A Study of Guselkumab Administered Subcutaneously in Bio-naive Participants With Active Psoriatic Arthritis Axial Disease
- Registration Number
- NCT04929210
- Lead Sponsor
- Janssen Research & Development, LLC
- Brief Summary
The purpose of this study is to evaluate the efficacy of guselkumab treatment in participants with active psoriatic arthritis (PsA) axial disease by assessing reduction in axial symptoms and inflammation.
- Detailed Description
PsA is a chronic inflammatory musculoskeletal disease that has 6 disease domains, and axial disease represents one of the domains. Guselkumab is a fully human immunoglobulin (Ig) G1 lambda monoclonal antibody (mAb) that by binding to the p19 protein subunit of interleukin (IL)-23, blocks the binding of extracellular IL-23 to the cell surface IL-23 receptor, inhibiting IL-23-mediated intracellular signaling, activation, and cytokine production. This study will consist of a screening phase (up to 6 weeks), a treatment phase (up to 48 weeks, including a placebo-controlled period from Week 0 to Week 24 and an active-controlled treatment phase from Week 24 to Week 48), and a safety follow-up phase (up to Week 60). The efficacy assessments will include assessment such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score and the safety assessments will include evaluations of physical examinations, vital signs, electrocardiograms, clinical laboratory tests, and adverse events. The overall duration of the study will be up to 14 months.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 405
- Have a diagnosis of psoriatic arthritis (PsA) for at least 6 months prior to the first administration of study intervention and meet classification criteria for psoriatic arthritis (CASPAR) criteria at screening
- Have active PsA as defined by: a) at least 3 swollen joints and at least 3 tender joints at screening and at baseline and b) C-reactive protein (CRP) greater than or equal to (>=) 0.3 milligram/deciliter (mg/dL) at screening from the central laboratory, and despite previous non-biologic disease modifying antirheumatic drug (DMARD), apremilast, and/or nonsteroidal anti-inflammatory drug (NSAID) therapy
- Have magnetic resonance imaging (MRI)-confirmed PsA axial disease (positive MRI spine and/or sacroiliac [SI] joints, shown by a Spondyloarthritis Research Consortium of Canada [SPARCC] score of >= 3 in either the spine or the sacroiliac joints)
- Have a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of at least 4, and have a spinal pain score (on a visual analog scale [VAS]) of at least 4
- Have active plaque psoriasis, with at least 1 psoriatic plaque of >= 2 centimeter (cm) diameter and/or nail changes consistent with psoriasis, or documented history of plaque psoriasis
- Has known allergies, hypersensitivity, or intolerance to guselkumab or its excipients
- Has other inflammatory diseases that might confound the evaluations of benefit of guselkumab therapy, including but not limited to rheumatoid arthritis (RA), ankylosing spondylitis (AS)/non-radiographic-axial spondyloarthritis (this does not include a primary diagnosis of PsA with spondylitis), systemic lupus erythematosus, or Lyme disease
- Has previously received any biologic treatment
- Has ever received a Janus kinase (JAK) inhibitor including but not limited to tofacitinib, baricitinib, filgotinib, peficitinib, decernotinib, upadacitinib or any other investigational JAK inhibitor
- Has received any systemic immunosuppressants (example, azathioprine, cyclosporine, 6 thioguanine, mercaptopurine, mycophenolate mofetil, hydroxyurea, tacrolimus) within 4 weeks of the first administration of study intervention
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group 1: Guselkumab and Placebo Placebo Participants will receive guselkumab and matching placebo subcutaneously (SC) to maintain the blind. Group 2: Guselkumab Guselkumab Participants will receive guselkumab SC. Group 1: Guselkumab and Placebo Guselkumab Participants will receive guselkumab and matching placebo subcutaneously (SC) to maintain the blind. Group 3: Placebo followed by Guselkumab Placebo Participants will receive matching placebo and will cross over to receive guselkumab SC. Group 3: Placebo followed by Guselkumab Guselkumab Participants will receive matching placebo and will cross over to receive guselkumab SC.
