A Study to Assess Adverse Events and Change in Disease Activity Comparing Oral Upadacitinib to Subcutaneous Dupilumab in Children From 2 to Less Than 12 Years of Age With Moderate to Severe Atopic Dermatitis
- Registration Number
- NCT06461897
- 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. Topical therapies applied over the skin may not be enough to control the AD in trial participants who require systemic anti-inflammatory treatment. This study compares upadacitinib to dupilumab in pediatric participants with moderate to severe AD who are candidates for systemic therapy. Adverse events and change in the disease activity will be assessed.
Upadacitinib is an approved drug for treating AD patients aged 12 or older. Participants will receive upadacitinib (given as daily dose) or dupilumab (given at label indicated dose every 2 or 4 weeks). Participants will be stratified depending on disease severity, age and response to previous treatment. There is 1 in 5 chance for participants to receive dupilumab during the randomized cohort. Approximately 675 participants aged 2 to less than 12 years of age will be enrolled in this study at approximately 150 sites worldwide. The study population (As defined by participants age or prior treatment) to be enrolled in the study is dependent on local regulatory requirement and/or agreement.
Participants will receive upadacitinib oral tablets once daily (or oral solution twice a day) for 160 weeks, or dupilumab as per its label for 52 weeks, and followed for 30 days after the last dose of upadacitinib and at least 12 weeks after the last dose of dupilumab.
There may be higher treatment burden for participants in this trial compared to their standard of care . Participants will attend regular visits during the study at a hospital or clinic. The effect of the treatment will be checked by clinical assessments, blood tests, checking for side effects and completing questionnaires.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 675
-
A minimum weight of 10 kg and weight and height > 5th percentile for their age according to local standard growth charts at the Baseline Visit.
-
Atopic Dermatitis (AD), according to Hanifin and Rajka criteria, with onset of symptoms at least 6 months prior to Baseline.
-
Eczema Area and Severity Index (EASI) score >= 16; vIGA-AD score >= 3 (Note: In countries where dupilumab is only approved for severe AD, subjects to be included in the Randomized Cohort should have severe AD [vIGA-AD = 4]); >= 10% Body Surface Area of AD involvement at the Baseline Visit; and Baseline weekly average of daily Worst Itch Scale (WIS) or Worst Scratch/Itch numerical rating scale (WSI-NRS) >= 4.
-
Participant must satisfy at least one of the following criteria (Note: More than 1 criterion may apply to an individual participant. All applicable criteria for each individual participant should be reported):
-
To be included in the Randomized Cohort (Note: Participants must have severe AD [vIGA-AD = 4] in countries where dupilumab is approved only for severe AD.):
- [For all countries except US] Documented history of inadequate response or intolerance to TCS and/or TCI OR for whom use of one or more of these topical treatments is medically inadvisable (e.g., high disease burden, Scoring Atopic Dermatitis (SCORAD) > 50, EASI score > 21, or vIGA-AD > 3).
- For dupilumab-naïve participants: History of inadequate response to a systemic therapy for AD other than dupilumab or oral corticosteroids or for whom the available systemic treatments are otherwise medically inadvisable (e.g., because of important side effects or safety risks).
- History of inadequate response to 2 or more courses of oral corticosteroid therapy given for >= 14 days within 6 months prior to Screening or history of oral corticosteroid rebound, defined as recurrence of AD symptoms within 4 months after its discontinuation.
- For dupilumab-exposed participants: Prior exposure to dupilumab without documented history of inadequate response or intolerance (i.e., discontinuation of dupilumab for a non-medical reason, such as, but not limited to, non-coverage or loss of coverage for the drug by health insurance, or other logistic challenges [not safety- or efficacy-related] precluding the participants continued access to dupilumab).
-
To be included in the Dupi-IR/Dupi-Medically Inadvisable Cohort:
- Previous inadequate response or intolerance to dupilumab OR
- Dupilumab is medically inadvisable (e.g., allergy to a component of dupilumab, etc.) AND a documented history of inadequate response or intolerance to TCS and/or TCI.
