Study to Assess Change in Disease Activity and Adverse Events of Oral Upadacitinib Compared to Subcutaneous Adalimumab in Adult Participants With Moderate to Severe Rheumatoid Arthritis
- Conditions
- Rheumatoid Arthritis
- Interventions
- Registration Number
- NCT05814627
- Lead Sponsor
- AbbVie
- Brief Summary
Rheumatoid Arthritis (RA) is a chronic inflammatory disease causing pain, stiffness, swelling and loss of joint function. This study will assess how safe and effective upadacitinib is in treating RA when compared to adalimumab in adult participants with inadequate response or intolerance to one TNF-inhibitor who are on a stable dose of methotrexate (MTX). Adverse events and change in disease activity will be assessed.
Upadacitinib is an approved drug for the treatment of RA. This study is double-blinded means that neither the participants nor the study doctors will know who will be given upadacitinib and who will be given adalimumab. Study doctors put the participants in 1 of the 2 groups, called treatment arms randomly, to receive either upadacitinib or adalimumab. There is 1 in 2 chance that participants will receive adalimumab. Each group consists of 2 periods. Approximately 480 participants diagnosed with RA will be enrolled in approximately 250 sites across the world.
Participants will receive the oral upadacitinib once daily and matching adalimumab placebo every other week, or the subcutaneous adalimumab every other week and matching upadacitinib placebo once daily during Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1 and will be followed for 30 days and 70 days.
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 medical assessments, checking for side effects and completing questionnaires.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 480
-
Diagnosis of Rheumatoid Arthritis (RA) for >= 3 months based on the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria for RA.
-
Treated for >= 3 consecutive months prior to screening with 1 tumor necrosis factor inhibitor (TNFi) (only 1 of originator or biosimilar certolizumab pegol, etanercept, golimumab or infliximab) for RA, but continue to exhibit active RA, or had to discontinue due to intolerability or toxicity, irrespective of treatment duration. Up to 15% of participants who were intolerant to 1 TNFi will be allowed to enroll. Prior administration of different biosimilar versions for the same originator TNFi or switching between originator and biosimilar version of the same originator TNFi are acceptable. Cycling between biosimilars of different originator TNF inhibitors is not acceptable.
-
On oral or parenteral methotrexate (MTX) therapy >= 3 consecutive months and on a stable prescription of 15 to 25 mg/week (or >= 10 mg/week in participants intolerant of MTX at doses >= 15 mg/week) for >= 4 weeks prior to the first dose of study drug. In addition, all participants should take a dietary supplement of folic acid or folinic acid throughout the study participation.
- For a Chinese, Japanese, Korean, or Taiwanese participant, a stable dose of MTX >= 7.5 mg/week is acceptable.
- Additional local requirements for MTX may apply.
-
Meets both of the following disease activity criteria:
- >= 6 swollen joint (based on 66 joint counts) and >= 6 tender joints (based on 68 joint counts) at screening and baseline;
- High-sensitivity C-reactive protein (hsCRP) >= 3 mg/L (central lab, upper limit of normal [ULN] 2.87 mg/L) at screening.
- History of any arthritis with onset prior to age 17 years or current diagnosis of inflammatory joint disease other than Rheumatoid Arthritis (RA).
- Prior exposure to any janus kinase (JAK) inhibitor.
- Prior exposure to adalimumab (original or biosimilar) or to any approved or investigational TNF inhibitor other than infliximab, etanercept, certolizumab pegol and golimumab.
- Prior exposure to an approved or investigational non-TNFi biologic disease modifying anti-rheumatic drug (bDMARD) or targeted synthetic disease modifying antirheumatic drug (tsDMARD).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Upadacitinib+ Adalimumab matching Placebo Upadacitinib Participants will receive upadacitinib once a day along with matching placebo for adalimumab at eow (every other week) in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1. Upadacitinib+ Adalimumab matching Placebo Adalimumab Matching Placebo Participants will receive upadacitinib once a day along with matching placebo for adalimumab at eow (every other week) in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1. Adalimumab + Upadacitinib matching Placebo Adalimumab Participants will receive adalimumab at eow (every other week) along with matching placebo for upadacitinib once a day in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1. Adalimumab + Upadacitinib matching Placebo Upadacitinib Matching Placebo Participants will receive adalimumab at eow (every other week) along with matching placebo for upadacitinib once a day in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1.