- Primary Outcome Measures
Name Time Method Change from Baseline in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Score at Week 24 Baseline and Week 24 BASDAI is a self-assessment tool that consists of 6 questions relating to 5 major symptoms of ankylosing spondylitis: fatigue, spinal pain, joint pain, enthesitis, qualitative morning stiffness and quantitative morning stiffness. First 5 items were scored on a 10 centimeter (cm) visual analog scale (VAS) ranging from 0 equals to (=) none to 10=very severe. Quantitative morning stiffness was scored on a 10 cm VAS ranging from 0=0 hours to 10=2 or more hours. 2 scores for qualitative and quantitative morning stiffness were averaged, and total BASDAI score was average of the 5 scores of each symptom, ranging from 0 (none) to 10 (very severe). Higher scores indicate greater disease severity.
- Secondary Outcome Measures
Name Time Method Percentage of Participants who Achieve a >= 50 % Improvement from Baseline in BASDAI Score at Week 24 Baseline and Week 24 Percentage of participants who achieve a \>= 50 % improvement from baseline in BASDAI score at week 24 will be reported.
Change from Baseline in Disease Activity Index for Psoriatic Arthritis (DAPSA) at Week 24 Baseline and Week 24 DAPSA assessed the joint domain of psoriatic arthritis (PsA) and was derived from the sum of the following components: tender joint count (0-68), swollen joint count (0-66), CRP level (milligram/deciliter \[mg/dL\], value less than \[\<\] lower limit of quantification \[LLOQ\] is considered equal to half of the value of LLOQ for numerical calculations), participant assessment of pain (0-10 cm VAS, 0=no pain, 10=worst possible pain), and participant's global assessment of disease activity on arthritis (0 to 10 cm VAS, 0=excellent and 10=poor). A higher score indicates more active disease activity. Negative changes from baseline indicate improvement of PsA disease activity. The assessment does not have a score range with an upper or lower bound.
Percentage of Participants with Investigator's Global Assessment (IGA) 0/1 Response at Week 24 among Participants with >= 3% Body Surface Area (BSA) Psoriatic Involvement and an IGA Score of >=2 (Mild) at Baseline Week 24 Percentage of participants with IGA 0/1 response at week 24 among the participants with \>= 3 percent (%) BSA psoriatic involvement and an IGA score of \>= 2 (mild) at baseline will be reported. The IGA documents the investigator's assessment of the participants psoriasis at a given timepoint. Overall lesions are graded for induration, erythema, and scaling using 0 (no evidence), 1 (minimal), 2 (mild), 3 (moderate) and 4 (severe) scale. The IGA score of psoriasis is based upon the average of induration, erythema and scaling scores. The participant's psoriasis is assessed as cleared (0), minimal (1), mild (2), moderate (3), or severe (4).
Change from Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI) Score at Week 24 Baseline and Week 24 HAQ-DI score assess functional status of participant. It is 20 question instrument that assess degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and activities of daily living). Responses in each functional area were scored from 0=indicating no difficulty, to 3=indicating inability to perform a task in that area. Total HAQ score is average of the computed categories scores ranging from 0-3 where 0=least difficulty and 3=extreme difficulty. Lower scores are indicative of better functioning. Negative change from baseline indicates improvement of physical function.
Percentage of Participants who Achieve ASDAS Major Improvement at Week 24 Week 24 Percentage of participants who achieve ASDAS major improvement at Week 24 will be reported.
Change from Baseline in SPARCC Score for MRI Spine at Week 24 Baseline and Week 24 Change from baseline in SPARCC score for MRI spine at week 24 among the participants with a positive MRI of the spine at baseline will be reported. The SPARCC scoring system for the spine scores the 6 discovertebral units considered by the reader as the most abnormal, and then separately assesses each quadrant of 3 adjacent sagittal slices, with additional points for "depth" and high "intensity" of the lesion.
Number of Participants with Serious Adverse Events (SAEs) Up to 60 weeks A SAE is any untoward medical occurrence that at any dose: results in death; is life-threatening; requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; is a suspected transmission of any infectious agent via a medicinal product; is medically important.
Number of Participants with Reasonably Related AEs Up to 60 weeks An AE is any untoward medical occurrence in a participant participating in a clinical study that does not necessarily have a causal relationship with the pharmaceutical/biological agent under study.
