Efficacy and Safety of Vedolizumab Subcutaneous (SC) as Maintenance Therapy in Crohn's Disease (CD)
- Conditions
- Crohn's Disease
- Interventions
- Registration Number
- NCT02611817
- Lead Sponsor
- Takeda
- Brief Summary
The purpose of this study is to assess the effect of vedolizumab subcutaneous (vedolizumab SC) as maintenance treatment in participants with moderately to severely active CD who achieved clinical response following administration of vedolizumab intravenous (vedolizumab IV) induction therapy.
- Detailed Description
The drug being tested in this study is called vedolizumab SC. Vedolizumab SC is being tested to treat people who have moderate to severely active CD. This study will look at clinical remission, as well as enhanced clinical response and corticosteroid-free remission in participants with CD who receive vedolizumab SC maintenance therapy after having achieved a clinical response to vedolizumab IV induction therapy.
The study will enroll approximately 824 participants. All participants will enter a 6 week Induction Phase where they will be administered open-label vedolizumab IV 300 mg via IV infusion at Week 0 (Day 1) and Week 2 (Day 15), and will then be assessed for a clinical response at Week 6. Participants who achieve a clinical response at Week 6 will be randomly assigned to one of the two treatment groups:
* Vedolizumab SC 108 mg Maintenance Arm
* Placebo SC Maintenance Arm
Participants who do not achieve a clinical response will not be randomized into the Maintenance Period, and instead will receive a third infusion of vedolizumab IV 300 mg at Week 6.
This multi-center trial will be conducted worldwide. The overall time to participate in this study is up to 71 weeks. Participants will make multiple visits to the clinic, plus a final visit 18 weeks after last dose of study drug for a follow-up assessment. Participants will also participate in a long-term safety follow-up, by phone, at 6 months after the last dose of study drug.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 644
-
Diagnosis of CD established at least 3 months prior to screening by clinical and endoscopic evidence corroborated by a histopathology report.
-
Moderately to severely active CD as determined by a CDAI score of 220 to 450 and 1 of the following:
- C-reactive protein (CRP) level greater than (>) 2.87 milligram per liter (mg/L) OR
- Ileocolonoscopy with photographic documentation of a minimum of 3 nonanastomotic ulcerations (each >0.5 centimeter [cm] in diameter) or 10 aphthous ulcerations (involving a minimum of 10 contiguous cm of intestine) consistent with CD OR
- Fecal calprotectin >250 microgram per gram (mcg/g) stool during the screening period in conjunction with computed tomography enterography (CTE), magnetic resonance enterography (MRE), contrast-enhanced small bowel radiography, or wireless capsule endoscopy revealing CD ulcerations (aphthae not sufficient).
-
CD involvement of the ileum and/or colon, at a minimum.
-
Inadequate response with, loss of response to, or intolerance to corticosteroids, immunomodulators, or Tumor necrosis factor-alpha (TNF-α) antagonists.
- Evidence of abdominal abscess at Screening.
- Extensive colonic resection, subtotal or total colectomy.
- History of >3 small bowel resections or diagnosis of short bowel syndrome.
- Ileostomy, colostomy, or known fixed symptomatic stenosis of the intestine.
- Prior exposure to investigational or approved non-biologic therapies (example, cyclosporine, tacrolimus, thalidomide, or tofacitinib) for the treatment of underlying disease within 30 days or 5 half-lives of screening (whichever is longer).
- Prior exposure to any investigational or approved biologic or biosimilar agent within 60 days or 5 half-lives of screening (whichever is longer).
- Prior exposure to vedolizumab.
- Surgical intervention for CD required at any time during the study.
- History or evidence of adenomatous colonic polyps that have not been removed, or of colonic mucosal dysplasia.
- Suspected or confirmed diagnosis of ulcerative colitis, indeterminate colitis, ischaemic colitis, radiation colitis, diverticular disease associated with colitis, or microscopic colitis.
