A Study to Examine the Efficacy and Safety of Anti-Fel d 1 Antibodies Injections in Cat-allergic Adolescent and Adult Patients With Allergic Rhinitis Who Live With a Cat

Phase 3

Terminated

Conditions: Allergic Rhinitis Due to Cat Allergy

Interventions: Drug: REGN1908-1909
Drug: Matching Placebo

Registration Number: NCT04981717

Lead Sponsor: Regeneron Pharmaceuticals

Brief Summary: The primary objective of the study is to determine the efficacy of REGN1908-1909, as compared to placebo, to reduce allergic rhinitis/conjunctivitis symptoms and allergy rescue medication use during natural cat exposure.

The Secondary Objectives are:

* To assess the reduction of allergic symptoms and use of allergy rescue medications after treatment with REGN1908-1909 versus placebo, as measured by the individual components of the CSMS

* To assess health-related quality of life (HRQoL) as measured by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ\[S\])

* To determine the efficacy of REGN1908-1909, as compared to placebo, to inhibit a wheal-and-flare response to a skin prick test with cat allergen

* To assess the durability of effect in allergic rhinitis and conjunctivitis symptom and medication scores after multiple doses of REGN1908-1909 compared to placebo given every 12 weeks (Q12W)

* To determine the efficacy following multiple doses of REGN1908-1909 compared to placebo at inhibiting a wheal-and-flare response to a skin prick test with cat allergen

* To estimate the effect of REGN1908-1909 on lung function, as compared to placebo, in patients with asthma

* To determine the efficacy of REGN1908-1909 as compared to placebo to reduce asthma symptoms in patients with asthma

* To assess whether there is a difference in asthma rescue medication use in patients with asthma who are treated with REGN1908-1909 compared to placebo

* To assess whether there is a difference in nighttime awakenings in patients with asthma treated with REGN1908-1909 compared to placebo

* To evaluate the short-term and long-term safety and tolerability of REGN1908-1909, including the incidence of hypersensitivity reactions, local injection site reactions, and asthma exacerbations

* To determine systemic exposure of total (free and antigen-bound) antibodies as measured by concentration of REGN1908 and REGN1909

* To assess the immunogenicity of REGN1908 and REGN1909

Detailed Description: Not available

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 446

Inclusion Criteria

Generally healthy males and females who are 12 years and older at the time of screening.
Weight must be ≥40 kg at the time of screening
Documented or patient reported history (for at least 2 years) of symptomatic cat allergen-triggered allergic rhinitis with or without conjunctivitis and with or without asthma as defined by all of the following criteria:
1. Positive skin prick test (SPT) with cat hair extract (mean wheal diameter at least 5 mm greater than a negative control) at screening
2. Positive allergen-specific IgE (sIgE) tests for cat and Fel d 1 (both ≥0.7 kUa/L at screening)
3. Documented or patient reported history of nasal and/or ocular symptoms upon cat exposure
4. Symptomatic despite the use of medications to treat their nasal and/or ocular symptoms
At least 1 generally healthy cat (that is unlikely to die during the study) living in the home resulting in regular exposure
A daily total rhinitis/conjunctivitis symptom score (total symptom score [TSS]) of at least 8 of 18 during at least 8 days of the 15-day baseline assessment period and use of standard, therapeutic doses of pharmacotherapy for the treatment of allergic rhinoconjunctivitis on at least 8 days of the 15-day baseline assessment period.