Change from Baseline in Spondyloarthritis Research Consortium of Canada (SPARCC) Score for Magnetic Resonance Imaging (MRI) Sacroiliac (SI) Joints at Week 24 Baseline and Week 24 Change from baseline in SPARCC score for MRI SI joints at week 24 among the participants with a positive MRI of the sacroiliac joints at baseline will be reported. SPARCC method focuses on the cartilaginous portion of the SI joint, and scores presence (score of 1) versus absence (score of 0) of bone marrow edema in each SI joint quadrant.
Number of Participants with Infections Up to 60 weeks Number of participants with infections will be reported.
Serum Guselkumab Concentration Over Time Up to 60 weeks Serum guselkumab concentration over time will be reported.
Change from Baseline in Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) at Week 24 Baseline and Week 24 The ASDAS-CRP is a composite of 5 disease activity variables with only partial overlap. The 4 self-reported items included in this index are back pain (VAS), duration of morning stiffness, peripheral pain/swelling, and participant global assessment of disease activity; these are combined with the C-reactive protein (CRP) value. Selected cut-offs for improvement scores are: a change greater than or equal to (\>=) 1.1 units for "clinically important improvement" and a change \>= 2.0 units for "major improvement.
Percentage of Participants who Achieve ASDAS Clinically Important Improvement at Week 24 Week 24 Percentage of participants who achieve ASDAS clinically important improvement at week 24 will be reported.
Percentage of Participants who Achieve Ankylosing Spondylitis Activity Score (ASAS) 40 Response at Week 24 Week 24 Percentage of participants who achieve ASAS 40 response at Week 24 will be reported. ASAS 40 defined as improvement from baseline of \>= 40% and with an absolute improvement from baseline of at least 2 on 0 to 10 cm scale in at least 3 of following 4 domains: Participant's global assessment (0 to 10 cm; 0=very well, 10=very poor), total back pain (0 to 10 cm; 0=no pain,10=most severe pain), BASFI (self-assessment represented as mean (0 to 10 cm; 0=easy to 10=impossible) of 10 questions, 8 of which relate to participant's functional anatomy and 2 relate to participant's ability to cope with everyday life), Inflammation (0 to 10 cm; 0=none, 10=very severe); no worsening at all from baseline in remaining domain.
Number of Participants with Adverse Events (AEs) Up to 60 weeks An AE is any untoward medical occurrence in a participant participating in a clinical study that does not necessarily have a causal relationship with the pharmaceutical/biological agent under study.
Number of Participants with AEs Leading to Discontinuation of Study Intervention Up to 60 weeks Number of participants with AEs leading to discontinuation of study intervention will be reported.
Number of Participants with Laboratory Abnormalities (Chemistry, Hematology) by Maximum Toxicity (Common Terminology Criteria for Adverse Events [CTCAE 5.0]) Grades Up to 60 weeks Number of participants with laboratory abnormalities (chemistry, hematology) by maximum toxicity (CTCAE 5.0) grades will be reported. Grade refers to the severity of the AE as follows: Grade 1- Mild, asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2- Moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental Activities of Daily Living (ADL); Grade 3- Severe or medically significant but not immediately life-threatening, hospitalization or prolongation of hospitalization indicated, disabling, limiting self-care ADL; Grade 4- Life-threatening consequences, urgent intervention indicated; Grade 5- Death related to AE.
Number of participants with Injection-Site Reactions Up to 60 weeks Number of participants with injection-site reactions will be reported. A study intervention injection-site reaction is any adverse reaction at a subcutaneous study intervention injection-site.
Number of Participants with Antibodies to Guselkumab Up to 60 weeks Number of participants with antibodies to guselkumab will be reported.
