National Observational Study On The Use Of Inflectra™ An Infliximab Biosimilar In Real Life
- Conditions
- Ankylosing SpondylitisPsoriatic ArthritisUlcerative ColitisRheumatoid ArthritisCrohn Disease
- Interventions
- Other: QOL questionaire
- Registration Number
- NCT02925338
- Lead Sponsor
- Pfizer
- Brief Summary
National, prospective, multicentre observational study designed for eligible patients treated with Inflectra.
Its objectives are to describe under real conditions of use, the profile of patients treated with Inflectra and the response to treatment.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1431
- Adult patients treated with Inflectra™ regardless of treatment phase in one of the following indications consistent with the SPC: Crohn's Disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis.
- Paediatric patients (children and adolescents between 6 and 17 years old) treated with Inflectra™, regardless of treatment phase from the time when Inflectra™ is prescribed in accordance with the indications listed in the SPC Crohn's Disease or ulcerative colitis Patients (or their legal representatives) who have received information (verbally and in writing) about the study and agreed to take part in it.
- Patients who have given their agreement for their clinical data and their medical file to be accessed by signing the information leaflet.
- Patients who refuse access to their medical file for collection of: their medical data
- Patients not treated with Inflectra™.
- Patients treated with Inflectra™ for psoriasis.
- Patients with a past history of hypersensitivity to infliximab, to other murine proteins or to one of the excipients in Inflectra™.
- Patients with tuberculosis or any other severe infection such as sepsis, abscess or opportunistic infection .
- Patients with moderate to severe heart failure (NYHA III/IV)
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Patients treated with Inflectra QOL questionaire -
- Primary Outcome Measures
Name Time Method Time Between Diagnosis and the First Inflectra Infusion Data collected and recorded at study inclusion visit Number of Participants With Pre-treatment Assessment Prior to Initiation of Inflectra Treatment (Anti-Tumor Necrosis Factor [TNF] Aplha) Therapy Data collected and recorded at study inclusion visit Pre-treatment assessment was a check-list with the set of measures determined by the physician to check the eligibility of a participant before initiation of treatment. Physician recorded as "Yes" if a participant was eligible for initiation of treatment and "No" if a participant was not eligible to initiate a treatment. In this outcome measure, number of participants whose pre-treatment assessment were performed prior to initiation of Inflectra are reported and whose data were missing are reported.
Time Between Diagnosis and Inclusion in Study Data collected and recorded at study inclusion visit Number of Participants Who Received Biotherapy Other Than Inflectra Before Inclusion in the Study Data collected and recorded at study inclusion visit Type of biotherapies received by participants before inclusion in the study were: anti-TNF alpha (remicade/ adalimumab/ golimumab / etanercept/ rituximab); anti-integrin (vedolizumab); immunosuppressant (abatacept); interleukin inhibitor (anakinra / tocilizumab); anti interleukin (IL) 12 and anti IL-23 (ustekinumab); and other. In this outcome measure number of participants who received biotherapies other than Inflectra and whose data were missing are reported.
Number of Participants With Reasons for Discontinuation of Previous Biotherapy Data collected and recorded at study inclusion visit Type of previous biotherapies included were: anti-TNF alpha (infliximab/adalimumab/etanercept/golimumab), selective immuno-suppressant (vedolizumab/abatacept), interleukin inhibitor (anakinra/ustekinumab/tocilizumab), and other. In this outcome measure, number of participants who discontinued previous biotherapy are reported according to reason of discontinuations.
Duration of Previous Biotherapies Data collected and recorded at study inclusion visit Type of previous biotherapies included were: anti-TNF alpha (infliximab/adalimumab/etanercept/golimumab), selective immuno-suppressant (vedolizumab/abatacept), interleukin inhibitor (anakinra/ustekinumab/tocilizumab), and other.
Percentage of Participants Without Treatment Failure During 2-Years of Observation 2 years post inclusion in the study Treatment failure was defined as permanent discontinuation of the Inflectra treatment due to intolerance and/or permanent discontinuation of treatment due to absence of response according to the physician's assessment, or death of the participant related to Inflectra. In this outcome measure percentage of participants without treatment failure and whose data were missing are reported.
