Guselkumab in Active Psoriatic Arthritis Participants With Inadequate Response/Intolerance to One Prior Anti-TNF Alpha Agent
- Conditions
- Arthritis, Psoriatic
- Interventions
- Drug: Placebo
- Registration Number
- NCT04936308
- 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) and inadequate response (IR) and/or intolerance to a prior anti-tumor necrosis factor (TNF) by assessing the reduction in signs and symptoms of PsA.
- Detailed Description
PsA is a chronic, immune-mediated inflammatory disease characterized by peripheral joint inflammation, enthesitis, dactylitis, axial disease, and the skin lesions associated with psoriasis. Guselkumab is a fully human monoclonal antibody (mAb) that binds to p19 protein subunit of interleukin (IL)-23 and blocks the binding of extracellular IL-23 to the cell surface IL-23 receptor, inhibiting IL-23 specific intracellular signaling, subsequent activation, and cytokine production. The primary hypothesis of this study is that guselkumab is superior to placebo as assessed by the proportion of participants who had an inadequate response (IR) and/or intolerance to one prior anti-tumor necrosis factor (anti-TNF) achieving an American College of Rheumatology 20 (ACR 20) response at Week 24. This study will consist of a screening phase (up to 6 weeks), blinded treatment phase (approximately up to 2 years), which includes a placebo-controlled period from Week 0 to Week 24, and an active-controlled treatment phase from Week 24 to Week 100, and safety follow-up phase (Week 112). Safety assessments will include physical examinations, vital signs, height, weight, electrocardiograms, and clinical safety laboratory assessments. The total duration of the study will be up to 118 weeks.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 453
- Have a diagnosis of active psoriatic arthritis (PsA) for at least 6 months before the first administration of study agent and meet Classification criteria for Psoriatic Arthritis (CASPAR) at screening
- Have active PsA as defined by: at least 3 swollen joints and at least 3 tender joints at screening and at baseline; and C-reactive protein (CRP) greater than or equal to (>=) 0.3 milligrams per deciliter (mg/dL) at screening from the central laboratory
- Have at least one of the following PsA subsets: distal interphalangeal joint involvement, polyarticular arthritis with absence of rheumatoid nodules, asymmetric peripheral arthritis, or spondylitis with peripheral arthritis
- Have active plaque psoriasis, with at least one psoriatic plaque of >= 2 centimeters (cm) diameter and/or nail changes consistent with psoriasis, or documented history of plaque psoriasis
- Have an inadequate response and/or intolerance to anti-tumor necrosis factor alpha (TNF alpha) therapy, defined as presence of active PsA despite previous treatment with one prior anti-TNF alpha agent
- Has other inflammatory diseases that might confound the evaluations of benefit of guselkumab therapy in the treatment of PsA, including but not limited to rheumatoid arthritis, ankylosing spondylitis/nonradiographic axial spondyloarthritis, systemic lupus erythematosus, or Lyme disease
- Has received more than 1 prior anti-tumor necrosis factor (TNF) alpha agent (or biosimilars)
- Has ever received 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
- Has known allergies, hypersensitivity, or intolerance to guselkumab or its excipients
- Has a history of chronic or recurrent infectious disease, including but not limited to chronic renal infection, chronic chest infection (example, bronchiectasis), recurrent urinary tract infection (example, recurrent pyelonephritis or chronic non-remitting cystitis), fungal infection (example, mucocutaneous candidiasis), or open, draining, or infected skin wounds or ulcers
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group 1: Guselkumab and Placebo Placebo Participants will receive guselkumab and placebo subcutaneously (SC) to maintain the blind. Group 2: Guselkumab Guselkumab Participants will receive guselkumab SC. Group 3: Placebo Followed by Guselkumab Placebo Participants will receive placebo SC and will cross over to receive guselkumab SC. Group 1: Guselkumab and Placebo Guselkumab Participants will receive guselkumab and placebo subcutaneously (SC) to maintain the blind. Group 3: Placebo Followed by Guselkumab Guselkumab Participants will receive placebo SC and will cross over to receive guselkumab SC.
