A Study Comparing Risankizumab to Placebo in Participants With Active Psoriatic Arthritis (PsA) Who Have a History of Inadequate Response to or Intolerance to at Least One Disease Modifying Anti-Rheumatic Drug (DMARD) Therapy
- Conditions
- Psoriatic Arthritis
- Interventions
- Biological: PlaceboBiological: Risankizumab
- Registration Number
- NCT03675308
- Lead Sponsor
- AbbVie
- Brief Summary
The purpose of this study is to compare the safety and efficacy of risankizumab versus placebo in participants with moderately to severely active psoriatic arthritis (PsA).
- Detailed Description
The study consists of a Screening Period (approximately 35 days), Period 1, Period 2, and a 20-week Follow-up Period. Period 1 is a 24-week randomized, double-blind, placebo-controlled, parallel-group treatment period. Period 2 is the long-term treatment period and starts at Week 24. To maintain the blind to the original treatment allocation, treatment at the Week 24 Visit is blinded: participants randomized to placebo receive blinded risankizumab 150 mg, and participants randomized to risankizumab receive blinded placebo. At Week 28 and for the remaining dosing visits (to Week 316), all participants are to receive open-label risankizumab 150 mg every 12 weeks. Participants will remain blinded to the original randomization allocation for the duration of the study. The total study duration is 336 weeks including a telephone call 140 days (20 weeks) after last dose of study drug.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 964
-
Clinical diagnosis of PsA with symptom onset at least 6 months prior to the Screening Visit and fulfillment of the Classification Criteria for PsA (CASPAR) at the Screening Visit.
-
Participant has active disease at Baseline defined as ≥ 5 tender joints (based on 68 joint counts) and ≥ 5 swollen joints (based on 66 joint counts)
-
Diagnosis of active plaque psoriasis with at least one psoriatic plaque of ≥ 2 cm diameter or nail changes consistent with psoriasis at Screening Visit.
-
Participant has demonstrated an inadequate response or intolerance to or contraindication for conventional synthetic disease modifying anti-rheumatic drugs (csDMARD) therapy(ies).
-
Presence of either at Screening:
- ≥ 1 erosion on radiograph as determined by central imaging review or;
- High sensitivity C-reactive protein (hsCRP) ≥ 3.0 mg/L.
- Participant is considered by investigator, for any reason, to be an unsuitable candidate for the study.
- Participant has a known hypersensitivity to risankizumab.
- Participant has previous treatment with biologic agent.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Risankizumab Placebo Participants randomized to receive 150 mg risankizumab administered by subcutaneous injection at Week 0, Week 4, and Week 16 in Period 1. At Week 24 participants will receive blinded placebo followed by open-label 150 mg risankizumab at Week 28, and every 12 weeks thereafter in Period 2 until the final dosing time point at Week 316. Placebo Placebo Participants randomized to receive double-blind placebo at Week 0, Week 4, and Week 16 in Period 1. At Week 24 participants will receive 150 mg risankizumab followed by open-label 150 mg risankizumab at Week 28, and every 12 weeks thereafter in Period 2 until the final dosing time point at Week 316. Placebo Risankizumab Participants randomized to receive double-blind placebo at Week 0, Week 4, and Week 16 in Period 1. At Week 24 participants will receive 150 mg risankizumab followed by open-label 150 mg risankizumab at Week 28, and every 12 weeks thereafter in Period 2 until the final dosing time point at Week 316. Risankizumab Risankizumab Participants randomized to receive 150 mg risankizumab administered by subcutaneous injection at Week 0, Week 4, and Week 16 in Period 1. At Week 24 participants will receive blinded placebo followed by open-label 150 mg risankizumab at Week 28, and every 12 weeks thereafter in Period 2 until the final dosing time point at Week 316.
- Primary Outcome Measures
Name Time Method Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 24 Baseline and Week 24 Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria:
1. ≥ 20% improvement in 68-tender joint count;
2. ≥ 20% improvement in 66-swollen joint count; and
3. ≥ 20% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).
- Secondary Outcome Measures
Name Time Method Percentage of Participants With an ACR20 Response at Week 16 Baseline and Week 16 Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria:
1. ≥ 20% improvement in 68-tender joint count;
2. ≥ 20% improvement in 66-swollen joint count; and
3. ≥ 20% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).Change From Baseline In 36-Item Short Form Health Survey (SF-36) Physical Component Summary (PCS) Score at Week 24 Baseline and Week 24 The Short Form 36-Item Health Survey (SF-36) Version 2 is a self-administered questionnaire that measures the impact of disease on overall quality of life during the past 4 weeks. The SF-36 consists of 36 questions in eight domains (physical function, pain, general and mental health, vitality, social function, physical and emotional health).
The physical component summary is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The SF-36 PCS ranges from 0 to 100. A linear algorithm was applied to the calculation of the PCS which has a normative mean value of 50. Higher scores are associated with less disability; a score of 100 is equivalent to no disability and a score of 0 is equivalent to maximum disability. A positive change from Baseline score indicates improvement.Change From Baseline In Health Assessment Questionnaire-Disability Index (HAQ-DI) at Week 24 Baseline and Week 24 The Health Assessment Questionnaire Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability.
