Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis, Study Two
- Conditions
- Multiple Sclerosis, Relapsing-Remitting
- Interventions
- Biological: Alemtuzumab 12 mgBiological: Alemtuzumab 24 mgBiological: Interferon beta-1a
- Registration Number
- NCT00548405
- Lead Sponsor
- Genzyme, a Sanofi Company
- Brief Summary
The purpose of this study was to establish the efficacy and safety of two different doses of alemtuzumab (Lemtrada™) as a treatment for relapsing-remitting multiple sclerosis (MS), in comparison with subcutaneous interferon beta-1a (Rebif®). The study enrolled participants who had received an adequate trial of disease-modifying therapies but experienced at least 1 relapse during prior treatment, and who met a minimum severity of disease as measured by magnetic resonance imaging (MRI). Participants had monthly laboratory tests and comprehensive testing every 3 months.
- Detailed Description
Every participant received active treatment; there was no placebo. After Amendment 2, the 24 mg alemtuzumab dose was closed to enrollment so newly enrolled participants were randomly assigned to treatment with either 12 mg alemtuzumab or interferon beta-1a in a 2:1 ratio (that is, 2 given 12 mg alemtuzumab for every 1 given interferon beta-1a). Alemtuzumab was administered in two annual courses, once at the beginning of the study and again 1 year later. Interferon beta-1a was self-injected 3 times per week for 2 years. All participants were required to return to their study site every 3 months for neurologic assessment. In addition, safety-related laboratory tests were performed at least monthly. Participation in this study ended 2 years after the start of treatment for each participant. Additionally, participants who received alemtuzumab might be followed in the CAMMS03409 Extension Study (NCT00930553) for safety and efficacy assessments. Participants who received interferon beta-1a and completed 2 years on study might be eligible to receive alemtuzumab in the Extension Study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 840
- Signed informed consent form (ICF)
- Age 18 to 55 years (inclusive) as of the date the ICF was signed
- Diagnosis of MS per update of McDonald criteria
- Onset of MS symptoms (as determined by a neurologist; could be retrospectively) within 10 years of the date the ICF was signed
- Expanded Disability Status Scale (EDSS) score 0.0 to 5.0 (inclusive) at Screening
- Greater than or equal to (>=) 2 MS attacks (first episode or relapse) occurring in the 24 months prior to the date the ICF was signed, with >=1 attack in the 12 months prior to the date the ICF was signed, with objective neurological signs confirmed by a physician, nurse practitioner, or other Genzyme-approved health-care provider and the objective signs could be identified retrospectively
- >=1 MS relapse during treatment with a beta interferon therapy or glatiramer acetate after having been on that therapy for >=6 months within 10 years of the date the ICF was signed
- MRI scan demonstrating white matter lesions attributable to MS and meeting at least 1 of the following criteria, as determined by the neurologist or a radiologist: >=9 time constant 2 (T2) lesions at least 3 millimeter (mm) in any axis; a gadolinium- (Gd-) enhancing lesion at least 3 mm in any axis plus >=1 brain T2 lesions; and a spinal cord lesion consistent with MS plus >=1 brain T2 lesion
- Received prior therapy with alemtuzumab
- Current participation in another clinical study or previous participation in CAMMS323 (Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis, CARE-MS I)
- Treatment with natalizumab, methotrexate, azathioprine, or cyclosporine in the past 6 months. Participants who received one of these medications more than 6 months before the date the ICF was signed were eligible for study entry if approval was granted by Genzyme
- Any progressive form of MS
- History of malignancy (except basal skin cell carcinoma)