- Primary Outcome Measures
Name Time Method Percentage of Participants Who Achieve an American College of Rheumatology (ACR) 20 Response at Week 24 Week 24 The ACR 20 Response is defined as greater than or equal to (\>=) 20 percent (%) improvement from baseline in both swollen joint count (66 joints) and tender joint count (68 joints) and \>=20 percent (%) improvement from baseline in 3 of following 5 assessments: participant's assessment of pain using Visual Analog Scale (VAS; 0-100 millimeter \[mm\], 0 mm=no pain and 100 mm=worst possible pain), participant's global assessment of disease activity by using VAS (scale ranges from 0 mm to 100 mm, \[0 mm= very well to 100 mm= very poor\]), physician's global assessment of disease activity using VAS (scale ranges from 0 to 100), \[0 = no arthritis to 100 = extremely active arthritis\], participant's assessment of physical function measured by Health Assessment Questionnaire-disability Index (HAQ-DI, defined as a 20-question instrument assessing 8 functional areas. The derived HAQ-DI ranges from 0, indicating no difficulty, to 3, indicating inability to perform a task in that area) and CRP.
- Secondary Outcome Measures
Name Time Method Percentage of Participants With Anti-guselkumab Antibodies Up to 112 weeks Percentage of participants with anti-guselkumab antibodies to guselkumab will be reported.
Percentage of Participants who Achieve a Psoriasis Response of IGA Psoriasis Score of 0 or 1 and >=2 Grade Reduction From Baseline at Week 24 Among Participants With >=3% Body Surface Area (BSA) Psoriatic Involvement and IGA Score of >=2 at Baseline Week 24 Psoriasis response is defined as an Investigator's Global Assessment (IGA) psoriasis score of 0 (cleared) or 1 (minimal) and \>=2- grade reduction from baseline. The IGA documents the investigator's assessment of the participants psoriasis and lesions are graded for induration, erythema and scaling, each using a 5-point scale: 0 (no evidence), 1 (minimal), 2 (mild), 3 (moderate), and 4 (severe). 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 Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F) Score at Week 24 Baseline and Week 24 The FACIT-F is a questionnaire that assesses self-reported tiredness, weakness, and difficulty conducting usual activities due to fatigue. The subscale consists 13-item instrument to measure fatigue. Each of the 13 items has a set of five response categories: Not at all (=0), A little bit (=1), Somewhat (=2), Quite a bit (=3) and Very much (=4). A total FACIT-Fatigue subscale score is calculated as the sum of the 13 item scores (reserved scores \[4 - score\]) and ranges from 0 to 52, with a higher score indicating less fatigue. Positive changes from baseline indicate improvement of fatigue. Items are reverse scored when appropriate to provide a scale in which higher scores represent better functioning or less fatigue.
Change From Baseline in 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 are 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 ACR 70 Response at Week 24 Week 24 ACR 70 response is defined as \>= 70% improvement from baseline in both swollen joint count (66 joints) and tender joint count (68 joints), and \>=70% improvement from baseline in 3 of 5 assessments: patient's assessment of pain using visual analog scale (VAS; 0-100 mm, 0=no pain and 100=worst possible pain), patient's global assessment of disease activity (arthritis, VAS; 0-100 mm, 0=excellent and 100= poor), physician's global assessment of disease activity (VAS; 0-100 mm, 0=no arthritis activity and 100=extremely active arthritis), patient's assessment of physical function measured by Disability Index of the Health Assessment Questionnaire (HAQ-DI; a 20-question instrument assessing 8 functional areas; range: 0-3, 0=no difficulty, 3=inability to perform a task in that area), and CRP.
Percentage of Participants who Achieve ACR 20 Response at Week 16 Week 16 ACR 20 response: \>=20% improvement from baseline in both swollen joint count (66 joints) and tender joint count (68 joints), and \>=20% improvement from baseline in 3 of 5 assessments: patient's assessment of pain using visual analog scale (VAS; 0-100 mm, 0=no pain and 100=worst possible pain), patient's global assessment of disease activity (arthritis, VAS; 0-100 mm, 0=excellent and 100= poor), physician's global assessment of disease activity (VAS; 0-100 mm, 0=no arthritis activity and 100=extremely active arthritis), patient's assessment of physical function measured by Disability Index of Health Assessment Questionnaire (HAQ-DI; 20-question instrument assessing 8 functional areas; range: 0-3, 0=indicating no difficulty, 3=indicating inability to perform task in that area), and CRP.
Percentage of Participants With Infections Up to 112 weeks Percentage of participants with infections will be reported.
Percentage of Participants With Injection-site Reactions Up to 100 weeks Percentage of participants with injection-site reactions will be reported. An injection-site reaction is any adverse reaction at a subcutaneous (SC) study intervention injection-site.
