A Study of Ustekinumab in Participants With Active Systemic Lupus Erythematosus
- Conditions
- Lupus Erythematosus, Systemic
- Interventions
- Registration Number
- NCT03517722
- Lead Sponsor
- Janssen Research & Development, LLC
- Brief Summary
The purpose of this study is to evaluate the efficacy of ustekinumab in participants with active systemic lupus erythematosus (SLE) who have not adequately responded to one or more standard of care treatments.
- Detailed Description
This study evaluates the efficacy, safety, and tolerability of ustekinumab in participants with active SLE according to Systemic Lupus International Collaborating Clinics (SLICC) criteria Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score greater than (\>=) 6, despite receiving one or more standard-of-care treatments (example, immunomodulators, antimalarial drugs, and/or glucocorticoids). The total duration of the study is up to 182 weeks, consisting of 3 study periods: a screening period (approximately 6 weeks), a double blind period (52 weeks), and an extension period (124 weeks). Other study evaluations will include pharmacokinetics, immunogenicity, biomarkers and pharmacogenomic evaluations. The safety of the participants enrolled in the study will be monitored on an ongoing basis throughout the study.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 516
-
Be male or female
-
Has a documented medical history (that is, met at least 1 of the two criteria below) that participant met the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for systemic lupus erythematosus (SLE) at least 3 months prior to first dose of study agent:
- Met a total of at least 4 SLICC criteria, including at least 1 clinical and at least 1 immunologic;
- Has a diagnosis of lupus nephritis, confirmed by renal biopsy and at least 1 of the following autoantibodies: antinuclear antibodies (ANA) or anti-double-stranded deoxyribonucleic acid (anti-dsDNA)
-
Has a positive test in the medical history and confirmed at screening for at least 1 of the following autoantibodies: antinuclear antibodies, anti-double-stranded deoxyribonucleic acid, and/or anti-Smith
-
Has greater than or equal to (>=) 1 British Isles Lupus Assessment Group (BILAG) A and/or >= 2 BILAG B scores observed during screening
-
Has a Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) activity score >=4 (excluding diffuse non-inflammatory alopecia) or >= 4 joints with pain and signs of inflammation at screening, Week 0, or both
-
Has a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score >=6 at screening. Must also have SLEDAI-2K >= 4 for clinical features (excluding headache and laboratory abnormalities) at Week 0
-
Cannot be pregnant, nursing, intending to become pregnant, or unwilling to follow contraception or egg/sperm donation guidelines
-
Must be receiving stable doses of >=1 protocol-permitted standard of care SLE treatment: oral glucocorticoids, anti-malarials, immunomodulators (methotrexate, azathioprine, 6-mercaptopurine, mycophenolate mofetil, mycophenolic acid)
- Has any unstable or progressive SLE manifestation (example: central nervous system lupus, systemic vasculitis, end-stage renal disease, severe or rapidly progressive glomerulonephritis, pulmonary hemorrhage, myocarditis) that may warrant escalation in therapy beyond permitted background medications. Participants requiring renal hemodialysis or peritoneal dialysis are also excluded
- Has other co-existent inflammatory diseases (example: rheumatoid arthritis, psoriasis, psoriatic arthritis, Crohn's disease)
- Has a urinary protein to creatinine ratio of greater than (>)4 gram per gram (g/g) per day
- Has an acute or chronic infectious illness (example: human immunodeficiency virus, hepatitis B or C virus, tuberculosis, opportunistic infections)
- Has a history of cancer or lymphoproliferative disease within the last 5 years except for treated and non-recurrent cutaneous basal cell carcinoma, squamous cell carcinoma, or cervical carcinoma
- Has any condition requiring multiple courses of systemic glucocorticoids (example: uncontrolled asthma, chronic obstructive pulmonary disease)
- Has a history of major surgery within the last month
- Has received live virus or bacterial vaccines within 16 weeks prior to first dose of study agent or Bacille Calmette-Guerin (BCG) vaccination within 12 months of screening
- Has previously received ustekinumab
- Has received cyclophosphamide orally within 90 days or intravenously within 180 days of screening
