A Study to Compare Safety and Efficacy of Upadacitinib to Dupilumab in Adult Participants With Moderate to Severe Atopic Dermatitis
- Conditions
- Atopic Dermatitis
- Interventions
- Biological: UpadacitinibBiological: DupilumabDrug: Placebo to upadacitinibDrug: Placebo to dupilumab
- Registration Number
- NCT03738397
- Lead Sponsor
- AbbVie
- Brief Summary
This study will evaluate upadacitinib compared to dupilumab (Dupixent®) in adults with moderate to severe atopic dermatitis (AD) who are candidates for systemic therapy.
- Detailed Description
The study is comprised of a 35-day screening period, a 24-week double-blinded treatment period, and a follow-up visit 12 weeks after the last dose. Participants who complete Week 24 have the option to enroll into an open-label study (Study M19-850; NCT04195698) of upadacitinib 30 mg once daily and receive treatment with upadacitinib for an additional 52 weeks.
Participants who meet eligibility criteria will be randomized in a 1:1 ratio to receive either upadacitinib or dupilumab. Randomization will be stratified by Baseline disease severity (Validated Investigator Global Assessment scale for Atopic Dermatitis \[vIGA-AD\] score of moderate \[3\] versus severe \[4\]) and age (\<40, ≥ 40 to \< 65, ≥ 65 years).
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 673
- Participant has active moderate to severe atopic dermatitis (AD) defined by Eczema Area and Severity Index (EASI) ≥ 16, Investigator's Global Assessment (IGA) ≥ 3, ≥ 10% body surface area (BSA) of AD involvement at the Screening and Baseline Visits, and Baseline weekly average of daily Worst Pruritus NRS ≥ 4.
- Participant is a candidate for systemic therapy or have recently required systemic therapy for AD.
- Participant has prior exposure to Janus Kinase (JAK) inhibitor.
- Participant has prior exposure to dupilumab.
- Participant is unable or unwilling to discontinue current AD treatments prior to the study.
- Participant has requirement of prohibited medications during the study.
- Participant has other active skin diseases or skin infections requiring systemic treatment or would interfere with appropriate assessment of AD lesions.
- Female participant who is pregnant, breastfeeding, or considering pregnancy during the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Upadacitinib 30 mg QD Upadacitinib Participants will receive 30 mg upadacitinib orally once a day (QD) up to Week 24 and placebo to dupilumab by subcutaneous injection every other week from Baseline to Week 22. Dupilumab 300 mg EOW Placebo to upadacitinib Participants will receive a loading dose of 600 mg dupilumab by subcutaneous (SC) injection on Day 1 followed by 300 mg dupilumab SC every other week (EOW) until Week 22 and placebo to upadacitinib orally QD up to Week 24. Dupilumab 300 mg EOW Dupilumab Participants will receive a loading dose of 600 mg dupilumab by subcutaneous (SC) injection on Day 1 followed by 300 mg dupilumab SC every other week (EOW) until Week 22 and placebo to upadacitinib orally QD up to Week 24. Upadacitinib 30 mg QD Placebo to dupilumab Participants will receive 30 mg upadacitinib orally once a day (QD) up to Week 24 and placebo to dupilumab by subcutaneous injection every other week from Baseline to Week 22.
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving a 75% Reduction From Baseline in Eczema Area and Severity Index Score (EASI 75) at Week 16 Baseline and Week 16 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
- Secondary Outcome Measures
Name Time Method Percent Change From Baseline in Worst Pruritus Numerical Rating Scale (NRS) Score at Week 16 Baseline (Week 0) to Week 16 The Worst Pruritus NRS is an assessment tool that participants used to report the intensity of their pruritus during a 24-hour recall period using an electronic hand-held device. Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on an 11-point scale from 0 (no itch) to 10 (worst imaginable itch).
The percent change from Baseline was calculated from a rolling weekly average; a negative change from Baseline indicates improvement.Percentage of Participants Achieving a 90% Reduction From Baseline in EASI Score (EASI 90) at Week 16 Baseline and Week 16 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.Percentage of Participants Achieving a 100% Reduction From Baseline in EASI Score (EASI 100) at Week 16 Baseline and Week 16 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.Percent Change From Baseline in Worst Pruritus Numerical Rating Scale (NRS) Score at Week 1 Baseline (Week 0) to Week 1 The Worst Pruritus NRS is an assessment tool that participants used to report the intensity of their pruritus during a 24-hour recall period using an electronic hand-held device. Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on an 11-point scale from 0 (no itch) to 10 (worst imaginable itch).
