Subcutaneous Treatment In Randomized Subjects To Evaluate Safety And Efficacy In Generalized Lupus Erythematosus

Phase 2

Completed

Conditions: Lupus Erythematosus, Systemic

Interventions: Biological: PF-04236921

Registration Number: NCT01405196

Lead Sponsor: Pfizer

Brief Summary: The objective of this study is to evaluate and compare efficacy of 3 dose levels of PF-04236921 to placebo in subjects with generalized lupus using a measure called the Systemic Lupus Erythematosus (SLE) Responder Index. The study will evaluate secondary and exploratory measures as well.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 183

Inclusion Criteria

Male or female subjects between ages of 18 and 75 years old at time of signing consent.
Have a clinical diagnosis of SLE according to 1997 update on the revised 1982 American College of Rheumatology (ACR) criteria.
Have a unequivocally positive anti-nuclear antibody (ANA) test result.
Active disease at screening defined by both: SLEDAI-2K score greater than or equal to 6 and BILAG Level A disease in more than or equal to 1 organ system (except renal or central nervous system) or BILAG B disease in more than or equal to 2 organ systems if no level A disease in present.

Exclusion Criteria

Any prior history of treatment with PF-04236921, or anti-IL-6 agent;
Have received any of the following within 364 days of day 1: a biologic investigational agent other than B cell targeted therapy; required 3 or more courses of systemic corticosteroids for concomitant conditions; history of previously untreated or current evidence of active or untreated latent infection with Tuberculosis (TB), evidence of prior untreated or currently active TB by chest radiography, residing with or frequent close contact with an individual with active TB.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
10 mg of PF-04236921	PF-04236921	-
50 mg of PF-04236921	PF-04236921	-
Placebo	PF-04236921	-
200 mg of PF-04236921	PF-04236921	-

Primary Outcome Measures

Name	Time	Method
Percentage of Participants Achieving Systemic Lupus Erythematosus (SLE) Responder Index (SRI) at Week 24	Week 24	SRI components include:Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI-2K),British Isles Lupus Assessment Group(BILAG) 2004,Physician's Global Assessment(PhGA).Participants classified as responder if they did not meet definition of treatment failure and met all the following criteria: greater than or equal to(\>=) 4 point reduction in SLEDAI-2K score; no new BILAG A organ domain score or 2 new BILAG B organ domain scores; no worsening (less than \[\<\] 0.3 point increase) in PhGA score. Treatment failure: any new/increased use of corticosteroids,immunosuppressants/antimalarial drug, any death, hospitalization/treatment discontinuation due to SLE, any flare of lupus interfering with participation in study. SLEDAI-2K:assesses improvement in disease activity (range: 0 to 105; higher score = higher severity). BILAG:assesses disease extent, severity (range: A\[severe\] to E\[no disease\]). PhGA: assesses worsening in participant's general health status(range: 0\[none\] to 3\[severe\]).

