A Study to Find Out How Safe Long-term Treatment With Fezolinetant is in Women With Hot Flashes Going Through Menopause

Phase 3

Completed

• Conditions: Hot Flashes
• Interventions: Drug: fezolinetant; Drug: placebo

• Registration Number: NCT04003389
• Lead Sponsor: Astellas Pharma Global Development, Inc.

Brief Summary

This study was for women in menopause with hot flashes. Menopause, a normal part of aging, was the time of a woman's last period. Hot flashes can interrupt a woman's daily life.

The purpose of this study was to find out how safe it is for these women to take fezolinetant in long term (up to 52 weeks). To do that, the study looked at the number and severity of the "adverse events." Those were the side effects that study participants had while they were in the study.

The study treatments were fezolinetant 30 milligrams (mg) (1 tablet of fezolinetant and 1 placebo tablet) once a day, fezolinetant 45 mg (2 tablets of fezolinetant) once a day or placebo (2 tablets) once a day. (Placebo was a dummy treatment that looked like medicine but did not have any medicine in it.) Women in this study were picked for 1 of the 3 study treatments by chance alone. The study participants took study treatment for 52 weeks.

This study was "double-blinded." That means that the study participants and the study doctors did not know who took which of the study treatments (fezolinetant 30 mg, fezolinetant 45 mg or placebo).

At weeks 2 and 4 and then once a month, the study participants went to the hospital or clinic for a check-up. They were asked about medications, side effects and how they felt. Other checks included physical exam and vital signs (heart rate, temperature and blood pressure). Blood and urine were collected for laboratory tests. At some study visits, study participants completed questionnaires that were about their quality of life. At the first and last study visits, they had a dual-energy x-ray absorptiometry (DXA for short) test done. To measure bone loss in the hips and spine, DXA created pictures of the inside of these areas with low-dose x-rays. (The dose was approximately one-tenth of the amount of a normal chest x-ray.) Study participants who still had their uterus had 2 more tests done at the first and last study visits. One of the 2 tests was endometrial biopsy. This test involved removing a small amount of tissue from the inside lining of the uterus. The tissue was then checked under a microscope. The other test was transvaginal ultrasound. It used sound waves to create pictures of the organs in the pelvis. The sound waves were transmitted by a probe (transducer), which was placed inside the vagina. Study participants might have had a screening mammogram done at the first and/or last study visit. A mammogram is an x-ray picture of the breasts used to screen for breast cancer. Study participants who did not had this test done in the last 12 months had it done at the first study visit. They had done at the last study visit if they were due for their screening mammogram and their own doctor agreed.

The last check-up at the hospital or clinic was at 3 weeks after the last dose of study treatment.

Detailed Description

This study consisted of a screening period and a 52 week treatment period. Safety follow up occurred 3 weeks after the last dose of study drug.

Study Timeline

• Study First Submitted: 2019-06-27
• Study First Submitted QC: 2019-06-27
• Study First Posted: 2019-07-01
• Study Start: 2019-07-10
• Primary Completion: 2022-01-04
• Study Completion: 2022-01-04
• Results First Submitted: 2023-01-04
• Results First Submitted QC: 2023-01-04
• Results First Posted: 2023-02-01
• Status Verified: 2024-10
• Last Update Submitted: 2024-10-23
• Last Update Posted: 2024-11-05

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 1831

Inclusion Criteria

• Subject has a body mass index ≥ 18 kg/m^2 and ≤ 38 kg/m^2.

• Subject must be seeking treatment or relief for vasomotor symptoms (VMS) associated with menopause and confirmed as menopausal per 1 of the following criteria at the screening visit:

  • Spontaneous amenorrhea for ≥ 12 consecutive months
  • Spontaneous amenorrhea for ≥ 6 months with biochemical criteria of menopause (follicle stimulating hormone > 40 IU/L), or
  • Having had bilateral oophorectomy ≥ 6 weeks prior to the screening visit.

• Subject is seeking treatment for relief for VMS associated with menopause.

