Study to Evaluate Efficacy and Safety of Two Drug Regimens in Subjects With Moderate to Severe Crohn's Disease
- Registration Number
- NCT02065570
- Lead Sponsor
- AbbVie
- Brief Summary
This study will evaluate higher versus standard adalimumab dosing regimens for induction and maintenance therapy in subjects with moderately to severely active Crohn's Disease and evidence of mucosal ulceration.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 514
- Diagnosis of Crohn's disease (CD) for at least 90 days, confirmed by endoscopy during the Screening Period.
- Active CD with a Crohn's Disease Activity Index (CDAI) despite treatment with oral corticosteroids and/or immunosuppressants.
- Mucosal ulceration on endoscopy.
- Subject with ulcerative colitis or indeterminate colitis.
- Subject who has had surgical bowel resections in the past 6 months or is planning resection.
- Subjects with an ostomy or ileoanal pouch.
- Subject with symptomatic bowel stricture or abdominal or peri-anal abcess.
- Subject who has short bowel syndrome.
- Chronic recurring infections or active Tuberculosis (TB).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Induction: Standard Induction Dose Placebo Participants randomized to receive received blinded adalimumab 160 mg at Baseline and matching placebo at Week 1, adalimumab 80 mg and matching placebo at Week 2, matching placebo at Week 3, and then adalimumab 40 mg every other week (eow) starting at Week 4 through Week 12. Induction: Standard Induction Dose Adalimumab Participants randomized to receive received blinded adalimumab 160 mg at Baseline and matching placebo at Week 1, adalimumab 80 mg and matching placebo at Week 2, matching placebo at Week 3, and then adalimumab 40 mg every other week (eow) starting at Week 4 through Week 12. Induction: Higher Induction Dose Adalimumab Participants randomized to receive blinded adalimumab 160 mg at Baseline, Week 1, Week 2, and Week 3. At Week 4, participants receive adalimumab 40 mg eow through Week 12. Maintenance: Clinically Adjusted (CA) Regimen Adalimumab Participants randomized to the CA regimen receive adalimumab 40 mg eow beginning at Week 12. The adalimumab dose will be escalated to every week (ew) starting as early as Week 14 and up to Week 54 based on Crohn's Disease Activity Index (CDAI) or high-sensitivity C-reactive protein (hs-CRP) values, using results from the prior or current study visit. Once participants in the CA regimen are escalated, they remain on adalimumab 40 mg ew dosing. Maintenance: Therapeutic Drug Monitoring (TDM) Regimen Adalimumab At Weeks 14, 28 and 42, the adalimumab dose for participants randomized to the TDM will be determined by protocol-established dose adjustment criteria. Doses will be determined using blinded serum concentrations at the prior visit (Weeks 12, 26 and 40, respectively) as well as the CDAI or hs-CRP values from the current or prior study visit. Participants who meet criteria for dose escalation at Weeks 14, 28 or 42 will receive 40 mg ew.
- Primary Outcome Measures
Name Time Method Percentage of Participants Who Achieved Clinical Remission at Week 4 Week 4 Crohn's Disease Activity Index (CDAI) is used to assess the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450.
Percentage of Participants With Endoscopic Response at Week 12 Week 12 Endoscopic response was scored using the Simplified Endoscopic Score for Crohn's Disease (SES-CD). The SES-CD evaluates 4 endoscopic variables (ulcer size ranging from 0 \[none\] to 3 \[very large\]; ulcerated surface ranging from 0 \[none\] to 3 \[\>30%\]; affected surface ranging from 0 \[none\] to 3 \[\>75%\], and narrowing ranging from 0 \[none\] to 3 \[cannot be passed\]) in 5 segments assessed during ileocolonoscopy (ileum, right colon, transverse colon, sigmoid and left colon, and rectum). The total score is the sum of the 4 endoscopic variable scores and range from 0 to 56, where higher scores indicate more severe disease. Endoscopic response was defined as SES-CD total score \> 50% from Baseline (or for a Baseline SES-CD of 4, at least a 2 point reduction from Baseline) at Week 12.
