MedPath

Long-Term Safety and Efficacy Evaluation of Amlitelimab in Participants of Previous Amlitelimab Moderate to Severe Atopic Dermatitis Clinical Trials

Phase 2
Recruiting
Conditions
Dermatitis Atopic
Interventions
Drug: Topical corticosteroids
Drug: Topical calcineurin inhibitors
Drug: Oral corticosteroids
Registration Number
NCT05492578
Lead Sponsor
Sanofi
Brief Summary

This is an open-label, Phase 2/Phase 3, long-term extension study for treatment of participants of previous amlitelimab clinical trials in moderate to severe atopic dermatitis.

The purpose of this study is to characterize the safety and efficacy of amlitelimab in treated participants with moderate to severe atopic dermatitis (AD) who have previously been enrolled in an amlitelimab clinical trial. All participants will have visits during the treatment period every 4 weeks. Responder participants rolling over from EFC17599 and EFC17600, and responder participants enrolling through screening from DRI17366 will be initiated into drug withdrawal (with no drug administration) at LTS17367 baseline visit to monitor durability of treatment response. If these responder participants relapse during LTS17367, they will have treatment restored. Non-responder participants rolling over from EFC17599 or EFC17600, and non-responder participants enrolling through screening from DRI17366 will have treatment administration from LTS17367 baseline. Participants rolling over from DRI17366, SFY17915 and INT18404 will also have treatment administration from LTS17367 baseline.

Remote visits with home dosing are allowed for the purpose of study drug administration, when applicable. In the case of remote visit with home dosing, the participant or a caregiver may administer study drug after appropriate training. Alternatively, if needed, and based on the investigator's judgement, home visits with healthcare professional assistance or on-site study drug administration visits can be performed. Where participants discontinue amlitelimab permanently during LTS17367, safety follow up will be performed for a minimum of 140 days from the last amlitelimab administration.

Detailed Description

Not available

Recruitment & Eligibility

Status
RECRUITING
Sex
All
Target Recruitment
1551
Inclusion Criteria
  • Participant must be at least 12 years of age inclusive at the time of signing the informed consent.

  • Participated in an amlitelimab clinical trial for moderate to severe AD and received study treatment, adequately completed the assessments required for the treatment period.

    • Have reached the rollover timepoint to LTS17367 at the last visit of the treatment period of their feeder study SFY17915, INT18404, EFC17599, or EFC17600

    • Participants in DRI17366 must only be enrolled from 1 of the following 3 groups:

      • The first group: participants at Week 24 in the DRI17336 study who have not achieved an ≥ Eczema Area and Skin Severity Index (EASI)-75 and are Investigator Global Assessment (IGA) ≥ 2.
      • The second group: participants entering LTS17367 between Week 28 and Week 52 of the feeder study, due to loss of clinical response in the part 2 of the feeder study. Timepoints for entering LTS17367 are Weeks 28, 32, 36, 40, 44, 48 or 52.
      • The third group: participants at Week 24 in DRI17366 who have been re-randomized and who subsequently complete the study to Week 52, enter safety follow-up and experience worsening of their AD during safety follow-up.
    • Participated in DRI17366 completing the previous study safety follow up (Week 68) and wish to re-initiate treatment with amlitelimab up to one year after the last visit

  • Complied with the previous clinical trial protocol to the satisfaction of the investigator

  • Body weight must be ≥25 kg

  • Provided signed informed assent/or consent and able to comply with the requirements of the protocol

Exclusion Criteria

Participants are excluded from the study if any of the following criteria apply:

  • Developed a medical condition that would preclude participation as described in the section for permanent discontinuation of the feeder study or LTS17367 protocol

  • Known history of or suspected current significant immunosuppression, including history of invasive opportunistic infections or helminthic infections despite infection resolution or otherwise recurrent infections of abnormal frequency or prolonged duration

  • History of solid organ or stem cell transplant

  • Any malignancies or history of malignancies prior to baseline (except for non-melanoma skin cancer that has been excised and completely cured for more than 5 years prior to baseline)

