabels": [
    "chondroitin and glucosamine"
  ]
}
Eligibility Criteria and population definition changes. Triage: High 1 ops
replace /protocolSection/eligibilityModule/eligibilityCriteria
Triage: High
Eligibility Change Operation 22
Matched rules
  • eligibility_criteria_change Eligibility criteria changes can alter the studied population.
Before
<p>Inclusion Criteria:</p><ul><li>Age &gt;21 years</li><li>Postmenopausal status defined as cessation of menses for &gt;1 year or FSH &gt;20 mIU&#x2F;mL</li><li>History of stage I, II or IIIA hormone receptor-positive breast cancer, without metastatic disease</li><li>Currently taking a third-generation aromatase inhibitor for at least 3 months</li><li>Clinical symptoms of knee and&#x2F;or hand joint pain and&#x2F;or stiffness for at least 3 months prior to study entry</li><li>Ongoing musculoskeletal pain&#x2F;stiffness in hand and&#x2F;or knee joints (50 or higher on the 100 point global assessment VAS) that started or increased since initiating aromatase inhibitor therapy, and has been present for at least 3 months.</li><li>patients must agree to refrain from use of glucosamine and chondroitin from sources outside of this study</li><li>If taking bisphosphonates, on a stable dose for at least 3 months and tolerating the dose.
Patients must agree to refrain from initiating bisphosphonate use during the course of the study.</li><li>ECOG performance status 0-2.</li><li>Hemoglobin A1c &lt;8.</li><li>Signed informed consent</li></ul><p>Exclusion Criteria:</p><ul><li>se of glucosamine or chondroitin within the past six months</li><li><p>Concurrent medical&#x2F;arthritic disease that could confound or interfere with evaluation of pain or efficacy including:</p><ul><li>Inflammatory arthritis (e.g., rheumatoid arthritis, systemic lupus, spondyloarthropathy, psoriatic arthritis, polymyalgia rheumatica)</li><li>gout</li><li>episodes of acute monarticular arthritis clinically consistent with pseudogout</li><li>Paget&#x27;s disease affecting the study joint</li><li>a history of septic arthritis or avascular necrosis or intra-articular fracture of the study joint</li><li>Wilson&#x27;s disease</li><li>hemochromatosis</li><li>alkaptonuria</li><li>primary osteochondromatosis</li></ul></li><li>History of significant collateral ligament, anterior cruciate ligament or meniscal injury of the index joint requiring surgery or non-weight bearing (requiring use of crutches or cane) for more than 3 weeks (minor ligamentous injury prior to 6 months is not an exclusion).</li><li>History of bone fracture or surgery of the afflicted knees and&#x2F;or hands within 6 months prior to study entry.</li><li>AST, ALT &gt; 2x normal.</li><li>Serum Creatinine of &gt; 1.8 mg&#x2F;dl.</li><li>Uncontrolled hypertension (Systolic Blood Pressure of &gt; 150 mm Hg or Diastolic Blood Pressure of &gt;95 mm Hg).</li><li>Uncontrolled diabetes mellitus, defined as Hemoglobin A1c level of &gt; 8%.</li></ul>
After
<p>Inclusion Criteria:</p><ul><li>Age &gt;21 years.</li><li>Postmenopausal status defined as cessation of menses for &gt;1 year or FSH &gt;20 mIU&#x2F;mL or bilateral oophorectomy.</li><li>History of stage I, II or III hormone receptor-positive breast cancer, without metastatic disease.</li><li>Currently taking a third-generation aromatase inhibitor for at least 3 months.</li><li>Clinical symptoms of knee and&#x2F;or hand joint pain and&#x2F;or stiffness for at least 3 months prior to study entry.</li><li>Ongoing musculoskeletal pain&#x2F;stiffness in hand and&#x2F;or knee joints (50 or higher on the 100 point global assessment VAS) that started or increased since initiating aromatase inhibitor therapy, and has been present for at least 3 months.</li><li>Patients must agree to refrain from use of glucosamine and chondroitin from sources outside of this study.</li><li>If taking bisphosphonates, on a stable dose for at least 3 months and tolerating the dose.
