A Study of Baricitinib (LY3009104) in Patients With Moderate to Severe Atopic Dermatitis

Phase 3

Completed

Conditions: Atopic Dermatitis

Interventions: Drug: Baricitinib
Drug: Placebo

Registration Number: NCT03334396

Lead Sponsor: Eli Lilly and Company

Brief Summary: The purpose of this study is to evaluate the efficacy and safety of baricitinib as monotherapy in participants with moderate to severe atopic dermatitis.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 660

Inclusion Criteria

Have been diagnosed with moderate to severe Atopic Dermatitis for at least 12 months.
Have had inadequate response or intolerance to existing topical (applied to the skin) medications within 6 months preceding screening.
Are willing to discontinue certain treatments for eczema (such as systemic and topical treatments during a washout period).
Agree to use emollients daily.

Exclusion Criteria

Are currently experiencing or have a history of other concomitant skin conditions (e.g., psoriasis or lupus erythematosus), or a history of erythrodermic, refractory, or unstable skin disease that requires frequent hospitalizations and/or intravenous treatment for skin infections.
A history of eczema herpeticum within 12 months, and/or a history of 2 or more episode of eczema herpeticum in the past.
Participants who are currently experiencing a skin infection that requires treatment, or is currently being treated, with topical or systemic antibiotics.
Have any serious illness that is anticipated to require the use of systemic corticosteroids or otherwise interfere with study participation or require active frequent monitoring (e.g., unstable chronic asthma).
Have been treated with the following therapies:
- Monoclonal antibody for less than 5 half-lives prior to randomization.
- Received prior treatment with any oral Janus kinase (JAK) inhibitor.
- Received any parenteral corticosteroids administered by intramuscular or intravenous (IV) injection within 2 weeks prior to study entry or within 6 weeks prior to planned randomization or are anticipated to require parenteral injection of corticosteroids during the study.
- Have had an intra-articular corticosteroid injection within 2 weeks prior to study entry or within 6 weeks prior to planned randomization.
Have high blood pressure characterized by a repeated systolic blood pressure >160 millimeters of mercury (mm Hg) or diastolic blood pressure >100 mm Hg.
Have had major surgery within the past eight weeks or are planning major surgery during the study.
Have experienced any of the following within 12 weeks of screening: venous thromboembolic event (VTE), myocardial infarction (MI), unstable ischemic heart disease, stroke, or New York Heart Association Stage III/IV heart failure.
Have a history of recurrent (≥ 2) VTE or are considered at high risk of VTE as deemed by the investigator.
Have a history or presence of cardiovascular, respiratory, hepatic, chronic liver disease gastrointestinal, endocrine, hematological, neurological, lymphoproliferative disease or neuropsychiatric disorders or any other serious and/or unstable illness.
Have a current or recent clinically serious viral, bacterial, fungal, or parasitic infection including herpes zoster, tuberculosis.
Have specific laboratory abnormalities.
Have received certain treatments that are contraindicated.
Pregnant or breastfeeding.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
1 mg Baricitinib	Baricitinib	1 mg Baricitinib administered orally once daily. Placebo 2 mg and 4 mg administered orally every day to match.
1 mg Baricitinib	Placebo	1 mg Baricitinib administered orally once daily. Placebo 2 mg and 4 mg administered orally every day to match.
1 mg Baricitinib Maximum Extended Enrollment Cohort	Placebo	1 mg Baricitinib administered orally once daily. Placebo 2 mg and 4 mg administered orally every day to match.
Placebo Maximum Extended Enrollment Cohort	Placebo	Placebo administered orally once daily.
4 milligram (mg) Baricitinib	Placebo	4 mg Baricitinib administered orally once daily. Placebo 1 mg and 2 mg administered orally every day to match.
2 mg Baricitinib	Placebo	2 mg Baricitinib administered orally once daily. Placebo 1 mg and 4 mg administered orally every day to match.
4 mg Baricitinib Maximum Extended Enrollment Cohort	Placebo	4 mg Baricitinib administered orally once daily. Placebo 1 mg, and 2 mg administered orally every day to match.
2 mg Baricitinib Maximum Extended Enrollment Cohort	Placebo	2 mg Baricitinib administered orally once daily. Placebo 1 mg and 4 mg administered orally every day to match.
Placebo	Placebo	Placebo administered orally once daily.
1 mg Baricitinib Maximum Extended Enrollment Cohort	Baricitinib	1 mg Baricitinib administered orally once daily. Placebo 2 mg and 4 mg administered orally every day to match.
2 mg Baricitinib Maximum Extended Enrollment Cohort	Baricitinib	2 mg Baricitinib administered orally once daily. Placebo 1 mg and 4 mg administered orally every day to match.
4 milligram (mg) Baricitinib	Baricitinib	4 mg Baricitinib administered orally once daily. Placebo 1 mg and 2 mg administered orally every day to match.
2 mg Baricitinib	Baricitinib	2 mg Baricitinib administered orally once daily. Placebo 1 mg and 4 mg administered orally every day to match.
4 mg Baricitinib Maximum Extended Enrollment Cohort	Baricitinib	4 mg Baricitinib administered orally once daily. Placebo 1 mg, and 2 mg administered orally every day to match.