- Active infections.
- Chronic hepatitis B virus (HBV) or C (HCV) infection, tuberculosis (TB) (active or latent), or congenital or acquired immunodeficiency. HBV immune participants (that is, being hepatitis B surface antigen [HBsAg] negative and hepatitis B antibody positive) may, however, be included.
- History of any major neurological disorders, including stroke, multiple sclerosis, brain tumor, or neurodegenerative disease.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Vedolizumab SC 108 mg Maintenance Arm Vedolizumab IV 300 mg Open-label Induction: vedolizumab IV 300 milligram (mg), infusion at Week 0 (Day 1) and Week 2 (Day 15) Double-blind Maintenance: vedolizumab SC 108 mg injection once every 2 weeks (Q2W) starting at Week 6 up to Week 50 Vedolizumab SC 108 mg Maintenance Arm Vedolizumab SC 108 mg Open-label Induction: vedolizumab IV 300 milligram (mg), infusion at Week 0 (Day 1) and Week 2 (Day 15) Double-blind Maintenance: vedolizumab SC 108 mg injection once every 2 weeks (Q2W) starting at Week 6 up to Week 50 Placebo SC Maintenance Arm Vedolizumab IV 300 mg Open-label Induction: vedolizumab IV 300 mg, infusion at Week 0 (Day 1) and Week 2 (Day 15) Double-blind Maintenance: matching placebo to vedolizumab SC injection Q2W starting at Week 6 up to Week 50 Placebo SC Maintenance Arm Placebo Open-label Induction: vedolizumab IV 300 mg, infusion at Week 0 (Day 1) and Week 2 (Day 15) Double-blind Maintenance: matching placebo to vedolizumab SC injection Q2W starting at Week 6 up to Week 50
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving Clinical Remission at Week 52 Week 52 Clinical remission is defined as a Crohn's Disease Activity Index (CDAI) score less than or equal to (\<=) 150 at Week 52. A CDAI is a multi-item instrument which measures severity of active Crohn's Disease monitored over 7 days includes participant reported symptoms, physician-assessed signs, and laboratory markers. CDAI score is equal to (=) sum of weighted scores for subjective items (number of liquid/soft stools, degree of abdominal pain, general well-being); and objective items (use of anti-diarrhoeal medication, abdominal mass, haematocrit, presence of extraintestinal manifestation, body weight). CDAI scores range approximately from 0 to 600, higher scores indicating greater disease activity.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Achieving Enhanced Clinical Response at Week 52 Week 52 Enhanced clinical response is defined as a decrease from Baseline of greater than or equal to (\>=) 100 points in the CDAI score at Week 52. A CDAI is a multi-item instrument which measures severity of active CD monitored over 7 days includes participant reported symptoms, physician-assessed signs, and laboratory markers. CDAI score = Sum of weighted scores for subjective items (number of liquid/soft stools, degree of abdominal pain, general well-being); and objective items (use of anti-diarrhoeal medication, abdominal mass, haematocrit, presence of extraintestinal manifestation, body weight). CDAI scores range approximately from 0 to 600, higher scores indicating greater disease activity.
Percentage of Participants Achieving Corticosteroid-free Remission at Week 52 Week 52 Corticosteroid-free remission is defined as participants using oral corticosteroids at Baseline (Week 0) who have discontinued oral corticosteroids and are in clinical remission at Week 52. Clinical remission is defined as a CDAI score \<=150 at Week 52. CDAI score = Sum of weighted scores for subjective items (number of liquid/soft stools, degree of abdominal pain, general well-being); and objective items (use of anti-diarrhoeal medication, abdominal mass, haematocrit, presence of extraintestinal manifestation, body weight). CDAI scores range approximately from 0 to 600, higher scores indicating greater disease activity.
