A Study of Seltorexant Compared to Quetiapine XR as Adjunctive Therapy to Antidepressants in Adult and Elderly Participants With Major Depressive Disorder With Insomnia Symptoms Who Have Responded Inadequately to Antidepressant Therapy
- Conditions
- Depressive Disorder, Major
- Interventions
- Registration Number
- NCT04513912
- Lead Sponsor
- Janssen Research & Development, LLC
- Brief Summary
The purpose of this study is to assess the efficacy of seltorexant compared with quetiapine extended-release (XR) as adjunctive therapy to an antidepressant drug in treatment response in participants with major depressive disorder with insomnia symptoms (MDDIS) who have had an inadequate response to current antidepressant therapy with a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).
- Detailed Description
Major depressive disorder (MDD) is a common, serious, recurrent disorder. Seltorexant (JNJ-42847922) is a potent and selective antagonist of the human orexin-2 receptor (OX2R) that is being developed for the adjunctive treatment of MDDIS. The hypothesis for this study is that seltorexant is superior to quetiapine XR in leading to a response after 26 weeks of treatment (greater than or equal to \[\>=\] 50 percent \[%\] improvement on baseline Montgomery Asberg Depression Rating Scale \[MADRS\] total score), when administered as adjunctive treatment to an antidepressant in adult and elderly participants with MDDIS who have had an inadequate response to treatment with an SSRI/SNRI. The study will be conducted in 3 phases: a screening phase (up to 30 days), a double-blind (DB) treatment phase (26 weeks), and a post treatment follow-up phase (7 to 14 days after the end of DB treatment phase for all participants, and up to 196 days from baseline for participants who stop study treatment early). The total study duration for each participant will be approximately 32 weeks. Efficacy, safety, pharmacokinetics, and biomarkers will be assessed at specified time points during this study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 757
- Meet diagnostic and statistical manual of mental disorders-5th edition (DSM-5) diagnostic criteria for major depressive disorder (MDD), without psychotic features, based upon clinical assessment and confirmed by the structured clinical interview for DSM-5 Axis I disorders-clinical trials version (SCID-CT) diagnosed with first depressive episode prior to age 60. The length of the current depressive episode must be less than or equal to (<=) 24 months
- Have had an inadequate response to at least 1 but no more than 2 antidepressants, administered at an adequate dose and duration in the current episode of depression. The current antidepressant cannot be the first antidepressant treatment for the first lifetime episode of depression. An inadequate response is defined as less than (<) 50 percent (%) reduction but with some improvement (that is, improvement greater than [>] 0%) in depressive symptom severity with residual symptoms present other than insomnia, and overall good tolerability, as assessed by the Massachusetts General Hospital-Antidepressant Treatment Response Questionnaire (MGH-ATRQ)
- Is receiving and tolerating well any one of the following selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) for depressive symptoms at screening, in any formulation and available in the participating country: citalopram, duloxetine, escitalopram, fluvoxamine, fluoxetine, milnacipran, levomilnacipran, paroxetine, sertraline, venlafaxine, desvenlafaxine, vilazodone, or vortioxetine at a stable dose (at or above therapeutic dose level) for at least 6 weeks, and for no greater than 18 months in the current episode
- Have a hamilton depression rating scale (HDRS)-17 total score greater than or equal to (>=) 20 at the first screening interview, must not demonstrate a clinically significant improvement (that is, an improvement of > 20% on their HDRS-17 total score) from the first to the second independent HDRS-17 rating, and must have a HDRS-17 total score >18 at the second screening interview
- Have a patient version insomnia severity index (ISI) total score >= 15 as well as a clinician version of the ISI total score >= 15 at the second screening visit
- Body mass index (BMI) between 18 and 40 kilogram per meter square (kg/m^2), inclusive (BMI=weight/height^2)
- Participant must be medically stable on the basis of the following: physical examination, vital signs (including blood pressure), and 12-lead electrocardiogram (ECG) performed at screening and baseline
- Has a recent (last 3 months) history of, or current signs and symptoms of, severe renal insufficiency (creatinine clearance [CrCl] less than [<] 30 milliliter per minute [mL/min]); clinically significant or unstable cardiovascular, respiratory, gastrointestinal, neurologic, hematologic, rheumatologic, immunologic or endocrine disorders. uncontrolled Type 1 or Type 2 diabetes mellitus
