Clinical trials

554

Search and review clinical trials. Use filters to narrow results by trial status, phase, treatment, biological sex and sponsor.

Condition / disease
Location
Status: Recruiting

A Study to Test How Well BAY 3670549 Works and How Safe it is in Patients With Atrial Fibrillation

The main goal of this study is to find out how well BAY 3670549 works, how safe it is, how well people can tolerate it, and how the body handles the medicine. The study will compare BAY 3670549 to a placebo (a dummy treatment with no active medicine) in people with AF who need a treatment called electrical cardioversion. Electrical cardioversion is a procedure that helps the heart return to a normal rhythm. In this study, each participant will get a single intravenous (IV) infusion of either BAY 3670549 or a placebo. Participants will then be observed to see whether the heart rhythm returns to a normal rhythm. If it does not, electrical cardioversion can still be performed as planned. The study will look at how many participants return from AF to a normal rhythm, without needing electrical cardioversion and how long it takes. It will also show how many participants experience medical problems after treatment and how BAY 3670549 move into, through and out of the participants' body. The total duration of the study for an individual participant may be up two months. The findings from this study may contribute to the development of a new treatment option for people with AF.

Participants needed: 360
Trial details
Phase: Phase 2Age: 18-85Biological sex: AllType: InterventionalSponsor: BayerUpdated: Sep 9, 2026Locations: 29
Eligibility criteria

Participant must be 18 to 85 years of age inclusive, at the time of signing the... [+8]

Current atrial flutter (AFL) or combined AF/AFL [+17]

Status: Recruiting

Continuation Study of Zasocitinib in Adults With Psoriatic Arthritis

Psoriatic arthritis (PsA) is a long-term inflammatory disease that affects the joints and skin. The purpose of this study is to check how safe zasocitinib is, how well it is tolerated and how well it works in adults with PsA over a longer period of time. Adults who completed the 1-year (52-week) treatment period in one of the parent studies (TAK-279-PsA-3001 \[NCT06671483\] or TAK-279-PsA-3002 \[NCT06671496\]) may be able to join this continuation study (also called long-term extension or LTE study). All participants in this continuation study, will receive zasocitinib (lower or higher dose), once a day (QD). Each participant can be in this study for approximately 2 years (108 weeks). This includes a treatment period of up to 2 years (104 weeks) and a 1-month (4-week) follow-up period to monitor a participant's health.

Participants needed: 1,182
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: TakedaUpdated: Sep 9, 2026Locations: 78
Eligibility criteria

The participant is aged 18 years or older at the time of signing the informed co... [+2]

Any participant who is deemed by the investigator to be not benefiting from the... [+3]

Status: Recruiting

A Study to Investigate the Effect of AZD6793 in Participants With Moderate to Very Severe Chronic Obstructive Pulmonary Disease

This Phase IIb dose-ranging study will evaluate the efficacy and safety of 2 different doses of AZD6793 compared with placebo tablets in participants with moderate to very severe chronic obstructive pulmonary disease.

Participants needed: 987
Trial details
Phase: Phase 2Age: 40+Biological sex: AllType: InterventionalSponsor: AstraZenecaUpdated: Sep 9, 2026Locations: 367
Eligibility criteria

Participant must be ≥40 years of age at the time of signing the informed consent... [+8]

Clinically important pulmonary disease other than COPD (eg, asthma [current diag... [+12]

Status: Recruiting

A Study of Gammagard Liquid (Immune Globulin Infusion, 10%) to Prevent Infections in Adults With Multiple Myeloma

Multiple myeloma is a cancer of the plasma cells in the bone marrow. The main aim of this study is to learn how well the Immune Globulin Infusion (human), 10 percentage (%) (IGI, 10%) can help prevent infections in participants with multiple myeloma receiving B-cell maturation antigen (BCMA) x cluster of differentiation 3 (CD3) directed bispecific antibody therapy. Participants will be randomly assigned to one of two groups: 1. Primary infection prevention group: They will receive IGI, 10% for 12 months. 2. Secondary infection prevention group: They will only receive IGI, 10% if they develop a serious infection during the 12 months study period. During the study, participants will visit their study clinic 15 times (for 4-week dosing interval) or 19 times (for 3-week dosing interval) and their total participation duration will be up to 14 months (including screening period approximately 8 weeks).