Primary Outcome Measures

Name	Time	Method
Percentage of Participants Achieving Investigator's Global Assessment (IGA) of 0 or 1 With a ≥ 2 Point Improvement (Placebo, 2 mg, or 4 mg Baricitinib)	16 Weeks	The IGA measures the investigator's global assessment of the participant's overall severity of their atopic dermatitis (AD), based on a static, numeric 5-point scale from 0 (clear skin) to 4 (severe disease). The score is based on an overall assessment of the degree of erythema, papulation/induration, oozing/crusting, and lichenification.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants Achieving IGA of 0 or 1 With a ≥ 2 Point Improvement (Placebo, 1 mg Baricitinib)	16 Weeks	The IGA measures the investigator's global assessment of the participant's overall severity of their AD, based on a static, numeric 5-point scale from 0 (clear skin) to 4 (severe disease). The score is based on an overall assessment of the degree of erythema, papulation/induration, oozing/crusting, and lichenification.
Percentage of Participants Achieving Eczema Area and Severity Index 75 (EASI75)	16 Weeks	The EASI assesses objective physician estimates of 2 dimensions of atopic dermatitis - disease extent and clinical signs affected: 0 = 0%; 1 = 1-9%; 2 = 10-29%; 3 = 30-49%; 4 = 50-69%; 5 = 70-89%; 6 = 90-100% and the severity of 4 clinical signs: (1) erythema, (2) edema/papulation, (3) excoriation, and (4) lichenification each on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe) at 4 body sites (head/neck, trunk, upper limbs, and lower limbs). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72 (severe). The EASI75 is defined as a ≥ 75% improvement from baseline in the EASI score.
Percentage of Participants Achieving EASI90	16 Weeks	The EASI assesses objective physician estimates of 2 dimensions of atopic dermatitis - disease extent and clinical signs affected: 0 = 0%; 1 = 1-9%; 2 = 10-29%; 3 = 30-49%; 4 = 50-69%; 5 = 70-89%; 6 = 90-100% and the severity of 4 clinical signs: (1) erythema, (2) edema/papulation, (3) excoriation, and (4) lichenification each on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe) at 4 body sites (head/neck, trunk, upper limbs, and lower limbs). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72 (severe). The EASI90 is defined as a ≥ 90% improvement from baseline in the EASI score.
Percent Change From Baseline in EASI Score	Baseline, 16 Weeks	The EASI assesses objective physician estimates of 2 dimensions of AD - disease extent and clinical signs affected: 0 = 0%; 1 = 1-9%; 2 = 10-29%; 3 = 30-49%; 4 = 50-69%; 5 = 70-89%; 6 = 90-100% and the severity of 4 clinical signs: (1) erythema, (2) edema/papulation, (3) excoriation, and (4) lichenification each on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe) at 4 body sites (head/neck, trunk, upper limbs, and lower limbs). Half scores are allowed between severities 1, 2, and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72 (severe). Least Square (LS) Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effect
Percentage of Participants Achieving SCORing Atopic Dermatitis 75 (SCORAD75)	16 Weeks	The SCORAD index uses the rule of nines to assess disease extent and evaluates 6 clinical characteristics to determine disease severity: (1) erythema, (2) edema/papulation, (3) oozing/crusts, (4) excoriation, (5) lichenification, and (6) dryness on a scale of 0 to 3 (0=absence, 1=mild, 2=moderate, 3=severe). The SCORAD index also assesses subjective symptoms of pruritus and sleep loss with visual analog scale (VAS) where 0 is no itching or no trouble sleeping and 10 is unbearable itching or a lot of trouble sleeping. These 3 aspects: extent of disease (A: 0-1-2), disease severity (B: 0-18), \& subjective symptoms (C: 0-20) combine using A/5 + 7\*B/2+ C to give a maximum possible score of 103, where 0 = no disease and 103 = severe disease. The SCORAD75 responder is defined as a participant who achieves a ≥ 75% improvement from baseline in the SCORAD score.