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving Disease Activity Score 28 C-reactive Protein [DAS28-CRP]) <= 3.2 Week 12 The DAS28-CRP is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (NRS), and high-sensitivity C-reactive protein (hsCRP; in mg/L). Scores on the DAS28-CRP range from 0 to approximately 10, where higher scores indicate more disease activity. Low Disease Activity (LDA) based on DAS28 (CRP) is defined as achieving a DAS28 (CRP) of less than or equal to 3.2.
- Secondary Outcome Measures
Name Time Method Change from Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI) Score Week 12 The HAQ-DI assesses physical function in RA. The HAQ-DI score is the average of the highest score in each of eight categories. The total score is between 0-3.0, in 0.125 increments. Increasing scores indicate worse functioning with 0 indicating no functional impairment and 3 indicating complete impairment.
Percentage of Participants Achieving American College of Rheumatology 50 % (ACR50) Response Week 12 Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR50 response criteria:
* 50% improvement in tender joint count (TJC68);
* 50% improvement in swollen joint count (SJC66); and
* 50% improvement in at least 3 of the 5 following parameters:
* Physician's Global Assessment of Disease Activity measured on a Numerical Rating Scale of 0 to 10 (NRS)
* Patient's Global Assessment of Disease Activity (NRS)
* Patient's Assessment of Pain (NRS)
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).Percentage of Participants Achieving Disease Activity Score 28 C-reactive Protein [DAS28-CRP]) < 2.6 Week 12 The DAS28-CRP is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (NRS), and high-sensitivity C-reactive protein (hsCRP; in mg/L). Scores on the DAS28-CRP range from 0 to approximately 10, where higher scores indicate more disease activity. Clinical remission (CR) based on DAS28 (CRP) is defined as achieving a DAS28 (CRP) of less than 2.6.
Change from Baseline in Disease Activity Score 28 C-reactive Protein [DAS28-CRP]) Week 12 The DAS28-CRP is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (NRS), and high-sensitivity C-reactive protein (hsCRP; in mg/L). Scores on the DAS28-CRP range from 0 to approximately 10, where higher scores indicate more disease activity.
Change from Baseline in Participants Assessment of Pain Week 12 Participants indicated their level of pain over the last 7 days using the Patient's Global Assessment Pain NRS. The range is 0 to 10 with no activity being indicated by 0 and severe activity by 10.