• Subject is in good general health as determined on the basis of medical history and general physical examination, including a bimanual clinical pelvic examination and clinical breast examination devoid of relevant clinical findings, performed at the screening visit; hematology and biochemistry parameters; pulse rate and/or blood pressure; and ECG within the reference range for the population studied, or showing no clinically relevant deviations.

• Subject has documentation of a normal/negative or no clinically significant mammogram findings (obtained at screening or within the prior 12 months of study enrollment). Appropriate documentation includes a written report or an electronic report indicating normal/negative or no clinically significant mammographic findings.

• Subject is willing to undergo a transvaginal ultrasound (TVU) to evaluate the uterus and ovaries at screening and at week 52 end of treatment (EOT). For subjects who are withdrawn from the study prior to completion, a TVU should be collected at the early discontinuation (ED) visit.

• Subject is willing to undergo an endometrial biopsy at screening and at week 52 (EOT) or the ED visit for subjects who are withdrawn from the study prior to completion, and any time during the study in the case of uterine bleeding. The endometrial biopsy obtained at screening must be considered evaluable.

• Subject has documentation of a normal or not clinically significant Papanicolaou (Pap) test (or equivalent cervical cytology) within the previous 12 months or at screening.

• Subject has a negative urine pregnancy test at screening.

• Subject has a negative serology panel (i.e., negative hepatitis B surface antigen, negative hepatitis C virus antibody and negative human immunodeficiency virus antibody screens) at screening.

• Subject agrees not to participate in another interventional study while participating in the present study.

Exclusion Criteria

• Subject uses a prohibited therapy (strong or moderate cytochrome P450 [CYP] 1A2 inhibitors, hormone replacement therapy [HRT], hormonal contraceptive, any treatment for VMS [prescription, over the counter or herbal]) or is not willing to wash out and discontinue such drugs for the full extent of the study.

• Subject has a known substance abuse or alcohol addiction within 6 months of screening.

• Subject has previous or current history of a malignant tumor, except for basal cell carcinoma.

• Subject's systolic blood pressure is ≥ 130 mmHg or diastolic blood pressure is ≥ 80 mmHg based on the average of 2 to 3 readings, on at least 2 different occasions within the screening period.

  • Subjects who do not meet these criteria may be re-assessed after initiation or review of antihypertensive measures.
  • Subjects with a medical history of hypertension can be enrolled once they are medically clear (stable and compliant).

• Subject has a history of severe allergy, hypersensitivity or intolerance to drugs in general, including the study drug and any of its excipients.

• Subject has an unacceptable result from the TVU assessment at screening, i.e., full length of endometrial cavity cannot be visualized or presence of a clinically significant finding.

• Subject has an endometrial biopsy confirming presence of disordered proliferative endometrium, endometrial hyperplasia, endometrial cancer, or other clinically significant findings at screening.

• Subject has a history within the last 6 months of undiagnosed uterine bleeding.

• Subject has a history of seizures or other convulsive disorders.

• Subject has a medical condition or chronic disease (including history of neurological [including cognitive], hepatic, renal, cardiovascular, gastrointestinal, pulmonary [e.g., moderate asthma], endocrine or gynecological disease) or malignancy that could confound interpretation of the study outcome.

• Subject has active liver disease, jaundice or elevated liver aminotransferases (alanine aminotransferase [ALT] or aspartate aminotransferase [AST]), elevated total or direct bilirubin, elevated international normalized ratio (INR), or elevated alkaline phosphatase (ALP). Patients with mildly elevated ALT or AST up to 1.5 times the upper limit of normal (ULN) can be enrolled if total and direct bilirubin are normal. Patients with mildly elevated ALP (up to 1.5 x ULN) can be enrolled if cholestatic liver disease is excluded and no cause other than fatty liver is diagnosed. Patients with Gilbert's syndrome with elevated total bilirubin may be enrolled as long as direct bilirubin, hemoglobin and reticulocytes are normal.

• Subject has creatinine > 1.5 x ULN; or estimated glomerular filtration rate using the Modification of Diet in Renal Disease formula ≤ 59 mL/min per 1.73 m^2 at the screening visit.

