A Study of Ocrelizumab in Participants With Primary Progressive Multiple Sclerosis
- Conditions
- Multiple Sclerosis, Primary Progressive
- Interventions
- Other: Placebo
- Registration Number
- NCT01194570
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This randomized, parallel group, double-blind, placebo controlled study will evaluate the efficacy and safety of ocrelizumab in participants with primary progressive multiple sclerosis. Eligible participants will be randomized 2 : 1 to receive either ocrelizumab or placebo.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 735
- Diagnosis of primary progressive multiple sclerosis (according to revised McDonald criteria)
- EDSS at screening from 3 to 6.5 points
- Disease duration from onset of MS symptoms less than (<) 15 years if EDSS greater than (>) 5.0; <10 years if EDSS greater than or equal to (>/=) 5.0
- Sexually active male and female participants of reproductive potential must use two methods of contraception throughout the study treatment phase and for 48 weeks after the last dose
- History of relapsing remitting MS, secondary progressive, or progressive relapsing MS at screening
- Inability to complete an MRI (contraindications for MRI)
- Known presence of other neurologic disorders
- Known active infection or history of or presence of recurrent or chronic infection
- History of cancer, including solid tumors and hematological malignancies (except for basal cell, in situ squamous cell carcinomas of the skin and in situ carcinoma of the cervix that have been excised and resolved)
- Previous treatment with B-cell targeted therapies (e.g. rituximab, ocrelizumab, atacicept, belimumab, or ofatumumab)
- Any previous treatment with lymphocyte trafficking blockers, with alemtuzumab, anti-cluster of differentiation 4 (CD4), cladribine, cyclophosphamide, mitoxantrone, azathioprine, mycophenolate mofetil, cyclosporine, methotrexate, total body irradiation, or bone marrow transplantation
- Any concomitant disease that may require chronic treatment with systemic corticosteroids or immunosuppressants during the course of the study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Placebo Participants with primary progressive multiple sclerosis (PPMS) received placebo matched to ocrelizumab at a schedule interval of 24 weeks up to at least 120 weeks. Placebo Ocrelizumab Participants with primary progressive multiple sclerosis (PPMS) received placebo matched to ocrelizumab at a schedule interval of 24 weeks up to at least 120 weeks. Ocrelizumab 600 mg Ocrelizumab Participants with PPMS received ocrelizumab as two IV infusions of 300 mg separated by 14 days at a scheduled interval of every 24 weeks up to at least 120 weeks.
- Primary Outcome Measures
Name Time Method Time to Onset of Clinical Disability Progression (CDP) Sustained for at Least 12 Weeks During the Double-Blind Treatment Period Maximal follow up: 216 weeks for Placebo arm and 217 weeks for Ocrelizumab arm The time to onset of CDP was defined as time from baseline to first disability progression, which is confirmed at next regularly scheduled visit \>=12 weeks (\>=84 days) after initial disability progression. Baseline for time to onset of CDP is the date of randomization, independent of the first day of dosing. Disability progression is defined as an increase of \>= 1.0 point from baseline expanded disability status scale (EDSS) score, if baseline EDSS value is \<=5.5 points (inclusive), or an increase of \>=0.5 points, if baseline EDSS is \>5.5 points. The total EDSS score ranges from 0 (normal) to 10 (death due to multiple sclerosis). The randomized participants who did not receive any treatment were censored at days 0 in each Arm.
- Secondary Outcome Measures
Name Time Method Time to Onset of Clinical Disability Progression (CDP) Sustained for at Least 24 Weeks During the Double-Blind Treatment Period Maximal follow up: 216 weeks for Placebo arm and 217 weeks for Ocrelizumab arm The time to onset of CDP was defined as time from baseline to first disability progression, which is confirmed at next regularly scheduled visit \>=12 weeks (\>=84 days) after initial disability progression. Baseline for time to onset of CDP is the date of randomization, independent of the first day of dosing. Disability progression is defined as an increase of \>= 1.0 point from baseline expanded disability status scale (EDSS) score, if baseline EDSS value is \<=5.5 points (inclusive), or an increase of \>=0.5 points, if baseline EDSS is \>5.5 points. The total EDSS score ranges from 0 (normal) to 10 (death due to multiple sclerosis). The randomized participants who did not receive any treatment were censored at days 0 in each Arm.