-
Current or past history of other active skin diseases (e.g., psoriasis or Netherton syndrome or lupus erythematosus) or skin infections (bacterial, fungal, or viral) requiring systemic treatment within 4 weeks of the Baseline Visit or which would interfere with the appropriate assessment of AD lesions.
-
Have used topical treatments for AD (except for topical emollient treatments) including but not limited to TCS, TCI, or topical phosphodiesterase type 4 (PDE-4) inhibitors, within 7 days of the Baseline Visit or any the following prohibited concomitant AD treatments within the specified timeframes below prior to the Baseline Visit:
- Systemic therapy for AD, including but not limited to corticosteroids, methotrexate, cyclosporine, azathioprine, PDE-4 inhibitors, interferon-γ, and mycophenolate mofetil within 4 weeks;
- Dupilumab within 8 weeks;
- Targeted biologic treatments (other than dupilumab) within 5 half-lives (if known) or within 12 weeks, whichever is longer;
- Phototherapy treatment, laser therapy, tanning booth, or extended sun exposure that could affect disease severity or interfere with disease assessments within 4 weeks.
-
Known history of retinal detachment, previous cataract surgery, previous significant ocular trauma, or a known congenital ocular abnormality.
-
For Randomized Cohort: diagnosed active parasitic infection; suspected or high risk of parasitic infection, unless clinical and (if necessary) laboratory assessment have ruled out active infection before randomization.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Dupi-IR Cohort Upadacitinib Participants in this cohort will receive upadacitinib medium dose. Randomized Cohort Dupilumab Participants in the Randomized Cohort will be randomized to receive either medium dose upadacitinib daily adult equivalent dose, low dose upadacitinib daily adult equivalent dose or dupilumab every 2 weeks or 4 weeks (at the label-indicated dose and frequency). Randomized Cohort Upadacitinib Participants in the Randomized Cohort will be randomized to receive either medium dose upadacitinib daily adult equivalent dose, low dose upadacitinib daily adult equivalent dose or dupilumab every 2 weeks or 4 weeks (at the label-indicated dose and frequency).
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving a 75% Reduction from Baseline in Eczema Area and Severity Index 75 (EASI 75) Score (other than US) At Week 16 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 (vIGA-AD) 0 or 1 with a reduction from Baseline of ≥ 2 points (US and China only, descriptive) Week 16 The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale:
* 0 - Clear: No inflammatory signs of AD;
* 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification;
* 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting;
* 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, oozing or crusting may be present;
* 4 - Severe: Marked erythema, induration/papulation and/or lichenification; Oozing or crusting may be present.Number of Participants with Adverse Events (AEs) Up to Approximately Week 172 An AE is defined as any untoward medical occurrence in a patient or clinical investigation in which a participant is administered a pharmaceutical product which does not necessarily have a causal relationship with this treatment.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Achieving a 75% Reduction from Baseline in EASI 75 Score (US) At Week 16 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 a 50% reduction from Baseline in EASI 50 score At Week 16 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.Percent change in Scoring Atopic Dermatitis (SCORAD) from Baseline At Week 16 SCORAD is a clinical tool used to assess the extent and severity of eczema (SCORing Atopic Dermatitis). The extent is assessed using the rule of 9 to calculate the affected area (A) as a percentage of the whole body (0-100%). The intensity part of the SCORAD (B) consists of 6 items: erythema, oedema/papulation, excoriations, lichenification, oozing/crusts and dryness, each graded on a scale from 0 (none) to 3 (severe), for a total score of 0 to 18. Subjective items (C) include daily pruritus and sleeplessness, each scored on a visual analogue scale (VAS) from 0 to 10 (total score 0-20). SCORAD is calculated as A/5 + 7B/2 + C, and ranges from 0 to 103 (worst). A negative change from Baseline indicates improvement.
