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Active Reference (Fluoxetine) Fixed-dose Study of Vortioxetine in Paediatric Participants Aged 7 to 11 Years With Major Depressive Disorder (MDD)

Phase 3
Completed
Conditions
Depressive Disorder, Major
Interventions
Registration Number
NCT02709655
Lead Sponsor
H. Lundbeck A/S
Brief Summary

Investigation of the efficacy and safety of a new potential treatment of Major depressive disorder (MDD) in paediatric participants (age 7 to 11 years).

Detailed Description

Not available

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
683
Inclusion Criteria
  1. The participant has MDD, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5™).
  2. The participant has a CDRS-R total score ≥45 at the Screening Visit and the Baseline.
  3. The participant has a CGI-S score ≥4 at the Screening Visit and the Baseline.
  4. The participant is a boy or girl, aged ≥7 and <12 years at Screening Visit
  5. The participant has provided assent to participation and parent(s)/legal representative (s) signed the Informed Consent Form.
Exclusion Criteria
  1. The participant has participated in a clinical study <30 days prior to the Screening Visit.
  2. The participant has previously participated in a study with vortioxetine.

Other protocol defined inclusion and exclusion criteria may apply

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Vortioxetine 10 mg/dayVortioxetine 10 mg/day-
Vortioxetine 20 mg/dayVortioxetine 20 mg/day-
Fluoxetine 20 mg/day,Fluoxetine 20mg/dayA decision has been taken to stop recruitment into this treatment arm.
PlaceboPlacebo-
Primary Outcome Measures
NameTimeMethod
Change From Baseline in Children Depression Rating Scale - Revised (CDRS-R) Total Score at Week 8 of Phase BBaseline (Week 4 of Phase A), Week 8 of Phase B

The CDRS-R is a clinician-rated scale to measure the severity of depression in children and adolescents. The CDRS-R was rated by a clinician following interviews with the child and parent and consisted of 17 items out of which 3 items rated nonverbal observations (listless speech, hypoactivity, and depressed affect). Fourteen items were rated on a 7-point scale from 1 to 7, and 3 items (sleep disturbance, appetite disturbance, and listless speech) were scored on a 5-point scale from 1 to 5. A rating of 1 indicated normal functioning and a higher number indicated a greater degree of depression. The total score ranged from 17 (normal) to 113 (severe depression). Least square (LS) mean was estimated using a restricted maximum likelihood (REML)-based Mixed Model Repeated Measurements (MMRM) approach.

Secondary Outcome Measures
NameTimeMethod
Change From Baseline in Paediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) Total Score (Items 1 to 14) at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PQ-LES-Q is a patient-rated scale designed to assess satisfaction with life. It is an adaptation of the Quality of Life Enjoyment and Satisfaction Questionnaire, which is used to measure quality of life in adults. The PQ-LES-Q consist of 15 items, item 1 to 14 assess the degree of satisfaction experienced by participants in various areas of daily functioning, and item 15 allows subjects to summarise their experience in a global rating. Each item is rated on a 5-point scale from 1 (very poor) to 5 (very good). The total score range of item 1 to 14 is 14 to 70, with higher scores indicating greater satisfaction.

Change From Baseline in CDRS-R Total Score at Weeks 2, 4, and 6 of Phase BBaseline (Week 4 of Phase A), Weeks 2, 4, and 6 of Phase B

The CDRS-R is a clinician-rated scale to measure the severity of depression in children and adolescents. The CDRS-R was rated by a clinician following interviews with the child and parent and consisted of 17 items out of which 3 items rated nonverbal observations (listless speech, hypoactivity, and depressed affect). Fourteen items were rated on a 7-point scale from 1 to 7, and 3 items (sleep disturbance, appetite disturbance, and listless speech) were scored on a 5-point scale from 1 to 5. A rating of 1 indicated normal functioning and a higher number indicated a greater degree of depression. The total score ranged from 17 (normal) to 113 (severe depression).

