A Study to Compare Upadacitinib (ABT-494) to Placebo in Adults With Rheumatoid Arthritis on Stable Dose of Conventional Synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs) With an Inadequate Response or Intolerance to Biologic DMARDs
- Registration Number
- NCT02706847
- Lead Sponsor
- AbbVie
- Brief Summary
The study objective of Period 1 (Day 1 to Week 24) is to compare the safety and efficacy of upadacitinib 30 mg once daily (QD) and 15 mg QD versus placebo for the treatment of signs and symptoms of participants with moderately to severely active rheumatoid arthritis (RA) who are on a stable dose of csDMARDs and had an inadequate response to or intolerance to at least 1 bDMARD.
The study objective of Period 2 (Week 24 to Week 260) is to evaluate the long-term safety, tolerability, and efficacy of upadacitinib 15 mg QD and 30 mg QD in participants with RA who completed Period 1.
- Detailed Description
This study includes a 35-day screening period; a 24-week randomized, double-blind, parallel-group, placebo controlled treatment period (Period 1); a 236-week blinded long-term extension period (Period 2); and a 30-day follow-up period (call or visit).
Period 1 consists of a 12-week double-blind, placebo-controlled treatment phase plus a 12-week double-blind phase where all participants were to receive upadacitinib; at Week 12 participants assigned to placebo will be switched to upadacitinib according to their randomization assignment.
Participants who meet eligibility criteria will be randomized in a 2:2:1:1 ratio to one of four treatment groups:
* Group 1: Upadacitinib 30 mg QD (Day 1 to Week 12) → upadacitinib 30 mg QD (Week 12 and thereafter)
* Group 2: Upadacitinib 15 mg QD (Day 1 to Week 12) → upadacitinib 15 mg QD (Week 12 and thereafter)
* Group 3: Placebo (Day 1 to Week 12) → upadacitinib 30 mg QD (Week 12 and thereafter)
* Group 4: Placebo (Day 1 to Week 12) → upadacitinib 15 mg QD (Week 12 and thereafter)
Participants will continue stable dose of csDMARD therapy for the first 24 weeks of the study.
Participants who complete the Week 24 visit (end of Period 1) will enter the blinded long-term extension portion of the study, Period 2 and continue to receive the same dose of upadacitinib per original randomization assignment in a blinded manner. Starting at Week 24, at least 20% improvement in both swollen joint count (SJC) and tender joint count (TJC) compared to Baseline is required to remain on study drug. Starting at Week 24, initiation of or change in corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or adding or increasing doses in up to 2 csDMARDs (concomitant use of up to 2 csDMARDs except the combination of methotrexate and leflunomide) is allowed as per local label.
With the implementation of Protocol Amendment 4, all participants in the extension period will receive open-label upadacitinib 15 mg QD, including those currently on upadacitinib 30 mg QD.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 499
- Diagnosis of rheumatoid arthritis (RA) for≥ 3 months.
- Treated for ≥ 3 months with ≥ 1 bDMARD therapy, but continue to exhibit active RA or had to discontinue due to intolerability or toxicity, irrespective of treatment duration prior to the first dose of study drug.
- Participant has been receiving csDMARD therapy ≥ 3 months and on a stable dose for ≥ 4 weeks prior to the first dose of study drug. The following csDMARDs are allowed: methotrexate (MTX), sulfasalazine, hydroxychloroquine, chloroquine, and leflunomide. A combination of up to two background csDMARDs is allowed except the combination of MTX and leflunomide.
- Meets both of the following criteria:
- ≥ 6 swollen joints (based on 66 joint counts) and ≥ 6 tender joints (based on 68 joint counts) at Screening and Baseline Visits.
- hsCRP ≥ 3mg/L at Screening Visit.
- Prior exposure to any Janus kinase (JAK) inhibitor (including but not limited to tofacitinib, baricitinib, and filgotinib).