Participants needed: 183
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: TakedaUpdated: Sep 9, 2026Locations: 56
Eligibility criteria

The participants must have a documented diagnosis of Multiple Myeloma (MM) accor... [+5]

The participant has not achieved at least a minimal response to teclistamab duri... [+28]

Status: Recruiting

A Study of Zasocitinib in Adults With Psoriatic Arthritis Who Have Not Taken Biologic Medicines

Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects the joints and skin in people who have psoriasis (PsO). The main aim of the study is to know how well zasocitinib (TAK-279) works in participants with active PsA who have not previously been treated with biologic disease-modifying antirheumatic drugs. The participants will be treated with either zasocitinib, active comparator, or placebo. Participants will be in the study for up to 60 weeks.

Participants needed: 1,088
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: TakedaUpdated: Sep 9, 2026Locations: 188
Eligibility criteria

The participant is aged 18 years or older at the time of signing the informed co... [+7]

The participant has other disease(s) that might confound the evaluations of bene... [+1]

Status: Recruiting

A Study to Find Out if the Study Drug Elecoglipron Helps Adults With Type 2 Diabetes Mellitus by Comparing it With Semaglutide, a Medicine Already Used to Treat Type 2 Diabetes Mellitus

The purpose of this study is to evaluate the efficacy, safety, and tolerability of elecoglipron compared with oral semaglutide in adults with T2DM and increased cardiovascular risk that is inadequately managed alone or on stable treatment with other background glucose-lowering medication(s).

Participants needed: 1,200
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: AstraZenecaUpdated: Sep 9, 2026Locations: 209
Eligibility criteria

Diagnosed with Type 2 Diabetes Mellitus (T2DM) for at least 90 days prior to scr... [+5]

Type 1 Diabetes Mellitus (T1DM), secondary forms of diabetes (including congenit... [+6]

Status: Recruiting

A Study to Investigate Efficacy and Safety of FWY003 Compared With Placebo in Participants With Geographic Atrophy Secondary to Age-related Macular Degeneration

To characterize the dose response relationship of FWY003 in participants with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

Participants needed: 272
Trial details
Phase: Phase 2Age: 50+Biological sex: AllType: InterventionalSponsor: Novartis PharmaceuticalsUpdated: Sep 9, 2026Locations: 55
Eligibility criteria

A diagnosis of GA secondary to AMD in at least one eye (study eye). If both eyes... [+4]

A history of, or current evidence of, choroidal neovascularization (exudative MN... [+4]

Status: Recruiting

Sonesitatug Vedotin in Combination With Capecitabine With or Without Rilvegostomig in Participants With Advanced or Metastatic Gastric, Gastroesophageal Junction, or Esophageal Adenocarcinoma Expressing Claudin18.2

The purpose of this study is to evaluate the efficacy and safety of sonesitatug vedotin in combination with capecitabine with or without rilvegostomig in first-line (1L) Claudin18.2 (CLDN18.2)-positive, human epidermal growth factor receptor 2 (HER2)-negative, gastric, gastroesophageal junction (GEJ), and esophageal adenocarcinoma.

Participants needed: 2,130
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: AstraZenecaUpdated: Sep 9, 2026Locations: 311
Eligibility criteria

Capable of giving signed informed consent [+11]

Known HER2-positive status [+11]

Status: Recruiting

Phase III Extension Study of Efficacy and Safety of Ianalumab With or Without Study Treatment Withdrawal in Participants With Lupus Nephritis (SIRIUS-LN Extension)

The purpose of this up to 6-year extension study is the evaluation of the efficacy and safety 1. after study treatment withdrawal in patients with lupus nephritis (LN) who achieved response (complete renal response \[CRR\] or partial renal response \[PRR\]) on double-blind treatment at the end of the SIRIUS-LN core study, and 2. of open-label ianalumab 300 mg treatment in patients who, at the end of the SIRIUS-LN core study, were either already receiving ianalumab open-label treatment or did not meet CRR/PRR criteria on double-blind treatment at the end of the SIRIUS-LN core study.