  • Participants positive for human immunodeficiency virus (HIV); participants with any of the following results at Screening (Visit 1) or at any point during the feeder study: presence of HBsAg with or without HBV DNA PCR test, or presence of anti-HBc Ab or presence of anti-HBs Ab with positive HBV DNA PCR test; positive HCVAb confirmed by positive HCV RNA PCR test

  • History (within last 2 years prior to baseline) of prescription drug or substance abuse, including alcohol, considered significant by the Investigator

  • Participants with active TB, latent TB, a history of incompletely treated TB, suspected extrapulmonary TB infection, non-TB mycobacterial infection, or who are at high risk of contracting TB (such as close contact with individuals with active or latent TB) or received Bacillus Calmette-Guérin (BCG)-vaccination within 12 weeks prior to screening

  • Participants with an indeterminate or a confirmed positive IGRA test are excluded from the study unless all of the following conditions are met:

    1. Have a history of prior documented completed chemoprophylaxis for latent TB infection (with a treatment regimen as per local guidelines), OR treated for active TB infection
    2. Have been in written form approved for participation in the present trial by a TB specialist who ruled out latent or active TB infection or other mycobacterial infection in the participant
    3. For whom review and approval from Sponsor have been granted are eligible
  • Severe concomitant illness that would in the Investigator's opinion inhibit the participant's participation in the study, including for example, but not limited to, hypertension, renal disease, neurological conditions, heart failure and pulmonary disease

  • Skin co-morbidity that would adversely affect the ability to undertake AD assessments (e.g., psoriasis, tinea corporis, lupus erythematosus) as per Investigator's judgment

  • Any medical condition which, in the opinion of the Investigator may present an unreasonable risk to the study participant as a result of his/her participation in this clinical study, may make participant's participation unreliable, or may interfere with study assessments

  • In the Investigator's opinion, medical conditions related to prior AD medications that have not healed/fully recovered for more than 2 weeks before screening visit, including, but not limited to, conjunctivitis, keratitis, eosinophilic conditions, arthralgia, herpes zoster, thrombosis

The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Study & Design

Study Type
INTERVENTIONAL
Study Design
SINGLE_GROUP
Arm && Interventions
GroupInterventionDescription
AmlitelimabTopical calcineurin inhibitorsSubcutaneous injection
AmlitelimabOral corticosteroidsSubcutaneous injection
AmlitelimabAmlitelimabSubcutaneous injection
AmlitelimabTopical corticosteroidsSubcutaneous injection
Primary Outcome Measures
NameTimeMethod
Percentage of participants who experienced treatment-emergent adverse event (TEAE)Baseline to Week 332
Secondary Outcome Measures
NameTimeMethod
Percentage of participants who experienced treatment-emergent serious adverse events (SAEs)Baseline to Week 332
Percentage of participants who experienced treatment-emergent adverse events of special interest (AESI)Baseline to Week 332
Percentage of participants who experienced TEAE leading to treatment discontinuationBaseline to Week 332
Absolute change from DRI17366 baseline in EASI score at each LTS17367 visit in participants entering the study from DRI17366 Week 24DRI17366 Baseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher scores indicated greater severity of AD.

Percent change from DRI17366 baseline in EASI score at each LTS17367 visit in participants entering the study from DRI17366 Week 24DRI17366 Baseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher scores indicated greater severity of AD.

Proportion of participants with EASI50/EASI75/EASI90/EASI100 from DRI17366 baseline at each LTS17367 visit in participants entering the study from DRI17366 Week 24DRI17366 Baseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher scores indicated greater severity of AD. EASI50: \>= 50% reduction in score from baseline; EASI75: \>= 75% reduction in score from baseline; EASI90: \>= 90% reduction in score from baseline; EASI100: \>= 100% reduction in score from baseline.