• Subject has a history of suicide attempt or suicidal behavior within the last 12 months or has suicidal ideation within the last 12 months (a response of "yes" to questions 4 or 5 on the suicidal ideation portion of the Columbia-Suicide Severity Rating Scale [C-SSRS]), or who is at significant risk to commit suicide, as assessed at screening and at the time of visit 2 (randomization).

• Subject has previously been enrolled in a clinical trial with fezolinetant.

• Subject is participating concurrently in another interventional study or participated in an interventional study within 28 days prior to screening, or received any investigational drug within 28 days or within 5 half-lives prior to screening, whichever is longer.

• Subject is unable or unwilling to complete the study procedures.

• Subject has any condition which makes the subject unsuitable for study participation.

• Subject has had a partial or full hysterectomy.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Fezolinetant 30 mg	fezolinetant	Participants received fezolinetant 30 mg (one 30 mg fezolinetant tablet and one placebo tablet) orally, once daily (QD) for a period of 52 Weeks.
Placebo	placebo	Participants received fezolinetant matching placebo (two fezolinetant matching placebo tablets) orally, QD for a of period of 52 Weeks.
Fezolinetant 45 mg	fezolinetant	Participants received fezolinetant 45 mg (one 30 mg tablet and one 15 mg tablet) orally, QD for a period of 52 Weeks.

Primary Outcome Measures

Name	Time	Method
Percentage of Participants With Endometrial Cancer	Baseline Up to 52 weeks	Endometrial cancer was confirmed from the endometrial biopsy report.
Number of Participants With Mild, Moderate and Severe TEAE	From first dose of study drug until 21 days after last dose of study drug (Up to 55 weeks)	An adverse event (AE) is any untoward medical occurrence in a participant administered a study drug, and which does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a medicinal product whether or not considered related to the medicinal product. A TEAE is defined as an AE observed after starting administration of the study drug and 21 days after the last dose of study drug. Severity of AE we were classified as Mild: No disruption of normal daily activities; Moderate: Affect normal daily activities; and Severe: Inability to perform daily activities.
Number of Participants With Treatment Emergent Adverse Events (TEAEs)	From first dose of study drug until 21 days after last dose of study drug (Up to 55 weeks)	An AE is any untoward medical occurrence in a participant administered a study drug, \& which does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable \& unintended sign, symptom, or disease temporally associated with the use of medicinal product (MP) whether or not considered related to MP. An AE is considered "serious" if it results in death, is life-threatening, results in persistent or significant disability/incapacity or substantial disruption of the ability to conduct normal life functions, results in congenital anomaly or birth defect, requires inpatient hospitalization or leads to prolongation of hospitalization, hospitalization for treatment/observation/examination caused by AE is to be considered as serious, discontinuation due to increases in liver enzymes, other medically important events. A TEAE is defined as an AE observed after starting administration of study drug \& 21 days after the last dose of study drug.
Percentage of Participants With Endometrial Hyperplasia	Baseline Up to 52 weeks	Endometrial hyperplasia was confirmed from the endometrial biopsy report.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in Endometrial Thickness at Week 52	Baseline and week 52	Endometrial thicness was obtained from the transvaginal ultrasound. The endometrium was measured in the long axis or sagittal plane. The measurement was of the thickest echogenic area from 1 basal endometrial interface across the endometrial canal to the other basal surface.
Number of Participants With Self-injurious Behavior Without Suicidal Intent as Assessed by C-SSRS	Baseline, week 12, week 24, week 52 and follow-up (week 55)	The C-SSRS assessed the risk for Self-injurious Behavior without Suicidal Intent. Question was asked "Has participant engaged in Non-Suicidal Self-Injurious Behavior?". Participants with 'yes' to the question were reported.
Percentage of Participants With Disordered Proliferative Endometrium	Baseline Up to 52 weeks	Disordered proliferative endometrium was confirmed from the endometrial biopsy report.
Change From Baseline in Trabecular Bone Score (TBS) at Hip at Week 52	Baseline and week 52	TBS was a bone texture assessment that serves as a substitute for bone microarchitecture and predicts fracture risk independent of BMD and clinical risk factors. The DXA imaging was processed and analyzed as it would normally be and then evaluated using an automated algorithm to determine the TBS. T-score ≥1.350 was considered to be normal; T-score between 1.200 and 1.350 is considered to be consistent with partially degraded microarchitecture; and T-score ≤1.200 defines degraded microarchitecture.
Change From Baseline in Bone Mineral Density (BMD) at Hip at Week 52	Baseline and week 52	Changes in BMD hip was assessed by dual-energy X-ray absorptiometry (DXA) scan.
Change From Baseline in TBS at Spine at Week 52	Baseline and week 52	TBS was a bone texture assessment that serves as a substitute for bone microarchitecture and predicts fracture risk independent of BMD and clinical risk factors. The DXA imaging was processed and analyzed as it would normally be and then evaluated using an automated algorithm to determine the TBS. T-score ≥1.350 was considered to be normal; T-score between 1.200 and 1.350 is considered to be consistent with partially degraded microarchitecture; and T-score ≤1.200 defines degraded microarchitecture.
Number of Participants With Suicidal Ideation and/or Behaviour as Assessed by Columbia-Suicide Severity Rating Scale (C-SSRS)	Baseline, week 12, week 24, week 52 and follow-up (week 55)	The C-SSRS assessed the risk for suicidal behavior and suicide ideation. Participants responded as "Yes" or "No" 10 items. Suicidal ideation (1. Wish to be dead; 2. Non-specific active suicidal thoughts; 3. Active suicidal ideation with any methods (not plan) without intent to act; 4. Active suicidal ideation with some intent to act, without specific plan; 5. Active suicidal ideation with specific plan and intent; ). Suicidal behaviour (1. Preparatory acts or behavior 2. Aborted attempt 3. Interrupted attempt 4. Actual attempt 5. Completed suicide). Participants with 'Yes' to any one of the above 10 questions for suicidal ideation and behavior were reported.
Change From Baseline in BMD at Spine at Week 52	Baseline and week 52	Changes in BMD spine was assessed by DXA scan.

