MedPath

Long Term, Extension Study of the Safety and Efficacy of AVP-786 for the Treatment of Agitation in Patients With Dementia of the Alzheimer's Type

Phase 3
Terminated
Conditions
Agitation in Patients With Dementia of the Alzheimer's Type
Interventions
Registration Number
NCT02446132
Lead Sponsor
Otsuka Pharmaceutical Development & Commercialization, Inc.
Brief Summary

This is an extension study of the Phase 3 Studies 15-AVP-786-301, 15-AVP-786-302, and 17-AVP-786-305, which also allows participants from the Phase 2 Study 12-AVR-131 to be included.

Detailed Description

Participant has successfully completed Studies 15-AVP-786-301, 15-AVP-786-302, 12-AVR-131, or 17-AVP-786-305.

Participants will be enrolled in the study for approximately 56 weeks (participants who have a follow-up visit 3 months after the last dose of treatment will be enrolled for approximately 64 weeks).

Approximately 1200 participants will be enrolled at approximately 250 centers globally.

All participants enrolled will receive AVP-786; the treatment dose assigned will be masked to the participant, investigator, study staff, and the sponsor.

Recruitment & Eligibility

Status
TERMINATED
Sex
All
Target Recruitment
1197
Inclusion Criteria
  • Participant has successfully completed Studies 15-AVP-786-301, 15-AVP-786-302, 12-AVR-131, or 17-AVP-786-305. (Note: A delay in enrollment may include delays associated with COVID-19 restrictions.)
  • Participants with a diagnosis of probable Alzheimer's Disease (AD) according to the 2011 National Institute on Aging-Alzheimer's Association (NIA-AA) working group criteria
  • Either out-patients or residents of an assisted-living facility or a skilled nursing home
  • Participants who delay enrollment must have clinically significant, moderate/severe agitation at least 2 weeks prior to baseline
  • Participants who delay enrollment must have a diagnosis of agitation that must meet the International Psychogeriatric Association (IPA) provisional definition of agitation
  • Participants who delay enrollment must have a Clinical Global Impression of Severity of Illness (CGIS) score assessing Agitation of ≥ 4 (moderately ill) at screening and baseline
  • Participants who delay enrollment must have a Mini-Mental State Examination (MMSE) score between 6 and 26 (inclusive) at screening and baseline
Exclusion Criteria
  • Participants with co-existent clinically significant or unstable systemic diseases that could confound the interpretation of the safety results of the study (e.g., malignancy, poorly controlled diabetes, poorly controlled hypertension, unstable pulmonary, renal or hepatic disease, unstable ischemic cardiac disease, dilated cardiomyopathy, or unstable valvular heart disease)
  • Participants determined to have a high imminent risk of falls during the study based on a clinical evaluation by the investigator
  • Participants who are currently using or were on NUEDEXTA® in the 2 weeks preceding baseline

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
AVP-786 (dose 2)AVP-786AVP-786 dose 2; capsules administered twice a day over a 52-week period
AVP-786 (dose 1)AVP-786AVP-786 dose 1; capsules administered twice a day over a 52-week period
AVP-786 (dose 3)AVP-786AVP-786 dose 3; capsules administered twice a day over a 52-week period
Primary Outcome Measures
NameTimeMethod
Number of Participants with any Treatment-Emergent Serious Adverse Eventup to 64 weeks
Number of Participants with any abnormal, clinically significant Physical and Neurological Examination findingup to 52 weeks
Number of Participants with any abnormal, clinically significant 12-lead Electrocardiogram (ECG) valueup to 52 weeks
Number of Participants with any Treatment-Emergent Adverse Eventup to 64 weeks
Number of participants with any abnormal, clinically significant vital sign valueup to 52 weeks
Change from Baseline to Week 64 in the Sheehan Suicidality Tracking Scale (S-STS) ScoreBaseline; Week 64
Number of Participants with any abnormal, clinically significant Clinical Laboratory Valueup to 52 weeks
Change from Baseline to Week 52 in the Mini-Mental State Examination (MMSE) ScoreBaseline; Week 52
Change from Baseline to Week 52 in the Epworth Sleepiness Scale (ESS) ScoreBaseline; Week 52
Secondary Outcome Measures
NameTimeMethod
Change from Baseline to Week 64 in the Cohen-Mansfield Agitation Inventory (CMAI) Composite ScoreBaseline; Week 64
Change from Baseline to Week 52 in the Agitation/Aggression, Irritability/Lability, and Aberrant Motor Behavior Domain Scores of the Neuropsychiatric Inventory (NPI)Baseline; Week 52
Change from Baseline to Week 52 in the Resource Utilization in Dementia (RUD) ScoreBaseline; Week 52
Change from Baseline to Week 64 in the modified Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change-Agitation (mADCS-CGIC-Agitation) ScoreBaseline; Week 64
Change from Baseline to Week 52 in the Patient Global Impression of Change (PGIC) ScoreBaseline; Week 52