The percent change from Baseline was calculated from a rolling weekly average; a negative change from Baseline indicates improvement.Percent Change From Baseline in Worst Pruritus Numerical Rating Scale (NRS) Score at Week 4 Baseline (Week 0) to Week 4 The Worst Pruritus NRS is an assessment tool that participants used to report the intensity of their pruritus during a 24-hour recall period using an electronic hand-held device. Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on an 11-point scale from 0 (no itch) to 10 (worst imaginable itch).
The percent change from Baseline was calculated from a rolling weekly average; a negative change from Baseline indicates improvement.Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 16 Baseline and Week 16 The Worst Pruritus NRS is an assessment tool that participants used to report the intensity of their pruritus during a 24-hour recall period using an electronic hand-held device. Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on an 11-point scale from 0 (no itch) to 10 (worst imaginable itch).
Percentage of Participants Achieving a 75% Reduction From Baseline in EASI Score at Week 2 Baseline and Week 2 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
Trial Locations
- Locations (159)
Northwestern University Feinberg School of Medicine /ID# 208680
🇺🇸Chicago, Illinois, United States
Medical Dermatology Associates of Chicago /ID# 210265
🇺🇸Chicago, Illinois, United States
Miami Dermatology and Laser Institute /ID# 212938
🇺🇸Miami, Florida, United States
Florida International Rsrch cr /ID# 211562
🇺🇸Miami, Florida, United States
Hospital Sultan Ismail /ID# 211037
🇲🇾Johor Bahru, Johor, Malaysia
Royal Alex Childrens County Hospital /ID# 209709
🇬🇧Brighton, Brighton And Hove, United Kingdom
Hospital de Manises /ID# 207062
🇪🇸Manises, Valencia, Spain
St Vincent's University Hosp /ID# 208441
🇮🇪Dublin, Ireland
Academisch Medisch Centrum /ID# 208578
🇳🇱Amsterdam, Noord-Holland, Netherlands
National Taiwan University Hospital /ID# 208309
🇨🇳Taipei City, Taipei, Taiwan
Dr. Chih-ho Hong Medical Inc. /ID# 211032
🇨🇦Surrey, British Columbia, Canada
Dermoklinika Medical Center /ID# 211026
🇵🇱Lodz, Lodzkie, Poland
Pratia MCM Krakow /ID# 207444
🇵🇱Krakow, Malopolskie, Poland
Kyiv City Clinical Skin and Venereal Hospital /ID# 210755
🇺🇦Kyiv, Ukraine
Enverus Medical Research /ID# 209503
🇨🇦Surrey, British Columbia, Canada
Charles Nicolle CHU Rouen /ID# 208973
🇫🇷Rouen CEDEX, Seine-Maritime, France
Rabin Medical Center /ID# 210012
🇮🇱Petakh Tikva, Israel
Centrum Oosterwal /ID# 209641
🇳🇱Alkmaar, Netherlands
Universitetssykehuset N-Norge, Tromso /ID# 209103
🇳🇴Tromso, Troms, Norway
Allergy, Asthma & Immunology Associates, PC /ID# 213481
🇺🇸Lincoln, Nebraska, United States
CHRU Lille - Hopital Claude Huriez /ID# 209317
🇫🇷Lille CEDEX, Hauts-de-France, France
Oroshazi Korhaz /ID# 210150
🇭🇺Oroshaza, Bekes, Hungary
Pecsi Tudomanyegyetem Klinikai l.sz. Belgyogyaszati Klinika /ID# 210892
🇭🇺Pecs, Hungary
ME "Rivne Regional Dermatology and Venereology Dispensary" of RRC /ID# 210434
🇺🇦Rivne, Ukraine
Hospital Universitario Dr. Negrin /ID# 208969
🇪🇸Las Palmas de Gran Canaria, Las Palmas, Spain
Taipei Municipal Wan Fang Hospital /ID# 209987
🇨🇳Taipei, Taiwan