Trial Locations

Locations (174)

Neuro-Behavioral Clinical Research, Inc; 🇺🇸 North Canton, Ohio, United States

Aventiv Research, Inc.; 🇺🇸 Columbus, Ohio, United States

Complete Healthcare For Women; 🇺🇸 Columbus, Ohio, United States

Medical Research Centers of South Florida, Inc.; 🇺🇸 Miami, Florida, United States

Florida International Research Center; 🇺🇸 Miami, Florida, United States

Medical Research Center of Miami II; 🇺🇸 Miami, Florida, United States

Advances in Health; 🇺🇸 Houston, Texas, United States

Centex Studies, Inc.; 🇺🇸 Houston, Texas, United States

Seattle Women's: Health, Research, Gynecology; 🇺🇸 Seattle, Washington, United States

Wake Research Associates, LLC; 🇺🇸 Raleigh, North Carolina, United States

CITrials, Inc; 🇺🇸 Santa Ana, California, United States

Women's Healthcare Affiliates; 🇺🇸 San Diego, California, United States

CTI; 🇺🇸 Cincinnati, Ohio, United States

Lillestol Research, LLC; 🇺🇸 Fargo, North Dakota, United States

Cypress Medical Research Center; 🇺🇸 Wichita, Kansas, United States

Downtown Women's Health Care; 🇺🇸 Denver, Colorado, United States

Horizons Clincial Research Center LLC; 🇺🇸 Denver, Colorado, United States

Medpharmics LLC; 🇺🇸 Phoenix, Arizona, United States

Del Sol Research Management; 🇺🇸 Tucson, Arizona, United States

Mesa Obstetricians and Gynecologists; 🇺🇸 Mesa, Arizona, United States

Hassman Research Institute, LLC; 🇺🇸 Berlin, New Jersey, United States

Site PL48004; 🇵🇱 Bialystok, Poland

Site PL48002; 🇵🇱 Katowice, Poland

Site PL48010; 🇵🇱 Szczecin, Poland

Site UA38006; 🇺🇦 Kiev, Ukraine

Dr.R. Garn Mabey, MD,Office Of; 🇺🇸 Las Vegas, Nevada, United States

Visions Clinical Research - Tuscon; 🇺🇸 Tucson, Arizona, United States

Southern Clinical Research Associates; 🇺🇸 Metairie, Louisiana, United States

Precision Trials; 🇺🇸 Phoenix, Arizona, United States

Eclipse Clinical Research; 🇺🇸 Tucson, Arizona, United States

Coastal Connecticut Research, LLC; 🇺🇸 New London, Connecticut, United States

The Healing Sanctuary, LLC; 🇺🇸 Idaho Falls, Idaho, United States

Clinical Research Center of Nevada (CRCN); 🇺🇸 Las Vegas, Nevada, United States

Office Of Edmond Pack, Md; 🇺🇸 Las Vegas, Nevada, United States

Medpharmics, LLC; 🇺🇸 Metairie, Louisiana, United States

Montana Medical Research Inc; 🇺🇸 Missoula, Montana, United States

Medical Research Center of Memphis, LLC; 🇺🇸 Memphis, Tennessee, United States

Site CA15004; 🇨🇦 Point Claire, Quebec, Canada

Site CA15012; 🇨🇦 Levis, Quebec, Canada