Percent Change From Baseline in Timed 25-Foot Walk (T25-FW) at Week 120 Baseline, Week 120 Percent Change From Baseline in Total Volume of T2 Lesions at Week 120 From Baseline to Week 120 Percent Change in Total Brain Volume From Week 24 to Week 120 From Week 24 to Week 120 Change in From Baseline Physical Component Summary Score (PCS) SF- 36 Health Survey (SF-36) at Week 120 From Baseline to Week 120 The SF-36v2 is a 36-item, self- reported, generic measure of quality of life that has been widely used in multiple disease areas. It is composed of 8 health domains: Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health. The PCS score was derived based on the SF-36 V2 User's Manual. Scoring for PCS involves (a) recoding item response values, (b) summing recoded response values for all items in a given scale to obtain the scale raw score, (c) transforming scale raw score to a 0-100 score. The PCS score was computed by (a) multiplying each health domain z score by a scale-specific physical factor score coefficient, (b) summing the resulting products, (c) converting the product total to T score. The total score ranges from 0-100, higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.
Number of Participants With at Least One Adverse Event (AE) From baseline to 9 years AEs included infusion related reactions (IRRs) and serious multiple sclerosis (MS) relapses, but excluded non-serious MS relapses.
Trial Locations
- Locations (184)
Maxine Mesinger MS Clinic/Baylor College of Medicine; Neurology
🇺🇸Houston, Texas, United States
Swedish Neuroscience Institute; Multiple Sclerosis Center
🇺🇸Seattle, Washington, United States
MidAmerica Neuroscience Institute
🇺🇸Prairie Village, Kansas, United States
Barrow Neurology Clinic
🇺🇸Phoenix, Arizona, United States
Wayne State University; Department of Neurology
🇺🇸Detroit, Michigan, United States
Henry Ford Health System; Neurology & Neurosurgery
🇺🇸Detroit, Michigan, United States
Oklahoma Medical Research Foundation; MS Center of Excellence
🇺🇸Oklahoma City, Oklahoma, United States
The Ottawa Hospital - General Campus
🇨🇦Ottawa, Ontario, Canada
Hopital Purpan; Fédération de neurologie
🇫🇷Toulouse, France
Medizinische Universitat Wien Medical University of Vienna
🇦🇹Wien, Austria
401 Military Hospital of Athens; Neurology Department
🇬🇷Athens, Greece
Timisoara Emergency County Clinical Hospital
🇷🇴Timi?oara, Romania
Phoenix Neurological Associates Ltd
🇺🇸Phoenix, Arizona, United States
MS Center of Southern California
🇺🇸Newport Beach, California, United States
University of Miami School of Medicine; Dept. of Neurology Movement Disorder Center
🇺🇸Miami, Florida, United States
Univ of CA San Francisco; Department of Neurology
🇺🇸San Francisco, California, United States
Indiana University Cancer Center
🇺🇸Indianapolis, Indiana, United States
Vero Beach Neurology and Research Institute
🇺🇸Vero Beach, Florida, United States
Michigan Institute for Neurological Disorders
🇺🇸Farmington Hills, Michigan, United States
Weill Medical College of Cornell University; Judith Jaffe MS Ctr
🇺🇸New York, New York, United States
Neurology Assoc of Stony Brook
🇺🇸Stony Brook, New York, United States
Winthrop University Hospital
🇺🇸Mineola, New York, United States
Comprehensive MS Care Center at South Shore Neurologic Assoc.
