A Long Term Study of the Safety of Tanezumab When Administered By Subcutaneous Injections
- Conditions
- Osteoarthritis, KneeOsteoarthritis, Hip
- Interventions
- Registration Number
- NCT00994890
- Lead Sponsor
- Pfizer
- Brief Summary
This study will investigate the safety of three fixed dose levels of tanezumab (2.5 mg, 5 mg, and 10 mg) administered at an 8-week interval by subcutaneous injection multiple (7) times during the study treatment period.
- Detailed Description
Safety study of tanezumab in relief of osteoarthritis pain This study was terminated on 6 December 2010 following a US FDA clinical hold for tanezumab osteoarthritis clinical studies which halted dosing and enrollment of patients on 23 June 2010 for potential safety issues.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 679
- Osteoarthritis of the knee or hip based on American College of Rheumatology criteria with a radiographic (X ray) confirmation (a Kellgren Lawrence x-ray grade of ≥2);
- Body mass index (BMI) of >39 kg/m2;
- Pregnancy or intent to become pregnant
- Planned surgical procedure during the duration of the study
- History of clinically significant cardiovascular, central nervous system or psychiatric disease
- Previous exposure to exogenous NGF or to an anti NGF antibody;
- Use of biologics other than study medication, Live or live-attenuated intranasal vaccines (eg, Flumist), are allowable exceptions
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Tanezumab 5 mg Tanezumab 5 mg - Tanezumab 10 mg Tanezumab 10 mg - Tanezumab 2.5 mg Tanezumab 2.5 mg -
- Primary Outcome Measures
Name Time Method Number of Participants With Laboratory Abnormalities Baseline to Week 50 Laboratory analysis included blood chemistry, hematology, urinalysis and pregnancy test.
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 24 Baseline, Week 24 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Number of Participants With Anti-Drug Antibody (ADA) at Week 24 Week 24 Human serum ADA samples were analyzed for the presence or absence of anti-tanezumab antibodies by using the semi-quantitative ELISA.
Number of Participants With Injection-Site Reactions at Week 4 Week 4 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
Number of Participants With Treatment-Emergent Adverse Events (AEs) or Serious Adverse Events (SAEs) Baseline up to 112 days after last dose of study medication (up to 345 days) An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. Treatment-emergent are events between first dose of study drug and up to 112 days after last dose that were absent before treatment or that worsened relative to pretreatment state.
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 2 Baseline, Week 2 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 4 Baseline, Week 4 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Number of Participants With Clinically Significant Change From Baseline in Physical Findings Baseline to Week 50 Physical examination included examination of abdomen, ears, extremities, eyes, head, heart, lungs, lymph nodes, neck, nose, skin, throat, thyroid, muscoskeletal, neurological and peripheral vascular system.
Number of Participants With Injection-Site Reactions at Week 16 Week 16 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
Number of Participants With Abnormal Electrocardiogram (ECG) Findings Baseline up to Week 50 All standard intervals (PR, QRS, QT, QT interval corrected for heart rate using Fridericia's formula \[QTcF\], QT interval corrected for heart rate using Bazett's formula \[QTcB\], RR intervals and heart rate) were analyzed. Participants with abnormal ECG findings reported as adverse events were presented.
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 32 Baseline, Week 32 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Number of Participants With Anti-Drug Antibody (ADA) at Week 8 Week 8 Human serum ADA samples were analyzed for the presence or absence of anti-tanezumab antibodies by using the semi-quantitative ELISA.
Number of Participants With Vital Sign Abnormalities Baseline up to Week 50 Examination of vital signs included body temperature, systolic blood pressure, diastolic blood pressure, pulse rate and respiratory rate. Participants with abnormal vital sign findings reported as adverse events were presented.
Number of Participants With Injection-Site Reactions at Week 2 Week 2 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
Number of Participants With Injection-Site Reactions at Week 24 Week 24 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
Number of Participants With Injection-Site Reactions at Week 40 Week 40 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 48 Baseline, Week 48 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Number of Participants With Anti-Drug Antibody (ADA) at Week 50 Week 50 Human serum ADA samples were analyzed for the presence or absence of anti-tanezumab antibodies by using the semi-quantitative ELISA.