Coastal Carolina Research Center; 🇺🇸 Mount Pleasant, South Carolina, United States

Chattanooga GYN-Oncology; 🇺🇸 Chattanooga, Tennessee, United States

WR Clinsearch, LLC; 🇺🇸 Chattanooga, Tennessee, United States

Site CA15003; 🇨🇦 Sherbrooke, Quebec, Canada

Site CA15001; 🇨🇦 Victoriaville, Quebec, Canada

Site PL48014; 🇵🇱 Lublin, Poland

Site PL48019; 🇵🇱 Katowice, Poland

Site UA38004; 🇺🇦 Zaporizhzhya, Zaporizka Oblast, Ukraine

Site PL48003; 🇵🇱 Warszawa, Poland

Site PL48007; 🇵🇱 Warszawa, Poland

Site GB44005; 🇬🇧 Corby, Northamptonshire, United Kingdom

Site GB44004; 🇬🇧 Kenilworth, Warwickshire, United Kingdom

Quality Clinical Research, Inc; 🇺🇸 Omaha, Nebraska, United States

Clinical Trials Research; 🇺🇸 Sacramento, California, United States

Northern California Research; 🇺🇸 Sacramento, California, United States

Bioclinica Research; 🇺🇸 Orlando, Florida, United States

Omega Research Consultants; 🇺🇸 Orlando, Florida, United States

Cornerstone Research Institute; 🇺🇸 Orlando, Florida, United States

Site LV37102; 🇱🇻 Riga, Latvia

SEC Clinical Research; 🇺🇸 Andalusia, Alabama, United States

Alabama Clinical Therapeutics, LLC; 🇺🇸 Birmingham, Alabama, United States

Achieve Clinical Research, LLC; 🇺🇸 Ensley, Alabama, United States

Marvel Clinical Research; 🇺🇸 Huntington Beach, California, United States

Downtown L.A. Research Center, Inc.; 🇺🇸 Los Angeles, California, United States

National Research Institute - Panorama; 🇺🇸 Los Angeles, California, United States

Grossmont Center for Clinical Research; 🇺🇸 La Mesa, California, United States

Alliance Research Inc; 🇺🇸 Canoga Park, California, United States

Hope Research Institute; 🇺🇸 Canoga Park, California, United States

Excell Research; 🇺🇸 Oceanside, California, United States

Bayview Research Group; 🇺🇸 Valley Village, California, United States

Women's Medical Group of Upland; 🇺🇸 Upland, California, United States

Millennium Clinical Trials; 🇺🇸 Thousand Oaks, California, United States

Emerson Clinical Research institute; 🇺🇸 Washington, District of Columbia, United States

Olympian Clinical Research; 🇺🇸 Clearwater, Florida, United States

Precision Clinical Research; 🇺🇸 Sunrise, Florida, United States

Universal Axon Clinical Research; 🇺🇸 Doral, Florida, United States

Avail Clinical Research, LLC; 🇺🇸 DeLand, Florida, United States

Nature Coast Clinical Research; 🇺🇸 Crystal River, Florida, United States

Fleming Island Center for Clinical Research; 🇺🇸 Fleming Island, Florida, United States