- CD4 +, CD8 +, CD19 + (that is, absolute CD3 + CD4 + , CD3 + CD8 + , or CD19 + /mm 3 ) count, absolute neutrophil count less than (<) lower limit of normal (LLN) at screening; if abnormal cell count(s) returned to within normal limits (WNL), eligibility could be reassessed
- Known bleeding disorder (for example, dysfibrinogenemia, factor IX deficiency, hemophilia, Von Willebrand's disease, disseminated intravascular coagulation, fibrinogen deficiency, or clotting factor deficiency)
- Significant autoimmune disease including but not limited to immune cytopenias, rheumatoid arthritis, systemic lupus erythematosus, other connective tissue disorders, vasculitis, inflammatory bowel disease, severe psoriasis
- Presence of anti-thyroid stimulating hormone (TSH) receptor (TSHR) antibodies (that is, above the LLN)
- Active infection or at high risk for infection
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Alemtuzumab 12 mg Alemtuzumab 12 mg Alemtuzumab (Lemtrada™) 12 milligram (mg) per day intravenous (IV) infusion on 5 consecutive days at Month 0, followed by alemtuzumab 12 mg per day IV infusion on 3 consecutive days at Month 12. Alemtuzumab 24 mg Alemtuzumab 24 mg Alemtuzumab 24 mg per day IV infusion on 5 consecutive days at Month 0, followed by alemtuzumab 24 mg per day IV infusion on 3 consecutive days at Month 12. Interferon Beta-1a Interferon beta-1a Interferon Beta-1a (Rebif®) 44 microgram (mcg) subcutaneously 3-times weekly for 24 months. Dose adjustment was done as per Investigator's discretion.
- Primary Outcome Measures
Name Time Method Percentage of Participants With Sustained Accumulation of Disability (SAD) Up to 2 years EDSS is an ordinal scale in half-point increments that qualifies disability in participants with MS. It assesses 7 functional systems (visual, brainstem, pyramidal, cerebellar, sensory, bowel/bladder and cerebral) as well as ambulation. EDSS total score: 0 (normal neurological examination) to 10 (death due to MS). As measured by EDSS score, SAD was defined as increase of at least 1.5 points for participants with Baseline score of 0 and increase of at least 1.0 point for participants with a Baseline score of 1.0 or more; and the increase persisted for at least the next 2 scheduled assessments, that is, 6 consecutive months. The onset date of SAD was date of first EDSS assessment that began 6 month consecutive period of SAD. Participants who did not reach SAD endpoint were censored at their last visit. Percentage of participants with SAD, estimated by Kaplan-Meier (KM) method, was reported.
Annualized Relapse Rate Up to 2 years Relapse was defined as new neurological symptoms or worsening of previous neurological symptoms with an objective change on neurological examination, attributable to multiple sclerosis that lasted for at least 48 hours, that were present at normal body temperature, and that were preceded by at least 30 days of clinical stability. Annualized relapse rate was estimated through negative binomial regression with robust variance estimation and covariate adjustment for geographic region using observed number of relapses as dependent variable, the log total amount of follow-up from date of first study treatment for each participant as an offset variable, and treatment group and geographic region as model covariates.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Who Were Relapse Free at Year 2 Year 2 Participants were considered relapse free at Year 2 if they did not experience a relapse from the date of first study treatment to study completion at 24 months. Percentage of participants who were relapse free at Year 2, estimated using the KM method, was reported.
Change From Baseline in Expanded Disability Status Scale (EDSS) Score at Year 2 Baseline, Year 2 EDSS is an ordinal scale in half-point increments that qualifies disability in participants with multiple sclerosis (MS). It assesses the 7 functional systems (visual, brainstem, pyramidal, cerebellar, sensory, bowel/bladder and cerebral) as well as ambulation. EDSS total score ranges from 0 (normal neurological examination) to 10 (death due to MS). Change was calculated by subtracting Baseline value from value at Year 2.
