A Study to Test the Efficacy and Safety of Bimekizumab in the Treatment of Subjects With Active Psoriatic Arthritis
- Conditions
- Psoriatic Arthritis
- Interventions
- Registration Number
- NCT03895203
- Lead Sponsor
- UCB Biopharma SRL
- Brief Summary
This is a study to demonstrate the clinical efficacy, safety and tolerability of bimekizumab administered subcutaneously (sc) compared with placebo in the treatment of subjects with active Psoriatic Arthritis (PsA).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 852
- An Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved written Informed Consent form is signed and dated by the subject
- Subject is male or female at least 18 years of age
- Female subject must be postmenopausal, permanently sterilized or willing to use a highly effective method of contraception
- Documented diagnosis of adult-onset Psoriatic Arthritis (PsA) meeting the Classification Criteria for Psoriatic Arthritis (CASPAR) for at least 6 months prior to Screening with active PsA and must have at Baseline tender joint count (TJC) >=3 out of 68 and swollen joint count (SJC) >=3 out of 66
- Subject must be negative for rheumatoid factor and anti-cyclic citrullinated peptide (CCP) antibodies
- Subject must have at least 1 active psoriatic lesion(s) and/or a documented history of psoriasis (PSO)
- Subject must be a suitable candidate for treatment with adalimumab and has no contraindications to receive adalimumab as per the local label as assessed by the Investigator
- Subjects currently taking NSAIDs, cyclooxygenase 2 (COX-2) inhibitors, analgesics (including mild opioids), corticosteroids, methotrexate (MTX), leflunomide (LEF), sulfasalazine (SSZ), hydroxychloroquine (HCQ) AND/OR apremilast can be allowed if they fulfill specific requirements prior to study entry
- Female subjects who are breastfeeding, pregnant, or plan to become pregnant during the study
- Subjects with current or prior exposure to any biologics for the treatment of Psoriatic Arthritis (PsA) or Psoriasis (PSO)
- Subject has an active infection or a history of recent serious infections
- Subject has known tuberculosis (TB) infection, is at high risk of acquiring TB infection, or has current or history of nontuberculous mycobacterium (NTMB) infection
- Subject has a diagnosis of inflammatory conditions other than PSO or PsA. Subjects with a diagnosis of Crohn's disease, ulcerative colitis, or other inflammatory bowel disease (IBD) are allowed as long as they have no active symptomatic disease at Screening or Baseline
- Subject had acute anterior uveitis within 6 weeks of Baseline
- Subject has any active malignancy or history of malignancy within 5 years prior to the Screening Visit EXCEPT treated and considered cured cutaneous squamous or basal cell carcinoma, or in situ cervical cancer
- Subject has a form of PSO other than chronic plaque-type (eg, pustular, erythrodermic and guttate PSO, or drug-induced PSO)
- Presence of active suicidal ideation, or moderately severe major depression or severe major depression
- Subject has a history of chronic alcohol or drug abuse within 6 months prior to Screening
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Bimekzumab dosage regimen Bimekizumab Subjects randomized to this arm will receive assigned bimekizumab dosage regimen and placebo to maintain the blinding with adalimumab and placebo arms during the Treatment Period. Bimekzumab dosage regimen Placebo Subjects randomized to this arm will receive assigned bimekizumab dosage regimen and placebo to maintain the blinding with adalimumab and placebo arms during the Treatment Period. Placebo Placebo Subjects randomized to this arm will receive placebo during the Double-Blind Treatment Period and will be reallocated to receive bimekizumab dosage regimen during the Maintenance Period. Adalimumab dosage regimen Adalimumab Subjects randomized to this arm will receive the assigned adalimumab dosage regimen during the Treatment Period. Placebo Bimekizumab Subjects randomized to this arm will receive placebo during the Double-Blind Treatment Period and will be reallocated to receive bimekizumab dosage regimen during the Maintenance Period.