Percentage of TNF-alpha Antagonist Naive Participants Achieving Clinical Remission at Week 52 Week 52 Clinical remission is defined as CDAI score \<=150 at Week 52. CDAI score = Sum of weighted scores for subjective items (number of liquid/soft stools, degree of abdominal pain, general well-being); and objective items (use of anti-diarrhoeal medication, abdominal mass, haematocrit, presence of extraintestinal manifestation, body weight). CDAI scores range approximately from 0 to 600, higher scores indicating greater disease activity.
Trial Locations
- Locations (194)
Royal Melbourne Hospital
🇦🇺Melbourne, Victoria, Australia
UMHAT 'Tsaritsa Yoanna - ISUL', EAD
🇧🇬Sofia, Bulgaria
Semmelweis Egyetem
🇭🇺Budapest, Hungary
Pest Megyei Flor Ferenc Korhaz
🇭🇺Kistarcsa, Hungary
Borsod-Abauj-Zemplen Megyei Kozponti Korhaz es Egyetemi Oktatokorhaz
🇭🇺Miskolc, Hungary
HaEmek Medical Center
🇮🇱Afula, Israel
Hyogo College of Medicine Hospital
🇯🇵Nishinomiya-shi, Hyogo-Ken, Japan
Gokeikai Ofuna Chuo Hospital
🇯🇵Kamakura-shi, Kanagawa-Ken, Japan
Kaplan Medical Center
🇮🇱Rechovot, Israel
IRCCS Ospedale Casa Sollievo della Sofferenza
🇮🇹San Giovanni Rotondo, Foggia, Italy
Kinshukai Infusion Clinic
🇯🇵Osaka-shi, Osaka-Fu, Japan
Tokushukai Sapporo Tokushukai Hospital
🇯🇵Sapporo-shi, Hokkaido, Japan
Sapporo-Kosei General Hospital
🇯🇵Sapporo-shi, Hokkaido, Japan
Tokushukai Sapporo Higashi Tokushukai Hospital
🇯🇵Sapporo-shi, Hokkaido, Japan
Santa Familia Centrum Badan, Profilaktyki i Leczenia
🇵🇱Lodz, Poland
Spitalul Clinic Colentina
🇷🇴Bucuresti, Romania
SBEIHPE Novosibirsk State Medical University
🇷🇺Novosibirsk, Russian Federation
Nzoz Vivamed
🇵🇱Warszawa, Poland
LexMedica Osrodek Badan Klinicznych
🇵🇱Wroclaw, Poland
BHI of Omsk region Clinical Oncology Dispensary
🇷🇺Omsk, Russian Federation
SBIH of Yaroslavl region " Regional Clinical Hospital "
🇷🇺Yaroslavl, Russian Federation
Clinical Helth Centre Zvezdara
🇷🇸Belgrade, Serbia
SBEI HPE "Rostov State Medical University" of the MoH of the RF
🇷🇺Rostov-on-Don, Russian Federation
SPb SBIH "City Hospital # 40 of Kurortnyi region"
🇷🇺Sestroretsk, Russian Federation
SPb SBIH "City Hospital of Saint Martyr Elizaveta"
🇷🇺St. Petersburg, Russian Federation
SI Institute of Gastroenterology of NAMSU Dept of Stomach & Duodenum Diseases, D&ThN SI DMA of MoHU
🇺🇦Dnipro, Ukraine
CNE Prof. O.O. Shalimov Kharkiv City Clinical Hospital #2 of KCC
🇺🇦Kharkiv, Ukraine
Fakultna nemocnica s poliklinikou F.D. Roosevelta
🇸🇰Banska Bystrica, Slovakia
RCI Chernivtsi RCH Dep of Surgery HSEI of Ukr Bukovinian SMU
🇺🇦Chernivtsi, Ukraine
Mackay Memorial Hospital
🇨🇳Taipei, Taiwan
Univerzitna nemocnica Bratislava, Nemocnica Ruzinov
🇸🇰Bratislava, Slovakia
Vinnytsia RCH of Veterans of War Dept of Therapy#1 Vinnytsia M.I.Pyrogov NMU
🇺🇦Vinnytsia, Ukraine
MCIC MC LLC Health Clinic
🇺🇦Vinnytsia, Ukraine
CI A.and O. Tropiny City Clinical Hospital
🇺🇦Kherson, Ukraine
Ternopil University Hospital
🇺🇦Ternopil, Ukraine
Royal Shrewsbury Hospital
🇬🇧Shrewsbury, Shropshire, United Kingdom
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
Vanderbilt University Medical Center
🇺🇸Nashville, Tennessee, United States
Hospital de Clinicas de Porto Alegre
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Centro de Investigacion Farmacologica del Bajio, S.C.