Trial Locations
- Locations (237)
UMHAT Kaspela
🇧🇬Plovdiv, Bulgaria
Medical Center Artmed
🇧🇬Plovdiv, Bulgaria
MHAT 'Lyulin' EAD
🇧🇬Sofia, Bulgaria
University Multiprofile Hospital Sofiamed Sofia
🇧🇬Sofia, Bulgaria
Military Medical Academy
🇧🇬Sofia, Bulgaria
UMHAT St. Ivan Rilski
🇧🇬Sofia, Bulgaria
DCC Convex EOOD
🇧🇬Sofia, Bulgaria
Tbilisi Heart and Vascular Clinic Ltd
🇬🇪T'bilisi, Georgia
Twoja Przychodnia - Centrum Medyczne Nowa Sol
🇵🇱Nowa Sol, Poland
Altay Medical State University
🇷🇺Barnaul, Russian Federation
Chelyabinck Regional Clinical Hospital
🇷🇺Chelyabinsk, Russian Federation
Chelyabinsk Regional Clinical Dermatovenerological Dispensary
🇷🇺Chelyabinsk, Russian Federation
Sverdlovsk Regional Clinical Hospital N. 1
🇷🇺Ekaterinbourg, Russian Federation
Regional Clinical Diagnostic Center of Udmurtia Region
🇷🇺Izhevsk, Russian Federation
LLL Medical Center Revma-Med
🇷🇺Kemerovo, Russian Federation
Reumatologicka ambulancia
🇸🇰Nove Mesto nad Vahom, Slovakia
Reumatologická ambulancia Thermium s.r.o.
🇸🇰Piestany, Slovakia
REUMAMED POPRAD, s.r.o.
🇸🇰Poprad, Slovakia
Reumex s.r.o
🇸🇰Rimavska Sobota, Slovakia
Hosp. Univ. de Cruces
🇪🇸Barakaldo, Spain
Hosp Clinic de Barcelona
🇪🇸Barcelona, Spain
Bekes Varmegyei Kozponti Korhaz Pandy Kalman Tagkorhaz
🇭🇺Gyula, Hungary
Skin Health Institute Inc.
🇦🇺Melbourne, Australia
Porcika Klinika - Vasarhelyi Sarkanyfu Kft.
🇭🇺Hodmezovasarhely, Hungary
Kistarcsai Flor Ferenc Korhaz
🇭🇺Kistarcsa, Hungary
Fejer Varmegyei Szent Gyorgy Egyetemi Oktatokorhaz
🇭🇺Székesfehérvár, Hungary
Eastern Health - Box Hill Hospital
🇦🇺Melbourne, Australia
Exacta Medica
🇧🇬Pleven, Bulgaria
UMHAT 'Dr. Georgi Stranski', EAD
🇧🇬Pleven, Bulgaria
Medical Center Unimed Plovdiv
🇧🇬Plovdiv, Bulgaria
Vital Medical Center Orvosi es Fogaszati Kozpont
🇭🇺Veszprem, Hungary
Bnai Zion Medical Center
🇮🇱Haifa, Israel
Carmel Medical Center
🇮🇱Hifa, Israel
Wolfson Medical Center
🇮🇱Holon, Israel
Meir Medical Center
🇮🇱Kfar-Sava, Israel
Sheba Medical Center
🇮🇱Ramat Gan, Israel
A.O. Universitaria Ospedali Riuniti di Ancona
🇮🇹Ancona, Italy
Azienda Ospedaliero-Universitaria di Cagliari
🇮🇹Monserrato, Italy
Arcispedale Santa Maria Nuova - IRCCS
🇮🇹Reggio Emilia, Italy
Policlinico Tor Vergata
🇮🇹Roma, Italy
Humanitas Hospital
🇮🇹Rozzano (MI), Italy
Azienda Ospedaliera Universitaria Integrata Verona
🇮🇹Verona, Italy
Hospital Selayang
🇲🇾Batu Caves, Malaysia
Hospital Pulau Pinang
🇲🇾George Town, Malaysia
Hospital Sultan Ismail
🇲🇾Johor Bahru, Malaysia
University Malaya Medical Centre
🇲🇾Kuala Lumpur, Malaysia
Hospital Tuanku Jaafar
🇲🇾Seremban, Malaysia
Cebu Doctors' University Hospital
🇵🇭Cebu City, Philippines
Davao Doctors Hospital
🇵🇭Davao City, Philippines
Lipa Medix Medical Hospital
🇵🇭Lipa, Philippines
ManilaMed Medical Center Manila
🇵🇭Manila, Philippines
Philippine General Hospital
🇵🇭Manila, Philippines
St. Luke's Medical Center
🇵🇭Quezon City, Philippines
ASIMP Rheumatology Centre St Irina EOOD
🇧🇬Sofia, Bulgaria
Medical Centre Synexus
🇧🇬Sofia, Bulgaria
DDC Sv. Ivan Rilski OOD
🇧🇬Targovishte, Bulgaria
NZOZ Lecznica MAK MED S C
🇵🇱Nadarzyn, Poland
G R M O Groupe de recherche en maladies osseuses Inc
🇨🇦Quebec, Canada
Revmacentrum MUDr Mostera s r o
🇨🇿Brno Zidenice, Czechia
Revmaclinic
🇨🇿Brno, Czechia
Revmatologie s r o
🇨🇿Brno, Czechia
L K N Arthrocentrum
🇨🇿Hlucin, Czechia
Revimex Pro s r o
🇨🇿Karvina Frystat, Czechia
MUDr Rosypalova s r o
🇨🇿Ostrava, Czechia
Arthrohelp S.R.O.