- Primary Outcome Measures
Name Time Method Percentage of Participants With an American College of Rheumatology (ACR) 50 Response at Week 16 Week 16 ACR50 response rate: 50% or greater improvement of arthritis relative to Baseline. Those who met following 3 conditions for improvement from Baseline were classified as meeting ACR50 response criteria: greater than or equal (≥) 50% improvement in 68-tender joint count; ≥ 50% improvement in 66-swollen joint count; ≥ 50% improvement in at least 3 of 5 following parameters: Physician global assessment of disease activity (0-100 millimeter \[mm\] visual analog scale \[VAS\] \[0 = no symptoms;100 = severe symptoms\]), Patient global assessment of disease activity (100 mm VAS \[0 = no limitation of normal activities; 100 = very poor\]), Patient assessment of pain (100 mm VAS \[0 = no pain; 100 = most severe pain\]), Health Assessment Questionnaire-Disability Index (HAQ-DI) assessed degree of difficulty experienced in 8 domains of daily living activities (20 questions), total score (0-3) computed from item scores, lower scores indicated less disability and high-sensitivity C-reactive protein (hsCRP).
- Secondary Outcome Measures
Name Time Method Change From Baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI) at Week 16 for Placebo and BKZ Baseline, Week 16 The HAQ-DI contains 20 items that measured the degree of difficulty experienced in the following 8 categories of the daily living activities: dressing and grooming (2 items), arising (2 items), eating (3 items), walking (2 items), hygiene (3 items), reach (2 items), grip (3 items), and common daily activities (3 items). Each question was scored 0-3 (0 = without any difficulty, 1 = with some difficulty, 2 = with much difficulty, and 3 = unable to do). The overall HAQ-DI total score was calculated by dividing the sum of the highest category scores (0 to 24) by the number of categories with at least 1 question answered. The HAQ-DI total score ranges from 0 (no difficulty) to 3 (maximum difficulty). A lower HAQ-DI score indicated an improvement in function. Change from baseline was computed as the value at Week 16 minus the baseline value. A negative value in change from baseline indicated an improvement.
Percentage of Participants With a Psoriasis Area Severity Index (PASI) 90 Response at Week 4 in the Subgroup of Participants With Psoriasis (PSO) Involving at Least 3% Body Surface Area (BSA) at Baseline Baseline, Week 4 The PASI90 response assessments are based on at least 90% improvement in PASI score from Baseline. Body divided into 4 areas: head, arms, trunk to groin, and legs to top of buttocks. Assignment of an average score for redness, thickness, and scaling for each of the 4 body areas with a score of 0 (clear) to 4 (very marked). Determining the percentage of skin covered with PSO for each of the body areas and converting to a 0 to 6 scale. Final PASI = average redness, thickness, and scaliness of the psoriatic skin lesions, multiplied by the involved psoriasis area score of respective section, and weighted by the percentage of the person's affected skin for respective section. The minimum possible PASI score is 0 = no disease, the maximum score is 72 = maximal disease.
Percentage of Participants With a PASI90 Response at Week 16 in the Subgroup of Participants With PSO Involving at Least 3% BSA at Baseline Baseline, Week 16 The PASI90 response assessments are based on at least 90% improvement in PASI score from Baseline. Body divided into 4 areas: head, arms, trunk to groin, and legs to top of buttocks. Assignment of an average score for redness, thickness, and scaling for each of the 4 body areas with a score of 0 (clear) to 4 (very marked). Determining the percentage of skin covered with PSO for each of the body areas and converting to a 0 to 6 scale. Final PASI = average redness, thickness, and scaliness of the psoriatic skin lesions, multiplied by the involved psoriasis area score of respective section, and weighted by the percentage of the person's affected skin for respective section. The minimum possible PASI score is 0 = no disease, the maximum score is 72 = maximal disease.
Change From Baseline in the Short Form 36-item Health Survey (SF-36) Physical Component Summary (PCS) at Week 16 for Placebo and BKZ Baseline, Week 16 SF-36 (version 2, standard recall):36-item generic health-related Quality of Life instrument that uses recall period of 4 weeks. Questionnaire has 36 questions composing scale that represent 8 domains:physical functioning; role physical; bodily pain;general health;vitality; social functioning;role emotional; and mental health. Scores for 8 domains were combined into two summary scores: physical component summary (PCS) score and mental component summary (MCS) score. Scores for 2 components summary (PCS and MCS) and 8 domains have been calculated and computed as raw/observed score to norm-based T-score metric(mean=50, standard deviation=10), raw score min=0(worst), max=100(best). Individual respondent's score falls outside T-score range of 45 to 55 was considered outside average range and when considering group-level data, score below 47 was considered indicative of impaired functioning within that health domain or dimension. Positive value in change from Baseline indicated improvement.