Percentage of participants With Laboratory Abnormalities With Maximum Toxicity Grades as per Common Terminology Criteria for Adverse Events (CTCAE) Toxicity Up to 112 weeks Percentage of participants with laboratory abnormalities (hematology, chemistry) with maximum toxicity grades as per CTCAE 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.
Percentage of Participants who Achieve ACR 50 Response at Week 16 Week 16 ACR 50 response is defined as \>=50% improvement from baseline in both swollen joint count (66 joints) and tender joint count (68 joints), and \>=50% improvement from baseline in 3 of 5 assessments: patient's assessment of pain using visual analog scale (VAS; 0-100 mm, 0=no pain and 100=worst possible pain), patient's global assessment of disease activity (arthritis, VAS; 0-100 mm, 0=excellent and 100= poor), physician's global assessment of disease activity (VAS; 0-100 mm, 0=no arthritis activity and 100=extremely active arthritis), patient's assessment of physical function measured by Disability Index of the Health Assessment Questionnaire (HAQ-DI; a 20-question instrument assessing 8 functional areas; range: 0-3, 0=no difficulty, 3=inability to perform a task in that area), and CRP.
Percentage of Participants With Change from Baseline in Clinical Laboratory Abnormalities Up to 112 weeks Percentage of participants with change from baseline in clinical laboratory abnormalities including chemistry and hematology will be reported.
Percentage of Participants who Achieve PASI 90 Response at Week 24 Among the Participants With >=3% BSA Psoriatic Involvement and an IGA Score of >=2 (Mild) at Baseline Week 24 Psoriasis Area and Severity Index (PASI) is a tool to assess and grade severity of psoriasis and response to therapy. In PASI, body is divided into 4 areas: head, trunk, upper extremities, lower extremities. Each area is assessed separately for percentage of area involved and translated to numeric score ranging from 0 (no involvement) to 6 (90 to 100% involvement), and for erythema, induration, and scaling, each rated on scale of 0 to 4 that is none to maximum severity. PASI numeric score range from 0 (no psoriasis) to 72. Higher scores indicate more severe disease. A PASI 90 response: \>=90% improvement in PASI score from baseline.
Change From Baseline in 36-item Short Form Health Survey (SF-36) Physical Component Summary (PCS) Score at Week 24 Baseline and Week 24 SF-36 is a multi-domain instrument with 36 items to evaluate the health status and quality of life. It included 8 subscales (physical functioning, physical role functioning, bodily pain, general health perception, vitality, social functioning, emotional role functioning, and mental health), which yielded a PCS with score range 0-100 (higher score-better quality of life) and a Mental Component Summary (MCS) with score range 0-100 (higher score-better quality of life) in addition to subscale scores. The PCS scores are normalized to a mean of 50 and standard deviations of 10, based upon general US population norms. A positive change indicates improvement while a negative change indicates worsening of health status and quality of life.
Percentage of Participants Achieving Minimal Disease Activity (MDA) at Week 24 Week 24 MDA is considered achieved if at least 5 of the following 7 criteria were met at the analysis visit: tender joint count \<=1; swollen joint count \<=1; psoriasis activity and severity index \<=1; patient's pain VAS score of \<=15; patient's global disease activity VAS (arthritis and psoriasis) score of \<=20; HAQ-DI \<=0.5; and tender entheseal points \<=1.
Serum Guselkumab Concentration Up to 112 weeks Serum guselkumab concentration will be measured.
Percentage of Participants who Achieve ACR 50 Response at Week 24 Week 24 ACR 50 response is defined as \>=50 percent (%) improvement from baseline in both swollen joint count (66 joints) and tender joint count (68 joints), and \>=50% improvement from baseline in 3 of 5 assessments: patient's assessment of pain using visual analog scale (VAS; 0-100 mm, 0=no pain and 100=worst possible pain), patient's global assessment of disease activity (arthritis, VAS; 0-100 mm, 0=excellent and 100= poor), physician's global assessment of disease activity (VAS; 0-100 mm, 0=no arthritis activity and 100=extremely active arthritis), patient's assessment of physical function measured by Disability Index of the Health Assessment Questionnaire (HAQ-DI; a 20-question instrument assessing 8 functional areas; range: 0-3, 0=no difficulty, 3=inability to perform a task in that area), and CRP.