🇲🇽Leon, Guanajuato, Mexico
Arizona Arthritis & Rheumatology Research, PLLC
🇺🇸Phoenix, Arizona, United States
Fundacao Faculdade Regional de Medicina de Sao Jose do Rio Preto
🇧🇷Sao Jose do Rio Preto, Sao Paulo, Brazil
Middlesex Gastroenterology Associates
🇺🇸Middletown, Connecticut, United States
Metropolitan Gastroenterology Group, PC, Chevy Chase Clinical Research
🇺🇸Chevy Chase, Maryland, United States
Louisiana Research Center, LLC
🇺🇸Shreveport, Louisiana, United States
Gastroenterology Associates of Central Georgia
🇺🇸Macon, Georgia, United States
Carle Foundation Hospital
🇺🇸Urbana, Illinois, United States
Medical Research Center of Connecticut, LLC
🇺🇸Hamden, Connecticut, United States
Shafran Gastroenterology Center
🇺🇸Winter Park, Florida, United States
Gastroenterology Associates of Western Michigan, P.L.C.
🇺🇸Wyoming, Michigan, United States
Gastro-Enterology Research of Lima
🇺🇸Lima, Ohio, United States
Gastroenterology Group of Naples
🇺🇸Naples, Florida, United States
Nature Coast Clinical Research, LLC
🇺🇸Inverness, Florida, United States
Grand Teton Research Group, PLL
🇺🇸Idaho Falls, Idaho, United States
Gastroenterology Center of the MidSouth PC
🇺🇸Germantown, Tennessee, United States
Universitair Ziekenhuis Gent
🇧🇪Gent, Belgium
ZNA Jan Palfijn
🇧🇪Merksem, Belgium
Allegiance Research Specialists, LLC
🇺🇸Milwaukee, Wisconsin, United States
Tri-State Gastroenterology Associates
🇺🇸Crestview Hills, Kentucky, United States
AZ Delta
🇧🇪Roeselare, Belgium
Gastroenterology Associates, LLC
🇺🇸Baton Rouge, Louisiana, United States
Clinical Research Institute of Michigan, LLC
🇺🇸Chesterfield, Michigan, United States
Fiona Stanley Hospital
🇦🇺Murdoch, Western Australia, Australia
Royal Adelaide Hospital
🇦🇺Adelaide, South Australia, Australia
Long Island Clinical Research Associates
🇺🇸Great Neck, New York, United States
Ehrhardt Clinical Research, LLC
🇺🇸Belton, Missouri, United States
St John of God Subiaco Hospital
🇦🇺Subiaco, Western Australia, Australia
Imeldaziekenhuis
🇧🇪Bonheiden, Belgium
AZ Groeninge - Kennedylaan
🇧🇪Kortrijk, Belgium
HUGG - Hospital Universitario Gaffree e Guinle
🇧🇷Rio de Janeiro, Rio Do Janeiro, Brazil
Irmandade da Santa Casa da Misericordia de Santos
🇧🇷Santos, Sao Paulo, Brazil
Nepean Hospital
🇦🇺Kingswood, New South Wales, Australia
University Clinical Centre of the Republic of Srpska
🇧🇦Banja Luka, Bosnia and Herzegovina
Options Health Research
🇺🇸Tulsa, Oklahoma, United States
Instituto Goiano de Gastroenterologia e Endoscopia Digestiva Ltda
🇧🇷Goiania, Goias, Brazil
San Antonio Gastroenterology
🇺🇸San Antonio, Texas, United States
University Clinical Hospital Mostar
🇧🇦Mostar, Bosnia and Herzegovina
UNESP - Faculdade de Medicina da Universidade Estadual Paulista - Campus Botucatu
🇧🇷Botucatu, Sao Paulo, Brazil
UMHAT "Sv. Ivan Rilski", EAD
🇧🇬Sofia, Bulgaria
PerCuro Clinical Research Ltd.