Change From Baseline in Multiple Sclerosis Functional Composite (MSFC) Score at Year 2 Baseline, Year 2 MSFC is a multidimensional measure consisting of quantitative tests of ambulation (Timed 25-Foot Walk), manual dexterity (9-Hole Peg Test; 9HPT), and cognitive function (Paced Auditory Serial Addition Test; PASAT). The MSFC score was calculated as the mean of the Z-scores of the 3 components. A Z-score was calculated by subtracting the mean of the reference population from the test result, then dividing by the standard deviation of the reference population. Higher Z-scores reflected better neurological function and a positive change from Baseline indicates improvement. An increase in score indicated an improvement (Z-score range: -3 to +3). Acquisition of disability was measured by change from Baseline in MSFC score at Year 2.
Percent Change From Baseline in Magnetic Resonance Imaging Time Constant 2 (MRI-T2) Hyperintense Lesion Volume at Year 2 Baseline, Year 2 Percent change in MS lesion volume as measured by MRI-T2 scan was calculated from MRI-T2-weighted scans as the following: (lesion volume at 2 years - lesion volume at Baseline)\*100/ (lesion volume at Baseline).
Trial Locations
- Locations (191)
Central Texas Neurology
🇺🇸Round Rock, Texas, United States
Sunnybrook Health Sciences Centre
🇨🇦Toronto, Ontario, Canada
Department of Neurology, Keck School of Medicine, University of Southern California
🇺🇸Los Angeles, California, United States
University of Pittsburgh, Kaufmann Medical Building
🇺🇸Pittsburgh, Pennsylvania, United States
Caritas St. Elizabeth's Medical Center
🇺🇸Boston, Massachusetts, United States
Josephson Wallack Munshower Neurology P.C.
🇺🇸Indianapolis, Indiana, United States
Partners Multiple Sclerosis Center/Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
University of Nevada School of Medicine
🇺🇸Las Vegas, Nevada, United States
Integra Clinical Research
🇺🇸San Antonio, Texas, United States
Montana Neurobehavioral Specialists
🇺🇸Missoula, Montana, United States
Unidad de Investigación en Salud de Chihuahua, S.C.
🇲🇽Chihuahua, Mexico
Centre for Neuroscience & Trauma, Blizard Institute of Cell and Molecular Science Barts and The London School of Medicine and Dentistry
🇬🇧London, England, United Kingdom
Hospital Angeles del Pedregal; Camino a Santa Teresa
🇲🇽Mexico City, Mexico
Clinical Centre Vojvodina Institute of Neurology
🇷🇸Novi Sad, Serbia
University of Rochester Medical Center
🇺🇸Rochester, New York, United States
Hospital Medica Sur CIF-BIOTEC
🇲🇽Delegacion, Tlalpan, Mexico
Azienda Ospedaliera Sant'Andrea Neurologia
🇮🇹Roma, Italy
Multiple Sclerosis Clinic, Connell 7, Kingston General Hospital
🇨🇦Kingston, Ontario, Canada
North Central Neurology Associates, P.C.
🇺🇸Cullman, Alabama, United States
East Bay Physicians Medical Group/Sutter East Bay Medical Foundation
🇺🇸Berkeley, California, United States
Neurology Center of North Orange County
🇺🇸La Habra, California, United States
Advanced Neurosciences Research
🇺🇸Fort Collins, Colorado, United States
George Washington University Medical Faculty Associates
🇺🇸Washington, District of Columbia, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Stanford University School of Medicine
🇺🇸Stanford, California, United States
Negroski, Stein, Sutherland and Hanes Neurology
🇺🇸Sarasota, Florida, United States
University of Florida Neuroscience Institute
🇺🇸Jacksonville, Florida, United States
Neurology Associates, P.A.
🇺🇸Maitland, Florida, United States
Emory University, Department of Neurology
🇺🇸Atlanta, Georgia, United States
Shepherd Center, Inc.