Percentage of Participants With a Minimal Disease Activity (MDA) at Week 16 Week 16 MDA is measure to indicate disease remission, and is based on composite score of 7 domains. Participant is considered having achieved MDA if participant fulfills at least 5 of following 7 criteria: Tender joint count (0-68 joints) less than or equal to (≤1); Swollen joint count (0-66 joints) ≤ 1; PASI ≤ 1 or BSA ≤ 3: In PASI, body divided into four parts, head and neck, upper limb, trunk and lower limbs. Each area assessed for erythema, induration and scaling, each rated on a scale of 0 to 4. Total score ranges from 0(no disease) to 72 (maximal disease)\]; Patient's Assessment of Arthritis Pain ≤ 15 \[using VAS on a scale of 0 (no pain) to 100 (severe pain)\]; Patient's Global Assessment of Disease Activity ≤ 20 \[using VAS on a scale of 0 (very well) to 100 (very poor)\]; HAQ-DI score ≤ 0.5, HAQ-DI score ranges from 0 (no difficulty) to 3 (maximum difficulty); Leeds Enthesitis Index score ≤ 1 for participants with enthesitis at baseline.
Change From Baseline in Van Der Heijde Modified Total Sharp Score (vdHmTSS) in Participants With Elevated Hs-CRP and/or at Least 1 Bone Erosion at Baseline at Week 16 for Placebo and BKZ Baseline, Week 16 The degree of joint damage was assessed using the vdHmTSS by quantifying the extent of bone erosions and joint space narrowing for 64 and 52 joints, respectively. The vdHmTSS ranges from 0 to 528, with higher scores representing greater damage. Descriptive statistics for ADA 40 mg reference arm was not calculated and reported since reference based imputation analysis method is used with Placebo as reference. As pre-specified in the SAP, this analysis was performed only for the participants randomized to Placebo and BKZ.
Percentage of Participants With an Enthesitis-free State in the Leeds Enthesitis Index (LEI) at Week 16 in the Subgroup of Participants With Enthesitis at Baseline in the Pooled Population of PA0010 and PA0011 Baseline of PA0010 for Participants of PA0010 and Baseline of PA0011 for Participants of PA0011, Week 16 Presence of enthesitis was assessed in the subgroup of participants with enthesitis by palpation on the lateral epicondyles of the humerus (elbows), medial femoral epicondyles (knees), and Achilles tendons (heels) bilaterally and scored as 0 (no tenderness) and 1 (tenderness) at Baseline. The LEI consists of 6 items, 3 for the right part and 3 for the left part of the body. LEI is derived as the sum of the enthesitis score over the 6 sites mentioned above. The total score ranges from 0 to 6, higher scores indicates greater degree of enthesitis. Descriptive/Inferential statistics for ADA 40 mg reference arm was not calculated and reported since pooled data with PA0011 study is used which did not have ADA 40 mg arm.
Percentage of Participants With a Dactylitis-free State Based on the Leeds Dactylitis Index (LDI) at Week 16 in the Subgroup of Participants With Dactylitis at Baseline in the Pooled Population of PA0010 and PA0011 Baseline of PA0010 for Participants of PA0010 and Baseline of PA0011 for Participants of PA0011, Week 16 The LDI quantitatively measures dactylitis using the circumference of involved digits and control digits and tenderness of involved digits. Digits affected by dactylitis are defined as those with a 10% difference in the ratio of circumference of the affected digit to the contralateral digit. The control digit is either the contralateral digit (digit on opposite hand or foot). The ratio of circumference between an affected digit and the control digit is multiplied by the tenderness score for the affected digit. The results from each involved digit are summed to provide the final LDI score. A higher LDI indicates worse dactylitis. Tenderness score (0 = no tenderness, 1 = tender). Descriptive/Inferential statistics for ADA 40 mg reference arm was not calculated and reported since pooled data with PA0011 study was used which did not have ADA 40 mg arm.