CHU de Nantes - Hotel Dieu /ID# 208974
🇫🇷Nantes CEDEX 1, Pays-de-la-Loire, France
Bravis Ziekenhuis /ID# 208584
🇳🇱Bergen op Zoom, Noord-Brabant, Netherlands
Universitetssykehuset N-Norge, Harstad /ID# 209105
🇳🇴Harstad, Troms, Norway
Hospital Universitario de Bellvitge /ID# 207063
🇪🇸L'Hospitalet de Llobregat, Barcelona, Spain
Cardiff & Vale University Health Board /ID# 209745
🇬🇧Cardiff, Wales, United Kingdom
National Skin Centre /ID# 208775
🇸🇬Singapore, Central Singapore, Singapore
Chung Shan Medical University /ID# 208311
🇨🇳Taichung City, Taiwan
Victoria Hospital /ID# 209853
🇬🇧Kirkcaldy, Fife, United Kingdom
Clinical Research Center AL /ID# 210277
🇺🇸Birmingham, Alabama, United States
Oregon Health and Science University /ID# 208809
🇺🇸Portland, Oregon, United States
University of Arkansas for Medical Sciences /ID# 211688
🇺🇸Little Rock, Arkansas, United States
UCSF Fresno /ID# 213253
🇺🇸Fresno, California, United States
California Allergy and Asthma Medical Group /ID# 213680
🇺🇸Los Angeles, California, United States
Los Angelos Cataract Center /ID# 208524
🇺🇸Los Angeles, California, United States
Dermatology Clinical Trials /ID# 214622
🇺🇸Newport Beach, California, United States
Ucsd /Id# 208990
🇺🇸San Diego, California, United States
Clinical Science Institute /ID# 211022
🇺🇸Santa Monica, California, United States
The Community Research of South Florida /ID# 211145
🇺🇸Hialeah, Florida, United States
GCP Research /ID# 216020
🇺🇸Saint Petersburg, Florida, United States
Integrated Clinical Research LLC /ID# 208831
🇺🇸West Palm Beach, Florida, United States
Georgia Pollens Clinical Research Centers, Inc /ID# 211092
🇺🇸Albany, Georgia, United States
Clinical Research Solutions, LLC /ID# 212542
🇺🇸Jackson, Tennessee, United States
Meridian Clinical Research Dermatology /ID# 213251
🇺🇸Savannah, Georgia, United States
Sneeze, Wheeze, & Itch Associates, LLC /ID# 212058
🇺🇸Normal, Illinois, United States
Dawes Fretzin, LLC /ID# 209187
🇺🇸Indianapolis, Indiana, United States
Clarkston Skin Research /ID# 208739
🇺🇸Clarkston, Michigan, United States
Henry Ford Health System /ID# 208741
🇺🇸Detroit, Michigan, United States
Clinical Research Institute, Inc /ID# 210852
🇺🇸Minneapolis, Minnesota, United States
Dartmouth-Hitchcock Medical Center /ID# 213727
🇺🇸Lebanon, New Hampshire, United States
Forest Hills Dermatology Group /ID# 209249
🇺🇸Kew Gardens, New York, United States
Univ Hosp Cleveland /ID# 208852
🇺🇸Cleveland, Ohio, United States
The Ohio State University /ID# 209254
🇺🇸Columbus, Ohio, United States
Southside Dermatology /ID# 212004
🇺🇸Tulsa, Oklahoma, United States
Oregon Medical Res Center PC /ID# 208807
🇺🇸Portland, Oregon, United States
Epiphany Dermatology - Fort Worth /ID# 211187
🇺🇸Fort Worth, Texas, United States
DiscoveResearch, Inc. /ID# 213171
🇺🇸Bryan, Texas, United States
Sante Clinical Research /ID# 212970
🇺🇸Kerrville, Texas, United States
Stephen Miller, MD PA /ID# 210071
🇺🇸San Antonio, Texas, United States
Sugar Land Allergy, Asthma, and Immunology Center /ID# 211153
🇺🇸Sugar Land, Texas, United States
University of Utah /ID# 209001
🇺🇸Salt Lake City, Utah, United States
Premier Clinical Research /ID# 212142
🇺🇸Spokane, Washington, United States
West Virginia Research Inst /ID# 212730