- Has received a single B-cell targeted therapy (e.g. belimumab) within 3 months, >1 previous B-cell targeted therapy within 6 months, or B-cell depleting therapy (example: rituximab) within 12 months of first dose of study agent
- Has received protocol-prohibited oral or biologic immunomodulatory therapy in the last 3 months or less than (<)5 half-lives (whichever is longer) prior to first dose of study agent
- Has received adrenocorticotropic hormone (ACTH) within 1 month prior to first dose of study agent
- Has received epidural, intravenous, intramuscular, intraarticular, intrabursal, intralesional glucocorticoids within 6 weeks of first dose of study agent
- Locally-delivered therapies except for ophthalmic use of cyclosporine A or topical use of nonsteroidal anti inflammatory drugs (NSAIDs), analgesics, or high-potency glucocorticoids (World Health Organization criteria) are prohibited
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Ustekinumab Ustekinumab (approximately 6 mg/kg) Participants will receive ustekinumab approximately 6 milligram per kilogram (mg/kg) intravenously (IV) based on body weight-range at Week 0 followed by 90 mg ustekinumab subcutaneously (SC) at Week 8 and every 8 weeks (q8w) thereafter through Week 48 during double-blind period. Eligible participants who will enter the extension period will continue to receive 90 mg ustekinumab SC q8w through Week 160. Ustekinumab Ustekinumab 90 mg Participants will receive ustekinumab approximately 6 milligram per kilogram (mg/kg) intravenously (IV) based on body weight-range at Week 0 followed by 90 mg ustekinumab subcutaneously (SC) at Week 8 and every 8 weeks (q8w) thereafter through Week 48 during double-blind period. Eligible participants who will enter the extension period will continue to receive 90 mg ustekinumab SC q8w through Week 160. Placebo Placebo Participants will receive matching placebo to ustekinumab IV at Week 0, followed by matching placebo to ustekinumab SC at Week 8 and q8w thereafter through Week 48 during double-blind period. Eligible participants who will enter the extension period will cross-over to receive 90 mg ustekinumab SC q8w through Week 160. Placebo Ustekinumab 90 mg Participants will receive matching placebo to ustekinumab IV at Week 0, followed by matching placebo to ustekinumab SC at Week 8 and q8w thereafter through Week 48 during double-blind period. Eligible participants who will enter the extension period will cross-over to receive 90 mg ustekinumab SC q8w through Week 160.
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving a Systemic Lupus Erythematosus Responder Index-4 (SRI-4) Composite Response at Week 52 Week 52 SRI-4 response:\>=4-point reduction in SLEDAI-2K total score, no British Isles Lupus Assessment Group (BILAG) A (severe disease) and no more than 1 new BILAG B (moderate disease) domain score and no worsening (\<10 % increase)from baseline in Physician's Global Assessment(PGA).SLEDAI measures disease activity in 9 organ systems,higher scores=more severe disease activity.Each organ system measured as either absent/present within last 30 days and weighted score across systems was utilized to calculate total SLEDAI score(range:0=no symptoms to 105=presence of all defined symptoms). Improvement is defined as reduction in SLEDAI score (BILAG) Index: assessing clinical signs, symptoms,or laboratory parameters related to SLE,divided into 9 domains. Each domain can range from A=new domain activity, B=worse domain activity, C=same domain activity, D=improving domain activity to E=absence of domain activity. PGA assesses disease activity on visual analogue scale from very well(0)-very poor(10).
- Secondary Outcome Measures
Name Time Method Time to First Flare Up to Week 52 Time to flare is defined as the time (in days) post baseline when the first flare occurs. It was calculated with flare defined as either 1 or more BILAG A (severe disease activity) or 2 or more new BILAG B (moderate disease activity) domain scores relative to baseline. BILAG was defined as a measure of alterations or intensification to therapy consisting of 97 questions in 9 domains. Each domain can range from A=new domain activity, B=worse domain activity, C=same domain activity, D=improving domain activity to E=absence of domain activity. BILAG A flare was defined as at least 1 new BILAG A scores. BILAG B flare was defined as at least 2 new BILAG B scores.