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants Achieving Pre-defined Criteria for Systemic Lupus Erythematosus (SLE) Responder Index (SRI) Components at Week 24	Week 24	SRI components include: SLEDAI-2K, BILAG 2004 and PhGA. Participants classified as responder if they did not meet definition of treatment failure and met all the following criteria: \>=4 point reduction in SLEDAI-2K score; no new BILAG A organ domain score or 2 new BILAG B organ domain scores; no worsening(\<0.3 point increase) in PhGA score. Treatment failure: any new/increased use of corticosteroids, immunosuppressants/antimalarial drug, any death, hospitalization/treatment discontinuation due to SLE, any flare of lupus interfering with participation in study. SLEDAI-2K: assesses improvement in disease activity(range: 0 to 105; higher score = higher severity). BILAG: assesses disease extent, severity (range: A\[severe\] to E \[no disease\]). PhGA: assesses worsening in participant's general health status (range: 0\[none\] to 3\[severe\]). Model percent estimates reported only for 'Reduction in SLEDAI Score','No Worsening in PhGA' categories; for remaining categories, raw percentages reported
Number of Participants Who Discontinued Due to Adverse Events	Baseline up to Week 52	An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. An 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. Number of participants who discontinued due to adverse events were reported.
Percentage of Participants With Normalized Serological Activity	Baseline up to Week 24	Serologic activity was to be assessed in the subgroup of participants who had positive serologic activity at baseline.
Change From Baseline in European Quality of Life 5 Dimensions Questionnaire (EQ-5D) at Week 4, 8, 12, 16, 20 and 24	Baseline, Week 4, 8, 12, 16, 20, 24	EQ-5D is a standardized, participant-administered measure of health outcome. It provides a descriptive profile for 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), using 3 levels (no, moderate, or extreme problems) and a single index value characterizing current health status using a 100-point VAS (0= worst imaginable health state, 100= best imaginable health state).
Percentage of Participants Achieving Systemic Lupus Erythematosus (SLE) Responder Index (SRI) at Week 4, 8, 12, 16, and 20	Week 4, 8, 12, 16, 20	SRI components include:SLEDAI-2K ,BILAG 2004, PhGA. Participants classified as responder if they did not meet definition of treatment failure and met all the following criteria: \>=4 point reduction in SLEDAI-2K score; no new BILAG A organ domain score or 2 new BILAG B organ domain scores; no worsening (\<0.3 point increase) in PhGA score. Treatment failure: any new/increased use of corticosteroids,immunosuppressants/antimalarial drug, any death, hospitalization/treatment discontinuation due to SLE, any flare of lupus interfering with participation in study. SLEDAI-2K: assesses improvement in disease activity (range: 0 to 105; higher score = higher severity). BILAG:assesses disease extent, severity (range: A \[severe\] to E \[no disease\]). PhGA: assesses worsening in participant's general health status(range: 0\[none\] to 3\[severe\]).
Percentage of Participants Achieving Modified Systemic Lupus Erythematosus (SLE) Responder Index (SRI) at Week 4, 8, 12, 16, 20, and 24	Week 4, 8, 12, 16, 20, 24	SRI components include: modified SLEDAI-2K (SLEDAI-2K without standard parameters "Low complement" and "Leukopenia"), BILAG 2004, PhGA. Participants classified as responder if they did not meet definition of treatment failure and met all the following criteria: \>=4 point reduction in SLEDAI-2K score; no new BILAG A organ domain score or 2 new BILAG B organ domain scores; no worsening (\<0.3 point increase) in PhGA score. Treatment failure: any new/increased use of corticosteroids, immunosuppressants/antimalarial drug, any death, hospitalization/treatment discontinuation due to SLE, any flare of lupus interfering with participation in study. Modified SLEDAI-2K: assesses improvement in disease activity (range: 0 to 102; higher score = higher severity). BILAG: assesses disease extent, severity (range: A \[severe\] to E \[no disease\]). PhGA: assesses worsening in participant's general health status (range: 0\[none\] to 3\[severe\]).
Number of Participants With Treatment-Emergent Adverse Events (AEs) or Serious Adverse Events (SAEs)	Baseline up to Week 52	An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. An 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 Week 52 that were absent before treatment or that worsened relative to pretreatment state. Number of participants with treatment-emergent AEs or SAEs (excluding infectious AEs or SAEs and injection site reactions) were reported. AEs include both SAEs and non-SAEs.