Percentage of Participants Achieving a 4-Point Improvement in Itch Numeric Rating Scale (NRS)	16 Weeks	The Itch Numeric Rating Scale (NRS) is a participant-administered, 11-point horizontal scale anchored at 0 and 10, with 0 representing "no itch" and 10 representing "worst itch imaginable." Overall severity of a participants itching is indicated by selecting the number, using a daily diary, that best describes the worst level of itching in the past 24 hours.
Change From Baseline in the Score of Item 2 of the Atopic Dermatitis Sleep Scale (ADSS)	Baseline, 16 Weeks	Atopic Dermatitis Sleep Scale (ADSS) is a 3-item, participant-administered questionnaire developed to assess the impact of itch on sleep including difficulty falling asleep, frequency of waking, and difficulty getting back to sleep last night. Item 2, frequency of waking last night is reported by selecting the number of times they woke up each night, ranging from 0 to 29 times,where the higher a number indicates a worse outcome. The ADSS is designed to be completed daily, using a daily diary, with respondents thinking about sleep "last night." Each item is scored individually. LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by- visit-interaction as fixed continuous effects.
Change From Baseline in the Skin Pain Numeric Rating Scale (NRS)	Baseline, 16 Weeks	Skin Pain NRS is a participant-administered, 11-point horizontal scale anchored at 0 and 10, with 0 representing "no pain" and 10 representing "worst pain imaginable." Overall severity of a participant's skin pain is indicated by selecting the number, using a daily diary, that best describes the worst level of skin pain in the past 24 hours. LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Percentage of Participants Achieving EASI50	16 Weeks	The EASI assesses objective physician estimates of 2 dimensions of atopic dermatitis - disease extent and clinical signs affected: 0 = 0%; 1 = 1-9%; 2 = 10-29%; 3 = 30-49%; 4 = 50-69%; 5 = 70-89%; 6 = 90-100%) and the severity of 4 clinical signs (erythema, edema/papulation, excoriation, and lichenification) each on a scale of 0 to 3 (0 = none, absent; 1 = mild; 2 = moderate; 3 = severe) at 4 body sites (head and neck, trunk, upper limbs, and lower limbs). Half scores are allowed between severities 1, 2 and 3. The final EASI score was obtained by weight-averaging these 4 scores and will range from 0 to 72 (severe). The EASI50 is defined as a ≥ 50% improvement from baseline in EASI score.
Percentage of Participants Achieving IGA of 0	16 Weeks	The IGA measures the investigator's global assessment of the participant's overall severity of their AD, based on a static, numeric 5-point scale from 0 (clear skin) to 4 (severe disease). The score is based on an overall assessment of the degree of erythema, papulation/induration, oozing/crusting, and lichenification.
Change From Baseline in SCORAD	Baseline, 16 Weeks	The SCORAD index uses the rule of nines to assess disease extent and evaluates 6 clinical characteristics to determine disease severity: (1) erythema, (2) edema/papulation, (3) oozing/crusts, (4) excoriation, (5) lichenification, and (6) dryness on a scale of 0 to 3 (0=absence, 1=mild, 2=moderate, 3=severe). The SCORAD index also assesses subjective symptoms of pruritus and sleep loss with VAS where 0 is no itching or no trouble sleeping and 10 is unbearable itching or a lot of trouble sleeping. These 3 aspects: extent of disease (A: 