Trial Locations
- Locations (216)
Ochsner Clinic Foundation /ID# 254059
🇺🇸New Orleans, Louisiana, United States
Diagnostic consultative center Focus-5 /ID# 252555
🇧🇬Sofiya, Bulgaria
Beth Israel Deaconess Medical Center - Rheumatology /ID# 255029
🇺🇸Boston, Massachusetts, United States
Qualmedica Research - Evansville /ID# 254005
🇺🇸Evansville, Indiana, United States
Western KY Rheumatology /ID# 255026
🇺🇸Hopkinsville, Kentucky, United States
Bluegrass Community Research /ID# 254653
🇺🇸Lexington, Kentucky, United States
The Arthritis & Diabetes Clinic, Inc. /ID# 254014
🇺🇸Monroe, Louisiana, United States
Rheumatology Associates PA - Portland /ID# 255014
🇺🇸Portland, Maine, United States
AA Medical Research Center - Grand Blanc /ID# 254007
🇺🇸Grand Blanc, Michigan, United States
Clinvest Research LLC /ID# 254054
🇺🇸Springfield, Missouri, United States
NYU Langone Ambulatory Care Brooklyn Heights /ID# 254621
🇺🇸Brooklyn, New York, United States
Advanced Rheumatology, PC /ID# 256059
🇺🇸Okemos, Michigan, United States
St. Paul Rheumatology, PA /ID# 255037
🇺🇸Eagan, Minnesota, United States
Arthritis Associates /ID# 253992
🇺🇸Hattiesburg, Mississippi, United States
Kansas City Physician Partners /ID# 255035
🇺🇸Kansas City, Missouri, United States
Dartmouth-Hitchcock Medical Center - 1 Medical Center Drive /ID# 253798
🇺🇸Lebanon, New Hampshire, United States
Logan Health Research /ID# 253738
🇺🇸Kalispell, Montana, United States
Physician Research Collaboration, LLC /ID# 254012
🇺🇸Lincoln, Nebraska, United States
Arthritis Rheumatic and Back Disease Associates. P.A. /ID# 255266
🇺🇸Voorhees, New Jersey, United States
Rheumatology Associates of Oklahoma /ID# 253994
🇺🇸Oklahoma City, Oklahoma, United States
Arthritis and Osteoporosis Associates of New Mexico /ID# 252684
🇺🇸Las Cruces, New Mexico, United States
Joint And Muscle Research Institute /ID# 275128
🇺🇸Charlotte, North Carolina, United States
Trinity Health Med Arts Clinic /ID# 254010
🇺🇸Minot, North Dakota, United States
Paramount Medical Research and Consulting /ID# 254048
🇺🇸Middleburg Heights, Ohio, United States
Clinical Research of Philadelphia, LLC /ID# 255025
🇺🇸Philadelphia, Pennsylvania, United States
West Tennessee Research Institute /ID# 254620
🇺🇸Jackson, Tennessee, United States
Rheumatology Clinic of Houston /ID# 254002
🇺🇸Tomball, Texas, United States
Consultorios Reumatologicos Pampa /ID# 254095
🇦🇷Ciudad Autonoma de Buenos Aire, Ciudad Autonoma De Buenos Aires, Argentina
Aprillus Asistencia e Investigacion /ID# 253258
🇦🇷Ciudad Autonoma de Buenos Aire, Ciudad Autonoma De Buenos Aires, Argentina
Centro de Investigaciones Medicas Tucuman /ID# 253297
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
UZ Gent /ID# 252306
🇧🇪Gent, Oost-Vlaanderen, Belgium
AZ Sint-Jan Brugge /ID# 252278
🇧🇪Brugge, Belgium
Peking University Third Hospital /ID# 252393
🇨🇳Beijing, Beijing, China
Nanjing Drum Tower Hospital /ID# 252613
🇨🇳Nanjing, Jiangsu, China