🇺🇸South Charleston, West Virginia, United States
Holdsworth House Medical Practice /ID# 214565
🇦🇺Darlinghurst, New South Wales, Australia
The Skin Hospital /ID# 214401
🇦🇺Darlinghurst, New South Wales, Australia
Veracity Clinical Research /ID# 211134
🇦🇺Woolloongabba, Queensland, Australia
Sinclair Dermatology /ID# 209395
🇦🇺East Melbourne, Victoria, Australia
Burswood Dermatology /ID# 214875
🇦🇺Victoria Park, Western Australia, Australia
Dermatology Research Institute Inc. /ID# 210942
🇨🇦Calgary, Alberta, Canada
Kirk Barber Research, CA /ID# 209504
🇨🇦Calgary, Alberta, Canada
Lynderm Research Inc. /ID# 209505
🇨🇦Markham, Ontario, Canada
Dr. Wei Jing Loo Medicine Prof /ID# 211400
🇨🇦London, Ontario, Canada
DermEdge Research Inc. /ID# 211122
🇨🇦Mississauga, Ontario, Canada
Niakosari Medicine Professional Corporation /ID# 211401
🇨🇦Toronto, Ontario, Canada
K. Papp Clinical Research /ID# 209509
🇨🇦Waterloo, Ontario, Canada
Dre Angelique Gagne-Henley M.D. inc. /ID# 209498
🇨🇦Saint-Jerome, Quebec, Canada
DermaPlus - Poliklinika za dermatologiju i venerologiju /ID# 209935
🇭🇷Zagreb, Grad Zagreb, Croatia
Djecja bolnica Srebrnjak /ID# 209939
🇭🇷Zagreb, Grad Zagreb, Croatia
Klinicki bolnicki centar Zagreb /ID# 209976
🇭🇷Zagreb, Grad Zagreb, Croatia
Fakultni Nemocnice Brno /ID# 212968
🇨🇿Brno, Czechia
Naftalan - Specijalna bolnica za medicinsku rehabilitaciju /ID# 209937
🇭🇷Ivanic-Grad, Zagrebacka Zupanija, Croatia
FN Hradec Kralove /ID# 209116
🇨🇿Hradec Kralove, Czechia
Nemocnice Jihlava, prispevkova organizace /ID# 209131
🇨🇿Jihlava, Czechia
Fakultni Nemocnice v Motole /ID# 209209
🇨🇿Praha, Czechia
Fakultni nemocnice Ostrava /ID# 209117
🇨🇿Ostrava, Czechia
Keski-pohjanmaa Central Hospital /ID# 209534
🇫🇮Kokkola, Keski-Pohjanmaa, Finland
Oulu University Hospital /ID# 208961
🇫🇮Oulu, Pohjois-Pohjanmaa, Finland
Mikkeli Central Hospital /ID# 210125
🇫🇮Mikkeli, Finland
Pihlajalinna Turku /ID# 209599
🇫🇮Turku, Finland
Hopital de la Timone /ID# 211245
🇫🇷Marseille, France
Centre Hospitalier Universitaire de Nice - Hopital l'Archet 2 /ID# 213374
🇫🇷Nice, France
Hopital Larrey - CHU de Toulouse /ID# 208976
🇫🇷Toulouse, France
Polyclinique Courlancy /ID# 208975
🇫🇷Reims, France
Universitatsklinikum Munster /ID# 210935
🇩🇪Munster, Niedersachsen, Germany
Gemeinschaftspraxis /ID# 211174
🇩🇪Blankenfeld-mahlow, Germany
Hautklinik Klinikum Darmstadt /ID# 210938
🇩🇪Darmstadt, Germany
Universitaetsklinikum Frankfurt /ID# 210934
🇩🇪Frankfurt, Germany
Medizinische Hochschule Hannover /ID# 210939
🇩🇪Hannover, Germany
Debreceni Egyetem Klinikai Kozpont /ID# 210893
🇭🇺Debrecen, Hungary
TU Uniklinik Munchen /ID# 210937
🇩🇪Munich, Germany
Uno Medical Trials Kft /ID# 211177
🇭🇺Budapest XIII, Hungary
Somogy Megyei Kaposi Mor Oktat /ID# 210149
🇭🇺Kaposvar, Hungary
University Hospital Waterford /ID# 208442
🇮🇪Waterford, Ireland
HaEmek Medical Center /ID# 210153
🇮🇱Afula, Israel
Ichilov Medical Center /ID# 210014
🇮🇱Tel Aviv, Israel
Sheba Medical Center /ID# 210013
🇮🇱Ramat Gan, Israel
Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico /ID# 210632
🇮🇹Milan, Lombardia, Italy
IBD Center - IRCCS Istituto Clinico Humanitas /ID# 215726
🇮🇹Rozzano, Milano, Italy
A.O. Policlinico Sant'Orsola Malpighi /ID# 209111
🇮🇹Bologna, Italy
Ospedale San Giovanni di Dio /ID# 209109