Percentage of Participants Receiving Glucocorticoid at Baseline Who Achieved Change in Glucocorticoid Dose by Week 40, Sustained That Change Through Week 52, and Achieved an SRI-4 Composite Response at Week 52 Up to Week 52 Percentage of participants with reduction in glucocorticoid dose by Week 40, its sustenance through Week 52, and SRI 4 composite response at Week 52 were reported. Reduction of glucocorticoid dose was defined as reduction in average daily oral glucocorticoid dose by at least 50% (relative to baseline dose) or reduction of average daily oral glucocorticoid dose by at least 25% (relative to baseline dose) so that average daily dose is reduced to \<=7.5 mg (prednisone or equivalent). Sustained reduction of glucocorticoid dose was defined as achieving an average daily oral glucocorticoid dose reduction between Weeks 24 and 40, and sustaining that reduction through Week 52, in those participants who,at baseline,were receiving oral glucocorticoids. SRI-4 was defined as composite of at least 4-point improvement in SLEDAI-2K score of 0=no symptoms to 105=presence of all defined symptoms with higher scores representing increased disease activity),no worsening in BILAG and no worsening in PGA.
Percentage of Participants With an SRI-4 Composite Response at Week 24 Week 24 SRI-4 response:\>=4-point reduction in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) total score, no BILAG A (severe disease) and no more than 1 new BILAG B (moderate disease) domain score and no worsening (\<10 % increase)from baseline in PGA.SLEDAI measures disease activity in 9 organ systems, higher scores=more severe disease activity. Each organ system measured as either absent/present within last 30 days and weighted score across systems was utilized to calculate total SLEDAI score(range:0=no symptoms to 105=presence of all defined symptoms). Improvement is defined as reduction in SLEDAI score (BILAG) Index: assessing clinical signs, symptoms,or laboratory parameters related to SLE,divided into 9 domains. Each domain can range from A=new domain activity, B=worse domain activity, C=same domain activity, D=improving domain activity to E=absence of domain activity. PGA assesses disease activity on visual analogue scale from very well(0)-very poor(10).
Percentage of Participants With 50 Percent (%) Improvement in Joints With Pain and Signs of Inflammation (Active Joints) at Week 52 Week 52 The percentage of participants who achieved at least 50% improvement from baseline in number of joints with pain and signs of inflammation at Week 52 for participants with at least 4 joints with pain and signs of inflammation at baseline were reported.
Percentage of Participants Receiving Glucocorticoid at Baseline Who Achieved Change in Glucocorticoid Dose by Week 40 and Sustain That Change Through Week 52 Up to Week 52 Reduction of glucocorticoid dose was defined as a reduction in average daily oral glucocorticoid dose by at least 50% (relative to the baseline dose) or reduction of average daily oral glucocorticoid dose by at least 25% (relative to the baseline dose) so that the average daily dose was reduced to less than or equal to (\<=) 7.5 milligram (mg) (prednisone or equivalent). Sustained reduction of glucocorticoid dose was defined as achieving an average daily oral glucocorticoid dose reduction between Weeks 24 and 40, and sustaining that reduction through Week 52, in those participants who, at baseline, were receiving oral glucocorticoids.
Percentage of Participants With at Least a 50% Improvement in the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) Activity Score at Week 52 Week 52 Percentage of participants achieving at least 50% improvement in CLASI activity score at Week 52 reported in participants with a CLASI activity score of 4 or greater at baseline. The CLASI is an instrument to assess the disease activity and damage caused to the skin for cutaneous lupus erythematosus participants with or without systemic involvement. The CLASI activity score ranges from 0-70 with lower score being improved. Activity is scored based on erythema, scale/hyperkeratosis, mucous membrane involvement, acute hair loss, and non-scarring alopecia.