Change From Baseline in CDRS-R Subscores (Mood, Somatic, Subjective, and Behaviour) at Weeks 2, 4, 6, and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 2, 4, 6, and 8 of Phase B

The CDRS-R was rated by a clinician following interviews with the child and parent and consisted of 17 items out of which 3 items rated nonverbal observations (listless speech, hypoactivity, and depressed affect). Fourteen items were rated on a 7-point scale from 1 to 7, and 3 items (sleep disturbance, appetite disturbance, and listless speech) were scored on a 5-point scale from 1 to 5. A rating of 1 indicated normal functioning and a higher number indicated a greater degree of depression. The total score ranged from 17 (normal) to 113 (severe depression). Four subscores were defined based on the CDRS-R: Mood: sum of items 8, 11, 14, 15; score range 4 to 28, Somatic: sum of items 4, 5, 6, 7, 16, 17; score range 6 to 36, Subjective: sum of items 9, 10, 12, 13; score range 4 to 28, and Behaviour: sum of items 1, 2, 3; score range 3 to 21. Higher scores indicated the most severe measure of depression.

Clinical Global Impression - Global Improvement (CGI-I) ScoreWeeks 1, 2, 3, 4, 6, and 8 of Phase B

The CGI-I provides the clinician's impression of the participant's improvement (or worsening). The clinician assesses the participant's condition relative to a baseline on a 7-point scale ranging from 1 (very much improved) to 7 (very much worse).

Percentage of Participants With CGI-S RemissionWeeks 1, 2, 3, 4, 6, and 8 of Phase B

CGI-S remission was defined as a CGI-S score of 1 or 2. The CGI-S provides the clinician's impression of the participant's current state of mental illness. The clinician uses his or her clinical experience of this participant population to rate the severity of the participant's current mental illness on a 7-point scale ranging from 1 (normal - not at all ill) to 7 (among the most extremely ill participants).

Percentage of Participants With CDRS-R ResponseWeeks 2, 4, 6, and 8 of Phase B

CDRS-R response was defined as a ≥50% decrease in CDRS-R total score, calculated as: (change from baseline \[Randomization\])/(baseline value - 17). The CDRS-R is a clinician-rated scale to measure the severity of depression in children and adolescents. The CDRS-R was rated by a clinician following interviews with the child and parent and consisted of 17 items out of which 3 items rated nonverbal observations (listless speech, hypoactivity, and depressed affect). Fourteen items were rated on a 7-point scale from 1 to 7, and 3 items (sleep disturbance, appetite disturbance, and listless speech) were scored on a 5-point scale from 1 to 5. A rating of 1 indicated normal functioning and a higher number indicated a greater degree of depression. The total score ranged from 17 (normal) to 113 (severe depression).

Percentage of Participants With CDRS-R RemissionWeeks 2, 4, 6, and 8 of Phase B

CDRS-R remission was defined as a CDRS-R total score ≤28. The CDRS-R is a clinician-rated scale to measure the severity of depression in children and adolescents. The CDRS-R was rated by a clinician following interviews with the child and parent and consisted of 17 items out of which 3 items rated nonverbal observations (listless speech, hypoactivity, and depressed affect). Fourteen items were rated on a 7-point scale from 1 to 7, and 3 items (sleep disturbance, appetite disturbance, and listless speech) were scored on a 5-point scale from 1 to 5. A rating of 1 indicated normal functioning and a higher number indicated a greater degree of depression. The total score ranged from 17 (normal) to 113 (severe depression).

Change From Baseline in General Behaviour Inventory (GBI) Depression Subscale Score, Using the 10-Item Depression Subscale Assessed by Parent (PGBI-10D) and Child (CGBI-10D) at Weeks 2, 4, 6, and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 2, 4, 6, and 8 of Phase B

The GBI 10-item depression scale was developed to screen for depressive symptoms in children and adolescents. Two versions of the GBI 10-item depression scale were used, the child rated version (CGBI) and the parent rated version (PGBI). The 10 depression items were rated on a 4-point scale from 0 (never or hardly ever) to 3 (very often or almost constantly). The total score ranged from 0 to 30, with higher scores indicating greater pathology.

Parent Global Assessment (PGA) ScoreWeeks 2, 4, 6, and 8 of Phase B

The PGA is a parent-rated variation of the CGI-I to evaluate the severity of the child's symptoms. The PGA reflects assessments of symptoms using a 7-point scale ranging from 1 (very much improved) to 7 (very much worse).

Change From Baseline in Children's Global Assessment Scale (CGAS) Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The CGAS is a clinician-rated global scale to measure the lowest level of functioning for a child (4 to 16 years) during a specified time period. The CGAS contains behaviourally-oriented descriptors at each anchor point that depict behaviours and life situations applicable to a child. The score ranges from 1 (most functionally impaired child) to 100 (the healthiest). A score greater than 70 indicates normal function.