- History of any arthritis with onset prior to age 17 years or current diagnosis of inflammatory joint disease other than RA (including but not limited to gout, systemic lupus erythematosus, psoriatic arthritis, axial spondyloarthritis including ankylosing spondylitis and non-radiographic axial spondyloarthritis, reactive arthritis, overlap connective tissue diseases, scleroderma, polymyositis, dermatomyositis, fibromyalgia [currently with active symptoms]). Current diagnosis of secondary Sjogren's Syndrome is permitted.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo / Upadacitnib 15 mg Placebo Period 1: Participants receive placebo once daily for 12 weeks followed by upadacitinib 15 mg once daily for 12 weeks. Period 2: Participants will continue on upadacitinib 15 mg once daily from Week 24 to Week 260. Placebo / Upadacitnib 30 mg Placebo Period 1: Participants receive placebo once daily for 12 weeks followed by upadacitinib 30 mg once daily for 12 weeks. Period 2: Participants continue on upadacitinib 30 mg once daily until implementation of Protocol Amendment 4, then participants begin to receive upadacitinib 15 mg once daily up to Week 260. Upadacitinib 15 mg Upadacitinib Period 1: Participants receive upadacitinib 15 mg once daily for 24 weeks. Period 2: Participants will continue on upadacitinib 15 mg once daily from Week 24 to Week 260. Upadacitinib 30 mg Upadacitinib Period 1: Participants receive upadacitinib 30 mg once daily for 24 weeks. Period 2: Participants continue on upadacitinib 30 mg once daily until implementation of Protocol Amendment 4, then participants begin to receive upadacitinib 15 mg once daily up to Week 260. Placebo / Upadacitnib 15 mg Upadacitinib Period 1: Participants receive placebo once daily for 12 weeks followed by upadacitinib 15 mg once daily for 12 weeks. Period 2: Participants will continue on upadacitinib 15 mg once daily from Week 24 to Week 260. Placebo / Upadacitnib 30 mg Upadacitinib Period 1: Participants receive placebo once daily for 12 weeks followed by upadacitinib 30 mg once daily for 12 weeks. Period 2: Participants continue on upadacitinib 30 mg once daily until implementation of Protocol Amendment 4, then participants begin to receive upadacitinib 15 mg once daily up to Week 260.
- Primary Outcome Measures
Name Time Method Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 12 Baseline and Week 12 The primary endpoint for United States (US)/Food and Drug Administration (FDA) regulatory purposes was ACR 20% response (ACR20) at Week 12. Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR20 response criteria:
1. ≥ 20% improvement in 68-tender joint count;
2. ≥ 20% improvement in 66-swollen joint count; and
3. ≥ 20% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).Percentage of Participants Achieving Low Disease Activity (LDA) Based on DAS28(CRP) at Week 12 Week 12 The primary endpoint for European Union (EU)/European Medicines Agency (EMA) regulatory purposes was low disease activity, based on a Disease Activity Score 28 (DAS28)-CRP score of ≤ 3.2 at Week 12.
The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity.
A DAS28 score less than or equal to 3.2 indicates low disease activity.
- Secondary Outcome Measures
Name Time Method Change From Baseline in in Disease Activity Score 28 (CRP) at Week 12 Baseline and Week 12 The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A negative change from baseline in DAS28 (CRP) indicates improvement in disease activity.
Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 12 Baseline and Week 12 The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability.
A negative change from Baseline in the overall score indicates improvement.Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 12 Baseline and Week 12 The Short Form 36-Item Health Survey (SF-36) Version 2 is a self-administered questionnaire that measures the impact of disease on overall quality of life during the past 4 weeks. The SF-36 consists of 36 questions in eight domains (physical function, pain, general and mental health, vitality, social function, physical and emotional health).