🇺🇸Atlanta, Georgia, United States
Neurological Associates
🇺🇸Pompano Beach, Florida, United States
Idaho Falls Multiple Sclerosis Center, PLLC
🇺🇸Idaho Falls, Idaho, United States
Fort Wayne Neurological Center
🇺🇸Fort Wayne, Indiana, United States
University of Chicago Medical Center, Department of Neurology
🇺🇸Chicago, Illinois, United States
Iowa Health Physicians
🇺🇸Des Moines, Iowa, United States
Indiana University School of Medicine, Department of Neurology
🇺🇸Indianapolis, Indiana, United States
Springfield Neurology Associates, LLC
🇺🇸Springfield, Massachusetts, United States
Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center
🇺🇸Lebanon, New Hampshire, United States
Louisiana State University Health Sciences Center
🇺🇸Shreveport, Louisiana, United States
University of Kansas Medical Center, Department of Neurology
🇺🇸Kansas City, Kansas, United States
Associates in Neurology, PSC
🇺🇸Lexington, Kentucky, United States
University of Louisville Research Foundation
🇺🇸Louisville, Kentucky, United States
UMass Memorial Medical Center
🇺🇸Worcester, Massachusetts, United States
Northern Michigan Neurology
🇺🇸Traverse City, Michigan, United States
Michigan Neurology Associates, P.C.
🇺🇸St. Clair Shores, Michigan, United States
Renown Institute for Neurosciences / Renown regional Medical Center
🇺🇸Reno, Nevada, United States
Neurology Consultants of Kansas City, Inc.
🇺🇸Kansas City, Missouri, United States
Northshore Clinical Associates
🇺🇸Erie, Pennsylvania, United States
Advanced Neurosciences Institute
🇺🇸Franklin, Tennessee, United States
Biomedical Research Alliance of NY, LLC
🇺🇸Franklin, Tennessee, United States
University of North Carolina-Chapel Hill, Department of Neurology
🇺🇸Chapel Hill, North Carolina, United States
Empire Neurology, PC
🇺🇸Latham, New York, United States
Neurology Specialists, Inc.
🇺🇸Dayton, Ohio, United States
SUNY Upstate Medical University, Department of Neurology
🇺🇸Syracuse, New York, United States
Cleveland Clinic Foundation, Mellen Center
🇺🇸Cleveland, Ohio, United States
Winthrop University Hospital, Clinical Trials Center
🇺🇸Mineola, New York, United States
Neurology Clinic, P.C.
🇺🇸Cordova, Tennessee, United States
Mount Sinai School of Medicine, Corinne Goldsmith Dickinson Center for Multiple Sclerosis
🇺🇸New York, New York, United States
Oak Clinic for Multiple Sclerosis
🇺🇸Uniontown, Ohio, United States
The Neurology Foundation, Inc.
🇺🇸Providence, Rhode Island, United States
UBC Hospital
🇨🇦Vancouver, British Columbia, Canada
Hope Neurology PC
🇺🇸Knoxville, Tennessee, United States
AKH Wien, Universitätsklinikum für Neurologie
🇦🇹Wien, Austria
University Hospital Leuven, Campus Gasthuisberg, Neurology
🇧🇪Leuven, Belgium
Liverpool Hospital, Neurology Department
🇦🇺Liverpool, Australia
MS Center of Greater Washington, P.C.
