A Study Comparing Upadacitinib (ABT-494) to Placebo in Participants With Active Psoriatic Arthritis Who Have a History of Inadequate Response to at Least One Biologic Disease Modifying Anti-Rheumatic Drug
- Conditions
- Psoriatic Arthritis
- Interventions
- Drug: ABT-494Drug: Placebo
- Registration Number
- NCT03104374
- Lead Sponsor
- AbbVie
- Brief Summary
This is a Phase 3 multicenter study that includes two periods. Period 1 is designed to compare the safety, tolerability, and efficacy of ABT-494 Dose A once daily (QD) and Dose B QD versus placebo in participants with moderately to severely active Psoriatic Arthritis (PsA) who have an inadequate response to Biological Disease Modifying Anti-Rheumatic Drug (bDMARDs). Period 2 evaluates the safety, tolerability and efficacy of ABT-494 Dose A QD and Dose B QD in subjects with PsA who have completed Period 1.
- Detailed Description
The study includes a 35-day screening period, a 56-week blinded period (Period 1), a long-term extension period of up to a total treatment duration of approximately 3 years (Period 2), and a 30-day follow-up call or visit.
Period 1 includes 24 weeks of randomized, double-blind, parallel-group, placebo-controlled treatment followed by an additional 32 weeks of blinded treatment where all participants were to receive upadacitinib; at Week 24 participants assigned to placebo will be switched to upadacitinib according to their randomization assignment.
Participants who meet eligibility criteria will be randomized in a 2:2:1:1 ratio to one of four treatment groups:
* Group 1: Upadacitinib 15 mg
* Group 2: Upadacitinib 30 mg
* Group 3: Placebo for 24 weeks followed by upadacitinib 15 mg
* Group 4: Placebo for 24 weeks followed by upadacitinib 30 mg
Participants who complete the Week 56 visit (end of Period 1) will enter the long-term extension portion of the study, Period 2, and continue study treatment as assigned in Period 1 in a blinded manner until the last participant completes the last visit of Period 1 (Week 56), when study drug assignment in both periods will be unblinded and study drug will be dispensed in an open-label fashion until the completion of Period 2.
At Week 16, rescue therapy will be offered to participants classified as non-responders (defined as not achieving at least 20% improvement in tender joint count (TJC) and/or swollen joint count (SJC) at both Week 12 and Week 16). Starting at Week 36, participants who fail to demonstrate at least 20% improvement in either or both TJC and SJC compared to Baseline at 2 consecutive visits will be discontinued from study drug treatment. Additionally, in participants continuing on study drug, starting at the Week 36 visit, initiation of or change in background PsA medication(s) is allowed as per local label.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 642
- 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) criteria
- Participant has active disease at Baseline defined as >= 3 tender joints (based on 68 joint counts) and >= 3 swollen joints (based on 66 joint counts) at Screening and Baseline Visits
- Diagnosis of active plaque psoriasis or documented history of plaque psoriasis
- Participant has had an inadequate response (lack of efficacy after a minimum 12 week duration of therapy) or intolerance to treatment with at least 1 bDMARD.
- Prior exposure to any Janus Kinase (JAK) inhibitor (including but not limited to ruxolitinib, tofacitinib, baricitinib, and filgotinib)
- Current treatment with > 2 non-biologic DMARDs or use of DMARDs other than Methotrexate (MTX), Sulfasalazine (SSZ), Leflunomide (LEF), apremilast, Hydroxychloroquine (HCQ), bucillamine or iguratimod or use of MTX in combination with LEF at Baseline.
- History of fibromyalgia, any arthritis with onset prior to age 17 years, or current diagnosis of inflammatory joint disease other than PsA (including, but not limited to rheumatoid arthritis, gout, overlap connective tissue diseases, scleroderma, polymyositis, dermatomyositis, systemic lupus erythematosus). Prior history of reactive arthritis or axial spondyloarthritis including ankylosing spondylitis and non-radiographic axial spondyloarthritis is permitted if documentation of change in diagnosis to PsA or additional diagnosis of PsA is made. Prior history of fibromyalgia is permitted if documentation of change in diagnosis to PsA or documentation that the diagnosis of fibromyalgia was made incorrectly.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description ABT-494 Dose A ABT-494 It is administered once daily. Placebo followed by ABT-494 Dose B Placebo It is administered once daily. Placebo followed by ABT-494 Dose B ABT-494 It is administered once daily. ABT-494 Dose B ABT-494 It is administered once daily. Placebo followed by ABT-494 Dose A Placebo It is administered once daily. Placebo followed by ABT-494 Dose A ABT-494 It is administered once daily.