Mean of Number of Doses Administered in Previous Biotherapy Data collected and recorded at study inclusion visit Type of previous biotherapies included were: anti-TNF alpha (infliximab/adalimumab/etanercept/golimumab), selective immuno-suppressant (vedolizumab/abatacept), interleukin inhibitor (anakinra/ustekinumab/tocilizumab), and other. In this outcome measure mean of number of doses administered in previous biotherapy is reported.
Last Dosage Administered of a Previous Biotherapy Data collected and recorded at study inclusion visit Type of previous biotherapies included were: anti-TNF alpha (infliximab/adalimumab/etanercept/golimumab), selective immuno-suppressant (vedolizumab/abatacept), interleukin inhibitor (anakinra/ustekinumab/tocilizumab), and other. In this outcome measure mean of last dosage (in units) of previous biotherapy administered dose is reported.
Number of Participants Who Received Concomitant Treatments Prior to Initiation of Inflectra Data collected and recorded at study inclusion visit Following concomitant treatments were received by participants before initiation of Inflectra: 1) Corticosteroids, 2) Salicylates, and 3) Azathioprine/6-MP, Methotrexate, and Cyclosporine.
- Secondary Outcome Measures
Name Time Method Physician Global Assessment (PGA) of Disease for RA, SpA and PA 24 months PGA was evaluated in participants with RA, SpA and PA on a 0 to 10 centimeter (cm) visual analog scale (VAS), with 0 cm = no disease activity and 10 cm = worst disease activity possible. Higher scores indicated worse condition.
Mean Administered Dose of Inflectra (in mg) Inclusion visit up to 6-Month visit, 6-Month visit to 12-Month visit, 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Mean dose (in milligrams \[mg\]) administered was sum of dose of all infusions administered divided by total number of doses administered.
Mean Administered Posology of Inflectra (in mg/kg) Inclusion visit up to 6-Month visit, 6-Month visit to 12-Month visit, 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Mean posology administered was sum of posology of all infusions administered divided by total number of infusions administered. Posology = dose (mg) / weight (kg).
Cumulative Dose Inclusion visit up to 6-Month visit, Inclusion visit up to 12-Month visit, Inclusion visit up to 18-Month visit, and Inclusion visit up to 24-Month visit Cumulative dose is the sum of doses administered during inclusion visit to month 6, 12, 18, and 24.
Mean Infusion Time Inclusion visit up to 6-Month visit, 6-Month visit to 12-Month visit, 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Mean infusion time was sum of duration of all infusions administered divided by total number of infusion times administered.
Mean Time Between Infusions Inclusion visit up to 6-Month visit, 6-Month visit to 12-Month visit, 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Mean Duration of Post-infusion Monitoring at the Hospital Inclusion visit up to 6-Month visit, 6-Month visit to 12-Month visit, 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Mean post-infusion monitoring at hospital was sum of duration of all monitoring at hospital divided by total number monitoring times.
Absolute Variation in Mean Bath Ankylosing Spondylitis Functional Index (BASFI) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 BASFI is a set of 10 questions to determine degree of functional limitation in participants with SpA. Participants answered each 10 questions on a scale of 0 (no functional impairment) to 10 (maximal impairment). BASFI score was calculated as mean of scores from 10 questions. BASFI score ranged from 0 (no functional impairment) to 10 (maximal impairment), where higher scores meant worse condition. Score \>4 indicated "significant functional impairment", and score \<=4 indicated "mild functional impairment". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Mayo Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 Mayo score was evaluated in participants with UC. Mayo score consists of 4 items (stool frequency, rectal bleeding, findings of endoscopy, physician global assessment), each graded from 0 (no severity) to 3 (maximum severity), with higher scores indicating more severe disease. Total score was sum of 4 items resulting in a score range of 0 (no severity) to 12 (maximum severity), where higher score indicated increased severity. Score \<=2 indicated "UC inactive", score between \>=3 and \<=5 indicated "mild UC", score between \>=6 and \<=10 indicated "moderate UC", and score \>11 indicated "severe UC". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Pediatric Ulcerative Colitis Activity Index (PUCAI) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 PUCAI score was intended for pediatric participants with UC. PUCAI had 6 items with scores as: abdominal pain (no pain =0, pain can be ignored =5, pain cannot be ignored =10); rectal bleeding (none =0, small amount only \[in less than 50% of stools\] =10, small amount with most stools =20, large amount \[\>50% of the stool content\] =30); stool consistency of most stools (formed =0, partially formed =5, completely unformed =10); number of stools per 24 hours (0-2 =0, 3-5 =5, 6-8 =10, \>8 =15); nocturnal stools (no =0, yes =10); activity level (no limitation of activity =0, occasional limitation of activity =5, severely restricted activity =10). PUCAI score = sum of scores of 6 items; score range of 0= no severity to 85= extreme severity. PUCAI score \<10: UC in remission, score between \>=10 and \<35: mild UC, score between \>=35 and \<65: moderate UC, and score \>=65: severe UC. Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Colitis Endoscopic Index of Severity (UCEIS) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 UCEIS score was evaluated in participants with indication UC. It had 3 sub-scales: endoscopic vascular pattern (scored 0 \[normal pattern\] to 2 \[complete obliteration of vascular pattern\]), bleeding (scored 0 \[none\] to 3 \[luminal moderate or severe\]), erosions and ulcerations (scored 0 \[none\] to 3 \[deep ulcers\]). UCEIS total score was calculated by sum of all 3 sub-scale scores. Total score ranged from 0 (remission in disease) to 8 (extreme severity of disease), with higher scores indicating more severe disease. Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Disease Activity Score (DAS) 28 Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 DAS28 score was evaluated in participants with RA and PA. DAS28 is calculated from the number of swollen joints (SJC) and painful joints (PJC) using the 28 joints count, the erythrocyte sedimentation rate (ESR) (in millimeters per hour \[mm/hour\]) and participant's global assessment (PtGA) of disease activity (participant rated arthritis activity assessment with scores ranging 0 to 10; higher scores indicated high disease activity). DAS28 was calculated as 0.56 sqrt (DAS 28 tender joint count) + 0.28 sqrt (DAS 28 swollen joint count) + 0.70 ln(ESR \[mm/first hour\] + 0.014 (PtGA \[mm\]). Total score range: 0-9.4. DAS 28 score \<=2.6 indicated "remission in disease", score between \>2.6 and \<=3.2 indicated "mildly active disease", score between \>3.2 and \<=2.6 indicated "moderately active disease", and score \>5.1 indicated "very active disease". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Health Assessment Questionnaire (HAQ) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 HAQ score was evaluated for indication RA. HAQ assesses degree of difficulty participant had experienced during past week in 8 domains of daily activities: dressing \& grooming, arising, eating, walking, hygiene, reach, grip and other activities. For each question in questionnaire, level of difficulty was scored from 0 (no difficulty) to 3 (unable to do). Any activity requiring assistance from another individual or required use of assistive device would adjust to minimum score of 2 to represent more limited functional status. Overall score = sum of scores divided by number of domains answered. Total possible score range was 0 (no difficulty) to 3 (unable to do). Higher score = more difficulty in performing daily living activities. HAQ score \>0.5 indicated "Existence of functional disability" \& HAQ score \<=0.5 indicated "Absence of functional disability". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Ankylosing Spondylitis Disease Activity Score (ASDAS) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 ASDAS score was evaluated for indication SpA. It is a score combining the assessment of overall pain (Q1), duration of morning stiffness (Q2), peripheral pain/swelling (Q3), PtGA (assessed on a sale of 0 \[not active\] to 10 \[very active\]), and CRP in mg/L. ASDAS total score ranged from 0 (no disease) to 10 (maximum severity), higher score indicates greater severity of disease and was derived using the following formula: ASDAS =0.12\*Q1 + 0.06\*Q2 + 0.11\* PtGA + 0.07\*Q3 + 0.58\*ln (CRP+1). ASDAS score \<1.3 indicated "SpA inactive", ASDAS score \>=1.3 and/or \<2.1 indicated "SpA mildly active", ASDAS score \>=2.1 and/or \<=3.5 indicated "SpA moderately active", and ASDAS score \>3.5 indicated "SpA very active". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Cook and Medley Score at Baseline Baseline (data recorded at inclusion visit) Cook-Medley questionnaire, also called cynical distrust scale, contained 8 items, scoring from 0 (trust) to 4 (no trust). The total score of the questionnaire was calculated by adding together the scores for the 8 items. Total possible score range was from 0 (trust) to 32 (no trust), higher score signifies greater cynical distrust. This outcome measure was evaluated in participants who were informed of a switch from infliximab reference to Inflectra.