Percentage of Participants With Adverse Events (AEs), Serious Adverse Events (SAEs), Reasonably Related AEs, as a Measure of Safety and Tolerability Up to 112 weeks Percentage of participants with AEs, SAEs reasonably related AEs will be assessed. 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. SAE is any AE that results in: death, persistent or significant disability/incapacity, requires inpatient hospitalization or prolongation of existing hospitalization, is life-threatening experience, is a congenital anomaly/birth defect, and suspects transmission of any infectious agent via a medicinal product. Reasonably related AEs are those AEs which are judged related to study treatment by the investigator.
Percentage of Participants With AEs leading to Discontinuation of Study Intervention Up to 112 weeks Percentage of participants with AEs leading to discontinuation of study intervention will be reported.
Trial Locations
- Locations (163)
DJL Clinical Research, PLLC
🇺🇸Charlotte, North Carolina, United States
Arthritis and Rheumatology Center of MI
🇺🇸Okemos, Michigan, United States
Clinical Research Institute of Michigan, LLC
🇺🇸Saint Clair Shores, Michigan, United States
St. Paul Rheumatology P A
🇺🇸Eagan, Minnesota, United States
Arthritis Consultants
🇺🇸Saint Louis, Missouri, United States
Arthritis Rheumatic And Back Disease Associates
🇺🇸Voorhees, New Jersey, United States
Albuquerque Center for Rheumatology
🇺🇸Albuquerque, New Mexico, United States
Arthritis and Osteoperosis Associates of New Mexico
🇺🇸Las Cruces, New Mexico, United States
Buffalo Rheumatology and Medicine PLLC
🇺🇸Orchard Park, New York, United States
STAT Research, Inc.
🇺🇸Vandalia, Ohio, United States
Military Medical Academy
🇧🇬Sofia, Bulgaria
UMHAT St. Ivan Rilski
🇧🇬Sofia, Bulgaria
ASIMP Rheumatology Centre St Irina EOOD
🇧🇬Sofia, Bulgaria
University Multiprofile Hospital Sofiamed Sofia
🇧🇬Sofia, Bulgaria
Medical Centre Synexus
🇧🇬Sofia, Bulgaria
RHEUMA s r o
🇨🇿Breclav, Czechia
L K N Arthrocentrum
🇨🇿Hlucin, Czechia
MUDr Rosypalova s r o
🇨🇿Ostrava, Czechia
Arthrohelp S.R.O.
🇨🇿Pardubice, Czechia
Revmatologicky ustav
🇨🇿Praha 2, Czechia
Medical Plus S R O
🇨🇿Uherske Hradiste, Czechia
PV Medical S R O
🇨🇿Zlin, Czechia
Betegapolo Irgalmas Rend Budai Irgalmasrendi Korhaz
🇭🇺Budapest, Hungary
Uno Medical Trials Ltd.
🇭🇺Budapest, Hungary
Debreceni Egyetem, Kenézy Gyula Egyetemi Oktatókórház
🇭🇺Debrecen, Hungary
Bekes Megyei Kozponti Korhaz Pandy Kalman Tagkorhaz
🇭🇺Gyula, Hungary
Pest Megyei Flor Ferenc Korhaz
🇭🇺Kistarcsa, Hungary
Szegedi Tudományegyetem, ÁOK, Szent-Györgyi Albert Klinikai Központ
🇭🇺Szeged, Hungary
Fejer Varmegyei Szent Gyorgy Egyetemi Oktatokorhaz
🇭🇺Szekesfehervar, Hungary
Vital Medical Center Orvosi es Fogaszati Kozpont
🇭🇺Veszprem, Hungary
Bnai Zion Medical Center
🇮🇱Haifa, Israel
Rambam Health Care Campus
🇮🇱Haifa, Israel
Carmel Medical Center
🇮🇱Hifa, Israel
Meir Medical Center
🇮🇱Kfar-Sava, Israel
Sheba Medical Center
🇮🇱Ramat Gan, Israel
Hospital Selayang
🇲🇾Batu Caves, Malaysia
Hospital Pulau Pinang
🇲🇾George Town, Malaysia
Hospital Raja Permaisuri Bainun
🇲🇾Ipoh, Malaysia
Hospital Tuanku Jaafar
🇲🇾Seremban, Malaysia
Nzoz Bif Med
🇵🇱Bytom, Poland
Centrum Kliniczno Badawcze
🇵🇱Elblag, Poland