🇺🇸Vienna, Virginia, United States
Rockwood Clinical Research Center
🇺🇸Spokane, Washington, United States
Clinical Center for Multiple Sclerosis
🇺🇸Dallas, Texas, United States
Clinical Hospital Centre Rijeka, Clinic for Neurology
🇭🇷Rijeka, Croatia
London Health Sciences Centre- University Hospital
🇨🇦London, Ontario, Canada
Swedish Neuroscience Institute
🇺🇸Seattle, Washington, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Cliniques Universitaires Saint-Luc, Neurology
🇧🇪Brussel, Belgium
Westmead Hospital
🇦🇺Westmead, New South Wales, Australia
Hospital de Clínicas USP
🇧🇷Sao Paulo, Brazil
DIABAID
🇦🇷Buenos Aires, Argentina
Hospital Sao Lucas PUC-RS
🇧🇷Porto Alegre, RS, Brazil
CHU Ourthe Amblève, Neurology
🇧🇪Esneux, Belgium
MS Center, Department of Neurology
🇨🇿Hradec Kralove, Czech Republic
Clinical Hospital Sestre Milosrdnice
🇭🇷Zagreb, Croatia
Clinical Cognitive Research Unit/Clinical Trials, The Queen Elizabeth Hospital, Neurology Department
🇦🇺Woodville South, South Australia, Australia
Clinique Neuro rive-sud, Recherche sepmus inc
🇨🇦Greenfield park, Quebec, Canada
Hospital da Restauracao
🇧🇷Recife, PE, Brazil
Neurologisches Fachzentrum Berlin
🇩🇪Berlin, Germany
General Hospital " Sveti Duh", Department of neurology
🇭🇷Zagreb, Croatia
Department of Neurology 1st Faculty of Medicine and General Teaching Hospital, MS Center
🇨🇿Praha 2, Czech Republic
Centre de Sante et de Services Sociaux de Gatineau-Hull Hospital
🇨🇦Gatineau, Quebec, Canada
General Hospital Varazdin, Department of neurology
🇭🇷Varazdin, Croatia
St. Anne's University Hospital Brno
🇨🇿Pekarska, Czech Republic
Clinical Hospital Centre Zagreb
🇭🇷Zagreb, Croatia
Århus Universitetshospital, Scleroseklinikken, Århus Sygehus
🇩🇰Aarhus, Denmark
Krajska zdravotni a.s. - Hospital Teplice
🇨🇿Teplice, Czech Republic
Scleroseklinikken, Rigshospitalet
🇩🇰København, Denmark
CHU Clermont-Ferrand, Hôpital Gabriel Montpied
🇫🇷Clermont-Ferrand, France
Odense University Hospital
🇩🇰Odense, Denmark
Krankenhaus Hohe Warte, Betriebsstätte der Bayreuth
🇩🇪Bayreuth, Germany
Judisches Krankenhaus Berlin
🇩🇪Berlin, Germany
Klinikum Rechts der Isar, Klinik für Neurologie
🇩🇪Muenchen, Germany
Klinikum Ingolstadt, Neurologische Klinik
🇩🇪Ingolstadt, Germany
Neurologische Universitätsklinik Bonn
🇩🇪Bonn, Germany
Military Medical Academy
🇷🇸Belgrade, Serbia
Sahlgrenska University Hospital, Neurologkliniken
🇸🇪Gothenburg, Sweden
Servicio de Neurología Hospital Clínico San Carlos
🇪🇸Madrid, Spain
Ospedale Binaghi - Centro Sclerosi Multipla
🇮🇹Cagliari, Italy
Asklepios Klinic Barmbek
🇩🇪Hamburg, Germany
Orbis Medisch Centrum, Department of Neurology
🇳🇱Sittard, Netherlands
Sheba Medical Centre
🇮🇱Tel Hashomer, Israel
Universitatsklinik Ulm
🇩🇪Ulm, Germany
Fachkrankenhaus Hubertusburg
🇩🇪Wermsdorf, Germany
Università di Genova Dipartimento di Neuroscienze Oftalmologia e Genetica
🇮🇹Genova, Italy
Ospedale Civile di Brescia c/o Ospedale Richiedei, Centro di riferimento per la Sclerosi Multiple
🇮🇹Montichiari, Italy
Hadassah Medical Center Ein Karem
🇮🇱Jerusalem, Israel
Ospedale San Luigi di Orbassano
🇮🇹Orbassano, Italy
Independent Public Healthcare Facility, Norbert Barlicki University Hospital No. 1 of the Medical University of Lodz
🇵🇱Lodz, Poland
Moscow State Public Medical Institution, City Clinical Hospital #11
