An Efficacy And Safety Study Evaluating Tofacitinib With And Without Methotrexate Compared To Adalimumab With Methotrexate
- Conditions
- Rhematoid Arthritis
- Interventions
- Biological: Adalimumab with methotrexate
- Registration Number
- NCT02187055
- Lead Sponsor
- Pfizer
- Brief Summary
To assess the efficacy of tofacitinib monotherapy or tofacitinib with methotrexate as compared to adalimumab with methotrexate. To compare the efficacy of tofacitinib monotherapy compared to tofacitinib combined with methotrexate. To compare effects on all health outcomes measures in the study. To evaluate the safety and tolerability of tofacitinib and adalimumab. To evaluate the safety of the zoster vaccine given prior to the initiation of tofacitinb or adalimumab.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1152
- Have moderate to severe rheumatoid arthritis
- On methotrexate but inadequately controlled
- Subjects must not have active tuberculosis or an inadequately treated tuberculosis infection
- Subjects must use contraception
- Subjects who have been previously treated with adalimumab or Tofacitinib
- Subjects with any current malignancy or a history of malignancy, with the exception of adequately treated or excised non metastatic basal cell or squamous cell cancer of the skin or cervical carcinoma in situ.
- Subjects with specific laboratory test abnormalities
- Subjects with specific types of infections
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Adalimumab with methotrexate Adalimumab with methotrexate - Tofacitinib 5 mg twice daily with methotrexate Tofacitinib with methotrexate - Tofacitinib 5 mg twice daily monotherapy Tofacitinib without methotrexate -
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving American College of Rheumatology Criteria 50% Improvement (ACR50) Response at Month 6 Month 6 ACR50 is a greater than or equal to (≥) 50 percent (%) improvement in tender joint count (TJC) or swollen joint count (SJC) and 50% improvement in 3 of the following 5 criteria: 1) physician's global assessment (PGA) of disease activity, 2) participant's assessment (PtGA) of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional disability via a health assessment questionnaire, and 5) C-reactive protein (CRP) at each visit.
- Secondary Outcome Measures
Name Time Method Change From Baseline in Simplified Disease Activity Index (SDAI) Value at Month 6 Month 6 SDAI is the numerical sum of five outcome parameters: TJC and SJC both based on a 28-joint assessment, PtGA and PGA both assessed on a 0 to 10 centimeter (cm) visual analogue scale (VAS) (higher scores indicate greater affection due to disease activity), and CRP (mg/dL). SDAI total score ranges from 0 to 86. SDAI less than or equal to (≤) 3.3 indicates disease remission, \>3.4 to 11 indicates low disease activity, \>11 to 26 indicates moderate disease activity, and \>26 indicates high disease activity.
Change From Baseline in Clinical Disease Activity Index (CDAI) Value at Month 6 Month 6 CDAI is the numerical sum of four outcome parameters: TJC and SJC both based on a 28-joint assessment, PtGA and PGA both assessed on a 0 to 10 cm VAS (higher scores indicate greater affection due to disease activity). CDAI total score ranges from 0 to 76. CDAI ≤2.8 indicates disease remission, \>2.8 to 10 indicates low disease activity, \>10 to 22 indicates moderate disease activity, and \>22 indicates high disease activity.
Change From Baseline in Disease Activity Score 28-4 (DAS28-4) Including CRP at Month 6 Month 6 DAS28-4 (CRP) was calculated from the SJC and TJC (both based on a 28-joint assessment), PtGA (assessed on a 0 to 10 cm VAS; higher scores indicate greater affection due to disease activity) and CRP (mg/L) using the following: DAS28-4(CRP) = 0.56\*sqrt(TJC28) + 0.28\*sqrt(SJC28) + 0.36\*ln(CRP+1) + 0.014\* PtGA (millimeters \[mm\]) + 0.96. Total score range: 0 to 9.4, higher score indicated higher disease activity. DAS28-4 (CRP) ≤3.2 indicates low disease activity, \>3.2 to 5.1 indicates moderate to high disease activity, and less than (\<) 2.6 indicates remission.
Change From Baseline in Disease Activity Score 28-4 (DAS28-4) Including Erythrocyte Sedimentation Rate (ESR) at Month 6 Month 6 DAS28-4 (ESR) was calculated from the SJC and TJC (both based on a 28-joint assessment), PtGA (assessed on a 0 to 10 cm VAS; higher scores indicate greater affection due to disease activity) and ESR (mm/hour) using the following: DAS28-4(ESR) = 0.56\*sqrt(TJC28) + 0.28\*sqrt(SJC28) + 0.70\*ln(ESR) + 0.014\* PtGA (mm). Total score range: 0 to 9.4, higher score indicated higher disease activity. DAS28-3 (ESR) ≤3.2 indicates low disease activity, \>3.2 to 5.1 indicates moderate to high disease activity, and \<2.6 indicates remission.
