A Study to Assess Treat-to-Target and Dosing Flexibility of Oral Upadacitinib Tablets in Adult Participants With Moderate to Severe Atopic Dermatitis
- Registration Number
- NCT05507580
- Lead Sponsor
- AbbVie
- Brief Summary
Atopic dermatitis (AD) is a skin condition that may cause a rash and itching due to inflammation of the skin. Therapies spread over the skin may not be enough to control the AD in trial participants who require systemic anti-inflammatory treatment. This study evaluates the dosing flexibility of upadacitinib in adult participants with moderate to severe AD. Adverse events and change in the disease activity will be assessed.
Upadacitinib is an approved drug for the treatment of moderate to severe/active immune-mediated inflammatory diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis (UC), Crohn's Disease (CD), and AD. The study is comprised of a 35-day Screening Period, a 12-week double-blind period and a 12-week single-blind period. During the double-blind period, participants are placed in 1 of 2 groups, called treatment arms and will be randomized in a 1:1 ratio to receive upadacitinib. At 12 weeks during the single blind period, participants will be blinded to the upadacitinib dose based on their EASI response and reassigned to in 1 of 4 arms. After the last study visit, there is a 30-day follow-up visit. Approximately 454 adult participants ages 18 to 64 with moderate to severe AD who are candidates for systemic therapy will be enrolled at up to 160 sites worldwide.
The study is comprised of a 12-week double-blind period, followed by a 12-week single-blind period. Participants will receive upadacitinib oral tablets once daily for up to 24 weeks.
There may be higher treatment burden for participants in this trial compared to their standard of care (due to study procedures). Participants will attend regular visits during the study at a hospital or clinic. The effect of the treatment will be checked by medical assessments, blood tests, checking for side effects and completing questionnaires.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 461
- Chronic atopic dermatitis (AD) with onset of symptoms at least 3 years prior to Baseline and participant meets Hanifin and Rajka criteria.
- Eczema Area and Severity Index (EASI) score >= 16, vIGA-AD score >= 3 and >= 10% Body Surface Area (BSA) of AD involvement at the Baseline Visit.
- Baseline weekly average of daily Worst Pruritus NRS >= 4.
- Candidate for systemic treatment defined as prior use of systemic treatment for AD, OR previous inadequate response to TCS, TCI or PDE-4 inhibitors, OR for whom topical treatments are otherwise medically inadvisable.
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Participants with current or past history of infection including:
- Two or more episodes of herpes zoster, or one or more episodes of disseminated herpes zoster;
- One or more episodes of disseminated herpes simplex (including eczema herpeticum);
- Human immunodeficiency virus (HIV) infection defined as confirmed positive anti-HIV antibody (HIV Ab) test;
- Active tuberculosis (TB) or meet TB exclusionary parameters (protocol specified requirements for TB testing);
- Japan only: Positive result of beta-D-glucan (screening for Pneumocystis jirovecii infection) or two consecutive indeterminate results of beta-D-glucan during the Screening Period;
- Active infection(s) requiring treatment with intravenous anti-infectives within 30 days, or oral/intramuscular anti-infectives within 14 days prior to the Baseline Visit;
- Chronic recurring infection and/or active viral infection that, based on the investigator's clinical assessment, makes the participant an unsuitable candidate for the study;
- COVID-19 infection: In participants who tested positive for COVID, at least 5 days must have passed since a COVID-19 positive test result for study entry of asymptomatic participants. Participants with mild/moderate COVID-19 infection can be enrolled if fever is resolved without use of antipyretics for 24 hours and other symptoms improved, or if 5 days have passed since the COVID-19 positive test result (whichever comes last). Participants may be rescreened if judged to be in good general health, as determined by the investigator based upon the medical history and physical examination.
-
Evidence of Hepatitis B virus (HBV) or Hepatitis C virus (HCV).
