A 2-Part Study to Learn Whether Litifilimab (BIIB059) Injections Can Improve Symptoms of Adult Participants Who Have Active Cutaneous Lupus Erythematosus (AMETHYST)
- Conditions
- Subacute Cutaneous Lupus ErythematosusChronic Cutaneous Lupus Erythematosus
- Interventions
- Drug: Placebo
- Registration Number
- NCT05531565
- Lead Sponsor
- Biogen
- Brief Summary
In this study, researchers will learn more about a study drug called litifilimab (BIIB059) in participants with cutaneous lupus erythematosus (CLE). The study will focus on participants who have either active subacute CLE or chronic CLE, or both. They may also have systemic lupus erythematosus (SLE). The participants did not respond to antimalarial therapy or had problems with the treatment that made it hard to continue.
The main objective of the study is to learn about the effect litifilimab has on lowering the activity of the skin disease. Researchers will measure symptoms of CLE over time using a variety of scoring tools. These include the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), the Cutaneous Lupus Activity of Investigator's Global Assessment-Revised (CLA-IGA-R), and the SELENA-SLEDAI Flare Index (SFI).
The main questions researchers want to answer are:
* How many participants have a score of 0 or 1 on the CLA-IGA-R looking at skin redness after treatment?
* How many participants have their skin disease activity go down by at least 70%?
Researchers will also learn more about the safety of litifilimab. They will study how participants' immune systems respond to litifilimab. Additionally, they will measure the effect litifilimab and CLE have on the quality of life of participants using a group of questionnaires.
The study will be split into 2 parts - Part A and Part B. Both parts will be done as follows:
* After screening, participants will be randomized to receive either litifilimab or placebo for the 1st treatment period. A placebo looks like the study drug but contains no real medicine.
* Participants will receive either litifilimab or placebo as injections under the skin once every 4 weeks.
* The 1st treatment period will be double blinded which means neither the researchers nor the participants will know if the participants are receiving litifilimab or placebo.
* This double blinded treatment period will last 24 weeks, after which the 2nd treatment period will begin.
* During the 2nd treatment period, all participants will receive litifilimab for 28 weeks.
* After completing treatment in this study, participants that qualify will be given the choice to join the Long-Term Extension study, 230LE305. If they do not, they will move into a follow-up safety period that will last up to 24 weeks.
* The total study duration for participants will be up to 80 weeks
- Detailed Description
Litifilimab is a humanized immunoglobulin G1 (IgG1) monoclonal antibody targeting blood dendritic cell antigen 2 and is being investigated for the potential treatment of systemic lupus erythematosus and cutaneous lupus erythematosus. The primary objectives of the study are to evaluate the efficacy of litifilimab compared with placebo in reducing skin disease activity measured by the CLA-IGA-R score \[Parts A and B (US)\] and the Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity (CLASI-A) score \[Part B (ROW)\] in participants with active SCLE and/or CCLE with or without systemic manifestations and refractory and/or intolerant to antimalarials. The secondary objectives of the study are to evaluate the efficacy of litifilimab in reducing SCLE and/or CCLE disease activity by CLA-IGA-R, CLASI-A; to evaluate additional efficacy parameters of litifilimab in reducing SCLE and/or CCLE disease activity; safety; tolerability; and immunogenicity of litifilimab \[Parts A and B\].
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 474
- Histologically confirmed (in the past or during the Screening period) diagnosis of CLE with or without systemic manifestations.
- Must have active cutaneous manifestations that meet study criteria.
- Must have a CLASI-A score ≥10.
- Must have an active CLE lesion despite an adequate trial of antimalarial treatment.
Key
- Any active skin conditions other than CLE that may interfere with the study assessments of CLE.
- Diagnosis of mixed connective tissue disease [(within 1 year of signing the informed consent form (ICF)] or any history of overlap syndromes of SLE including concomitant presence with rheumatoid arthritis, dermatomyositis and/or polymyositis, systemic sclerosis, psoriatic arthritis, or any other autoimmune disease that may confound the evaluation of the disease activity or the effect of the investigational product. Exceptions for overlap syndrome of SLE include participants with overlap syndrome of SLE with myositis and secondary Sjögren's syndrome at screening is permitted provided the participant also meets the criteria for classification as SLE. A past history of mixed connective tissue disease that over time has developed into a diagnosis of SLE is permitted, provided diagnosis of SLE has been present for at least 1 year.
- Active severe lupus nephritis.
- Active neuropsychiatric SLE.
- Use of intralesional corticosteroids within 1 week prior to Screening and during the study.
- Use of immunosuppressive or disease-modifying treatments for SLE or CLE [via an oral, intravenous (IV), or SC route] that were initiated less than 12 weeks prior to randomization, have not been at a stable and allowable dose.