Percentage of participants achieving vIGA-AD of 0 or 1 (on a 5-point scale) with a reduction from Baseline of ≥ 2 Points At Week 160 The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale:
* 0 - Clear: No inflammatory signs of AD;
* 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification;
* 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting;
* 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, oozing or crusting may be present;
* 4 - Severe: Marked erythema, induration/papulation and/or lichenification; Oozing or crusting may be present.Percentage of participants ≥ 4 years of age with a Baseline Children's Dermatology Life Quality Index (CDLQI) score of >1 achieving a CDLQI score of 0 or 1 At Week 8 The CDLQI is a 10-item, validated questionnaire used in clinical practice and clinical trials to assess the impact of dermatological disease symptoms and treatment on quality of life. The CDLQI has been validated for use in Participants 4 to 16 years of age. It consists of 10 questions assessing impact of skin diseases on different aspects of quality of life over the prior week. The CDLQI items include symptoms and feelings, daily activities, leisure, school, relationships, sleep, and treatment. Each item is scored on a 4-point scale: 0 = not at all; 1 = only a little; 2 = quite 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 quality of life.
Percentage of participants ≥ 4 years of age with a Baseline CDLQI score of >1 achieving a CDLQI score of 0 or 1 At Week 16 The CDLQI is a 10-item, validated questionnaire used in clinical practice and clinical trials to assess the impact of dermatological disease symptoms and treatment on quality of life. The CDLQI has been validated for use in Participants 4 to 16 years of age. It consists of 10 questions assessing impact of skin diseases on different aspects of quality of life over the prior week. The CDLQI items include symptoms and feelings, daily activities, leisure, school, relationships, sleep, and treatment. Each item is scored on a 4-point scale: 0 = not at all; 1 = only a little; 2 = quite 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 quality of life.
Use of topical or systemic rescue therapy from Baseline to Week 16 Baseline to Week 16 Percentage of participants achieving a EASI 75 response for low dose upadacitinib daily adult equivalent dose At Week 16 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 \[1\],
An EASI 75 response is defined as a 75% reduction (improvement) from Baseline in EASI score.Percentage of participants achieving an improved (reduced) Patient Oriented Eczema Measure (POEM) of ≥ 4 points from from participants with POEM ≥ 4 at Baseline At Week 16 The POEM is a 7-item, validated questionnaire used to assess disease symptoms in both children and adults. Participants respond to 7 questions, including dryness, itching, flaking, cracking, sleep loss, bleeding, and weeping, each scored on a 5-point scale based on frequency of occurrence during the previous week: 0 = no days, 1 = 1 to 2 days, 2 = 3 to 4 days, 3 = 5 to 6 days, and 4 = all days. Item scores are added to provide a total score ranging from 0 (clear) to 28 (very severe atopic eczema). A change in POEM score of 3.4 points is considered the minimal clinically important difference.