Trial Locations
- Locations (204)
Wallace Rheumatic Study Center
🇺🇸Los Angeles, California, United States
Emory University
🇺🇸Atlanta, Georgia, United States
Toronto Western Hospital
🇨🇦Toronto, Ontario, Canada
University of Miami Miller School of Medicine
🇺🇸Miami, Florida, United States
Oklahoma Medical Research Foundation
🇺🇸Las Vegas, Nevada, United States
Innovative Health Research
🇺🇸Las Vegas, Nevada, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Sun Research Institute
🇺🇸San Antonio, Texas, United States
UT Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Pinnacle Research Group, LLC
🇺🇸Anniston, Alabama, United States
Medvin Clinical Research
🇺🇸Covina, California, United States
Loma Linda University Health Care
🇺🇸Loma Linda, California, United States
East Bay Rheumatology Medical Group
🇺🇸San Leandro, California, United States
Stamford Therapeutics Consortium
🇺🇸Stamford, Connecticut, United States
Bay Area Arthritis and Osteoporosis
🇺🇸Brandon, Florida, United States
Biomedical Research Alliance Of New York
🇺🇸Lake Success, New York, United States
DJL Clinical Research, PLLC
🇺🇸Charlotte, North Carolina, United States
The Feinstein Institute for Medical Research
🇺🇸Manhasset, New York, United States
Nzoz Bif-Med
🇵🇱Bytom, Poland
Affiliated Hospital of Inner Mongolia Med U
🇨🇳Hohhot, China
Bekes Megyei Pandy Kalman Korhaz
🇭🇺Gyula, Hungary
Belvarosi Egeszseghaz Kft. (Leda-Platan Maganklinika es Sebeszeti Kozpont)
🇭🇺Zalaegerszeg, Hungary
Szt, Istvan and Szt. Laszlo
🇭🇺Budapest, Hungary
National Hospital Organization Kyushu Medical Center
🇯🇵Fukuoka, Japan
Medizinische Hochschule Hannover
🇩🇪Hannover, Germany
Sasebo Chuo Hospital
🇯🇵Sasebo, Japan
Tohoku University Hospital
🇯🇵Sendai-shi, Japan
Vilnius University Hospital Santariskiu Clinics
🇱🇹Vilnius, Lithuania
Szpital Uniwersytecki nr 2 im. dr. Jana Biziela w Bydgoszczy
🇵🇱Bydgoszcz, Poland
Lietuvos sveikatos mokslų universiteto ligoninė Kauno klinik
🇱🇹Kaunas, Lithuania
Ajou University Hospital
🇰🇷Suwon, Korea, Republic of
Centrum Medyczne Medens S.C. Grupowa Praktyka Lekarska
🇵🇱Sonoswiec, Poland
Centrum Medyczne Pratia Warszawa
🇵🇱Warszawa, Poland
Hosp. Clinico San Carlos
🇪🇸Madrid, Spain
LLL Medical Center Revma-Med
🇷🇺Kemerovo, Russian Federation
ULSAM, EPE - Hospital Conde de Bertiandos
🇵🇹Ponte de Lima, Portugal
Instituto Portugues de Reumatologia
🇵🇹Lisboa, Portugal
University Clinical Center Kragujevac
🇷🇸Kragujevac, Serbia
Clinical Center of Vojvodina
🇷🇸Vojvodina, Serbia
Panorama Medical Centre
🇿🇦Cape Town, South Africa
Hosp. Univ. Vall D Hebron
🇪🇸Barcelona, Spain
Institute of Rheumatology Belgrade
🇷🇸Belgrade, Serbia
Institute of Rheumatology
🇷🇸Belgrade, Serbia
Hosp. Reina Sofia
🇪🇸Cordoba, Spain
Hosp. Univ. Infanta Sofia
🇪🇸San Sebastián de los Reyes, Spain
Hosp. Univ. 12 de Octubre
🇪🇸Madrid, Spain
Taipei Veterans General Hospital
🇨🇳Taipei, Taiwan
Chang Gung Memorial Hospital
🇨🇳Kwei-san Hsiang, Taiwan
Hosp. Infanta Luisa
🇪🇸Sevilla, Spain
National Taiwan University Hospital
🇨🇳Taipei, Taiwan
Taipei Medical University
🇨🇳Taipei, Taiwan
Cathay General Hospital
🇨🇳Taipei, Taiwan
MNPE 'Vinnytsia Regional Clinical Hospital named after M.I. Pyrogov of Vinnytsia Regional Council'
🇺🇦Vinnytsia, Ukraine
Naukovo-doslidnyi inst. Reabilit. Pyrogova [Revmatologichne]
🇺🇦Vinnytsia, Ukraine
Vanderbilt University Medical Center
🇺🇸Nashville, Tennessee, United States
University of Alabama at Birmingham
🇺🇸Birmingham, Alabama, United States
National Hospital Organization Chibahigashi National Hospital
🇯🇵Chiba, Japan
National Hospital Organization Osaka Minami Medical Center
🇯🇵Kawachi-Nagano, Japan
Keio University Hospital
🇯🇵Shinjuku-ku, Japan
Clinical Diagnostic Center 'Ultramed'
🇷🇺Omsk, Russian Federation
City Clinical Hospital #31
🇷🇺St. Petersburg, Russian Federation
Ulyanovsk Regional Clinical Hospital
🇷🇺Ulyanovsk, Russian Federation
Hosp. Univ. de Basurto
🇪🇸Bilbao, Spain
Clinical Research of West Florida
🇺🇸Tampa, Florida, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
CHU de Québec
🇨🇦Quebec, Canada
Lugene Eye Institute
🇺🇸Glendale, California, United States
Advanced Medical Research - Lakewood
🇺🇸Lakewood, California, United States
C.V. Mehta, MD Medical Corp.