A negative change from Baseline in the overall score indicates improvement.Percentage of Participants Achieving Psoriasis Area Severity Index (PASI) 90 Response at Week 24 Baseline and Week 24 PASI is a composite score based on the percentage of the body surface area (BSA) affected by psoriasis and the intensity of erythema (reddening), induration (thickening or hardening of the skin), and desquamation (peeling of the skin) of lesions assessed at 4 anatomic sites (head, upper extremities, trunk, and lower extremities). At each location, the percentage of BSA involvement is assigned a score from 0 (no involvement) to 6 (90% to 100% involvement), and erythema, induration, and desquamation are scored on a scale from 0 (no symptoms) to 4 (very marked).
The PASI score ranges from 0 (no psoriasis) to 72 (very severe psoriasis). A PASI 90 response is the percentage of participants who achieved at least a 90% reduction (improvement) from Baseline in PASI score.Percentage of Participants With Resolution of Enthesitis at Week 24 Week 24 Resolution of enthesitis is defined as a Leeds Enthesitis Index (LEI) score = 0.
LEI is an enthesitis measure developed specifically for PsA and assesses the presence or absence of tenderness at the following 3 bilateral enthesial sites: medial femoral condyles, lateral epicondyles of the humerus, and Achilles tendon insertions. Tenderness on examination is recorded as either present (coded as 1), absent (coded as 0), or not assessed for each of the 6 sites. The LEI is calculated by taking the sum of the scores from the 6 sites. The LEI ranges from 0 to 6 (worst).
To increase the sample size due to the smaller number of participants with enthesitis at Baseline, the pre-specified analysis of the resolution of enthesitis included pooled data from KEEPsAKE 1 (this study) and the companion study KEEPsAKE 2 (M15-998; NCT03671148).Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 24 Baseline and Week 24 Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR50 response criteria:
1. ≥ 50% improvement in 68-tender joint count;
2. ≥ 50% improvement in 66-swollen joint count; and
3. ≥ 50% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).Percentage of Participants Achieving Minimal Disease Activity (MDA) at Week 24 Week 24 A participant was classified as achieving MDA if 5 of the following 7 criteria were met:
* Tender joint count (out of 68 joints) ≤ 1
* Swollen joint count (out of 66 joints) ≤ 1
* PASI score ≤ 1 (score ranges from 0 - 72) or percent BSA involved with psoriasis ≤ 3%
* Patient's assessment of pain ≤ 15 (VAS from 0 to 100)
* Patient's Global Assessment of disease activity ≤ 20 (VAS from 0 to 100)
* HAQ-DI score ≤ 0.5 (index score ranges from 0 to 3)
* Leeds Enthesitis Index ≤ 1 (assesses the presence or absence of enthesitis at 3 bilateral sites, for an overall score range from 0 to 6)Change From Baseline in Fingernail-Physician Global Assessment (PGA-F) Baseline and Week 24 The PGA-F is a clinician-rated outcomes assessment used to measure the severity of signs and symptoms associated with fingernail psoriasis. Participant's fingernails were assessed separately for nail bed signs and nail matrix signs of disease on a scale from 0 (clear) to 4 (severe). A participant's overall global score is the worse of the nail bed score and nail matrix score. For example, if a participant had a nail bed score '2' and a nail matrix score of '4,' this participant's overall score was '4.' A negative change from Baseline indicates improvement.
Change From Baseline in PsA Modified Total Sharp Score (mTSS) at Week 24 Baseline and Week 24 The Sharp-van der Heijde modified scoring method for PsA measures the level of joint damage from radiographs of the hands and feet, and was assessed by 2 independent, blinded readers.
Joint erosion severity was assessed in 20 joints in each hand and wrist and 6 joints in each foot. Each joint was scored from 0 (no erosion) to 5 for hands/wrists or to 10 for feet (complete collapse). The total erosion score ranges from 0 to 320 (worst).
Joint space narrowing (JSN) was assessed in 20 joints of each hand and wrist, and 6 joints of each foot, from 0 (normal) to 4 (complete loss of joint space, bony ankylosis, or luxation). The total JSN score ranges from 0 to 208 (worst).
Joints with gross osteolysis or pencil in cup were assigned the maximum score for both erosions and JSN.
The total mTSS score is the sum of the joint erosion and JSN scores and ranges from 0 (normal) to 528 (worst).Change From Baseline in Modified Nail Psoriasis Severity Index (mNAPSI) Score at Week 24 Baseline and Week 24 The investigator assessed each fingernail for onycholysis (separation of the nail plate from the nail bed) and oil-drop (salmon patch) dyschromia (reddish-brown discoloration under the nail plate) on a scale of 0 (none present) to 3 (\>30% of the nail), pitting (small, sharply defined depressions in the nail surface) on a scale of 0 (0 pits present) to 3 (\> 50 pits present), and nail plate crumbling on a scale of 0 (no crumbling) to 3 (\>50% of nail has crumbling) and presence (1) or absence (0) of leukonychia (white spots), splinter hemorrhages, nail bed hyperkeratosis, and red spots in the lunula.