Stress Score Baseline (inclusion visit) up to Month 12 The questionnaire on stress after the switch to the biosimilar contained 3 items (emotional reactivity, repetition syndrome and tendency to avoid), each scored from 0 (no stress) to 4 (extreme stress). The overall score of stress was calculated by adding together the scores for the 3 items, ranged from 0 (no stress) to 12 (highest level of stress), higher scores indicated greater levels of stress. This outcome measure was evaluated in participants who were informed of a switch from infliximab reference to Inflectra.
Absolute Variation in Mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 BASDAI is a set of 6 questions to determine disease activity in participant with SpA. Participants answered each 6 questions on a scale of 0 (no problem) to 10 (the worst problem). The BASDAI score is calculated by computing the mean of questions 5 and 6 and adding it to the sum of questions (Q) 1-4. This score is then divided by 5. BASDAI score = (Q1 + Q2 + Q3+ Q4+ \[Q5 + Q6/2\])/5. BASDAI score ranges from 0 (best) to 10 (worst), where higher scores meant worse condition. BASDAI score \>4 indicated "SpA active", and score \<=4 indicated "SpA inactive". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Harvey-Bradshaw Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 Harvey-Bradshaw score was evaluated for indication CD. Harvey-Bradshaw measures 5 parameters; general well-being (0= very well to 4= terrible), abdominal pain (0= none to 3= severe), number of liquid stools per day (0 to no maximum score), presence of an abdominal mass on physical exam (0= none to 3= definite and tender), and whether there are any complications (0= no complications, 1= arthralgia, 2= uveitis, 3= erythema nodosum, 4= aphthous ulcer, 5= pyoderma gangrenosum, 6= anal fissure, 7= new fistula, 8= abscess). Total HBI score: sum of all 5 individual parameters, minimum score is 0 and there was no pre-specified maximum score as it depended on number of liquids stools. Higher HBI scores = greater disease activity score \<4 indicated "Inactive disease", score \>=4 and/or \<=12 indicated "Active disease", and score \>12 indicated "Very active disease". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Crohn's Disease Endoscopic Index of Severity (CDEIS) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 CDEIS is an index for determining the severity of CD with endoscopic localization to ileum and colon. CDEIS considered 4 parameters: deep ulcerations, superficial ulcerations, ulcerated and non-ulcerated surface, and the presence of ulcerated/non-ulcerated stenosis. These 4 parameters were evaluated in 5 pre-defined segments of the colon (ileum, ascending colon, transverse colon, descending colon and sigmoid loop, and rectum). CDEIS score ranged from 0 (no lesions) to 44 (severe lesions) where higher scores indicate more severity. CDEIS score \<=7 indicated "Endoscopic remission", and score \>7 indicated "Absence of endoscopic remission". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation of Mean Global Disease Assessment Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 The global disease assessment by the physician for participants with RA, SpA and PA was evaluated on a 0 to 10 cm VAS, with 0 cm = no disease activity and 10 cm = worst disease activity. Higher scores indicated worse condition. Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation of Mean Fatigue Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 Fatigue score was evaluated among participants with RA, SpA, and PA. Participants' fatigue severity was measured on a VAS with a score range of 0 (no fatigue) to 10 (highest level of fatigue). Higher score signifies more severity. Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
Absolute Variation in Mean Simple Disease Activity Index (SDAI) Score Compared With Baseline at Month 6, 12, 18, and 24 Baseline (Inclusion Visit), Month 6, 12, 18, and 24 SDAI was evaluated in participants with indication RA. SDAI is the numerical sum of 5 parameters: TJC and SJC based on a 28-joint assessment, PtGA and PGA assessed on 0 (very well) -10 cm (worst) VAS; higher scores = greater affection due to disease activity, and C-reactive protein (CRP) (mg/dL). SDAI total score =0 (no disease) to 86 (extreme severity of disease), where higher scores indicated higher disease activity. SDAI score \<=3.3 indicated "achievement of remission state", score \>3.3 and/or \<=11 indicated "mildly active state", score \>11 and/or \<=26 indicated "moderately active state", and score \>26 indicated "very active state". Absolute variation = mean result of laboratory test during period in question - result of laboratory test at baseline.