Key

Exclusion Criteria

History of significant multiple and/or severe allergies, as assessed by the investigator, that would potentially interfere with the assessments during the baseline and 12-week efficacy assessment periods or confound results, per investigator discretion, including significant rhinitis or sinusitis due to daily contact with other allergens causing symptoms that are expected to coincide with the baseline period or any of the efficacy assessment periods
Received REGN1908-1909 in a prior REGN1908-1909 clinical trial (receipt of placebo in a previous trial is allowed)
Active lung disease other than asthma
FEV1 less than 70% of predicted at screening or randomization
Treatment with an investigational drug within 2 months or within 5 half-lives (if known), whichever is longer, prior to screening
Persistent chronic or recurring acute infection requiring treatment with antibiotics, antivirals, or antifungals, or any untreated respiratory infections within 4 weeks prior to screening. Patients may be re-evaluated after resolution of symptoms and specified time duration

NOTE: Other protocol-defined Inclusion/ Exclusion Criteria apply

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
REGN1908-1909	REGN1908-1909	Randomized 1:1
Placebo	Matching Placebo	Randomized 1:1

Primary Outcome Measures

Name	Time	Method
Daily Combined Symptom and Medication Score (CSMS) Averaged Over Last 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60	CSMS is calculated by adding the Daily Medication Score (DMS) and Total Symptom Score (TSS) together, with scores ranging between 0 (none) and 38 (severe).