Percentage of Participants Achieving Observed American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) Boolean Remission Criteria at Month 6 Month 6 To meet the ACR-EULAR Boolean remission criteria, a participant must satisfy all of the following: TJC ≤1 and SJC ≤1 (both based on a 28-joint assessment), CRP ≤1 mg/dL, and PtGA ≤1 on a 0 to 10 cm VAS (higher scores indicate greater affection due to disease activity).
Percentage of Participants Achieving SDAI ≤3.3 at Month 6 Month 6 SDAI is the numerical sum of five outcome parameters: TJC and SJC both based on a 28-joint assessment, PtGA and PGA both assessed on a 0 to 10 cm VAS (higher scores indicate greater affection due to disease activity), and CRP (mg/dL). SDAI total score ranges from 0 to 86. SDAI ≤3.3 indicates disease remission.
Percentage of Participants Achieving CDAI ≤10 at Month 6 Month 6 CDAI is the numerical sum of four outcome parameters: TJC and SJC both based on a 28-joint assessment, PtGA and PGA both assessed on a 0 to 10 cm VAS (higher scores indicate greater affection due to disease activity). CDAI total score ranges from 0 to 76. CDAI ≤2.8 indicates disease remission, \>2.8 to 10 indicates low disease activity.
Change From Baseline in the SF-36 Health Survey, Mental Component Score at Month 6 Month 6 The SF-36 health survey is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The health domains are aggregated into two summary scores known as the PCS score and the MCS score. Normalized domain scores, PCS and MCS scores are used in the analyses. The component and domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher MCS score represents better physical health status.
Percentage of Participants Achieving CDAI ≤2.8 at Month 6 Month 6 CDAI is the numerical sum of four outcome parameters: TJC and SJC both based on a 28-joint assessment, PtGA and PGA both assessed on a 0 to 10 cm VAS (higher scores indicate greater affection due to disease activity). CDAI total score ranges from 0 to 76. CDAI ≤2.8 indicates disease remission.
Percentage of Participants Achieving DAS28-4 (ESR) <2.6 at Month 6 Month 6 DAS28-4 (ESR) was calculated from the SJC and TJC (both based on a 28-joint assessment), PtGA (assessed on a 0 to 10 cm VAS; higher scores indicate greater affection due to disease activity) and ESR (mm/hour) using the following: DAS28-4(ESR) = 0.56\*sqrt(TJC28) + 0.28\*sqrt(SJC28) + 0.70\*ln(ESR) + 0.014\* PtGA (mm). Total score range: 0 to 9.4, higher score indicates higher disease activity. DAS28-4 (ESR) \<2.6 indicates disease remission.
Percentage of Participants Achieving DAS28-4 (CRP) <2.6 at Month 6 Month 6 DAS28-4 (CRP) was calculated from the SJC and TJC (both based on a 28-joint assessment), PtGA (assessed on a 0 to 10 cm VAS; higher scores indicate greater affection due to disease activity) and CRP (mg/L) using the following: DAS28-4(CRP) = 0.56\*sqrt(TJC28) + 0.28\*sqrt(SJC28) + 0.36\*ln(CRP+1) + 0.014\* PtGA (mm) + 0.96. Total score range: 0 to 9.4, higher score indicates higher disease activity. DAS28-4 (CRP) \<2.6 indicates remission.
Percentage of Participants Achieving SDAI ≤11 at Month 6 Month 6 SDAI is the numerical sum of five outcome parameters: TJC and SJC both based on a 28-joint assessment, PtGA and PGA both assessed on a 0 to 10 cm VAS (higher scores indicate greater affection due to disease activity), and CRP (mg/dL). SDAI total score ranges from 0 to 86. SDAI ≤3.3 indicates disease remission, \>3.4 to 11 indicates low disease activity.
Percentage of Participants Achieving DAS28-4 (ESR) ≤3.2 at Month 6 Month 6 DAS28-4 (ESR) was calculated from the SJC and TJC (both based on a 28-joint assessment), PtGA (assessed on a 0 to 10 cm VAS; higher scores indicate greater affection due to disease activity) and ESR (mm/hour) using the following: DAS28-4(ESR) = 0.56\*sqrt(TJC28) + 0.28\*sqrt(SJC28) + 0.70\*ln(ESR) + 0.014\* PtGA (mm). Total score range: 0 to 9.4, higher score indicates higher disease activity. DAS28-4 (ESR) ≤3.2 indicates low disease activity.
Percentage of Participants Achieving DAS28-4 (CRP) ≤3.2 at Month 6 Month 6 DAS28-4 (CRP) was calculated from the SJC and TJC (both based on a 28-joint assessment), PtGA (assessed on a 0 to 10 cm VAS; higher scores indicate greater affection due to disease activity) and CRP (mg/L) using the following: DAS28-4(CRP) = 0.56\*sqrt(TJC28) + 0.28\*sqrt(SJC28) + 0.36\*ln(CRP+1) + 0.014\* PtGA + 0.96. Total score range: 0 to 9.4, higher score indicated higher disease activity. DAS28-4 (CRP) ≤3.2 indicates low disease activity.