General Anxiety Disorder (GAD7) Score Baseline (inclusion visit) through post each infusion (during 2 years) GAD7: questionnaire of anxiety with 7 items, scoring from 0 (no anxiety) to 3 (extreme anxiety). The total GAD7 score was calculated by adding together the scores for the 7 items, ranged from 0 (no anxiety) to 21 (extreme anxiety), higher scores indicated severe anxiety. This outcome measure was evaluated in participants who were informed of a switch from infliximab reference to Inflectra.
Number of Participants With Immunogenicity Assay at Inclusion Visit Baseline (data recorded at inclusion visit) Number of Participants With Anti-Infliximab Antibody Assay Assessment at Inclusion Visit Baseline (data recorded at inclusion visit) Number of Participants With Presence of Anti-infliximab Antibodies at Inclusion Visit Baseline (data recorded at inclusion visit) Number of Participants With Infliximab Trough Level (IFX-TL) Assay at Inclusion Visit Baseline (data recorded at inclusion visit) Trough level was plasma concentration of drug before infusion.
Infliximab Trough Level (IFX-TL) at Inclusion Visit Before infusion at baseline (data recorded at inclusion visit) Trough level was plasma concentration of drug before infusion.
Mean of Number of Immunogenicity Assays Done (Inclusion Visit up to 6-Month Visit, 6-Month Visit up to 12-Month Visit, 12-Month Visit up to 18-Month Visit, and 18-Month Visit up to 24-Month Visit) Inclusion visit up to 6-Month visit, 6-Month visit up to 12-Month visit, 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Number of Participants With Presence of At-least 1 Anti-Infliximab Antibodies (Inclusion Visit up to 6-Month Visit, 6-Month Visit up to 12-Month Visit, 12-Month Visit up to 18-Month Visit, and 18-Month Visit up to 24-Month Visit) Inclusion visit up to 6-Month visit, 6-Month visit up to 12-Month visit, 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Mean Inflectra Trough Level (IFX-TL) (Inclusion Visit up to 6-Month Visit, 6-Month Visit up to 12-Month Visit, 12-Month Visit up to 18-Month Visit, and 18-Month Visit up to 24-Month Visit) Before every infusion occurred during: inclusion visit up to 6-Month visit; 6-Month visit up to 12-Month visit; 12-Month visit up to 18-Month visit, and 18-Month visit up to 24-Month visit Trough level was plasma concentration of drug before infusion. In this outcome measure mean of all IFX-TLs for all infusions occurring during specified duration is reported.
Trial Locations
- Locations (65)
Centre Hospitalier
🇫🇷Metz Tessy, France
Hopital Saint Philibert
🇫🇷Lomme, France
Hopitaux Universitaires de Strasbourg - Hopital de Hautepierre
🇫🇷Strasbourg, Alsace, France
Service de rhumatologie - CHU Nantes, Hopital Hotel Dieu
🇫🇷Nantes cedex 1, Loire-atlantique, France
Centre Hospitalier du Pays d'Aix
🇫🇷Aix En Provence, France
CHU Jean Minjoz
🇫🇷Besancon, France
Centre Hospitalier Universitaire Gabriel Montpied
🇫🇷Clermont Ferrand Cedex, Puy-de-dôme, France
CHU - Hôpital Pellegrin-tripode