Patients must agree to refrain from initiating bisphosphonate use during the course of the study, therefore it is recommended that routine bone density testing be performed prior to enrollment or after completing trial.</li><li>ECOG performance status 0-2.</li><li>Hemoglobin A1c &lt;8 within the last year.</li><li>Signed informed consent.</li></ul><p>Exclusion Criteria:</p><ul><li>Use of glucosamine or chondroitin within the past three (3) months.</li><li>Concurrent medical&#x2F;arthritic disease that could confound or interfere with evaluation of pain or efficacy.</li><li>History of significant collateral ligament, anterior cruciate ligament or meniscal injury of the index joint requiring surgery or non-weight bearing (requiring use of crutches or cane) for more than 3 weeks (minor ligamentous injury prior to 6 months is not an exclusion).</li><li>History of bone fracture or surgery of the afflicted knees and&#x2F;or hands within 6 months prior to study entry.</li><li>Uncontrolled diabetes mellitus, defined as Hemoglobin A1c level of &gt; 8%.</li><li>History of any illness that, in the opinion of the investigator, might confound the results of the study or pose additional risk to the patient.</li><li>Allergy to, or history of significant clinical or laboratory adverse experience associated with acetaminophen, glucosamine or chondroitin sulfate.</li><li>Allergy to shellfish.</li><li>Inability to understand and complete study questionnaires including questions requiring a visual analog scale (VAS) response.</li><li>Inability to understand the study procedures and&#x2F;or give written informed consent.</li><li>Alcohol use in excess of 3 mixed drinks&#x2F;day.</li><li>Corticosteroid treatment was used or administered.</li><li>Aspirin (up to 325 mg&#x2F;day) for cardiovascular reasons may be continued.</li><li>Intra-articular injection of hyaluronic acid or congeners into the study joint within 12 months.</li><li>Topical analgesics (e.g., capsaicin preparations) to the study joint, or any oral analgesics (e.g., opiates, tramadol; with the exception of ibuprofen and acetaminophen) within 2 weeks of baseline visit or during the study.</li><li>Implementation of any other medical therapy for arthritis within one month prior to entry.</li><li>Other medications, unrelated to the patient&#x27;s joint pain&#x2F;stiffness must have been used at a stable dosage for at least 1 month.
In addition, it should be anticipated that the dose of the concomitant medication will be stable during the entire treatment period.</li><li>Participation in another clinical study with an investigational agent within the last 4 weeks.</li><li>Exposure to glucosamine within 3 months or chondroitin sulfate within 3 months of Baseline Visit.</li><li>Initiation of physical therapy or muscle conditioning program within 2 months prior to study entry.</li><li><p>Concurrent use of the following medications and dietary supplements.</p><ul><li>Chronic therapy with tetracycline or tetracycline derivatives.</li><li>Other new complementary or alternative regimens for the treatment of osteoarthritis, including, but not limited to, acupuncture, topical creams, oral agents, and magnets.</li></ul></li></ul>
Timeline Start, primary completion, and completion date movement. Triage: Medium 2 ops
replace /protocolSection/statusModule/startDateStruct/date
Triage: Medium
Timeline Shift Operation 2
Matched rules
  • start_timeline_change Start date changes are operational timeline signals.
Before
2008-05
After
2008-10
replace /protocolSection/statusModule/completionDateStruct/date
Triage: Medium
Timeline Shift Operation 3
Matched rules
  • completion_timeline_change Completion date changes are operational timeline signals.