Malopolskie Badania Kliniczne Sp z o o
🇵🇱Krakow, Poland
Malopolskie Centrum Kliniczne
🇵🇱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
NZOZ Lecznica MAK MED S C
🇵🇱Nadarzyn, Poland
Twoja Przychodnia - Centrum Medyczne Nowa Sol
🇵🇱Nowa Sol, Poland
Twoja Przychodnia PCM
🇵🇱Poznan, Poland
Centrum Medyczne
🇵🇱Poznan, Poland
Lubelskie Centrum Diagnostyczne
🇵🇱Swidnik, Poland
MICS Centrum Medyczne Warszawa
🇵🇱Warsaw, Poland
Rheuma Medicus Sp z o o
🇵🇱Warszawa, Poland
Centrum Medyczne Reuma Park
🇵🇱Warszawa, Poland
WroMedica I Bielicka A Strzalkowska s c
🇵🇱Wroclaw, Poland
GCM Medical Group
🇵🇷San Juan, Puerto Rico
Mindful Medical Research
🇵🇷San Juan, Puerto Rico
FDI Clinical Research
🇵🇷San Juan, Puerto Rico
Altay Medical State University
🇷🇺Barnaul, Russian Federation
Chelyabinck Regional Clinical Hospital
🇷🇺Chelyabinsk, Russian Federation
Akdeniz University Medical Faculty
🇹🇷Antalya, Turkey
Uludag University Medical Faculty
🇹🇷Bursa, Turkey
Pamukkale University Medical Faculty
🇹🇷Denizli, Turkey
Osmangazi University Medical Faculty
🇹🇷Eskisehir, Turkey
Istanbul University Istanbul Medical Faculty
🇹🇷Istanbul, Turkey
Medical Center of 'Institute of Rheumatology', LLC
🇺🇦Kyiv, Ukraine
Kyiv City Clinical Hospital #3
🇺🇦Kyiv, Ukraine
Istanbul University Cerrahpasa Medical Faculty
🇹🇷Istanbul, Turkey
Kartal Dr Lutfi Kirdar sehir Hastanesi
🇹🇷Istanbul, Turkey
Marmara University Medical Faculty
🇹🇷Istanbul, Turkey
Kocaeli University Medical Faculty
🇹🇷Kocaeli, 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
City Clinical Hospital No. 2
🇺🇦Kryvyi Rih, Ukraine
Medical Center LLC 'Harmony of Beauty'
🇺🇦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
Medical Center 'Consylium Medical'
🇺🇦Kyiv, Ukraine
Volyn Regional Clinical Hospital
🇺🇦Lutsk, Ukraine
LLC Medical House
🇺🇦Odessa, Ukraine
ME Poltava Regional Clinical Hospital named after M.V. Sklifosovsky of Poltava Regional Consuil
🇺🇦Poltava, Ukraine
Vinnitsia Regional Clinical Hospital n.a. M. I. Pyrogov
🇺🇦Vinnytsya, Ukraine
Medical Center LLC 'Modern Clinic'
🇺🇦Zaporizhzhya, Ukraine
Great Lakes Center of Rheumatology
🇺🇸Lansing, Michigan, United States
Arthritis Associates
🇺🇸Mountain Brook, Alabama, United States
Arizona Arthritis and Rheumatology Research PLLC
🇺🇸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
Newport Huntington Medical Group
🇺🇸Huntington Beach, California, United States
Medvin Clinical Research
🇺🇸Tujunga, California, United States
Clinical Research Center of Connecticut
🇺🇸Danbury, Connecticut, United States
Bay Pines VA Healthcare System
🇺🇸Bay Pines, Florida, United States
Clinical Research of West Florida
🇺🇸Tampa, Florida, United States
Omega Research Consultants
🇺🇸DeBary, Florida, United States
Advanced Clinical Research of Orlando
🇺🇸Ocoee, 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
Clinic of Robert Hozman
🇺🇸Skokie, Illinois, United States
The Arthritis and Diabetes Clinic
🇺🇸Monroe, Louisiana, United States
Johns Hopkins University
🇺🇸Baltimore, Maryland, United States
Klein And Associates M D P A
🇺🇸Hagerstown, Maryland, United States
Health Research of Oklahoma
🇺🇸Oklahoma City, Oklahoma, United States
Rheumatology Associates of Oklahoma
🇺🇸Oklahoma City, Oklahoma, United States
Dr. Ramesh Gupta