🇺🇸Hemet, California, United States
Achieve Clinical Research, LLC
🇺🇸Vestavia Hills, Alabama, United States
University of California at San Diego
🇺🇸La Jolla, California, United States
Loma Linda University
🇺🇸Loma Linda, California, United States
Keck School of Medicine of USC
🇺🇸Los Angeles, California, United States
Valerius Medical Group & Research Center
🇺🇸Los Alamitos, California, United States
University Clinical Investigators, Inc
🇺🇸Tustin, California, United States
Westlake Medical Research Clinical Trials
🇺🇸Thousand Oaks, California, United States
University of Colorado
🇺🇸Aurora, Colorado, United States
Inland Rheumatology Clinical Trials Inc.
🇺🇸Upland, California, United States
Denver Arthritis Clinic
🇺🇸Denver, Colorado, United States
New Horizon Research Center
🇺🇸Miami, Florida, United States
University of Florida Health Jacksonville
🇺🇸Jacksonville, Florida, United States
Arthritis and Rheumatic Disease Specialties
🇺🇸Aventura, Florida, United States
Centre for Rheumatology, Immunology and Arthritis
🇺🇸Fort Lauderdale, Florida, United States
Millennium Research
🇺🇸Ormond Beach, Florida, United States
Integral Rheumatology & Immunology Specialists
🇺🇸Plantation, Florida, United States
Piedmont Healthcare - Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
June DO, PC.
🇺🇸Lansing, Michigan, United States
Graves-Gilbert Clinic - Bowling Green
🇺🇸Bowling Green, Kentucky, United States
Arthritis and Diabetes Clinic
🇺🇸Monroe, Louisiana, United States
The Center for Rheumatology and Bone Research
🇺🇸Wheaton, Maryland, United States
St Paul Rheumatology PA
🇺🇸Eagan, Minnesota, United States
NYU Center for Musculoskeletal Care
🇺🇸New York, New York, United States
Hospital for Special Surgery
🇺🇸New York, New York, United States
SUNY Upstate Medical University
🇺🇸Syracuse, New York, United States
Joint and Muscle Research Institute
🇺🇸Charlotte, North Carolina, United States
Allegheny Rheumatology/Allegheny Singer Research Institute
🇺🇸Wexford, Pennsylvania, United States
Columbia Arthritis Center
🇺🇸Columbia, South Carolina, United States
Lewis Katz School of Medicine, Temple University
🇺🇸Philadelphia, Pennsylvania, United States
West Tennessee Research Institute
🇺🇸Jackson, Tennessee, United States
Dr. Ramesh Gupta
🇺🇸Memphis, Tennessee, United States
Amarillo Center for Clinical Research
🇺🇸Amarillo, Texas, United States
Arthritis Centers of Texas
🇺🇸Dallas, Texas, United States
Rheumatology & Pulmonary Clinic
🇺🇸Beckley, West Virginia, United States
Fundacion CENIT para la Investigacion en Neurociencias
🇦🇷Buenos Aires, Argentina
Centro Privado de Medicina Familiar
🇦🇷Buenos Aires, Argentina
Instituto Centenario
🇦🇷Buenos Aires, Argentina
Framingham Centro Medico
🇦🇷Ciudad De La Plata, Argentina
Hospital Italiano de Cordoba
🇦🇷Cordoba, Argentina
Hospital Escuela 'Gral. Jose F. de San Martin'