PGIC (rated by caregiver)

Change from Baseline to Week 52 in the Clinical Global Impression of Severity of Illness (CGIS)-Agitation Domain ScoreBaseline; Week 52
Change from Baseline to Week 52 in the Dementia Quality of Life (DEMQOL) ScoreBaseline; Week 52
Change from Baseline to Week 52 in the EuroQol 5-Dimension 5-Level (EQ-5D-5L) for Participants from Study 17-AVP-786-305Baseline; Week 52

Trial Locations

Locations (227)

Collier Neurologic Specialists, LLC

🇺🇸

Naples, Florida, United States

Naples Research, Inc

🇺🇸

Naples, Florida, United States

Bayside Clinical Research Site #556

🇺🇸

New Port Richey, Florida, United States

Columbus Research & Wellness Institute, INC

🇺🇸

Columbus, Georgia, United States

Medical Research & Health Education Foundation, Inc.

🇺🇸

Columbus, Georgia, United States

NeuroStudies. Net, LLC

🇺🇸

Decatur, Georgia, United States

Alzheimer's Disease Center

🇺🇸

Quincy, Massachusetts, United States

Millennium Psychiatric Associates, LLC

🇺🇸

Creve Coeur, Missouri, United States

The NeuroCognitive Institute

🇺🇸

Mount Arlington, New Jersey, United States

Bio Behavioral Health

🇺🇸

Toms River, New Jersey, United States

Dent Neurologic Institute

🇺🇸

Amherst, New York, United States

Integrative Clinical Trials LLC #1

🇺🇸

Brooklyn, New York, United States

Integrative Clinical Trials LLC #2

🇺🇸

Brooklyn, New York, United States

Columbia University Medical Center

🇺🇸

New York, New York, United States

Havana Research Institute

🇺🇸

Pasadena, California, United States

Pacific Research Network, Inc. #1

🇺🇸

San Diego, California, United States

Pacific Research Network, Inc. #2

🇺🇸

San Diego, California, United States

HB Clinical Trials Inc.