Proportion of participants with a response of Validated Investigator Global Assessment scale for atopic dermatitis (vIGA-AD) 0 or 1 at each LTS17367 visit in participants entering the study from DRI17366 Week 24Baseline to Week 332

The vIGA-AD is an assessment instrument used to rate the severity of AD globally, based on a 5-point scale ranging from (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe), higher score indicated higher severity.

Proportion of participants with vIGA-AD score 0/1 in all participants entering the study [each LTS17367 visit]Baseline to Week 332

The vIGA-AD is an assessment instrument used to rate the severity of AD globally, based on a 5-point scale ranging from (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe), higher score indicated higher severity.

Proportion of participants with vIGA-AD score 0 [each LTS17367 visit]Baseline to Week 332

The vIGA-AD is an assessment instrument used to rate the severity of AD globally, based on a 5-point scale ranging from (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe), higher score indicated higher severity.

Proportion of participants with vIGA-AD score 0 or 1 with presence of only barely perceptible erythema (no induration/papulation, no lichenification, no oozing or crusting) at each LTS17367 visitBaseline to Week 332

The vIGA-AD is an assessment instrument used to rate the severity of AD globally, based on a 5-point scale ranging from (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe), higher score indicated higher severity.

Time to first vIGA-AD 0/1 after LTS17367 enrollment in those participants who had not achieved vIGA-AD 0/1 by the time of LTS17367 enrollmentBaseline to Week 332

The vIGA-AD is an assessment instrument used to rate the severity of AD globally, based on a 5-point scale ranging from (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe), higher score indicated higher severity.

Absolute change from feeder study baseline in EASI score in all participants entering the study [each LTS17367 visit]Baseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher scores indicated greater severity of AD.

Percent change from feeder study baseline in EASI score in all participants entering the study [each LTS17367 visit]Baseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher scores indicated greater severity of AD.

Proportion of participants with EASI50/EASI75/EASI90 in all participants entering the study [each LTS17367 visit]Baseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher scores indicated greater severity of AD. EASI50: \>= 50% reduction in score from baseline; EASI75: \>= 75% reduction in score from baseline; EASI90: \>= 90% reduction in score from baseline.

Time to first EASI75/EASI90 in those participants who had not achieved it by the time of LTS17367 enrollmentBaseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher scores indicated greater severity of AD. EASI75: \>= 75% reduction in score from baseline; EASI90: \>= 90% reduction in score from baseline.

Proportion of participants requiring topical treatment in all participants entering the study [each LTS17367 visit]Baseline to Week 332
Proportion of participants requiring rescue treatment [each LTS17367 visit]: all treatments in all participants entering the studyBaseline to Week 332
Number of days on topical medication (per patient-year) in all participants entering the studyBaseline to Week 332
Change from feeder study baseline atopic dermatitis control tool (ADCT) in all participants entering the study [each LTS17367 visit]Baseline to Week 332

ADCT is a six-item patient self-administered instrument designed and validated to assess atopic dermatitis (AD) control. The score ranges from 0-24 with higher scores indicate worsening disease control.

Change from feeder study baseline in dermatology life quality index (DLQI/cDLQI) in all participants entering the study [each LTS17367 visit]Baseline to Week 332

The DLQI is a validated 10-item questionnaire to measure dermatology specific quality of life (QoL) in adult patients. Overall scoring ranges from 0 to 30, with a higher score indicating a poorer QoL.

The children's DLQI (cDLQI) measures dermatology specific quality of life (QoL) in children patients. Overall scoring ranges from 0 to 30, with a higher score indicating a poorer QoL.

Change from feeder study baseline in patient oriented eczema measure (POEM) in all participants entering the study [each LTS17367 visit]Baseline to Week 332

The POEM is a 7-item self-assessment questionnaire that assesses disease symptoms on a scale ranging from 0 to 4 (0 = no days, 1 = 1 to 2 days, 2 = 3 to 4 days, 3 = 5 to 6 days, 4 = all days). The sum of the 7 items gives the total POEM score of 0 (absent disease) to 28 (severe disease). Higher scores indicated more severe disease and poor quality of life.