The physical component score is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The PCS was calculated using norm-based scoring so that 50 is the average score and the standard deviation equals 10. Higher scores are associated with better functioning/quality of life; a positive change from baseline score indicates an improvement.Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 12 Baseline and Week 12 Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR50 response criteria:
1. ≥ 50% improvement in 68-tender joint count;
2. ≥ 50% improvement in 66-swollen joint count; and
3. ≥ 50% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 12 Baseline and Week 12 Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR70 response criteria:
1. ≥ 70% improvement in 68-tender joint count;
2. ≥ 70% improvement in 66-swollen joint count; and
3. ≥ 70% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 1 Baseline and week 1 Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR20 response criteria:
1. ≥ 20% improvement in 68-tender joint count;
2. ≥ 20% improvement in 66-swollen joint count; and
3. ≥ 20% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).
Trial Locations
- Locations (188)
AZ Arthritis and Rheum Assoc /ID# 148593
🇺🇸Mesa, Arizona, United States
NEA Baptist Clinic /ID# 149280
🇺🇸Jonesboro, Arkansas, United States
New England Research Associates, LLC /ID# 142763
🇺🇸Bridgeport, Connecticut, United States
Buffalo Rheumatology /ID# 142766
🇺🇸Orchard Park, New York, United States
Arthritis Associates, PLLC /ID# 155462
🇺🇸Kingsport, Tennessee, United States
Metroplex Clinical Research /ID# 142758
🇺🇸Dallas, Texas, United States
Lakes Research, LLC /ID# 142755
🇺🇸Miami, Florida, United States
Rheumatology Clinic of Houston /ID# 150915
🇺🇸Houston, Texas, United States
Trinity Health Med Arts Clinic /ID# 142754
🇺🇸Minot, North Dakota, United States
Centre Hospitalier Le Mans /ID# 145956
🇫🇷Le Mans CEDEX 9, Sarthe, France
AZ Arthritis and Rheum Researc /ID# 146075
🇺🇸Phoenix, Arizona, United States
AZ Arthritis and Rheum Researc /ID# 148592
🇺🇸Phoenix, Arizona, United States
Arizona Research Center, Inc. /ID# 142741
🇺🇸Phoenix, Arizona, United States
Denver Arthritis Clinic /ID# 142771
🇺🇸Denver, Colorado, United States
Arthritis & Osteo Ctr of S. TX /ID# 142773
🇺🇸San Antonio, Texas, United States
St. Joseph Heritage Healthcare /ID# 149273
🇺🇸Fullerton, California, United States
Covina Arthritis Clinic /ID# 142794
🇺🇸Covina, California, United States
AZ Arthr & Rheum Research /ID# 155256
🇺🇸Prescott, Arizona, United States
Pacific Arthritis Ctr Med Grp /ID# 142783
🇺🇸Los Angeles, California, United States
Arthritis & Osteo Medical Ctr /ID# 142770
🇺🇸La Palma, California, United States
Valerius Med Grp & Res Ctr /ID# 142799
🇺🇸Los Alamitos, California, United States
Stanford University School of Med /ID# 142761
🇺🇸Stanford, California, United States
Robin K. Dore MD, Inc /ID# 150908