Participants needed: 348
Trial details
Phase: Phase 3Age: 18-100Biological sex: AllType: InterventionalSponsor: Novartis PharmaceuticalsUpdated: Sep 9, 2026Locations: 49
Eligibility criteria

Signed informed consent prior to participation in the extension study. [+1]

Use of prohibited therapies [+1]

Status: Recruiting

A Clinical Study to Evaluate Ianalumab in Participants With Diffuse Cutaneous Systemic Sclerosis

The purpose of this study is to evaluate efficacy, safety and tolerability of s.c. ianalumab administered in participants with diffuse cutaneous systemic sclerosis relative to placebo

Participants needed: 200
Trial details
Phase: Phase 2Age: 18-70Biological sex: AllType: InterventionalSponsor: Novartis PharmaceuticalsUpdated: Sep 9, 2026Locations: 128
Eligibility criteria

Male and female participants >= 18 and =< 70 years (at the time of the screening... [+13]

Rheumatic disease other than dcSSc, including limited cutaneous disease (lcSSc)... [+11]

Status: Recruiting

A Study to Assess the Adverse Events and Change in Disease Activity of Oral Atogepant Tablets in Pediatric Participants (6-17 Years of Age) With Episodic Migraine

A migraine is a moderate to severe headache on one side of the head. A migraine attack is a headache that may be accompanied by throbbing, nausea, vomiting, sensitivity to light and sound, or other symptoms. A number of treatments are available for adults with migraine but there are limited approved treatments available for pediatric participants. The main goal of the study is to evaluate the safety and efficacy (how well treatment works) of a low-dose and high-dose of atogepant in pediatric participants between the ages of 6 and 17. Atogepant is a medicine currently approved to treat adults with migraine (0 to 14 migraine days per month) and is being studied in pediatric participants between the ages of 6 and 17 with a history of episodic migraine. This is a Phase 3, randomized, double-blind study of atogepant in participants with a history of episodic migraine with an open-label pharmacokinetic substudy. Eligible participants will be randomized into 6 different groups. Participants between the ages of 12 and 17 will be randomized to receive placebo, low-dose atogepant, or high-dose atogepant for 12 weeks. Participants between the ages of 6 and 11 will also be randomized to receive placebo, low-dose atogepant, or high-dose atogepant for 12 weeks. The specific atogepant doses to be used in participants between the ages of 6 and 11 will be determined after the PK substudy is complete. Around 450 participants will be enrolled in approximately 100 sites worldwide. Placebo, low-dose atogepant, and high-dose atogepant are given as a tablet to take by mouth once a day. At the end of Week 12, participants will either undergo a follow-up visit 4 weeks after last study treatment or join an extension study where they can continue to receive atogepant for another 52 weeks. There may be a bigger responsibility for participants in this study. Participants will attend regular visits during the study at a hospital or clinic. The effects of treatment will be checked by medical assessments, blood tests, checking for side effects, and completing questionnaires.

Participants needed: 450
Trial details
Phase: Phase 3Age: 6-17Biological sex: AllType: InterventionalSponsor: AbbVieUpdated: Sep 9, 2026Locations: 98
Eligibility criteria

Weight is >= 20 kg (44 lbs) and < 135 kg (298 lbs). [+3]

History of migraine brainstem aura, hemiplegic migraine, or retinal migraine as... [+2]

Status: Recruiting

A Clinical Study of Calderasib (MK-1084) and Other Treatments for Participants With Non-Small Cell Lung Cancer (MK-1084-007/KANDLELIT-007)

Researchers want to learn if the study medicines calderasib and subcutaneous (SC) pembrolizumab can be used to treat non-small cell lung cancer (NSCLC) when given together. Calderasib is a targeted therapy for the KRAS G12C mutation. The goal of this study is to learn if people who receive calderasib with SC pembrolizumab live longer without the cancer growing or spreading than in people who receive SC pembrolizumab with chemotherapy.