The mNAPSI score is calculated as the sum of all the components for all of the participant's fingernails giving a range of possible scores from 0 (absence of nail psoriasis) to 130 (the most severe nail psoriasis). A negative change from Baseline indicates improvement.Percentage of Participants With Resolution of Dactylitis at Week 24 Week 24 Resolution of dactylitis is defined as a Leeds Dactylitis Index (LDI) score = 0.
LDI basic is a score based on finger circumference and tenderness, assessed across all digits. The LDI basic measures the ratio of the circumference of the affected digit to the circumference of the digit on the opposite hand or foot, using a minimum difference of 10% to define a dactylitic digit. The ratio of circumference is multiplied by a tenderness score (1 for tender, 0 for non-tender). If both sides of a digit are considered involved, or the circumference of the contralateral digit cannot be obtained, a standard reference table is used. Scores from each digit are summed to provide the final LDI. A higher LDI indicates worse dactylitis.
To increase sample size due to the smaller number of participants with dactylitis at Baseline, the pre-specified analysis of the resolution of dactylitis included pooled data from KEEPsAKE 1 (this study) and the companion study KEEPsAKE 2 (M15-998; NCT03671148).Change From Baseline In Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Score at Week 24 Baseline and Week 24 The FACIT-Fatigue questionnaire is a self-administered patient questionnaire that consists of 13 questions designed to measure the degree of fatigue experienced by participants in the previous 7 days, including physical fatigue (e.g., I feel tired), functional fatigue (e.g., trouble finishing things), emotional fatigue (e.g., frustration), and social consequences of fatigue (e.g., limits social activity). Participants respond to the questions on a scale from 0 (not at all) to 4 (very much).
The FACIT-Fatigue score is computed by summing the item scores, after reversing those items that are worded in the negative direction. The FACIT-Fatigue score ranges from 0 to 52, where higher scores represent less fatigue.
A positive change from Baseline indicates improvement.Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 24 Baseline and Week 24 Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR70 response criteria:
1. ≥ 70% improvement in 68-tender joint count;
2. ≥ 70% improvement in 66-swollen joint count; and
3. ≥ 70% improvement in at least 3 of the 5 following parameters:
* Physician global assessment of disease activity
* Patient global assessment of disease activity
* Patient assessment of pain
* Health Assessment Questionnaire - Disability Index (HAQ-DI)
* High-sensitivity C-reactive protein (hsCRP).
Trial Locations
- Locations (256)
Duplicate_Azienda Ospedaliero-Universitaria Policlinico di Modena /ID# 207799
🇮🇹Modena, Emilia-Romagna, Italy
Medvin Clinical Research /ID# 211127
🇺🇸Whittier, California, United States
June DO, PC /ID# 208915
🇺🇸Lansing, Michigan, United States
Joint & Muscle Research Instit /ID# 208620
🇺🇸Charlotte, North Carolina, United States
Coastal Carolina Health Care /ID# 208619
🇺🇸New Bern, North Carolina, United States
Paramount Medical Research Con /ID# 201583
🇺🇸Middleburg Heights, Ohio, United States
Altoona Ctr Clinical Res /ID# 168037
🇺🇸Duncansville, Pennsylvania, United States
Clinical Research Ctr Reading /ID# 168070
🇺🇸Wyomissing, Pennsylvania, United States
Amarillo Ctr for Clin Research /ID# 208347
🇺🇸Amarillo, Texas, United States
Precision Comprehensive Clinical Research Solutions /ID# 210597
🇺🇸Fort Worth, Texas, United States
Kadlec Clinic Rheumatology /ID# 207969
🇺🇸Kennewick, Washington, United States