Percentage of Participants With an American College of Rheumatology (ACR) 20 Response at Week 16 Week 16 The ACR20 response rate was based on a 20% or greater improvement of arthritis relative to Baseline. Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: Physician global assessment of disease activity (100 mm VAS \[0 = no symptoms; 100 = severe symptoms\]), Patient global assessment of disease activity (100 mm VAS \[0 = no limitation of normal activities; 100 = very poor\]), Patient assessment of pain (100 mm VAS \[0 = no pain; 100 = most severe pain\]), HAQ-DI assessed degree of difficulty experienced in 8 domains of daily living activities (20 questions), its score (0-3) computed from item scores, lower scores indicated less disability, hsCRP.
Change From Baseline in Van Der Heijde Modified Total Sharp Score (vdHmTSS) in the Overall Population at Week 16 for Placebo and BKZ Baseline, Week 16 The degree of joint damage was assessed using the vdHmTSS by quantifying the extent of bone erosions and joint space narrowing for 64 and 52 joints, respectively. The vdHmTSS ranges from 0 to 448, with higher scores representing greater damage. Descriptive statistics for ADA 40 mg reference arm was not calculated and reported since reference based imputation analysis method was used with Placebo as reference.
Percentage of Participants With an American College of Rheumatology (ACR) 70 Response at Week 16 Week 16 The ACR70 response rate was based on a 70% or greater improvement of arthritis relative to Baseline. Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR70 response criteria: 1. ≥ 70% improvement in 68-tender joint count; 2. ≥ 70% improvement in 66-swollen joint count; and 3. ≥ 70% improvement in at least 3 of the 5 following parameters: Physician global assessment of disease activity (100 mm VAS \[0 = no symptoms;100 = severe symptoms\]), Patient global assessment of disease activity (100 mm VAS \[0 = no limitation of normal activities;100 = very poor\]), Patient assessment of pain (100 mm VAS \[0 = no pain; 100 = most severe pain\]), HAQ-DI assessed degree of difficulty experienced in 8 domains of daily living activities (20 questions), its score (0-3) computed from item scores, lower scores indicated less disability, hsCRP.
Percentage of Participants With Investigator Global Assessment (IGA) Response Defined as Score of 0 (Clear) or 1 (Almost Clear) AND at Least a 2-grade Reduction From Baseline at Week 4 in the Subset of Participants With Psoriatic Skin Lesions at Baseline Baseline, Week 4 IGA measured the overall severity of PSO using the following 5-point scale and score was rated as 0 = clear (No signs of PSO; post-inflammatory hyperpigmentation may be present), 1 = almost clear (No thickening; normal to pink coloration; no to minimal focal scaling), 2 = mild (Just detectable to mild thickening; pink to light red coloration; predominately fine scaling), 3 = moderate (Clearly distinguishable to moderate thickening; dull to bright red, moderate scaling), and 4 = severe (Severe thickening with hard edges; bright to deep dark red coloration; severe/coarse scaling covering almost all or all lesions). The IGA response is defined as score of 0 (clear) or 1 (almost clear) with at least a 2-category improvement relative to Baseline.
Percentage of Participants With an IGA Response Defined as Score of 0 (Clear) or 1 (Almost Clear) AND at Least a 2-grade Reduction From Baseline at Week 16 in the Subset of Participants With Psoriatic Skin Lesions at Baseline Baseline, Week 16 IGA measured the overall severity of PSO using the following 5-point scale and score was rated as 0 = clear (No signs of PSO; post-inflammatory hyperpigmentation may be present), 1 = almost clear (No thickening; normal to pink coloration; no to minimal focal scaling), 2 = mild (Just detectable to mild thickening; pink to light red coloration; predominately fine scaling), 3 = moderate (Clearly distinguishable to moderate thickening; dull to bright red, moderate scaling), and 4 = severe (Severe thickening with hard edges; bright to deep dark red coloration; severe/coarse scaling covering almost all or all lesions). The IGA response is defined as score of 0 (clear) or 1 (almost clear) with at least a 2-category improvement relative to Baseline.