Before
2012-07
After
2012-09
Other registry fields Changes outside the current high-signal rule families. Triage: Uncategorized 9 ops
replace /protocolSection/statusModule/statusVerifiedDate
Triage: Uncategorized
Uncategorized Operation 1
Before
2013-02
After
2017-06
replace /protocolSection/statusModule/lastUpdateSubmitDate
Triage: Uncategorized
Uncategorized Operation 4
Before
2013-02-19
After
2017-06-15
replace /protocolSection/statusModule/lastUpdatePostDateStruct/date
Triage: Uncategorized
Uncategorized Operation 5
Before
2013-02-20
After
2017-06-19
replace /protocolSection/statusModule/lastUpdatePostDateStruct/type
Triage: Uncategorized
Uncategorized Operation 6
Before
ESTIMATED
After
ACTUAL
replace /protocolSection/descriptionModule/briefSummary
Triage: Uncategorized
Uncategorized Operation 7
Before
Investigators are hoping to learn if glucosamine with chondroitin can help relieve joint pain&#x2F;stiffness associated with aromatase inhibitors
After
Investigators are hoping to learn if glucosamine with chondroitin can help relieve joint pain&#x2F;stiffness associated with aromatase inhibitors.
add /protocolSection/descriptionModule/detailedDescription
Triage: Uncategorized
Uncategorized Operation 8
After
Due to early detection and improved treatments, women with breast cancer are living longer.
The increase in breast cancer survival is largely due to the benefits of hormonal therapy, such as tamoxifen and aromatase inhibitors (AIs), for the treatment of hormone-sensitive breast cancer.
Recent clinical trials have demonstrated that AIs are more effective than tamoxifen at reducing breast cancer recurrences.
However, breast cancer patients receiving AIs have a higher incidence of osteoporosis, bone fractures and musculoskeletal symptoms, particularly joint pain and stiffness.
Musculoskeletal pain, which occurs in up to 50% of patients treated with AIs, often does not respond to conventional pain medications, may lead to noncompliance, may cause major disability, and may interfere with quality of life.
Many women are unable to tolerate these life-saving drugs because of severe joint pain, therefore, safe and effective treatments that alleviate these symptoms are needed.
add /protocolSection/conditionsModule/conditions/1
Triage: Uncategorized
Uncategorized Operation 9
After
Joint Pain
add /protocolSection/ipdSharingStatementModule
Triage: Uncategorized
Uncategorized Operation 23
After
{
  "ipdSharing": "UNDECIDED"
}
add /annotationSection
Triage: Uncategorized
Uncategorized Operation 24
After
{
  "annotationModule": {
    "unpostedAnnotation": {
      "unpostedEvents": [
        {
          "date": "2021-07-13",
          "type": "RELEASE"
        },
        {
          "date": "2021-08-03",
          "type": "RESET"
        }
      ],
      "unpostedResponsibleParty": "Dawn L. Hershman, Associate Professor of Medicine &amp; Epidemiology, Columbia University"
    }
  }
}
Raw JSON Patch
[
  {
    "op": "replace",
    "path": "/protocolSection/statusModule/statusVerifiedDate",
    "value": "2017-06"
  },
  {
    "op": "replace",
    "path": "/protocolSection/statusModule/startDateStruct/date",
    "value": "2008-10"
  },
  {
    "op": "replace",
    "path": "/protocolSection/statusModule/completionDateStruct/date",
    "value": "2012-09"
  },
  {
    "op": "replace",
    "path": "/protocolSection/statusModule/lastUpdateSubmitDate",
    "value": "2017-06-15"
  },
  {
    "op": "replace",
    "path": "/protocolSection/statusModule/lastUpdatePostDateStruct/date",
    "value": "2017-06-19"
  },
  {
    "op": "replace",
    "path": "/protocolSection/statusModule/lastUpdatePostDateStruct/type",
    "value": "ACTUAL"
  },
  {
    "op": "replace",
    "path": "/protocolSection/descriptionModule/briefSummary",
    "value": "Investigators are hoping to learn if glucosamine with chondroitin can help relieve joint pain&#x2F;stiffness associated with aromatase inhibitors."