🇺🇸Tustin, California, United States
Medvin Clinical Research /ID# 142814
🇺🇸Whittier, California, United States
Advanced Clinical Research /ID# 153089
🇺🇸Meridian, Idaho, United States
Medallion Clinical Research Institute, LLC /ID# 142740
🇺🇸Naples, Florida, United States
Arthritis Research of Florida /ID# 142811
🇺🇸Palm Harbor, Florida, United States
Clinical Investigation Special /ID# 149270
🇺🇸Skokie, Illinois, United States
St. Luke's Clinic - Rheumatolo /ID# 150923
🇺🇸Boise, Idaho, United States
Arthritis Center, Inc. /ID# 142822
🇺🇸Palm Harbor, Florida, United States
Institute of Arthritis Res /ID# 142810
🇺🇸Idaho Falls, Idaho, United States
Westroads Clinical Research /ID# 142802
🇺🇸Omaha, Nebraska, United States
Dartmouth-Hitchcock Medical Center /ID# 145958
🇺🇸Lebanon, New Hampshire, United States
Barbara Caciolo, MD /ID# 142749
🇺🇸Saint Louis, Missouri, United States
Atlantic Coast Research /ID# 148347
🇺🇸Toms River, New Jersey, United States
North Shore University Hospital /ID# 142772
🇺🇸New Hyde Park, New York, United States
Shanahan Rheuma & Immuno /ID# 142812
🇺🇸Raleigh, North Carolina, United States
East Penn Rheumatology Assoc /ID# 142790
🇺🇸Bethlehem, Pennsylvania, United States
Health Research Oklahoma /ID# 142751
🇺🇸Oklahoma City, Oklahoma, United States
Clinical Research Ctr Reading /ID# 151714
🇺🇸Wyomissing, Pennsylvania, United States
Healthcare Research Consultant /ID# 142815
🇺🇸Tulsa, Oklahoma, United States
STAT Research, Inc. /ID# 142821
🇺🇸Vandalia, Ohio, United States
Columbia Arthritis Center /ID# 153728
🇺🇸Columbia, South Carolina, United States
West Tennessee Research Inst /ID# 142739
🇺🇸Jackson, Tennessee, United States
Arthritis Associates, PLLC /ID# 142774
🇺🇸Kingsport, Tennessee, United States
Baylor College of Medicine /ID# 142753
🇺🇸Houston, Texas, United States
Houston Institute for Clin Res /ID# 142768
🇺🇸Houston, Texas, United States
AZ Damiaan /ID# 142427
🇧🇪Oostende, Belgium
Arthritis & Osteoporosis Assoc /ID# 147567
🇺🇸Lubbock, Texas, United States
P&I Clinical Research /ID# 151345
🇺🇸Lufkin, Texas, United States
Emeritus Research /ID# 142416
🇦🇺Camberwell, Victoria, Australia
Arthritis Clinic of Central TX /ID# 148346
🇺🇸San Marcos, Texas, United States
The Vancouver Clinic, INC. PS /ID# 147946
🇺🇸Vancouver, Washington, United States
Universitaetsklinik fuer Inner /ID# 142423
🇦🇹Graz, Austria
Cliniques Universitaires Saint Luc /ID# 142426
🇧🇪Woluwe-Saint-Lambert, Bruxelles-Capitale, Belgium
East Tallinn Central Hospital /ID# 142543
🇪🇪Tallinn, Estonia
Medical Plus, s.r.o. /ID# 148345
🇨🇿Uherské Hradište, Czechia
Ciads /Id# 142526
🇨🇦Winnipeg, Manitoba, Canada
Revmatologie MUDr. Klara Sirova /ID# 142536
🇨🇿Ostrava, Czechia
Kiljava Medical Research /ID# 142546
🇫🇮Hyvinkaa, Finland
Paijat-Hame Central Hospital /ID# 149185
🇫🇮Lahti, Finland
Vital Medical Center Orvosi es /ID# 142586
🇭🇺Veszprém, Veszprem, Hungary
Hopital Saint Eloi /ID# 142552