Change From Baseline in the Patient's Assessment of Arthritis Pain (PtAAP) at Week 16 Baseline, Week 16 The PtAAP VAS is part of the American College of Rheumatology core set of measures in arthritis. Participants assessed their arthritis pain using a VAS ranging from 0 (no pain) to 100 (most severe pain). A negative change from baseline indicates improvement.
Percentage of Participants With an Enthesitis-free State Based on the Spondyloarthritis Research Consortium of Canada (SPARCC) Index at Week 16 in the Subgroup of Participants With Enthesitis at Baseline Baseline, Week 16 Presence of enthesitis was assessed in the subgroup of participants with enthesitis at Baseline. The SPARCC index measures the severity of enthesitis through the assessment of 16 sites, 8 for the right part and 8 for the left part of the body: the greater trochanter (right/left), quadriceps tendon insertion into the patella (right/left), patellar ligament insertion into the patella and tibial tuberosity (right/left), achilles tendon insertion (right/left), plantar fascia insertion (right/left), medial and lateral epicondyles (right/left), and the supraspinatus insertion (right/left). Tenderness on examination is recorded as either present (1) or absent (0) for each of the 16 sites, for an average range of 0 (no enthesitis) to 16 (severe enthesitis).
Change From Baseline in Psoriatic Arthritis Impact of Disease-12 (PsAID-12) Total Score at Week 16 Baseline, Week 16 The PsAID-12 is a patient-reported outcome measure for assessing the impact of Psoriatic Arthritis (PsA) in 12 physical and psychological domains, including pain, fatigue, skin problems, work and/or leisure activities, functional capacity, discomfort, sleep disturbance, coping, anxiety/fear/uncertainty, embarrassment and/or shame, social participation, and depression. Each domain is assessed with a single question using a 0 to 10 numerical rating scale. Each domain score was multiplied by a weighting factor and the results were then summed to provide the total score. The total score ranged from 0 to 10, with higher scores indicating a worse status. A negative change from baseline indicates improvement.
Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) During the Study From Baseline until Safety Follow-Up (up to Week 72) An Adverse Event (AE) is any untoward medical occurrence in a patient or clinical investigation participants administered a pharmaceutical product, which does not necessarily have a causal relationship with this treatment. An AE could therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. TEAEs were defined as any AEs with an onset date on or after the date of first IMP administration and within 140 days after the final dose of IMP.
Percentage of Participants With Treatment-emergent Serious Adverse Events (SAEs) During the Study From Baseline until Safety Follow-Up (up to Week 72) A SAE is any untoward medical occurrence that at any dose: Results in death, is life-threatening, requires in patient hospitalization or prolongation of existing hospitalization; is a congenital anomaly or birth defect; is an infection that requires treatment parenteral antibiotics, other important medical events which based on medical or scientific judgement may jeopardize the patients, or may require medical or surgical intervention to prevent any of the above. TEAEs were defined as any AEs with an onset date on or after the date of first IMP administration and within 140 days after the final dose of IMP.
Percentage of Participants With TEAEs Leading to Withdrawal From IMP During the Study From Baseline until Safety Follow-Up (up to Week 72) An AE is any untoward medical occurrence in a patient or clinical investigation participants administered a pharmaceutical product, which does not necessarily have a causal relationship with this treatment. An AE could therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. TEAEs were defined as any AEs with an onset date on or after the date of first IMP administration and within 140 days after the final dose of IMP.