Change from feeder study baseline in body surface area affected by AD (BSA-AD) [each LTS17367 visit]Baseline to Week 332

BSA-AD measured as percentage of body affected by AD.

Time from enrollment in LTS17367 to first loss of vIGA-AD 0 in those participants who were vIGA-AD 0 at LTS17367 rollover from EFC17600 (ESTUARY) and EFC17599 (AQUA)Baseline to Week 332

The vIGA-AD is an assessment instrument used to rate the severity of AD globally, based on a 5-point scale ranging from (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe), higher score indicated higher severity.

Time from enrollment in LTS17367 to first loss EASI75 in those participants who had reached EASI75 at LTS17367 rollover coming from EFC17600 (ESTUARY) and EFC17599 (AQUA)Baseline to Week 332

EASI measures the severity \& extent of AD based on 4 AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\] \& lichenification). Total score ranges from 0 (minimum) to 72 (maximum), higher indicated greater severity of AD. EASI75: \>= 75% reduction in score from baseline.

Time from enrollment in LTS17367 to first loss of vIGA-AD 0/1 in those participants who were vIGA-AD 0/1 at LTS17367 rollover from EFC17600 (ESTUARY) and EFC17599 (AQUA)Baseline to Week 332

The vIGA-AD is an assessment instrument used to rate the severity of AD globally, based on a 5-point scale ranging from (0 = clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe), higher score indicated higher severity.

Serum amlitelimab concentration assessed at prespecified time points through the end of the studyBaseline to Week 332

Serum amlitelimab concentration assessed at prespecified time points through the end of the study.

Number of participants with anti-drug antibodies (ADAs) of amlitelimab at specified timepointsBaseline to Week 332

Trial Locations

Locations (123)

Investigational Site Number : 2032104

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Ostrava, Czechia

Investigational Site Number : 2032102

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Prague, Czechia

Investigational Site Number : 2032101

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Prague, Czechia

Investigational Site Number : 2032103

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Prague, Czechia

Investigational Site Number : 2762203

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Berlin, Germany

Investigational Site Number : 2762202

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Blankenfelde-mahlow, Germany

Investigational Site Number : 2762207

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Gera, Germany

Investigational Site Number : 2762208

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Kiel, Germany

Investigational Site Number : 2762201

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Münster, Germany

Investigational Site Number : 3482303

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Debrecen, Hungary

Investigational Site Number : 3482306

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Szolnok, Hungary

Investigational Site Number : 3923115

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Chuo, Tokyo, Japan

Investigational Site Number : 3923104

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Edogawa, Tokyo, Japan

Investigational Site Number : 3923107

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Minato, Tokyo, Japan

Investigational Site Number : 6162409

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Krakow, Poland

Investigational Site Number : 6162408

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Krakow, Poland

Investigational Site Number : 7242501

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Córdoba, Spain

Investigational Site Number : 1583201

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Kaohsiung City, Taiwan

Investigational Site Number : 1583202

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Taichung, Taiwan

Investigational Site Number : 1580001

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Taipei City, Taiwan

Investigational Site Number : 1583203

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Taoyuan City, Taiwan

Investigational Site Number : 3923108

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Kagoshima, Japan

Investigational Site Number : 3923102

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Kyoto, Japan

Investigational Site Number : 3923112

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Tokyo, Japan

Investigational Site Number : 4100015

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Bupyeong-gu, Incheon-gwangyeoksi, Korea, Republic of

Investigational Site Number : 6162414

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Wroclaw, Dolnoslaskie, Poland

Investigational Site Number : 6162418

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Wroclaw, Dolnoslaskie, Poland

Investigational Site Number : 6162417

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Wroclaw, Dolnoslaskie, Poland

Investigational Site Number : 6162415

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Lodz, Lódzkie, Poland

Investigational Site Number : 6162416

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Lodz, Lódzkie, Poland

Clinical Research Center of Alabama - Homewood- Site Number : 8401101

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Birmingham, Alabama, United States