Percentage of Participants Achieving British Isles Lupus Assessment Group-based Composite Lupus Assessment (BICLA) Response at Week 4, 8, 12, 16, 20, and 24	Week 4, 8, 12, 16, 20, 24	BICLA include: BILAG-2004, SLEDAI-2K, PhGA of disease activity. Participants classified as responder if they did not meet the definition of treatment failure and met all the following criteria: BILAG-2004 improvement (all A scores at baseline improved to B/C/D and all B scores improved to C or D); no worsening in disease activity (no new BILAG-2004 A scores or =\<1 new B score); no worsening of total SLEDAI-2K score; no significant deterioration (\<10 percent \[%\] worsening) in analogue PhGA. Treatment failure: any new/increased use of corticosteroids,immunosuppressants/antimalarial, any death, hospitalization/treatment discontinuation due to SLE, any flare of lupus interfering with participation in study. BILAG:assesses disease extent, severity (range: A\[severe\] to E\[no disease\]). SLEDAI-2K:assesses improvement in disease activity (range: 0 to 105; higher score = higher severity). PhGA: assesses worsening in participant's general health status(range: 0\[none\] to 3\[severe\]).
Number of Participants With Clinically Significant Laboratory Tests Results	Baseline up to Week 52	Pre-defined criteria were established for each laboratory test to define the values that would be identified as of potential clinical importance. Laboratory values included Alanine Aminotransferase (ALT) \[\>5.0 - 10.0\Upper limit of normal range (ULN)\], Albumin \[\<26-20 gram per liter (g/L)/ \<20 g/L\], Amylase \[\>2.0 - 5.0\ULN\], Aspartate Aminotransferase (AST) \[\>5.0 - 10.0\ULN\], Creatine Kinase (CK) \[\>5.0 - 10.0\ ULN/ \>10.0\ULN\], Glucose (Hyperglycemia) \[\>13.9 - 27.8 millimoles/liter (mmol/L)\], Hemoglobin (HGB) \[\<80 - 65 g/L/ \<65 g/L\], Lipase \[\>2.0 - 5.0\ULN\], Lymphocytes (Lymph.)(Absolute \[Abs\]) \[\<0.5 - 0.2\10\^3/microliter (UL)/ \<0.2\10\^3/UL\], Platelets \[\<50-25\10\^3/UL/ \<25\10\^3/UL\], potassium (low) \[\<3.0 - 2.5 mmol/L\], Sodium (low) \[\<130 - 120 mmol/L\], Total Neutrophils (TN) (Abs) \[\<1.0 - 0.5\10\^3/UL/ \<0.5\10\^3/UL\], Triglycerides \[\>5.7 - 11.4 mmol/L\], White Blood Cell Count (WBC) \[\<2.0 - 1.0\10\^3/UL/ \<1.0\10\^3/UL\].
Number of Participants With Treatment-Emergent Infectious Adverse Events (AEs) or Serious Adverse Events (SAEs)	Baseline up to Week 52	An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. An 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 Week 52 that were absent before treatment or that worsened relative to pretreatment state. Number of participants with treatment-emergent infectious AEs or SAEs were reported. AEs include both SAEs and non-SAEs.
Number of Participants With Potentially Clinically Important (PCI) Electrocardiogram (ECG) Findings	Baseline up to Week 52	Criteria for potentially clinically important (PCI) findings in ECG were defined as: heart rate \<=40 beats per minute (bpm) or \>=120 bpm; PR interval \>=220 millisecond (msec); QT interval \>=480 msec; QRS interval \>=120 msec; QT interval corrected using the Fridericia formula (QTcF) \>=500msec; no sinus rhythm.
Number of Participants With Potentially Clinically Important Vital Signs Findings	Baseline up to Week 52	Criteria for PCI findings in vital signs were defined as: sitting systolic blood pressure (Increase from baseline \>=20 millimeter of mercury (mm Hg) and \>=160 mm Hg or a decrease from baseline \>=20 mm Hg and \<=90 mm Hg) and sitting diastolic blood pressure (increase from baseline \>=15 mm Hg and \>=90 mm Hg or decrease from baseline \>=15 mm Hg and \<=60 mm Hg), pulse rate (increase from baseline \>=15 beats/min and \>=120 beats/min or decrease from baseline \>=15 beats/min and \<=50 beats /min), body temperature (increase of \>=2 degree Fahrenheit (F) and temperature \>=101 degree F) and weight (change of \>=7% in body weight)
Number of Participants With Anti-drug Antibodies (ADAs) and Neutralizing Antibodies (Nabs)	Baseline up to Week 52	Human serum samples were analyzed for the presence or absence of anti-PF-04236921 antibodies. A positive ADA sample was further tested for neutralizing antibodies using a validated assay.
Serum Concentration of PF-04236921	Day 1, Week 2, 4, 6, 8, 12, 16, 20, 24	Serum PF-04236921 concentrations over time were summarized.
Percentage of Participants With Corticosteroid Dose Reduced by Both Greater Than or Equal to (>=) 25 Percent (%) From Baseline and Less Than or Equal to (<=) 7.5 Milligrams Per Day (mg/Day)	Week 12, 16, 20, 24	Participants were given supplemental corticosteroids at baseline to control disease activity, if necessary. The steroid taper was based on participant's symptoms. Participants recorded their steroid usage on a diary card. Least Observation Carried Forward (LOCF) method was used to impute missing data.