- Primary Outcome Measures
Name Time Method Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 12 Baseline and Week 12 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 Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 12 Baseline and Week 12 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) 75 Response at Week 16 Baseline and Week 16 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-75 response is the percentage of participants who achieved at least a 75% reduction (improvement) from Baseline in PASI score.Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 12 Baseline and Week 12 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 score is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The PCS was calculated using norm-based scoring so that 50 is the average score and the standard deviation equals 10. Higher scores are associated with better functioning/quality of life; a positive change from Baseline score indicates an improvement.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 ≤ 1.5 (NRS from 0 to 10)
* Patient's Global Assessment of disease activity ≤ 2 (NRS from 0 to 10)
* 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, with an overall score range from 0 to 6)Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 2 Baseline and Week 2 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 Self-Assessment of Psoriasis Symptoms (SAPS) Score at Week 16 Baseline and Week 16 The SAPS is an 11-item self-assessment of psoriasis symptoms that includes questions on: pain, itching, redness, scaling, flaking, bleeding, burning, stinging, tenderness, pain due to skin cracking, and joint pain. Each item is scored from 0 to 10, with 0 being least severe and 10 being most severe. The total score is generated by summing the 11 items and ranges from 0 to 110 (worst). A negative change from Baseline in the total score indicates improvement.
Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 12 Baseline and Week 12 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 a Static Investigator Global Assessment (sIGA) of Psoriasis of 0 or 1 and at Least a 2-point Improvement From Baseline (sIGA 0/1) at Week 16 Baseline and Week 16 The sIGA is a 5 point scale ranging from 0 to 4, based on the investigator's assessment of the average elevation, erythema, and scaling of all psoriatic lesions at the current visit. A lower score indicates less severe psoriasis (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate and 4 = severe).
Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 12 Baseline and Week 12 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).Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score at Week 12 Baseline and Week 12 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 subscale score ranges from 0 to 52, where higher scores represent less fatigue. A positive change from Baseline indicates improvement.
Trial Locations
- Locations (165)
Arizona Arthritis & Rheumatology Research, PLLC /ID# 160047
🇺🇸Mesa, Arizona, United States
Sun Valley Arthritis Center Ltd. /ID# 161203
🇺🇸Peoria, Arizona, United States
Duplicate_AZ Arthritis and Rheumotology Research, PLLC /ID# 160006