🇫🇷Montpellier CEDEX 5, Herault, France
Bekes Megyei Pandy Kalman Korh /ID# 142588
🇭🇺Gyula, Hungary
St Vincent's University Hosp /ID# 142593
🇮🇪Dublin, Ireland
Asklepios Klinik Altona /ID# 142561
🇩🇪Hamburg, Germany
CHU Bordeaux-Hopital Pellegrin /ID# 144700
🇫🇷Bordeaux, France
LMU Klinikum der Universität München /ID# 142564
🇩🇪Munich, Germany
Centre Hospitalier Jean Rougie /ID# 142556
🇫🇷Cahors, France
Charité Universitätsmedizin Campus Mitte /ID# 142559
🇩🇪Berlin, Germany
Schoen Klinikum Hamburg Eilbek /ID# 142566
🇩🇪Hamburg, Germany
Rheumaforschungszentrum II /ID# 142560
🇩🇪Hamburg, Germany
Debreceni Egyetem Kenezy Gyula Egyetemi Korhaz /ID# 142587
🇭🇺Debrecen, Hungary
Tel Aviv Sourasky Medical Ctr /ID# 142597
🇮🇱Tel Aviv-Yafo, Tel-Aviv, Israel
Bnai Zion Medical Center /ID# 151945
🇮🇱Haifa, Israel
The Lady Davis Carmel MC /ID# 142599
🇮🇱Haifa, Israel
P. Stradins Clinical Univ Hosp /ID# 142623
🇱🇻Riga, Latvia
Hanyang University Seoul Hospi /ID# 150883
🇰🇷Seoul, Seongdong-gu, Korea, Republic of
Arthritis Clinic Ltd /ID# 153560
🇱🇻Riga, Latvia
Centrum Medyczne Pratia Warszawa /ID# 142667
🇵🇱Warsaw, Mazowieckie, Poland
Inha University Hospital /ID# 150881
🇰🇷Incheon, Korea, Republic of
LTD M+M Centers /ID# 142624
🇱🇻Adazi, Latvia
Seoul National University Hospital /ID# 142622
🇰🇷Seoul, Korea, Republic of
Timaru Medical Specialists Ltd /ID# 142657
🇳🇿Timaru, New Zealand
Pratia MCM Krakow /ID# 142664
🇵🇱Krakow, Malopolskie, Poland
Sahlgrenska University Hosp /ID# 142720
🇸🇪Goteborg, Sweden
ARTROMAC n.o. /ID# 142692
🇸🇰Kosice, Slovakia
Nemocnica Kosice Saca, a.s. /ID# 142693
🇸🇰Kosice, Slovakia
Orebro Universitetssjukhuset /ID# 142718
🇸🇪Orebro, Sweden
Hospital Regional de Malaga /ID# 142707
🇪🇸Málaga, Malaga, Spain
Clinica Gaias /ID# 142709
🇪🇸Santiago de Compostela, Spain
Capio Movement Halmstad /ID# 148236
🇸🇪Halmstad, Sweden
Vastmanlands Sjukhus /ID# 142721
🇸🇪Vasteras, Sweden
Universitaetsspital Basel /ID# 145610
🇨🇭Basel, Switzerland
Arrowe Park Hospital /ID# 148991
🇬🇧Wirral, United Kingdom
HFR Fribourg - Hopital Canton /ID# 142723
🇨🇭Fribourg, Switzerland
Hacettepe University Medical Faculty /ID# 142729
🇹🇷Ankara, Turkey
Mid Essex Hospitals NHS Trust /ID# 148992
🇬🇧Chelmsford, United Kingdom
Ondokuz mayis University Facul /ID# 142728
🇹🇷Samsun, Turkey
Queen Alexandra Hospital /ID# 142735
🇬🇧Portsmouth, United Kingdom
Whipps Cross Univ Hospital /ID# 145957
🇬🇧London, London, City Of, United Kingdom
The Royal Free Hospital /ID# 142733
🇬🇧London, London, City Of, United Kingdom
Western General Hospital /ID# 142732
🇬🇧Edinburgh, United Kingdom
West Suffolk Hospital /ID# 148993
🇬🇧Ipswich, United Kingdom
Uniklinik Koln /ID# 142563
🇩🇪Köln, Nordrhein-Westfalen, Germany
MVZ Planegg /ID# 142565
🇩🇪Planegg, Germany
Rheum Assoc of North Alabama /ID# 145959
🇺🇸Huntsville, Alabama, United States
University of South Florida /ID# 145611
🇺🇸Tampa, Florida, United States
BayCare Medical Group, Inc. /ID# 142747
🇺🇸Tampa, Florida, United States