Change From Baseline in Patient Global Visual Analog Scale (VAS) at Week 2, 4, 6, 8, 12, 16, 20 and 24	Baseline, Week 2, 4, 6, 8, 12, 16, 20, 24	Participants assessed their disease activity using a 100 mm VAS. Participants answered the following question "Considering all the ways your disease affects you, how are you feeling today?" Response was recorded by placing a mark on the scale between 0 (very well) and 100 (extremely bad).
Thirty Six-Item Short-Form Health Survey (SF-36) Physical Component Score (PCS) and Mental Component Score (MCS) at Baseline	Baseline	SF-36 is a standardized survey evaluating 8 aspects of functional health and well-being: physical and social functioning, physical and emotional role limitations, bodily pain, general health, vitality, mental health. These 8 aspects can also be summarized as PCS and mental component score MCS. The score for each aspect and PCS/MCS is an average of the individual question scores, which are scaled 0-100 (100=highest level of functioning). LOCF method was used to impute missing values.
Change From Baseline in 36-Item Short-Form Health Survey (SF-36) PCS and MCS at Week 4, 8, 12, 16, 20 and 24	Baseline, Week 4, 8, 12, 16, 20, 24	SF-36 is a standardized survey evaluating 8 aspects of functional health and well-being: physical and social functioning, physical and emotional role limitations, bodily pain, general health, vitality, mental health. These 8 aspects can also be summarized as physical component score (PCS) and mental component score (MCS). The score for each aspect and PCS/MCS is an average of the individual question scores, which are scaled 0-100 (100=highest level of functioning). LOCF method was used to impute missing values.
Change From Baseline in Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) Score at Week 4, 8, 12, 16, 20 and 24	Baseline, Week 4, 8, 12, 16, 20, 24	FACIT-F is a 13-item questionnaire. Participants scored each item on a 5-point scale: 0 (not at all) to 4 (very much). Larger the participant's response to the questions (with the exception of 2 negatively stated), greater was the participant's fatigue. For all questions, except for the 2 negatively stated ones, the code was reversed and a new score was calculated as (4 minus the participant's response). The sum of all responses resulted in the FACIT-Fatigue score for a total possible score of 0 (worse score) to 52 (better score). LOCF method was used to impute missing values.
Patient Global Visual Analog Scale (VAS) Scores at Baseline	Baseline	Participants assessed their disease activity using a 100 millimeter (mm) VAS. Participants answered the following question "Considering all the ways your disease affects you, how are you feeling today?" Response was recorded by placing a mark on the scale between 0 (very well) and 100 (extremely bad).
Change From Baseline in Vitality Scores at Week 4, 8, 12, 16, 20 and 24	Baseline, Week 4, 8, 12, 16, 20, 24	SF-36 is a standardized survey evaluating 8 aspects of functional health and well being: physical and social functioning, physical and emotional role limitations, bodily pain, general health, vitality, mental health. Vitality sub-score is a component of SF-36 Health Survey Questionnaire and assesses energy and fatigue. The vitality score ranged from 0-100 (100=highest level of functioning). LOCF method was used to impute missing values.
Change From Baseline in Short Form-6 Dimension (SF-6D) at Week 4, 8, 12, 16, 20 and 24	Baseline, Week 4, 8, 12, 16, 20, 24	The SF-6D focuses on seven of the eight health domains covered by the SF-36 Health Survey: physical functioning, role participation (combined role-physical and role-emotional), social functioning, bodily pain, mental health, and vitality. The SF-6D is an attempt to derive a single index from the SF-36 Health Survey for use in economic evaluation studies. As such, it represents a summary score based on a subset of the SF-36 data. Consequently, in lieu of the SF-6D, PCS and MCS SF-36 results are being provided. The score for each aspect and PCS/MCS is an average of the individual question scores, which are scaled 0-100 (100=highest level of functioning). LOCF method was used to impute missing values.
Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) Score at Baseline	Baseline	FACIT-F is a 13-item questionnaire. Participants scored each item on a 5-point scale: 0 (not at all) to 4 (very much). Larger the participant's response to the questions (with the exception of 2 negatively stated), greater was the participant's fatigue. For all questions, except for the 2 negatively stated ones, the code was reversed and a new score was calculated as (4 minus the participant's response). The sum of all responses resulted in the FACIT-Fatigue score for a total possible score of 0 (worse score) to 52 (better score).