🇦🇷Corrientes, Argentina
Centro Medico Privado de Reumatologia
🇦🇷San Miguel de Tucumán, Argentina
CER San Juan Centro Polivalente de Asistencia e Investigacion Clinica
🇦🇷San Juan, Argentina
MHAT Trimantium
🇧🇬Plovdiv, Bulgaria
University of Calgary
🇨🇦Calgary, Alberta, Canada
University of Manitoba
🇨🇦Winnipeg, Manitoba, Canada
Medical Centre Synexus
🇧🇬Sofia, Bulgaria
Peking Union Medical College Hospital
🇨🇳Beijing, China
West China Hospital, Sichuan University
🇨🇳Chengdu, China
The First Affiliated Hospital of Baotou Medical University
🇨🇳Baotou, China
Shanghai Ruijin Hospital
🇨🇳Shanghai, China
Guangdong Provincial People's Hospital
🇨🇳Guangzhou, China
Tianjin Medical University General Hospital
🇨🇳Tianjin, China
Centro de Investigación en Reumatología y especialidades médicas S.A.S. - CIREEM S.A.S.
🇨🇴Bogotá, Colombia
IPS Medicity SAS
🇨🇴Bucaramanga, Colombia
Tongji Hospital of Tongji Medical College of Huangzhong Univ
🇨🇳Wuhan, China
The 1st affiliated Hospital of Xi'an Traffic University
🇨🇳Xi'an, China
Preventive Care Ltda
🇨🇴Chia, Colombia
Clinica Universitaria Bolivariana
🇨🇴Medellin, Colombia
Funcentra
🇨🇴Montería, Colombia
Rheumatology Unit
🇩🇪Leipzig, Germany
Rheumazentrum Ruhrgebiet
🇩🇪Herne, Germany
Charite - Universitaetsmedizin Berlin (CCM)
🇩🇪Berlin, Germany
Chiba University Hospital
🇯🇵Chiba, Japan
Universitaetsmedizin Mainz
🇩🇪Mainz, Germany
Fukushima Medical University Hospital
🇯🇵Fukushima, Japan
Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
🇯🇵Hiroshima, Japan
Hospital of the University of Occupational and Environmental Health
🇯🇵Hukuoka, Japan
Kawasaki Rheumatism and Internal Medicine Clinic
🇯🇵Kitakyushu, Japan
National Hospital Organization Nagoya Medical Center
🇯🇵Nagoya, Japan
Toho University Medical Center, Ohashi Hospital
🇯🇵Meguro-ku, Japan
Nagasaki University Hospital
🇯🇵Nagasaki-shi, Japan
Kitasato University Hospital
🇯🇵Sagamihara, Japan
Hokkaido University Hospital
🇯🇵Sapporo-shi, Japan
Sapporo City General Hospital
🇯🇵Sapporo, Japan
National Center for Global Health and Medicine
🇯🇵Shinjuku-ku, Japan
Juntendo University Hospital
🇯🇵Tokyo, Japan
St. Luke's International Hospital
🇯🇵Tokyo, Japan
Fujita Health University Hospital
🇯🇵Toyoake, Japan
National Hospital Organization Yokohama Medical Center
🇯🇵Yokohama, Japan
Chonbuk National Univ Hospital
🇰🇷JeonJu, Korea, Republic of
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
Daegu Catholic University Medical Center
🇰🇷Daegu, Korea, Republic of
Konkuk University Medical Center
🇰🇷Seoul, Korea, Republic of
Vaiku ligonine Vilniaus Universiteto ligon. Santariskiu fil
🇱🇹Vilnius, Lithuania
Klaipeda University Hospital
🇱🇹Klaipeda, Lithuania
Centrum Medyczne Pratia Tychy
🇵🇱Tychy, Poland
Reumatika-Centrum Reumatologii, NZOZ
🇵🇱Warszawa, Poland
Uniwersytecki Szpital Kliniczny im. J. Mikulicza-Radeckiego
🇵🇱Wroclaw, Poland