Clayton Medical Associates dba Saint Louis Rheumatology /ID# 142745
🇺🇸Saint Louis, Missouri, United States
Comple Hosp Univ de A Coruna /ID# 142708
🇪🇸A Coruna, Spain
H. Un. Marques de Valdecilla /ID# 142706
🇪🇸Santander, Cantabria, Spain
Hospital Universitario La Fe /ID# 142716
🇪🇸Valencia, Spain
Hospital Clin Univ San Carlos /ID# 142711
🇪🇸Madrid, Spain
University of California, Los Angeles /ID# 148348
🇺🇸Los Angeles, California, United States
Millennium Research /ID# 142782
🇺🇸Ormond Beach, Florida, United States
Advent Clinical Research /ID# 142817
🇺🇸Pinellas Park, Florida, United States
St. Anthony Comprehsve Res Ins /ID# 148349
🇺🇸Saint Petersburg, Florida, United States
Springfield Clinic /ID# 142818
🇺🇸Springfield, Illinois, United States
Great Lakes Clinical Trials /ID# 148341
🇺🇸Chicago, Illinois, United States
Deerbrook Medical Associates /ID# 151712
🇺🇸Vernon Hills, Illinois, United States
Joint & Muscle Research Instit /ID# 142797
🇺🇸Charlotte, North Carolina, United States
Cincinnati Rheumatic Disease Study Group, Inc. /ID# 142791
🇺🇸Cincinnati, Ohio, United States
Pioneer Research Solutions, Inc. /ID# 151346
🇺🇸Houston, Texas, United States
DM Clinical Research /ID# 151007
🇺🇸Tomball, Texas, United States
Arthritis & Osteoporosis Clinic /ID# 142760
🇺🇸Waco, Texas, United States
The Center for Rheumatology & /ID# 142742
🇺🇸Wheaton, Maryland, United States
Lovelace Scientific Resources /ID# 142779
🇺🇸Venice, Florida, United States
Desert Medical Advances /ID# 142765
🇺🇸Palm Desert, California, United States
Cape Fear Arthritis Care /ID# 148344
🇺🇸Leland, North Carolina, United States
Jefrey D. Lieberman, MD, P.C. /ID# 151713
🇺🇸Decatur, Georgia, United States
The Center for Rheumatology /ID# 142784
🇺🇸Albany, New York, United States
SW Rheumatology Res. LLC /ID# 142813
🇺🇸Mesquite, Texas, United States
Trinity Universal Research Association /ID# 149278
🇺🇸Plano, Texas, United States
AZ Arthritis and Rheum Researc /ID# 142816
🇺🇸Phoenix, Arizona, United States
TriWest Research Associates- La Mesa /ID# 142792
🇺🇸La Mesa, California, United States
AZ Arthritis & Rheum Research /ID# 156090
🇺🇸Sun City, Arizona, United States
Rheumatology Ctr of San Diego /ID# 153576
🇺🇸Escondido, California, United States
Arthritis Assoc & Osteo Ctr /ID# 142809
🇺🇸Colorado Springs, Colorado, United States
Delaware Arthritis /ID# 142803
🇺🇸Lewes, Delaware, United States
Marietta Rheumatology Assoc /ID# 151347
🇺🇸Marietta, Georgia, United States
DJL Clinical Research, PLLC /ID# 142769
🇺🇸Charlotte, North Carolina, United States
Coastal Carolina Health Care /ID# 148351
🇺🇸New Bern, North Carolina, United States
Diagnostic Group Integrated He /ID# 148340
🇺🇸Beaumont, Texas, United States
Rheumatic Disease Clin Res Ctr /ID# 150914
🇺🇸Houston, Texas, United States
Arth and Osteo Clin Brazo Valley /ID# 148343
🇺🇸College Station, Texas, United States
Arthritis Care and Diagnostic /ID# 151344
🇺🇸Dallas, Texas, United States