Trial Locations

Locations (111): Johns Hopkins University School of Medicine
🇺🇸
Baltimore, Maryland, United States
Pinnacle Research Group, LLC
🇺🇸
Anniston, Alabama, United States
Anniston Medical Clinic, PC
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Anniston, Alabama, United States
Premier Clinical Research, LLC
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Lakewood, California, United States
Achieve Clinical Research, LLC
🇺🇸
Birmingham, Alabama, United States
Med Investigations, Inc.
🇺🇸
Fair Oaks, California, United States
Novo Research
🇺🇸
Long Beach, California, United States
St Mary Medical Center
🇺🇸
Long Beach, California, United States
Cedars-Sinai Medical Center
🇺🇸
Los Angeles, California, United States
Wallace Rheumatic Study Center
🇺🇸
Los Angeles, California, United States
UCLA Division of Rheumatology
🇺🇸
Los Angeles, California, United States
UCLA Rheumatology Clinical Research Center
🇺🇸
Los Angeles, California, United States
UCLA Medical Center
🇺🇸
Los Angeles, California, United States
Ronald Reagan UCLA Medical Center
🇺🇸
Los Angeles, California, United States
Inland Rheumatology and Osteoporosis Medical Group
🇺🇸
Upland, California, United States
Inland Rheumatology Clinical Trials, Inc.
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Upland, California, United States
Southeastern Arthritis Center
🇺🇸
Gainesville, Florida, United States
Asthma, Allergy, Arthritis and Lung Center
🇺🇸
Daytona Beach, Florida, United States
Southeastern lmaging & Diagnostics
🇺🇸
Gainesville, Florida, United States
Millennium Research
🇺🇸
Ormond Beach, Florida, United States
New Horizon Research Center
🇺🇸
Miami, Florida, United States
Southeastern Community Pharmacy
🇺🇸
Gainesville, Florida, United States
Southeastern Integrated Medical, PL, d/b/a Florida Medical Research Institute
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Gainesville, Florida, United States
Arthritis Associates
🇺🇸
Orlando, Florida, United States
The Arthritis Center
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Palm Harbor, Florida, United States
Burnette & Silverfield, MDS PLC
🇺🇸
Tampa, Florida, United States
Advent Clinical Research Centers, Inc.
🇺🇸
Pinellas Park, Florida, United States
Emory University
🇺🇸
Atlanta, Georgia, United States
Grady Health Systems
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Atlanta, Georgia, United States
University of Chicago Medical Center
🇺🇸
Chicago, Illinois, United States
Idaho Arthritis Center
🇺🇸
Meridian, Idaho, United States
Beacon Medical Group Rheumatology
🇺🇸
Granger, Indiana, United States
Indiana CTSI Clinical Research Center
🇺🇸
Indianapolis, Indiana, United States
Investigational Drug Services
🇺🇸
Indianapolis, Indiana, United States
Johns Hopkins Outpatient Center
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Baltimore, Maryland, United States
Johns Hopkins Outpatient Express Testing Center
🇺🇸
Baltimore, Maryland, United States
Tufts Medical Center/ Center for Arthritis and Rheumatic Diseases
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Boston, Massachusetts, United States
University of Michigan
🇺🇸