🇷🇺Moscow, Russian Federation
Tel Aviv Sourasky Medical Center, Department of Neurology
🇮🇱Tel Aviv, Israel
Ospedale S. Antonio Abate di Gallarate
🇮🇹Gallarate, Italy
Independent Public Teaching Hospital No. 4 in Lublin
🇵🇱Lublin, Poland
Jeroen Bosch Ziekenhuis
🇳🇱Hertogenbosch, Netherlands
Municipal Treatment and Prevention Institution, "City Hospital #33"
🇷🇺Nizhniy Novgorod, Russian Federation
State Medical Institution, "Samara Regional Clinical Hospital n.a. M.I. Kalinin"
🇷🇺Samara, Russian Federation
Institution of the Russian Academy of Medical Sciences, "Neurology Scientific Center under RAMS"
🇷🇺Moscow, Russian Federation
Clinic of Neurology, Clinical Centre of Serbia
🇷🇸Belgrade, Serbia
Clinical Centre of Kragujevac
🇷🇸Kragujevac, Serbia
Norrlands Universitets sjukhus
🇸🇪Umea, Sweden
Servicio de Neurología Hospital Carlos Haya
🇪🇸Malaga, Spain
Servicio de Neurología Hospital Virgen de la Macarena
🇪🇸Sevilla, Spain
Servicio de Neurología Hospital Vall d'Hebron Paseo de Vall d'Hebron
🇪🇸Barcelona, Spain
Institute of Neurology, Psychiatry and Narcology under the Academy of Medical Sciences of Ukraine
🇺🇦Kharkov, Ukraine
Frenchay Hospital
🇬🇧Bristol, United Kingdom
Salford Royal NHS Foundation Trust, Clinical Trials Unit
🇬🇧Salford, United Kingdom
Barrow Neurological Institute, St. Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Hope Research Institute
🇺🇸Phoenix, Arizona, United States
Neurological Consultants
🇺🇸Denver, Colorado, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Wayne State University, School of Medicine, Department of Neurology
🇺🇸Detroit, Michigan, United States
Mayo Clinic Rochester
🇺🇸Rochester, Minnesota, United States
MS Center of Oklahoma
🇺🇸Oklahoma City, Oklahoma, United States
Vanderbilt Multiple Sclerosis Center
🇺🇸Nashville, Tennessee, United States
Multiple Sklerose Zentrum am, Zentrum für klinische Neurowissenschaften, Neurologische Uniklinik Dresden
🇩🇪Dresden, Germany
Medizinische Hochshule Hannover
🇩🇪Hannover, Germany
Oberhavelkliniken Hennigsdorf
🇩🇪Hennigsdorf, Germany
Klinik und Poliklinik fur Neurologie der Universitat Rockstock
🇩🇪Rostock, Germany
Hôpital Pitié Salpétrière, Service de Neurologie
🇫🇷Paris, France
Hôpital General, Service de Neurologie
🇫🇷Dijon Cedex, France
Hôpital Civil, Departement de Neurologie
🇫🇷Strasbourg Cedex, France
Moscow State Medical Institution City Clinical Hospital #11, Moscow City Center for Multiple Sclerosis
🇷🇺Moscow, Russian Federation
Research Medical Complex "Your Health" Ltd
🇷🇺Kazan, Russian Federation
Federal State Institution: Siberian District Medical Center
🇷🇺Novosibirsk, Russian Federation
Institution of the Russian Academy of Sciences, "Institute of the Human Brain n.a. N.P. Bekhtereva within the Russian Academy of Sciences"
🇷🇺St. Petersburg, Russian Federation
St. Petersburg Pavlov State Medical University, Department of Neurology and Neurosurgery with a Clinic
🇷🇺St. Petersburg, Russian Federation
St.Petersburg State Medical Institution, "City Multispecialty Hospital #2"
🇷🇺St. Petersburg, Russian Federation
St.Petersburg State Medical Institution, "Nikolayevskaya Hospital"
🇷🇺St. Petersburg, Russian Federation
Comprehensive Multiple Sclerosis Care Center at South Shore Neurologic Associates, P.C.