Percentage of Participants Achieving American College of Rheumatology Criteria 20% Improvement (ACR20) Response at Month 6 Month 6 ACR20 response is a ≥20% improvement in TJC or SJC and 20% improvement in 3 of the following 5 criteria: 1) PGA of disease activity, 2) PtGA of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional disability via a health assessment questionnaire, and 5) CRP at each visit.
Percentage of Participants Achieving American College of Rheumatology Criteria 70% Improvement (ACR70) Response at Month 6 Month 6 ACR70 response is a ≥70% improvement in TJC or SJC and 70% improvement in 3 of the following 5 criteria: 1) PGA of disease activity, 2) PtGA of disease activity, 3) participant's assessment of pain, 4) participant's assessment of functional disability via a health assessment questionnaire, and 5) CRP at each visit.
Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI) at Month 6 Month 6 The HAQ-DI is a participant-reported assessment of ability to perform tasks in 8 categories of daily living activities: dressing and grooming, arising, eating, walking, reach, grip, hygiene and other activities over the past week. Each activity category consists of 2 to 3 items. Each item is scored on 4-point scale from 0 to 3: 0=no difficulty; 1=some difficulty; 2=much difficulty; 3=unable to do. Any activity requiring assistance from another individual or the use of an assistive device adjusts to a minimum score of 2 to represent a more limited functional status. Overall score was computed as the sum of domain scores and divided by the number of domains answered. Total possible score ranges from 0 to 3 where 0 = least difficulty and 3 = extreme difficulty.
Change From Baseline in the Short-Form-36 (SF-36) Health Survey, Physical Component Score at Month 6 Month 6 The SF-36 health survey is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The health domains are aggregated into two summary scores known as the physical component summary (PCS) score and the mental component summary (MCS) score. Normalized domain scores, PCS and MCS scores are used in the analyses. The component and domain scores were scored using the United States (US) 1998 general population norms. The resulting norm-based scores for both the SF-36 version 2 (v2) and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher PCS score represents better physical health status.
Percentage of Participants Achieving an HAQ-DI Decrease of at Least 0.22 at Month 6 Month 6 The HAQ-DI is a participant-reported assessment of ability to perform tasks in 8 categories of daily living activities: dressing and grooming, arising, eating, walking, reach, grip, hygiene and other activities over the past week. Each activity category consists of 2 to 3 items. Each item is scored on 4-point scale from 0 to 3: 0=no difficulty; 1=some difficulty; 2=much difficulty; 3=unable to do. Any activity requiring assistance from another individual or the use of an assistive device adjusts to a minimum score of 2 to represent a more limited functional status. Overall score was computed as the sum of domain scores and divided by the number of domains answered. Total possible score ranges from 0 to 3 where 0 = least difficulty and 3 = extreme difficulty. A decrease of 0.22 or more is considered a positive response.
Change From Baseline in the SF-36 Health Survey, General Health Domain Score at Month 6 Month 6 The SF-36v2 acute is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The general health scale consists of 5 items including a rating of health and 4 items addressing the respondent's view and expectations of his or her health. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher general health domain score represents better general health perceptions.
Change From Baseline in the SF-36 Health Survey, Vitality Domain Score at Month 6 Month 6 The SF-36v2 acute is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The 4-item measure of vitality captures a broad range of subjective evaluations of well-being from feelings of tiredness and being worn out to feeling full of energy all or most of the time. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher vitality domain score represents better vitality.
Change From Baseline in the SF-36 Health Survey, Social Functioning Domain Score at Month 6 Month 6 The SF-36v2 acute is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The 2-item social functioning scale assesses health-related effects on quantity and quality of social activities. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher social functioning domain score represents better social functioning.
Change From Baseline in the SF-36 Health Survey, Role Emotional Domain Score at Month 6 Month 6 The SF-36v2 acute is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The 3-item role emotional scale assesses mental health-related role limitations in terms of a) time spent in work or other usual activities; b) amount of work or activities accomplished; c) care with which work or other activities were performed. All 3 items are answered on a 5-point scale. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher role emotional domain score represents better role emotional functioning.
Change From Baseline in the SF-36 Health Survey, Mental Health Domain Score at Month 6 Month 6 The SF-36v2 acute is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The 5-item mental health scale includes 1 or more items from each of 4 major mental health dimensions: anxiety, depression, loss of behavioral/emotional control, and psychological well-being. All items are answered on a 5-point scale. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher mental health domain score represents better mental health functioning.