🇺🇸Phoenix, Arizona, United States
Osteoporosis Medical Center /ID# 161411
🇺🇸Beverly Hills, California, United States
Triwest Research Associates /ID# 159915
🇺🇸El Cajon, California, United States
Duplicate_Providence Medical Foundation /ID# 160005
🇺🇸Fullerton, California, United States
Care Access Research, Huntington Beach /ID# 160049
🇺🇸Huntington Beach, California, United States
Purushotham & Akther Kotha MD, Inc /ID# 159834
🇺🇸La Mesa, California, United States
Colorado Arthritis Associates /ID# 159856
🇺🇸Lakewood, Colorado, United States
Duplicate_Arthritis & Rheumatic Disease Specialties /ID# 161409
🇺🇸Aventura, Florida, United States
International Medical Research /ID# 160051
🇺🇸Daytona Beach, Florida, United States
Precision Research Organization /ID# 161293
🇺🇸Miami Lakes, Florida, United States
Duplicate_Suncoast Clinical Research /ID# 161417
🇺🇸New Port Richey, Florida, United States
West Broward Rheumatology Associates /ID# 161412
🇺🇸Tamarac, Florida, United States
Clinical Research of West Florida - Tampa /ID# 160069
🇺🇸Tampa, Florida, United States
Clinical Research of West Florida, Inc /ID# 159840
🇺🇸Tampa, Florida, United States
Jefrey D. Lieberman, MD, P.C. /ID# 159842
🇺🇸Decatur, Georgia, United States
Velocity Clinical Research - Boise /ID# 159922
🇺🇸Meridian, Idaho, United States
Duplicate_Clinic of Robert Hozman/Clinical Investigation Specialists /ID# 160068
🇺🇸Skokie, Illinois, United States
Arthritis Treatment Center /ID# 160053
🇺🇸Frederick, Maryland, United States
The Center for Rheumatology and Bone Research /ID# 159900
🇺🇸Wheaton, Maryland, United States
Clinical Pharmacology Study Group /ID# 158712
🇺🇸Worcester, Massachusetts, United States
Duplicate_Arthritis and Osteo Assoc /ID# 160015
🇺🇸Las Cruces, New Mexico, United States
Center for Rheumatology LLP /ID# 167046
🇺🇸Albany, New York, United States
Physicians East, PA /ID# 159898
🇺🇸Greenville, North Carolina, United States
Shanahan Rheuma & Immuno /ID# 160012
🇺🇸Raleigh, North Carolina, United States
University of Pittsburgh MC /ID# 161193
🇺🇸Pittsburgh, Pennsylvania, United States
Diagnostic Group /ID# 161406
🇺🇸Beaumont, Texas, United States
Arthritis and Osteoporosis Clinic Of Brazos Valley /ID# 163439
🇺🇸College Station, Texas, United States
Rheumatic Disease Clin Res Ctr /ID# 161252
🇺🇸Houston, Texas, United States
DM Clinical Research - Tomball /ID# 161753
🇺🇸Tomball, Texas, United States
Arthritis Clinic of N. VA, P.C /ID# 159858
🇺🇸Arlington, Virginia, United States
Duplicate_Swedish Medical Center /ID# 159918
🇺🇸Seattle, Washington, United States
Emeritus Research Sydney /ID# 166751
🇦🇺Botany, New South Wales, Australia
The Queen Elizabeth Hospital /ID# 200840
🇦🇺Woodville South, South Australia, Australia
Box Hill Hospital /ID# 166752
🇦🇺Box Hill, Victoria, Australia
Heidelberg Repatriation Hospital /ID# 167441
🇦🇺Heidelberg West, Victoria, Australia
ReumaClinic /ID# 164214
🇧🇪Genk, Limburg, Belgium
UZ Gent /ID# 164210
🇧🇪Gent, Oost-Vlaanderen, Belgium
Duplicate_Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto - USP /ID# 163317
🇧🇷Ribeirão Preto, Sao Paulo, Brazil
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao /ID# 161793
🇧🇷Sao Paulo, Brazil
CIADS Research Co Ltd /ID# 157843