🇺🇸Patchogue, New York, United States
St. Vincent's Hospital, MS Education & Research, Department of Clinical Neurosciences
🇦🇺Fitzroy, Victoria, Australia
Royal Hobart Hospital
🇦🇺Hobart, Tasmania, Australia
Southern Neurology
🇦🇺Kogarah, Australia
Ruan Neurology Clinic and Research Center
🇺🇸Des Moines, Iowa, United States
University of Michigan Department of Neurology
🇺🇸Ann Arbor, Michigan, United States
Wake Forest University Health Science, Department of Neurology
🇺🇸Winston-Salem, North Carolina, United States
University of California, Davis Medical Center
🇺🇸Sacramento, California, United States
University of Colorado Hospital, Anschutz Outpatient Pavilioin
🇺🇸Aurora, Colorado, United States
Axiom Clinical Research of Florida
🇺🇸Tampa, Florida, United States
University of South Florida, Department of Neurology
🇺🇸Tampa, Florida, United States
MS Center at Holy Name Hospital
🇺🇸Teaneck, New Jersey, United States
Consultants in Neurology, Ltd
🇺🇸Northbrook, Illinois, United States
Griffith School of Medicine, Gold Coast Campus, Griffith University
🇦🇺Southport, Queensland, Australia
Department of Neurology Glossop Road, Royal Hallamshire Hospital
🇬🇧Sheffield, United Kingdom
Heliodor Swiecicki Teaching Hospital of the Poznan, University of Medical Sciences
🇵🇱Poznan, Poland
Neuro-Therapeutics, Inc
🇺🇸Pasadena, California, United States
Northwest NeuroSpecialists, PLLC
🇺🇸Tucson, Arizona, United States
Mayo Clinic Arizona, Department of Neurology
🇺🇸Scottsdale, Arizona, United States
Neuro-Therapeutics Inc.
🇺🇸Pasadena, California, United States
MidAmerica Neuroscience Institute
🇺🇸Lenexa, Kansas, United States
University of New Mexico, Health Sciences Center, MS Specialty Clinic
🇺🇸Alburquerque, New Mexico, United States
Neurology Center of San Antonio
🇺🇸San Antonio, Texas, United States
Lehigh Valley Hospital, Neuroscience and Pain Research
🇺🇸Allentown, Pennsylvania, United States
Royal Melbourne Hospital, Department of Neurology
🇦🇺Parkville, Victoria, Australia
Concord Repatriation General Hospital, Neurosciences Department
🇦🇺Concord, Australia
Austin Health
🇦🇺Heidelberg, Victoria, Australia
Montreal Neurological Institute and Hospital
🇨🇦Montreal, Quebec, Canada
The Ottawa Hospital, General Campus
🇨🇦Ottawa, Ontario, Canada
Hospital Maisonneuve-Rosemont
🇨🇦Montreal, Quebec, Canada
Irmandade da Santa Casa de Misericordia de Sao Paulo
🇧🇷Sao Paulo, Brazil
Hospital Roger Salengro
🇫🇷Lille Cedex, France
Sevice de Neurologie
🇫🇷Rennes Cedex, France
Danylo Halytsky Lviv National Medical University, Department of Neurology
🇺🇦Lviv, Ukraine
Department Of Neurosciences, Addenbrookes Hospital
🇬🇧Cambridge, England, United Kingdom
Kyiv Municipal Clinical Hospital #4, Department of Demyelinating Diseases of the Nervous System
🇺🇦Kyiv, Ukraine
Spectrum Health Medical Group, Neurology (Previously known as Michigan Medical P.C., Neurology)
🇺🇸Grand Rapids, Michigan, United States
The Wesley Research Institute
🇦🇺Auchenflower, Queensland, Australia