NOTE: Other protocol-defined Inclusion/Exclusion criteria may apply
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Part A (Phase 2): Litifilimab Litifilimab Participants will receive litifilimab subcutaneously (SC) once every 4 weeks (Q4W) from Week 0 to Week 20, with an additional dose of litifilimab at Week 2 during the double-blind placebo-controlled (DBPC) treatment period. Following the DBPC treatment period, participants will receive litifilimab during the extended treatment period (ETP) from Week 24 to Week 48, with an additional dose of litifilimab-matching placebo at Week 26. Part A (Phase 2): Placebo Placebo Participants will receive litifilimab-matching placebo SC Q4W from Week 0 to Week 20, with an additional dose of litifilimab-matching placebo at Week 2 during the DBPC treatment period. Following the DBPC treatment period, participants will receive litifilimab during the ETP from Week 24 to Week 48, with an additional dose of litifilimab at Week 26. Part B (Phase 3): Litifilimab Litifilimab Participants will receive litifilimab SC Q4W from Week 0 to Week 20, with an additional dose of litifilimab at Week 2 during the DBPC treatment period. Following the DBPC treatment period, participants will receive litifilimab during the ETP from Week 24 to Week 48, with an additional dose of litifilimab-matching placebo at Week 26. Part B (Phase 3): Placebo Placebo Participants will receive litifilimab-matching placebo SC Q4W from Week 0 to Week 20, with an additional dose of litifilimab-matching placebo at Week 2 during the DBPC treatment period. Following the DBPC treatment period, participants will receive litifilimab during the ETP from Week 24 to Week 48, with an additional dose of litifilimab at Week 26.
- Primary Outcome Measures
Name Time Method Parts A (US+ROW) and B (US): Percentage of Participants who Achieve a Cutaneous Lupus Activity of Physician's Global Assessment-Revised (CLA-IGA-R) Erythema Score of 0 or 1 Week 16 Part B (ROW): Percentage of Participants who Achieve Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity Score (CLASI-70) Response, Defined as ≥ 70% Decrease in CLASI-A Score From Baseline Baseline to Week 24
- Secondary Outcome Measures
Name Time Method Part A (US+ROW): Percentage of Participants who Achieve a CLASI-50 Response, Defined as a ≥ 50% Decrease in CLASI-A Score From Baseline Weeks 16 and 24 Part A (US+ROW): Absolute Change in Cutaneous Lupus Erythematosus Disease Area and Severity Index Damage (CLASI-D) Score at Week 52 Baseline to Week 52 Part A (US+ROW): Percent Change in CLASI-D Score Baseline to Week 52 Part B (US+ROW): Percentage of Participants who Achieve a CLA-IGA-R Erythema Score of 0 or 1, at Week 16 and Week 24, Respectively, for Participants in Full Analysis Set (FAS), who had CLA-IGA-R Erythema Score ≥3 and Other OMC Score ≥3 at Baseline Weeks 16 and 24 Part B (US+ROW): Percentage of Participants who Achieve a CLA-IGA-R OMC Score of 0 or 1, at Week 16 and Week 24, Respectively, for Participants in FAS, who had CLA-IGA-R Erythema Score ≥3 and OMC Score ≥3 at Baseline Weeks 16 and 24 Part B (US+ROW): Percentage of Participants who Achieve at Least 1 Level of Improvement From Baseline in the CLA-IGA-R Erythema Score Up to Week 24 Part B (US+ROW): Absolute Change in CLASI-D Score Week 52 Part B (US+ROW): Percent Change in CLASI-D Score Week 52 Part B (US+ROW): Change From Baseline in Cutaneous Lupus Erythematosus-Quality of Life (CLE-QoL) Score Part B (US): Weeks 16 and 52; Part B (ROW): Weeks 24 and 52 Part B (US+ROW): Change From Baseline in Dermatology Life Quality Index (DLQI) Score Part B (US): Weeks 16 and 52; Part B (ROW): Weeks 24 and 52 Part B (US+ROW): Change From Baseline in Numerical Rating Scale (NRS) for Pain in Skin Rash Part B (US): Weeks 16 and 52; Part B (ROW): Weeks 24 and 52 Part B (US+ROW): Change From Baseline in NRS for Itch in Skin Rash Part B (US): Weeks 16 and 52; Part B (ROW): Weeks 24 and 52 Parts A (US+ROW) and B (US): Percentage of Participants who Achieve a CLASI-70 Response, Defined as a ≥ 70% Decrease in CLASI-A Score From Baseline Part A (US+ROW): Weeks 16 and 24; Part B (US): Week 16 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLA-IGA-R Erythema Score of 0 or 1 Part A (US+ROW): Week 24; Part B (ROW): Week 24; Part B (US+ROW): Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLA-IGA-R Other Morphologic Characteristics (OMC) Score of 0 or 1 and at Least 1 Level of Improvement From Baseline Part A (US+ROW): Weeks 16 and 24; Part B (US): Week 16; Part B (ROW): Week 24; Part B (US+ROW): Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLA-IGA-R