Rheumatology and Pulmonary Clinic /ID# 200446
🇺🇸Beckley, West Virginia, United States
Aurora Rheumatology and Immunotherapy Center /ID# 168066
🇺🇸Franklin, Wisconsin, United States
Gundersen Clinic, Ltd /ID# 209459
🇺🇸Onalaska, Wisconsin, United States
Framingham Centro Medico /ID# 210409
🇦🇷La Plata, Buenos Aires, Argentina
Hospital General de Agudos J. M. Ramos Mejia /ID# 169164
🇦🇷Buenos Aires, Ciuadad Autonoma De Buenos Aires, Argentina
Hospital Italiano de Buenos Aires /ID# 208474
🇦🇷Ciudad Autonoma Buenos Aires, Ciuadad Autonoma De Buenos Aires, Argentina
Centro Medico Privado de Reumatologia /ID# 208343
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
Duplicate_Inst de Rehab Psicofisica /ID# 214681
🇦🇷Buenos Aires, Argentina
Duplicate_Hospital Privado Univesitario /ID# 211623
🇦🇷Cordoba, Argentina
The Canberra Hospital /ID# 207592
🇦🇺Garran, Australian Capital Territory, Australia
Rheumatology Research Unit Sunshine Coast /ID# 207200
🇦🇺Maroochydore, Queensland, Australia
Medical center Excelsior /ID# 167741
🇧🇬Sofia, Bulgaria
Manitoba Clinic /ID# 206819
🇨🇦Winnipeg, Manitoba, Canada
SKIN Centre for Dermatology /ID# 169604
🇨🇦Peterborough, Ontario, Canada
K. Papp Clinical Research /ID# 169603
🇨🇦Waterloo, Ontario, Canada
Groupe de Recherche en Maladies Osseuses Inc /ID# 169598
🇨🇦Sainte-foy, Quebec, Canada
Duplicate_Policlinico Univ Tor Vergata /ID# 207271
🇮🇹Rome, Italy
Centro Internacional de Estudios Clinicos /ID# 209908
🇨🇱Santiago, Chile
Poliklinika Solmed /ID# 210965
🇭🇷Zagreb, Grad Zagreb, Croatia
UHC Osijek /ID# 208623
🇭🇷Osijek, Osjecko-baranjska Zupanija, Croatia
Klinicki bolnicki centar Split /ID# 208626
🇭🇷Split, Splitsko-dalmatinska Zupanija, Croatia
Medical Center Kuna-Peric /ID# 208047
🇭🇷Zagreb, Croatia
Poliklinika Bonifarm /ID# 208750
🇭🇷Zagreb, Croatia
PV MEDICAL Services s.r.o. /ID# 210222
🇨🇿Praha, Czechia
Revmacentrum MUDr. Mostera, s.r.o. /ID# 209025
🇨🇿Brno, Czechia
Aarhus University Hospital /ID# 168761
🇩🇰Aarhus C, Midtjylland, Denmark
Innomedica /ID# 211416
🇪🇪Tallinn, Harjumaa, Estonia
MediTrials /ID# 207816
🇪🇪Tartu, Tartumaa, Estonia
Turku University Hospital /ID# 207726
🇫🇮Turku, Finland
Rheumazentrum Ruhrgebiet /ID# 207216
🇩🇪Herne, Nordrhein-Westfalen, Germany
Immanuel Krankenhaus Berlin /ID# 207218
🇩🇪Berlin-buch, Germany
MVZ Rheumatologie und Autoimmunmedizin Hamburg GmbH /ID# 209484
🇩🇪Hamburg, Germany
424 General MILITARY Hospital /ID# 210974
🇬🇷Efkarpia (Thessalonikis), Thessaloniki, Greece
Rambam Health Care Campus /ID# 208170
🇮🇱Haifa, Israel
Barzilai Medical Center /ID# 207476
🇮🇱Ashkelon, Israel
Meir Medical Center /ID# 207473
🇮🇱Kfar Saba, Israel
Rabin Medical Center /ID# 207475
🇮🇱Petakh Tikva, Israel
A.O.U. Policlinico G. Rodolico S.Marco - Presidio San Marco /ID# 207795
🇮🇹Catania, Italy
Hanyang University Seoul Hospital /ID# 209263
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Duplicate_Konkuk University Medical Ctr /ID# 207509
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Kyungpook National Univ Hosp /ID# 207408
🇰🇷Daegu, Korea, Republic of
Hospital Selayang /ID# 208938
🇲🇾Batu Caves, Selangor, Malaysia
University Malaya Med Ctr /ID# 208937
🇲🇾Kuala Lumpur, Malaysia
Malopolskie Centrum Kliniczne /ID# 208007
🇵🇱Krakow, Malopolskie, Poland
Ulyanovsk Regional Clinical Hospital /ID# 169515
🇷🇺Ulyanovsk, Russian Federation
Kazan State Medical University /ID# 169511
🇷🇺Kazan, Tatarstan, Respublika, Russian Federation
Institute for Rheumatology /ID# 168199
🇷🇸Belgrade, Beograd, Serbia
Hospital Universitario Torrecardenas /ID# 212716
🇪🇸Almeria, Spain
Chung Shan Medical University Hospital /ID# 207257
🇨🇳Taichung, Taiwan
Arthritis and Rheumatology /ID# 168046
🇺🇸Atlanta, Georgia, United States
Precision Comprehensive Clinical Research Solutions /ID# 208386