Change From Baseline in the Work Productivity and Activity Impairment (WPAI) Questionnaire at Month 6 Month 6 The WPAI: Rheumatoid Arthritis is a 6 item questionnaire that is specific for rheumatoid arthritis and yields four types of scores: absenteeism, presenteesism (impairment at work/reduced job effectiveness), work productivity loss and activity impairment. WPAI outcomes are expressed as impairment percentages ranging from 0 to 100, with higher numbers indicating greater impairment and less productivity.
Change From Baseline in the EuroQol European Quality of Life-5 Dimensions (EuroQol EQ-5D) at Month 6 Month 6 The EQ-5D is a participant rated questionnaire to assess health-related quality of life in terms of a single utility score. Health State Profile component assesses level of current health for 5 domains: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression; 1 indicates better health state (no problems); 3 indicates worst health state ("confined to bed"). This profile of scores across the 5-dimensions (e.g. 11231, 33212, etc.) is transformed into a single health utility score using a formula developed by the EuroQol Group that applies country specific preference weights. Score is transformed and results in a total score range -0.594 to 1.000; higher score indicates a better health state. The VAS component rated the current health state on a scale ranging from 0 (worst imaginable health state) to 100 (best imaginable health state); higher scores indicating a better health state.
Change From Baseline in the SF-36 Health Survey, Physical Functioning Domain Score at Month 6 Month 6 SF-36v2 acute is a 36-item measure evaluating 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The 10 items of the physical functioning scale represent levels and kinds of limitations between extremes of physical activities, including lifting and carrying groceries; climbing stairs; bending, kneeling, or stooping; walking moderate distances; self-care limitations. The physical functioning items capture the presence and extent of physical limitations using a 3-level response continuum. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher physical functioning domain score represents better physical functioning.
Change From Baseline in the SF-36 Health Survey, Bodily Pain Domain Score at Month 6 Month 6 The SF-36v2 acute is a 36-item measure that evaluates 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The bodily pain scale comprises of 2 items pertaining to the intensity of bodily pain and extent of interference with normal work activities. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher bodily pain domain score represents less bodily pain.
Change From Baseline in the SF-36 Health Survey, Role Physical Domain Score at Month 6 Month 6 SF-36v2 acute is a 36-item measure evaluating 8 domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. The 4-item role physical scale covers an array of physical health-related role limitations, including: a) limitations in the kind of work or other usual activities; b) reductions in the amount of time spent on work or other usual activities; c) difficulty performing work or other usual activities; and d) accomplishing less. Items in the role physical scale are answered on a 5-point scale. The domain scores were scored using the US 1998 general population norms. The resulting norm-based scores for both the SF-36 v2 and SF-36 health domain scales and component summary measures have means of 50 and standard deviations of 10. A higher role physical domain score represents better role physical functioning.
Change From Baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Scale Total Score at Month 6 Month 6 FACIT-F is a 13-item questionnaire. Participants scored each item on a 5-point scale: 0 (not at all) to 4 (very much). The larger the participant's response (with the exception of 2 negatively stated), the greater the participant's fatigue. For all questions, except for the 2 negatively stated ones, the code was reversed and a new score was calculated as (4 minus the participant's response). The sum of all responses resulted in the FACIT-Fatigue score for a total possible score of 0 (worse score) to 52 (better score).
Trial Locations
- Locations (211)
Ochsner Clinic Baton Rouge
🇺🇸Baton Rouge, Louisiana, United States
Centre for Rheumatology, Immunology and Arthritis
🇺🇸Fort Lauderdale, Florida, United States
Houston Institute For Clinical Research
🇺🇸Houston, Texas, United States
Centro de Investigacion de Tratamientos Innovadores de Sinaloa S.C.
🇲🇽Culiacan, Sinaloa, Mexico
UMHAT "Dr. Georgi Stranski" EAD
🇧🇬Pleven, Bulgaria
MHAT Akta Medika OOD
🇧🇬Ruse, Bulgaria
MHAT Ruse AD
🇧🇬Ruse, Bulgaria
MHAT Shumen AD
🇧🇬Shumen, Bulgaria
NMTH Tsar Boris Clinic of Internal Diseases
🇧🇬Sofia, Bulgaria
MHAT "Targovishte" AD
🇧🇬Targovisthe, Bulgaria
Foundation Parnu Hospital
🇪🇪Parnu, Estonia
North Estonia Medical Centre Foundation
🇪🇪Tallinn, Estonia
Health Center 4
🇱🇻Riga, Latvia
ORTO clinic Ltd
🇱🇻Riga, Latvia
Davao Doctors Hospital
🇵🇭Davao, Philippines
St. Paul's Hospital of Iloilo, Inc.
🇵🇭Iloilo City, Philippines
Covamed Serv SRL
🇷🇴Sfantu Gheorghe, Covasna, Romania
Synexus Polska Sp. z o.o. Oddzial w Warszawie
🇵🇱Warszawa, Poland
Jacksonville Center for Clinical Research
🇺🇸Jacksonville, Florida, United States
St. Jude Hospital Yorba Linda DBA St. Joseph Heritage Healthcare
🇺🇸Fullerton, California, United States
Joao M. A. Nascimento
🇺🇸Bridgeport, Connecticut, United States
Inland Rheumatology Clinical Trials, Inc.