- Has a history of treatment-resistant MDD, defined as a lack of response to 2 or more adequate antidepressant treatments in the current episode, as indicated by no or minimal (<25% improvement in symptoms) when treated with an antidepressant of adequate dose (per MGH-ATRQ) and duration (at least 6 weeks)
- Has history or current diagnosis of a psychotic disorder, bipolar disorder, intellectual disability, autism spectrum disorder, borderline personality disorder, somatoform disorders
- Has a history of moderate to severe substance use disorder including alcohol use disorder according to DSM-5 criteria within 6 months before screening
- Has any significant primary sleep disorder, including but not limited to obstructive sleep apnea, restless leg syndrome, or parasomnias. Participants with insomnia disorder are allowed
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Quetiapine Extended-Release (XR) Quetiapine XR Adult participants will receive quetiapine XR once daily from Day 1-2, followed by an increase in dose from Day 3-7, and from Day 8-14 together with matching placebo. After Day 14, quetiapine XR twice daily from Day 14 till Day 182. Elderly participants will receive quetiapine XR once daily from Day 1-3 and twice from Day 4-7, followed by an increase in dose once daily from Day 8-14 together with matching placebo. After Day 14 till Day 182, quetiapine XR will be adjusted by investigator based on the participant's clinical response and tolerability. Quetiapine Extended-Release (XR) Matching placebo to Quetiapine XR Adult participants will receive quetiapine XR once daily from Day 1-2, followed by an increase in dose from Day 3-7, and from Day 8-14 together with matching placebo. After Day 14, quetiapine XR twice daily from Day 14 till Day 182. Elderly participants will receive quetiapine XR once daily from Day 1-3 and twice from Day 4-7, followed by an increase in dose once daily from Day 8-14 together with matching placebo. After Day 14 till Day 182, quetiapine XR will be adjusted by investigator based on the participant's clinical response and tolerability. Seltorexant Matching placebo to Seltorexant Adult participants will receive seltorexant once daily from Day 1-7 and together with matching placebo from Day 8 till Day 182. Elderly participants will receive seltorexant once daily from Day 1-3 and together with matching placebo from Day 4 till Day 182. Seltorexant Seltorexant Adult participants will receive seltorexant once daily from Day 1-7 and together with matching placebo from Day 8 till Day 182. Elderly participants will receive seltorexant once daily from Day 1-3 and together with matching placebo from Day 4 till Day 182.
- Primary Outcome Measures
Name Time Method Percentage of Participants with Response (>=50 Percent improvement in MADRS total score from baseline) at Week 26 Week 26 Responders are defined as percentage of participants with greater than or equal to (\>=) 50 percent (%) improvement in the montgomery-asberg depression rating scale (MADRS) total score from baseline. MADRS is a clinician-administered scale designed to measure depression severity and detects changes due to antidepressant treatment. The MADRS evaluates the following 10 items: apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts. Each item is scored from 0 (item not present or normal) to 6 (severe or continuous presence of the symptoms), for a total possible score of 60. Higher scores represent a more severe condition.
- Secondary Outcome Measures
Name Time Method Change from Baseline in the MADRS Without Sleep Item (MADRS-WOSI) Total Score Baseline to Week 26 The MADRS is a 10-item clinician-rated instrument for evaluating severity of symptoms of depression. Each item is rated on a scale from 0 to 6, with higher scores indicating greater symptom severity. MADRS-WOSI considered 9 of the 10 MADRS items, excluding "reduced sleep" item. The total score ranged from 0 to 54, with higher scores corresponding to greater symptom severity.
Percentage of Participants with Weight Increase >=7 Percent from Baseline at Week 26 Week 26 Percentage of participants with weight increase \>=7 percent from baseline will be reported.
Time to Study Drug Discontinuation for Potentially Treatment Related Reasons Up to Week 26 Time to discontinuation of study drug for potentially treatment related reasons will be reported. Potentially treatment related reasons are defined as all study drug discontinuations excluding the potentially non-treatment related discontinuations (eg, loss of insurance for antidepressant therapy, movement/travel out of the area, change of work-schedule being unable to accommodate visit schedule, family circumstances).