OMC Score of 0 Part A (US+ROW): Weeks 16 and 24; Part B (US+ROW): Up to Week 24 Parts A and B (US+ROW): Percentage of Participants With at Least 1 Level of Improvement From Baseline in CLA-IGA-R OMC Score Part A (US+ROW): Weeks 16 and 24; Part B (US+ROW): Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLA-IGA-R Follicular Activity Score of 0 Parts A and B (US+ROW): Weeks 16 and 24; Part B (US+ROW): Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLASI-A Score of 0 or 1 Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLASI-A Score of 0 to 3 Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLASI 70 Response Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a CLASI 50 Response Up to Week 24 Parts A and B (US+ROW): Percentage of Participants who Achieve a 7-Point Reduction From Baseline in CLASI-A Score Up to Week 24 Parts A and B (US+ROW): Percentage of Participants With a CLASI-70 Response at Week 52 Among CLASI-70 Responders at Week 16 and Week 24, Respectively, who Were Randomly Assigned to Receive Litifilimab During the DBPC Treatment Period (TP) Week 52 Parts A and B (US+ROW): Percentage of Participants With CLA-IGA-R Erythema Score of 0 or 1 at Week 52 Among CLA-IGA-R Erythema Responders at Week 16 and Week 24, Respectively, who Were Randomly Assigned to Receive Litifilimab During the DBPC TP Week 52 Parts A and B(US+ROW): Percentage of Participants With CLA-IGA-R OMC Score of 0/1 & at Least 1 Level of Improvement From Baseline at Week 52 Among CLA-IGA-R OMC Responders at Weeks 16 &24, Respectively, who Were Assigned to Receive Litifilimab in DBPC TP Week 52 Parts A and B (US+ROW): Percentage of Participants With CLA-IGA-R OMC Score of 0 at Week 52 Among CLA-IGA-R OMC Responders With CLA-IGA-R OMC Score of 0 at Week 16 and Week 24, Respectively, who Were Randomly Assigned to Litifilimab During DBPC TP Week 52 Parts A and B(US+ROW):Percentage of Participants With CLA-IGA-R Follicular Activity Score of 0 at Week 52 Among CLA-IGA-R Follicular Activity Responders at Week 16 and Week 24, Respectively, who Were Randomly Assigned to Receive Litifilimab in DBPC TP Week 52 Parts A and B (US+ROW): Percentage of Participants With a CLASI-70 Response at Week 52 Among CLASI-70 Nonresponders at Week 16 and Week 24, Respectively, who Were Randomly Assigned to Receive Placebo During the DBPC TP Week 52 Parts A and B (US+ROW): Percentage of Participants With a CLA-IGA-R Erythema Score of 0 or 1 at Week 52 Among CLA-IGA-R Erythema Nonresponders at Week 16 and Week 24, Respectively, who Were Randomly Assigned to Receive Placebo During the DBPC TP Week 52 Parts A, B(US+ROW):Percentage of Participants With CLA-IGA-R OMC Score of 0/1 and at Least 1 Level of Improvement From Baseline at Week 52 Among CLA-IGA-R OMC Nonresponders at Weeks 16 and 24, Respectively, who Were Assigned to Receive Placebo in DBPC TP Week 52 Parts A and B (US+ROW): Number of Participants With Anti-Litifilimab Antibodies in Serum During the Study Up to Week 76 Parts A and B (US+ROW): Percentage of Participants With a CLA-IGA-R OMC Score of 0 at Week 52 Among CLA-IGA-R OMC Nonresponders at Week 16 and Week 24, Respectively, who Were Randomly Assigned to Receive Placebo During the DBPC TP Week 52 Parts A and B(US+ROW): Percentage of Participants who Achieve CLA-IGA-R Follicular Activity Score of 0 at Week 52 Among CLA-IGA-R Follicular Activity Nonresponders at Weeks 16 and 24, Respectively, who Were Randomly Assigned to Receive Placebo in DBPC TP Week 52 Parts A and B (US+ROW): Annualized Mild and Moderate Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index Flare Index (SFI) Rate and Annualized Severe SFI Rate Through Week 24 Up to Week 24 Parts A and B (US+ROW): Annualized Mild and Moderate SFI Rate and Annualized Severe SFI Rate Through Week 16 Up to Week 16 Parts A and B (US+ROW): Annualized Mild and Moderate SFI Rate and Annualized Severe SFI Rate Through Week 52 Up to Week 52 Parts A and B (US+ROW): Number of Participants Experiencing Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) Up to Week 76
Trial Locations
- Locations (255)
Pinnacle Research Group, LLC
🇺🇸Anniston, Alabama, United States
UAB Center for Women's Reproductive Health
🇺🇸Birmingham, Alabama, United States
Arizona Arthritis & Rheumatology Research, PLLC
🇺🇸Phoenix, Arizona, United States
The Regents of the University of California
🇺🇸La Jolla, California, United States
Dermatology Research Associates
🇺🇸Los Angeles, California, United States
Clinical Science Institute
🇺🇸Santa Monica, California, United States
Inland Rheumatology Clinical Trials, Inc.