-
Any of the following medical diseases or disorders:
- Recent (within past 6 months) cerebrovascular accident, myocardial infarction, coronary stenting, and aorto-coronary bypass surgery;
- History of an organ transplant which requires continued immunosuppression;
- History of an allergic reaction or significant sensitivity to constituents of the study drug (and its excipients) and/or other products in the same class;
- History of gastrointestinal perforation (other than due to appendicitis or mechanical injury), diverticulitis, or significantly increased risk for gastrointestinal perforation per investigator judgment;
- Conditions that could interfere with drug absorption including but not limited to short bowel syndrome or gastric bypass surgery; participants with a history of gastric banding/segmentation are not excluded;
- History of malignancy except for successfully treated non-melanoma skin cancer (NMSC) or localized carcinoma in situ of the cervix.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Double-Blind Treatment Period Dose A Upadacitinib Participants will be administered updadacitinib Dose A once daily (QD) for 12 weeks. Single-Blinded Treatment Period Arm C Upadacitinib Participants will be administered updadacitinib once daily (QD) for 12 weeks. Single-Blinded Treatment Period Arm B Upadacitinib Participants will be administered updadacitinib once daily (QD) for 12 weeks. Double-Blind Treatment Period Dose B Upadacitinib Participants will be administered updadacitinib Dose B once daily (QD) for 12 weeks. Single-Blinded Treatment Period Arm A Upadacitinib Participants will be administered updadacitinib once daily (QD) for 12 weeks. Single-Blinded Treatment Period Arm D Upadacitinib Participants will be administered updadacitinib once daily (QD) for 12 weeks.
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving Eczema Area and Severity Index (EASI) 90 Week 24 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Achieving EASI 90 and Worst Pruritus Numerical Rating Scale (NRS) of 0 or 1 Week 12 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The final EASI score ranges from 0 to 72 where higher scores represent worse disease.
Worst Pruritus NRS is a validated single self-reported item designed to measure peak pruritus, with '0' being 'no itch' and '10' being 'worst imaginable itch', over the previous 24 hours.Percentage of Participants Achieving EASI 90 Week 12 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.Percentage of Participants Achieving DLQI of 0 or 1 Up to Week 24 DLQI is a 10-item, validated questionnaire used in clinical practice and clinical trials to assess the impact of AD disease symptoms and treatment on health-related quality of life (HRQoL). It consists of 10 questions assessing impact of skin diseases on different aspects of participant's QoL over the prior week. Each item is scored on a 4-point scale: 0 = not at all/not relevant; 1 = a little; 2 = a lot; and 3 = very much. Item scores (0 to 3) are added to provide a total score range of 0 to 30. Higher scores indicate greater impairment of HRQoL.
Percentage of Participants Achieving EASI 75 Week 12 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.Percentage of Participants Achieving Validated Investigator Global Assessment for Atopic Dermatitis (vlGA-AD) of 0 or 1 Up to Week 24 vIGA-AD is a validated assessment instrument used in clinical studies to rate the severity of AD globally. A 5-point scale is used to measure the severity of disease at the time of the investigator's evaluation of the participant ranging from 0 - Clear (no inflammatory signs of atopic dermatitis (no erythema, no induration/papulation, no lichenification, no oozing/crusting). Post-inflammatory hyperpigmentation and/or hypopigmentation may be present.) to 4 - Severe (marked erythema (deep or bright red), marked induration/papulation, and/or marked lichenification.
Percentage of Participants Achieving Improvement (reduction) in Worst Pruritus NRS of >= 4 Up to Week 24 Worst Pruritus NRS is a validated single self-reported item designed to measure peak pruritus, with '0' being 'no itch' and '10' being 'worst imaginable itch', over the previous 24 hours. Higher score denoting worse itch.
Percentage of Participants Achieving EASI 100 Week 12 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema).
The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.Percentage of Participants Achieving EASI 90 and Worst Pruritus NRS of 0 or 1 Week 24 EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The final EASI score ranges from 0 to 72 where higher scores represent worse disease.
Worst Pruritus NRS is a validated single self-reported item designed to measure peak pruritus, with '0' being 'no itch' and '10' being 'worst imaginable itch', over the previous 24 hours.Percentage of Participants Achieving Worst Pruritus NRS of 0 or 1 Up to Week 24 Worst Pruritus NRS is a validated single self-reported item designed to measure peak pruritus, with '0' being 'no itch' and '10' being 'worst imaginable itch', over the previous 24 hours. Higher score denoting worse itch.