Number of Participants With Treatment-Emergent Adverse Events (TEAEs) From first dose of study drug until 70 days following last dose of study drug in the induction study (up to 12 weeks) or maintenance study (up to 56 weeks). Adverse event (AE): any untoward medical occurrence that does not necessarily have a causal relationship with this treatment. The investigator assessed the relationship of each event to the use of study drug as either probably related, possibly related, probably not related or not related. Serious AE (SAE) is an event that results in death, is life-threatening, requires or prolongs hospitalization, results in a congenital anomaly, persistent or significant disability/incapacity or is an important medical event that, based on medical judgment, may jeopardize the subject and may require medical or surgical intervention to prevent any of the outcomes listed above. TEAEs: any event that began or worsened in severity after the first dose of study drug in the induction or maintenance study. Events with unknown severity were counted as severe. Events with unknown relationship to study drug were counted as drug-related.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Achieving Response in IBDQ Bowel Symptom Domain at Week 12 Week 12 The IBDQ is a self-administered 32-item questionnaire to evaluate quality of life across 4 dimensional scores: bowel, systemic, social and emotional. Responses to each question range from 1 (severe problem) to 7 (normal health). The range for Bowel Symptom domain score is 10 (severe problem) to 70 (normal health). Response in IBDQ Bowel Symptom domain is defined as an increase of IBDQ Bowel Symptom domain score ≥ 8.
Percentage of Participants With Sustained Clinical Remission (Per CDAI) at Both Weeks 4 and 12 Week 4 and Week 12 CDAI is used to assess the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450.
Percentage of Participants Who Achieve Clinical Response at Week 4 and Endoscopic Response at Week 12 Week 12 Clinical response was scored using CDAI, which assesses the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450. Clinical response was defined as a decrease in CDAI ≥ 70 points from Baseline.
Endoscopic response was scored using the SES-CD, which evaluates 4 endoscopic variables (ulcer size ranging from 0 \[none\] to 3 \[very large\]; ulcerated surface ranging from 0 \[none\] to 3 \[\>30%\]; affected surface ranging from 0 \[none\] to 3 \[\>75%\], and narrowing ranging from 0 \[none\] to 3 \[cannot be passed\]) in 5 segments assessed during ileocolonoscopy. The total score is the sum of the 4 endoscopic variable scores and range from 0 to 56, where higher scores indicate more severe disease. Endoscopic response was defined as SES-CD total score \>50% from Baseline (or for Baseline SES-CD of 4, at least a 2-point reduction from Baseline) at Week 12.Percentage of Participants With Clinical Remission at Week 12 Week 12 Clinical remission was scored using the CDAI. CDAI assesses the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450.
Percentage of Participants Who Discontinued Corticosteroid Use and Achieved Clinical Remission at Week 12 Among Participants Taking Corticosteroids at Baseline Week 12 Clinical remission was scored using the CDAI. CDAI assesses the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450.
Percentage of Participants With Endoscopic Remission at Week 12 Week 12 Endoscopic remission was scored using the SES-CD.The SES-CD evaluates 4 endoscopic variables (ulcer size ranging from 0 \[none\] to 3 \[very large\]; ulcerated surface ranging from 0 \[none\] to 3 \[\>30%\]; affected surface ranging from 0 \[none\] to 3 \[\>75%\], and narrowing ranging from 0 \[none\] to 3 \[cannot be passed\]) in 5 segments assessed during ileocolonoscopy (ileum, right colon, transverse colon, sigmoid and left colon, and rectum). The total score is the sum of the 4 endoscopic variable scores and range from 0 to 56, where higher scores indicate more severe disease. Endoscopic remission was defined as SES-CD ≤ 4 and at least a 2-point reduction versus baseline and no subscore greater than 1 in any individual variable.