Number of Participants With Injection-Site Reactions at Week 8 Week 8 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
Number of Participants With Injection-Site Reactions at Week 32 Week 32 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 8 Baseline, Week 8 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 16 Baseline, Week 16 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Change From Baseline in Neuropathy Impairment Score (NIS) at Week 40 Baseline, Week 40 NIS: 74-item, assess cranial nerves, muscle weakness, reflexes, sensation; scored separately for left, right limbs (37 items for each). Cranial nerves included 5 items (3rd nerve, 6th nerve, facial weakness, palate weakness, tongue weakness), muscle weakness included 19 items (respiratory,neck flexion, shoulder abduction, elbow flexion, brachioradialis,elbow extension, wrist flexion,wrist extension,finger flexion,finger spread,thumb abduction,hip flexion,hip extension,knee flexion,knee extension,ankle dorsiflexors,ankle plantar flexors,toe extensors,toe flexors), each item scored on scale 0=normal to 4=paralysis, higher score=greater weakness. Reflexes included 5 items (quadriceps femoris, triceps surae, biceps brachii, triceps brachii, brachioradialis), sensation included 4 items each for great toe and index finger (touch pressure, pin prick, vibration, joint position), each item scored as 0=normal, 1=decreased, 2=absent. Total NIS score range 0-244, higher score=greater impairment.
Number of Participants With Anti-Drug Antibody (ADA) at Day 1 Day 1 Human serum ADA samples were analyzed for the presence or absence of anti-tanezumab antibodies by using the semi-quantitative enzyme-linked immunosorbent assay (ELISA).
Number of Participants With Injection-Site Reactions at Day 1 Day 1 Assessment of the injection-site reactions were based on presence of erythema (redness), induration (swelling), ecchymosis (bruising), pruritus (itching) and pain that occurred after the injection had been administered (not related to pain of needle insertion).
- Secondary Outcome Measures
Name Time Method Percentage of Participants With Cumulative Reduction From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Score Week 2, 4, 8, 16, 24, 32, 40, 48, 56 WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to osteoarthritis in index knee or index hip during past 48 hours. It is calculated as mean of the scores from 5 individual questions scored on a numerical rating scale (NRS) of 0 to 10, where higher scores indicate higher pain. Total score range for WOMAC pain subscale score is 0 to 10, where higher scores indicate higher pain. Participants with specified reduction (as percent) from baseline at Week 16 are reported.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function Subscale Score at Week 2, 4, 8, 16, 24, 32, 40, 48 and 56 Baseline, Week 2, 4, 8, 16, 24, 32, 40, 48, 56 WOMAC physical function subscale is a 17-item questionnaire used to assess the degree of difficulty experienced due to osteoarthritis in index joint and index hip during past 48 hours. It was calculated as mean of the scores from 17 individual questions scored on NRS of 0 to 10, with higher scores indicated worse function. Total score range for WOMAC physical function subscale score was 0 to 10, where higher scores indicated worse function.
Change From Baseline in Patient Global Assessment (PGA) of Osteoarthritis at Week 2, 4, 8,16, 24, 32, 40, 48 and 56 Baseline, Week 2, 4, 8, 16, 24, 32, 40, 48, 56 Participants answered: "Considering all the ways your osteoarthritis in your knee (or hip) affects you, how are you doing today?" Participants responded by using a 5-point scale where 1 = very good (no symptom and limitation of normal activities) and 5 = very poor (very severe symptoms and inability to carry out normal activities).
Percentage of Participants Who Used Concomitant Analgesic Medication Week 2, 4, 8, 16, 24, 32, 40, 48, 56, 64 United States Food and Drug Administration (FDA) approved analgesics were permitted as concomitant medications to relieve the pain of osteoarthritis. These medications included opioids, topical analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), capsaicin products and viscosupplementation (example, hyaluronan) and were prescribed at the discretion of the Investigator.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Stiffness Subscale Score at Week 2, 4, 8, 16, 24, 32, 40, 48 and 56 Baseline, Week 2, 4, 8, 16, 24, 32, 40, 48, 56 WOMAC stiffness subscale is a 2-item questionnaire used to assess the amount of stiffness experienced due to osteoarthritis in index knee or index hip during past 48 hours. It is calculated as mean of the scores from 2 individual questions scored on NRS of 0 to 10, with higher scores indicate higher stiffness. Total score range for WOMAC stiffness subscale score is 0 to 10, where higher scores indicate higher stiffness. Stiffness is defined as a sensation of decreased ease in movement of knee or hip.