Trial Locations
- Locations (136)
Pa0010 40026
🇩🇪Ratingen, Germany
Pa0010 40030
🇭🇺Eger, Hungary
Pa0010 40084
🇮🇹Catania, Italy
Pa0010 20031
🇯🇵Sapporo-City, Japan
Pa0010 20042
🇯🇵Sasebo, Japan
Pa0010 40102
🇪🇸Málaga, Spain
Pa0010 40079
🇭🇺Szentes, Hungary
Pa0010 40078
🇩🇪Leipzig, Germany
Pa0010 40076
🇩🇪Cottbus, Germany
Pa0010 40014
🇨🇿Praha 4, Czechia
Pa0010 30005
🇦🇺Camberwell, Australia
Pa0010 40002
🇧🇪Leuven, Belgium
Pa0010 50043
🇨🇦Sidney, Canada
Pa0010 40065
🇨🇿Brno, Czechia
Pa0010 40009
🇨🇿Pardubice, Czechia
Pa0010 50042
🇨🇦Rimouski, Canada
Pa0010 40066
🇨🇿Praha 2, Czechia
Pa0010 40061
🇨🇿Brno, Czechia
Pa0010 40062
🇨🇿Ostrava, Czechia
Pa0010 50040
🇺🇸Dayton, Ohio, United States
Pa0010 40019
🇫🇷Paris, France
Pa0010 50041
🇨🇦Québec City, Canada
Pa0010 40010
🇨🇿Uherské Hradiště, Czechia
Pa0010 40063
🇨🇿Praha 5, Czechia
Pa0010 40032
🇭🇺Debrecen, Hungary
Pa0010 40059
🇧🇪Mons, Belgium
Pa0010 40027
🇩🇪Herne, Germany
Pa0010 40081
🇭🇺Budapest, Hungary
Pa0010 40082
🇭🇺Kistarcsa, Hungary
Pa0010 40119
🇵🇱Bydgoszcz, Poland
Pa0010 20044
🇯🇵Minato-Ku, Japan
Pa0010 40348
🇩🇪Magdeburg, Germany
Pa0010 40083
🇭🇺Budapest, Hungary
Pa0010 20005
🇷🇺Moscow, Russian Federation
Pa0010 40041
🇵🇱Warszawa, Poland
Pa0010 40104
🇪🇸Santiago De Compostela, Spain
Pa0010 50017
🇺🇸Phoenix, Arizona, United States
Pa0010 50004
🇺🇸Tustin, California, United States
Pa0010 50035
🇺🇸San Diego, California, United States
Pa0010 50039
🇺🇸Atlanta, Georgia, United States
Pa0010 50015
🇺🇸Hagerstown, Maryland, United States
Pa0010 50049
🇺🇸Corpus Christi, Texas, United States
Pa0010 40044
🇵🇱Poznań, Poland
Pa0010 40037
🇵🇱Lublin, Poland
Pa0010 40094
🇵🇱Warszawa, Poland
Pa0010 40093
🇵🇱Białystok, Poland
Pa0010 40039
🇵🇱Wrocław, Poland
Pa0010 40080
🇭🇺Szombathely, Hungary
Pa0010 40042
🇵🇱Kraków, Poland
Pa0010 40068
🇫🇷Tours, France
Pa0010 50044
🇨🇦Trois-Rivières, Canada
Pa0010 40015
🇨🇿Praha, Czechia
Pa0010 40012
🇨🇿Zlín, Czechia
Pa0010 50037
🇺🇸Tampa, Florida, United States
Pa0010 20030
🇯🇵Tokyo, Japan
Pa0010 50033
🇺🇸Palm Harbor, Florida, United States
Pa0010 50016
🇺🇸Saint Louis, Missouri, United States
Pa0010 50028
🇺🇸Lexington, Kentucky, United States
Pa0010 50029
🇺🇸Albuquerque, New Mexico, United States
Pa0010 50010
🇺🇸Brooklyn, New York, United States
Pa0010 50125
🇺🇸Charlotte, North Carolina, United States
Pa0010 50020
🇺🇸Duncansville, Pennsylvania, United States
Pa0010 50006
🇺🇸Wyomissing, Pennsylvania, United States
Pa0010 50008
🇺🇸Johnston, Rhode Island, United States
Pa0010 50012
🇺🇸Memphis, Tennessee, United States
Pa0010 50001
🇺🇸Jackson, Tennessee, United States
Pa0010 50002
🇺🇸Austin, Texas, United States
Pa0010 50051