Change From Baseline in Fecal Calprotectin Level at Week 4 Baseline, Week 4 Percentage of Participants With Hs-CRP < 5 mg/L and Fecal Calprotectin < 250 µg/g at Week 4 Week 4 Percentage of Participants With Clinical Remission, Hs-CRP < 5 mg/L and Fecal Calprotectin < 250 µg/g at Week 4 Week 4 Clinical remission was scored using the CDAI. CDAI assesses the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450.
Percentage of Participants With Clinical Remission, Hs-CRP < 5 mg/L and Fecal Calprotectin < 250 µg/g and Endoscopic Remission at Week 12 Week 12 Clinical remission was scored using the CDAI. CDAI assesses the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450.
Endoscopic remission was scored using the SES-CD.The SES-CD evaluates 4 endoscopic variables (ulcer size ranging from 0 \[none\] to 3 \[very large\]; ulcerated surface ranging from 0 \[none\] to 3 \[\>30%\]; affected surface ranging from 0 \[none\] to 3 \[\>75%\], and narrowing ranging from 0 \[none\] to 3 \[cannot be passed\]) in 5 segments assessed during ileocolonoscopy. The total score is the sum of the 4 endoscopic variable scores and range from 0 to 56, where higher scores indicate more severe disease. Endoscopic remission was defined as SES-CD ≤ 4 and at least a 2-point reduction versus baseline and no subscore greater than 1 in any individual variable.Percentage of Participants Who Achieved an SES-CD ≤ 2 at Week 12 Week 12 The SES-CD evaluates 4 endoscopic variables (ulcer size ranging from 0 \[none\] to 3 \[very large\]; ulcerated surface ranging from 0 \[none\] to 3 \[\>30%\]; affected surface ranging from 0 \[none\] to 3 \[\>75%\], and narrowing ranging from 0 \[none\] to 3 \[cannot be passed\]) in 5 segments assessed during ileocolonoscopy (ileum, right colon, transverse colon, sigmoid and left colon, and rectum). The total score is the sum of the 4 endoscopic variable scores and range from 0 to 56, where higher scores indicate more severe disease.
Percentage of Participants With Clinical Response at Week 4 Week 4 Clinical response was scored using CDAI is used to assess the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450. Clinical response was defined as a decrease in CDAI ≥ 70 points from baseline.
Percentage of Participants With Clinical Response at Week 12 Week 12 Clinical response was scored using CDAI. CDAI assesses the symptoms of participants with Crohn's Disease. Scores generally range from 0 to 600, where clinical remission of Crohn's disease is defined as CDAI \< 150, and very severe disease is defined as CDAI \> 450. Clinical response was defined as a decrease in CDAI ≥ 70 points from Baseline.
Percentage of Participants Achieving Response in IBDQ Fatigue Item at Week 12 Week 12 The IBDQ is a self-administered 32-item questionnaire to evaluate quality of life across 4 dimensional scores: bowel, systemic, social and emotional. Responses to each question range from 1 (severe problem) to 7 (normal health). The IBDQ Fatigue item score range is from 1 (severe problem) to 7 (normal health). Response is defined as an increase of IBDQ Fatigue item score ≥ 1.
Percentage of Participants Achieving Response in Inflammatory Bowel Disease Questionnaire (IBDQ) Bowel Symptom Domain at Week 4 Week 4 The IBDQ is a self-administered 32-item questionnaire to evaluate quality of life across 4 dimensional scores: bowel, systemic, social and emotional. Responses to each question range from 1 (severe problem) to 7 (normal health). The range for Bowel Symptom domain score is 10 (severe problem) to 70 (normal health). Response in IBDQ Bowel Symptom domain is defined as an increase of IBDQ Bowel Symptom domain score ≥ 8.