Percentage of Participants With At Least 30 Percent (%), 50%, 70% and 90% Reduction in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Score Week 2, 4, 8, 16, 24, 32, 40, 48, 56 Percentage of participants with at least 30%, 50%, 70% and 90% reduction from baseline in WOMAC pain subscale score are reported. WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to osteoarthritis in index knee or index hip during past 48 hours. It was calculated as mean of the scores from the 5 individual questions scored on a 0 to 10 NRS, where higher scores indicated higher pain. Total score range for WOMAC pain subscale score is 0 to 10, where higher scores indicated higher pain.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Average Score at Week 2, 4, 8, 16, 24, 32, 40, 48 and 56 Baseline, Week 2, 4, 8, 16, 24, 32, 40, 48, 56 WOMAC: self-administered, disease-specific 24-item questionnaire which assesses clinically important, participant-relevant symptoms for pain (5 items), stiffness (2 items) and physical function (17 items) in participants with osteoarthritis of knee or hip. Each item was scored on a 0 to 10 NRS scale, where higher scores indicated higher pain/stiffness or worse function. WOMAC average score was the mean of WOMAC pain, physical function and stiffness subscale scores and ranged from 0 to 10, where higher score indicated worse response.
Change From Baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale Score at Week 2, 4, 8, 16, 24, 32, 40, 48 and 56 Baseline, Week 2, 4, 8, 16, 24, 32, 40, 48, 56 WOMAC pain subscale is a 5-item questionnaire used to assess the amount of pain experienced due to osteoarthritis in index knee or index hip during past 48 hours. It was calculated as mean of the scores from the 5 individual questions scored on a numerical rating scale (NRS) of 0 to 10, where higher scores indicated higher pain. Total score range for WOMAC pain subscale score was 0 to 10, where higher scores indicated higher pain.
Percentage of Participants With Outcome Measures in Rheumatology - Osteoarthritis Research Society International (OMERACT-OARSI) Response Week 2, 4, 8, 16, 24, 32, 40, 48, 56 OMERACT-OARSI response: greater than or equal to (\>=) 50 percent (%) improvement from baseline and absolute change from baseline of \>=2 units in WOMAC pain or physical function subscale, or at least 2 of the following 3 being true: \>=20% improvement from baseline and absolute change from baseline of \>=1 unit in 1) WOMAC pain subscale, 2) WOMAC physical function subscale, 3) PGA of osteoarthritis (score: 1-5, higher score=more affected). WOMAC pain, physical function subscales assess amount of pain/difficulty experienced (score: 0-10, higher score=higher pain/difficulty).
Percentage of Participants With Improvement of At Least 2 Points in Patient Global Assessment (PGA) of Osteoarthritis Week 2, 4, 8, 16, 24, 32, 40, 48, 56 Participants answered: "Considering all the ways your osteoarthritis in your knee (or hip) affects you, how are you doing today?" Participants responded by using a 5-point scale where 1 = very good and 5 = very poor. Improvement signifies a decrease of at least 2 points on the 5-point scale relative to baseline value.
Change From Baseline in WOMAC Pain Subscale Item: Pain When Walking on a Flat Surface at Week 2, 4, 8, 16, 24, 32, 40, 48 and 56 Baseline, Weeks 2, 4, 8, 16, 24, 32, 40, 48, 56 Participants answered: "How much pain have you had when walking on a flat surface?" Participants responded by using a NRS of 0 to 10, where 0 = no pain and 10 = extreme pain.
Change From Baseline in WOMAC Pain Subscale Item: Pain When Going Up or Down Stairs at Week 2, 4, 8, 16, 24, 32, 40, 48 and 56 Baseline, Weeks 2, 4, 8, 16, 24, 32, 40, 48, 56 Participants answered: "How much pain have you had when going up or down the stairs?" Participants responded by using a NRS of 0 to 10, where 0 = no pain and 10 = extreme pain.
Time to Discontinuation Due to Lack of Efficacy Baseline up to Week 50 Median time to discontinuation due to lack of efficacy was estimated using Kaplan-Meier method.