Number of days on rescue topical corticosteroid or topical calcineurin inhibitor from Baseline to Week 16 Baseline to Week 16
Trial Locations
- Locations (121)
Unidade Local de Saude de Sao Joao, EPE /ID# 266111
🇵🇹Porto, Portugal
Applied Research Center Of Arkansas /ID# 268547
🇺🇸Little Rock, Arkansas, United States
Integrative Skin Science and Research /ID# 265108
🇺🇸Sacramento, California, United States
Clearlyderm Dermatology - West Boca /ID# 266323
🇺🇸Boca Raton, Florida, United States
Pediatric Skin Research /ID# 266308
🇺🇸Coral Gables, Florida, United States
Neoclinical Research - Hialeah /ID# 269694
🇺🇸Hialeah, Florida, United States
Cleaver Medical Group Dermatology /ID# 265099
🇺🇸Dawsonville, Georgia, United States
Aeroallergy Research Laboratory /ID# 267247
🇺🇸Savannah, Georgia, United States
Treasure Valley Medical Research /ID# 266838
🇺🇸Boise, Idaho, United States
Sneeze Wheeze & Itch Associates /ID# 267238
🇺🇸Normal, Illinois, United States
Dawes Fretzin, LLC /ID# 265097
🇺🇸Indianapolis, Indiana, United States
International Clinical Research - Tennessee /ID# 268548
🇺🇸Murfreesboro, Tennessee, United States
Progressive Clinical Research - San Antonio /ID# 267262
🇺🇸San Antonio, Texas, United States
Medizinische Universitaet Graz /ID# 262741
🇦🇹Graz, Steiermark, Austria
Landeskrankenhaus Salzburg-Universitaetsklinikum der PMU (LKH) /ID# 265427
🇦🇹Salzburg, Austria
Medizinische Universitaet Wien /ID# 265417
🇦🇹Wien, Austria
Irmandade da Santa Casa de Misericórdia de Porto Alegre /ID# 267455
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Hospital e Maternidade Celso Pierro - PUC-Campinas /ID# 266965
🇧🇷Campinas, Sao Paulo, Brazil
Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto /ID# 266964
🇧🇷Ribeirão Preto, Sao Paulo, Brazil
Equity Medical, LLC /ID# 268270
🇺🇸Bowling Green, Kentucky, United States
Medical University of South Carolina /ID# 265113
🇺🇸Charleston, South Carolina, United States
Arlington Research Center, Inc /ID# 266330
🇺🇸Arlington, Texas, United States
Wisconsin Medical Center /ID# 267236
🇺🇸Milwaukee, Wisconsin, United States
Maryland Allergy & Asthma Center /ID# 268032
🇺🇸Lanham, Maryland, United States
DermAssociates - Rockville /ID# 266457
🇺🇸Rockville, Maryland, United States
Jordan Valley Dermatology & Research Center /ID# 267092
🇺🇸South Jordan, Utah, United States
Monash Health - Monash Medical Centre /ID# 267149
🇦🇺Clayton, Victoria, Australia
Institute for Skin, Health and Immunity /ID# 266158
🇦🇺Mitcham, Victoria, Australia
Washington University School of Medicine - St. Louis /ID# 268545
🇺🇸Saint Louis, Missouri, United States
Skin Specialists /ID# 266331
🇺🇸Omaha, Nebraska, United States
DOCS Clinical Research - Canal Winchester /ID# 268271
🇺🇸Canal Winchester, Ohio, United States
3A Research - East location /ID# 267622
🇺🇸El Paso, Texas, United States
West Virginia University Hospitals /ID# 265114
🇺🇸Morgantown, West Virginia, United States
Wright State Physicians Health Center /ID# 268841
🇺🇸Fairborn, Ohio, United States
Prime Clinical Research - Mansfield - East Broad Street /ID# 268042
🇺🇸Mansfield, Texas, United States
Texas Dermatology and Laser Specialists /ID# 267249
🇺🇸San Antonio, Texas, United States
Clinica de Alergia Martti Antila /ID# 266197
🇧🇷Sorocaba, Sao Paulo, Brazil
Medical Center Cordis /ID# 265250