🇺🇸Houston, Texas, United States
Pa0010 50036
🇺🇸Mesquite, Texas, United States
Pa0010 50009
🇺🇸Waco, Texas, United States
Pa0010 50050
🇺🇸Beckley, West Virginia, United States
Pa0010 30003
🇦🇺Maroochydore, Australia
Pa0010 30006
🇦🇺Woodville, Australia
Pa0010 30002
🇦🇺Clayton, Australia
Pa0010 30008
🇦🇺Hobart, Australia
Pa0010 40003
🇧🇪Genk, Belgium
Pa0010 30007
🇦🇺Victoria Park, Australia
Pa0010 40013
🇨🇿Praha 11, Czechia
Pa0010 40028
🇩🇪Berlin, Germany
Pa0010 40025
🇩🇪Berlin, Germany
Pa0010 40074
🇩🇪Bad Doberan, Germany
Pa0010 40117
🇩🇪Frankfurt, Germany
Pa0010 40029
🇩🇪Hamburg, Germany
Pa0010 40023
🇩🇪Erlangen, Germany
Pa0010 40071
🇩🇪Hamburg, Germany
Pa0010 40033
🇭🇺Székesfehérvár, Hungary
Pa0010 40087
🇮🇹Milano, Italy
Pa0010 40085
🇮🇹Pisa, Italy
Pa0010 40086
🇮🇹Reggio Emilia, Italy
Pa0010 20043
🇯🇵Itabashi, Japan
Pa0010 20036
🇯🇵Kawachi-Nagano-shi, Japan
Pa0010 20035
🇯🇵Bunkyō-Ku, Japan
Pa0010 40091
🇵🇱Nowa Sól, Poland
Pa0010 20049
🇯🇵Kitakyushu, Japan
Pa0010 20045
🇯🇵Kita, Japan
Pa0010 20033
🇯🇵Nagoya, Japan
Pa0010 20046
🇯🇵Osaka, Japan
Pa0010 20041
🇯🇵Osaka, Japan
Pa0010 20048
🇯🇵Saitama, Japan
Pa0010 20032
🇯🇵Suita, Japan
Pa0010 40038
🇵🇱Elbląg, Poland
Pa0010 40088
🇵🇱Elbląg, Poland
Pa0010 40096
🇵🇱Gdynia, Poland
Pa0010 40092
🇵🇱Kraków, Poland
Pa0010 40090
🇵🇱Poznań, Poland
Pa0010 40118
🇵🇱Toruń, Poland
Pa0010 40097
🇵🇱Warszawa, Poland
Pa0010 40098
🇵🇱Warszawa, Poland
Pa0010 40095
🇵🇱Wrocław, Poland
Pa0010 20002
🇷🇺Moscow, Russian Federation
Pa0010 40043
🇵🇱Wrocław, Poland
Pa0010 20017
🇷🇺Moscow, Russian Federation
Pa0010 20010
🇷🇺Moscow, Russian Federation
Pa0010 20012
🇷🇺Ryazan', Russian Federation
Pa0010 20016
🇷🇺Ryazan', Russian Federation
Pa0010 20013
🇷🇺Petrozavodsk, Russian Federation
Pa0010 20083
🇷🇺Saint Petersburg, Russian Federation
Pa0010 20009
🇷🇺Saint Petersburg, Russian Federation
Pa0010 20001
🇷🇺Saint Petersburg, Russian Federation
Pa0010 20007
🇷🇺Saratov, Russian Federation
Pa0010 20006
🇷🇺Vladimir, Russian Federation
Pa0010 20014
🇷🇺Ulyanovsk, Russian Federation
Pa0010 20008
🇷🇺Yaroslavl, Russian Federation
Pa0010 40045
🇪🇸Coruña, Spain
Pa0010 20015
🇷🇺Yaroslavl, Russian Federation
Pa0010 40105
🇪🇸Córdoba, Spain
Pa0010 40101
🇪🇸Sabadell, Spain
Pa0010 40103
🇪🇸Sevilla, Spain
Pa0010 40049
🇪🇸Sevilla, Spain
Pa0010 40099
🇪🇸Vigo, Spain
Pa0010 40111
🇬🇧Leeds, United Kingdom
Pa0010 40106
🇪🇸Sevilla, Spain
Pa0010 40107
🇬🇧Wolverhampton, United Kingdom
Pa0010 50007
🇺🇸Orangeburg, South Carolina, United States
Pa0010 20004
🇷🇺Saint Petersburg, Russian Federation
Pa0010 20003
🇷🇺Saint Petersburg, Russian Federation
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