Number of Participants Who Discontinued Due to Lack of Efficacy Baseline up to Week 50 Days Per Week of Concomitant Analgesic Medication Usage Week 2, 4, 8, 16, 24, 32, 40, 48, 56, 64 United States FDA-approved analgesics were permitted as concomitant medications to relieve the pain of OA. These medications included opioids, topical analgesics, NSAIDs, capsaicin products and viscosupplementation (example, hyaluronan) and were prescribed at the discretion of the Investigator.
Trial Locations
- Locations (93)
OrthoArkansas, PA
🇺🇸Little Rock, Arkansas, United States
Radiology Consultants
🇺🇸Little Rock, Arkansas, United States
Montana Medical Research, Inc
🇺🇸Missoula, Montana, United States
Carolina Health Specialists
🇺🇸Myrtle Beach, South Carolina, United States
Sarah Cannon Research Institute, LLC
🇺🇸Germantown, Tennessee, United States
Seton Medical Management, Inc.
🇺🇸Mobile, Alabama, United States
Orthopaedic Center of South Flordia
🇺🇸Plantation, Florida, United States
Pacific Arthritis Center Medical Group
🇺🇸Santa Maria, California, United States
Medical Research Group of Central Florida
🇺🇸Orange City, Florida, United States
Pensacola Research Consultants, Inc.
🇺🇸Pensacola, Florida, United States
Methodist Medical Group Rheumatology
🇺🇸Peoria, Illinois, United States
Arthritis Center of North Georgia
🇺🇸Gainesville, Georgia, United States
RASF Clinical Research Center
🇺🇸Boca Raton, Florida, United States
Melbourne Internal Medicine Associates
🇺🇸Melbourne, Florida, United States
Osler Medical, Inc.
🇺🇸Melbourne, Florida, United States
American Family Medical
🇺🇸Ocala, Florida, United States
Paddock Park Clinical Research
🇺🇸Ocala, Florida, United States
Sunrise Medical Research
🇺🇸Lauderdale Lake, Florida, United States
Advanced Arthritis Care and Research
🇺🇸Scottsdale, Arizona, United States
Lynn Institute of the Ozarks
🇺🇸Little Rock, Arkansas, United States
Staywell Research
🇺🇸Northridge, California, United States
Center for Arthritis and Rheumatic Diseases
🇺🇸South Miami, Florida, United States
St. Louis Center for Clinical Research
🇺🇸Saint Louis, Missouri, United States
Arthritis Group
🇺🇸Philadelphia, Pennsylvania, United States
University Physicians
🇺🇸Columbia, Missouri, United States
Medvin Clinical Research
🇺🇸Whittier, California, United States
University Imaging Centers
🇺🇸Northridge, California, United States
Barbara A. Caciolo
🇺🇸Saint Louis, Missouri, United States
Primary Care Associates
🇺🇸Anderson, South Carolina, United States
Healthcare Research Consultants
🇺🇸Tulsa, Oklahoma, United States
Rockford Health Physicians
🇺🇸Rockford, Illinois, United States
Kentucky Medical Research Center
🇺🇸Lexington, Kentucky, United States
Physicians' Research Options, LLC
🇺🇸Draper, Utah, United States
Buffalo Rheumatology
🇺🇸Orchard Park, New York, United States
Woodrail Clinic
🇺🇸Columbia, Missouri, United States
Central Kentucky Research Associates
🇺🇸Mount Sterling, Kentucky, United States
Anderson Radiology
🇺🇸Anderson, South Carolina, United States
Mt. Sterling Clinic
🇺🇸Mount Sterling, Kentucky, United States
Bone Joint & Spine Surgeons, Inc.
🇺🇸Toledo, Ohio, United States
Integrated Medical Group PC/Fleetwood Clinical Research
🇺🇸Fleetwood, Pennsylvania, United States
Clayton Medical Research
🇺🇸Saint Louis, Missouri, United States
Wolf River Medical Group. LLC
🇺🇸Germantown, Tennessee, United States
Jeffry A. Lindenbaum D.O., P.C.
🇺🇸Yardley, Pennsylvania, United States
Office of John M. Joseph, M.D.