🇧🇬Pleven, Bulgaria
UMHAT Alexandrovska EAD /ID# 265256
🇧🇬Sofiya, Bulgaria
Dermatology Research Institute - Blackfoot Trail /ID# 266744
🇨🇦Calgary, Alberta, Canada
Rejuvenation Dermatology - Edmonton Downtown /ID# 267871
🇨🇦Edmonton, Alberta, Canada
Maritime Dermatology /ID# 267359
🇨🇦Halifax, Nova Scotia, Canada
Leader Research /ID# 266745
🇨🇦Hamilton, Ontario, Canada
Triple A Lab Inc /ID# 266615
🇨🇦Hamilton, Ontario, Canada
Lynde Institute for Dermatology /ID# 267006
🇨🇦Markham, Ontario, Canada
Allergy Research Canada /ID# 270230
🇨🇦Niagara Falls, Ontario, Canada
DermAtelier on Avenue /ID# 267850
🇨🇦Toronto, Ontario, Canada
Beijing Children's Hospital /ID# 266350
🇨🇳Beijing, Beijing, China
Poliklinika DermaPlus /ID# 265724
🇭🇷Zagreb, Grad Zagreb, Croatia
Henan Children's Hospital Zhengzhou Children's Hospital /ID# 266832
🇨🇳Zhengzhou, Henan, China
Hunan Children's Hospital /ID# 266365
🇨🇳Changsha, Hunan, China
Dalian Medical University - Dalian Children's Hospital /ID# 266675
🇨🇳Dalian, Liaoning, China
Chengdu Women and Children Center Hospital /ID# 266402
🇨🇳Chengdu, Sichuan, China
Klinika za dječje bolesti Zagreb /ID# 264936
🇭🇷Zagreb, Grad Zagreb, Croatia
Poliklinika Solmed /ID# 265070
🇭🇷Zagreb, Grad Zagreb, Croatia
Klinicki Bolnicki Centar (KBC) Split /ID# 265359
🇭🇷Split, Splitsko-dalmatinska Zupanija, Croatia
Specialty hospital Medico /ID# 266116
🇭🇷Rijeka, Croatia
CHU Toulouse - Hopital Larrey /ID# 255048
🇫🇷Toulouse, Haute-Garonne, France
Centre Hospitalier Régional Universitaire de Nancy - Hôpitaux de Brabois /ID# 265455
🇫🇷Vandœuvre-lès-Nancy, Meurthe-et-Moselle, France
CHU Bordeaux - Hopital Pellegrin /ID# 266818
🇫🇷Bordeaux, Nouvelle-Aquitaine, France
Centre Hospitalier Universitaire de Clermont Ferrand - Hopital Estaing /ID# 267327
🇫🇷Clermont-Ferrand, Puy-de-Dome, France
CHU Amiens-Picardie Site Sud /ID# 255083
🇫🇷Amiens CEDEX 1, Somme, France
Centre Hospitalier d'Argenteuil Victor Dupouy /ID# 265448
🇫🇷Argenteuil, France
Centre Hospitalier Universitaire de Nantes - L' Hopital l'hôtel-Dieu /ID# 265449
🇫🇷Nantes, France
AP-HP - Hopital Necker /ID# 255050
🇫🇷Paris, France
Universitaetsklinikum Erlangen /ID# 255168
🇩🇪Erlangen, Bayern, Germany
Fachklinik Bad Bentheim /ID# 255165
🇩🇪Bad Bentheim, Niedersachsen, Germany
Universitaetsklinikum Carl Gustav Carus Dresden /ID# 255167
🇩🇪Dresden, Sachsen, Germany
Charite Universitaetsmedizin Berlin - Campus Mitte /ID# 267411
🇩🇪Berlin, Germany
DermaMed Research - Oroshaza /ID# 266995
🇭🇺Oroshaza, Bekes, Hungary
Szegedi Tudomanyegyetem Szent-Gyorgyi Albert Klinikai Kozpont /ID# 265653
🇭🇺Szeged, Csongrad, Hungary
Debreceni Egyetem-Klinikai Kozpont /ID# 265331
🇭🇺Debrecen, Hajdu-Bihar, Hungary
Soroka Medical Center /ID# 265251
🇮🇱Be'er Sheva, HaDarom, Israel
Schneider Childrens Medical Center of Israel /ID# 265617
🇮🇱Petah Tikva, HaMerkaz, Israel
Hadassah Medical Center-Hebrew University /ID# 255041
🇮🇱Jerusalem, Yerushalayim, Israel
Korea University Ansan Hospital /ID# 264169
🇰🇷Ansan-si, Gyeonggido, Korea, Republic of
HaEmek Medical Center /ID# 266416
🇮🇱Afula, H_efa, Israel
The Chaim Sheba Medical Center /ID# 265254
🇮🇱Ramat Gan, Tel-Aviv, Israel
Erasmus Medisch Centrum /ID# 265408
🇳🇱Rotterdam, Zuid-Holland, Netherlands
Klinika Ambroziak Dermatologia /ID# 265458
🇵🇱Warszawa, Mazowieckie, Poland