🇨🇿Pardubice, Czechia
Revmatologicky ustav
🇨🇿Praha, Czechia
Medical Plus S R O
🇨🇿Uherske Hradiste, Czechia
Frederiksberg Hospital
🇩🇰Frederiksberg, Denmark
Rigshospitalet Glostrup
🇩🇰Glostrup, Denmark
Køge Sygehus Region Sjaelland
🇩🇰Køge, Denmark
Vejle Sygehus
🇩🇰Vejle, Denmark
Ltd Health Center
🇬🇪Batumi, Georgia
LTD Clinic LJ
🇬🇪Kutaisi, Georgia
Ltd American Hospital Network
🇬🇪T'bilisi, Georgia
Hosp Univ A Coruna
🇪🇸A Coruna, Spain
Hosp Reina Sofia
🇪🇸Cordoba, Spain
LTD 'Aversi Clinic'
🇬🇪T'bilisi, Georgia
Clinic on Mtskheta Street
🇬🇪T'bilisi, Georgia
Aleksandre Aladashvili Clinic LLC
🇬🇪Tbilisi, Georgia
LTD Helsicore
🇬🇪Tbilisi, Georgia
Twoja Przychodnia PCM
🇵🇱Poznan, Poland
Reumedika s c Wieslawa Porawska Lukasz Porawski
🇵🇱Poznan, Poland
Lubelskie Centrum Diagnostyczne
🇵🇱Swidnik, Poland
MICS Centrum Medyczne Torun
🇵🇱Torun, Poland
MICS Centrum Medyczne Warszawa
🇵🇱Warsaw, Poland
Narodowy Instytut Geriatrii Reumatologii i Rehabilitacji im prof dr hab med Eleonory Reicher
🇵🇱Warsaw, Poland
Rheuma Medicus Sp z o o
🇵🇱Warszawa, Poland
Centrum Medyczne Reuma Park
🇵🇱Warszawa, Poland
LLC Family Outpatient Clinic # 4
🇷🇺Korolev, Russian Federation
Regional SBI of PH Krasnoyarsk Regional Clinical hospital #20 named after I.S. Berzon
🇷🇺Krasnoyarsk, Russian Federation
Clinical-Diagnostic Center Euromedservice, JSC
🇷🇺Moscow, Russian Federation
FGBU Research Institute of Rheumatology named V.A.Nasonova
🇷🇺Moscow, Russian Federation
GBUZ of Moscow Region 'Moscow Region SRI n.a. Vladimirskyi'
🇷🇺Moscow, Russian Federation
Hosp. Univ. de Basurto
🇪🇸Bilbao, Spain
Hosp. Clinico San Carlos
🇪🇸Madrid, Spain
Clinica Gaias
🇪🇸Santiago de Compostela, Spain
Hosp. Virgen Macarena
🇪🇸Sevilla, Spain
Ltd New Hospitals
🇬🇪Tbilisi, Georgia
ETG Warszawa
🇵🇱Warszawa, Poland
Centrum Medyczne AMED Targowek
🇵🇱Warszawa, Poland
WroMedica I Bielicka A Strzalkowska s c
🇵🇱Wroclaw, Poland
Uls Braga - Hosp. Braga
🇵🇹Braga, Portugal
Ulsg - Hosp. Sousa Martins
🇵🇹Guarda, Portugal
Ipr Inst Port de Reumatologia
🇵🇹Lisboa, Portugal
Uls Lisboa Ocidental - Hosp. Egas Moniz
🇵🇹Lisboa, Portugal
Hosp. Cuf Tejo
🇵🇹Lisboa, Portugal
Uls Santa Maria - Hosp. Santa Maria
🇵🇹Lisboa, Portugal
Ulsam - Hosp. Conde de Bertiandos
🇵🇹Ponte de Lima, Portugal
Uls Sao Joao - Hosp. Sao Joao
🇵🇹Porto, Portugal
Llc Ultramed
🇷🇺Omsk, Russian Federation
GBOU VPO Orenburg State Medical University
🇷🇺Orenburg, Russian Federation
GBUZ Perm Regional Clinical Hospital
🇷🇺Perm, Russian Federation
Republican Hospital n.a.V.A.Baranov