🇺🇸Upland, California, United States
UCLA David Geffen School of Medicine, Division of Rheumatology
🇺🇸Los Angeles, California, United States
Arthritis and Rheumatic Disease Specialties
🇺🇸Aventura, Florida, United States
University of Southern California (USC) Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
AARDS Research, Inc.
🇺🇸Aventura, Florida, United States
Dr. Prem C. Chatpar M.D.,LLC
🇺🇸Plainview, New York, United States
Medvin Clinical Research
🇺🇸Whittier, California, United States
West Tennessee Research Institute
🇺🇸Jackson, Tennessee, United States
CER San Juan, Centro Polivalente de Asistencia e Investigacion Clinica
🇦🇷San Juan, Argentina
Accurate Clinical Management, LLC
🇺🇸Houston, Texas, United States
Arthritis Center, Inc.
🇺🇸Palm Harbor, Florida, United States
Southwest Rheumatology Research, LLC.
🇺🇸Mesquite, Texas, United States
The Office of Alastair C. Kennedy, MD
🇺🇸Vero Beach, Florida, United States
QML Pathology
🇦🇺Southport, Queensland, Australia
RK Will Pty Ltd
🇦🇺Victoria Park, Western Australia, Australia
University Hospital Clinical Center Banja Luka
🇧🇦Banja Luka, Republika Srpska, Bosnia and Herzegovina
Centro Radiologico Luis Mendez Collado SRL
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
Rowan Diagnostic Clinic
🇺🇸Salisbury, North Carolina, United States
Jasper Clinic
🇺🇸Kalamazoo, Michigan, United States
PMG Research of Wilmington
🇺🇸Wilmington, North Carolina, United States
St. Louis Center For Clinical Research Barbara Caciolo, MD
🇺🇸Saint Louis, Missouri, United States
MHAT "Kaspela" EOOD
🇧🇬Plovdiv, Bulgaria
Arthritis Northwest, PLLC
🇺🇸Spokane, Washington, United States
Arthritis Group
🇺🇸Philadelphia, Pennsylvania, United States
Royal Prince Alfred Hospital
🇦🇺Camperdown, New South Wales, Australia
Metroplex Clinical Research Center
🇺🇸Dallas, Texas, United States
University Clinical Center Tuzla
🇧🇦Tuzla, Bosnia and Herzegovina
MHAT EUROHOSPITAL Plovdiv
🇧🇬Plovdiv, Bulgaria
Vesalion, s.r.o.
🇨🇿Ostrava- Moravska Ostrava, Czechia
Hadassah Medical Center
🇮🇱Jerusalem, Israel
The Chaim Sheba Medical Center
🇮🇱Tel-Hashomer, Israel
Prosalud
🇨🇱Santiago, Metropolitana, Chile
Revmatologie s.r.o.
🇨🇿Brno, Czechia
Rambam Health Care Campus
🇮🇱Haifa, Israel
Revmatologicka ambulance
🇨🇿Ceska Lipa, Czechia
East-Tallinn Central Hospital Ltd
🇪🇪Tallinn, Estonia
Inha University Hospital
🇰🇷Jung-Gu, Incheon, Korea, Republic of
Centro de Investigacion en Tratamientos Innovadores de Sinaloa S.C.
🇲🇽Culiacan, Sinaloa, Mexico
Clinical Research Unit, University of Pretoria
🇿🇦Pretoria, Gauteng, South Africa
Hanyang University Seoul Hospital
🇰🇷Seoul, Korea, Republic of
Netcare Jakaranda Hospital
🇿🇦Pretoria, Gauteng, South Africa
Centro Integral en Reumatologia, SA de CV
🇲🇽Guadalajara, Jalisco, Mexico
Unidad de Investigacion en Medicina Interna y Enfermedades criticas-Hogar Clinica San Juan de Dios
🇵🇪Arequipa, Peru
Investigacion y Biomedica de Chihuahua, SC
🇲🇽Chihuahua, Mexico
Iloilo Doctors' Hospital, Inc
🇵🇭Iloilo City, Iloilo, Philippines
WCR: Wits Clinical Research
🇿🇦Johannesburg, Gauteng, South Africa
Complexo Hospitalario Universitario A Coruna
🇪🇸A Coruna, Spain
Hospital Infanta Luisa
🇪🇸Sevilla, Spain
University of Pretoria
🇿🇦Pretoria, Gauteng, South Africa
MTZ Clinical Research Sp. z o.o.