Change from Baseline in Montgomery-Asberg Depression Rating Scale (MADRS) Total Score Baseline to Week 26 MADRS is a clinician-administered scale designed to measure depression severity and detects changes due to antidepressant treatment. The MADRS evaluates the following 10 items: apparent sadness, reported sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts. Each item is scored from 0 (item not present or normal) to 6 (severe or continuous presence of the symptoms), for a total possible score of 60. Higher scores represent a more severe condition.
Percentage of Participants with Remission (MADRS Total Score less than or equal to (<=) 12) at Week 26 Week 26 Percentage of participants with remission (MADRS total Score \<=12) will be reported.
Change from baseline in Weight up to Week 26 Baseline to Week 26 Change from baseline in weight will be reported.
Change from Baseline in MADRS-6 Total Score Baseline to Week 26 The MADRS-6 scale is a clinician-administered questionnaire used to measure the severity of MDD symptoms. The MADRS-6 scale is a subset of the MADRS-10 scale, comprised of the following individual questionnaire items: Apparent Sadness, Reported Sadness, Inner Tension, Lassitude, Inability to Feel, and Pessimistic Thoughts. Scores range from 0 (no apparent symptoms) to 36 (most severe symptoms).
Change from Baseline in Patient Health Questionnaire, 9-Item (PHQ-9) Total Score Baseline to Week 26 The PHQ-9 is a 9-item, participant reported outcome measure to assess depressive symptoms. The scale scores each of the 9 symptom domains of the diagnostic and statistical manual of mental disorders-5th edition (DSM-5) major depressive disorder (MDD) criteria. Each item is rated on a 4 point scale (0=not at all, 1=several days, 2=more than half the days, and 3=nearly every day). The participant's item responses are summed to provide a total score (range of 0 to 27), with higher scores indicating greater severity of depressive symptoms.
Percentage of Participants with a >=50 Percent Improvement in MADRS Total Score and MADRS <=18 at Week 26 Week 26 Percentage of participants with a \>=50 percent improvement in MADRS total score and MADRS \<=18 at Week 26.
Trial Locations
- Locations (169)
Centrum Badan Klinicznych PI House sp z o o
🇵🇱Gdansk, Poland
University of Alabama at Birmingham
🇺🇸Birmingham, Alabama, United States
SW Biomedical Research LLC
🇺🇸Tucson, Arizona, United States
Proscience Research Group
🇺🇸Culver City, California, United States
NRC Research Institute
🇺🇸Orange, California, United States
Prospective Research Innovations Inc
🇺🇸Rancho Cucamonga, California, United States
Anderson Clinical Research
🇺🇸Redlands, California, United States
CI Trials
🇺🇸Santa Ana, California, United States
Schuster Medical Research Institute
🇺🇸Sherman Oaks, California, United States
Bio Behavioral Health
🇺🇸Toms River, New Jersey, United States
Pharmacology Research Institute
🇺🇸Newport Beach, California, United States
Collaborative NeuroScience Network
🇺🇸Long Beach, California, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
Moonshine Research Center, Inc
🇺🇸Doral, Florida, United States
Velocity Clinical Research, Hallandale Beach
🇺🇸Hallandale Beach, Florida, United States
CalNeuro Research
🇺🇸Los Angeles, California, United States
CNRI-Los Angeles, LLC
🇺🇸Pico Rivera, California, United States
University of California at San Diego
🇺🇸San Diego, California, United States
Pacific Clinical Research Medical Group
🇺🇸Upland, California, United States
Pacific Neuropsychiatric Specialists
🇺🇸Orange, California, United States
National Research Institute
🇺🇸Santa Ana, California, United States
CMB Clinical Trials
🇺🇸Santee, California, United States
Indago Research & Health Center Inc
🇺🇸Hialeah, Florida, United States
New Life Medical Research Center, Inc.