🇨🇦Victoria, British Columbia, Canada
"City Clinic UMHAC" EOOD
🇧🇬Sofia, Bulgaria
Fourth MHAT - Sofia EAD
🇧🇬Sofia, Bulgaria
Zeidler Ledcor Centre - University of Alberta
🇨🇦Edmonton, Alberta, Canada
Regionshospitalet Silkeborg
🇩🇰Silkeborg, Denmark
Medizinische Hochschule Hannover
🇩🇪Hannover, Niedersachsen, Germany
CCBR - Czech Brno, s.r.o..
🇨🇿Brno, Czechia
CCBR Czech Prague, s.r.o.
🇨🇿Praha 3, Czechia
LHSC - Victoria Hospital
🇨🇦London, Ontario, Canada
A-SHINE s.r.o.
🇨🇿Plzen, Czechia
North Estonia Medical Centre Foundation
🇪🇪Tallinn, Estonia
LHSC - University Hospital
🇨🇦London, Ontario, Canada
Toronto Digestive Disease Associates, Inc.
🇨🇦Vaughan, Ontario, Canada
Chaim Sheba Medical Center
🇮🇱Ramat Gan, Israel
Tel Aviv Sourasky Medical Center
🇮🇱Tel Aviv, Israel
Azienda Ospedaliera Universitaria Policlinico Sant'Orsola Malpighi
🇮🇹Bologna, Italy
Hepato-Gastroenterologie HK s.r.o.
🇨🇿Hradec Kralove, Czechia
Policlinico Universitario Agostino Gemelli
🇮🇹Roma, Italy
Axon Clinical s.r.o.
🇨🇿Praha 5, Czechia
Fejer Megyei Szent Gyorgy Egyetemi Oktato Korhaz
🇭🇺Szekesfehervar, Hungary
Krankenhaus Waldfriede e. V.
🇩🇪Berlin, Germany
Universitaetsmedizin der Johannes Gutenberg-Universitaet Mainz
🇩🇪Mainz, Rheinland Pfalz, Germany
Karolina Korhaz-Rendelointezet
🇭🇺Mosonmagyarovar, Hungary
Tolna Megyei Balassa Janos Korhaz
🇭🇺Szekszard, Hungary
Azienda Ospedaliera Ospedale Cannizzaro
🇮🇹Catania, Italy
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
EUGASTRO GmbH
🇩🇪Leipzig, Sachsen, Germany
Shaare Zedek Medical Center
🇮🇱Jerusalem, Israel
Azienda Socio Sanitaria Territoriale Fatebenefratelli (Presidio Ospedale Sacco)
🇮🇹Milano, Italy
Azienda Ospedaliera Vincenzo Cervello
🇮🇹Palermo, Italy
DRK Kliniken Berlin Westend
🇩🇪Berlin, Germany
Obudai Egeszsegugyi Centrum Kft.