Change From Baseline in PedsQL VAS: Tired (Fatigue) Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue and pain using visual analogue scales. The functionality for each domain is measured on a 10 cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. A lower value represents a better outcome.

Change From Baseline in PedsQL VAS: Pain or Hurt Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue and pain using visual analogue scales. The functionality for each domain is measured on a 10 cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. A lower value represents a better outcome.

Change From Baseline in Clinical Global Impression - Severity of Illness (CGI-S) Score at Weeks 1, 2, 3, 4, 6, and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 1, 2, 3, 4, 6, and 8 of Phase B

The CGI-S provides the clinician's impression of the participant's current state of mental illness. The clinician uses his or her clinical experience of this participant population to rate the severity of the participant's current mental illness on a 7-point scale ranging from 1 (normal - not at all ill) to 7 (among the most extremely ill participants).

Change From Baseline in Pediatric Quality of Life Inventory (PedsQL) Visual Analogue Scales (VAS): Afraid or Scared (Anxiety) Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue and pain using visual analogue scales. The functionality for each domain is measured on a 10 cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. A lower value represents a better outcome.

Change From Baseline in PedsQL VAS: Sad or Blue (Sadness) Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue and pain using visual analogue scales. The functionality for each domain is measured on a 10 cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. A lower value represents a better outcome.

Change From Baseline in PedsQL VAS: Angry Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue and pain using visual analogue scales. The functionality for each domain is measured on a 10 cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. A lower value represents a better outcome.

Change From Baseline in PQ-LES-Q Overall Evaluation Score (Item 15) at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PQ-LES-Q is a patient-rated scale designed to assess satisfaction with life. It is an adaptation of the Quality of Life Enjoyment and Satisfaction Questionnaire, which is used to measure quality of life in adults. The PQ-LES-Q consist of 15 items, item 1 to 14 assess the degree of satisfaction experienced by participants in various areas of daily functioning, and item 15 allows subjects to summarize their experience in a global rating. Item 15 is rated on a 5-point scale from 1 (very poor) to 5 (very good).

Change From Baseline in PedsQL VAS: Worry Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue and pain using visual analogue scales. The functionality for each domain is measured on a 10 cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. A lower value represents a better outcome.

Change From Baseline in PedsQL VAS Total Average Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL™ VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue, and pain using visual analogue scales. The functionality for each domain is measured on a 10cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. The total score is the average of all 6 items. A lower value represents a better outcome.

Change From Baseline in PedsQL Emotional Distress Summary Average Score at Weeks 4 and 8 of Phase BBaseline (Week 4 of Phase A), Weeks 4 and 8 of Phase B

The PedsQL™ VAS is designed to measure at-that-moment functioning in children and adolescents. The PedsQL VAS consists of 6 domains: anxiety, sadness, anger, worry, fatigue and pain using visual analogue scales. The functionality for each domain is measured on a 10 cm line with a happy face at one end and a sad face at the other (0-10 points). The participants are asked to mark on the line how they feel. The average emotional distress summary score is the mean of the anxiety, sadness, anger, and worry items. A lower value represents a better outcome.

Trial Locations

Locations (98)

Sun Valley Research Center

🇺🇸

Imperial, California, United States

Atlanta Center for Medical Research

🇺🇸

Atlanta, Georgia, United States

Northwest Behavioral Research Center

🇺🇸

Marietta, Georgia, United States

American Medical Research, Inc.

🇺🇸

Chicago, Illinois, United States

Centro para el Desarrollo de la Medicina y de Asistencia Medica Especializada S.C

🇲🇽

Culiacan De Rosales, Sinaloa, Mexico

B & B Investigaciones Medicas, SC

🇲🇽

Mazatlan, Sinaloa, Mexico

Kansas University School of Medicine-Wichita

🇺🇸

Wichita, Kansas, United States

Hospital Universitario Fundacion Alcorcon

🇪🇸

Alcorcon, Madrid, Spain

Paediatric Sleep Research Inc.