Azienda Ospedaliero-Universitaria Policlinico Umberto I /ID# 267070
🇮🇹Rome, Roma, Italy
Chungang University Hospital /ID# 266383
🇰🇷Dongjak-gu, Seoul Teugbyeolsi, Korea, Republic of
IRCCS AOU di Bologna Policlinico Sant Orsola Malpighi /ID# 255118
🇮🇹Bologna, Italy
Soon Chun Hyang University Hospital Bucheon /ID# 264171
🇰🇷Bucheon-si, Gyeonggido, Korea, Republic of
Konkuk University Medical Center /ID# 264178
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Amsterdam UMC, locatie AMC /ID# 265406
🇳🇱Amsterdam, Noord-Holland, Netherlands
MICS Centrum Medyczne Torun /ID# 265454
🇵🇱Torun, Kujawsko-pomorskie, Poland
Centrum Nowoczesnych Terapii 'Dobry Lekarz' sp.z.o.o. /ID# 266030
🇵🇱Krakow, Malopolskie, Poland
Klinika Osipowicz & Turkowski sp.z.o.o /ID# 267490
🇵🇱Warszawa, Mazowieckie, Poland
Hallym University Kangnam Sacred Heart Hospital /ID# 267318
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Royalderm Agnieszka Nawrocka /ID# 266606
🇵🇱Warsaw, Mazowieckie, Poland
Clinical Research Group Sp. z o.o. /ID# 266924
🇵🇱Warszawa, Mazowieckie, Poland
NZOZ Specjalistyczny Osrodek Dermatologiczny Dermal /ID# 266613
🇵🇱Bialystok, Podlaskie, Poland
Centrum Badan Klinicznych PI-House sp. z o.o. /ID# 265451
🇵🇱Gdansk, Pomorskie, Poland
Centrum Medyczne Angelius Provita /ID# 265456
🇵🇱Katowice, Slaskie, Poland
Specjalistyczny Niepubliczny Zaklad Opieki Zdrowotnej Alergologia Plus /ID# 265457
🇵🇱Poznan, Wielkopolskie, Poland
Unidade Local de Saude de Coimbra, EPE /ID# 266115
🇵🇹Coimbra, Portugal
Unidade Local de Saude de Santo Antonio, E.P.E. /ID# 266112
🇵🇹Porto, Portugal
Clinical Research Investigator Group, LLC /ID# 268366
🇵🇷Bayamon, Puerto Rico
Private Practice - Dr. Alma Cruz /ID# 264234
🇵🇷Carolina, Puerto Rico
National University Hospital /ID# 265685
🇸🇬Singapore, Singapore
Narodny Ustav Detskych Chorob /ID# 265253
🇸🇰Bratislava, Bratislavsky Kraj, Slovakia
ALERSA, s.r.o. /ID# 266245
🇸🇰Kosice, Kosicky Kraj, Slovakia
Univerzitna nemocnica L. Pasteura Kosice /ID# 265239
🇸🇰Košice, Kosicky Kraj, Slovakia
Univerzitna nemocnica Martin /ID# 265947
🇸🇰Martin, Zilinsky Kraj, Slovakia
Fakultna nemocnica Trnava /ID# 265245
🇸🇰Trnava, Slovakia
Hospital Sant Joan de Deu /ID# 255287
🇪🇸Esplugues de Llobregat, Barcelona, Spain
Hospital General Universitario Gregorio Maranon /ID# 255288
🇪🇸Madrid, Spain
Hospital Universitario La Paz /ID# 255286
🇪🇸Madrid, Spain
Consorci Hospital General Universitario de Valencia /ID# 255289
🇪🇸Valencia, Spain
Hospital Universitario Miguel Servet /ID# 255290
🇪🇸Zaragoza, Spain
Kaohsiung Chang Gung Memorial Hospital /ID# 267791
🇨🇳Kaohsiung City, Kaohsiung, Taiwan
National Taiwan University Hospital /ID# 265510
🇨🇳Taipei City, Taipei, Taiwan
New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical /ID# 266349
🇨🇳New Taipei City, Taiwan
Taipei Veterans General Hospital /ID# 265507
🇨🇳Taipei City, Taiwan
Linkou Chang Gung Memorial Hospital /ID# 263664
🇨🇳Taoyuan City, Taiwan
Derriford Hospital and the Royal Eye Infirmary /ID# 266980
🇬🇧Plymouth, Devon, United Kingdom
Chelsea and Westminster Hospital /ID# 266389
🇬🇧London, Greater London, United Kingdom
St. George's Hospital /ID# 266984
🇬🇧London, Greater London, United Kingdom
Queen Elizabeth University Hospital /ID# 265219
🇬🇧Glasgow, Lanarkshire, United Kingdom
Royal Victoria Infirmary /ID# 265238
🇬🇧Newcastle upon Tyne, United Kingdom