🇷🇺Petrozavodsk, Russian Federation
Rostov Regional Clinical Dermatovenerological Dispensary
🇷🇺Rostov, Russian Federation
St. Petersburg GBUZ Clinical Reumatological Hospital 25
🇷🇺St. Petersburg, Russian Federation
X7 Clinical Research Company Limited
🇷🇺St. Petersburg, Russian Federation
Hosp Regional Univ de Malaga
🇪🇸Málaga, Spain
Corporacio Sanitari Parc Tauli
🇪🇸Sabadell, Spain
Hosp. Quiron Sagrado Corazon
🇪🇸Sevilla, Spain
Hosp. Univ. I Politecni La Fe
🇪🇸Valencia, Spain
TSMU The First University Clinic
🇬🇪Tbilisi, Georgia
JSC K Eristavi National Center of experimental and Clinical surgery
🇬🇪Tbilisi, Georgia
LTD MediClub Georgia
🇬🇪Tbilisi, Georgia
LTD The First Medical Center
🇬🇪Tbilisi, Georgia
Consilium Medulla-multiprofile clinic Ltd
🇬🇪Tbilisi, Georgia
JSC Evex Hospitals
🇬🇪Tnilisi, Georgia
ISA - Interdisciplinary Study Association GmbH
🇩🇪Berlin, Germany
Hamburger Rheuma Forschungszentrum II
🇩🇪Hamburg, Germany
Rheumazentrum Ruhrgebiet
🇩🇪Herne, Germany
Rheumazentrum Ratingen
🇩🇪Ratingen, Germany
Prince Of Wales Hospital
🇭🇰Hong Kong, Hong Kong
Betegapolo Irgalmas Rend Budai Irgalmasrendi Korhaz
🇭🇺Budapest, Hungary
Obudai Egeszsegugyi Centrum Kft
🇭🇺Budapest, Hungary
Qualiclinic Kft
🇭🇺Budapest, Hungary
Health Clinic Limited Liability Company
🇺🇦Vinnytsia, Ukraine
Medical Center LLC 'Modern Clinic'
🇺🇦Zaporizhzhya, Ukraine
Royal Free London NHS Foundation Trust
🇬🇧Barnet, United Kingdom
St. Lukes Hospital
🇬🇧Bradford, United Kingdom
University Hospital Coventry & Warwickshire NHS Trust
🇬🇧Coventry, United Kingdom
City Clinical Hospital No. 2
🇺🇦Kryvyi Rih, Ukraine
Medical Center of 'Institute of Rheumatology', LLC
🇺🇦Kyiv, Ukraine
Kyiv Railway Clinical Hospital #2 Of Branch 'Health Center' Of The Company 'Ukrainian Railway'
🇺🇦Kyiv, Ukraine
SI National Scientific Center Institute of Cardiology of M.D. Strazhesko of NAMS of Ukraine
🇺🇦Kyiv, Ukraine
Volyn Regional Clinical Hospital
🇺🇦Lutsk, Ukraine
Municipal Non-profit Enterprise 'Odesa Regional Clinical Hospital' Odesa Regional Council
🇺🇦Odessa, Ukraine
ME Poltava Regional Clinical Hospital named after M.V. Sklifosovsky of Poltava Regional Consuil
🇺🇦Poltava, Ukraine
Municipal institution of Tepnopil Regional Council 'Ternopil University Hospital'
🇺🇦Ternopil, Ukraine
Rheumatology Research Unit
🇦🇺Maroochydore, Australia
Arizona Arthritis and Rheumatology Research PLLC
🇺🇸Mesa, Arizona, United States
Arizona Arthritis & Rheumatology Research, PLLC
🇺🇸Chandler, Arizona, United States
Arizona Arthritis Research, PLC.