Ann Arbor, Michigan, United States
University of Michigan Health System,
🇺🇸
Ann Arbor, Michigan, United States
Henry Ford Health System (Henry Ford Medical Center)
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Detroit, Michigan, United States
Shores Rheumatology P.C
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Saint Clair Shores, Michigan, United States
University of Nevada School of Medicine
🇺🇸
Las Vegas, Nevada, United States
Albuquerque Clinical Trials
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Albuquerque, New Mexico, United States
Arthritis and Osteoporosis Medical Associates, PLLC
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Brooklyn, New York, United States
NYU Center for Musculoskeletal Care
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New York, New York, United States
Allergy/Immunology and Rheumatology
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Rochester, New York, United States
The University of North Carolina Clinical and Translational Research Center
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Chapel Hill, North Carolina, United States
The University of North Carolina at Chapel Hill
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Chapel Hill, North Carolina, United States
The University of North Carolina Hospitals Investigational Drug Services
🇺🇸
Chapel Hill, North Carolina, United States
Joint and Muscle Medical Care
🇺🇸
Charlotte, North Carolina, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Box Arthritis & Rheumatology of the Carolinas, PLLC
🇺🇸
Charlotte, North Carolina, United States
Paramount Medical Research and Consulting, LLC
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Middleburg Heights, Ohio, United States
Clinical Research Center of Reading, LLP
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Wyomissing, Pennsylvania, United States
Oklahoma Medical Research Foundation
🇺🇸
Oklahoma City, Oklahoma, United States
UT Southwestern Medical Center
🇺🇸
Dallas, Texas, United States
Arthritis Clinic
🇺🇸
Jackson, Tennessee, United States
Low Country Rheumatology, PA/Low Country Research
🇺🇸
Charleston, South Carolina, United States
West Tennessee Research Institute
🇺🇸
Jackson, Tennessee, United States
Southwest Rheumatology Research, LLC
🇺🇸
Mesquite, Texas, United States
Rheumatic Disease Clinical Research Center, LLC
🇺🇸
Houston, Texas, United States
Mountain State Clinical Research
🇺🇸
Clarksburg, West Virginia, United States
Accurate Clinical Research, Inc.
🇺🇸
Houston, Texas, United States
Instituto CAICI S.R.L.
🇦🇷
Rosario, Santa FE, Argentina
The Seattle Arthritis Clinic
🇺🇸
Seattle, Washington, United States
Tacoma Center for Arthritis Research, PS
🇺🇸
Tacoma, Washington, United States
Framingham Centro Medico
🇦🇷
La Plata, Buenos Aires, Argentina
Centro Medico Privado de Reumatologia
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San Miguel de Tucuman, Tucuman, Argentina
Centro de Educación Medica e Investigaciones Clinicas "Norberto Quirno" CEMIC
🇦🇷
C.a.b.a, Argentina
Centro Polivalente de Asistencia e Investigación Clínica - CER- San Juan
🇦🇷
San Juan, Argentina