Participants needed: 675
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: Merck Sharp & Dohme LLCUpdated: Sep 9, 2026Locations: 206
Eligibility criteria

Has nonsquamous NSCLC (Stage IIIB, Stage IIIC) not eligible for curative resecti... [+1]

Has diagnosis of small cell lung cancer or, for mixed tumors, presence of small... [+12]

Status: Recruiting

Single-Fraction Very Accelerated Partial Breast Irradiation (sfVAPBI)

To investigate clinical outcomes, late side effects, and cosmetic results of a single-fraction very accelerated partial breast irradiation as postoperative local treatment for the treatment of early stage breast cancer.

Participants needed: 250
Trial details
Age: 40+Biological sex: FemaleType: InterventionalSponsor: National Institute of Oncology, HungaryUpdated: Sep 9, 2026Locations: 23
Eligibility criteria

Stage 0 & I & II (< 3 cm) breast carcinoma [+11]

Stage III-IV breast cancer [+10]

Status: Recruiting

A Clinical Study of Calderasib (MK-1084) With Targeted Therapy and Chemotherapy in People With Colorectal Cancer (MK-1084-012/KANDLELIT-012)

Researchers are looking for other ways to treat locally advanced or metastatic colorectal cancer (mCRC) that is unresectable and has a gene mutation called KRAS G12C. Standard (or usual) treatments for this type of colorectal cancer may include mFOLFOX6 with or without bevacizumab. Researchers want to learn if adding calderasib (the study medicine) and cetuximab to mFOLFOX6 can treat locally advanced or mCRC with the KRAS G12C mutation. Calderasib and cetuximab are targeted therapies. The goals of this study are to learn: * About the safety of calderasib with cetuximab and mFOLFOX6 and if people tolerate the treatments * If people who receive calderasib with cetuximab and mFOLFOX6 live longer without mCRC growing or spreading compared to people who receive mFOLFOX6 with or without bevacizumab.

Participants needed: 477
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: Merck Sharp & Dohme LLCUpdated: Sep 9, 2026Locations: 234
Eligibility criteria

Has a histologically confirmed diagnosis of locally advanced unresectable or met... [+5]

Has active inflammatory bowel disease requiring immunosuppressive medication or... [+10]

Status: Recruiting

Extension Study of Long-term Safety and Efficacy of Tulisokibart in Participants With Crohn's Disease or Ulcerative Colitis (MK-7240-011)

Researchers want to learn more about tulisokibart (also known as MK-7240) in an extension study. Tulisokibart is a medicine designed to treat active, moderate to severe Crohn's disease (CD) and ulcerative colitis (UC). An extension study is a type of study where people who received tulisokibart in certain other studies for CD or UC (called a parent study) may be able to join this study. The goals of this study are to learn about the safety of tulisokibart over time in people with CD or UC, and if people tolerate it.

Participants needed: 1,380
Trial details
Phase: Phase 3Biological sex: AllType: InterventionalSponsor: Merck Sharp & Dohme LLCUpdated: Sep 9, 2026Locations: 37
Eligibility criteria

Has participated in a qualifying tulisokibart Phase 2 or Phase 3 parent study fo... [+4]

Has prematurely discontinued study intervention in their parent study [+2]

Status: Recruiting

A Study to Evaluate the Efficacy and Safety of Tulisokibart (MK-7240) in Participants With Moderate to Severe Crohn's Disease (MK-7240-008)

The purpose of this protocol is to evaluate the efficacy and safety of tulisokibart in participants with moderately to severely active Crohn's disease. Study 1's primary hypotheses are that at least 1 tulisokibart dose level is superior to placebo in the proportion of participants achieving clinical remission per Crohn's Disease Activity Index score (\<150, US/FDA) or per stool frequency and abdominal pain score (EU/EMA) and in the proportion of participants achieving endoscopic response at Week 52 (US/FDA and EU/EMA), and that at least 1 tulisokibart dose level is superior to placebo in the proportion of participants achieving clinical remission per Crohn's Disease Activity Index score (\<150, US/FDA) or per stool frequency and abdominal pain score (EU/EMA) and in the proportion of participants achieving endoscopic response at Week 12 (US/FDA and EU/EMA). Study 2's primary hypothesis is that at least 1 tulisokibart dose level is superior to placebo in the proportion of participants achieving clinical remission per Crohn's Disease Activity Index score (\<150, US/FDA) or stool frequency and abdominal pain score (EU/EMA) and in the proportion of participants achieving endoscopic response at Week 12 (US/FDA and EU/EMA).