🇺🇸

Santa Ana, California, United States

Syrentis Clinical Research

🇺🇸

Santa Ana, California, United States

Viking Clinical Research

🇺🇸

Temecula, California, United States

Lytle and Weiss, PLLC dba Clinical Trials of the Rockies

🇺🇸

Denver, Colorado, United States

Coastal Connecticut Research, LLC

🇺🇸

New London, Connecticut, United States

Alzheimer's Research and Treatment Center #2

🇺🇸

Lake Worth, Florida, United States

Alzheimer's Research and Treatment Center #3

🇺🇸

Lake Worth, Florida, United States

Meridien Research Site #558

🇺🇸

Lakeland, Florida, United States

Innovative Clinical Research, Inc. Site #819

🇺🇸

Lauderhill, Florida, United States

New Med Research, Inc Site #812

🇺🇸

Miami Gardens, Florida, United States

Homestead Associates in Research Site# 797

🇺🇸

Miami, Florida, United States

Premier Clinical Research Institute, Inc. #1

🇺🇸

Miami, Florida, United States

Premier Clinical Research Institute, Inc. #2

🇺🇸

Miami, Florida, United States

Global Medical Institutes, LLC

🇺🇸

Miami, Florida, United States

Optimus U Corp

🇺🇸

Miami, Florida, United States

Project 4 Research #1

🇺🇸

Miami, Florida, United States

Project 4 Research #2

🇺🇸

Miami, Florida, United States

BioMed Research Institute

🇺🇸

Miami, Florida, United States

Finlay Medical Research Corp Site #552

🇺🇸

Miami, Florida, United States

First Class Medical Services Site #807

🇺🇸

Miami, Florida, United States

CCM Clinical Research Group

🇺🇸

Miami, Florida, United States

Innova Clinical Trials

🇺🇸

Miami, Florida, United States

Advance Medical Research Center #1

🇺🇸

Miami, Florida, United States

Advance Medical Research Center #2

🇺🇸

Miami, Florida, United States

Dade Research Center Llc

🇺🇸

Miami, Florida, United States

Vitae Researrch Center LLC

🇺🇸

Miami, Florida, United States

Roper St. Francis Healthcare

🇺🇸

Charleston, South Carolina, United States

BG Neurology

🇺🇸

Spartanburg, South Carolina, United States

Texas Neurology, P.A.

🇺🇸

Dallas, Texas, United States

Neurology Consultants of Dallas, PA

🇺🇸

Dallas, Texas, United States

University Texas Southwestern Medical Center

🇺🇸

Dallas, Texas, United States

InSite Clinical Research Site #576

🇺🇸

DeSoto, Texas, United States

Baylor College of Medicine

🇺🇸

Houston, Texas, United States

Houston Methodist Neurological Institute

🇺🇸

Houston, Texas, United States

PRX Research Site #825

🇺🇸

Mesquite, Texas, United States

Texas Medical Research Associates, L.L.C.

🇺🇸

San Antonio, Texas, United States

Ericksen Research and Development

🇺🇸

Clinton, Utah, United States

Pharmaceuticals Research Associates, Inc.

🇺🇸

Salt Lake City, Utah, United States

Fondazione Santa Lucia - Istituto di Ricovero e Cura a Carattere Scientifico

🇮🇹

Roma, Italy

Ksiedza Hugona Kollataja 9

🇵🇱

Bydgoszcz, Poland

Care Clinic Clinical Research Site #750

🇵🇱

Katowice, Poland

Wielospecjalistyczna Poradnia Lekarska Synapsis Site #741

🇵🇱

Katowice, Poland

Krakowska Akademia Neurologii Site #740

🇵🇱

Kraków, Poland

Malopolskie Centrum Medyczne Site #747

🇵🇱

Kraków, Poland

Medycyna Milorzab Site #743

🇵🇱

Lodz, Poland

Solumed Centrum Medyczne Site #753

🇵🇱

Poznań, Poland

Centrum Medyczne Euromedis

🇵🇱

Szczecin, Poland

Centrum Medyczne NeuroProtect Site #742

🇵🇱

Warszawa, Poland

ClinHouse Centrum Medyczne

🇵🇱

Zabrze, Poland

Semmelweis Egyetem

🇭🇺

Budapest, Hungary

Debreceni Egyetem Kenezy Gyula Egyetemi Korhaz

🇭🇺

Debrecen, Hungary

Dr. Mathe es Tarsa Beteti Tarsasag Site #593

🇭🇺

Kalocsa, Hungary

Galen Research

🇺🇸

Chesterfield, Missouri, United States

PsychoTech Clinical Research Site# 580

🇭🇺

Pécs, Hungary

Azienda Ospedaliera Sant'Andrea Site #606

🇮🇹

Roma, Italy

Fondazione Policlinico Tor Vergata Site #609

🇮🇹

Roma, Italy

Medical and Dental Centre

🇿🇦

Rosebank, South Africa

MD First Research, LLC Site #767

🇺🇸

Chandler, Arizona, United States

Alliance for Wellness, Inc dba Alliance for Research Site #789

🇺🇸

Long Beach, California, United States

Central Miami Medical Institute Site #798

🇺🇸

Miami, Florida, United States

VICIS Clinical Research Inc. Site #777

🇺🇸

Tampa, Florida, United States

Twoja Przychodnia - Centrum Medyczne Nowa Sol Site #757

🇵🇱

Nowa Sól, Lubuskie, Poland

RCMed Oddział Sochaczew Site #510

🇵🇱

Sochaczew, Mazowieckie, Poland

NoesisPharma, LLC

🇺🇸

Phoenix, Arizona, United States

Perseverance Research Center, LLC

🇺🇸

Scottsdale, Arizona, United States

Health Initiatives Research

🇺🇸

Fayetteville, Arkansas, United States

Advanced Research Center, Inc. Site #835

🇺🇸

Anaheim, California, United States

ATP Clinical Research, Inc. Site #763

🇺🇸

Costa Mesa, California, United States

Behavioral Research Specialists, LLC

🇺🇸

Glendale, California, United States

Irvine Center for Clinical Research

🇺🇸

Irvine, California, United States

Sheenath Clinical Service Site #770

🇺🇸

Lakewood, California, United States

Torrance Clinical Research Institute, Inc. Site #826

🇺🇸

Lomita, California, United States

Collaborative Neuroscience Network, LLC.