Centro Integral de Reumatología del Caribe SAS - Circaribe SAS /ID# 252587
🇨🇴Barranquilla, Atlantico, Colombia
Fundacion Oftalmologica de Santander - FOSCAL /ID# 252589
🇨🇴Bucaramanga, Santander, Colombia
Poliklinika Repromed /ID# 252451
🇭🇷Zagreb, Grad Zagreb, Croatia
Arthritis and Rheumatology Research Institute, PLLC /ID# 254045
🇺🇸Allen, Texas, United States
Adriana Pop-Moody MD Clinic PA /ID# 255030
🇺🇸Corpus Christi, Texas, United States
Accurate Clinical Research - Houston /ID# 254647
🇺🇸Houston, Texas, United States
West Texas Clinical Research /ID# 253736
🇺🇸Lubbock, Texas, United States
Sun Research Institute /ID# 255019
🇺🇸San Antonio, Texas, United States
Aurora Rheumatology and Immunotherapy Center /ID# 254049
🇺🇸Franklin, Wisconsin, United States
CIMER Centro Integral de Medicina Respiratoria /ID# 255277
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
CHU de Liege /ID# 252309
🇧🇪Liege, Belgium
Hospital de Clinicas de Porto Alegre /ID# 254916
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Fundacao Faculdade Regional de Medicina de Sao Jose do Rio Preto /ID# 254917
🇧🇷Sao Jose Do Rio Preto, Sao Paulo, Brazil
Centre de Recherche Musculo-Squelettique /ID# 256273
🇨🇦Trois-rivières, Quebec, Canada
Medical Center Kuna-Peric /ID# 252452
🇭🇷Zagreb, Grad Zagreb, Croatia
MHAT Plovdiv /ID# 252342
🇧🇬Plovdiv, Bulgaria
Tekton Research, L.L.C /ID# 254004
🇺🇸Austin, Texas, United States
JPS Rheumatology Clinic /ID# 254050
🇺🇸Fort Worth, Texas, United States
Biopharma Informatic - Houston - Business Center Drive /ID# 254053
🇺🇸Houston, Texas, United States
Rheumatic Disease Center, LLP /ID# 254015
🇺🇸Glendale, Wisconsin, United States
CEPIC - Centro Paulista de Investigacao Clinica /ID# 254200
🇧🇷Sao Paulo, Brazil
Diagnostic consultative center 17 Sofia /ID# 252341
🇧🇬Sofia, Bulgaria
Corporacion de Beneficiencia Osorno /ID# 252556
🇨🇱Osorno, Los Lagos, Chile
The Third Affiliated Hospital, Sun Yat-Sen University /ID# 252394
🇨🇳Guangzhou, Guangdong, China
Zhuzhou Central Hospital /ID# 252390
🇨🇳Zhuzhou, Hunan, China
Jiangxi Pingxiang People's Hospital /ID# 252381
🇨🇳Pingxiang, Jiangxi, China
West China Hospital, Sichuan University /ID# 252364
🇨🇳Chengdu, Sichuan, China
Centro de Investigacion en Reumatologia y especialidades Medicas S.A.S- CIREEM /ID# 252586
🇨🇴Bogotá, Cundinamarca, Colombia
Trinity Universal Research Associates - Carrollton /ID# 254648
🇺🇸Carrollton, Texas, United States
Biopharma Informatic - Houston - Business Center Drive /ID# 254051
🇺🇸Houston, Texas, United States
R & H Clinical Research - 777 Katy /ID# 255024
🇺🇸Katy, Texas, United States
Advanced Rheumatology of Houston /ID# 254003
🇺🇸The Woodlands, Texas, United States
CETI - Centro de Estudos em Terapias Inovadoras /ID# 254201
🇧🇷Curitiba, Parana, Brazil
LMK Sevicos Medicos S/S /ID# 254202
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Manitoba Clinic /ID# 254019
🇨🇦Winnipeg, Manitoba, Canada
Dr. Latha Naik Medical Professional Corporation /ID# 254018