🇺🇸Patchogue, New York, United States
Raleigh Neurology Associates
🇺🇸Raleigh, North Carolina, United States
Carolinas Medical Center; Ms Center
🇺🇸Charlotte, North Carolina, United States
Kepler Universitätsklinikum GmbH - Neuromed Campus; Neurologie
🇦🇹Linz, Austria
Kepler Universitätskliniken GmbH - Med Campus III; Neurologie & Psychiatrie
🇦🇹Linz, Austria
Hospital Universitario Clementino Fraga Filho - UFRJ
🇧🇷Rio de Janeiro, RJ, Brazil
CHU Tivoli
🇧🇪La Louvière, Belgium
Hospital das Clinicas - UFG;Reumatologia
🇧🇷Goiania, GO, Brazil
Hospital Sao Lucas - PUCRS
🇧🇷Porto Alegre, RS, Brazil
AZ Alma vzw (Sijsele)
🇧🇪Sijsele, Belgium
Shat Np Sveti Naum; 3Rd Clinic of Neurology
🇧🇬Sofia, Bulgaria
Foothills Medical Centre
🇨🇦Calgary, Alberta, Canada
University of British Columbia UBC Hospital; Multiple Sclerosis (MS) Clinic - Vancouver
🇨🇦Vancouver, British Columbia, Canada
St. Michael'S Hospital
🇨🇦Toronto, Ontario, Canada
Montreal Neurological Institute and Hospital
🇨🇦Montreal, Quebec, Canada
Recherche Sepmus Inc.
🇨🇦Greenfield Park, Quebec, Canada
Vseobecna fakultni nemocnice v Praze; MS Centrum, Neurologicka klinika
🇨🇿Praha 2, Czechia
Krajska zdravotni, a. s. ? Nemocnice Teplice, o. z.; Neurologicke oddeleni
🇨🇿Teplice, Czechia
Helsingin yliopistollinen keskussairaala
🇫🇮Helsinki, Finland
Tampereen yliopisto; Kliinisen lääketieteen laitos, Neurologian yksikkö
🇫🇮Tampere, Finland
Turku University Central Hospital; Pharmacy
🇫🇮Turku, Finland
Hopital Neurologique et Neurochirurgical Pierre Wertheimer; Service de Neurologie A
🇫🇷Bron, France
Groupe Hospitalier Pellegrin; Service de neurochirurgie B
🇫🇷Bordeaux, France
Hopital Gabriel Montpied CHU de Clermont-Ferrand; Service de Neurologie B
🇫🇷Clermont-Ferrand, France
Hopital Cote De Nacre; Unite Neurologie Generale
🇫🇷Caen, France
Hopital Roger Salengro Service de Neurologie
🇫🇷Lille, France
CHU de la Timone - Hopital d Adultes; Service de Neurologie
🇫🇷Marseille, France
Hôpital de Poissy; Service neurologie
🇫🇷Poissy, France
Chu De Strasbourg; Hopital Civil
🇫🇷Strasbourg, France
Klinikum Bayreuth GmbH; Neurologische Klinik
🇩🇪Bayreuth, Germany
Charite - Universitatsmedizin Berlin; Klinik fur Neurologie
🇩🇪Berlin, Germany
Universitätsklinikum "Carl Gustav Carus"; Klinik und Poliklinik für Neurologie
🇩🇪Dresden, Germany
Universitätsklinikum Gießen und Marburg GmbH; Neurologie
🇩🇪Gießen, Germany
Universitatsklinikum Munster
🇩🇪Münster, Germany
Medizinische Einrichtungen des Bezirks Oberpfalz GmbH; Neurologie
🇩🇪Regensburg, Germany
Pécsi Tudományegyetem
🇭🇺Pécs, Hungary
Szegedi Tudományegyetem Szent-Györgyi Albert Klinikai Központ; Neurológiai Klinika
🇭🇺Szeged, Hungary
Veszprém Megyei Csolnoky Ferenc Kórház; Reumatológia
🇭🇺Veszprem, Hungary
Rabin Medical Center; Multiple Sclerosis Clinic
🇮🇱Petach Tikva, Israel
Barzilai Medical Center; Neurology Department
🇮🇱Ashkelon, Israel
Medical Center Ziv Safed; Neurology Department
🇮🇱Safed, Israel
Hospital San Raffaele
🇮🇹Milano, Lombardia, Italy
Zuyderland Medisch Centrum - Sittard Geleen
🇳🇱Sittard-Geleen, Netherlands
Instituto Biomedico De Investigacion A.C.