🇭🇺Budapest, Hungary
Pannonia Maganorvosi Centrum
🇭🇺Budapest, Hungary
Azienda Ospedaliera San Camillo Forlanini
🇮🇹Roma, Italy
I.R.C.C.S Policlinico San Donato
🇮🇹San Donato Milanese (MI), Milano, Italy
Azienda Ospedaliera di Padova
🇮🇹Padova, Italy
Hamamatsu South Hospital
🇯🇵Hamamatsu-shi, Shizuoka-Ken, Japan
Ars-Medica S.C Rybak Maria, Rybak Zbigniew
🇵🇱Wroclaw, Poland
JCHO Tokyo Yamate Medical Center
🇯🇵Shinjuku-ku, Tokyo-To, Japan
Kyungpook National University Hospital
🇰🇷Daegu, Korea, Republic of
Kangbuk Samsung Hospital
🇰🇷Seoul, Korea, Republic of
Vilnius University Hospital Santariskiu Clinic, Public Institution
🇱🇹Vilnius, Lithuania
Kyung Hee University Hospital
🇰🇷Seoul, Korea, Republic of
Morales Vargas Centro de Investigacion, S.C.
🇲🇽Leon, Guanajuato, Mexico
Gabinet Endoskopii Przewodu Pokarmowego
🇵🇱Krakow, Poland
SPZOZ Uniwersytecki Szpital Klin. nr 1 im.N.Barlickiego UM
🇵🇱Lodz, Poland
Instituto de Investigaciones Aplicadas a la Neurociencia A.C.
🇲🇽Durango, Mexico
Sociedad de Metabolismo y Corazon S.C
🇲🇽Veracruz, Mexico
Academisch Medisch Centrum
🇳🇱Amsterdam, Netherlands
Albert Schweitzer Ziekenhuis, Dordwijk
🇳🇱Dordrecht, Netherlands
Erasmus Medisch Centrum
🇳🇱Rotterdam, Netherlands
NZOZ Vitamed
🇵🇱Bydgoszcz, Poland
Centralny Szpital Kliniczny MSW w Warszawie
🇵🇱Warszawa, Poland
Twoja Przychodnia-Szczecinskie Centrum Medyczne
🇵🇱Szczecin, Poland
Centrum Onkologii-Instytut im. M. Sklodowskiej Curie
🇵🇱Warszawa, Poland
FSBSI "Scientific and Research Institute of Physiology and Basic Medicine"
🇷🇺Novosibirsk, Russian Federation
Kazan State Medical University
🇷🇺Kazan, Russian Federation
Institutul Clinic Fundeni
🇷🇴Bucuresti, Romania
S.C Centrul de Gastroenterologie Dr. Goldis S.R.L
🇷🇴Timisoara, Romania
SBEI of HPE "Omsk SMA" SBEI HPE "Omsk State Medical University" of the MoH of the RF
🇷🇺Omsk, Russian Federation
Clinical Center of Vojvodina
🇷🇸Novi Sad, Serbia
Military Medical Academy
🇷🇸Belgrade, Serbia
Clinical Center Bezanijska kosa
🇷🇸Belgrade, Serbia
Clinical Center Kragujevac
🇷🇸Kragujevac, Serbia
Dr CCM Ziady Practice
🇿🇦Pretoria, Gauteng, South Africa
Dr JP Wright Practice
🇿🇦Cape Town, Western Cape, South Africa
Ankara University Medical Faculty
🇹🇷Ankara, Turkey
Karolinska Universitetssjukhuset - Solna
🇸🇪Stockholm, Sweden
Haydarpasa Numune Training and Research Hospital
🇹🇷Istanbul, Turkey
Marmara University Pendik Research and Training Hospital
🇹🇷Istanbul, Turkey
Kocaeli Derince Training and Research Hospital
🇹🇷Kocaeli, Turkey
CI of Kyiv RC Kyiv Regional Clinical Hospital
🇺🇦Kyiv, Ukraine
MI of Healthcare Kyiv RCH P.L. Shupyk NMA of PGE
🇺🇦Kyiv, Ukraine
Mersin University Medical Faculty
🇹🇷Mersin, Turkey
Kyiv CCH #12 Dept of Therapy O.O.Bogomolets NMU
🇺🇦Kyiv, Ukraine
Whipps Cross University Hospital
🇬🇧London, Greater London, United Kingdom
University Hospital Coventry
🇬🇧Coventry, West Midlands, United Kingdom
CI City Hospital #1
🇺🇦Zaporizhzhia, Ukraine
Private Small Enterprise Medical Center Pulse
🇺🇦Vinnytsia, Ukraine
Yeungnam University Hospital
🇰🇷Daegu, Korea, Republic of
Severance Hospital, Yonsei University
🇰🇷Seoul, Korea, Republic of
Cotton-O'Neil Clinical Research Center, Digestive Health
🇺🇸Topeka, Kansas, United States
Hospital of Lithuanian University of Health Sciences Kaunas Clinics
🇱🇹Kaunas, Lithuania
L & L Research Choices, Inc.