Center for Dermatology and Plastic Surgery- Site Number : 8401119

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Scottsdale, Arizona, United States

Orange County Clinical Trials- Site Number : 8401271

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Anaheim, California, United States

First OC Dermatology- Site Number : 8401025

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Fountain Valley, California, United States

Sunwise Clinical Research- Site Number : 8401022

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Lafayette, California, United States

Antelope Valley Clinical Trials- Site Number : 8401099

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Lancaster, California, United States

Torrance Clinical Research- Site Number : 8401027

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Lomita, California, United States

Long Beach Clinical Trials- Site Number : 8401188

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Long Beach, California, United States

Clinical Science Institute- Site Number : 8401028

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Santa Monica, California, United States

Encore Medical Research of Boynton Beach- Site Number : 8401030

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Boynton Beach, Florida, United States

Alliance for Multispeciality Research - Fort Myers- Site Number : 8401111

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Fort Myers, Florida, United States

Doral Medical Research- Site Number : 8401094

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Hialeah, Florida, United States

C&R Research Services - Kendall- Site Number : 8401029

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Kendall, Florida, United States

Medical Research Center of Miami II- Site Number : 8401019

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Miami, Florida, United States

Acevedo Clinical Research Associates- Site Number : 8401088

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Miami, Florida, United States

Future Care Solution - Miami- Site Number : 8401144

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Miami, Florida, United States

Sanchez Clinical Research- Site Number : 8401095

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Miami, Florida, United States

Florida International Research Center- Site Number : 8401091

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Miami, Florida, United States

Global Clinical Professionals (GCP)- Site Number : 8401045

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Saint Petersburg, Florida, United States

Clinical Research Trials of Florida- Site Number : 8401023

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Tampa, Florida, United States

Alliance Clinical Research of Tampa- Site Number : 8401013

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Tampa, Florida, United States

Aeroallergy Research Laboratory- Site Number : 8401004

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Savannah, Georgia, United States

Skin Sciences- Site Number : 8401039

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Louisville, Kentucky, United States

Velocity Clinical Research at The Dermatology Clinic- Site Number : 8401072

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Baton Rouge, Louisiana, United States

Continental Clinical Research Solutions- Site Number : 8401011

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Baltimore, Maryland, United States

Revival Research Corporation - Michigan - ClinEdge - PPDS- Site Number : 8401012

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Troy, Michigan, United States

Boeson Research- Site Number : 8401269

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Missoula, Montana, United States

Pulmonology Group - Henderson- Site Number : 8401169

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Henderson, Nevada, United States

Skin Search Rochester- Site Number : 8401216

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Rochester, New York, United States

Vital Prospects Clinical Research Institute - Tulsa- Site Number : 8401005

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Tulsa, Oklahoma, United States

Vial Health - DermDox Dermatology- Site Number : 8401031

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Camp Hill, Pennsylvania, United States

International Clinical Research - Tennessee- Site Number : 8401008

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Murfreesboro, Tennessee, United States

Arlington Research Center- Site Number : 8401248

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Arlington, Texas, United States

Modern Research Associates- Site Number : 8401093

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Dallas, Texas, United States

Stryde Research - Epiphany Dermatology- Site Number : 8401185

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Southlake, Texas, United States

Virginia Dermatology & Skin Cancer Center- Site Number : 8401047

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Norfolk, Virginia, United States

Investigational Site Number : 0320007

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Rosario, Santa Fe, Argentina

Investigational Site Number : 0320011

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Buenos Aires, Argentina

Investigational Site Number : 0363002

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Carlton, Victoria, Australia

Investigational Site Number : 0363003

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Melbourne, Victoria, Australia

Investigational Site Number : 0363001

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Parkville, Victoria, Australia