Centro Integral de Reumatologia REUMALAB S.A.S.
🇨🇴
Envigado, Antioquia, Colombia
Hospital Pablo Tobon Uribe
🇨🇴
Medellin, Antioquia, Colombia
Organizacion Clinica General del Norte S.A.
🇨🇴
Barranquilla, Atlantico, Colombia
Farmamix Ltda.
🇨🇴
Bogota, Colombia
Centro Integral de Reumatologia e Inmunologia S.A.S.- CIREI S.A.S.
🇨🇴
Bogota, Cundinamarca, Colombia
Charité University Medicine Berlin. Schlosspark-Klinik
🇩🇪
Berlin, Germany
Charité - Universitaetsmedizin Berlin
🇩🇪
Berlin, Germany
Universitaetsklinikum Erlangen
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Erlangen, Germany
CIRI am Klinikum der Goethe-Universitaet
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Frankfurt/Main, Germany
Universitaetsklinikum Koeln
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Koeln, Germany
Universitaetsklinikum Leipzig AoeR, Department fuer Innere Medizin
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Leipzig, Germany
Qualiclinic Kft.
🇭🇺
Budapest, Hungary
Debreceni Egyetem Orvos és Egeszsegtudomanyi Centrum
🇭🇺
Debrecen, Hungary
Bekes Megyei Kepviselo-testulet Pandy Kalman Korhaz Infektologia, Hepatologia es Immunologia
🇭🇺
Gyula, Hungary
Spitalul Clinic Republican
🇲🇩
Chisinau, Md-2025, Moldova, Republic of
Dong-A University Medical Center 1
🇰🇷
Busan, Korea, Republic of
Centro de Investigacion REUMED, Clinica Anglo Americana
🇵🇪
San Isidro, Lima, Peru
Investigaciones Clínicas SAC
🇵🇪
Santiago de Surco, Lima, Peru
Unidad de Investigación en Medicina Interna y Enfermedades Críticas
🇵🇪
Arequipa, Peru
University of Puerto Rico
🇵🇷
Rio Piedras, Puerto Rico
Prywatna Praktyka Lekarska Prof. UM Dr hab. med. Pawel Hrycaj
🇵🇱
Poznan, Poland
Investigaciones Clinicas SAC
🇵🇪
Surco, Lima, Peru
NZOZ Centrum Reumatologiczne Indywidualna Specjalistyczna Praktyka Lekarska lek.med. Barbara Bazela
🇵🇱
Elblag, Poland
Medyczne Centrum Hetmanska - Indywidualna Specjalistyczna Praktyka Lekarska -
🇵🇱
Poznan, Poland
Centralny Szpital Kliniczny Ministerstwa Spraw Wewnetrznych
🇵🇱
Warszawa, Poland
Division of Rheumatology, Allergy and Immunology
🇵🇷
San Juan, Puerto Rico
Spitalul Clinic Sf. Maria
🇷🇴
Bucuresti, Romania
Spitalul Clinic Jedetean de urgenta Cluj, Reumatologie
🇷🇴
Cluj Napoca, Romania
Feinstein Institute for Medical Research
🇺🇸
Manhasset, New York, United States
Centro Medico Prosalud
🇨🇱
Santiago, RM, Chile
National Taiwan University Hospital
🇨🇳
Taipei TOC, Taiwan
Servimed E.U
🇨🇴
Bucaramanga, Santander, Colombia
Centro Integral de Reumatología del Caribe CIRCARIBE SAS
🇨🇴
Barranquilla, Atlantico, Colombia
Congregacion de Hermanas Franciscanas Misioneras de Maria Auxiliadora- Clinica Asunción
🇨🇴
Barranquilla, Atlantico, Colombia
University of Michigan Health System
🇺🇸
Ann Arbor, Michigan, United States
Centro de Estudios Reumatologicos
🇨🇱
Santiago, RM, Chile
Riesgo De Fractura S.A
🇨🇴
Bogota, Cundinamarca, Colombia
Spitalul Clinic Colentina
🇷🇴
Bucuresti, Romania
Sociedad Medica del Aparato Locomotor S.A. (SOMEAL)
🇨🇱
Santiago, Region Metropolitana, Chile
Mix Supplier S.A.
🇨🇴
Envigado, Antioquia, Colombia, Colombia
Spitalul Clinic Judetean de Urgenta "Sf. Apostol Andrei"
🇷🇴
Galati, Romania