Hospital Curry Cabral-Centro Hospital Lisboa Central
🇵🇹Lisboa, Portugal
Hospital da Luz
🇵🇹Lisboa, Portugal
Leningrad region clinical hospital
🇷🇺Saint-Petersburg, Russian Federation
C.H. de Vila Nova de Gaia/Espinho
🇵🇹Vila Nova de Gaia, Portugal
Regional Clinical Hospital for War Veterans
🇷🇺Kemerovo, Russian Federation
Clinical Hospital Center Bezanijska Kosa
🇷🇸Belgrade, Serbia
Northen-Western State Medical University n.a. I.I. Mechnikov
🇷🇺St.-Petersburg, Russian Federation
Clinical Emergency Hospital n.a. N.V. Solovyev
🇷🇺Yaroslavl, Russian Federation
Clinical Research Unit, University of Pretoria
🇿🇦Pretoria, South Africa
Winelands Medical Research Centre
🇿🇦Stellenbosch, South Africa
Excellentis Clinical trial Consultants
🇿🇦George, South Africa
Rajavhiti Hospital
🇹🇭Bangkok, Thailand
Hosp. Regional Univ. de Malaga
🇪🇸Málaga, Spain
Hosp. Do Meixoeiro
🇪🇸Vigo -Pontevedra, Spain
Chiang Mai University
🇹🇭Muang, Thailand
Songklanagarind hospital
🇹🇭Hat Yai, Thailand
Kyivska oblasna klinichna likarnia
🇺🇦Kyiv, Ukraine
Mechnikov Inst, Miska bagatoprofilna likarnia #18
🇺🇦Kharkiv, Ukraine
Odeska oblasna klinichna likarnia
🇺🇦Odesa, Ukraine
OK Center for Arthritis Therapy & Research, Inc.
🇺🇸Tulsa, Oklahoma, United States
DeKalb Medical Specialty Center
🇺🇸Decatur, Georgia, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Chicago
🇺🇸Chicago, Illinois, United States
UMHAT St. Ivan Rilski
🇧🇬Sofia, Bulgaria
Centrum Medyczne AMED oddzial w Lodzi
🇵🇱Lodz, Poland
Military Medical Academy
🇷🇸Belgrade, Serbia
Siriraj Hospital
🇹🇭Bangkok, Thailand
Institute for Treatment and Rehabilitation Niska Banja
🇷🇸Niska Banja, Serbia
Servimed S.A.S
🇨🇴Bucaramanga, Colombia
Samodzielny Publiczny Szpital Kliniczny Nr 4 w Lublinie
🇵🇱Lublin, Poland
Kaohsiung Medical University Chung-Ho Memorial Hospital
🇨🇳Kaohsiung, Taiwan
Kyiv City Clinical Hospital #3
🇺🇦Kyiv, Ukraine
Multidisciplinary Medical Center of Odessa National Medical University
🇺🇦Odessa, Ukraine
University of Washington
🇺🇸Seattle, Washington, United States
McMaster University
🇨🇦Hamilton, Ontario, Canada
Ramathibodi Hospital
🇹🇭Bangkok, Thailand
Diagnostic-Consultative Center (DCC) Aleksandrovska
🇧🇬Sofia, Bulgaria
Twoja Przychodnia - Centrum Medyczne Nowa Sol
🇵🇱Nowa Sol, Poland
Chung Shan Medical University Hospital
🇨🇳Taichung, Taiwan
China Medical University Hospital
🇨🇳Taichung, Taiwan
Phramongkutklao Hospital and Medical College
🇹🇭Bangkok, Thailand
UPMC Lupus Center of Excellence
🇺🇸New Haven, Connecticut, United States
Omega Research Consultants
🇺🇸Orlando, Florida, United States
Rheumatology Associates of Central Florida, PA
🇺🇸Orlando, Florida, United States
Wake Forest Baptist Medical Center
🇺🇸Winston-Salem, North Carolina, United States
Albuquerque Center for Rheumatology
🇺🇸Albuquerque, New Mexico, United States
Austin Regional Clinic
🇺🇸Austin, Texas, United States