🇺🇸Colleyville, Texas, United States
Dallas VA Medical Center /ID# 208389
🇺🇸Dallas, Texas, United States
Advanced Rheumatology of Houston /ID# 208354
🇺🇸The Woodlands, Texas, United States
Royal Brisbane and Women's Hospital /ID# 212785
🇦🇺Herston, Queensland, Australia
Percuro Clinical Research, Ltd /ID# 169601
🇨🇦Victoria, British Columbia, Canada
DM Clinical Research /ID# 208351
🇺🇸Tomball, Texas, United States
SER - Serviços Especializados em Reumatologia /ID# 207489
🇧🇷Salvador, Bahia, Brazil
Special Hospital for Rheuma /ID# 210284
🇷🇸Novi Sad, Vojvodina, Serbia
General Hospital Asklepieio Voulas /ID# 212956
🇬🇷Athens, Attiki, Greece
Naval Hospital of Athens /ID# 206838
🇬🇷Athens, Greece
LMK Sevicos Medicos S/S /ID# 207491
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Klaipeda University Hospital /ID# 207329
🇱🇹Klaipeda, Lithuania
Centro Integral en Reumatologia S.A de C.V /ID# 208346
🇲🇽Guadalajara, Jalisco, Mexico
Logan Health Research /ID# 213707
🇺🇸Kalispell, Montana, United States
Thermium s.r.o. /ID# 208015
🇸🇰Piestany, Slovakia
Midlands Partnership NHS Foundation Trust /ID# 214941
🇬🇧Stafford, Staffordshire, United Kingdom
Centro de Enfermedades del Hígado y Aparato Digestivo /ID# 169163
🇦🇷Rosario, Santa Fe, Argentina
Dr. Latha Naik /ID# 212188
🇨🇦Saskatoon, Saskatchewan, Canada
North Estonia Medical Centre /ID# 208325
🇪🇪Mustamäe Linnaosa, Harjumaa, Estonia
Unidade Local de Saúde do Alto Minho, EPE - Hospital Conde de Bertiandos /ID# 208147
🇵🇹Ponte de Lima, Viana Do Castelo, Portugal
Dr Jenny Potts /ID# 168691
🇿🇦Port Elizabeth, Eastern Cape, South Africa
NHS Greater Glasgow and Clyde /ID# 214942
🇬🇧Glasgow, Scotland, United Kingdom
Ite Pihlajanlinna Kuopio /ID# 208322
🇫🇮Kuopio, Finland
VAKK Dr. Kilda's Clinic /ID# 207330
🇱🇹Kaunas, Lithuania
Institute for Rheumatology /ID# 168198
🇷🇸Belgrade, Beograd, Serbia
Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation /ID# 207567
🇨🇳Chia-Yi, Taiwan
CTR Estudios Clinicos /ID# 208166
🇨🇱Providencia, Chile
Changi General Hospital /ID# 208965
🇸🇬Singapore, Singapore
Helsinki University Hospital /ID# 207724
🇫🇮Helsinki, Uusimaa, Finland
Eukarya PharmaSite, SC /ID# 208431
🇲🇽Monterrey, Nuevo Leon, Mexico
Spitalul Clinic de Recuperare Iasi /ID# 207371
🇷🇴Iasi, Romania
Bispebjerg and Frederiksberg Hospital /ID# 207576
🇩🇰Frederiksberg, Hovedstaden, Denmark
Affidea Praha s.r.o. /ID# 210223
🇨🇿Praha, Czechia
MEDICAL PLUS, s.r.o. /ID# 210439
🇨🇿Uherske Hradiste, Czechia
DOM Centro de Reumatologia /ID# 208479
🇦🇷Ciudad Autonoma de Buenos Aire, Ciuadad Autonoma De Buenos Aires, Argentina
Rheumatology Center of San Diego /ID# 201642
🇺🇸San Diego, California, United States
Medication Management, LLC /ID# 211734
🇺🇸Greensboro, North Carolina, United States
Pinnacle Research Group /ID# 167955
🇺🇸Anniston, Alabama, United States
Arizona Arthritis & Rheumatology Research, PLLC /ID# 209875
🇺🇸Tucson, Arizona, United States
Inland Rheum Clin Trials Inc. /ID# 201641
🇺🇸Upland, California, United States
Southern Arizona VA Health Care System /ID# 209247
🇺🇸Tucson, Arizona, United States
Arthritis and Rheumatism Associates /ID# 209882
🇺🇸Jonesboro, Arkansas, United States
Valerius Medical Group & Research Center /ID# 207428
🇺🇸Los Alamitos, California, United States
New England Research Associates, LLC /ID# 207237
🇺🇸Bridgeport, Connecticut, United States
Arthritis & Rheumatic Disease Specialties /ID# 210802
🇺🇸Aventura, Florida, United States
Arthritis & Osteoporosis Center /ID# 207236
🇺🇸Hamden, Connecticut, United States
Rheumatology Associates of South Florida (RASF) - Clinical Research /ID# 211099
🇺🇸Boca Raton, Florida, United States
Sweet Hope Research Specialty Inc /ID# 209393
🇺🇸Hialeah, Florida, United States
Jacksonville Center for Clinical Research /ID# 209876