🇲🇽Aguascalientes, Mexico
Oslo universitetssykehus HF, Ullevål; Nevrologisk avdeling
🇳🇴Oslo, Norway
Niepubliczny Zaklad Opieki Zdrowotnej KENDRON ; Poradnia Neurologiczna
🇵🇱Bialystok, Poland
Akson - Clinical Research Maciejowski - Bielecki Sp. Jawna
🇵🇱Jaroslaw, Poland
Hospital Nacional Dos de Mayo - Centro de Investigacion en Oncología
🇵🇪Lima, Peru
Hospital Prof. Dr. Fernando Fonseca; Servico de Neurologia
🇵🇹Amadora, Portugal
Samodzielny Publiczny Szpital Kliniczny nr 4 w Lublinie; Klinika Neurochirurgii i Neurochirurgii Dzi
🇵🇱Lublin, Poland
SC Clubul Sanatatii SRL
🇷🇴Campulung, Romania
Elias Emergency University Hospital Neurology Dept; Neurology Department
🇷🇴Bucharest, Romania
Spitalul Clinic Judetean de Urgenta Targu Mures; Clinica Neurologie
🇷🇴Targu Mures, Romania
Research Medical Complex "Vashe Zdorovie"; Neurology Department
🇷🇺Kazan, Tatarstan, Russian Federation
Hospital Donostia
🇪🇸San Sebastian, Guipuzcoa, Spain
Hospital del Mar; Servicio de Neurologia
🇪🇸Barcelona, Spain
Hospital de la Santa Creu i Sant Pau; Servicio de Neurologia
🇪🇸Barcelona, Spain
Hospital Universitario Virgen Macarena; Servicio de Neurologia
🇪🇸Sevilla, Spain
Hospital Ramon y Cajal; Servicio de Neurologia
🇪🇸Madrid, Spain
Municipal Non-profit Enterprise Odessa Regional Clinical Hospital of Odessa Regional Council
🇺🇦Odesa, Kherson Governorate, Ukraine
Ukrainian State Inst. of Med. and Social Problems of Disability; Neuro
🇺🇦Dnipropetrovsk, Ukraine
Kh. Med. Ac. of P.-Gr. Ed.; Cl. Cen. Hosp. of UkrZal.; 3rd Dept. Neurology
🇺🇦Kharkiv, Ukraine
Volyn Regional Clinical Hospital
🇺🇦Lutsk, Ukraine
University of Colorado; Anschutz Medical Campus Department of Neurology
🇺🇸Aurora, Colorado, United States
Marianne-Strauß-Klinik; Behandlung Kempfen für Multip Sklero Kranke gemeinnütz GmbH
🇩🇪Berg, Germany
Mayo Clinic- Scottsdale
🇺🇸Scottsdale, Arizona, United States
Sutter East Bay Medical Foundation
🇺🇸Berkeley, California, United States
Arizona Neuroscience Research LLC
🇺🇸Phoenix, Arkansas, United States
Holy Name Hospital
🇺🇸Teaneck, New Jersey, United States
University of Minnesota; Clin. Neuro Research Unit
🇺🇸Minneapolis, Minnesota, United States
Washington University School of Medicine; Department of Neurology
🇺🇸Saint Louis, Missouri, United States
Mount Sinai School of Medicine; Neurology
🇺🇸New York, New York, United States
The Ohio State University Wexner Medical Center; Department of Neurology
🇺🇸Columbus, Ohio, United States
The Neurology Foundation, Inc.