🇺🇸Memphis, Tennessee, United States
Precision Comprehensive Clinical Research Solutions
🇺🇸Fort Worth, Texas, United States
Adriana Pop Moody MD Clinic PA
🇺🇸Corpus Christi, Texas, United States
Metroplex Clinical Research Center
🇺🇸Dallas, Texas, United States
West Texas Clinical Research
🇺🇸Lubbock, Texas, United States
Southwest Rheumatology Research LLC
🇺🇸Mesquite, Texas, United States
Texas Rheumatology Care
🇺🇸Plano, Texas, United States
Advanced Rheumatology of Houston
🇺🇸The Woodlands, Texas, United States
DM Clinical Research
🇺🇸Tomball, Texas, United States
Arthritis And Osteoporosis Clinic
🇺🇸Waco, Texas, United States
Arthritis Northwest PLLC
🇺🇸Spokane, Washington, United States
Rheumatology and Pulmonary Clinic
🇺🇸Beckley, West Virginia, United States
Cosultorios Reumatologógicos Pampa
🇦🇷Buenos Aires, Argentina
Centro Privado de Medicina Familiar
🇦🇷Buenos Aires, Argentina
Hospital Central Militar Cirujano Mayor Dr Cosme Argerich
🇦🇷Buenos Aires, Argentina
CIPREC
🇦🇷Ciudad Autonoma de Buenos Aires, Argentina
OMI
🇦🇷Ciudad Autónoma de Buenos Aires, Argentina
Instituto de Reumatología Mendoza
🇦🇷Ciudad de Mendoza, Argentina
Centro de Investigaciones Medicas Tucuman
🇦🇷San Miguel De Tucuman, Argentina
Southern Clinical Research
🇦🇺Hobart, Australia
Liverpool Hospital
🇦🇺Liverpool, Australia
Skin Health Institute Inc.
🇦🇺Melbourne, Australia
Eastern Health - Box Hill Hospital
🇦🇺Melbourne, Australia
UMHAT 'Dr. Georgi Stranski', EAD
🇧🇬Pleven, Bulgaria
Medical Center Unimed Plovdiv
🇧🇬Plovdiv, Bulgaria
UMHAT Kaspela
🇧🇬Plovdiv, Bulgaria
Diagnosis-consulting centre-1
🇧🇬Ruse, Bulgaria
Chelyabinsk Regional Clinical Dermatovenerological Dispensary
🇷🇺Chelyabinsk, Russian Federation
Kemerovo State Medical University
🇷🇺Kemerovo, Russian Federation
LLL Medical Center Revma-Med
🇷🇺Kemerovo, Russian Federation
LLC Family Outpatient Clinic # 4
🇷🇺Korolev, Russian Federation
Krasnodar Clinical Dermatovenerologic Dispensary
🇷🇺Krasnodar, 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
GBOU VPO Orenburg State Medical University
🇷🇺Orenburg, Russian Federation
Rostov Regional Clinical Dermatovenerological Dispensary
🇷🇺Rostov, Russian Federation
Saratov Regional Clinical Hospital
🇷🇺Saratov, Russian Federation
Smolensk regional hospital on Smolensk railway station
🇷🇺Smolensk, Russian Federation
St. Petersburg GBUZ Clinical Reumatological Hospital 25
🇷🇺St. Petersburg, Russian Federation
X7 Clinical Research Company Limited
🇷🇺St. Petersburg, Russian Federation
GBUZ of Samara Region 'Tolyatti City Clinical Hospital 5'
🇷🇺Tolyatti, Russian Federation
Tula Regional Clinical Dermatovenerological Dispensary
🇷🇺Tula, Russian Federation
Republican Clinical Hospital - G.G. Kuvatov
🇷🇺Ufa, Russian Federation
Hosp. Univ. de Cruces
🇪🇸Barakaldo, Spain
Hosp. Univ. de La Princesa
🇪🇸Madrid, Spain
Hosp. Quiron Madrid Pozuelo
🇪🇸Madrid, Spain
Hosp Regional Univ de Malaga
🇪🇸Malaga, Spain
Clinica Gaias
🇪🇸Santiago de Compostela, Spain
Hosp. Quiron Sagrado Corazon
🇪🇸Sevilla, Spain
Hosp. Clinico Univ. de Valencia
🇪🇸Valencia, Spain
Adana City Hospital
🇹🇷Adana, Turkey
Gulhane Training and Research Hospital
🇹🇷Ankara, Turkey
Ankara Bilkent City Hospital
🇹🇷Ankara, Turkey
Hacettepe University Medical Faculty
🇹🇷Ankara, Turkey