Percentage of Participants Achieving Improvement (reduction) in Dermatology Life Quality Index (DLQI) of >= 4 Up to Week 24 DLQI is a 10-item, validated questionnaire used in clinical practice and clinical trials to assess the impact of AD disease symptoms and treatment on health-related quality of life (HRQoL). It consists of 10 questions assessing impact of skin diseases on different aspects of participant's QoL over the prior week. Each item is scored on a 4-point scale: 0 = not at all/not relevant; 1 = a little; 2 = a lot; and 3 = very much. Item scores (0 to 3) are added to provide a total score range of 0 to 30. Higher scores indicate greater impairment of HRQoL.
Trial Locations
- Locations (106)
Azienda Ospedaliera di Perugia /ID# 246632
🇮🇹Perugia, Umbria, Italy
Dermatology Research Institute - Blackfoot Trail /ID# 246703
🇨🇦Calgary, Alberta, Canada
Medical center Cordis /ID# 253310
🇧🇬Pleven, Bulgaria
Acibadem City Clinic Tokuda University Hospital EAD /ID# 246395
🇧🇬Sofia, Bulgaria
Medical center EuroHealth /ID# 246305
🇧🇬Sofia, Bulgaria
Alberta DermaSurgery Centre /ID# 247286
🇨🇦Edmonton, Alberta, Canada
Grand Hopital de Charleroi /ID# 245837
🇧🇪Charleroi, Hainaut, Belgium
Dermatologie Maldegem /ID# 245840
🇧🇪Maldegem, Oost-Vlaanderen, Belgium
DERMA-B Egeszsegugyi es Szolgaltato - Debrecen - Gyepusor Utca /ID# 246426
ðŸ‡ðŸ‡ºDebrecen, Hungary
Amsterdam UMC, locatie AMC /ID# 245673
🇳🇱Amsterdam, Noord-Holland, Netherlands
Centrum Nowoczesnych Terapii Dobry Lekarz Sp. z o.o. /ID# 245836
🇵🇱Krakow, Malopolskie, Poland
BeneDerma s.r.o. /ID# 247513
🇸🇰Bratislava, Slovakia
Beacon Dermatology Inc /ID# 246705
🇨🇦Calgary, Alberta, Canada
Clinexpert Kft /ID# 246427
ðŸ‡ðŸ‡ºBudapest, Hungary
Medical Center Euroderma /ID# 246736
🇧🇬Sofiya, Bulgaria
Cliniques Universitaires UCL Saint-Luc /ID# 245842
🇧🇪Woluwe-Saint-Lambert, Bruxelles-Capitale, Belgium
Ambulatory for Specialized Medical Care for skin and venereal diseases /ID# 247027
🇧🇬Sofia, Bulgaria
Dermed Centrum Medyczne Sp. z o.o /ID# 246329
🇵🇱Lodz, Lodzkie, Poland
Santa Sp. z o.o. Santa Familia Centrum Badan, Profilaktyki i Leczenia /ID# 253872
🇵🇱Lodz, Lodzkie, Poland
Klinika Ambroziak Sp. z o.o. /ID# 245748
🇵🇱Warszawa, Mazowieckie, Poland
Centro Hospitalar Universitario de Sao Joao, EPE /ID# 245704
🇵🇹Porto, Portugal
University Hospital Southampton NHS Foundation Trust /ID# 246393
🇬🇧Southampton, Hampshire, United Kingdom
CHU de Liege /ID# 245839
🇧🇪Liege, Belgium
Dermatologische Gemeinschaftspraxis Mahlow /ID# 245629
🇩🇪Blankenfelde-Mahlow, Brandenburg, Germany
Gyongyosi Bugat Pal Korhaz /ID# 246422
ðŸ‡ðŸ‡ºGyongyos, Heves, Hungary
Amphia Ziekenhuis /ID# 246397
🇳🇱Breda, Noord-Brabant, Netherlands
MICS Centrum Medyczne Torun /ID# 245749
🇵🇱Torun, Kujawsko-pomorskie, Poland
CenterMed Krakow Sp. z o.o. /ID# 253940
🇵🇱Krakow, Malopolskie, Poland
Specjalistyczna Przychodnia Lekarska Alergo-Med sp. z o.o. /ID# 253846
🇵🇱Poznan, Wielkopolskie, Poland
Hospital CUF Descobertas /ID# 245702