Trial Locations
- Locations (143)
Texas Digestive Disease Consultants - Dallas /ID# 138121
🇺🇸Dallas, Texas, United States
University of Chicago DCAM /ID# 119077
🇺🇸Chicago, Illinois, United States
Atlanta Gastro Assoc /ID# 119065
🇺🇸Atlanta, Georgia, United States
MGG Group Co, Inc.Chevy Chase Clinical Research /ID# 119042
🇺🇸Chevy Chase, Maryland, United States
Consultants for Clinical Res /ID# 119052
🇺🇸Cincinnati, Ohio, United States
Baylor College of Medicine /ID# 137277
🇺🇸Houston, Texas, United States
NZOZ Vivamed /ID# 126255
🇵🇱Warsaw, Poland
CHU NANCY - Hopital Brabois Adultes /ID# 127742
🇫🇷Vandoeuvre les Nancy CEDEX, Meurthe-et-Moselle, France
Universitaetsklinikum Schleswig-Holstein /ID# 126260
🇩🇪Kiel, Schleswig-Holstein, Germany
LKH Salzburg and Paracelsus /ID# 126248
🇦🇹Salzburg, Austria
Vseobecna Nemocnica s poliklinikou Lucenec n.o. /ID# 127748
🇸🇰Lucenec, Slovakia
Gastroenterologicke centrum ASSIDUO a IBD centrum /ID# 126262
🇸🇰Bratislava, Slovakia
UOSD - Azienda Ospedaliera San Camillo Forlanini /ID# 127745
🇮🇹Rome, Lazio, Italy
Medizinische Universitat Wien /ID# 126279
🇦🇹Vienna, Wien, Austria
CHRU Lille - Hopital Claude Huriez /ID# 127743
🇫🇷Lille CEDEX, Hauts-de-France, France
Centrul Medical de Diagnostic si Tratament Ambulator Neomed SRL /ID# 126277
🇷🇴Brasov, Romania
Norfolk and Norwich Univ Hosp /ID# 126197
🇬🇧Norwich, Norfolk, United Kingdom
Nashville Med Res Inst /ID# 119050
🇺🇸Nashville, Tennessee, United States
Vanderbilt Univ Med Ctr /ID# 125501
🇺🇸Nashville, Tennessee, United States
University of Utah /ID# 119062
🇺🇸Salt Lake City, Utah, United States
Louisana Research Center, LLC /ID# 136749
🇺🇸Shreveport, Louisiana, United States
Rocky Mountain Gastroenterology /ID# 119038
🇺🇸Wheat Ridge, Colorado, United States
Ctr for Digest and Liver Dis /ID# 119040
🇺🇸Mexico, Missouri, United States
Wake Research Associates, LLC /ID# 119029
🇺🇸Raleigh, North Carolina, United States
Minnesota Gastroenterology, P. A. /ID# 137280
🇺🇸Plymouth, Minnesota, United States
The Mount Sinai Hospital /ID# 127116
🇺🇸New York, New York, United States
Investigative Clinical Research /ID# 119033
🇺🇸Annapolis, Maryland, United States
Winship Cancer Institute of Emory University /ID# 136851
🇺🇸Atlanta, Georgia, United States
Northwestern University Feinberg School of Medicine /ID# 119043
🇺🇸Chicago, Illinois, United States
Albany Medical College /ID# 140200
🇺🇸Albany, New York, United States
Krankenhaus der Barmherzigen Bruder /ID# 126270
🇦🇹St Veit An Der Glan, Austria
AZ Sint-Lucas /ID# 126242
🇧🇪Ghent, Belgium
UZ Leuven /ID# 126240
🇧🇪Leuven, Belgium
KH der Elisabethinen Linz GmbH /ID# 126280
🇦🇹Linz, Oberoesterreich, Austria
ISCARE a.s. /ID# 137977
🇨🇿Praha 9, Czechia