🇺🇸Hialeah, Florida, United States
Amedica Research Institute Inc
🇺🇸Hialeah, Florida, United States
Meridien Research
🇺🇸Lakeland, Florida, United States
Premier Clinical Research
🇺🇸Miami, Florida, United States
Global Medical Institutes
🇺🇸Scranton, Pennsylvania, United States
Miami Jewish Health System
🇺🇸Miami, Florida, United States
Clinical Neuroscience Solutions
🇺🇸Orlando, Florida, United States
Synexus Research Orlando
🇺🇸Orlando, Florida, United States
University of South Florida
🇺🇸Tampa, Florida, United States
Compass Research LLC-Bioclinica Research
🇺🇸The Villages, Florida, United States
Synexus Clinical Research US Inc
🇺🇸Atlanta, Georgia, United States
Atlanta Center for Medical Research
🇺🇸Atlanta, Georgia, United States
iResearch Atlanta LLC
🇺🇸Decatur, Georgia, United States
Psych Atlanta, P.C.
🇺🇸Marietta, Georgia, United States
Chicago Research Center
🇺🇸Chicago, Illinois, United States
Capstone Clinical Research
🇺🇸Libertyville, Illinois, United States
Alexian Brothers Health System
🇺🇸Lisle, Illinois, United States
Baber Research Group
🇺🇸Naperville, Illinois, United States
Lemah Creek Clinical Research
🇺🇸Oakbrook Terrace, Illinois, United States
Ascension via Christi Research
🇺🇸Wichita, Kansas, United States
Riverstar Research
🇺🇸New Orleans, Louisiana, United States
Pharmasite Research, Inc.
🇺🇸Baltimore, Maryland, United States
BTC of New Bedford
🇺🇸New Bedford, Massachusetts, United States
Boston Clinical Trials & Medical Research
🇺🇸Roslindale, Massachusetts, United States
SPRI Clinical Trials, LLC
🇺🇸Brooklyn, New York, United States
The Medical Research Network, LLC
🇺🇸New York, New York, United States
Velocity Clinical Research, Inc.
🇺🇸Durham, North Carolina, United States
Family Psychiatry of The Woodlands
🇺🇸The Woodlands, Texas, United States
Northwest Clinical Research Center
🇺🇸Bellevue, Washington, United States
Core Clinical Research
🇺🇸Everett, Washington, United States
AZ Sint-Lucas
🇧🇪Brugge, Belgium
MC 'Synexus Sofia' EOOD
🇧🇬Stara Zagora, Bulgaria
UMHAT Prof. Dr. St. Kirkovich AD
🇧🇬Stara Zagora, Bulgaria
Vilnius Mental Health Center
🇱🇹Vilnius, Lithuania
Przychodnia Srodmiescie SP. z o.o.
🇵🇱Bydgoszcz, Poland
Engels psychiatric hospital
🇷🇺Engels, Russian Federation
GUZ Lipetsk Regional psychoneurological Hospital #1
🇷🇺Lipetsk Region, Russian Federation
General Hospital Acibadem Bel Medic
🇷🇸Belgrade, Serbia
Psychomed-Svatosavsky, s.r.o.
🇸🇰Banska Bystrica, Slovakia
Fakultna nemocnica s poliklinikou v Ziline
🇸🇰Zilina, Slovakia
Kyiv Territorial Medical Incorporation 'Psychiatry'
🇺🇦Kyiv, Ukraine
Mnpe 'Regional Clinical Psychiatric Hospital of Kirovohrad Regional Council'
🇺🇦Nove, Ukraine
Ternopil RCCPH Depts of Psychiatry #2 (m) & Psychiatry #4 (f) Ternopil I.Ya. Gorbachevskyi SMU
🇺🇦Ternopil, Ukraine
Psychiatric Care and Research Center (PCRC)
🇺🇸O'Fallon, Missouri, United States
Fieve Clinical Research Inc
🇺🇸New York, New York, United States
Finger Lakes Clinical Research
🇺🇸Rochester, New York, United States
Neuro Behavioral Clinical Research
🇺🇸North Canton, Ohio, United States
Cary J. Kohlenberg, MD, SC, dba, IPC Research.