🇺🇸Upland, California, United States
Denver Arthritis Clinic
🇺🇸Denver, Colorado, United States
Omega Research Debary, LLC
🇺🇸DeBary, Florida, United States
Centre for Rheumatology, Immunology and Arthritis
🇺🇸Fort Lauderdale, Florida, United States
University of Florida
🇺🇸Gainesville, Florida, United States
Charisma Medical and Research Center
🇺🇸Miami Lakes, Florida, United States
University of Miami Miller School of Medicine
🇺🇸Miami, Florida, United States
Medical Research Center of Miami
🇺🇸Miami, Florida, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
OrthoIllinois
🇺🇸Rockford, Illinois, United States
Dawes Fretzin Clinical Research Group, LLC
🇺🇸Indianapolis, Indiana, United States
LSU Health Sciences Center Shreveport
🇺🇸New Orleans, Louisiana, United States
Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
Brigham And Women's Hospital
🇺🇸Boston, Massachusetts, United States
Essential Dermatology
🇺🇸Natick, Massachusetts, United States
Beacon Clinical Research, LLC
🇺🇸Quincy, Massachusetts, United States
University of Massachusetts, Worcester
🇺🇸Worcester, Massachusetts, United States
David Fivenson, MD, Dermatology, PLLC
🇺🇸Ann Arbor, Michigan, United States
Oakland Hills Dermatology
🇺🇸Auburn Hills, Michigan, United States
AA MRC LLC Ahmed Arif Medical Research Center
🇺🇸Flint, Michigan, United States
Aomori Prefectural Central Hospital
🇯🇵Aomori-shi, Aomori-Ken, Japan
Revival Research Institute, LLC
🇺🇸Troy, Michigan, United States
Saint Louis University
🇺🇸Saint Louis, Missouri, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Albuquerque Center For Rheumatology
🇺🇸Albuquerque, New Mexico, United States
University of New Mexico School of Medicine
🇺🇸Albuquerque, New Mexico, United States
NYU Langone Brooklyn
🇺🇸Brooklyn, New York, United States
Universal Dermatology, PLLC
🇺🇸Fairport, New York, United States
Northwell Health, Inc. PRIME
🇺🇸Great Neck, New York, United States
Columbia University Medical center
🇺🇸New York, New York, United States
University of North Carolina at Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States
Duke Dermatology South Durham
🇺🇸Durham, North Carolina, United States
Medication Management, LLC
🇺🇸Greensboro, North Carolina, United States
University of Cincinnati Department of Dermatology
🇺🇸Cincinnati, Ohio, United States
University Hospitals Cleveland Medical Center
🇺🇸Cleveland, Ohio, United States
Ohio State University
🇺🇸Columbus, Ohio, United States
Penn State University Milton S. Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
University of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States
Vanderbilt University Medical Center
🇺🇸Nashville, Tennessee, United States
Austin Regional Clinic, P.A.
🇺🇸Austin, Texas, United States
Precision Comprehensive Clinical Research Solutions
🇺🇸Colleyville, Texas, United States
Metroplex Clinical Research Center, LLC
🇺🇸Dallas, Texas, United States
UT Southwestern Medical Center
🇺🇸Dallas, Texas, United States
North Texas Center for Clinical Research
🇺🇸Frisco, Texas, United States
UTMB Department of Dermatology
🇺🇸Galveston, Texas, United States
University of Texas Health Science Center at Houston
🇺🇸Houston, Texas, United States
Arthritis & Osteoporosis Clinic
🇺🇸Waco, Texas, United States
University of Utah Health Sciences Center
🇺🇸Salt Lake City, Utah, United States
West End Dermatology Associates
🇺🇸Richmond, Virginia, United States
CINME - Centro De Investigaciones Metabolicas
🇦🇷Caba, Buenos Aires, Argentina
Centro de Investigaciones Medicas Mar del Plata
🇦🇷Mar del Plata, Buenos Aires, Argentina
Instituto de Investigaciones Clinicas Quilmes
🇦🇷Quilmes, Buenos Aires, Argentina
APRILLUS Asistencia e Investigacion
🇦🇷Ciudad Autonoma de Buenos Aires, Ciudad Autonoma Buenos Aires, Argentina
Fundacion Respirar
🇦🇷Ciudad Autonoma de Buenos Aires, Ciudad Autonoma Buenos Aires, Argentina
Instituto CAICI
🇦🇷Rosario, Santa Fe, Argentina
Clinica Mayo de Urgencias Medicas Cruz Blanca SRL
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
Centro de Investigaciones Medicas Tucuman
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
Investigaciones Clinicas Tucuman
🇦🇷San Miguel de Tucuman, Tucuman, Argentina
Hospital Italiano de La Plata
🇦🇷Buenos Aires, Argentina
Centro Privado de Medicina Familiar - Mind Out Research
🇦🇷Ciudad Autonoma Buenos Aires, Argentina
Clinica Adventista Belgrano
🇦🇷Ciudad Autonoma Buenos Aires, Argentina
Instituto de Reumatologia
🇦🇷Mendoza, Argentina
CER San Juan Centro Polivalente de Asistencia e Inv. Clinica
🇦🇷San Juan, Argentina
Clínica SER da Bahia
🇧🇷Salvador, Bahia, Brazil
HUWC - UFC - Hospital Universitário Walter Cantídio - Universidade Federal do Ceará
🇧🇷Fortaleza, Ceará, Brazil
L2IP - Instituto de Pesquisas Clínicas Ltda.