🇺🇸Jacksonville, Florida, United States
IRIS Research and Development, LLC /ID# 208955
🇺🇸Plantation, Florida, United States
Springfield Clinic /ID# 200244
🇺🇸Springfield, Illinois, United States
Clinical Pharmacology Study Gr /ID# 168019
🇺🇸Worcester, Massachusetts, United States
Klein and Associates MD /ID# 169483
🇺🇸Hagerstown, Maryland, United States
St. Paul Rheumatology /ID# 208471
🇺🇸Eagan, Minnesota, United States
Center for Rheumatology LLP /ID# 207313
🇺🇸Albany, New York, United States
NYU Langone Ambulatory Care Brooklyn Heights /ID# 207310
🇺🇸Brooklyn, New York, United States
STAT Research, Inc. /ID# 213805
🇺🇸Springboro, Ohio, United States
Velocity Clinical Research /ID# 200452
🇺🇸Blue Ash, Ohio, United States
Marietta Memorial Hospital /ID# 210179
🇺🇸Marietta, Ohio, United States
Allegheny Health Network Research Institute /ID# 210349
🇺🇸Pittsburgh, Pennsylvania, United States
Holy Family Memorial, Inc. /ID# 209387
🇺🇸Manitowoc, Wisconsin, United States
Fundacion CIDEA /ID# 210494
🇦🇷Ciudad Autonoma de Buenos Aire, Ciuadad Autonoma De Buenos Aires, Argentina
Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich /ID# 211622
🇦🇷Ciudad Autonoma de Buenos Aire, Ciuadad Autonoma De Buenos Aires, Argentina
Instituto CAICI /ID# 169168
🇦🇷Rosario, Santa Fe, Argentina
Cimer /Id# 169167
🇦🇷San Miguel de Tucuman, Argentina
Griffith University /ID# 207505
🇦🇺Southport, Queensland, Australia
ReumaClinic /ID# 208213
🇧🇪Genk, Belgium
Flinders Medical Centre /ID# 210562
🇦🇺Bedford, Park, South Australia, Australia
Duplicate_UZ Ghent /ID# 210036
🇧🇪Ghent, Oost-Vlaanderen, Belgium
University Clinical Centre of the Republic of Srpska /ID# 208269
🇧🇦Banja Luka, Republika Srpska, Bosnia and Herzegovina
University Clinical Centre of the Republic of Srpska /ID# 210047
🇧🇦Banja Luka, Republika Srpska, Bosnia and Herzegovina
University Clinical Centre of the Republic of Srpska /ID# 208268
🇧🇦Banja Luka, Republika Srpska, Bosnia and Herzegovina
ZNA - Jan Palfijn /ID# 208212
🇧🇪Merksem, Belgium
Clinical Center University of Sarajevo /ID# 208272
🇧🇦Sarajevo, Bosnia and Herzegovina
CMiP - Centro Mineiro de Pesquisa Ltda - ME /ID# 207496
🇧🇷Juiz de Fora, Minas Gerais, Brazil
EDUMED Educacao em Saude S/S L /ID# 207488
🇧🇷Curitiba, Parana, Brazil
CPCLIN - Centro de Pesquisas Clínicas /ID# 207493
🇧🇷Sao Paulo, Brazil
Military Medical Academy Multiprofile Hospital /ID# 210829
🇧🇬Sofia, Bulgaria
Medical center Medconsult /ID# 211399
🇧🇬Pleven, Bulgaria
Diagnostic consultative center 17 Sofia /ID# 210506
🇧🇬Sofia, Bulgaria
CIADS Research Co Ltd /ID# 169600
🇨🇦Winnipeg, Manitoba, Canada
Poliklinika Repromed /ID# 208628
🇭🇷Zagreb, Grad Zagreb, Croatia
Klinicki bolnicki centar Rijeka /ID# 208621
🇭🇷Rijeka, Primorsko-goranska Zupanija, Croatia
Clinica Dermacross S.A /ID# 208163
🇨🇱Vitacura Santiago, Chile
MUDr. Zuzana Stejfova - revmatologicka ambulance /ID# 209027
🇨🇿Praha, Czechia
Center of Innovative Diagnostics and Therapeutics (CIRI GmbH) /ID# 209483
🇩🇪Frankfurt, Germany
University General Hospital of Heraklion PA.G.N.I /ID# 206839
🇬🇷Heraklion, Kriti, Greece
Advanced Rheumatology, PC /ID# 168042
🇺🇸Lansing, Michigan, United States
Sheba Medical Center /ID# 207474
🇮🇱Ramat Gan, Tel-Aviv, Israel
Olympion General Clinic SA /ID# 207048
🇬🇷Patras, Greece
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona /ID# 207269
🇮🇹Ancona, Italy
Azienda Ospedaliera Universitaria di Verona/Ospedale Borgo Roma /ID# 207265
🇮🇹Verona, Italy
M & M Centrs LTD /ID# 208733
🇱🇻Adazi, Latvia
Riga East Clinical University Hospital /ID# 207223
🇱🇻Riga, Latvia
D.Saulites-Kandevicas PP in Cardiology and Rheumatology /ID# 207224
🇱🇻Liepaja, Latvia
Pauls Stradins Clinical University Hospital /ID# 207220
🇱🇻Riga, Latvia
Clinic ORTO /ID# 216218
🇱🇻Riga, Latvia