0-1-2), disease severity (B: 0-18), \& subjective symptoms (C: 0-20) combine using A/5 + 7\*B/2+ C to give a maximum possible score of 103, where 0 = no disease and 103 = severe disease. LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Percentage of Participants Achieving SCORAD90	16 Weeks	The SCORAD index uses the rule of nines to assess disease extent and evaluates 6 clinical characteristics to determine disease severity: (1) erythema, (2) edema/papulation, (3) oozing/crusts, (4) excoriation, (5) lichenification, and (6) dryness on a scale of 0 to 3 (0=absence, 1=mild, 2=moderate, 3=severe). The SCORAD index also assesses subjective symptoms of pruritus and sleep loss with VAS where 0 is no itching or no trouble sleeping and 10 is unbearable itching or a lot of trouble sleeping. These 3 aspects: extent of disease (A: 0-1-2), disease severity (B: 0-18), \& subjective symptoms (C: 0-20) combine using A/5 + 7\*B/2+ C to give a maximum possible score of 103, where 0 = no disease and 103 = severe disease. SCORAD90 is defined as a ≥ 90% improvement from baseline in the SCORAD score.
Change From Baseline in Body Surface Area (BSA) Affected	Baseline, 16 Weeks	Body surface area affected by AD will be assessed for 4 separate body regions and is collected as part of the EASI assessment: head and neck, trunk (including genital region), upper extremities, and lower extremities (including the buttocks). Each body region will be assessed for disease extent ranging from 0% to 100% involvement. The overall total percentage will be reported based off of all 4 body regions combined, after applying specific multipliers to the different body regions to account for the percent of the total BSA represented by each of the 4 regions. Use the percentage of skin affected for each region (0 to 100%) in EASI as follows: BSA Total = 0.1\BSAhead and neck + 0.3\BSAtrunk + 0.2\* BSAupper limbs + 0.4\*BSAlower limbs. LS Means were calculated using MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Percentage of Participants Developing Skin Infections Requiring Antibiotic Treatment	16 Weeks	Percentage of participants developing skin infections requiring antibiotic treatment.
Percent Change From Baseline in Itch NRS	Baseline, 16 Weeks	The Itch NRS is a participant-administered, 11-point horizontal scale, with 0 representing "no itch" and 10 representing "worst itch imaginable." Overall severity of a participant's itching is indicated by selecting the number, using a daily diary, that best describes the worst level of itching in the past 24 hours. LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Change From Baseline in the Total Score of the Patient Oriented Eczema Measure (POEM)	Baseline, 16 Weeks	The POEM is a 7-item self-assessment questionnaire that assesses disease symptoms (dryness, itching, flaking, cracking, sleep loss, bleeding and weeping) on a scale ranging from 0-4 (0 = no days, 1 = 1-2 days, 2 = 3-4 days, 3 = 5-6 days, 4 = everyday). The sum of the 7 items gives the total POEM score of 0 (absent disease) to 28 (severe disease). High scores are indicative of more severe disease and poor quality of life. LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Change From Baseline in the Patient Global Impression of Severity-Atopic Dermatitis (PGI-S-AD) Score	Baseline, 16 Weeks	The PGI-S-AD asked the participant to evaluate the severity of the disease at that point in time on a single-item, 5-point scale, using a daily diary. The same category labels used in the Physician's Global Assessment were used for the PGI-S-AD, i.e., "(0) no symptoms", "(1) very mild", "(2) mild" "(3) moderate", and "(4) severe." LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Change From Baseline on