Vital Pharma Research Inc.; 🇺🇸 Hialeah, Florida, United States

Health Awareness; 🇺🇸 Port Saint Lucie, Florida, United States

LCC Medical Research Institute, LLC; 🇺🇸 Miami, Florida, United States

Multi-Specialty Research Associates, Inc.; 🇺🇸 Lake City, Florida, United States

Altus Research; 🇺🇸 Lake Worth, Florida, United States

New Age Medical Research Corporation; 🇺🇸 Miami, Florida, United States

Healthcare Clinical Data Inc; 🇺🇸 North Miami, Florida, United States

Spotlight research center; 🇺🇸 Miami, Florida, United States

Med Research Of Florida, LLC; 🇺🇸 Miami, Florida, United States

Suncoast Clinical Research, Inc.; 🇺🇸 New Port Richey, Florida, United States

Sensible Healthcare LLC; 🇺🇸 Ocoee, Florida, United States

Clinical Neuroscience Solutions, Inc; 🇺🇸 Memphis, Tennessee, United States

Progressive Medical Research; 🇺🇸 Port Orange, Florida, United States

St. Johns Center for Clinical Research; 🇺🇸 Ponte Vedra, Florida, United States

Ormond Medical Arts Pharmaceutical Research Center; 🇺🇸 Ormond Beach, Florida, United States

GCP Clinical Research, LLC; 🇺🇸 Tampa, Florida, United States

Sunset Point Medical Associates; 🇺🇸 Palm Harbor, Florida, United States

Premier Medical Associates; 🇺🇸 The Villages, Florida, United States

Agile Clinical Research Trials, LLC; 🇺🇸 Atlanta, Georgia, United States

Clinical Research of Central Florida; 🇺🇸 Winter Haven, Florida, United States

iResearch Atlanta LLC; 🇺🇸 Decatur, Georgia, United States

NuDirections Clinical Research; 🇺🇸 Duluth, Georgia, United States

Infinite Clinical Trials; 🇺🇸 Riverdale, Georgia, United States

WR-Mount Vernon Clinical Research; 🇺🇸 Sandy Springs, Georgia, United States

Rosemark Women Care Specialists; 🇺🇸 Idaho Falls, Idaho, United States

Georgia Clinical Research; 🇺🇸 Snellville, Georgia, United States

Affinity Clinical Research Institute; 🇺🇸 Oak Brook, Illinois, United States

Womens Health USA, Inc.; 🇺🇸 Champaign, Illinois, United States

Investigators Research Group, Llc; 🇺🇸 Brownsburg, Indiana, United States

MediSphere Medical Research; 🇺🇸 Evansville, Indiana, United States

Avant Research Associates, LLC; 🇺🇸 Crowley, Louisiana, United States

Pharmasite Research Inc; 🇺🇸 Baltimore, Maryland, United States

Praetorian Pharmaceutical Research; 🇺🇸 Marrero, Louisiana, United States

Bay State Clinical Trials, Inc.; 🇺🇸 Watertown, Massachusetts, United States

Saginaw Valley Medical Research Group, Llc; 🇺🇸 Saginaw, Michigan, United States

Excel Clinical Research, LLC; 🇺🇸 Sugar Land, Texas, United States

Rochester Clinical Research, Inc.; 🇺🇸 Rochester, New York, United States

Circuit Clinical; 🇺🇸 West Seneca, New York, United States

Upstate Clinical Research Associates LLC; 🇺🇸 Williamsville, New York, United States

Carolina women's research and wellness center; 🇺🇸 Durham, North Carolina, United States

OnSite Clinical Solutions, LLC; 🇺🇸 Charlotte, North Carolina, United States

Carolina Insitute for Clinical Research; 🇺🇸 Fayetteville, North Carolina, United States

Unified Women's Clinical Research; 🇺🇸 Winston-Salem, North Carolina, United States