Montreal General Hospital - McGill University Health Center /ID# 119025
🇨🇦Montreal, Quebec, Canada
Magyar Elhizastudomanyi KKft. /ID# 126276
🇭🇺Budapest, Hungary
Soroka University Medical Center /ID# 126243
🇮🇱Be'er Sheva, Israel
Institutul Clinic Fundeni /ID# 127747
🇷🇴Sector 2, Bucuresti, Romania
Salvo-san Ciobanca SRL / Medicina Interna /ID# 126224
🇷🇴Zalau, Romania
Tvm Med Serv Srl /Id# 126268
🇷🇴Cluj, Romania
Cabinet Medical Dr. Fratila SRL /ID# 126247
🇷🇴Oradea, Romania
Poliklinika Libris /ID# 126222
🇸🇰Nove Mesto Nad Vahom, Slovakia
Hospital Clinic /ID# 127749
🇪🇸Barcelona, Spain
Hospital Parc Tauli de Sabadell /ID# 138124
🇪🇸Sabadell, Barcelona, Spain
Gastroenterologicka ambulancia /ID# 137964
🇸🇰Bratislava, Slovakia
Hospital Universitario de Girona Doctor Josep Trueta /ID# 137976
🇪🇸Girona, Spain
Hospital Clinico Universitario Lozano Blesa /ID# 126252
🇪🇸Zaragoza, Spain
Kantonsspital St. Gallen /ID# 127750
🇨🇭St. Gallen, Sankt Gallen, Switzerland
Universitaetsspital Zuerich /ID# 127751
🇨🇭Zurich, Zuerich, Switzerland
Herlev Hospital /ID# 127741
🇩🇰Herlev, Hovedstaden, Denmark
Shafran Gastroenterology Ctr /ID# 119057
🇺🇸Winter Park, Florida, United States
Moore UC San Diego Cancer Center /ID# 119053
🇺🇸La Jolla, California, United States
Axis Clinical Trials /ID# 130390
🇺🇸Los Angeles, California, United States
Digestive Health Specialists of the Southeast /ID# 122483
🇺🇸Dothan, Alabama, United States
Gastroenterology Associates of Central Georgia, LLC /ID# 119056
🇺🇸Macon, Georgia, United States
Medical Research Ctr CT /ID# 119037
🇺🇸Hamden, Connecticut, United States
Gastroenterology Group Naples /ID# 122493
🇺🇸Naples, Florida, United States
Carle Foundation Hospital Digestive Health Research Center /ID# 136008
🇺🇸Urbana, Illinois, United States
Kansas City Research Institute /ID# 119034
🇺🇸Kansas City, Missouri, United States
Commonwealth Clinical Studies /ID# 136850
🇺🇸Brockton, Massachusetts, United States
NYU Langone Long Island Clinical Research Associates /ID# 119035
🇺🇸Great Neck, New York, United States
Charlotte Gastroenterology and Hepatology, PLLC /ID# 119041
🇺🇸Charlotte, North Carolina, United States
West Bay Clinical Research /ID# 138330
🇺🇸Warwick, Rhode Island, United States
Gastro United of Tulsa /ID# 122485
🇺🇸Tulsa, Oklahoma, United States
Medical University of South Carolina /ID# 138122
🇺🇸Charleston, South Carolina, United States
Gastro One /ID# 119068
🇺🇸Germantown, Tennessee, United States
Erlanger Institute for Clinical Research /ID# 129008
🇺🇸Chattanooga, Tennessee, United States
Austin Institute for Clinical Research /ID# 125500
🇺🇸Pflugerville, Texas, United States
Texas Digestive Disease Consultants - Southlake /ID# 137283
🇺🇸Southlake, Texas, United States