🇺🇸

Long Beach, California, United States

NRC Research Institute

🇺🇸

Orange, California, United States

California Neurological Services

🇺🇸

Panorama City, California, United States

Havana Research Institute Site 787

🇺🇸

Pasadena, California, United States

Research Center for Clinical Studies, Inc.

🇺🇸

Norwalk, Connecticut, United States

Neurology of Central Florida Rsch Ctr Site #803

🇺🇸

Altamonte Springs, Florida, United States

JEM Research Institute

🇺🇸

Atlantis, Florida, United States

Negron Research Services / Humanity Clinical Research Site# 766

🇺🇸

Aventura, Florida, United States

SFM Clinical Research, LLC Site #563

🇺🇸

Boca Raton, Florida, United States

Bradenton Research Center Site #834

🇺🇸

Bradenton, Florida, United States

Clinical Research Of Brandon, LLC Site #838

🇺🇸

Brandon, Florida, United States

Clinical Research of Brandon

🇺🇸

Brandon, Florida, United States

Meridien Research

🇺🇸

Brooksville, Florida, United States

Quantum Laboratories, Inc.

🇺🇸

Deerfield Beach, Florida, United States

Moonshine Research Center, Inc

🇺🇸

Doral, Florida, United States

Science Connections, LLC Site #814

🇺🇸

Doral, Florida, United States

Finlay Medical Research Corp

🇺🇸

Greenacres City, Florida, United States

Direct Helpers Research Center #801

🇺🇸

Hialeah, Florida, United States

Indago Research & Health Center, Inc.

🇺🇸

Hialeah, Florida, United States

New Life Medical Research Center, Inc.

🇺🇸

Hialeah, Florida, United States

Reliable Clinical Research,LLC

🇺🇸

Hialeah, Florida, United States

Research in Miami, Inc

🇺🇸

Hialeah, Florida, United States

The Research Center, Inc

🇺🇸

Hialeah, Florida, United States

Berma Research Group

🇺🇸

Hialeah, Florida, United States

Galiz Research

🇺🇸

Hialeah, Florida, United States

Maxblue Institute

🇺🇸

Hialeah, Florida, United States

Clinical Neuroscience Solutions, Inc.

🇺🇸

Jacksonville, Florida, United States

Alphab Global Research #793

🇺🇸

Jupiter, Florida, United States

SIH Research, LLC

🇺🇸

Kissimmee, Florida, United States

Alzheimer's Research and Treatment Center #1

🇺🇸

Lake Worth, Florida, United States

Oakland Medical Research Site #762

🇺🇸

Troy, Michigan, United States

University of Miami

🇺🇸

Miami, Florida, United States

Miami Jewish Health Systems, Inc.

🇺🇸

Miami, Florida, United States

United Health Research Corp. #1

🇺🇸

Miami, Florida, United States

United Health Research Corp. #2

🇺🇸

Miami, Florida, United States

Advanced Medical Center Group

🇺🇸

Miami, Florida, United States

Future Care Solution, LLC

🇺🇸

Miami, Florida, United States

Reliant Medical Research LLC Site #811

🇺🇸

Miami, Florida, United States

Hope Research Network LLC Site #773

🇺🇸

Miami, Florida, United States

Clinical Research Associates of South Florida #1

🇺🇸

Miami, Florida, United States

Clinical Research Associates of South Florida #2

🇺🇸

Miami, Florida, United States

Coral Research Clinic Corp

🇺🇸

Miami, Florida, United States

P&S RESEARCH, LLC. Site #805

🇺🇸

Miami, Florida, United States

Pharmax Research of South Florida

🇺🇸

Miami, Florida, United States

Kendall Research Institute

🇺🇸

Miami, Florida, United States

Nuovida Research Center Corp.