🇵🇹Lisboa, Regiao Autonoma Da Madeira, Portugal
Chung Shan Medical University Hospital /ID# 245707
🇨🇳Taichung, Keelung, Taiwan
Skin Health Institute Inc /ID# 246146
🇦🇺Carlton, Victoria, Australia
Miyata Dermatology Clinic /ID# 255491
🇯🇵Matsudo-Shi, Chiba, Japan
Fukuoka University Hospital /ID# 255182
🇯🇵Fukuoka-shi, Fukuoka, Japan
Nomura Dermatology Clinic /ID# 255534
🇯🇵Yokohama-shi, Kanagawa, Japan
Oftalmika sp. z o.o. /ID# 253429
🇵🇱Bydgoszcz, Kujawsko-pomorskie, Poland
Centrum Badan Klinicznych PI-House sp. z o.o. /ID# 245741
🇵🇱Gdansk, Pomorskie, Poland
Centro Hospitalar de Lisboa Central /ID# 246247
🇵🇹Lisbon, Portugal
Poliklinika Bezrucova (Cliniq s.r.o.) /ID# 247515
🇸🇰Bratislava, Slovakia
Dr. Chih-ho Hong Medical Inc. /ID# 246700
🇨🇦Surrey, British Columbia, Canada
Somogy Varmegyei Kaposi Mor Oktato Korhaz /ID# 246428
ðŸ‡ðŸ‡ºKaposvár, Somogy, Hungary
Maruyama Dermatology Clinic /ID# 255441
🇯🇵Koto-ku, Tokyo, Japan
Royalderm Agnieszka Nawrocka /ID# 245746
🇵🇱Warsaw, Mazowieckie, Poland
Silmedic Sp. z o.o. /ID# 253863
🇵🇱Katowice, Slaskie, Poland
Specjalistyczny Niepubliczny Zaklad Opieki Zdrowotnej Alergologia Plus /ID# 253508
🇵🇱Poznań, Wielkopolskie, Poland
Centro Hospitalar Universitario do Porto, EPE - Hospital Santo Antonio /ID# 245701
🇵🇹Porto, Regiao Autonoma Da Madeira, Portugal
Univerzitna nemocnica Martin /ID# 246948
🇸🇰Martin, Zilinsky Kraj, Slovakia
Hospital Universitari de Bellvitge /ID# 246326
🇪🇸L'Hospitalet de Llobregat, Barcelona, Spain
Kaohsiung Chang Gung Memorial Hospital /ID# 245710
🇨🇳Kaohsiung City, Kaohsiung, Taiwan
Istituto Clinico Humanitas /ID# 246630
🇮🇹Rozzano, Milano, Italy
Duplicate_Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona /ID# 254355
🇮🇹Ancona, Italy
Holdsworth House Medical Practice /ID# 254028
🇦🇺Darlinghurst, New South Wales, Australia
Premier Specialist /ID# 246150
🇦🇺Kogarah, New South Wales, Australia
Veracity Clinical Research /ID# 246154
🇦🇺Woolloongabba, Queensland, Australia
North Eastern Health Specialists /ID# 246153
🇦🇺Campbelltown, South Australia, Australia
AZ Sint-Lucas /ID# 253708
🇧🇪Gent, Oost-Vlaanderen, Belgium
UMHAT Alexandrovska EAD /ID# 246594
🇧🇬Sofiya, Sofia, Bulgaria
SKiN Centre for Dermatology /ID# 246702
🇨🇦Peterborough, Ontario, Canada
Private Practice - Dr. Kim Papp Clinical Research /ID# 246698
🇨🇦Waterloo, Ontario, Canada
Peking University Third Hospital /ID# 247842
🇨🇳Beijing, Beijing, China
Beijing Friendship Hospital /ID# 247719
🇨🇳Beijing, Beijing, China
Dermatology Hospital of Southern Medical University /ID# 247951
🇨🇳Guangzhou, Guangdong, China
The First Hospital of China Medical University /ID# 247686
🇨🇳Shenyang, Liaoning, China
Huashan Hospital, Fudan University /ID# 247680
🇨🇳Shanghai, Shanghai, China
Klinikum Darmstadt /ID# 247028
🇩🇪Darmstadt, Hessen, Germany
Universitaetsklinikum Frankfurt /ID# 245627
🇩🇪Frankfurt am Main, Hessen, Germany
Studienzentrum an der Hase GbR Dr. Weyergraf/Dr. Frick/Thomas Heiber /ID# 245636
🇩🇪Bramsche, Niedersachsen, Germany