🇵🇱Warszawa, Poland
Arthritis Clinical Research Trials
🇿🇦Cape Town, Western CAPE, South Africa
Netcare St Augustine's Hospital
🇿🇦Durban, Kwazulu-natal, South Africa
Limited Liability Company AVA-PETER
🇷🇺Saint Petersburg, Russian Federation
State Budgetary Institution of Healthcare "Samara Regional Clinical Hospital n.a. V.D. Seredavin"
🇷🇺Samara, Russian Federation
Charlotte Maxeke Johannesburg Academic Hospital
🇿🇦Parktown, Johannesburg, Gauteng, South Africa
Panorama Medical Centre
🇿🇦Cape Town, Western CAPE, South Africa
Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
🇨🇳Hualien, Taiwan
Siriraj Hospital Mahidol University
🇹🇭Bangkok, Thailand
Songklanagarind Hospital - Prince of Songkhla University
🇹🇭Songkhla, Thailand
Kaohsiung Veterans General Hospital
🇨🇳Kaohsiung, Taiwan
Hospital Universitario Fundacion Jimenez Diaz
🇪🇸Madrid, Spain
Ankara Universitesi Tip Fakultesi Ibn-i Sina Hastanesi
🇹🇷Ankara, Turkey
Chang Gung Medical Foundation - Linkou Branch
🇨🇳Taoyuan County, Taiwan
Ondokuz Mayis Universitesi Tip Fakultesi Saglik Uygulama ve Egitim Merkezi
🇹🇷Samsun, Turkey
The Royal Wolverhamptons NHS Trust
🇬🇧Cannock, United Kingdom
The Leeds Teaching Hospitals NHS Trust
🇬🇧Leeds, United Kingdom
Diagnostic Rheumatology and Research PC
🇺🇸Indianapolis, Indiana, United States
Centre de Recherche Musculo-Squelettique
🇨🇦Trois-Rivieres, Quebec, Canada
Aintree University Hospital NHS Foundation Trust
🇬🇧Liverpool, United Kingdom
State Institution of Healthcare "Regional Clinical Hospital"
🇷🇺Saratov, Russian Federation
State Budgetary Institution of Ryazan Region "Regional Clinical Cardiology Dispensary"
🇷🇺Ryazan, Russian Federation
State Budgetary Healthcare Institution of Yaroslavl Region "Clinical Hospital #3"
🇷🇺Yaroslavl, Russian Federation
Non-state Healthcare Institution "Regional Hospital at Smolensk Station of OJSC "Russian Railways"
🇷🇺Smolensk, Russian Federation
Clinvest/ A Division of Banyan Group, Inc.
🇺🇸Springfield, Missouri, United States
Konkuk University Medical Center
🇰🇷Seoul, Korea, Republic of
BayCare Medical Group Inc
🇺🇸Tampa, Florida, United States
Arthrocare, Arthritis Care & Research, PC
🇺🇸Gilbert, Arizona, United States
Keck Medicine of USC - Division of Rheumatology
🇺🇸Los Angeles, California, United States
HealthCare Partners Medical Group
🇺🇸Huntington Beach, California, United States
Ronald Reagan UCLA Medical Center - Drug Information Center
🇺🇸Los Angeles, California, United States
San Diego Arthritis Medical Clinic
🇺🇸San Diego, California, United States
Riverside Clinical Research
🇺🇸Edgewater, Florida, United States
Gulf Region Clinical Research Institute Llc
🇺🇸Pensacola, Florida, United States
West Broward Rheumatology Associates, Inc.
🇺🇸Tamarac, Florida, United States
Advanced Clinical Research of Orlando, Inc.
🇺🇸Winter Garden, Florida, United States
Coeur D'Alene Arthritis Clinic
🇺🇸Coeur d'Alene, Idaho, United States
Deerbrook Medical Associates
🇺🇸Vernon Hills, Illinois, United States
Institute of Arthritis Research
🇺🇸Idaho Falls, Idaho, United States
Arthritis and Diabetes Clinic, Inc
🇺🇸Monroe, Louisiana, United States
Arthritis Treatment Center
🇺🇸Frederick, Maryland, United States
PMG Research of Salisbury, LLC
🇺🇸Salisbury, North Carolina, United States
Trinity Health Center - Medical Arts
🇺🇸Minot, North Dakota, United States
Altoona Center For Clinical Research
🇺🇸Duncansville, Pennsylvania, United States
Lynn Health Science Institute
🇺🇸Oklahoma City, Oklahoma, United States
Arthritis Care And Diagnostic Center, P.A.
🇺🇸Dallas, Texas, United States
Rheumatology Clinic of Houston, PA
🇺🇸Houston, Texas, United States
Arthritis & Osteoporosis Associates, LLP
🇺🇸Lubbock, Texas, United States
Arthritis & Osteoporosis Center of South Texas
🇺🇸San Antonio, Texas, United States
Accurate Clinical Research, Inc.