Participants needed: 1,200
Trial details
Phase: Phase 3Age: 16-80Biological sex: AllType: InterventionalSponsor: Merck Sharp & Dohme LLCUpdated: Sep 9, 2026Locations: 499
Eligibility criteria

Has had a diagnosis of Crohn's disease (CD) at least 3 months before study. [+17]

Status: Recruiting

A Study to Investigate CV Outcomes With Elecoglipron Compared With Placebo in Adult Participants With HFpEF or HFmrEF

This is a Phase III, randomized, double-blind, parallel-group, placebo-controlled, multicenter study to investigate CV outcomes with elecoglipron compared with placebo, in adults with heart failure with preserved ejection fraction (HFpEF)/heart failure with mildly reduced ejection fraction (HFmrEF), irrespective of T2DM status, and who are on background dapagliflozin in addition to other background standard of care.

Participants needed: 6,950
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: AstraZenecaUpdated: Sep 9, 2026Locations: 672
Eligibility criteria

Left ventricular ejection fraction (LVEF) of > 40% within 12 months prior to scr... [+2]

BMI <25 kg/m² at screening. [+10]

Status: Recruiting

A Study to Investigate Outcomes With Elecoglipron Compared With Placebo in Adult Participants With Chronic Kidney Disease.

This is a Phase III, randomized, double-blind, parallel-group, placebo-controlled multicenter study to investigate outcomes with elecoglipron compared with placebo in participants with CKD with and without T2DM who are on background SGLT2i (dapagliflozin) as GDMT and other SoC treatments for CKD.

Participants needed: 7,000
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: AstraZenecaUpdated: Sep 9, 2026Locations: 715
Eligibility criteria

Adults with confirmed CKD; UACR ≥30 mg/g and eGFR ≥20 mL/min/1.73 m² within spec... [+1]

BMI <23 kg/m² at screening [+8]

Status: Recruiting

A Study to Test How BI 3034701 is Taken up and Processed by the Body in Healthy Men With Normal Weight or Overweight

The main objectives of this trial are: To assess the mass balance (total recovery of \[14C\]-radioactivity) in urine, faeces, and expired air after a single subcutaneous dose of BI 3034701 (C-14) in healthy male trial participants.

Participants needed: 8
Trial details
Phase: Phase 1Age: 18-65Biological sex: MaleType: InterventionalSponsor: Boehringer IngelheimUpdated: Sep 9, 2026Locations: 1
Eligibility criteria

Healthy male trial participant according to the assessment of the investigator,... [+3]

Any finding in the medical examination (including blood pressure, pulse rate or... [+4]

Status: Recruiting

A Study to See if Lepodisiran Can Reduce Plaque in Coronary Arteries of Adults With Elevated Lp(a) Who Have Had Heart Events or Are at High Risk

Lipoprotein(a), also known as Lp(a), is a protein that carries cholesterol and proteins in your blood. People with high Lp(a) have a higher risk for heart disease. The main purpose of the study is to investigate how lepodisiran, compared to a placebo, affects the amount and type of plaque in the heart's vessels using an imaging technology known as Coronary Computed Tomography Angiography (CCTA) in adults who have high levels of Lp(a). Participation will last about 120 weeks.

Participants needed: 252
Trial details
Phase: Phase 3Age: 45-80Biological sex: AllType: InterventionalSponsor: Eli Lilly and CompanyUpdated: Sep 8, 2026Locations: 58
Eligibility criteria

Have an Lp(a) ≥175 nmol/L [+3]

Have had a major CV event less than 60 days before measurement of the Lp(a) leve... [+6]

Status: Recruiting

A Study of LY4395089 and Mirikizumab (LY3074828) Given Together and Mirikizumab (Alone) in Adults With Crohn's Disease

The main purpose of this study is to see how the safety and efficacy of a farnesoid X receptor (FXR) agonist (LY4395089), given together with mirikizumab compares with mirikizumab (alone) in adults with moderately to severely active Crohn's disease (CD). This study is part of the IIBD master protocol and will last approximately 62 weeks.