Hospital of Lithuanian University of Health Sciences Kaunas Clinics /ID# 207331
🇱🇹Kaunas, Lithuania
Republican Siauliai hospital /ID# 207328
🇱🇹Siauliai, Lithuania
Hospital Tuanku Jaafar /ID# 207919
🇲🇾Seremban, Negeri Sembilan, Malaysia
Hospital Raja Permaisuri Bainun /ID# 207920
🇲🇾Ipoh, Perak, Malaysia
CINTRE, Centro de Investigación y Tratamiento Reumatológico SC /ID# 208331
🇲🇽Mexico City, Ciudad De Mexico, Mexico
Centro Peninsular de Investigación Clínica SCP /ID# 208345
🇲🇽Colonia Centro, Yucatan, Mexico
Hospital General Regional No. 1 Dr. Carlos Mac Gregor Sánchez Navarro /ID# 210835
🇲🇽Ciudad de Mexico, Mexico
RM Pharma Specialists S.A de C.V /ID# 208330
🇲🇽Mexico City, Mexico
Antonius Ziekenhuis /ID# 208587
🇳🇱Sneek, Fryslan, Netherlands
Waikato Hospital /ID# 213257
🇳🇿Hamilton, Waikato, New Zealand
Universitair Medisch Centrum Groningen /ID# 208580
🇳🇱Groningen, Netherlands
Medisch Centrum Leeuwarden /ID# 168453
🇳🇱Leeuwarden, Netherlands
Middlemore Clinical Trials /ID# 213256
🇳🇿Papatoetoe, Auckland, New Zealand
CGM Research Trust /ID# 210498
🇳🇿Burwood, New Zealand
Spolka Lekarzy INTERCOR /ID# 210191
🇵🇱Bydgoszcz, Kujawsko-pomorskie, Poland
Nasz Lekarz Przychodnie Medyczne /ID# 216176
🇵🇱Torun, Kujawsko-pomorskie, Poland
Centrum Kliniczno-Badawcze /ID# 208010
🇵🇱Elblag, Warminsko-mazurskie, Poland
Osteo-Medic S.C. /ID# 208008
🇵🇱Bialystok, Podlaskie, Poland
Centrum Medyczne Reuma Park w Warszawie /ID# 210352
🇵🇱Warsaw, Mazowieckie, Poland
ClinicMed Daniluk, Nowak Sp.j. /ID# 210824
🇵🇱Bialystok, Podlaskie, Poland
McBk Sc /Id# 209132
🇵🇱Grodzisk Mazowiecki, Mazowieckie, Poland
Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE /ID# 208145
🇵🇹Vila Nova De Gaia, Porto, Portugal
ETYKA-Osrodek Badan Klinicznych /ID# 216241
🇵🇱Olsztyn, Warminsko-mazurskie, Poland
Centro Hospitalar do Baixo Vouga /ID# 215979
🇵🇹Aveiro, Portugal
Instituto Português De Reumatologia /ID# 208149
🇵🇹Lisboa, Portugal
CCA Braga - Hospital de Braga /ID# 208146
🇵🇹Braga, Portugal
Mindful Medical Research /ID# 211129
🇵🇷San Juan, Puerto Rico
Centro Hospitalar Universitário de Lisboa Norte, EPE - Hospital de Santa Maria /ID# 208148
🇵🇹Lisboa, Portugal
Spitalul Clinic Sf. Maria /ID# 210054
🇷🇴Bucuresti, Romania
Cabinet Medical Dr Triff Carina /Id# 207528
🇷🇴Timisoara, Timis, Romania
Spitalul Clinic Judetean de Urgenta Cluj -Napoca /ID# 207340
🇷🇴Cluj-Napoca, Romania
LLC Family Outpatient Clinic № /ID# 169510
🇷🇺Korolev, Moskva, Russian Federation
LLC Medical Center /ID# 169516
🇷🇺Novosibirsk, Novosibirskaya Oblast, Russian Federation
Federal Center for Brain and Neurotechnology /ID# 207646
🇷🇺Moscow, Russian Federation
Nort-Western State Medical University n.a. Mechnikov /ID# 207641
🇷🇺St. Petersburg, Sankt-Peterburg, Russian Federation
Institute for Rheumatology /ID# 168197
🇷🇸Belgrade, Beograd, Serbia
Perm Regional Clinical Hospital /ID# 207642
🇷🇺Perm, Russian Federation
Institute for Rheumatology /ID# 168194
🇷🇸Belgrade, Beograd, Serbia
Military Medical Academy /ID# 168218
🇷🇸Belgrade, Beograd, Serbia
Singapore General Hospital /ID# 207917
🇸🇬Singapore, Singapore
Special Hospital for Rheuma /ID# 168255
🇷🇸Novi Sad, Vojvodina, Serbia
National University Hospital /ID# 208599
🇸🇬Singapore, Singapore
REUMA-GLOBAL, s.r.o. /ID# 208017
🇸🇰Biely Kostol, Slovakia
MEDMAN s.r.o. /ID# 208018
🇸🇰Martin, Slovakia
Reum.hapi s.r.o. /ID# 208016
🇸🇰Nove Mesto nad Vahom, Slovakia
REUMAMED POPRAD s.r.o. /ID# 208407
🇸🇰Poprad, Slovakia
University of Pretoria /ID# 167621
🇿🇦Pretoria, Gauteng, South Africa
Dr Elsa van Duuren /ID# 207577
🇿🇦Pretoria, Gauteng, South Africa
Arthritis Clinical Research Trials /ID# 167625
🇿🇦Cape Town, Western Cape, South Africa
Consorci Corporacio Sanitaria Parc Tauli Sabadell /ID# 207830
🇪🇸Sabadell, Barcelona, Spain
Hospital Universitario A Coruna - CHUAC /ID# 207826