🇺🇸Waukesha, Wisconsin, United States
Hospital Italiano
🇦🇷Ciudad Autonoma de Buenos Aires, Argentina
FunDaMos
🇦🇷Ciudad Autonoma de Buenos Aires, Argentina
Fundacion Lennox
🇦🇷Cordoba, Argentina
Instituto Privado Kremer
🇦🇷Cordoba, Argentina
CENAIN
🇦🇷Mendoza, Argentina
AZ Nikolaas
🇧🇪Sint-Niklaas, Belgium
MC 'Hipokrat - N', EOOD
🇧🇬Plovdiv, Bulgaria
State Psychiatric Hospital - Tzarev Brod
🇧🇬Tzarev Brod, Bulgaria
Diagnostic Consulting Center Mladost - M Varna
🇧🇬Varna, Bulgaria
Mental Health Center - Veliko Tarnovo EOOD
🇧🇬Veliko Tarnovo, Bulgaria
The Mental Hospital of Jelgava Ģintermuiža - Psychiatry
🇱🇻Jelgava, Latvia
Kaunas Silainiu Outpatient Clinic, Public Institution
🇱🇹Kaunas, Lithuania
Republic Kaunas Hospital
🇱🇹Kaunas, Lithuania
Romuvos Klinika, JSC
🇱🇹Kaunas, Lithuania
Hospital Permai
🇲🇾Johor Bahru, Malaysia
Wlokiennicza MED Specjalistyczna Praktyka Lekarska dr n.med. Tomasz Markowski
🇵🇱Bialystok, Poland
Specjalistyczna Indywidualna Praktyka Lekarska
🇵🇱Lodz, Poland
Specjalistyczna Praktyka Lekarska Marek Domanski
🇵🇱Lublin, Poland
Sverdlov Regional Psychiatric Clinical Hospital
🇷🇺Ekaterinburg, Russian Federation
Kemerovo Regional Clinical Psychiatric Hospital
🇷🇺Kemerovo, Russian Federation
JSC Scientific Centre of Personalized Medicine
🇷🇺Moscow, Russian Federation
FSI Moscow SRI of Psychiatry of Minzdravsocrazvitia
🇷🇺Moscow, Russian Federation
Specialized Hospital for Neuropsychiatric Diseases Sveti Vracevi
🇷🇸Novi Knezevac, Serbia
Richmond Behavioral Associates
🇺🇸Staten Island, New York, United States
Midwest Clinical Research Center
🇺🇸Dayton, Ohio, United States
Paradigm Research Professionals, LLC
🇺🇸Oklahoma City, Oklahoma, United States
Suburban Research Associates
🇺🇸Pine Hill, Pennsylvania, United States
Coastal Carolina Research Center
🇺🇸Mount Pleasant, South Carolina, United States
North Texas Clinical Trials
🇺🇸Fort Worth, Texas, United States
Hawkins Psychiatry, PC
🇺🇸Mansfield, Texas, United States
Hospital Fleni
🇦🇷Ciudad Autonoma Buenos Aires, Argentina
Medical Center Medconsult-Pleven
🇧🇬Pleven, Bulgaria
Medical Center St. Naum
🇧🇬Sofia, Bulgaria
A.K. Munshi Medical Inc.
🇨🇦Sydney, Nova Scotia, Canada
NeuropsychiatrieHK, s.r.o.
🇨🇿Praha 6, Czechia
L. Keruze Practice in Psychiatry
🇱🇻Liepaja, Latvia
CCBR - Lodz - PL
🇵🇱Lodz, Poland
Synexus Polska Sp. z.o.o. Oddzial w Poznaniu
🇵🇱Poznan, Poland
Specjalistyczny Osrodek Medycyny Wieku Dojrzalego Sp z o.o.
🇵🇱Warszawa, Poland
Klinika StoLet Ltd
🇷🇺Tomsk, Russian Federation
General Hospital Euromedik
🇷🇸Belgrade, Serbia
Institute of Mental Health Serbia
🇷🇸Belgrade, Serbia
University Clinical Hospital Center Dr Dragisa Misovic- Dedi
🇷🇸Belgrade, Serbia
University Clinical Center Kragujevac
🇷🇸Kragujevac, Serbia
Nemocnica s poliklinikou Prievidza so sidlom v Bojniciach
🇸🇰Bojnice, Slovakia
MNCE of Kyiv RC Regional Psychiatric and Narcological Medical Association
🇺🇦Glevakha, Ukraine
Medical Center Health and Happy
🇺🇦Kyiv, Ukraine
University of Cincinnati, Dept of Psychiatry & Behavioral Neuroscience
🇺🇸Cincinnati, Ohio, United States
Sooner Clinical Research
🇺🇸Oklahoma City, Oklahoma, United States
West Houston Clinical Research Service
🇺🇸Bellaire, Texas, United States
CENPIA
🇦🇷La Plata, Argentina
Clinica Privada de Salud Mental Santa Teresa de Ávila
🇦🇷La Plata, Argentina
Medical Center Intermedica, OOD
🇧🇬Sofia, Bulgaria
Clintrial s r o
🇨🇿Praha 10, Czechia
Zirmunai Mental Health Center, Public Institution
🇱🇹Vilnius, Lithuania
Antakalnis Psychiatric Consultation Centre, Public Institution
🇱🇹Vilnius, Lithuania
Hospital Pulau Pinang
🇲🇾Pulau Pinang, Malaysia
Hospital Tuanku Jaafar
🇲🇾Seremban, Malaysia
Gabinet Lekarski Psychiatryczny Ireneusz Kaczorowski
🇵🇱Belchatow, Poland
Instytut Psychiatrii I Neurologii
🇵🇱Warsaw, Poland
Special Neuropsychiatric Hospital Kovin
🇷🇸Kovin, Serbia
Psychiatricka Ambulancia Psycholine S.R.O.