🇨🇦Winnipeg, Manitoba, Canada
Centre de Recherche Musculo-Squelettique /ID# 163557
🇨🇦Trois-rivières, Quebec, Canada
CTR Estudios Clinicos /ID# 206038
🇨🇱Providencia, Aisen Del General Carlos Ibanez Del Campo, Chile
Duplicate_Clinica Dermacross /ID# 169537
🇨🇱Santiago, Chile
Duplicate_Centro Internacional de Estudios Clinicos /ID# 169543
🇨🇱Santiago, Chile
Centre Hospitalier du Mans /ID# 163746
🇫🇷Le Mans CEDEX 9, Sarthe, France
CHRU Tours - Hopital Trousseau /ID# 163772
🇫🇷Chambray Les Tours, France
Duplicate_CHU-Hospital Henri Mondor /ID# 163895
🇫🇷Creteil, France
Duplicate_AP-HP - Hopital Lariboisiere /ID# 163773
🇫🇷Paris, France
Reg Gen Univ Hosp Larissa /ID# 163493
🇬🇷Larisa, Greece
Gyor-Moson-Sopron Varmegyei Petz Aladar Egyetemi Oktato Korhaz /ID# 162573
🇭🇺Gyor, Gyor-Moson-Sopron, Hungary
Vital Medicina Kft /ID# 162571
🇭🇺Veszprém, Veszprem, Hungary
Betegapolo Irgalmasrend Budai Irgalmasrendi Korhaz /ID# 170911
🇭🇺Budapest, Hungary
Obudai Egeszsegugyi Centrum Kft. /ID# 162576
🇭🇺Budapest, Hungary
Debreceni Egyetem Kenezy Gyula Egyetemi Korhaz /ID# 162572
🇭🇺Debrecen, Hungary
MÁV Kórház /ID# 162574
🇭🇺Szolnok, Hungary
Azienda Ospedaliera Universitaria Federico II /ID# 202410
🇮🇹Napoli, L Aquila, Italy
Duplicate_Fondazione Policlinico Universitario Campus Bio-Medico di Roma /ID# 164123
🇮🇹Rome, Roma, Italy
Duplicate_Fondazione PTV Policlinico Tor Vergata /ID# 162749
🇮🇹Rome, Roma, Italy
Duplicate_Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona /ID# 162748
🇮🇹Ancona, Italy
Duplicate_A.O.U. Policlinico G. Rodolico S.Marco- Presidio G.Rodolico /ID# 164126
🇮🇹Catania, Italy
Duplicate_AOU Arcispedale Sant Anna di /ID# 164127
🇮🇹Cona, Italy
ASST Gaetano Pini/Presidio Ospedaliero Pini /ID# 164125
🇮🇹Milan, Italy
Duplicate_Azienda Unita Sanitaria Locale/IRCCS /ID# 162751
🇮🇹Reggio Emilia, Italy
Duplicate_Kitakyushu Municipal Medical Center /ID# 163516
🇯🇵Kitakyushu-shi, Fukuoka, Japan
Hospital of the University of Occupational and Environmental Health, Japan /ID# 161472
🇯🇵Kitakyushu-shi, Fukuoka, Japan
Osaka Metropolitan University Hospital /ID# 162082
🇯🇵Osaka-shi, Osaka, Japan
Duplicate_Ajou University Hospital /ID# 163893
🇰🇷Suwon, Gyeonggido, Korea, Republic of
Duplicate_Inha University Hospital /ID# 163892
🇰🇷중구, Incheon Gwang Yeogsi, Korea, Republic of
Medisch Centrum Leeuwarden /ID# 163049
🇳🇱Leeuwarden, Zuid-Holland, Netherlands
Duplicate_Erasmus Medisch Centrum /ID# 163052
🇳🇱Rotterdam, Zuid-Holland, Netherlands
Sint Maartenskliniek /ID# 163703
🇳🇱Ubbergen, Netherlands
Duplicate_Middlemore Hospital /ID# 166411
🇳🇿Otahuhu, Auckland, New Zealand
Timaru Medical Specialists Ltd /ID# 166410
🇳🇿Timaru, Canterbury, New Zealand
Duplicate_Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE /ID# 165897
🇵🇹Vila Nova De Gaia, Porto, Portugal
Unidade Local de Saúde do Alto Minho, EPE - Hospital Conde de Bertiandos /ID# 165898
🇵🇹Ponte de Lima, Viana Do Castelo, Portugal
Centro Hospitalar de Lisboa Ocidental, EPE - Hospital Egas Moniz /ID# 165896
🇵🇹Lisboa, Portugal
Unidade Local de Saude de Santa Maria, EPE /ID# 165895
🇵🇹Lisboa, Portugal
Alma M. Cruz Santana, MD-Private practice /ID# 163308
🇵🇷Carolina, Puerto Rico
Ponce Medical School Foundation /ID# 163918