🇺🇸Carrollton, Texas, United States
Trinity Clinic, Rheumatology
🇺🇸Tyler, Texas, United States
Allegheny North Arthritis Center
🇺🇸Wexford, Pennsylvania, United States
Granger Medical Clinic
🇺🇸West Valley City, Utah, United States
Radiant Research, Inc
🇺🇸Columbus, Ohio, United States
Pacific Arthritis Care Center
🇺🇸Los Angeles, California, United States
Arthritis Care and Diagnostic Center
🇺🇸Dallas, Texas, United States
Houston Medical Research Associates
🇺🇸Houston, Texas, United States
Mobile Diagnostic Center
🇺🇸Mobile, Alabama, United States
Ft. Smith Rheumatology, PC
🇺🇸Fort Smith, Arkansas, United States
Catalina Pointe Clinical Research, Inc
🇺🇸Tucson, Arizona, United States
Larry Watkins, MD
🇺🇸Little Rock, Arkansas, United States
MIMA Century Research Associate
🇺🇸Melbourne, Florida, United States
Jarred Frydman, DO
🇺🇸Plantation, Florida, United States
Advanced Medical Research
🇺🇸Port Orange, Florida, United States
Boston Clinical Trails, Inc.
🇺🇸Boston, Massachusetts, United States
Graves Gilbert Clinic
🇺🇸Bowling Green, Kentucky, United States
Arthritis and Osteoporosis Consultants of the Carolinas
🇺🇸Charlotte, North Carolina, United States
Research Across America @ Oyster Point Family Health Center
🇺🇸Lancaster, Pennsylvania, United States
Radiant Research, Inc.
🇺🇸Anderson, South Carolina, United States
The Jackson Clinic, PA
🇺🇸Jackson, Tennessee, United States
Nothwest Diagonstic Clinic, PA
🇺🇸Houston, Texas, United States
Texas Research Center, LP
🇺🇸Sugar Land, Texas, United States
Lone Peak Family Medicine
🇺🇸Draper, Utah, United States
Richard Neiman, MD Inc.
🇺🇸Kirkland, Washington, United States
South Puget Sound Clinical Research Center
🇺🇸Olympia, Washington, United States
Rainier Clinical Research Center, Inc.
🇺🇸Renton, Washington, United States
Rheumatology and Pulmonary Clinic
🇺🇸Beckley, West Virginia, United States
Advance Clinical Research Inc
🇺🇸Saint Louis, Missouri, United States
Methodist Research Administration Office
🇺🇸Peoria, Illinois, United States
Phoenix Rheumatology Specialists, Ltd.
🇺🇸Phoenix, Arizona, United States
Tampa Medical Group, P.A.
🇺🇸Tampa, Florida, United States
C Michael Neuwelt, MD
🇺🇸San Leandro, California, United States
The Center for Clinical Research
🇺🇸Winston-Salem, North Carolina, United States
Robert A. Harrell, MD
🇺🇸Durham, North Carolina, United States
McBride Clinic
🇺🇸Oklahoma City, Oklahoma, United States
Piedmont Imaging
🇺🇸Winston-Salem, North Carolina, United States
Arthritis & Osteoporosis Center of South Texas
🇺🇸San Antonio, Texas, United States
Alan E. Schulman, MD
🇺🇸Richmond, Virginia, United States
Steven Maestrello, M.D.
🇺🇸Richmond, Virginia, United States
Aurora Advanced Healthcare
🇺🇸Milwaukee, Wisconsin, United States
Lynn Health Science Institute
🇺🇸Oklahoma City, Oklahoma, United States
Internal Medical Associates of Grand Island, PC
🇺🇸Grand Island, Nebraska, United States
Kansas City Internal Medicine
🇺🇸Lee's Summit, Missouri, United States
Clinical Research Source, Inc.
🇺🇸Perrysburg, Ohio, United States
Trinity Clinic, Office of Research Administration
🇺🇸Tyler, Texas, United States
Arthritis Clinic
🇺🇸Racine, Wisconsin, United States
Renstar Medical Research
🇺🇸Ocala, Florida, United States
Upstate Clinical Research Associates
🇺🇸Williamsville, New York, United States
Arthritis and Rheumatic Disease Associates, PC
🇺🇸Burke, Virginia, United States