the Hospital Anxiety and Depression Scale (HADS)	Baseline, 16 Weeks	The HADS is a participant-rated instrument used to assess both anxiety and depression. This instrument consists of 14 item questionnaire, each item is rated on a 4-point scale, giving maximum scores of 21 for anxiety and depression. Scores of 11 or more on either subscale are considered to be a significant 'case' of psychological morbidity, while scores of 8-10 represent 'borderline' and 0-7, 'normal.' LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Change From Baseline in the Dermatology Life Quality Index (DLQI)	Baseline, 16 Weeks	The DLQI is a simple, participant-administered,10 question, validated, quality-of-life questionnaire that covers 6 domains including symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment. The recall period of this scale is over the last "week." Response categories include "not at all," "a lot," and "very much," with corresponding scores of 1, 2, and 3, respectively, and at unanswered ("not relevant") responses scored as "0." Scores range from 0 to 30 (less to more impairment), and a 4-point change from baseline is considered as the minimal clinically important difference threshold. LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Change From Baseline on the Work Productivity and Activity Impairment - Atopic Dermatitis (WPAI-AD) Questionnaire	Baseline, 16 Weeks	The WPAI-AD participant questionnaire was developed to measure the effect of general health and symptom severity on work productivity and regular activities in the 7 days prior to the visit. The WPAI-AD consists of 6 items grouped in 4 domains: absenteeism (work time missed), presenteeism (impairment at work/reduced on-the-job effectiveness), work productivity loss (overall work impairment/absenteeism plus presenteeism), and activity impairment, that range from 0% to 100%, with higher values indicating greater impairment. LS Means were calculated using a MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Change From Baseline on the European Quality of Life-5 Dimensions 5 Levels (EQ-5D-5L) Index Score United States and United Kingdom Algorithm	Baseline, 16 Weeks	EQ-5D-5L is a 2-part measurement. The first part is comprised of the following 5 participant-reported dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. The responses are used to derive the health state index scores using the United Kingdom (UK) algorithm, with scores ranging from -0.594 to 1, and the United States (US) algorithm, with scores ranging from -0.109 to 1, with higher score indicating better health state. LS Means were calculated using MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Change From Baseline on the European Quality of Life-5 Dimensions 5 Levels (EQ-5D-5L) Visual Analog Score (VAS)	Baseline, 16 Weeks	EQ-5D-5L is a 2-part measurement. The second part is assessed using a visual analog scale (VAS) that ranged from 0 to 100 millimeter (mm), where 0 is the worst health you can imagine and 100 is the best health you can imagine. LS Means were calculated using MMRM model with treatment, region, baseline disease severity (IGA), visit, and treatment-by-visit-interaction as fixed categorical effects and baseline and baseline-by-visit-interaction as fixed continuous effects.
Percentage of Participants Achieving Investigator's Global Assessment (IGA) of 0 or 1 With a ≥ 2 Point Improvement	4 Weeks	The IGA measures the investigator's global assessment of the participant's overall severity of their AD, based on a static, numeric 5-point scale from 0 (clear skin) to 4 (severe disease). The score is based on an overall assessment of the degree of erythema, papulation/induration, oozing/crusting, and lichenification.