🇺🇸

Miami, Florida, United States

Accellacare Alcobendas

🇪🇸

Alcobendas, Spain

Research Centers of America, LLC

🇺🇸

Oakland Park, Florida, United States

Compass Research, LLC

🇺🇸

Orlando, Florida, United States

Combined Research Orlando Site #799

🇺🇸

Orlando, Florida, United States

Neurology Associates of Ormond Beach

🇺🇸

Ormond Beach, Florida, United States

Innovation Medical Research Center

🇺🇸

Palmetto Bay, Florida, United States

IMIC Inc.

🇺🇸

Palmetto Bay, Florida, United States

Innovation Medical Research Center Site #802

🇺🇸

Palmetto Bay, Florida, United States

Fundació ACE

🇪🇸

Barcelona, Spain

University of West Florida

🇺🇸

Pensacola, Florida, United States

Neurostudies Inc. Site#796

🇺🇸

Port Charlotte, Florida, United States

Roskamp Institute

🇺🇸

Sarasota, Florida, United States

Olympian Clinical Research

🇺🇸

Tampa, Florida, United States

Compass Research North, LLC

🇺🇸

The Villages, Florida, United States

Neurology Research Institute Palm Beach, LLC #1

🇺🇸

West Palm Beach, Florida, United States

Neurology Research Institute Palm Beach, LLC #2

🇺🇸

West Palm Beach, Florida, United States

Florida Premier Research Institute

🇺🇸

Winter Park, Florida, United States

NeuroTrials Research Inc

🇺🇸

Atlanta, Georgia, United States

Indiana University School of Medicine

🇺🇸

Indianapolis, Indiana, United States

Josephson Wallack Munshower Neurology, PC

🇺🇸

Indianapolis, Indiana, United States

MidAmerica Neuroscience Research Foundation

🇺🇸

Lenexa, Kansas, United States

Four Rivers Clinical Research Inc.

🇺🇸

Paducah, Kentucky, United States

The Samuel & Alexia Bratton Memory Clinic

🇺🇸

Easton, Maryland, United States

Mir Neurology

🇺🇸

Hagerstown, Maryland, United States

Alzheimer Disease Center Site #804

🇺🇸

Braintree, Massachusetts, United States

Boston Center for Memory

🇺🇸

Newton, Massachusetts, United States

Onyx Clinical Research, LLC

🇺🇸

Caro, Michigan, United States

Michigan State University Department of Neurology

🇺🇸

East Lansing, Michigan, United States

Manhattan Behavioral Medicine, PLLC

🇺🇸

New York, New York, United States

Eastside Comprehensive Medical Center, LLC

🇺🇸

New York, New York, United States

Nathan S. Kline Institute for Psychiatric Research #1

🇺🇸

Orangeburg, New York, United States

Nathan S. Kline Institute for Psychiatric Research #571

🇺🇸

Orangeburg, New York, United States

University of Rochester Medical Center

🇺🇸

Rochester, New York, United States

Richmond Behavioral Associates

🇺🇸

Staten Island, New York, United States

Burke Rehabilitation Hospital

🇺🇸

White Plains, New York, United States

Herbert Harris, Md, Phd, Pa

🇺🇸

Chapel Hill, North Carolina, United States

ANI Neurology PLLC dba Alzheimer's Memory Center

🇺🇸

Charlotte, North Carolina, United States

Duke University Medical Center

🇺🇸

Durham, North Carolina, United States

Neurology and Neuroscience Associates, Inc.

🇺🇸

Akron, Ohio, United States

Insight Clinical Trials, LLC Site #570

🇺🇸

Beachwood, Ohio, United States

Valley Medical Research Site #788

🇺🇸

Centerville, Ohio, United States

Valley Medical Research

🇺🇸

Centerville, Ohio, United States

University of Cincinnati

🇺🇸

Cincinnati, Ohio, United States

The Ohio State University

🇺🇸

Columbus, Ohio, United States

Cleveland Clinic Lou Ruvo Center for Brain Health at Lakewood Hospital

🇺🇸

Lakewood, Ohio, United States

NorthStar Medical Research Site #778

🇺🇸

Middleburg Heights, Ohio, United States

IPS Research Company

🇺🇸

Oklahoma City, Oklahoma, United States

Oklahoma Clinical Research Center

🇺🇸

Oklahoma City, Oklahoma, United States

Heritage Valley Medical Group, Inc.