🇺🇸San Antonio, Texas, United States
The Queen Elizabeth Hospital
🇦🇺Woodville South, South Australia, Australia
Pacific Private Clinic
🇦🇺Southport, Queensland, Australia
Centro Medico Privado de Reumatologia
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
Organizacion Medica de Investigacion S.A - OMI
🇦🇷Buenos Aires, Argentina
Emeritus Research
🇦🇺Malvern East, Victoria, Australia
Kw Musculoskeletal Research Inc
🇨🇦Kitchener, Ontario, Canada
Revmacentrum MUDr. Mostera, s.r.o.
🇨🇿Brno - Zidenice, Czech Republic, Czechia
Estudios Clinicos Quinta Region Ltda.
🇨🇱Vina del Mar, Valparaiso, Chile
Revmatologie
🇨🇿Praha 4, Czechia
Bnai Zion Medical Center
🇮🇱Haifa, Israel
Daegu Catholic University Medical Center
🇰🇷Daegu, Korea, Republic of
Kyungpook National University Hospital
🇰🇷Daegu, Korea, Republic of
Alytaus District S. Kudirkos Hospital
🇱🇹Alytus, Lithuania
PI Republican Siauliai Hospital
🇱🇹Siauliai, Lithuania
Unidad de Enfermedades Reumaticas y Cronico Degenerativas S. C.
🇲🇽Torreon, Coahuila, Mexico
Laboratorio clínico del Hospital Star Medica Merida
🇲🇽Merida, Yucatan, Mexico
Unidad de Investigaciones Reumatologicas A.C.
🇲🇽San Luis Potosi, Mexico
Centro Multidisciplinario para el Desarrollo Especializado de la Invetigacion Clinica en Yucatan
🇲🇽Merida, Yucatan, Mexico
Centro de Alta Especialidad en Reumatologia e Investigacion del Potosi, S.C.
🇲🇽San Luis Potosi, Mexico
Instituto Peruano del Hueso y la Articulacion
🇵🇪Lima, Peru
Far Eastern University - NRMF Medical Center
🇵🇭Quezon City, Metro Manila, Philippines
Perpetual Succour Hospital
🇵🇭Cebu City, Philippines
Szpital Uniwersytecki nr 2 im. dr Jana Biziela w Bydgoszczy,
🇵🇱Bydgoszcz, Poland
Centrum Medyczne Amed
🇵🇱Warszawa, WOJ Mazowieckie, Poland
Centrum Terapii Wspolczesnej J.M. Jasnorzewska Spolka Komandytowo-Akcyjna
🇵🇱Lodz, Poland
Synexus Polska Sp. z o.o. Oddzial w Katowicach
🇵🇱Katowice, Poland
Spitalul Clinic de Recuperare Iasi
🇷🇴Iasi, Romania
Prywatna Praktyka Lekarska
🇵🇱Poznan, Poland
Spitalul Clinic Judetean de Urgenta Cluj Napoca Reumatologie
🇷🇴Cluj Napoca, Cluj, Romania
Synexus Polska Sp. z o.o. Oddzial we Wroclawiu
🇵🇱Wroclaw, Poland
S.C. Clinica Somesan S.R.L.
🇷🇴Baia Mare, Maramures, Romania
Spitalul Judetean de Urgenta "Dr. Constantin Opris"
🇷🇴Baia Mare, Maramures, Romania
Ianuli Med Consult SRL, Reumatologie
🇷🇴Bucuresti, Romania
Spitalul Clinic Sf. Maria
🇷🇴Bucuresti, Romania
Spitalul Clinic "Dr. I. Cantacuzino"
🇷🇴Bucuresti, Romania
Centrul Clinic de Boli Reumatismale "Dr. Ion Stoia"
🇷🇴Bucuresti, Romania
Spitalul Clinic Sf. Maria, Medicina interna - Reumatologie
🇷🇴Bucuresti, Romania
Spitalul Clinic Judetean de Urgenta - "Sf.Apostol Andrei" Galati
🇷🇴Galati, Romania
Republic Hospital n.a. V.A. Baranov
🇷🇺Petrozawodsk, Karelia Republic, Russian Federation
SAHI of KR "Kemerovo Regional Clinical Hospital"
🇷🇺Kemerovo, Russian Federation
State Budgetary Healthcare Institution of Karelia Republic "Republic Hospital n.a. V.A. Baranov"
🇷🇺Petrozawodsk, Karelia Republic, Russian Federation
CJSC "European Medical Center"
🇷🇺Moscow, Russian Federation
SBEI HPE First Moscow State Medical University n.a.I.M.Sechenov of MoH of RF based on UCH#1
🇷🇺Moscow, Russian Federation
SBEI HPE Novosibirsk State Medical University of MoH of RF
🇷🇺Novosibirsk, Russian Federation
State Budgetary Healthcare Institution "Orenburg Regional Clinical Hospital"
🇷🇺Orenburg, Russian Federation
Iatros International
🇿🇦Bloemfontein, FREE State, South Africa
State Autonomous Healthcare lnstitution of Yarostavl Region
🇷🇺Yaroslavl, Russian Federation
LCS Clinical Research Unit
🇿🇦Johannesburg, Gauteng, South Africa
Complejo Hospitalario Universitario de Santiago de Compostela, Hospital Clinico Universitario
🇪🇸Santiago de Compostela, A Coruna, Spain
Hospital Regional Universitario de Malaga
🇪🇸Malaga, Spain
Hospital Clinic de Barcelona
🇪🇸Barcelona, Spain
Div. of Allergy Immunology and Rheumatology, Dept. of Medicine,
🇹🇭Bangkok, Thailand
Ondokuz Mayis Universitesi Tip Fakultesi Saglik Uyg. ve Eg.