🇮🇹Cagliari, Italy
Policlinico Univ Tor Vergata /ID# 209112
🇮🇹Rome, Italy
A.O.U. di Brescia /ID# 209115
🇮🇹Brescia, Italy
AO Univ di Modena /ID# 209110
🇮🇹Modena, Italy
Hospital Pulau Pinang /ID# 210212
🇲🇾Penang, Malaysia
UKM Medical Centre /ID# 209178
🇲🇾Kuala Lumpur, Selangor, Malaysia
University Malaya Med Ctr /ID# 208861
🇲🇾Kuala Lumpur, Malaysia
Hospital Putrajaya /ID# 209177
🇲🇾Putrajaya, Malaysia
Universitair Medisch Centrum Groningen /ID# 208583
🇳🇱Groningen, Netherlands
Erasmus Medisch Centrum /ID# 208582
🇳🇱Rotterdam, Netherlands
Universitair Medisch Centrum Utrecht /ID# 208579
🇳🇱Utrecht, Netherlands
Optimal Clinical Trials Ltd /ID# 209475
🇳🇿Auckland, New Zealand
Clinical Trials NZ /ID# 215590
🇳🇿Hamilton, New Zealand
Wellington Hospital (Capital and Coast District Health Board) /ID# 215001
🇳🇿Wellington, New Zealand
St. Olavs Hospital HF /ID# 209137
🇳🇴Trondheim, Sor-Trondelag, Norway
Szpital Uniwersytecki nr 1 im. dr. A. Jurasza w Bydgoszczy /ID# 211103
🇵🇱Bydgoszcz, Kujawsko-pomorskie, Poland
Klinika Ambroziak Sp. z o.o. /ID# 207443
🇵🇱Warsaw, Mazowieckie, Poland
Royalderm Agnieszka Nawrocka /ID# 211015
🇵🇱Warszawa, Mazowieckie, Poland
ClinicMed Daniluk, Nowak Sp.j. /ID# 211112
🇵🇱Bialystok, Podlaskie, Poland
National University Hospital /ID# 208774
🇸🇬Singapore, Singapore
Singapore General Hospital /ID# 208776
🇸🇬Singapore, Singapore
Complejo Hospitalario Universitario de Pontevedra /ID# 207139
🇪🇸Pontevedra, Spain
Hospital Universitario Arnau Vilanova /ID# 207065
🇪🇸Valencia, Spain
Hospital Universitario y Politecnico La Fe /ID# 207064
🇪🇸Valencia, Spain
Skanes Universitetssjukhus /ID# 206783
🇸🇪Malmö, Skane Lan, Sweden
Karolinska University Hospital /ID# 207909
🇸🇪Stockholm, Sweden
Military Hospital of Military-Medical Clinical Center of Southern Region /ID# 210435
🇺🇦Zaporizhzhya, Zaporizka Oblast, Ukraine
Royal Hospital for Children /ID# 210451
🇬🇧Glasgow, Glasgow City, United Kingdom
Jonathan Corren, MD. INC /ID# 208987
🇺🇸Los Angeles, California, United States
Dermatology Research Associates /ID# 209097
🇺🇸Los Angeles, California, United States
The Royal Free Hospital /ID# 208659
🇬🇧London, London, City Of, United Kingdom
Guy's and St Thomas' NHS Found /ID# 208881
🇬🇧London, London, City Of, United Kingdom
Progressive Medical Research /ID# 211994
🇺🇸Port Orange, Florida, United States
Tien Q Nguyen MD, Inc /ID# 208934
🇺🇸Fountain Valley, California, United States
Beacon Clinical Research, LLC /ID# 209280
🇺🇸Quincy, Massachusetts, United States
UC Davis Health /ID# 209285
🇺🇸Sacramento, California, United States
Skin Specialists, PC /ID# 208843
🇺🇸Omaha, Nebraska, United States
Clinical Research Trials of Florida, Inc. /ID# 210751
🇺🇸Tampa, Florida, United States
Montefiore Medical Center /ID# 209647
🇺🇸Bronx, New York, United States
Wake Forest Univ HS /ID# 208892
🇺🇸Winston-Salem, North Carolina, United States
Medical University of South Carolina /ID# 211054
🇺🇸Charleston, South Carolina, United States
Orion Clinical Research /ID# 208765
🇺🇸Austin, Texas, United States
Clinical Research Partners, LLC /ID# 212262
🇺🇸Richmond, Virginia, United States
Hospital Pakar Sultanah Fatimah /ID# 210185
🇲🇾Muar, Johor, Malaysia
China Medical University Hosp /ID# 209770
🇨🇳Taichung City, Taichung, Taiwan