🇪🇸A Coruna, Spain
Synexus Helderberg Clinical Research Centre /ID# 210891
🇿🇦Somerset West, Western Cape, South Africa
Orebro Universitetssjukhuset /ID# 207948
🇸🇪Orebro, Orebro Lan, Sweden
Skane University hospital /ID# 210070
🇸🇪Malmo, Skane Lan, Sweden
Hospital Universitario y Politecnico La Fe /ID# 207831
🇪🇸Valencia, Spain
Winelands Medical Research Centre /ID# 167629
🇿🇦Stellenbosch, Western Cape, South Africa
Hospital Universitario Germans Trias i Pujol /ID# 208543
🇪🇸Badalona, Barcelona, Spain
Duplicate_Karolinska Univ Sjukhuset /ID# 208175
🇸🇪Solna, Sweden
Falu Lasarett /ID# 210322
🇸🇪Falun, Sweden
Hospital Parc de Salut del Mar /ID# 209698
🇪🇸Barcelona, Spain
Linkou Chang Gung Memorial Ho /ID# 207255
🇨🇳Taoyuan City, Taiwan
Duplicate_Vastmanlands Sjukhus /ID# 207943
🇸🇪Vasteras, Sweden
Uppsala University Hospital /ID# 207944
🇸🇪Uppsala, Sweden
MNPE Chernihiv Regional Hospital of the Chernihiv Region Council /ID# 207730
🇺🇦Chernihiv, Ukraine
State Institution L. T. Malaya Therapy National Institution of NAMS of Ukraine /ID# 209556
🇺🇦Kharkiv, Kharkivska Oblast, Ukraine
PNE City Multifunctional Hospital No.18 /ID# 207911
🇺🇦Kharkiv, Ukraine
Communal Enterprise Volyn Regional Clinical hospital of the Volyn Regional Coun /ID# 208276
🇺🇦Lutsk, Ukraine
PI "Poltava Regional Clinical Hospital n.a. M.V.Sklifosovsky" /ID# 207872
🇺🇦Poltava, Ukraine
Medical Center OK Clinic /ID# 207749
🇺🇦Kyiv, Ukraine
Lviv Municipal City Clinical Hospital #4 /ID# 207715
🇺🇦Lviv, Ukraine
Duplicate_Barts Health NHS Trust /ID# 210534
🇬🇧London, London, City Of, United Kingdom
Manchester University NHS Foundation Trust /ID# 207928
🇬🇧Manchester, United Kingdom
Duplicate_Wirral University Teaching Hospital NHS Foundation Trust /ID# 210535
🇬🇧Wirral, United Kingdom
Torbay and South Devon Nhs Foundation Trust /Id# 207931
🇬🇧Torquay, United Kingdom
Affinity Clinical Research /ID# 210816
🇺🇸Oak Brook, Illinois, United States
OrthoIllinois /ID# 205300
🇺🇸Rockford, Illinois, United States
ForCare Clinical Research /ID# 168034
🇺🇸Tampa, Florida, United States
Nashville Arthritis and Rheumatology /ID# 168069
🇺🇸Nashville, Tennessee, United States
Health Research of Oklahoma /ID# 168027
🇺🇸Oklahoma City, Oklahoma, United States
Physician Research Collaboration, LLC /ID# 208670
🇺🇸Lincoln, Nebraska, United States
Hospital Clinico Universitario San Carlos /ID# 207832
🇪🇸Madrid, Spain
Emeritus Research /ID# 207202
🇦🇺Camberwell, Victoria, Australia
AZ Arthritis and Rheumotology Research, PLLC /ID# 209873
🇺🇸Phoenix, Arizona, United States
Sun Valley Arthritis Center Ltd. /ID# 200270
🇺🇸Peoria, Arizona, United States
Danbury Clinical Research, LLC /ID# 209517
🇺🇸Danbury, Connecticut, United States
Monash Medical Centre /ID# 208034
🇦🇺Clayton, Victoria, Australia
Research Institute of Rheumatology named after V.A. Nasonova /ID# 207643
🇷🇺Moscow, Moskva, Russian Federation
Hospital Universitario 12 de Octubre /ID# 207827
🇪🇸Madrid, Spain
Portsmouth Hospitals University NHS Trust /ID# 207932
🇬🇧Portsmouth, United Kingdom
CNE Cherkasy Regional Hospital of Cherkasy Regional Council /ID# 207912
🇺🇦Cherkasy, Ukraine
Khmelnytskyi Regional Hospital /ID# 207753
🇺🇦Khmelnytskyi, Ukraine
Public Institution 6th City Clinical Hospital /ID# 207754
🇺🇦Zaporizhzhia, Ukraine
MI Kryvyi Rih City Clinical Hospital No.2 /ID# 207748
🇺🇦Kryvyi Rih, Ukraine
SIMED Health, LLC /ID# 207461
🇺🇸Gainesville, Florida, United States
Rheum Assoc of Central FL /ID# 201622
🇺🇸Orlando, Florida, United States
HMD Research LLC /ID# 208427
🇺🇸Orlando, Florida, United States
Scientific Research Institute of Invalid Rehabilitation /ID# 207873
🇺🇦Vinnytsia, Vinnytska Oblast, Ukraine
The Center for Rheumatology and Bone Research /ID# 168017
🇺🇸Wheaton, Maryland, United States