Secondary Outcome Measures

Name	Time	Method
Daily Total Nasal Symptom Score (TNSS) Averaged Over the Last 12 Weeks of Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60	Total nasal symptom score (TNSS) is from 0 to 12 and is based on assessment of 4 nasal symptoms graded on a Likert scale ranging from 0 (none) to 3 (severe) for congestion, itching, and rhinorrhea, and from 0 (none) to 3 (5 or more sneezes) for sneezing.
Percent Change From Pre-treatment Baseline in Average TNSS Over the Last 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60
Daily CSMS Averaged Over the Initial 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	The combined symptom and medication score (CSMS) is defined as the daily combined allergic rhinitis and conjunctivitis total symptom score (TSS: calculated as the sum of total nasal symptom score \[TNSS\] and total ocular symptom score \[TOSS\]) plus daily medication score (DMS). Scores ranging between 0 (none) and 38 (severe).
Percent Change From Pre-treatment Baseline in Average TSS Over the Initial 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	Total symptom score (TSS: calculated as the sum of TNSS and total ocular symptom score \[TOSS\]) plus daily medication score (DMS).
Percent Change From Pre-treatment Baseline in Average TOSS, Over the Initial 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	Total ocular symptom score is 0 to 6 and is based on itching/redness/gritty feeling and tearing/watering; each of the 2 symptoms is graded 0 (absent), 1 (mild), 2 (moderate), and 3 (severe)
Percent Change From Pre-treatment Baseline in Average TOSS Over the Last 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60	Total ocular symptom score is 0 to 6 and is based on itching/redness/gritty feeling and tearing/watering; each of the 2 symptoms is graded 0 (absent), 1 (mild), 2 (moderate), and 3 (severe)
Percent Change From Pre-treatment Baseline in Average CSMS Over the Last 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60
Daily Total Symptom Score (TSS) Averaged Over the Last 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60	TSS is a combined score of TOSS and TNSS. TNSS and TOSS are scored as in part 1 each for a combined TSS of 0 (none) to 18 (severe)
Percent Change From Pre-treatment Baseline in Average TSS Over the Last 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60
Percent Change From Baseline to the End of Treatment in Cat Skin Prick Test (SPT) Mean Wheal Diameter in Patients Who Receive REGN1908-1909 Versus Placebo	Week 60
Daily TNSS Averaged Over the Initial 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	The TNSS ranges from 0 to 12 and is based on assessment of 4 nasal symptoms graded on a Likert scale ranging from 0 (none) to 3 (severe) for nasal congestion, itching, and runny nose, and sneezing.
Percent Change From Pre-treatment Baseline in Average CSMS Over the Initial 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	The combined symptom and medication score (CSMS) is defined as the daily combined allergic rhinitis and conjunctivitis total symptom score (TSS: calculated as the sum of total nasal symptom score \[TNSS\] and total ocular symptom score \[TOSS\]) plus daily medication score (DMS).
Percent Change From Pre-treatment Baseline in Average TNSS Over the Initial 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	The TNSS ranges from 0 to 12 and is based on assessment of 4 nasal symptoms graded on a Likert scale ranging from 0 (none) to 3 (severe) for nasal congestion, itching, and runny nose, and sneezing.
Daily TSS Score Averaged Over the Initial 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	Total symptom score (TSS: calculated as the sum of TNSS and total ocular symptom score \[TOSS\]) plus daily medication score (DMS).
Change From Baseline to Week 60 in Rhinoconjunctivitis Quality of Life Questionnaire for Ages 12+ (RQLQ(S)+12) in Participants Who Received REGN1908-1909 Versus Placebo	Baseline to week 60	The RQLQ had 25 questions in 6 domains (nose symptoms, eye symptoms, practical problems, activity limitation, non-hay fever symptoms and emotional function). Participants recalled how they have been during the previous week and responded to each question on a 7-point scale. The overall RQLQ score was the mean of all 25 responses and the individual domain scores were the means of the items in those domains. The RQLQ(S) responses are based on a 7-point Likert scale with responses ranging from 0 (not troubled) to 6 (extremely troubled).
Daily TOSS Averaged Over the Last 12 Weeks of the Treatment Period in Patients Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60	Total ocular symptom score is 0 to 6 and is based on itching/redness/gritty feeling and tearing/watering; each of the 2 symptoms is graded 0 (absent), 1 (mild), 2 (moderate), and 3 (severe)
Percent Change in FEV1 in Patients With Asthma Who Receive REGN1908-1909 Versus Placebo	Baseline to week 60	In-clinic spirometry on all patients to determine FEV1 (forced expiratory volume in 1 second) in liters (L).