Gastro Assoc of Tidewater /ID# 135897
🇺🇸Chesapeake, Virginia, United States
Advanced Research Institute /ID# 119048
🇺🇸Ogden, Utah, United States
New River Valley Research Inst /ID# 127807
🇺🇸Christiansburg, Virginia, United States
Medizinische Universitat Innsbruck,Universitatsklinik fur Innere Medizin 1 /ID# 126249
🇦🇹Innsbruck, Austria
AZ Maria Middelares /ID# 126194
🇧🇪Ghent, Belgium
CHU de Liege /ID# 126241
🇧🇪Liege, Belgium
AZ-Delta /ID# 126195
🇧🇪Roeselare, Belgium
University of Calgary Cumming School of Medicine Adult Cystic Fibrosis Clinic /ID# 119017
🇨🇦Calgary, Alberta, Canada
Winnipeg Regional Health Authority /ID# 119015
🇨🇦Winnipeg, Manitoba, Canada
University of Alberta /ID# 119022
🇨🇦Edmonton, Alberta, Canada
Medicor Research Inc /ID# 119024
🇨🇦Sudbury, Ontario, Canada
London Health Sciences Centre - University Hospital /ID# 119026
🇨🇦London, Ontario, Canada
Toronto Digestive Disease Asso /ID# 119019
🇨🇦Vaughan, Ontario, Canada
Qe Ii Hsc /Id# 127115
🇨🇦Halifax, Nova Scotia, Canada
Fakultni Nemocnice Olomouc /ID# 126264
🇨🇿Olomouc, Olomoucky Kraj, Czechia
Nemocnice Ceske Budejovice a.s. /ID# 126266
🇨🇿Ceske Budejovice, Czechia
Hepato-Gastroenterologie HK s.r.o. /ID# 126269
🇨🇿Hradec Kralove, Czechia
Silkeborg Hospital /ID# 126251
🇩🇰Silkeborg, Denmark
Krajska zdravotni a.s. Masarykova nemocnice v Usti nad Labem o.z. /ID# 138331
🇨🇿Usti Nad Labem, Czechia
CHU Amiens-Picardie Site Sud /ID# 126237
🇫🇷Amiens CEDEX 1, Somme, France
Centre Hospitalier Universitaire de Grenoble - Hopital Michallon /ID# 126200
🇫🇷Grenoble, France
CHU de Saint-Etienne, Hopital Nord /ID# 134450
🇫🇷SAINT-ETIENNE Cedex 1, France
Hopital Rangueil /ID# 126239
🇫🇷Toulouse, France
Hopital l'Archet 2 /ID# 126238
🇫🇷Nice, France
Charite Universitaetsmedizin Berlin /ID# 126196
🇩🇪Berlin, Germany
Private Practice - Dr. Michael R. MroB Dipl. med. S. Schache /ID# 126257
🇩🇪Berlin, Germany
Israelitisches Krankenhaus Hamburg /ID# 136549
🇩🇪Hamburg, Germany
Asklepios Westklinikum Hamburg /ID# 126275
🇩🇪Hamburg, Germany
Universitaetsklinikum Jena /ID# 126261
🇩🇪Jena, Germany
Universitatsklinikum Magdeburg /ID# 126256
🇩🇪Magdeburg, Germany
EUGASTRO GmbH /ID# 126259
🇩🇪Leipzig, Germany
Gastro Campus Research GbR /ID# 126274
🇩🇪Munster, Germany
Pecsi Tudomanyegyetem Klinikai l.sz. Belgyogyaszati Klinika /ID# 137895
🇭🇺Pecs, Hungary
University of Szeged /ID# 126263
🇭🇺Szeged, Hungary
Semmelweis Egyetem /ID# 137896
🇭🇺Budapest, Hungary
Rabin Medical Center /ID# 126198
🇮🇱Petakh Tikva, Tel-Aviv, Israel
Kaplan Medical Center /ID# 126246
🇮🇱Rehovot, Israel
Gastroenterology Institute, Division of Medicine /ID# 126245
🇮🇱Jerusalem, Israel
Policlinico Agostino Gemelli /ID# 127746
🇮🇹Rome, Lazio, Italy
IBD Center - IRCCS Istituto Clinico Humanitas /ID# 126226