Centro de Pesquisas da Clínica IBIS- Site Number : 0760002

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Salvador, Bahia, Brazil

Investigational Site Number : 1002004

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Pleven, Bulgaria

Investigational Site Number : 1002005

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Sofia, Bulgaria

Investigational Site Number : 1002003

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Sofia, Bulgaria

Investigational Site Number : 1002006

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Sofia, Bulgaria

Investigational Site Number : 1002002

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Sofia, Bulgaria

Investigational Site Number : 1240019

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Calgary, Alberta, Canada

Investigational Site Number : 1240023

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Calgary, Alberta, Canada

Investigational Site Number : 1240016

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Edmonton, Alberta, Canada

Investigational Site Number : 1240014

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Barrie, Ontario, Canada

Investigational Site Number : 1240020

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Hamilton, Ontario, Canada

Investigational Site Number : 1240017

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London, Ontario, Canada

Investigational Site Number : 1241106

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Markham, Ontario, Canada

Investigational Site Number : 1240018

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Newmarket, Ontario, Canada

Investigational Site Number : 1241108

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Niagara Falls, Ontario, Canada

Investigational Site Number : 1240024

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Richmond Hill, Ontario, Canada

Investigational Site Number : 1240021

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Toronto, Ontario, Canada

Investigational Site Number : 1240026

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Toronto, Ontario, Canada

Investigational Site Number : 1241107

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Waterloo, Ontario, Canada

Investigational Site Number : 1241101

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Windsor, Ontario, Canada

Investigational Site Number : 1520002

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Santiago, Reg Metropolitana De Santiago, Chile

Investigational Site Number : 1520003

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Santiago, Reg Metropolitana De Santiago, Chile

Investigational Site Number : 1520001

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Santiago, Reg Metropolitana De Santiago, Chile

Investigational Site Number : 2032108

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Brno, Czechia

Investigational Site Number : 2032106

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Kutná Hora, Czechia

Investigational Site Number : 3923114

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Obihiro, Hokkaido, Japan

Investigational Site Number : 3923101

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Sapporo, Hokkaido, Japan

Investigational Site Number : 3923113

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Yokohama, Japan

Investigational Site Number : 3923110

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Sakai, Osaka, Japan

Investigational Site Number : 3923106

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Mibu, Tochigi, Japan

Investigational Site Number : 3923105

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Setagaya, Tokyo, Japan

Investigational Site Number : 3920001

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Tachikawa, Tokyo, Japan

Investigational Site Number : 3923109

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Habikino, Japan

Investigational Site Number : 6162407

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Krakow, Malopolskie, Poland

Investigational Site Number : 6162406

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Krakow, Malopolskie, Poland

Investigational Site Number : 6162412

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Warsaw, Mazowieckie, Poland

Investigational Site Number : 6162411

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Warsaw, Mazowieckie, Poland

Investigational Site Number : 6162413

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Warsaw, Mazowieckie, Poland

Investigational Site Number : 6162401

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Rzeszow, Podkarpackie, Poland

Investigational Site Number : 6162419

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Bialystok, Podlaskie, Poland

Investigational Site Number : 6162402

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Gdansk, Pomorskie, Poland

Investigational Site Number : 6162403

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Gdansk, Pomorskie, Poland

Investigational Site Number : 6162404

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Gdynia, Pomorskie, Poland

Investigational Site Number : 6162405

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Katowice, Slaskie, Poland

Investigational Site Number : 6162410

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Szczecin, Zachodniopomorskie, Poland

Investigational Site Number : 7242504

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Pontevedra, Galicia [Galicia], Spain

Investigational Site Number : 7242503

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Madrid, Madrid, Comunidad De, Spain

Investigational Site Number : 7242505

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Alicante, Spain

Investigational Site Number : 8260003

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Portsmouth, Hampshire, United Kingdom

Investigational Site Number : 8262603

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London, London, City Of, United Kingdom

Investigational Site Number : 8262601

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London, London, City Of, United Kingdom

Investigational Site Number : 8260010

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Nottingham, Nottinghamshire, United Kingdom

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