🇵🇷Ponce, Puerto Rico
GCM Medical Group PSC /ID# 163716
🇵🇷San Juan, Puerto Rico
Duplicate_Hospital Universitario A Coruna - CHUAC /ID# 161019
🇪🇸A Coruna, Spain
Duplicate_Hospital Universitario Reina Sofia /ID# 170764
🇪🇸Cordoba, Spain
Hospital Campus de la Salud /ID# 170768
🇪🇸Granada, Spain
Hospital Universitario Ramon y Cajal /ID# 161020
🇪🇸Madrid, Spain
Barts Health NHS Trust /ID# 161053
🇬🇧London, London, City Of, United Kingdom
Guys and St Thomas NHS Foundation Trust /ID# 161063
🇬🇧London, London, City Of, United Kingdom
Duplicate_NHS Greater Glasgow and Clyde /ID# 162712
🇬🇧Glasgow, United Kingdom
Duplicate_Bedfordshire Hospitals NHS Foundation Trust /ID# 162713
🇬🇧Luton, United Kingdom
Duplicate_Christchurch University Hospitals Dorset NHS University Hospitals Dors /ID# 162711
🇬🇧Poole, United Kingdom
Alabama Medical Group, PC /ID# 159836
🇺🇸Mobile, Alabama, United States
Covina Arthritis Clinic /ID# 159919
🇺🇸Covina, California, United States
C.V. Mehta MD, Med Corporation /ID# 161192
🇺🇸Hemet, California, United States
Stanford University School of Med /ID# 161402
🇺🇸Stanford, California, United States
Inland Rheum Clin Trials Inc. /ID# 159839
🇺🇸Upland, California, United States
Medvin Clinical Research /ID# 160045
🇺🇸Whittier, California, United States
Denver Arthritis Clinic /ID# 159899
🇺🇸Denver, Colorado, United States
Millennium Research /ID# 159833
🇺🇸Ormond Beach, Florida, United States
Arthritis Center, Inc. /ID# 163463
🇺🇸Palm Harbor, Florida, United States
Gulf Region Clinical Res Inst /ID# 159860
🇺🇸Pensacola, Florida, United States
BayCare Medical Group /ID# 161405
🇺🇸Saint Petersburg, Florida, United States
Sarasota Arthritis Center /ID# 159854
🇺🇸Sarasota, Florida, United States
USF Health Morsani Center for /ID# 161291
🇺🇸Tampa, Florida, United States
BayCare Medical Group, Inc. /ID# 159912
🇺🇸Tampa, Florida, United States
Florida Medical Clinic /ID# 160013
🇺🇸Zephyrhills, Florida, United States
Atlanta Research Center for Rheumatology /ID# 161201
🇺🇸Marietta, Georgia, United States
Great Lakes Clinical Trials /ID# 163438
🇺🇸Chicago, Illinois, United States
Deerbrook Medical Associates /ID# 159815
🇺🇸Libertyville, Illinois, United States
The Arthritis & Diabetes Clinic, Inc. /ID# 161294
🇺🇸Monroe, Louisiana, United States
Clinvest Research LLC /ID# 161208
🇺🇸Springfield, Missouri, United States
Westroads Clinical Research /ID# 160004
🇺🇸Omaha, Nebraska, United States
Atlantic Coast Research /ID# 159810
🇺🇸Toms River, New Jersey, United States
St. Lawrence Health System /ID# 159857
🇺🇸Potsdam, New York, United States
DJL Clinical Research, PLLC /ID# 161414
🇺🇸Charlotte, North Carolina, United States
PMG Research of Wilmington LLC /ID# 161403
🇺🇸Wilmington, North Carolina, United States
Trinity Health Med Arts Clinic /ID# 159811
🇺🇸Minot, North Dakota, United States
STAT Research, Inc. /ID# 161416
🇺🇸Vandalia, Ohio, United States
Health Research of Oklahoma /ID# 159913
🇺🇸Oklahoma City, Oklahoma, United States
Altoona Ctr Clinical Res /ID# 159861
🇺🇸Duncansville, Pennsylvania, United States
Articularis Healthcare Group, Inc d/b/a Low Country Rheumatology /ID# 163462
🇺🇸Summerville, South Carolina, United States