🇧🇷Brasilia, Distrito Federal, Brazil
CEDOES - Diagnóstico e Pesquisa
🇧🇷Vitória, Espírito Santo, Brazil
IPC MT Instituto de Pesquisas Clinicas do Mato Grosso
🇧🇷Santo Ângelo, Mato Grosso, Brazil
Santa Casa de Misericordia de Belo Horizonte
🇧🇷Belo Horizonte, Minas Gerais, Brazil
CMiP - Centro Mineiro de Pesquisa
🇧🇷Juiz de Fora, Minas Gerais, Brazil
Instituto Brasil de Pesquisa Clínica-IBPCLIN S/A
🇧🇷Rio de Janeiro, Rio Do Janeiro, Brazil
IDERJ - Instituto de Dermatologia e Estética do Brasil Ltda
🇧🇷Rio de Janeiro, Rio Do Janeiro, Brazil
Hospital Bruno Born
🇧🇷Lajeado, Rio Grande Do Sul, Brazil
Hospital de Clínicas de Porto Alegre
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Nucleo de Pesquisa Clinica do Rio Grande do Sul
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
LMK Serviços Médicos S/S Ltda
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Charité - Campus Charité Mitte
🇩🇪Berlin, Germany
CEMEC - Centro Multidisciplinar de Estudos Clínicos
🇧🇷Sao Bernardo Do Campo, Sao Paulo, Brazil
CEPIC - Centro Paulista de Investigação Clínica e Serviços Médicos
🇧🇷São Paulo, Sao Paulo, Brazil
Medical center Medconsult Pleven OOD
🇧🇬Pleven, Bulgaria
UMHAT 'Dr. Georgi Stranski', EAD
🇧🇬Pleven, Bulgaria
DCC 1 - Ruse, EOOD
🇧🇬Ruse, Bulgaria
DCC 'Alexandrovska', EOOD
🇧🇬Sofia, Bulgaria
DCC Focus 5 - MEOH OOD
🇧🇬Sofia, Bulgaria
Military Medical Academy - MHAT - Sofia
🇧🇬Sofia, Bulgaria
Laser Rejuvenation Clinics, Inc.
🇨🇦Calgary, Alberta, Canada
Laster Rejuvenation Clinics Edmonton D.T. Inc.
🇨🇦Edmonton, Alberta, Canada
Dermatology Ottawa Research Centre
🇨🇦Ottawa, Ontario, Canada
Medicor Research Inc
🇨🇦Sudbury, Ontario, Canada
DIEX Recherche Sherbrooke Inc.
🇨🇦Sherbrooke, Quebec, Canada
Centro Medico SkinMed
🇨🇱Las Condes, Chile
Dermacross
🇨🇱Santiago, Chile
BioMedica Research Group
🇨🇱Santiago, Chile
CeCim Biocinetic
🇨🇱Santiago, Chile
CIEC - Centro Internacional de Estudios Clínicos
🇨🇱Santiago, Chile
Clinical Research Chile SpA.