Universitaetsklinikum Muenster /ID# 245623
🇩🇪Muenster, Nordrhein-Westfalen, Germany
Fachklinik Bad Bentheim /ID# 245634
🇩🇪Bad Bentheim, Saarland, Germany
Elbe Klinikum Buxtehude /ID# 245626
🇩🇪Buxtehude, Germany
Universitaetsklinikum Carl Gustav Carus an der TU Dresden /ID# 248413
🇩🇪Dresden, Germany
Derma Study Center Friedrichshafen GmbH /ID# 245640
🇩🇪Friedrichshafen, Germany
Universitaetsklinikum Halle (Saale) /ID# 245637
🇩🇪Halle (Saale), Germany
Dermatologikum Hamburg /ID# 245635
🇩🇪Hamburg, Germany
Dermatologie Quist-BAG Dres. med. Quist PartG /ID# 245628
🇩🇪Mainz, Germany
ASST Spedali civili di Brescia /ID# 246631
🇮🇹Brescia, Italy
Universita degli Studi Gabriele dAnnunzio /ID# 246629
🇮🇹Chieti, Italy
Korea University Ansan Hospital /ID# 245653
🇰🇷Ansan-si, Gyeonggido, Korea, Republic of
Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico /ID# 246634
🇮🇹Milan, Italy
Takagi Dermatological Clinic Branch /ID# 255181
🇯🇵Obihiro-shi, Hokkaido, Japan
Tohoku University Hospital /ID# 255183
🇯🇵Sendai-shi, Miyagi, Japan
Soon Chun Hyang University Hospital Bucheon /ID# 245654
🇰🇷Bucheon-si, Gyeonggido, Korea, Republic of
Ajou University Hospital /ID# 245652
🇰🇷Suwon-si, Gyeonggido, Korea, Republic of
Chungang University Hospital /ID# 245655
🇰🇷Dongjak-gu, Gyeonggido, Korea, Republic of
Clinical Trials New Zealand /ID# 246557
🇳🇿Hamilton, Manawatu-Wanganui, New Zealand
Greenlane Clinical Centre /ID# 246556
🇳🇿Epsom, Auckland, New Zealand
Centrum Medyczne Pratia Gdynia /ID# 245835
🇵🇱Gdynia, Pomorskie, Poland
Hospital Universitario Puerta de Hierro - Majadahonda /ID# 253820
🇪🇸Majadahonda, Madrid, Spain
Hospital Universitario Virgen del Rocio /ID# 253822
🇪🇸Sevilla, Spain
National Taiwan University Hospital /ID# 245711
🇨🇳Taipei City, Taipei, Taiwan
Linkou Chang Gung Memorial Hospital /ID# 245709
🇨🇳Taoyuan City, Taiwan
Konkuk University Medical Center /ID# 245657
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Seoul National University Hospital /ID# 245651
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Aotearoa Clinical Trials /ID# 246559
🇳🇿Auckland, New Zealand
Hospital Universitario Germans Trias i Pujol /ID# 246320
🇪🇸Badalona, Barcelona, Spain
Hospital Universitario Infanta Leonor /ID# 246272
🇪🇸Madrid, Spain
Hospital Universitario Ramon y Cajal /ID# 246273
🇪🇸Madrid, Spain
Hospital General Universitario de Alicante Doctor Balmis /ID# 246270
🇪🇸Alicante, Spain
Complejo Hospitalario Universitario de Pontevedra /ID# 246323
🇪🇸Pontevedra, Spain
Taipei Municipal Wan Fang Hospital /ID# 245712
🇨🇳Taipei, Keelung, Taiwan
NHS Greater Glasgow and Clyde /ID# 246253
🇬🇧Glasgow, Scotland, United Kingdom
Mackay Memorial Hospital /ID# 245713
🇨🇳Taipei City, Taiwan
NHS Lothian /ID# 246245
🇬🇧Edinburgh, United Kingdom
Leeds Teaching Hospitals NHS Trust /ID# 246241
🇬🇧Leeds, United Kingdom
Rejuvenation Dermatology - Edmonton Downtown /ID# 256790
🇨🇦Edmonton, Alberta, Canada
Lynde Institute for Dermatology /ID# 246699
🇨🇦Markham, Ontario, Canada