🇺🇸Phoenix, Arizona, United States
Arizona Arthritis and Rheumatology Associates
🇺🇸Sun City, Arizona, United States
Southern Arizona VA Healthcare System
🇺🇸Tucson, Arizona, United States
Unity Health-White County Medical Center
🇺🇸Searcy, Arkansas, United States
Kaiser Permanent Medical Center
🇺🇸Fontana, California, United States
Newport Huntington Medical Group
🇺🇸Huntington Beach, California, United States
University Of California San Diego
🇺🇸La Jolla, California, United States
Rheumatology Center of San Diego
🇺🇸San Diego, California, United States
Clinical Research Center of Connecticut
🇺🇸Danbury, Connecticut, United States
Bay Pines VA Healthcare System
🇺🇸Bay Pines, Florida, United States
Integral Rheumatology And Immunology Specialists
🇺🇸Plantation, Florida, United States
Florida Medical Clinic, P.A.
🇺🇸Zephyrhills, Florida, United States
Great Lakes Clinical Trials
🇺🇸Chicago, Illinois, United States
OrthoIllinois
🇺🇸Rockford, Illinois, United States
Willow Rheumatology and Wellness
🇺🇸Willowbrook, Illinois, United States
Johns Hopkins Bayview Medical
🇺🇸Baltimore, Maryland, United States
Klein And Associates M D P A
🇺🇸Hagerstown, Maryland, United States
Clinical Research Institute of Michigan, LLC
🇺🇸Saint Clair Shores, Michigan, United States
St. Paul Rheumatology P A
🇺🇸Eagan, Minnesota, United States
Kansas City Physician Partners
🇺🇸Kansas City, Missouri, United States
Clinvest
🇺🇸Springfield, Missouri, United States
STAT Research, Inc.
🇺🇸Vandalia, Ohio, United States
OHSU Rheumatology Clinic, Marquam Hill
🇺🇸Portland, Oregon, United States
Amarillo Center for Clinical Research
🇺🇸Amarillo, Texas, United States
Austin Regional Clinic
🇺🇸Austin, Texas, United States
Precision Comprehensive Clinical Research Solutions
🇺🇸Colleyville, Texas, United States
Adriana Pop Moody MD Clinic PA
🇺🇸Corpus Christi, Texas, United States
AARA Clinical Research Lone Star Arthritis and Rheumatology
🇺🇸Irving, Texas, United States
UT Physicians Center for Autoimmunity
🇺🇸Houston, Texas, United States
West Texas Clinical Research
🇺🇸Lubbock, Texas, United States
Southwest Rheumatology Research LLC
🇺🇸Mesquite, Texas, United States
Epic Medical Research
🇺🇸Red Oak, Texas, United States
DM Clinical Research
🇺🇸Tomball, Texas, United States
Swedish Medical Center
🇺🇸Seattle, Washington, United States
Cosultorios Reumatologógicos Pampa
🇦🇷Buenos Aires, Argentina
Hospital Italiano de Buenos Aires
🇦🇷Buenos Aires, Argentina
Centro Privado de Medicina Familiar
🇦🇷Buenos Aires, Argentina
Hospital Italiano La Plata
🇦🇷La Plata, Argentina
MR Medicina Reumatologica
🇦🇷San Fernando, Argentina
Centro Medico Privado de Reumatologia
🇦🇷San Miguel De Tucuman, Argentina
Emeritus Research
🇦🇺Camberwell, Australia
Southern Clinical Research
🇦🇺Hobart, Australia
Liverpool Hospital
🇦🇺Liverpool, Australia
Skin Care Centre
🇨🇦Vancouver, British Columbia, Canada
Eastern Regional Health Authority St Clares Mercy Hospital
🇨🇦St Johns, Newfoundland and Labrador, Canada
Toronto Western Hospital
🇨🇦Toronto, Ontario, Canada
Ilocos Training and Regional Medical Center
🇵🇭San Fernando, Philippines
ClinicMed Daniluk Nowak Spolka Komandytowa
🇵🇱Bialystok, Poland
Szpital Uniwersytecki nr 2 im dr Jana Biziela
🇵🇱Bydgoszcz, Poland
Nzoz Bif Med
🇵🇱Bytom, Poland
Ambulatorium sp. z o.o.