🇫🇷Bordeaux, France
Hopital Saint Andre - Chu Bordeaux
🇫🇷Bordeaux, France
Centre Hospitalier Regional de Besancon, Service de Gastrologie
🇫🇷Besancon, France
CHG Montauban
🇫🇷Montauban Cedex, France
Centre Hospitalier Universitaire de Bordeaux - Hopital Pellegrin
🇫🇷Bordeaux Cedex, France
Clinique Jean Vilar
🇫🇷Bruges, France
Ch de Cannes Hopital Pierre Nouveau
🇫🇷Cannes Cedex, France
Centre Hospitalier Universitaire (CHU) de Caen - Hopital Cote de Nacre
🇫🇷Caen, France
Centre Hospitalier Carcassonne, Service de Rhumatologie
🇫🇷Carcassonne, France
Centre Hospitalier de Cannes
🇫🇷Cannes, France
Centre Hospitalier de Cholet Service d'Hépato-Gastro-Entérologie
🇫🇷Cholet, France
Chu Henri Mondor
🇫🇷Creteil, France
CHU de Grenoble - Hopital Sud
🇫🇷Echirolles, France
Centre Hospitalier de Cholet
🇫🇷Cholet, France
Hôpital Haut-Lévêque
🇫🇷Pessac Cedex, France
Hopital Robert Debre, Service D'Hepato-gastro-enterolo
🇫🇷Reims CEDEX, France
Centre Hospitalier Estaing, Service de Medicine Interne
🇫🇷Clermont Ferrand, France
CHU Grenoble Alpes
🇫🇷La Tronche, France
CHU Limoges - Hôpital Dupuytren
🇫🇷Limoges, France
Centre Hospitalier Universitaire Grenoble Alpes
🇫🇷La Tronche, France
Centre Hospitalier de Montpellier Hopital Saint Eloi
🇫🇷Montpellier, France
Groupe Hospitalier du Havre
🇫🇷Montivilliers, France
Hopital Cochin
🇫🇷Paris, France
Fondation Maison Sante Bagatelle, Gastro Enterologie
🇫🇷Talence Cedex, France
Hopital Lyon Sud
🇫🇷Pierre Benite Cedex, France
Hôpital Cochin
🇫🇷Paris, France
CHU Nice-Hopital Archet I
🇫🇷Nice Cedex 3, France
CHRU Charles Nicolle
🇫🇷Rouen, France
CHU
🇫🇷Montpellier, France
Centre Hospitalier Lyon-Sud
🇫🇷Pierre Benite, France
Hopital Robert Debre, Service d'Hepato-gastro-enterologie et de Cancerologie Digestive
🇫🇷Reims cedex, France
Hopital du Leman
🇫🇷Thonon les Bains, France
Hopitaux du Leman
🇫🇷Thonon Les Bains, France
Chu Brabois
🇫🇷Vandoeuvre Les Nancy, France
Hopital Purpan
🇫🇷Toulouse, France
Hopital Saint Nicolas
🇫🇷Vitre, France
Hopital Rangueil
🇫🇷Toulouse cedex 04, France
Clinique Jean Vila
🇫🇷Bruges, France
Centre Hospitalier de Cannes Hopital Pierre Nouveau
🇫🇷Cannes, France
Service Rhumatologie
🇫🇷Saint Etienne, France
Hopital Beaujon
🇫🇷Clichy, France
Hopital Nord
🇫🇷St Priest En Jarez Cedex, France
Hospital Huriez, CHRU de Lille
🇫🇷Little Cedex, France
Hopital Edouard Herriot Pav H
🇫🇷Lyon, France
CHU de MONTPELLIER HOPITAL LAPEYRONIE
🇫🇷Montpellier, France
CHU de Rouen
🇫🇷Rouen, France
Centre Hospitalier Universitaire (CHU) de Saint-Etienne - Hopital Nord
🇫🇷St. Priest En Jarez, France
Centre Hospitalier de la Gespe
🇫🇷Tarbes, France
Hopital des Hauts Clos
🇫🇷Troyes, France
Centre Hospitalier de Lille Hopital Roger Salengro
🇫🇷Lille, France
Chi Aix Pertuis
🇫🇷Aix-En-Provence, France
Centre Hospitalier de la Cote Basque
🇫🇷Bayonne, France
CHD Vendee
🇫🇷La Roche Sur Yon, France
CHU De Grenoble
🇫🇷Grenoble, France
CHU de Montpellier - Saint Eloi
🇫🇷Montpellier, France
Hopital de l'Archet
🇫🇷NICE Cedex 3, France
Hopital Claude Bichat
🇫🇷Paris Cedex 18, France
CHU Nimes
🇫🇷Nimes, France