Number of Participants With Serious Treatment-Emergent Adverse Events (TEAEs) Throughout the Study	Weeks 0 to 60
Number of Participants With Treatment-emergent Adverse Events (TEAEs) Throughout the Study	Weeks 0 to 72
Percent Change in Cat SPT Mean Wheal Diameter in Patients Who Receive REGN1908-1909 Versus Placebo (up to Week 12)	Baseline to week 12
Percent Change in Forced Expiratory Volume (FEV)1 in Patients With Asthma Who Receive REGN1908-1909 Versus Placebo	Baseline to week 12	In-clinic spirometry on all patients to determine FEV1 (forced expiratory volume in 1 second) in liters (L).
Percent Change in Cat SPT Mean Wheal Diameter in Patients Who Receive REGN1908-1909 Versus Placebo	Baseline to week 72	The full analysis set (FAS) includes all randomized participants; it is based on the treatment allocated (as randomized). Efficacy endpoints will be analyzed using the FAS.
Number of Participants With Adverse Event of Special Interests (AESIs) Throughout the Study	Weeks 0 to 72
Total REGN1909 Concentration in Serum Over the Study Duration	Weeks 0 to 60
Incidence of Treatment-emergent Anti-drug Antibodies (ADAs) to REGN1908 Throughout the Study	Weeks 0 to 72
Daily Number of Nighttime Awakenings Averaged Over the Initial 12 Weeks of the Treatment Period in Patients With Asthma Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12
Total REGN1908 Concentration in Serum Over the Study Duration	Weeks 0 to 60
Incidence of Treatment-emergent ADAs to REGN1909 Throughout the Study	Weeks 0 to 72
Percent Change in FEV1 in Participants With Asthma Who Receive REGN1908-1909 Versus Placebo (up to Week 12)	Baseline to week 12
Percent Change in FEV1 in Participants With Asthma Who Receive REGN1908-1909 Versus Placebo (up to Week 60)	Baseline to week 60
Daily Medication Score (DMS) Averaged Over the Initial 12 Weeks of the Treatment Period in Participants Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	The Daily Medication Score (DMS) was calculated by adding points for each pre-specified medication. Participants will be asked to record their daily rescue medication use using an e-diary, including which medications and the amount of these prespecified medications. The scale is 0 (minimum) to 20 (maximum)
Asthma Daily Symptom (ADS) Score, Averaged Over the Initial 12 Weeks of the Treatment Period Using Asthma Daytime Symptom Diary (ADSD) and the Asthma Nighttime Symptom Diary (ANSD) in Participants With Asthma Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	The total daily asthma symptom score is a participant-reported outcome concerning the occurrence of asthma symptoms and their effect on a patient's daily activities and sleep. It is composed of two parts: daytime (five items) and nighttime (four items), both scored ordinally. Higher scores indicate more severe symptoms. The ADSD score will be based on 6 patient-reported symptoms (difficulty breathing, wheezing, shortness of breath, chest tightness, chest pain, and cough at their worst using an 11-point numeric rating scale (NRS) ranging from 0 ('None') to 10 ('As bad as you can imagine').
ADS Score Averaged Over the Last 12 Weeks of the Treatment Period Using ADSD and the ANSD in Participants With Asthma Who Receive REGN1908-1909 Versus Placebo (Weeks 48 to 60)	Weeks 48 to 60
DMS Averaged Over the Last 12 Weeks of the Treatment Period in Participants Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60
Percent Change From Pre-treatment Baseline in Average DMS Averaged Over the Last 12 Weeks of the Treatment Period in Participants Who Receive REGN1908-1909 Versus Placebo	Weeks 48 to 60
Daily TOSS Averaged Over the Initial 12 Weeks of the Treatment Period in Participants Who Receive REGN1908-1909 Versus Placebo	Weeks 0 to 12	The TOSS ranges from 0 to 6 and is based on 2 eye symptoms: itching/redness/gritty feeling and tearing/watering. Each of the 2 symptoms is graded on a Likert scale ranging from 0 (none) to 3 (severe).
Change From Baseline to Week 60 in Asthma Control Questionnaire 5 Question Version (ACQ-5) in Participant With Asthma Who Receive REGN1908-1909 Versus Placebo	Baseline to week 60	The ACQ-5 had 5 questions, reflecting the top-scoring five asthma symptoms: woken at night by symptoms, wake in the mornings with symptoms, limitation of daily activities, shortness of breath and wheeze. Participants were asked to recall how their asthma had been during the previous week and to respond to each of the five symptom questions on a 7-point scale ranged from 0 (no impairment) to 6 (maximum impairment). ACQ-5 total mean score was mean of the scores of all 5 questions and, therefore, ranged from 0 (totally controlled) to 6 (severely uncontrolled), higher scores indicated lower asthma control.
Daily Number of Nighttime Awakenings Averaged Over the Last 12 Weeks of the Treatment Period in Patients With Asthma Who Receive REGN1908-1909 Versus Placebo (Weeks 48 to 60)	Weeks 48 to 60