Trial Locations

Locations (92): Hospital Univ. Dr. Jose Eleuterio Gonzalez
🇲🇽
Monterrey, Nuevo León, Mexico
RM Pharma Specialists S.A. de C.V.
🇲🇽
Distrito Federal, Mexico
National Cheng Kung University Hospital
🇨🇳
Tainan City, Taiwan
Chang Gung Memorial Hospital - Kaohsiung
🇨🇳
Kaohsiung City, Taiwan
Chang Gung Memorial Hospital - Linkou
🇨🇳
Taoyuan City, Taiwan
Chru De Nantes Hotel-Dieu
🇫🇷
Nantes Cedex 1, France
Rosenpark Research Geschäftsbereich der Rosenparkklinik GmbH
🇩🇪
Darmstadt, Hessen, Germany
Dermatologisches Zentrum Osnabrück Nord
🇩🇪
Bramsche, Niedersachsen, Germany
Klinikum der Johann Wolfgang Goethe-Universität Frankfurt
🇩🇪
Frankfurt am Main, Hessen, Germany
Universitätsmedizin Göttingen
🇩🇪
Göttingen, Niedersachsen, Germany
Nemocnice Novy Jicin a.s.
🇨🇿
Novy Jicin, Moravskoslezsky Kraj, Czechia
Kozni ambulance Kutna Hora, s.r.o.
🇨🇿
Kutna Hora, Stredocesky Kraj, Czechia
Gemeinschaftspraxis Mahlow
🇩🇪
Blankenfelde-Mahlow, Brandenburg, Germany
Praxis Gerlach
🇩🇪
Dresden, Sachsen, Germany
Policlinico di Tor Vergata
🇮🇹
Roma, Italy
Rothhaar Studien GmbH
🇩🇪
Berlin, Germany
CRI Centro Regiomontano de Investigacion S.C.
🇲🇽
Monterrey, Nuevo Leon, Mexico
Universitätsmedizin Rostock
🇩🇪
Rostock, Mecklenburg-Vorpommern, Germany
Chennai Meenakshi Multispeciality Hospital
🇮🇳
Chennai, Tamil Nadu, India
Hopital Saint-Louis
🇫🇷
Paris, Cedex 10, France
JA Shizuoka Kohseiren Enshu Hospital
🇯🇵
Hamamatsu-shi, Shizuoka, Japan
Centre Hospitalier Lyon Sud
🇫🇷
Pierre Benite Cedex, France
Universitätsklinikum Otto-von-Guericke-Universität
🇩🇪
Magdeburg, Sachsen-Anhalt, Germany
Clintrial, s.r.o.
🇨🇿
Praha 10, Hl. M. Praha, Czechia
Krajska zdravotni a.s. - Masarykova nemocnice v Usti nad Labem, o.z.
🇨🇿
Usti nad Labem, Ustecký Kraj, Czechia
TFS Trial Form Support GmbH
🇩🇪
Hamburg, Germany
Dr. D. Y. Patil Medical College & Hospital
🇮🇳
Navi Mumbai, Maharashtra, India
Universitätsklinikum Freiburg
🇩🇪
Freiburg im Breisgau, Baden-Württemberg, Germany
Nihonbashi Sakura Clinic
🇯🇵
Chuo-ku, Tokyo, Japan
Sumire Dermatology Clinic
🇯🇵
Edogawa-ku, Tokyo, Japan
Instituto de Investigaciones Aplicadas a la Neurociencia A.C
🇲🇽
Durango, Mexico
Kume Clinic
🇯🇵
Nishi-ku Sakai-shi, Osaka, Japan
LLC ArsVitae NorthWest
🇷🇺
Saint-Petersburg, Russian Federation
LLC Medical Center "Kurator"
🇷🇺
Saint-Petersburg, Russian Federation
CHRU de Brest - Hôpital Morvan
🇫🇷
Brest, France
State scientific centre for dermatovenerology and cosmetolog
🇷🇺
Moscow, Russian Federation
Hospital de Jesus I.A.P.
🇲🇽
Mexico City, Distrito Federal, Mexico
Grupo Médico CAMINO S.C.
🇲🇽
México City, Distrito Federal, Mexico
Taipei Medical University- Shuang Ho Hospital
🇨🇳
New Taipei City, Taiwan
Iidabashi Clinic
🇯🇵
Chiyoda-ku, Tokyo, Japan
Azienda Ospedaliera - Universitaria Pisana
🇮🇹
Pisa, Italy
Ospedale Policlinico Giambattista Rossi, Borgo Roma
🇮🇹
Verona, Italy
Praxis für Ganzheitliche Dermatologie im Ärztehaus
🇩🇪
Berlin, Germany
MV Hospital and Research Centre
🇮🇳
Lucknow, Uttar Pradesh, India
NTT Medical Center Tokyo