🇨🇦Saskatoon, Saskatchewan, Canada
Complejo Asistencial Dr. Sotero del Rio /ID# 252559
🇨🇱Santiago, Region Metropolitana De Santiago, Chile
Clinica Dermacross /ID# 252560
🇨🇱Vitacura, Region Metropolitana Santiago, Chile
Trinity Universal Research Associates, Inc /ID# 253995
🇺🇸Plano, Texas, United States
DM Clinical Research - Tomball /ID# 254001
🇺🇸Tomball, Texas, United States
Organizacion Medica de Investigacion (OMI) /ID# 253253
🇦🇷Ciudad Autonoma de Buenos Aire, Ciudad Autonoma De Buenos Aires, Argentina
ReumaClinic /ID# 252277
🇧🇪Genk, Limburg, Belgium
CMiP - Centro Mineiro de Pesquisa Ltda - ME /ID# 254203
🇧🇷Juiz de Fora, Minas Gerais, Brazil
Umbal Kaspela /ID# 252343
🇧🇬Plovdiv, Bulgaria
Medical center Unimed /ID# 252344
🇧🇬Plovdiv, Bulgaria
Military Medical Academy Multiprofile Hospital /ID# 252355
🇧🇬Sofia, Bulgaria
Diagnostic consultative center Focus-5 /ID# 252354
🇧🇬Sofiya, Bulgaria
Centre Rhumatologie de l'Est /ID# 254932
🇨🇦Rimouski, Quebec, Canada
Groupe de Recherche en Maladies Osseuses Inc /ID# 253409
🇨🇦Sainte-foy, Quebec, Canada
Centro Internacional de Estudios Clinicos - CIEC /ID# 252561
🇨🇱Santiago, Region Metropolitana Santiago, Chile
The first affiliated hospital of bengbu medical college /ID# 252612
🇨🇳Bengbu, Anhui, China
Peking University First Hospital /ID# 252392
🇨🇳Beijing, Beijing, China
Healthy Medical Center S.A.S /ID# 252585
🇨🇴Zipaquirá, Cundinamarca, Colombia
Hospital Pablo Tobón Uribe /ID# 253371
🇨🇴Medellín, Antioquia, Colombia
Poliklinika Bonifarm /ID# 252741
🇭🇷Zagreb, Grad Zagreb, Croatia
Poliklinika Solmed /ID# 252453
🇭🇷Zagreb, Grad Zagreb, Croatia
University General Hospital of Heraklion PA.G.N.I /ID# 252261
🇬🇷Heraklion, Kriti, Greece
CHU Toulouse - Hopital Purpan /ID# 252402
🇫🇷TOULOUSE Cedex 9, Haute-Garonne, France
CHU Montpellier - Hôpital Lapeyronie /ID# 252386
🇫🇷Montpellier, Herault, France
Rheumatologische-Immunologische Praxis Templin /ID# 252863
🇩🇪Templin, Brandenburg, Germany
CHU Amiens-Picardie Site Sud /ID# 252384
🇫🇷Amiens CEDEX 1, Somme, France
Hamanomachi Hospital /ID# 253168
🇯🇵Fukuoka-shi, Fukuoka, Japan
Hokkaido Medical Center For Rheumatic Diseases /ID# 270019
🇯🇵Sapporo-shi, Hokkaido, Japan
Centre Hospitalier Régional d'Orléans - Hôpital de la Source /ID# 252385
🇫🇷Orléans, France
Hôpital Charles-Nicolle /ID# 252908
🇫🇷Rouen, France
Rheumazentrum Ruhrgebiet /ID# 252670
🇩🇪Herne, Nordrhein-Westfalen, Germany
MVZ Rheumatologie und Autoimmunmedizin Hamburg GmbH /ID# 252667
🇩🇪Hamburg, Germany
Vital Medicina Kft /ID# 252399
🇭🇺Veszprém, Veszprem, Hungary
Klinische Forschung im med. Versorgungsalltag GbR /ID# 254221
🇩🇪Planegg, Germany
Betegapolo Irgalmasrend Budai Irgalmasrendi Korhaz /ID# 253311
🇭🇺Budapest, Hungary
Shono Rheumatism Clinic /ID# 252591
🇯🇵Fukuoka-shi, Fukuoka, Japan
Rheumazentrum Ratingen /ID# 252669
🇩🇪Ratingen, Germany
General Hospital of Athens Laiko /ID# 252258
🇬🇷Athens, Attiki, Greece
University General Hospital Attikon /ID# 254751
🇬🇷Athens, Attiki, Greece
ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO /ID# 252461
🇮🇹Milan, Milano, Italy
CMED Rehabilitacios es Diagnosztikai Kozpont /ID# 252400
🇭🇺Szekesfehervar, Hungary
Matsubara Mayflower Hospital /ID# 252834
🇯🇵Kato-shi, Hyogo, Japan
Kumamoto Orthopaedic Hospital /ID# 253167
🇯🇵Kumamoto shi, Kumamoto, Japan
Tokito Clinic Rheumatology and Orthopaedics Surgery /ID# 253057
🇯🇵Shimonoseki-shi, Yamaguchi, Japan
MÁV Kórház /ID# 252628
🇭🇺Szolnok, Hungary
Azienda Ospedaliero Universitaria Careggi /ID# 252460
🇮🇹Florence, Firenze, Italy
Japan Organization of Occupational Health and Safety Chubu Rosai Hospital /ID# 252836
🇯🇵Nagoya-shi, Aichi, Japan
Azienda Ospedaliero Universitaria delle Marche /ID# 252459
🇮🇹Ancona, Italy
Sugimoto Rheumatology and Internal Medicine Clinic /ID# 252774
🇯🇵Fukui-shi, Fukui, Japan
Daido Clinic - Nagoya /ID# 253058
🇯🇵Nagoya-shi, Aichi, Japan
Kashiwa Kousei General Hospital /ID# 270033
🇯🇵Kashiwa-shi, Chiba, Japan
Katayama Orthopedic Rheumatology Clinic /ID# 252746
🇯🇵Asahikawa-shi, Hokkaido, Japan
Sagawa Akira Rheumatology Clin /ID# 252773
🇯🇵Sapporo-shi, Hokkaido, Japan
Sanuki Municipal Hospital /ID# 252747
🇯🇵Sanuki-shi, Kagawa, Japan
Bay Side Misato Medical Center /ID# 252661
🇯🇵Kochi-shi, Kochi, Japan
Medical Corporation Keiai Kai Clinic /ID# 252750
🇯🇵Miyazaki-shi, Miyazaki, Japan
Sasebo Chuo Hospital /ID# 252662
🇯🇵Sasebo-shi, Nagasaki, Japan
Rinku Hashimoto Rheumatology Orthopaedics /ID# 270396
🇯🇵Izumisano-shi, Osaka, Japan
St.Luke's International Hospital /ID# 253131
🇯🇵Chuo-ku, Tokyo, Japan
Keio University Hospital /ID# 253205
🇯🇵Shinjuku-ku, Tokyo, Japan
Maeshima Rheumatology Clinic /ID# 270448
🇯🇵Oita, Japan
Specijalna bolnica za medicinsku rehabilitaciju Krapinske Toplice /ID# 252455
🇭🇷Krapinske Toplice, Croatia
Centre Hospitalier Universitaire de Nice Hopital Pasteur /ID# 254224
🇫🇷Nice CEDEX 1, Alpes-Maritimes, France
Toyama Prefectural Central Hospital /ID# 270871
🇯🇵Toyama, Japan
SoonChunHyang University Hospital Cheonan /ID# 254942
🇰🇷Cheonan-si, Chungcheongnamdo, Korea, Republic of
Chungnam National University Hospital /ID# 252159
🇰🇷Daejeon, Daejeon Gwang Yeogsi, Korea, Republic of
Chonnam National University Bitgoeul Hospital /ID# 254802
🇰🇷Gwangju, Gwangju Gwang Yeogsi, Korea, Republic of
Seoul National University Hospital /ID# 252160
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Hanyang University Seoul Hospital /ID# 252161
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
CINTRE, Centro de Investigación y Tratamiento Reumatológico SC /ID# 252873
🇲🇽Mexico City, Ciudad De Mexico, Mexico
Unidade Local de Saude de Santa Maria, EPE /ID# 252492
🇵🇹Lisboa, Portugal
Institute for Rheumatology /ID# 252334
🇷🇸Belgrade, Beograd, Serbia
Hospital de Jesus /ID# 253114
🇲🇽Mexico City, Distrito Federal, Mexico
Clinica de Investigacion en Reumatologia y Obesidad S.C. /ID# 253480
🇲🇽Guadalajara, Jalisco, Mexico
Unidade Local de Saúde do Alto Minho, EPE - Hospital Conde de Bertiandos /ID# 252489