Trial Locations

Locations (92): Integrated Research of Inland, Inc
🇺🇸
Riverside, California, United States
Allergy and Asthma Specialists PSC
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Owensboro, Kentucky, United States
Allergy Partners of Western North Carolina
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Asheville, North Carolina, United States
Optimed Research Ltd - Clinedge - PPDS
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Columbus, Ohio, United States
Aventiv Research Inc - Columbus - HyperCore - PPDS
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Dublin, Ohio, United States
Allergy and Clinical Immunology Associates
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Pittsburgh, Pennsylvania, United States
Aggarwal and Associates Ltd
🇨🇦
Brampton, Ontario, Canada
Bernstein Clinical Research Center Inc
🇺🇸
Cincinnati, Ohio, United States
Asthma and Allergy Associates PC - CRN - PPDS
🇺🇸
Colorado Springs, Colorado, United States
Velocity Clinical Research, Inc. (Meridan)
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Meridian, Idaho, United States
South Bend Clinic
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South Bend, Indiana, United States
Institute For Asthma and Allergy
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Chevy Chase, Maryland, United States
Charleston Allergy and Asthma
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Baltimore, Maryland, United States
Somnos Clinical Research
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Lincoln, Nebraska, United States
Nebraska Medical Research Institute, Inc. - CRN - PPDS
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Papillion, Nebraska, United States
Atlantic Research Center LLC
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Ocean City, New Jersey, United States
Allergy Partners of NJ, P.C.
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Teaneck, New Jersey, United States
SUNY Downstate Health Science University
🇺🇸
Brooklyn, New York, United States
Seattle Allergy & Asthma Research Institute
🇺🇸
Seattle, Washington, United States
Hamilton Allergy
🇨🇦
Hamilton, Ontario, Canada
Kingston Health Science Centre
🇨🇦
Kingston, Ontario, Canada
Stouffville Medical Clinic
🇨🇦
Stouffville, Ontario, Canada
Gordon Sussman Clinical Research Inc
🇨🇦
Toronto, Ontario, Canada
LMC Manna Research - Quebec - HyperCore - PPDS
🇨🇦
Levis, Quebec, Canada
Klinikum Stuttgart
🇩🇪
Stuttgart, Baden-Wurttemberg, Germany
Praxis Dr. med. Elke Decot
🇩🇪
Dreieich, Hessen, Germany
BAG Prof. Dr. G. Hoheisel Dr. A. Bonitz
🇩🇪
Leipzig, Sachsen, Germany
Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej Centralny Szpital Weteranow
🇵🇱
Lodz, Lodzkie, Poland
ETG Warszawa - PPDS
🇵🇱
Piaseczno, Mazowieckie, Poland
EMed Centrum Uslug Medycznych
🇵🇱
Rzeszow, Podkarpackie, Poland
ETG Kielce
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Kielce, Swietokrzyskie, Poland
Specjalistyczna Przychodnia Lekarska Alergo-Med Sp. z.o.o
🇵🇱
Poznan, Poland
Bluegrass Allergy Research
🇺🇸
Lexington, Kentucky, United States
Montana Medical Research
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Missoula, Montana, United States
Respiratory Medicine Research Institute of Michigan PLC
🇺🇸
Ypsilanti, Michigan, United States
Princeton Center For Clinical Research - CRN - PPDS
🇺🇸
Skillman, New Jersey, United States
UZ Leuven
🇧🇪
Leuven, Vlaams Brabant, Belgium
Universitätsklinikum Carl Gustav Carus an der TU Dresden
🇩🇪
Dresden, Sachsen, Germany
Riverside Medical Group - Circuit - PPDS
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Belleville, New Jersey, United States
Clinical Research Institute, Inc - CRN - PPDS
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Plymouth, Minnesota, United States
Private Practice Dr Jean Benoit Martinot
🇧🇪
Erpent, Belgium
Allergy Consultants PA
🇺🇸
Verona, New Jersey, United States
HNO Praxis am Neckar
🇩🇪
Heidelberg, Baden-Wurttemberg, Germany
Toronto Allergy Clinic
🇨🇦
Toronto, Ontario, Canada
Beldio Research GmbH
🇩🇪
Memmingen, Bayern, Germany