🇺🇸Providence, Rhode Island, United States
Neurology Clinic PC
🇺🇸Cordova, Tennessee, United States
Trustees of the University of Pennsylvania; Neurology
🇺🇸Philadelphia, Pennsylvania, United States
Royal Hobart Hospital
🇦🇺Hobart, Tasmania, Australia
St Vincent's Hospital Melbourne; Clinical Neuroscience and Neurological Research
🇦🇺Fitzroy, Victoria, Australia
Uniklinik fuer Neurologie, Medizinische Universitaet Innsbruck; Department fuer Neurologie
🇦🇹Innsbruck, Austria
Santa Casa de Misericordia; de Belo Horizonte
🇧🇷Belo Horizonte, MG, Brazil
Health Sciences Centre
🇨🇦Winnipeg, Manitoba, Canada
Fakultni nemocnice Brno; Interni kardiologicka klinika
🇨🇿Brno, Czechia
Hopital Gui de Chauliac; Neurologie
🇫🇷Montpellier, France
CHRU Nancy; Service de neurologie
🇫🇷Nancy, France
Fondation Rothschild; Service de Neurologie
🇫🇷Paris, France
Hôpital Guillaume et René Laënnec; Service Neurologie
🇫🇷Nantes, France
Hôpital Pasteur; Service de Neurologie
🇫🇷Nice, France
Groupe Hospitalier Pitié- Salpétrière; Service Neurologie
🇫🇷Paris, France
Groupe Hospitalo-Universitaire Caremeau; Service Neurologie
🇫🇷Nimes, France
Hôpital Maison Blanche; Service de Neurologie
🇫🇷Reims, France
Jüdisches Krankenhaus Berlin; Abteilung fur Neurologie
🇩🇪Berlin, Germany
Berufsgenossenschaftliches Uni-Klinikum Bergmannsheil GmbH
🇩🇪Bochum, Germany
Klinikum Joh.Wolfg.Goethe-UNI Senckenbergisches Institut für Neuroonkologie
🇩🇪Frankfurt am Main, Germany
Heinrich Heine Universität Düsseldorf; Neurologische Klinik
🇩🇪Düsseldorf, Germany
Kliniken der Stadt Koln gGmbH
🇩🇪Koln, Germany
Universitaetsklinikum Heidelberg
🇩🇪Heidelberg, Germany
Universität Leipzig; Innere Medizin, Neurologie, Dermatologie
🇩🇪Leipzig, Germany
Universitätsklinikum Tübingen, Zentrum für Neurologie
🇩🇪Tübingen, Germany
Klinikum rechts der Isar der Technischen Universität München
🇩🇪Munchen, Germany
Universitätsklinikum Ulm; Klinik für Neurologie
🇩🇪Ulm, Germany
DKD Helios Klinik (Deutsche Klinik für Diagnostik GmbH)
🇩🇪Wiesbaden, Germany
Georgios Papanikolaou General Hosp. of Thessaloniki
🇬🇷Thessaloniki, Greece
Jahn Ferenc Del-Pesti Korhaz es Rendelointezet
🇭🇺Budapest, Hungary
Vaszary Kolos Korhaz; Neurology
🇭🇺Esztergom, Hungary
Hadassah University Hospital Ein Kerem; Neurology Department
🇮🇱Jerusalem, Israel
The Chaim Sheba Medical Center; Multiple Sclerosis Center
🇮🇱Ramat-Gan, Israel
A.O. Universitaria S. Martino Di Genova
🇮🇹Genova, Liguria, Italy
Tel Aviv Sourasky Medical Center; Department of Neurology
🇮🇱Tel Aviv, Israel
Azienda Sanitaria Ospedaliera S. Luigi Gonzaga; Centro Regionale Sclerosi Multipla - Neurologia II
🇮🇹Orbassano, Piemonte, Italy
Klaipeda University Hospital Public Institution
🇱🇹Klaipeda, Lithuania
Eleccion Salud SC
🇲🇽Mexico, Mexico CITY (federal District), Mexico
Ospedale Binaghi; Centro Sclerosi Multipla
🇮🇹Cagliari, Sardegna, Italy
Hospital of Lithuanian University of Health. Sciences Kaunas Clinics
🇱🇹Kaunas, Lithuania
Siauliai Hospital
🇱🇹Siauliai, Lithuania
Centro de Estudios Clinicos y Espec. Med. SC
🇲🇽Monterrey, Nuevo LEON, Mexico
Erasmus MC; Afdeling Neurologie
🇳🇱Rotterdam, Netherlands
Hospital IV Alberto Sabogal Sologuren; Unidad de Investigacion
🇵🇪Bellavista, Peru
Clinica Anglo Americana
🇵🇪Lima, Peru
Wellington Hospital; Department of Neurology
🇳🇿Wellington, New Zealand
Niepubliczny Zaklad Opieki Zdrowotnej; Neuro-Medic
🇵🇱Katowice, Poland
Diagnomed Clinical Research Sp. z o.o.