🇨🇦

Toronto, Ontario, Canada

Przychodnia Syntonia Poradnia Zdrowia Psychicznego

🇵🇱

Kielce, Poland

Spectrum Centrum Psychiatrii Specjalistyczny Gabinet Psychiatryczny

🇵🇱

Lublin, Poland

Woodland International Research Group

🇺🇸

Little Rock, Arkansas, United States

Sarkis Clinical Trials

🇺🇸

Gainesville, Florida, United States

Lake Charles Clinical Trials

🇺🇸

Lake Charles, Louisiana, United States

Kennedy Krieger Institute

🇺🇸

Baltimore, Maryland, United States

Centro de investigaciones del Sistema Nervioso SAS Grupo CISNE SAS

🇨🇴

Bogota, DC, Colombia

Medical Research Group of Central Florida

🇺🇸

Orange City, Florida, United States

Aspen Clinical Research, LLC

🇺🇸

Orem, Utah, United States

Psynapsis Salud Mental S.A.

🇨🇴

Pereira, Risaralda, Colombia

Children's National Medical Center Merge

🇺🇸

Washington, District of Columbia, United States

Princeton Medical Institute

🇺🇸

Princeton, New Jersey, United States

Marienthali Kliinik

🇪🇪

Tallinn, Estonia

Cabinet Psyche

🇫🇷

Douai, Nord, France

Shalvata Mental Health Center

🇮🇱

Hod Hasharon, Israel

The Chaim Sheba Medical Center - The Edmond and Lily Safra Children's Hospital

🇮🇱

Tel Hashomer, Israel

CHU de Nantes - Hopital Hotel Dieu

🇫🇷

Nantes Cedex 1, France

Westside Medical

🇺🇸

Clinton, Utah, United States

Centro Investigacion Medico Biologica Y Terapia Avanzada

🇲🇽

Guadalajara, Jalisco, Mexico

Centro de Investigaciones y Proyectos en Neurociencias CIPNA LTDA IPS.

🇨🇴

Barranquilla, Atlantico, Colombia

Centre Medical Ambroise Pare

🇫🇷

Elancourt, France

Bekes Megyei Kozponti Korhaz Pandy Kalman Tagkorhaza

🇭🇺

Gyula, Hungary

Instituto Nacional de Pediatria (INP) (National Institute of Pediatrics)

🇲🇽

Ciudad de Mexico, Distrito Federal, Mexico

CRI Centro Regiomontano de Investigacion SC

🇲🇽

Monterrey, Nuevo Leon, Mexico

ICARO Investigaciones en Medicina S.A. de C.V.

🇲🇽

Chihuahua, Mexico

BIND Investigaciones S.C

🇲🇽

San Luis Potosi, Mexico

MHAT Targovishte AD

🇧🇬

Targovisthe, Bulgaria

Rheinhessen-Fachklinik Mainz, Kinder und Jugendpsychiatri

🇩🇪

Mainz, Germany

Linda Keruze's Psychiatric Center, LLC

🇱🇻

Liepaja, Latvia

GUZ Engels Psychiatric Hospital

🇷🇺

Engels, Russian Federation

Rostov State Medical University of the Minzdravsotsrazvitiya of Russia

🇷🇺

Rostov-on-Don, Russian Federation

Yaroslavl Regional Clinical Psychiatry Hospital

🇷🇺

Yaroslavl, Russian Federation

University Clinical Center Kragujevac

🇷🇸

Kragujevac, Serbia

Ternopil Regional Clinical Municipal Psycho-Neurological Hospital, Ternopil State Medical Univers...

🇺🇦

Ternopil, Ukraine

Ramat Chen - Mental Health Clinic

🇮🇱

Tel Aviv, Israel

Scientific Institute Fondazione Stella Maris

🇮🇹

Calambrone Pisa, Pisa, Italy

Children Hospilal -Gailezers

🇱🇻

Riga, Latvia

Stavropol Region Psychiatric Hospital No.2

🇷🇺

Stavropol, Stavropol Region, Russian Federation

Arkhangelsk Regional Clinical Mental Hospital

🇷🇺

Arkhangelsk, Russian Federation

State Budgetary Healthcare Institution (SBHI) Specialized Clinical Psychiatric Hospital 1 of the ...

🇷🇺

Krasnodar, Russian Federation

Guz Saratov Regional Psychiatric Hospital St. Sofii

🇷🇺

Saratov, Russian Federation

City Psychiatric Hospital No.3 named after I.I. Skvortsov-Stepanov

🇷🇺

St-Petersburg, Russian Federation

Institute of Mental Health

🇷🇸

Belgrade, Serbia

Centrum Badan Klinicznych PI-House Sp. z o.o.