🇮🇹Rozzano, Milano, Italy
Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico /ID# 126221
🇮🇹Milan, Lombardia, Italy
Azienda Ospedaliera Spedali Civili /ID# 127744
🇮🇹Brescia, Italy
Academisch Medical center Amsterdam /ID# 126227
🇳🇱Amsterdam, Noord-Holland, Netherlands
Fondazione di Religione e di Culto Casa Sollievo della Sofferenza /ID# 129856
🇮🇹San Giovanni Rotondo, Italy
Azienda Ospedaliera di Padova /ID# 126267
🇮🇹Padua, Italy
Erasmus Medisch Centrum /ID# 126228
🇳🇱Rotterdam, Netherlands
Centrum.Medyczne. Szpital Swietej Rodziny /ID# 137974
🇵🇱Lodz, Lodzkie, Poland
Centrum Medyczne sw. Lukasza Sp. z o.o. /ID# 126271
🇵🇱Czestochowa, Poland
Sint Franciscus Gasthuis /ID# 127877
🇳🇱Rotterdam, Netherlands
Endoterapia PFG sp. z o.o. /ID# 126199
🇵🇱Warszawa, Mazowieckie, Poland
Centrum Endoskopii Zabiegowej /ID# 126272
🇵🇱Bydgoszcz, Poland
KO-Med Centra Kliniczne Pulawi /ID# 126278
🇵🇱Pulawy, Poland
School of Medicine University of Puerto Rico-Medical Science Campus /ID# 137735
🇵🇷San Juan, Puerto Rico
Hospital Universitario Puerta de Hierro, Majadahonda /ID# 140425
🇪🇸Majadahonda, Madrid, Spain
Complejo Hospitalario Universitario de Pontevedra /ID# 138126
🇪🇸Pontevedra, Spain
Hospital Clinico Universitario San Carlos /ID# 126253
🇪🇸Madrid, Spain
Hospital de Leon /ID# 141675
🇪🇸Leon, Spain
State Institution L. T. Malaya Therapy National Institution of NAMS of Ukraine /ID# 127753
🇺🇦Kharkiv, Kharkivska Oblast, Ukraine
Public Institution Kherson City Clinical Hospital named after le.le. Karabelesha /ID# 127754
🇺🇦Kherson, Ukraine
Lviv Regional Clinical Hospital /ID# 126234
🇺🇦Lviv, Ukraine
Kyiv City Clinical Hospital No.8 /ID# 126232
🇺🇦Kiev, Ukraine
Guy's and St Thomas' NHS Found /ID# 144366
🇬🇧London, London, City Of, United Kingdom
Public Institution 6th City Clinical Hospital /ID# 126236
🇺🇦Zaporizhzhia, Ukraine
University Hospital Southampton NHS Fundation Trust /ID# 126225
🇬🇧Southampton, United Kingdom
Hull University Teaching Hospitals NHS Trustust /ID# 126265
🇬🇧Hull, United Kingdom
The Royal Wolverhampton NHS Tr /ID# 126201
🇬🇧Wolverhampton, United Kingdom
Birmingham Gastroenterology Associates O.C /ID# 137282
🇺🇸Birmingham, Alabama, United States
Internal Med Specialists /ID# 137737
🇺🇸Orlando, Florida, United States
University of Michigan Health Systems /ID# 119076
🇺🇸Ann Arbor, Michigan, United States
Mayo Clinic /ID# 122489
🇺🇸Rochester, Minnesota, United States
The Oregon Clinic, Gastroenterology - West /ID# 135272
🇺🇸Portland, Oregon, United States
Wisconsin Center for Advanced Research, a division of GI Associates, LLC /ID# 119036
🇺🇸Milwaukee, Wisconsin, United States
Froedtert Memorial Lutheran Hospital /ID# 119081
🇺🇸Milwaukee, Wisconsin, United States