🇵🇹Ponte de Lima, Viana Do Castelo, Portugal
Mindful Medical Research /ID# 252693
🇵🇷San Juan, Puerto Rico
Cabinet Medical Dr. Avram S.R.L /ID# 254133
🇷🇴Timisoara, Timis, Romania
Institute for Rheumatology /ID# 252333
🇷🇸Belgrade, Beograd, Serbia
University of Pretoria /ID# 252368
🇿🇦Pretoria, Gauteng, South Africa
Dr Elsa van Duuren /ID# 252387
🇿🇦Pretoria, Gauteng, South Africa
Centro Integral en Reumatologia S.A de C.V /ID# 252872
🇲🇽Guadalajara, Jalisco, Mexico
Investigacion y Biomedicina de Chihuahua /ID# 253115
🇲🇽Chihuahua, Mexico
Hospital Garcia de Orta /ID# 252491
🇵🇹Almada, Setubal, Portugal
GCM Medical Group PSC /ID# 252700
🇵🇷San Juan, Puerto Rico
Banat Carina Med SRL /ID# 252757
🇷🇴Timisoara, Timis, Romania
Spitalul Clinic Sf. Maria /ID# 253334
🇷🇴Bucuresti, Romania
Spitalul Judetean de Urgenta Bacau /ID# 252860
🇷🇴Bacau, Romania
Spitalul Clinic Sf. Maria /ID# 252759
🇷🇴Bucuresti, Romania
Institute for Rheumatology /ID# 252335
🇷🇸Belgrade, Beograd, Serbia
Institute for Rheumatology /ID# 252338
🇷🇸Belgrade, Beograd, Serbia
Special Hospital for Rheuma /ID# 252336
🇷🇸Novi Sad, Vojvodina, Serbia
Special Hospital for Rheuma /ID# 252339
🇷🇸Novi Sad, Vojvodina, Serbia
Emmed Research cc /ID# 254317
🇿🇦Pretoria, Gauteng, South Africa
Dr Asokan Naidoo /ID# 252894
🇿🇦Umhlanga, Kwazulu-Natal, South Africa
Winelands Medical Research - Somerset West /ID# 252745
🇿🇦Cape Town, Western Cape, South Africa
Arthritis Clinical Research Trials /ID# 252370
🇿🇦Cape Town, Western Cape, South Africa
Winelands Medical Research Centre /ID# 252369
🇿🇦Stellenbosch, Western Cape, South Africa
Complejo Hospitalario Universitario de Santiago (CHUS) /ID# 252430
🇪🇸Santiago de Compostela, A Coruna, Spain
Hospital Marina Baixa /ID# 254141
🇪🇸Villajoyosa, Alicante, Spain
Hospital Universitario Germans Trias i Pujol /ID# 254144
🇪🇸Badalona, Barcelona, Spain
Consorci Corporacio Sanitaria Parc Tauli Sabadell /ID# 252425
🇪🇸Sabadell, Barcelona, Spain
Hospital Universitario y Politecnico La Fe /ID# 254143
🇪🇸Valencia, Spain
Royal Free Hospital /ID# 252297
🇬🇧London, Greater London, United Kingdom
The Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust /ID# 252301
🇬🇧Kings Lynn, Norfolk, United Kingdom
Queen Mary University of London /ID# 252671
🇬🇧London, United Kingdom
Portsmouth Hospitals University NHS Trust /ID# 252772
🇬🇧Portsmouth, United Kingdom
AZ Arthritis and Rheumotology Research, PLLC - Flagstaff /ID# 253431
🇺🇸Flagstaff, Arizona, United States
Arizona Arthritis and Rheumatology Research - Glendale Office /ID# 255018
🇺🇸Glendale, Arizona, United States
Sun Valley Arthritis Center Ltd. /ID# 254654
🇺🇸Peoria, Arizona, United States
Arizona Arthritis & Rheumatology Associates - East Bell Road /ID# 253432
🇺🇸Phoenix, Arizona, United States
Arizona Arthritis & Rheumatology Associates - East Bell Road /ID# 255021
🇺🇸Phoenix, Arizona, United States
Arizona Arthritis & Rheumatology Associates - Tucson /ID# 255017
🇺🇸Tucson, Arizona, United States