  },
  {
    "op": "add",
    "path": "/protocolSection/descriptionModule/detailedDescription",
    "value": "Due to early detection and improved treatments, women with breast cancer are living longer.\nThe increase in breast cancer survival is largely due to the benefits of hormonal therapy, such as tamoxifen and aromatase inhibitors (AIs), for the treatment of hormone-sensitive breast cancer.\nRecent clinical trials have demonstrated that AIs are more effective than tamoxifen at reducing breast cancer recurrences.\nHowever, breast cancer patients receiving AIs have a higher incidence of osteoporosis, bone fractures and musculoskeletal symptoms, particularly joint pain and stiffness.\nMusculoskeletal pain, which occurs in up to 50% of patients treated with AIs, often does not respond to conventional pain medications, may lead to noncompliance, may cause major disability, and may interfere with quality of life.\nMany women are unable to tolerate these life-saving drugs because of severe joint pain, therefore, safe and effective treatments that alleviate these symptoms are needed."
  },
  {
    "op": "add",
    "path": "/protocolSection/conditionsModule/conditions/1",
    "value": "Joint Pain"
  },
  {
    "op": "replace",
    "path": "/protocolSection/designModule/designInfo/allocation",
    "value": "NA"
  },
  {
    "op": "replace",
    "path": "/protocolSection/armsInterventionsModule/armGroups/0/label",
    "value": "chondroitin and glucosamine"
  },
  {
    "op": "replace",
    "path": "/protocolSection/armsInterventionsModule/armGroups/0/description",
    "value": "Postmenopausal breast cancer patients that have joint symptoms induced by aromatase inhibitors and are receiving chondroitin and glucosamine."
  },
  {
    "op": "replace",
    "path": "/protocolSection/armsInterventionsModule/armGroups/0/interventionNames/0",
    "value": "Drug: Chondroitin"
  },
  {
    "op": "add",
    "path": "/protocolSection/armsInterventionsModule/armGroups/0/interventionNames/1",
    "value": "Drug: Glucosamine"
  },
  {
    "op": "replace",
    "path": "/protocolSection/armsInterventionsModule/interventions/0/name",
    "value": "Chondroitin"
  },
  {
    "op": "replace",
    "path": "/protocolSection/armsInterventionsModule/interventions/0/description",
    "value": "400mg chondroitin TID for twenty-four weeks"
  },
  {
    "op": "replace",
    "path": "/protocolSection/armsInterventionsModule/interventions/0/armGroupLabels/0",
    "value": "chondroitin and glucosamine"
  },
  {
    "op": "add",
    "path": "/protocolSection/armsInterventionsModule/interventions/0/otherNames",
    "value": [
      "Chondroitin sulfate"
    ]
  },
  {
    "op": "add",
    "path": "/protocolSection/armsInterventionsModule/interventions/1",
    "value": {
      "name": "Glucosamine",
      "type": "DRUG",
      "otherNames": [
        "Glucosamine sulfate"
      ],
      "description": "500mg glucosamine TID for twenty-four weeks",
      "armGroupLabels": [
        "chondroitin and glucosamine"
      ]
    }
  },
  {
    "op": "replace",
    "path": "/protocolSection/outcomesModule/primaryOutcomes/0/measure",
    "value": "Prevalence of reduced knee and&#x2F;or joint pain and&#x2F;or stiffness"
  },
  {
    "op": "add",
    "path": "/protocolSection/outcomesModule/primaryOutcomes/0/description",
    "value": "Using the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria, which provides a combined assessment of changes in pain, function, and the patient&#x27;s global assessment of disease status."