🇵🇱Elblag, Poland
Centrum Kliniczno Badawcze
🇵🇱Elblag, Poland
Malopolskie Badania Kliniczne Sp z o o
🇵🇱Krakow, Poland
Centrum Medyczne Promed
🇵🇱Krakow, Poland
Dermed Centrum Medyczne Sp z o o
🇵🇱Lodz, Poland
Centrum Terapii Wspolczesnej J M Jasnorzewska Spolka Komandytowo Akcyjna
🇵🇱Lodz, Poland
Centrum Medyczne AMED oddzial w Lodzi
🇵🇱Lodz, Poland
Velocity Lublin
🇵🇱Lublin, Poland
Reumed Zespol Poradni Specjalistycznych Filia nr 1
🇵🇱Lublin, Poland
Pro Life Medica Sp. z o.o.
🇵🇱Lublin, Poland
GBUZ of Samara Region 'Tolyatti City Clinical Hospital 5'
🇷🇺Tolyatti, Russian Federation
Republican Clinical Hospital - G.G. Kuvatov
🇷🇺Ufa, Russian Federation
Clinical Hospital #3
🇷🇺Yaroslavl, Russian Federation
Karolinska Universitetssjukhuset
🇸🇪Solna, Sweden
Akademiska Sjukhuset
🇸🇪Uppsala, Sweden
National Taiwan University Hospital
🇨🇳Hsin Chu, Taiwan
National Cheng Kung University Hospital
🇨🇳Tainan, Taiwan
Linkou Chang Gung Memorial Hospital
🇨🇳Taoyuan, Taiwan
Phramongkutklao Hospital and Medical College
🇹🇭Bangkok, Thailand
Ramathibodi Hospital Mahidol University
🇹🇭Bangkok, Thailand
Chiang Mai University
🇹🇭Chiangmai, Thailand
Adana City Hospital
🇹🇷Adana, Turkey
Gulhane Training and Research Hospital
🇹🇷Ankara, Turkey
Ankara Bilkent City Hospital
🇹🇷Ankara, Turkey
Hacettepe University Medical Faculty
🇹🇷Ankara, Turkey
Akdeniz University Medical Faculty
🇹🇷Antalya, Turkey
Uludag University Medical Faculty
🇹🇷Bursa, Turkey
Istanbul University Cerrahpasa Medical Faculty
🇹🇷Istanbul, Turkey
Marmara University Medical Faculty
🇹🇷Istanbul, Turkey
Necmettin Erbakan University Meram Medical Faculty
🇹🇷Konya, Turkey
Communal Noncommercial Enterprise Cherkasy Regional Hospital of Cherkasy Regional Council
🇺🇦Cherkasy, Ukraine
Municipal non-commercial enterprise of Kharkiv Regional Council Regional Clinical Hospital
🇺🇦Kharkiv, Ukraine
Khmelnitckiy regional hospital
🇺🇦Khmelnytsky, Ukraine
Chapel Allerton Hospital
🇬🇧Leeds, United Kingdom
Central Manchester University Hospitals NHS Foundation Trust
🇬🇧Manchester, United Kingdom
North Tyneside General Hospital
🇬🇧Newcastle, United Kingdom
Haywood Hospital
🇬🇧Stoke on Trent, United Kingdom