Western Washington Arthritis C /ID# 142776
🇺🇸Bothell, Washington, United States
Aurora Rheumatology and Immunotherapy Center /ID# 142820
🇺🇸Franklin, Wisconsin, United States
Arthritis Northwest, PLLC /ID# 150924
🇺🇸Spokane, Washington, United States
West Virginia Research Inst /ID# 153087
🇺🇸South Charleston, West Virginia, United States
CHR Orleans - Hopital de la Source /ID# 142557
🇫🇷Orleans CEDEX 2, Centre-Val De Loire, France
Hopital Edouard Herriot /ID# 144698
🇫🇷Lyon, France
Rheumazentrum Ruhrgebiet /ID# 145600
🇩🇪Herne, Nordrhein-Westfalen, Germany
Knappschaftsklinikum Saar /ID# 142562
🇩🇪Püttlingen, Germany
General Hospital of Athens Laiko /ID# 142579
🇬🇷Athens, Attiki, Greece
MMP Women's Health /ID# 145612
🇺🇸Portland, Maine, United States
The Arthritis & Diabetes Clinic, Inc. /ID# 142793
🇺🇸Monroe, Louisiana, United States
Medizinische Universität Wien /ID# 142424
🇦🇹Vienna, Wien, Austria
ReumaClinic Genk /ID# 142431
🇧🇪Genk, Belgium
Centro Hospitalar Lisboa Norte, EPE /ID# 142668
🇵🇹Lisboa, Portugal
Ankara Ataturk Training & Res /ID# 142727
🇹🇷Ankara, Turkey
Vanguard Medical Research, LLC /ID# 153123
🇺🇸Shreveport, Louisiana, United States
June DO, PC /ID# 142756
🇺🇸Lansing, Michigan, United States
Mansfield Health Center /ID# 147628
🇺🇸Mansfield, Massachusetts, United States
North Mississippi Med Clinics /ID# 142781
🇺🇸Tupelo, Mississippi, United States
Rheuma Zentrum Favoriten GmbH /ID# 142421
🇦🇹Vienna, Austria
Rheuma-Zentrum Wien-Oberlaa /ID# 142425
🇦🇹Wien, Austria
Wilhelminenspital der Stadt Wien /ID# 142422
🇦🇹Wien, Austria
Rhumaconsult SPRL /ID# 151378
🇧🇪Charleroi, Hainaut, Belgium
UZ Gent /ID# 142429
🇧🇪Gent, Oost-Vlaanderen, Belgium
MediTrials /ID# 151777
🇪🇪Tartu, Tartumaa, Estonia
Hopital Universitaire Purpan /ID# 144697
🇫🇷Toulouse, Haute-Garonne, France
Centrum Medyczne AMED Warszawa Targowek /ID# 142663
🇵🇱Warszawa, Mazowieckie, Poland
Centrum Medyczne Pratia Gdynia /ID# 142666
🇵🇱Gdynia, Pomorskie, Poland
Narodny ustav reumatickych chorob Piestany /ID# 142691
🇸🇰Pieštany, Slovakia
Clinical Pharmacology Study Gr /ID# 142744
🇺🇸Worcester, Massachusetts, United States
Centro Hospitalar De Vila Nova /ID# 142670
🇵🇹Vila Nova De Gaia, Porto, Portugal
GCM Medical Group /ID# 142671
🇵🇷San Juan, Puerto Rico
WroMedica I. Bielicka, A. Strzalkowska s.c. /ID# 142665
🇵🇱Wrocław, Dolnoslaskie, Poland
Revita Reumatologiai Rendelo /ID# 142590
🇭🇺Budapest, Hungary
Family Outpatient clinic#4,LLC /ID# 150910
🇷🇺Korolev, Moskva, Russian Federation
Omega Research Consultants /ID# 142780
🇺🇸Orlando, Florida, United States
Tekton Research, Inc. /ID# 142805
🇺🇸Austin, Texas, United States
Inland Rheum Clin Trials Inc. /ID# 142787
🇺🇸Upland, California, United States
Ocean Rheumatology, PA /ID# 142785
🇺🇸Toms River, New Jersey, United States
Dr. Ramesh Gupta /ID# 142767
🇺🇸Memphis, Tennessee, United States
The Queen Elizabeth Hospital /ID# 142419
🇦🇺Woodville, South Australia, Australia