🇵🇱

Gdansk, Poland

Specjalistyczny Szpital im. dra A. Sokolowskiego w Walbrzychu

🇵🇱

Walbrzych, Poland

State Budgetary Healthcare Institution of Sverdlovsk Region ¿Sverdlovsk Regional Clinical Psychi...

🇷🇺

Ekaterinburg, Russian Federation

Medicorehabilitation Research Center Phoenix

🇷🇺

Rostov-On-Don, Rostov State, Russian Federation

Saratov State Medical University

🇷🇺

Saratov, Russian Federation

Daily Hospital for Children and Adolescents

🇷🇸

Pantelej-Nis, Serbia

Odessa Regional Medical Centre of Mental Health

🇺🇦

Odessa, Ukraine

University Federico II Of Naples

🇮🇹

Napoli, Italy

Clinica Cemelli

🇲🇽

Guadalajara, Jalisco, Mexico

Diagnostic Consultative Center Mladost-M Varna OOD

🇧🇬

Varna, Bulgaria

IPS Research Company

🇺🇸

Oklahoma City, Oklahoma, United States

University of Cincinnati Medical Center

🇺🇸

Cincinnati, Ohio, United States

Clinical Trials of Texas, Inc.

🇺🇸

San Antonio, Texas, United States

Paradigm Research Professionals, LLC

🇺🇸

Oklahoma City, Oklahoma, United States

NRC Research Institute

🇺🇸

Orange, California, United States

Asclepes Research Center

🇺🇸

Panorama City, California, United States

Alliance for Wellness dba Alliance for Research

🇺🇸

Long Beach, California, United States

Synergy Clinical Research Center

🇺🇸

Lemon Grove, California, United States

AMR- Baber Research, Inc.

🇺🇸

Naperville, Illinois, United States

AMR Conventions Research

🇺🇸

Warrenville, Illinois, United States

St. Charles Psychiatric Associates - Midwest Research Group

🇺🇸

Saint Charles, Missouri, United States

Finger Lakes Clinical Research

🇺🇸

Rochester, New York, United States

Millennium Psychiatric Associates, LLC

🇺🇸

Saint Louis, Missouri, United States

Manhattan Behavioral Medicine

🇺🇸

New York, New York, United States

AIM Trials, LLC

🇺🇸

Plano, Texas, United States

Research Strategies Of Memphis, Llc

🇺🇸

Memphis, Tennessee, United States

BioBehavioral Research of Austin

🇺🇸

Austin, Texas, United States

North Star Medical Research, LLC

🇺🇸

Middleburg Heights, Ohio, United States

University Hospital Cleveland Medical Center Division of Child and Adolescent Psychiatry

🇺🇸

Cleveland, Ohio, United States

Research Across America

🇺🇸

Plano, Texas, United States

E.S.E. Hospital Mental de Antioquia HOMO

🇨🇴

Bello, Antioquia, Colombia

Vadaskert Alapitvany

🇭🇺

Budapest, Hungary

Sciaf Ulss 16 Padova

🇮🇹

Padova, Regione Veneto, Italy

Roberto Zepeda Sanchez

🇲🇽

Guadalajara, Jalisco, Mexico

Prywatne Gabinety Lekarskie Promedicus

🇵🇱

Bialystok, Podlaskie, Poland

Filip Rybakowski Specjalistyczna Praktyka Lekarska

🇵🇱

Poznan, Poland

LLC City Neurological Center Sibneuromed

🇷🇺

Novosibirsk, Russian Federation

Nebbiolo LLC

🇷🇺

Tomsk, Russian Federation

Child and Adolescent Neurology and Psychiatry Clinic

🇷🇸

Belgrade, Serbia

Clinical Center of Vojvodina - Clinic of Psychiatry

🇷🇸

Novi Sad, Serbia

Cape Trial Centre

🇿🇦

Bellville, Cape Town, South Africa

Tara Hospital

🇿🇦

Sandhurst, Gauteng, South Africa

Unidad de Salud Mental Infanto-Juvenil (USMI-J) Edificio de Consultas Externas. Hospital MarAtimo

🇪🇸

Torremolinos, Malaga, Spain

Ukrainian Research Institute Of Social, Forensic Psychiatry And Drug Abuse, Kiev City Psychoneuro...

🇺🇦

Kyiv, Ukraine

Maltsev Poltava Regional Clinical Psychiatric Hospital, Higher State Educational Institution Of U...

🇺🇦

Poltava, Ukraine

Seoul National University Hospital

🇰🇷

Seoul, Korea, Republic of

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