🇸🇰Rimavska Sobota, Slovakia
FN Trencin
🇸🇰Trencin, Slovakia
Pro mente sana s.r.o.
🇸🇰Trencin, Slovakia
Grayline Research Center
🇺🇸Wichita Falls, Texas, United States
Alpine Research Organization
🇺🇸Clinton, Utah, United States
Cedar Clinical Research
🇺🇸Draper, Utah, United States
University of Virginia
🇺🇸Charlottesville, Virginia, United States
CENydET - Centro Neurobiologico y de Stress Traumatico
🇦🇷Buenos Aires, Argentina
Centro Medico Luquez
🇦🇷Cordoba, Argentina
Clinica Mayo de UMCB
🇦🇷San Miguel de Tucuman, Argentina
Mental Health Center - Rousse
🇧🇬Ruse, Bulgaria
Canadian Phase Onward
🇨🇦Toronto, Ontario, Canada
Clinique Force Medic (GCP Trials)
🇨🇦Montreal, Quebec, Canada
Psychiatricka ambulance Saint Anne s.r.o.
🇨🇿Brno, Czechia
A Shine S R O
🇨🇿Plzen, Czechia
AD71 s.r.o.
🇨🇿Praha 10, Czechia
Institut Neuropsychiatricke pece
🇨🇿Praha 8, Czechia
Hospital of Rezekne
🇱🇻Outpatient Centre Of Psychiatry, Latvia
Riga Centre of Psychiatry and Narcology
🇱🇻Riga, Latvia
Hospital of Lithuanian University of Health Sciences Kaunas Clinics
🇱🇹Kaunas, Lithuania
Medical Center Puriena JSC
🇱🇹Silute, Lithuania
Hospital Raja Permaisuri Bainun
🇲🇾Ipoh, Malaysia
Moscow Scientific Research Institute of Psychiatry
🇷🇺Moscow, Russian Federation
Clinical Psychiatry Hospital n.a. N.N. Solodovnikov
🇷🇺Omsk, Russian Federation
St-Petersburg Bekhterev Psychoneurological Research Institute
🇷🇺St. Petersburg, Russian Federation
University Clinical Center of Serbia
🇷🇸Belgrade, Serbia
Clinical Center Nis
🇷🇸Nis, Serbia
Epamed sro
🇸🇰Koshice, Slovakia
Liptovska Nemocnica S Poliklinikou Mudr. Ivana Stodolu
🇸🇰Liptovsky Mikulas, Slovakia
Mnpe of Kharkiv Regional Council 'Regional Clinical Psychiatric Hospital #3'
🇺🇦Kharkiv, Ukraine
Railway Clinical Hospital #1 of Kiev Railway station of DTGO 'South-Western Railway'
🇺🇦Kyiv, Ukraine
Zaporizhzhia Regional Clinical Hospital
🇺🇦Zaporizhzhia, Ukraine
Kingsway Hospital
🇬🇧Derby, United Kingdom
Synexus
🇬🇧Greater Manchester, United Kingdom
Garden Valleys Resource Centre
🇬🇧Harrogate, United Kingdom
Kings College Hospital NHS Trust
🇬🇧London, United Kingdom
Cornwall Partnership Foundation Trust
🇬🇧Redruth, United Kingdom