Rheumatology Consultants, PLLC /ID# 161408
🇺🇸Knoxville, Tennessee, United States
Dr. Ramesh Gupta /ID# 160067
🇺🇸Memphis, Tennessee, United States
Tekton Research, Inc. /ID# 160008
🇺🇸Austin, Texas, United States
Adriana Pop-Moody MD Clinic PA /ID# 160009
🇺🇸Corpus Christi, Texas, United States
Metroplex Clinical Research /ID# 159818
🇺🇸Dallas, Texas, United States
Accurate Clinical Research /ID# 160052
🇺🇸Houston, Texas, United States
P&I Clinical Research /ID# 159837
🇺🇸Lufkin, Texas, United States
SW Rheumatology Res. LLC /ID# 160014
🇺🇸Mesquite, Texas, United States
Arthritis & Osteoporosis Clinic /ID# 161400
🇺🇸Waco, Texas, United States
CIP - Centro Internacional de Pesquisa /ID# 161808
🇧🇷Goiânia, Goias, Brazil
Faculdade de Medicina do ABC /ID# 163489
🇧🇷Santo André, La Spezia, Brazil
Hospital de Clínicas da Universidade Federal de Uberlândia /ID# 161794
🇧🇷Uberlândia, Minas Gerais, Brazil
Hospital de Clinicas de Porto Alegre /ID# 161795
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
LMK Sevicos Medicos S/S /ID# 161806
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Percuro Clinical Research, Ltd /ID# 157835
🇨🇦Victoria, British Columbia, Canada
The Waterside Clinic /ID# 157838
🇨🇦Orillia, Ontario, Canada
Groupe de Recherche en Maladies Osseuses Inc /ID# 157836
🇨🇦Sainte-foy, Quebec, Canada
Prosalud Ltda. /ID# 169542
🇨🇱Santiago, Chile
Revmatologie Bruntal, s.r.o /ID# 159632
🇨🇿Prostejov, Czechia
Medical Plus, s.r.o. /ID# 159631
🇨🇿Uherske Hradiste, Czechia
Hopital Saint Joseph /ID# 163755
🇫🇷Marseille, Bouches-du-Rhone, France
CHU Toulouse /ID# 163743
🇫🇷Toulouse, Occitanie, France
General Hospital of Athens Laiko /ID# 163474
🇬🇷Athens, Attiki, Greece
Naval Hospital of Athens /ID# 163495
🇬🇷Athens, Greece
Revita Reumatologiai Rendelo /ID# 162575
🇭🇺Budapest, Hungary
Nagoya City University Hospital /ID# 162563
🇯🇵Nagoya shi, Aichi, Japan
Daido Hospital /ID# 163639
🇯🇵Nagoya-shi, Aichi, Japan
Fukuoka University Hospital /ID# 161774
🇯🇵Fukuoka-shi, Fukuoka, Japan
Asahikawa Medical University Hospital /ID# 200684
🇯🇵Asahikawa-shi, Hokkaido, Japan
Mie University Hospital /ID# 162085
🇯🇵Tsu-shi, Mie, Japan
Tohoku University Hospital /ID# 164035
🇯🇵Sendai-shi, Miyagi, Japan
Oribe Clinic of Rheumatism and Medicine /ID# 163704
🇯🇵Oita-shi, Oita, Japan
Kansai Medical University Hospital /ID# 162081
🇯🇵Hirakata-shi, Osaka, Japan
National Hospital Organization Osaka Minami Medical Center /ID# 162589
🇯🇵Kawachinagano Shi, Osaka, Japan
Nippon Life Saiseikai Public Interest Foundation Nippon Life Hospital /ID# 161773
🇯🇵Osaka-shi, Osaka, Japan
Juntendo University Hospital /ID# 162089
🇯🇵Bunkyo-ku, Tokyo, Japan
St.Luke's International Hospital /ID# 162013
🇯🇵Chuo-ku, Tokyo, Japan
Keio University Hospital /ID# 162130
🇯🇵Shinjuku-ku, Tokyo, Japan
Maasstad Ziekenhuis /ID# 163050
🇳🇱Rotterdam, Zuid-Holland, Netherlands
Waikato Hospital /ID# 166412
🇳🇿Hamilton, Waikato, New Zealand
Porter Rheumatology Ltd /ID# 200422
🇳🇿Nelson, New Zealand
Instituto Portugues De Reumatologia /ID# 165894
🇵🇹Lisboa, Portugal
Hospital Clinico Universitario Virgen de la Arrixaca /ID# 163138
🇪🇸El Palmar, Murcia, Spain
Royal United Hospitals Bath /ID# 161054
🇬🇧Bath, Bath And North East Somerset, United Kingdom