Wojewodzkie Wielospecjalistyczne Centrum Onkologii i Traumatologii im. M. Kopernika w Lodzi
🇵🇱
Lodz, Lodzkie, Poland
IP Clinic Sp. z o. o.
🇵🇱
Lodz, Lodzkie, Poland
ETG Zamosc - PPDS
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Zamosc, Lubelskie, Poland
Alergo-Med Specjalistyczna Przychodnia Lekarska Sp. z.o.o
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Tarnow, Malopolskie, Poland
Clinica Vitae Sp z o o
🇵🇱
Gdansk, Pomorskie, Poland
PDX Allergy, LLC dba Portland Research
🇺🇸
Happy Valley, Oregon, United States
The Medical College of Wisconsin, Inc.
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Greenfield, Wisconsin, United States
Emovis GmbH
🇩🇪
Berlin, Germany
UZ Gent
🇧🇪
Gent, Oost-Vlaanderen, Belgium
Universitatsklinikum Munster
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Munster, Nordrhein-Westfalen, Germany
Klinische Forschung Dresden GmbH (KFGN)
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Dresden, Sachsen, Germany
Salvus-Klinische Studien GmbH
🇩🇪
Leipzig, Sachsen, Germany
ALL-MED - Specjalistyczna Opieka Medyczna - Medyczny Instytut Badawczy
🇵🇱
Wroclaw, Dolnoslaskie, Poland
SPZOZ Uniwersytecki Szpital Kliniczny nr 1 im Norberta Barlickiego Uniwersytetu Medycznego w Lodzi
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Lodz, Lodzkie, Poland
Red Maple Trials
🇨🇦
Ottawa, Ontario, Canada
Joel Liem Medicine Professional Corporation
🇨🇦
Windsor, Ontario, Canada
Centre d'investigation Clinique Mauricie
🇨🇦
Trois-Rivieres, Quebec, Canada
Clinique Spécialisée en Allergie de la Capitale
🇨🇦
Quebec, Canada
Nouvel Hopital Civil
🇫🇷
Strasbourg, Bas-Rhin, France
AES - DRS - Synexus Polska Sp. z o.o. Oddzial we Wroclawiu
🇵🇱
Wroclaw, Dolnoslaskie, Poland
Centrum Alergologii Specjalistyczna Przychodnia Alergologiczna
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Lublin, Lubelskie, Poland
Centrum Alergologii Teresa Hofman
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Pila, Wielkopolskie, Poland
Praxis Dr. med. Claus Keller
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Frankfurt am Main, Hessen, Germany
Praxis Dr. med. Gerhard Schindlbeck
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Viernheim, Hessen, Germany
Praxis für HNO und Allergologie
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Dresden, Sachsen, Germany
ETG Lublin - PPDS
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Lublin, Lubelskie, Poland
Malopolskie Centrum Alergologii
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Krakow, Malopolski, Poland
Centrum Nowoczesnych Terapii Dobry Lekarz Sp. z o.o.
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Krakow, Malopolskie, Poland
Charité - Universitätsmedizin Berlin
🇩🇪
Berlin, Germany
Homeo Medicus Szczesiul sp. j.
🇵🇱
Bialystok, Podlaskie, Poland
Allergy and Asthma Associates of Southern California - CRN - PPDS
🇺🇸
Mission Viejo, California, United States
Peninsula Research Associates - CRN - PPDS
🇺🇸
Rolling Hills Estates, California, United States
Allergy and Asthma Medical Group and Research Center - CRN - PPDS
🇺🇸
San Diego, California, United States
Emory University
🇺🇸
Atlanta, Georgia, United States
Rush University Medical Center
🇺🇸
Chicago, Illinois, United States
Asthma and Allergy Center of Chicago Sc-Oak Park
🇺🇸
Oak Park, Illinois, United States
Sneeze Wheeze and Itch Associates LLC
🇺🇸
Springfield, Illinois, United States
University of Missouri - Hospital
🇺🇸
Columbia, Missouri, United States
NYU Langone Medical Center
🇺🇸
New York, New York, United States
Asthma, Nasal Disease and Allergy Research Center of New England
🇺🇸
East Providence, Rhode Island, United States
Asthma & Allergy Physicians of Rhode Island Clinical Research Institute (AAPRI CRI)
🇺🇸
Warwick, Rhode Island, United States
CHR de la Citadelle
🇧🇪
Liege, Belgium
ETG Lodz - PPDS
🇵🇱
Lodz, Lodzkie, Poland
Allergy Asthma and Clinical Research Center
🇺🇸
Oklahoma City, Oklahoma, United States
Colorado Allergy and Asthma Centers PC - CRN - PPDS
🇺🇸
Denver, Colorado, United States
Northwest Research Center - CRN - PPDS
🇺🇸
Portland, Oregon, United States
Montefiore Medical Center
🇺🇸
Bronx, New York, United States