🇯🇵
Shinagawa-KU, Tokyo, Japan
JM Research S.C.
🇲🇽
Cuernavaca, Mexico
National Taiwan University Hospital
🇨🇳
Taipei City, Taiwan
GBUZ Clinical dermatology and venereological dispensary
🇷🇺
Krasnodar, Russian Federation
SPb SBHI Skin-venerologic dispensary #10
🇷🇺
St. Petersburg, Russian Federation
Azienda Ospedaliera Universitaria Federico II
🇮🇹
Napoli, Italy
Fumimori Clinic
🇯🇵
Fukuoka-shi, Fukuoka, Japan
Byramjee Jeejeebhoy Medical College & Civil Hospital
🇮🇳
Ahmedabad, Gujarat, India
Russian state medical-stomatological university n.a. Evdokimov
🇷🇺
Moscow, Russian Federation
M S Ramaiah Medical College Hospital
🇮🇳
Bangalore, Karnataka, India
Seth GS Medical College & KEM Hospital
🇮🇳
Mumbai, Maharshtra, India
Clínica Enfermedades Crónicas y Procedimientos Especiales SC
🇲🇽
Morella, Michoacan, Mexico
Istituto Clinico Humanitas
🇮🇹
Rozzano, Milano, Italy
Shirasaki Clinic
🇯🇵
Takaoka-shi, Toyama, Japan
Shimane University Hospital
🇯🇵
Izumo, Shimane, Japan
Yokohama City Minato Red Cross Hospital
🇯🇵
Yokohama-shi, Kanagawa, Japan
Hautarztzentrum Kiel
🇩🇪
Kiel, Schleswig-Holstein, Germany
Universitätsklinikum Schleswig-Holstein
🇩🇪
Lübeck, Schleswig-Holstein, Germany
Aarhus Universitehospital Marselisborg Centret
🇩🇰
Aarhus, Denmark
Queen's Square Dermatology and Allergology
🇯🇵
Nishi-ku, Yokohama-city, Kanagawa, Japan
Hiroshima University Hospital
🇯🇵
Hiroshima-shi, Hiroshima-ken, Japan
Kyoto Prefectural University of Medicine
🇯🇵
Kyoto-shi, Kyoto, Japan
Fukuoka University Hospital
🇯🇵
Fukuoka, Japan
CHU de Nice Hopital de L'Archet
🇫🇷
Nice cedex 3, France
Fakultni Nemocnice Plzen
🇨🇿
Plzen, Jizni Predmesti, Plzensky Kraj, Czechia
CHU Grenoble Alpes
🇫🇷
Grenoble Cédex 9, France
Fakultni Nemocnice v Motole
🇨🇿
Praha 5, Hl. M. Praha, Czechia
Fakultni nemocnice Kralovske Vinohrady
🇨🇿
Praha 10, Hl. M. Praha, Czechia
Nemocnice Na Bulovce
🇨🇿
Praha 8, Hl. M. Praha, Czechia
Fakultni Nemocnice U svate Anny
🇨🇿
Brno, Jihomoravský Kraj, Czechia
CHU de Bordeaux Hopital Saint Andre
🇫🇷
Bordeaux Cedex, France
Hopital Larrey
🇫🇷
Toulouse, France
Klinikum der Universität München
🇩🇪
München, Bayern, Germany
Universitätsklinikum Bonn
🇩🇪
Bonn, Nordrhein-Westfalen, Germany
Praxis Dr. Thomas Dirschka
🇩🇪
Wuppertal, Nordrhein-Westfalen, Germany
Universitätsklinikum Carl Gustav Carus
🇩🇪
Dresden, Sachsen, Germany
Universität Leipzig - Universitätsklinikum
🇩🇪
Leipzig, Sachsen, Germany
All India Institue of Medical Sciences (AIIMS)
🇮🇳
New Delhi, Delhi, India
Sir Ganga Ram Hospital
🇮🇳
New Delhi, Delhi, India
King George Hospital
🇮🇳
Vizag, Andhra Pradesh, India
ISA GmbH
🇩🇪
Berlin, Germany
Panchshil Hospital
🇮🇳
Ahmedabad, Gujarat, India
Jehangir Hospital
🇮🇳
Pune, Maharashtra, India
Gandhi Hospital
🇮🇳
Secunderabad, Telangana, India
Kawashima Dermatology Clinic
🇯🇵
Ichikawa-shi, Chiba, Japan
Yamanashi Prefectural Central Hospital
🇯🇵
Kofu, Yamanashi, Japan
Chung Shan Medical University Hospital
🇨🇳
Taichung City, Taiwan
Chang Gung Memorial Hospital - Taipei
🇨🇳
Taipei City, Taiwan