Arthritis and Rheumatism Associates /ID# 254013
🇺🇸Jonesboro, Arkansas, United States
Providence - St. Jude Medical Center /ID# 252690
🇺🇸Fullerton, California, United States
Newport Huntington Medical Group /ID# 252687
🇺🇸Huntington Beach, California, United States
Purushotham & Akther Kotha MD, Inc /ID# 252704
🇺🇸La Mesa, California, United States
Valerius Medical Group & Research Center of Greater Long Beach, Inc /ID# 252692
🇺🇸Los Alamitos, California, United States
Rheumatology Center of San Diego /ID# 255038
🇺🇸San Diego, California, United States
Millennium Clinical Trials /ID# 252689
🇺🇸Thousand Oaks, California, United States
The Lundquist Institute at Harbor-UCLA Medical Center /ID# 252691
🇺🇸Torrance, California, United States
Comprehensive Rheumatology Center /ID# 252688
🇺🇸Woodland Hills, California, United States
University of Colorado Hospital /ID# 254617
🇺🇸Aurora, Colorado, United States
Denver Arthritis Clinic /ID# 254058
🇺🇸Denver, Colorado, United States
Tekton Research - Fort Collins - East Harmony Road /ID# 255036
🇺🇸Fort Collins, Colorado, United States
Arthritis and Rheumatic Disease Specialties /ID# 260583
🇺🇸Aventura, Florida, United States
Rheumatology Associates of South Florida (RASF) - Clinical Research /ID# 253733
🇺🇸Boca Raton, Florida, United States
Bay Area Arthritis and Osteo /ID# 254046
🇺🇸Brandon, Florida, United States
Believe Clinical Trials /ID# 262355
🇺🇸Coral Springs, Florida, United States
International Medical Research /ID# 254651
🇺🇸Daytona Beach, Florida, United States
Omega Research Debary, LLC /ID# 253735
🇺🇸DeBary, Florida, United States
Neoclinical Research /ID# 254622
🇺🇸Hialeah, Florida, United States
Life Clinical Trials /ID# 256061
🇺🇸Margate, Florida, United States
Lakes Research, LLC /ID# 255023
🇺🇸Miami, Florida, United States
HMD Research LLC /ID# 253732
🇺🇸Orlando, Florida, United States
Millennium Research /ID# 253744
🇺🇸Ormond Beach, Florida, United States
Vitalia Research /ID# 274213
🇺🇸Palm Beach Gardens, Florida, United States
BayCare Medical Group /ID# 253799
🇺🇸Saint Petersburg, Florida, United States
Clinical Research of West Florida - Tampa /ID# 255264
🇺🇸Tampa, Florida, United States
Clinical Research of West Florida, Inc /ID# 254649
🇺🇸Tampa, Florida, United States
University of South Florida- Neuroscience Institute /ID# 253745
🇺🇸Tampa, Florida, United States
BayCare Medical Group, Inc. /ID# 255268
🇺🇸Tampa, Florida, United States
Atlanta Research Center for Rheumatology /ID# 254623
🇺🇸Marietta, Georgia, United States
Deerbrook Medical Associates /ID# 254008
🇺🇸Libertyville, Illinois, United States
OrthoIllinois /ID# 254057
🇺🇸Rockford, Illinois, United States
Greater Chicago Specialty Physicians /ID# 254000
🇺🇸Schaumburg, Illinois, United States
Clinic Of Dr. Robert Hozman/Clinical Investigation Specialists, Inc /ID# 253999
🇺🇸Skokie, Illinois, United States
Willow Rheumatology and Wellness, PLLC /ID# 254712
🇺🇸Willowbrook, Illinois, United States