🇺🇸

Beaver, Pennsylvania, United States

Abington Neurological Associates, LTD

🇺🇸

Willow Grove, Pennsylvania, United States

Rhode Island Mood & Memory Research Institute

🇺🇸

East Providence, Rhode Island, United States

RH Johnson VA Medical Center

🇺🇸

Charleston, South Carolina, United States

Clinical Neuroscience Research Associates, Inc. dba The Memory Clinic

🇺🇸

Bennington, Vermont, United States

Neuropsychiatric Associates

🇺🇸

Woodstock, Vermont, United States

Veteran Affairs Medical Center, Salem Virginia

🇺🇸

Salem, Virginia, United States

Northwest Clinical Research Center

🇺🇸

Bellevue, Washington, United States

Core Clinical Research Site #772

🇺🇸

Everett, Washington, United States

IPC Research

🇺🇸

Waukesha, Wisconsin, United States

Center for Mental Health - Ruse

🇧🇬

Ruse, Bulgaria

Mental Health Centre Prof. Nikola Shipkovenski Site #713

🇧🇬

Sofia, Bulgaria

Medical Center Sveti Naum Site #707

🇧🇬

Sofia, Bulgaria

Vrach and Sv. Sv. Kuzma and Damian Site #710

🇧🇬

Sofia, Bulgaria

University Multiprofile Hospital for Active Treatment Alexandrovska Site #704

🇧🇬

Sofia, Bulgaria

Medical Center Mladost-M

🇧🇬

Varna, Bulgaria

Medica Plus Medical Center

🇧🇬

Veliko Tarnovo, Bulgaria

Dr. Alexander McIntyre Inc.

🇨🇦

Penticton, Canada

Fakultni Nemocnice u sv. Anny v Brne Site #722

🇨🇿

Brno, Czechia

Fakultní Nemocnice Hradec Králové Site #724

🇨🇿

Hradec Kralové, Czechia

NeuropsychiatrieHK Site #729

🇨🇿

Hradec Kralové, Czechia

Brain-Soultherapy

🇨🇿

Kladno, Czechia

Námestí národního odboje 692 Site #723

🇨🇿

Kutna Hora, Czechia

A-Shine s.r.o. Site #731

🇨🇿

Plzen, Czechia

AD71

🇨🇿

Praha, Czechia

Clintrial

🇨🇿

Praha, Czechia

Neurologicka Ambulance - Forbeli

🇨🇿

Praha, Czechia

Neuropsychiatrie Site #726

🇨🇿

Praha, Czechia

Vestra Clinics

🇨🇿

Rychnov nad Kněžnou, Czechia

Centre Hospitalier Universitaire de Saint-Étienne - Hôpital Nord Site #535

🇫🇷

Saint-Etienne, Auvergne-Rhone-Alpes, France

Centre Hospitalier Universitaire Dijon Bourgogn Site #536

🇫🇷

Dijon Cedex, France

Centre Hospitalier Universitaire Toulouse - Casselardit Ancely Site #533

🇫🇷

Toulouse, France

Dr. Kenessey Albert Kórház-Rendelőintézet

🇭🇺

Balassagyarmat, Hungary

Pszichiatriai es Pszichiatriai Rehabilitacios Osztaly Site #586

🇭🇺

Budapest, Hungary

ACF Neurological Services

🇿🇦

Cape Town, South Africa

Cape Trial Centre

🇿🇦

Cape Town, South Africa

Flexivest Fourteen Research Centre

🇿🇦

Cape Town, South Africa

Apollo Clinical Research Site #623

🇿🇦

Johannesburg, South Africa

Hospital Clinic de Barcelona

🇪🇸

Barcelona, Spain

Hospital General Universitario de Elche

🇪🇸

Elche, Spain

Hospital Universitario de Salamanca

🇪🇸

Salamanca, Spain

Hospital Universitario Virgen Macarena Site #649

🇪🇸

Sevilla, Spain

Complejo Asistencial de Zamora Hospital Virgen de la Concha

🇪🇸

Zamora, Spain

Hospital Viamed Montecanal Site #643

🇪🇸

Zaragoza, Spain

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