🇨🇱Valdivia, Chile
Oncocentro APYS
🇨🇱Viña del Mar, Chile
Beijing Tongren Hospital, Capital Medical University
🇨🇳Beijing, Beijing, China
Peking Union Medical College Hospital
🇨🇳Beijing, Beijing, China
The First Affiliated Hospital of Chongqing Medical University
🇨🇳Chongqing, Chongqing, China
The First Affiliated Hospital of Fujian Medical University
🇨🇳Fuzhou, Fujian, China
Pecsi Tudomanyegyetem
🇭🇺Pecs, Hungary
Dongguan People's Hospital
🇨🇳Dongguan, Guangdong, China
Nanfang Hospital of Southern Medical University
🇨🇳Guangzhou, Guangdong, China
Shenzhen Second People's Hospital
🇨🇳Shenzhen, Guangdong, China
Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
🇨🇳Guangzhou, Guangzhou, China
Nanyang First People's Hospital
🇨🇳Nanyang, Henan, China
Henan Provincial People's Hospital
🇨🇳Zhengzhou, Henan, China
The second Xiangya Hospital of Central South University
🇨🇳Changsha, Hunan, China
The First Affiliated Hospital of Baotou Medical College
🇨🇳Baotou, Inner Mongolia, China
Hospital for Skin Diseases, Chinese Academy of Medical Sciences
🇨🇳Nanjing, Jiangsu, China
Affiliated Hospital of Jiangsu University
🇨🇳Zhenjiang, Jiangsu, China
The First Hospital of Jilin University
🇨🇳Changchun City, Jilin, China
Qilu Hospital of Shandong University
🇨🇳Jinan, Shandong, China
Ruijin Hospital of Shanghai Jiaotong University School of Medicine
🇨🇳Shanghai, Shanghai, China
Zhongshan Hospital Fudan University
🇨🇳Shanghai, Shanghai, China
Shanghai Skin Disease Hospital
🇨🇳Shanghai, Shanghai, China
The Second Affiliated Hospital of Kunming Medical University
🇨🇳Kunming, Yunnan, China
The First Affiliated Hospital of Zhejiang University school of medicine
🇨🇳Hangzhou, Zhejiang, China
Hangzhou First People's Hospital
🇨🇳Hangzhou, Zhejiang, China
The First Affiliated Hospital of Wenzhou Medical University
🇨🇳Wenzhou, Zhejiang, China
Centro de Investigacion Medico Asistencial S.A.S
🇨🇴Barranquilla, Atlántico, Colombia
Healthy Medical Center
🇨🇴Zipaquirá, Cundinamarca, Colombia
Servimed S.A.S.
🇨🇴Bucaramanga, Santander, Colombia
Centro de Investigacion en Reumatologia y Especialidades Medicas SAS. CIREEM
🇨🇴Bogotá, Colombia
CHU Nice - Hopital de l Archet
🇫🇷Nice cedex 3, Alpes Maritimes, France
Hôpital de la Timone
🇫🇷Marseille cedex 5, Bouches-du-Rhône, France
CHU de Caen - Hopital de la Cote de Nacre
🇫🇷Caen, Calvados, France
CHU Besançon - Hôpital Jean Minjoz
🇫🇷Besançon Cedex, Doubs, France
Hopital Larrey
🇫🇷Toulouse Cedex 9, Haute Garonne, France
Hôpital Privé d'Antony
🇫🇷Antony, Hauts De Seine, France
Hopital Saint Eloi
🇫🇷Montpellier Cedex 5, Herault, France
Hôpital Saint-Louis
🇫🇷Cedex 10, Paris, France
Hopital Edouard Herriot - CHU Lyon
🇫🇷Lyon, Rhone, France
Hopital Tenon
🇫🇷Paris, France
Universitaetsklinikum Heidelberg
🇩🇪Heidelberg, Baden Wuerttemberg, Germany
Universitaetsklinikum Erlangen
🇩🇪Erlangen, Bayern, Germany
Medical Center Manila
🇵🇭Manila, Philippines
Fachklinik Bad Bentheim Dermatologie
🇩🇪Bad Bentheim, Niedersachsen, Germany
Elbekliniken Buxtehude GmbH
🇩🇪Buxtehude, Niedersachsen, Germany
Klinikum Oldenburg AoeR
🇩🇪Oldenburg, Niedersachsen, Germany
Universitaetsklinikum Aachen AoeR
🇩🇪Aachen, Nordrhein Westfalen, Germany
Universitaetsklinikum Bonn AoeR
🇩🇪Bonn, Nordrhein Westfalen, Germany
Universitaetsklinikum Duesseldorf AoeR
🇩🇪Duesseldorf, Nordrhein Westfalen, Germany
Universitaetsklinikum Muenster
🇩🇪Muenster, Nordrhein Westfalen, Germany
Universitaetsklinikum Halle (Saale)
🇩🇪Halle, Sachsen Anhalt, Germany
Universitaetsklinikum Carl Gustav Carus TU Dresden