🇺🇸Miami, Florida, United States
Atlanta Gastroenterology Associates
🇺🇸Atlanta, Georgia, United States
Mayo Clinic - Rochester
🇺🇸Rochester, Minnesota, United States
University of North Carolina at Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States
Concord Repatriation General Hospital
🇦🇺Concord, New South Wales, Australia
Ballarat Base Hospital
🇦🇺Ballarat, Victoria, Australia
The Alfred Hospital
🇦🇺Melbourne, Victoria, Australia
HUCFF-UFRJ - Hospital Universitario Clementino Fraga Filho - Universidade Federal do Rio de Janeiro
🇧🇷Rio de Janeiro, Rio Do Janeiro, Brazil
Faculdade de Medicina do ABC
🇧🇷Santo Andre, Sao Paulo, Brazil
MHAT "Hadzhi Dimitar", OOD
🇧🇬Sliven, Bulgaria
Odense Universitetshospital
🇩🇰Odense C, Denmark
Soroka University Medical Center
🇮🇱Beer Sheva, Israel
Szent Janos Korhaz es Eszak-budai Egyesitett Korhazak
🇭🇺Budapest, Hungary
A.O.U. Policlinico di Modena
🇮🇹Modena, Italy
Saga University Hospital
🇯🇵Saga-shi, Saga-Ken, Japan
Toho University Sakura Medical Center
🇯🇵Sakura-shi, Chiba-Ken, Japan
Fukuoka University Chikushi Hospital
🇯🇵Chikushino-shi, Fukuoka-Ken, Japan
Iwate Medical University Hospital
🇯🇵Morioka-shi, Iwate-Ken, Japan
Kitasato University Kitasato Institute Hospital
🇯🇵Minato-ku, Tokyo-To, Japan
Wakayama Medical University Hospital
🇯🇵Wakayama-shi, Wakayama-Ken, Japan
Asan Medical Center
🇰🇷Seoul, Korea, Republic of
Samsung Medical Center
🇰🇷Seoul, Korea, Republic of
Centrum Zdrowia MDM
🇵🇱Warszawa, Poland
TSBIH "Territorial Clinical Hospital"
🇷🇺Krasnoyarsk, Russian Federation
GASTROMED Sp. z o.o.
🇵🇱Lublin, Poland
LLC "RIAT SPb"
🇷🇺Saint-Petersburg, Russian Federation
CI Odesa Regional Clinical Hospital
🇺🇦Odesa, Ukraine
Communal City Clinical Hospital of Ambulance, Dept of Therapy #1 D.Halytskyi Lviv NMU
🇺🇦Lviv, Ukraine
St George's Hospital
🇬🇧London, Greater London, United Kingdom
Royal Devon and Exeter Hospital (Wonford)
🇬🇧Exeter, Devon, United Kingdom
Atlanta Gastroenterology Specialists, PC
🇺🇸Suwanee, Georgia, United States
Tennyson Centre Day Hospital
🇦🇺Bedford Park, South Australia, Australia