Participants needed: 60
Trial details
Phase: Phase 2Age: 18-80Biological sex: AllType: InterventionalSponsor: Eli Lilly and CompanyUpdated: Sep 8, 2026Locations: 70
Eligibility criteria

Participants taking glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), GLP...

Must not have a hepatic disease [+7]

Status: Recruiting

A Master Protocol (IIBD): A Study of Multiple Drugs in Adults With Ulcerative Colitis or Crohn's Disease

Study IIBD is a master protocol that will support a collection of individual sub studies that share key design components. Participants will be assigned to the appropriate study prior to randomization to a treatment group. The studies aim to evaluate the efficacy and safety of new treatments in adults with moderately to severely active ulcerative colitis or Crohn's disease and will last at least 62 weeks.

Participants needed: 60
Trial details
Phase: Phase 2Age: 18-80Biological sex: AllType: InterventionalSponsor: Eli Lilly and CompanyUpdated: Sep 8, 2026Locations: 70
Eligibility criteria

Must have an established diagnosis of Ulcerative Colitis (UC) or Crohn's Disease... [+4]

Must not have a current diagnosis of inflammatory bowel disease (IBD)-unclassifi... [+8]

Status: Recruiting

LY4268989 in Adults With Moderately to Severely Active Ulcerative Colitis

The main purpose of this study is to evaluate the safety and effectiveness of LY4268989 when compared to placebo in adult participants with moderately to severely active ulcerative colitis (UC). The study drug will be administered orally. The study will last up to approximately 108 weeks, excluding screening.

Participants needed: 1,431
Trial details
Phase: Phase 2Age: 18-80Biological sex: AllType: InterventionalSponsor: Eli Lilly and CompanyUpdated: Sep 8, 2026Locations: 259
Eligibility criteria

Have had an established diagnosis of ulcerative colitis (UC) for ≥3 months prior... [+5]

Have a current diagnosis of [+8]

Status: Recruiting

A Study to Test Whether Different Doses of BI 3000202 Help People With Systemic Lupus Erythematosus (SLE)

This study is open to adults with systemic lupus erythematosus (SLE). The purpose of this study is to find out whether a medicine called BI 3000202 helps people with SLE. The study tests different doses of BI 3000202 and aims to find the best dose for people with this condition. Participants are put into 5 groups randomly, which means by chance. 4 groups get different doses of BI 3000202, and 1 group gets a placebo. Placebo tablets look like BI 3000202 tablets but do not contain any medicine. Participants take the tablets for 1 year. All participants also continue their regular treatment for SLE. Participants are in the study for a bit longer than 1 year. During this time, they visit the study site regularly. Doctors check the participants' health and take note of any unwanted effects. They also compare the results between the groups to see if the treatment works.

Participants needed: 405
Trial details
Phase: Phase 2Age: 18-74Biological sex: AllType: InterventionalSponsor: Boehringer IngelheimUpdated: Sep 8, 2026Locations: 140
Eligibility criteria

Male and female adult patients from ≥18 years (or alternative age for adults bas... [+4]

Drug-induced SLE [+4]

Status: Recruiting

A Study to Evaluate the Efficacy of Pumitamig Versus Pembrolizumab in Participants With Previously Untreated Advanced Non-Small Cell Lung Cancer and PD-L1 ≥ 50%. (ROSETTA Lung-202)

The purpose of this study is to evaluate the efficacy of Pumitamig versus Pembrolizumab in participants with previously untreated advanced Non-Small Cell Lung Cancer and PD-L1 ≥ 50%.

Participants needed: 750
Trial details
Phase: Phase 3Age: 18+Biological sex: AllType: InterventionalSponsor: Bristol-Myers SquibbUpdated: Sep 8, 2026Locations: 279
Eligibility criteria

Participants must have a histologically or cytologically confirmed diagnosis of... [+4]

Participants must not have any documented actionable genomic alteration (AGA) fo... [+4]