PMG Research of Hickory, LLC; 🇺🇸 Hickory, North Carolina, United States

Greater Cincinnati OB/GYN; 🇺🇸 Cincinnati, Ohio, United States

OB-GYN Associates; 🇺🇸 Erie, Pennsylvania, United States

Hwc Women's Research Center; 🇺🇸 Englewood, Ohio, United States

Philadelphia Clinical Research, LLC; 🇺🇸 Philadelphia, Pennsylvania, United States

The Clinical Trial Center LLC; 🇺🇸 Jenkintown, Pennsylvania, United States

Frontier Clinical Research; 🇺🇸 Smithfield, Pennsylvania, United States

International Clinical Research; 🇺🇸 Murfreesboro, Tennessee, United States

FMC Science; 🇺🇸 Lampasas, Texas, United States

DiscoveResarch, Inc.; 🇺🇸 Bryan, Texas, United States

Protenium Clinical Research, LLC; 🇺🇸 Hurst, Texas, United States

Gadolin Research, LLC; 🇺🇸 Beaumont, Texas, United States

Clinical Trials of Texas; 🇺🇸 San Antonio, Texas, United States

ClinRx Research; 🇺🇸 Plano, Texas, United States

Northeast Clinical Research Centers, Inc.; 🇺🇸 Schertz, Texas, United States

Advanced Clinical Research-Old Farm OB/GYN (Utah); 🇺🇸 Salt Lake City, Utah, United States

Charlottesville Medical Research; 🇺🇸 Charlottesville, Virginia, United States

EPIC Medical Research; 🇺🇸 Murray, Utah, United States

Health Research of Hampton Roads Inc; 🇺🇸 Newport News, Virginia, United States

Wasatch Clinical Research, LLC; 🇺🇸 Salt Lake City, Utah, United States

Tidewater Clinical Research, Inc.; 🇺🇸 Virginia Beach, Virginia, United States

Site CA15005; 🇨🇦 Brampton, Ontario, Canada

Site CA15006; 🇨🇦 Burlington, Ontario, Canada

Site CA15010; 🇨🇦 Sarnia, Ontario, Canada

Site CA15007; 🇨🇦 Toronto, Ontario, Canada

Site CA15002; 🇨🇦 Quebec, Canada

Site CA15009; 🇨🇦 Quebec, Canada

Site CZ42008; 🇨🇿 Vodnany, Jihocesky, Czechia

Site CZ42001; 🇨🇿 Olomouc, Czechia

Site LV37101; 🇱🇻 Riga, Latvia

Site CZ42010; 🇨🇿 Pisek, Czechia

Site CZ42003; 🇨🇿 Olomouc, Czechia

Site CZ42009; 🇨🇿 Praha 2, Czechia

Site CZ42005; 🇨🇿 Tabor 3, Czechia

Site PL48005; 🇵🇱 Bydgoszcz, Poland

Site PL48006; 🇵🇱 Lublin, Poland

Site PL48016; 🇵🇱 Poznan, Poland

Site PL48020; 🇵🇱 Warsaw, Poland

Site ES34005; 🇪🇸 Centelles, Spain

Site GB44008; 🇬🇧 Sidcup, Kent, United Kingdom

Site GB44003; 🇬🇧 Wokingham, Berkshire, United Kingdom

Site GB44006; 🇬🇧 Middlesex, United Kingdom

Site GB44007; 🇬🇧 Romford, United Kingdom

Site GB44001; 🇬🇧 Shipley, United Kingdom

Site ES34002; 🇪🇸 Madrid, Spain

Clinical Physiology Associates; 🇺🇸 Fort Myers, Florida, United States

Florida Medical Research; 🇺🇸 Gainesville, Florida, United States

Albuquerque Clinical Trials, Inc.; 🇺🇸 Albuquerque, New Mexico, United States

Bosque Women's Care; 🇺🇸 Albuquerque, New Mexico, United States

Clinical Trials of South Carolina; 🇺🇸 Charleston, South Carolina, United States

Tekton Research - Georgetown; 🇺🇸 Austin, Texas, United States

Lawrence OBGYN Associates; 🇺🇸 Lawrenceville, New Jersey, United States

Radiant Research; 🇺🇸 Pinellas Park, Florida, United States