🇵🇱Katowice, Poland
Zespol Opieki Zdrowotnej w Konskich; Oddzial Neurologiczny
🇵🇱Konskie, Poland
SPZOZ Uni. Szpital Kliniczny nr 1 im. Norberta Barlickiego Uni. Medycznego w Lodzi ; Neurologii
🇵🇱Lodz, Poland
Hospital Garcia de Orta; Servico de Neurologia
🇵🇹Almada, Portugal
Hospital de Santa Maria; Servico de Neurologia
🇵🇹Lisboa, Portugal
HUC; Servico de Neurologia
🇵🇹Coimbra, Portugal
Hospital Geral; Servico de Neurologia
🇵🇹Coimbra, Portugal
Hospital Geral de Santo Antonio; Servico de Neurologia
🇵🇹Porto, Portugal
Hospital Universitari de Girona Dr. Josep Trueta; Servicio de Neurologia
🇪🇸Salt, Girona, Spain
Complejo Hospitalario Universitario de Santiago (CHUS) ; Intermedios y Urgencias Pediatricas
🇪🇸Santiago de Compostela, LA Coruña, Spain
Hospital de Basurto Servicio de Neurologia
🇪🇸Bilbao, Vizcaya, Spain
Hospital Universitari Vall d'Hebron; Servicio de Neumo-Inmunologia
🇪🇸Barcelona, Spain
Hospital General Univ. de Alicante
🇪🇸Alicante, Spain
Hospital Clinic i Provincial; Servicio de Neurologia
🇪🇸Barcelona, Spain
Hospital Universitario Clínico San Carlos; Servicio de Neurología
🇪🇸Madrid, Spain
Universitario de La Princesa; Servicio de Neurología
🇪🇸Madrid, Spain
Hospital Regional Universitario Carlos Haya; Servicio de Neurologia
🇪🇸Malaga, Spain
Universitätsspital Basel; Neurologie
🇨🇭Basel, Switzerland
Ospedale Regionale di Lugano - Civico; Neurologia
🇨🇭Lugano, Switzerland
CNPE City Clinical Hospital #3 of Chernivtsi City Council
🇺🇦Chernivtsi, Chernihiv Governorate, Ukraine
Dnipropetrovsk State Medical Academy; Dept of Neurology
🇺🇦Dnipropetrovsk, Ukraine
Municipal Non-profit Enterprise of Kyiv Regional Council Kyiv Regional Clinical Hospital
🇺🇦Kyiv, KIEV Governorate, Ukraine
Kyiv City Clinical Hospital #4 MAHC of Kyiv; Chair of Neurology
🇺🇦Kyiv, Ukraine
Ams of Ukraine; Inst. of Neurology, Psychiatry & Narcology
🇺🇦Kharkov, Ukraine
Vinnytsya National Med. Uni. n.a. M.I. Pyrohov; Dept. of Neurology #3
🇺🇦Vinnytsya, Ukraine
Lviv Regional Clinical Hospital; Department of Neurology
🇺🇦Lviv, Ukraine
Walton Centre NHS Foundation Trust, Neuroscience Research Centre; CLINICAL TRIALS UNIT
🇬🇧Liverpool, United Kingdom
Barts and the London NHS Trust
🇬🇧London, United Kingdom
Kings College Hospital; Neurology
🇬🇧London, United Kingdom
Royal Victoria Infirmary; Neurology Dept.
🇬🇧Newcastle Upon Tyne, United Kingdom
Uni Hospital Queens Medical Centre; Neurology
🇬🇧Nottingham, United Kingdom
University of Texas Southwestern
🇺🇸Dallas, Texas, United States
Waikato Hospital; Neurology
🇳🇿Hamilton, New Zealand
Univ of CA Davis Med Ctr; Neurology
🇺🇸Sacramento, California, United States
Christian-Doppler-Klinik - Universitätsklinikum; Universitätskliniik für Neurologie
🇦🇹Salzburg, Austria
Instituto Nacional de Neurologia y Neurocirugia
🇲🇽Ciudad de México, Mexico CITY (federal District), Mexico
Fövárosi Önkormányzat uzsoki utcai Kórház
🇭🇺Budapest, Hungary
Multiprofile Hosp. for Active Treatment;National Cardiology Hosp.
🇧🇬Sofia, Bulgaria
AHEPA Univ. General Hospital of Thessaloniki; B' Neurology Dept.
🇬🇷Thessaloniki, Greece
Neurological Associates, Inc.
🇺🇸Richmond, Virginia, United States
University of New Mexico; MS Specialty Clinic
🇺🇸Albuquerque, New Mexico, United States
University of Kansas Medical Center
🇺🇸Kansas City, Kansas, United States