  },
  {
    "op": "replace",
    "path": "/protocolSection/eligibilityModule/eligibilityCriteria",
    "value": "<p>Inclusion Criteria:</p><ul><li>Age &gt;21 years.</li><li>Postmenopausal status defined as cessation of menses for &gt;1 year or FSH &gt;20 mIU&#x2F;mL or bilateral oophorectomy.</li><li>History of stage I, II or III hormone receptor-positive breast cancer, without metastatic disease.</li><li>Currently taking a third-generation aromatase inhibitor for at least 3 months.</li><li>Clinical symptoms of knee and&#x2F;or hand joint pain and&#x2F;or stiffness for at least 3 months prior to study entry.</li><li>Ongoing musculoskeletal pain&#x2F;stiffness in hand and&#x2F;or knee joints (50 or higher on the 100 point global assessment VAS) that started or increased since initiating aromatase inhibitor therapy, and has been present for at least 3 months.</li><li>Patients must agree to refrain from use of glucosamine and chondroitin from sources outside of this study.</li><li>If taking bisphosphonates, on a stable dose for at least 3 months and tolerating the dose.\nPatients must agree to refrain from initiating bisphosphonate use during the course of the study, therefore it is recommended that routine bone density testing be performed prior to enrollment or after completing trial.</li><li>ECOG performance status 0-2.</li><li>Hemoglobin A1c &lt;8 within the last year.</li><li>Signed informed consent.</li></ul><p>Exclusion Criteria:</p><ul><li>Use of glucosamine or chondroitin within the past three (3) months.</li><li>Concurrent medical&#x2F;arthritic disease that could confound or interfere with evaluation of pain or efficacy.</li><li>History of significant collateral ligament, anterior cruciate ligament or meniscal injury of the index joint requiring surgery or non-weight bearing (requiring use of crutches or cane) for more than 3 weeks (minor ligamentous injury prior to 6 months is not an exclusion).</li><li>History of bone fracture or surgery of the afflicted knees and&#x2F;or hands within 6 months prior to study entry.</li><li>Uncontrolled diabetes mellitus, defined as Hemoglobin A1c level of &gt; 8%.</li><li>History of any illness that, in the opinion of the investigator, might confound the results of the study or pose additional risk to the patient.</li><li>Allergy to, or history of significant clinical or laboratory adverse experience associated with acetaminophen, glucosamine or chondroitin sulfate.</li><li>Allergy to shellfish.</li><li>Inability to understand and complete study questionnaires including questions requiring a visual analog scale (VAS) response.</li><li>Inability to understand the study procedures and&#x2F;or give written informed consent.</li><li>Alcohol use in excess of 3 mixed drinks&#x2F;day.</li><li>Corticosteroid treatment was used or administered.</li><li>Aspirin (up to 325 mg&#x2F;day) for cardiovascular reasons may be continued.</li><li>Intra-articular injection of hyaluronic acid or congeners into the study joint within 12 months.</li><li>Topical analgesics (e.g., capsaicin preparations) to the study joint, or any oral analgesics (e.g., opiates, tramadol; with the exception of ibuprofen and acetaminophen) within 2 weeks of baseline visit or during the study.</li><li>Implementation of any other medical therapy for arthritis within one month prior to entry.</li><li>Other medications, unrelated to the patient&#x27;s joint pain&#x2F;stiffness must have been used at a stable dosage for at least 1 month.\nIn addition, it should be anticipated that the dose of the concomitant medication will be stable during the entire treatment period.</li><li>Participation in another clinical study with an investigational agent within the last 4 weeks.</li><li>Exposure to glucosamine within 3 months or chondroitin sulfate within 3 months of Baseline Visit.</li><li>Initiation of physical therapy or muscle conditioning program within 2 months prior to study entry.</li><li><p>Concurrent use of the following medications and dietary supplements.</p><ul><li>Chronic therapy with tetracycline or tetracycline derivatives.</li><li>Other new complementary or alternative regimens for the treatment of osteoarthritis, including, but not limited to, acupuncture, topical creams, oral agents, and magnets.</li></ul></li></ul>"
  },
  {
    "op": "add",
    "path": "/protocolSection/ipdSharingStatementModule",
    "value": {
      "ipdSharing": "UNDECIDED"
    }
  },
  {
    "op": "add",
    "path": "/annotationSection",
    "value": {
      "annotationModule": {
        "unpostedAnnotation": {
          "unpostedEvents": [
            {
              "date": "2021-07-13",
              "type": "RELEASE"
            },
            {
              "date": "2021-08-03",
              "type": "RESET"
            }
          ],
          "unpostedResponsibleParty": "Dawn L. Hershman, Associate Professor of Medicine &amp; Epidemiology, Columbia University"
        }
      }
    }
  }
]