🇩🇪Dresden, Sachsen, Germany
Universitaetsklinikum Schleswig-Holstein - Campus Kiel
🇩🇪Kiel, Schleswig Holstein, Germany
Azienda Ospedaliera Universitaria Policlinico Sant'Orsola Malpighi IRCCS
🇮🇹Bologna, Italy
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (Presidio Spedali Civili)
🇮🇹Brescia, Italy
Università degli studi di Firenze
🇮🇹Firenze, Italy
IRCCS Ospedale Policlinico San Martino
🇮🇹Genova, Italy
Fondazione IRCCS CA' Granda Ospedale Maggiore Policlinico
🇮🇹Milano, Italy
Ospedale San Raffaele
🇮🇹Milano, Italy
Azienda Ospedaliera Universitaria Policlinico 'Federico II'
🇮🇹Napoli, Italy
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
🇮🇹Roma, Italy
JCHO Chukyo Hospital
🇯🇵Nagoya-shi, Aichi-Ken, Japan
NHO Nagoya Medical Center
🇯🇵Nagoya-shi, Aichi-Ken, Japan
Fujita Health University Hospital
🇯🇵Toyoake-shi, Aichi-Ken, Japan
Juntendo University Urayasu Hospital
🇯🇵Urayasu-shi, Chiba-Ken, Japan
University of Fukui Hospital
🇯🇵Yoshida-gun, Fukui-Ken, Japan
Hospital of the University of Occupational and Environmental Health
🇯🇵Kitakyushu-shi, Fukuoka-Ken, Japan
Hokkaido University Hospital
🇯🇵Sapporo-shi, Hokkaido, Japan
Kakogawa Central City Hospital
🇯🇵Kakogawa-shi, Hyogo-Ken, Japan
Kita Harima Medical Center
🇯🇵Ono-shi, Hyogo-Ken, Japan
Kanazawa University Hospital
🇯🇵Kanazawa-shi, Ishikawa-Ken, Japan
St. Marianna University Hospital
🇯🇵Kawasaki-shi, Kanagawa-Ken, Japan
Yokohama City University Medical Center
🇯🇵Yokohama-shi, Kanagawa-Ken, Japan
Yokohama City University Hospital
🇯🇵Yokohama-shi, Kanagawa-Ken, Japan
NHO Yokohama Medical Center
🇯🇵Yokohama-shi, Kanagawa-Ken, Japan
Kumamoto University Hospital
🇯🇵Kumamoto-shi, Kumamoto-Ken, Japan
Tohoku University Hospital
🇯🇵Sendai-shi, Miyagi-Ken, Japan
Nagasaki University Hospital
🇯🇵Nagasaki-Shi, Nagasaki-Ken, Japan
Niigata University Medical & Dental Hospital
🇯🇵Niigata-shi, Niigata-Ken, Japan
Japanese Red Cross Okayama Hospital
🇯🇵Okayama-shi, Okayama-Ken, Japan
NHO Osaka Minami Medical Center
🇯🇵Kawachinagano-shi, Osaka-Fu, Japan
Daini Osaka Police Hospital
🇯🇵Osaka-shi, Osaka-Fu, Japan
Kindai University Hospital
🇯🇵Osakasayama-shi, Osaka-Fu, Japan
Osaka University Hospital
🇯🇵Suita-shi, Osaka-Fu, Japan
Takatsuki Red Cross Hospital
🇯🇵Takatsuki-shi, Osaka-Fu, Japan
Shiga University of Medical Science Hospital
🇯🇵Otsu-shi, Shiga-Ken, Japan
Shimane University Hospital
🇯🇵Izumo-shi, Shimane-Ken, Japan
Teikyo University Hospital
🇯🇵Itabashi-ku, Tokyo-To, Japan
Showa University East Hospital
🇯🇵Shinagawa-ku, Tokyo-To, Japan
Wakayama Medical University Hospital
🇯🇵Wakayama-shi, Wakayama-Ken, Japan
Korea University Ansan Hospital
🇰🇷Ansan-si, Gyeonggi-do, Korea, Republic of
Ajou University Hospital
🇰🇷Suwon, Gyeonggi-do, Korea, Republic of
Chonnam National University Hospital
🇰🇷Gwangju, Korea, Republic of
Severance Hospital, Yonsei University Health System
🇰🇷Seoul, Korea, Republic of
Hanyang University Seoul Hospital
🇰🇷Seoul, Korea, Republic of
The Catholic University of Korea, Seoul St. Mary's Hospital
🇰🇷Seoul, Korea, Republic of
Clinstile, S.A. de C.V.
🇲🇽Ciudad de México, Distrito Federal, Mexico
Centro de Investigacion Clínica GRAMEL S.C
🇲🇽Mexico, Distrito Federal, Mexico
Centro de investigacion medica y reumatologia
🇲🇽Guadalajara, Jalisco, Mexico
Consultorio Privado Dr. Miguel Cortes Hernandez
🇲🇽Cuernavaca, Morelos, Mexico
Medical Care & Research SA de CV
🇲🇽Merida, Yucatán, Mexico
Derma Norte del Bajio S.C.
🇲🇽Aguascalientes, Mexico
Investigacion y Biomedicina de Chihuahua, S.C.