🇹🇷Samsun, Turkey
Cumhuriyet Universitesi Tip Fakultesi Hastanesi
🇹🇷Sivas, Turkey
The Dudley Group NHS Foundation Trust
🇬🇧Dudley, WEST Midlands, United Kingdom
The Center for Arthritis and Rheumatism
🇺🇸Vero Beach, Florida, United States
Rheumatology Associates of North Alabama, PC
🇺🇸Huntsville, Alabama, United States
Arthritis and Osteoporosis Treatment and Research Center
🇺🇸Flowood, Mississippi, United States
WCR: Wits Clinical Research Charlotte Maxeke Johannesburg Academic Hospital
🇿🇦Johannesburg, Gauteng, South Africa
Omega Research Consultants, LLC
🇺🇸Orlando, Florida, United States
Low Country Rheumatology, PA
🇺🇸Charleston, South Carolina, United States
Nzoz Bif-Med
🇵🇱Bytom, Poland
Synexus Polska Sp. z o.o. Oddzial w Gdyni
🇵🇱Gdynia, Poland
Lecznica MAK-MED, NZOZ
🇵🇱Nadarzyn, Poland
Atencion Integral en Reumatologia (AIR)
🇦🇷Caba, Buenos Aires, Argentina
MHAT Lyulin EAD
🇧🇬Sofia, Bulgaria
Quantum Research Ltda
🇨🇱Puerto Varas, X Region, Chile
Quantum Research
🇨🇱Puerto Varas, X Region, Chile
VAKK "Clinic of Dr. Kilda"
🇱🇹Kaunas, Lithuania
CINTRE, Centro de Investigacion y Tratamiento Reumatologico S.C. Consultorio Medico de Reumatologia
🇲🇽Mexico, Distrito Federal, Mexico
Departamento de Imagen de Hospital Star Medica Merida
🇲🇽Merida, Yucatan, Mexico
Centro de Integral en Reumatologia SA de CV
🇲🇽Jalisco, Mexico
ABK REUMAR S.R.L. de Medicentro Biociencias_ BIO CIENCIAS PERU S.R.L.
🇵🇪Lima, Peru
Investigaciones Clinicas S.A.C.
🇵🇪Lima, Peru
Mary Mediatrix Medical Center
🇵🇭Lipa City, Batangas, Philippines
Brokenshire Integrated Health Ministries, Inc.
🇵🇭Davao, Davao DEL SUR, Philippines
Centrum Medyczne SILESIANA Sp. z o.o.
🇵🇱Bytom, Poland
Chonnam National University Hospital
🇰🇷Gwangju, Korea, Republic of
Storage for lab kits and study materials
🇲🇽Merida, Yucatan, Mexico
Medica Pro Familia Sp. z o.o. S.K.A. Oddzial Krakow
🇵🇱Krakow, Malopolska, Poland
St. Luke's Medical Center
🇵🇭Quezon City, Metro Manila, Philippines
Centrum Kliniczno-Badawcze J.Brzezicki, B.Gornikiewicz-Brzezicka
🇵🇱Elblag, Poland
Chung Shan Medical University Hospital
🇨🇳Taichung, Taiwan ROC, Taiwan
Wineland Medical Research Centre
🇿🇦Stellenbosch, Western CAPE, South Africa
Taipei Veterans General Hospital
🇨🇳Taipei, Taiwan
Kaohsiung Medical University Chung-Ho Memorial Hospital - New
🇨🇳Kaohsiung, Taiwan
Phramongkutklao Hospital
🇹🇭Bangkok, Rajthevi, Thailand
Cardiology Unit,Department of Medicine, Faculty of Medicine, Ramathibodi Hospital,Mahidol University
🇹🇭Bangkok, Thailand
University of the Philippines Manila-Philippine General Hospital
🇵🇭Manila, Metro Manila, Philippines
Jose R. Reyes Memorial Medical Center-Rayuma Klinik
🇵🇭Manila, Metro Manila, Philippines
Royal Free London NHS Foundation Trust
🇬🇧London, United Kingdom