🇲🇽Chihuahua, Mexico
Invest Clinicas Sac Inst de Ginecologia y Reproduccion
🇵🇪Lima, Peru
The Medical City Clark
🇵🇭Mabalacat, Pampanga, Philippines
Cebu Doctors University Hospital
🇵🇭Cebu City, Philippines
Mary Mediatrix Medical Center
🇵🇭Lipa City, Philippines
Philippine General Hospital
🇵🇭Manila, Philippines
Jose R. Reyes Memorial Medical Center
🇵🇭Manila, Philippines
Far Eastern University - Dr. Nicanor Reyes Medical Foundation
🇵🇭Quezon City, Metro Manila, Philippines
St. Luke's Medical Center
🇵🇭Quezon City, Philippines
Ilocos Training and Regional Medical Center
🇵🇭San Fenando, La Union, Philippines
Specjalistyczny Gabinet Dermatologiczny Aplikacyjno-Badawczy Marek Brzewski
🇵🇱Krakow, Poland
SPZOZ Szpital Uniwersytecki w Krakowie
🇵🇱Kraków, Poland
Dermoklinika Centrum Medyczne SC M Kierstan J Narbutt A Lesiak
🇵🇱Lodz, Poland
Kliniczny Szpital Wojewodzki nr 1 im.F.Chopina
🇵🇱Rzeszow, Poland
Szpital Kliniczny Dzieciatka Jezus
🇵🇱Warszawa, Poland
Royalderm
🇵🇱Warszawa, Poland
Cityclinic Przychodnia Lekarsko-Psychologiczna Matusiak Spółka Partnerska
🇵🇱Wroclaw, Poland
Centro Hospitalar e Universitário de Coimbra, E.P.E (HUC)
🇵🇹Coimbra, Portugal
Hospital de Egas Moniz
🇵🇹Lisboa, Portugal
Hospital CUF Descobertas
🇵🇹Lisboa, Portugal
Centro Hospitalar Universitártio do Porto, E.P.E.
🇵🇹Porto, Portugal
Unidade Local de Saúde do Alto Minho, E.P.E.
🇵🇹Viana do Castelo, Portugal
Dr. Samuel Sanchez PSC
🇵🇷Caguas, Puerto Rico
GCM Medical Group PSC - Hato Rey
🇵🇷San Juan, Puerto Rico
King Faisal Specialist Hospital & Research Center
🇸🇦Riyadh, Saudi Arabia
King Saud University
🇸🇦Riyadh, Saudi Arabia
Institute of Rheumatology
🇷🇸Belgrade, Serbia
University Clinical Center of Serbia
🇷🇸Belgrade, Serbia
Clinical Center of Vojvodina
🇷🇸Novi Sad, Serbia
Artromac n.o.
🇸🇰Kosice, Slovakia
Narodny ustav reumatickych chorob
🇸🇰Piestany, Slovakia
Hospital Universitari Germans Trias i Pujol
🇪🇸Badalona, Barcelona, Spain
Hospital Universitario Rio Hortega
🇪🇸Valladolid, Cantabria, Spain
Hospital Universitario Fundacion Alcorcon
🇪🇸Alcorcón, Madrid, Spain
Hospital Universitario Puerta de Hierro Majadahonda
🇪🇸Majadahonda, Madrid, Spain
Hospital del Mar
🇪🇸Barcelona, Spain
Hospital de la Santa Creu i Sant Pau
🇪🇸Barcelona, Spain
Hospital Universitario Reina Sofia
🇪🇸Cordoba, Spain
Complejo Hospitalario Universitario A Coruña
🇪🇸La Coruña, Spain
Hospital Universitario Virgen del Rocio
🇪🇸Sevilla, Spain
Karolinska Universitetssjukhuset - Solna
🇸🇪Stockholm, Sweden
Universitaetsspital Zuerich
🇨🇭Zurich-Flughafen, Zurich, Switzerland
Centre Hospitalier Universitaire Vaudois (CHUV)
🇨🇭Lausanne, Switzerland
Kantonsspital St. Gallen
🇨🇭St. Gallen, Switzerland
Changhua Christian Medical Foundation Changhua Christian Hospital
🇨🇳Changhua, Taiwan
Kaohsiung Chang Gung Memorial Hospital
🇨🇳Kaohsiung, Taiwan
Taichung Veterans General Hospital
🇨🇳Taichung, Taiwan
Taipei Veterans General Hospital
🇨🇳Taipei, Taiwan
Whipps Cross University Hospital
🇬🇧London, Greater London, United Kingdom
Manchester Royal Infirmary
🇬🇧Manchester, Greater Manchester, United Kingdom
Queen Elizabeth Hospital
🇬🇧Birmingham, West Midlands, United Kingdom
Chapel Allerton Hospital
🇬🇧Leeds, West Yorkshire, United Kingdom