A Clinical Study to Test How Effective and Safe GLPG1690 is for Participants With Idiopathic Pulmonary Fibrosis (IPF) When Used Together With Standard of Care

Phase 3

Terminated

Conditions: Idiopathic Pulmonary Fibrosis

Interventions: Drug: Placebo
Drug: GLPG1690

Registration Number: NCT03733444

Lead Sponsor: Galapagos NV

Brief Summary: The main purpose of this study was to see how GLPG1690 works together with the current standard treatment on your lung function and IPF disease in general. The study also investigated how well GLPG1690 is tolerated (for example if you get any side effects while on study drug).

Detailed Description: Not available

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 781

Inclusion Criteria

Male or female subject aged ≥40 years on the day of signing the Informed Consent Form (ICF).
A diagnosis of IPF within 5 years prior to the screening visit, as per applicable American Thoracic Society (ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society (JRS)/Latin American Thoracic Association (ALAT) guidelines at the time of diagnosis.
Chest high-resolution computed tomography (HRCT) historically performed within 12 months prior to the screening visit and according to the minimum requirements for IPF diagnosis by central review based on subject's HRCT only (if no lung biopsy (LB) available), or based on both HRCT and LB (with application of the different criteria in either situation). If an evaluable HRCT <12 months prior to screening is not available, an HRCT can be performed at screening to determine eligibility, according to the same requirements as the historical HRCT.
Subjects receiving local standard of care for the treatment of IPF, defined as either pirfenidone or nintedanib, at a stable dose for at least two months before screening, and during screening; or neither pirfenidone or nintedanib (for any reason). A stable dose is defined as the highest dose tolerated by the subject during those two months.
The extent of fibrotic changes is greater than the extent of emphysema on the most recent HRCT scan (investigator-determined).
Meeting all of the following criteria during the screening period: FVC ≥45% predicted of normal, Forced expiratory volume in 1 second (FEV1)/FVC ≥0.7, diffusing capacity of the lung for carbon monoxide (DLCO) corrected for Hb ≥30% predicted of normal.
Estimated minimum life expectancy of at least 30 months for non IPF related disease in the opinion of the investigator.
Male subjects and female subjects of childbearing potential agree to use highly effective contraception/preventive exposure measures from the time of first dose of investigational medicinal product (IMP) (for the male subject) or the signing of the ICF (for the female subject), during the study, and until 90 days (male) or 30 days (female) after the last dose of IMP.
Able to walk at least 150 meters during the 6-Minute Walk Test (6MWT) at screening Visit 1; without having a contraindication to perform the 6MWT or without a condition putting the subject at risk of falling during the test (investigator's discretion). The use of a cane is allowed, the use of a stroller is not allowed at all for any condition. At Visit 2, for the oxygen titration test, resting oxygen saturation (SpO2) should be ≥88% with maximum 6 L O2/minute; during the walk, SpO2 should be ≥83% with 6 L O2/minute or ≥88% with 0, 2 or 4 L O2/minute.

Exclusion Criteria

History of malignancy within the past 5 years (except for carcinoma in situ of the uterine cervix, basal cell carcinoma of the skin that has been treated with no evidence of recurrence, prostate cancer that has been medically managed through active surveillance or watchful waiting, squamous cell carcinoma of the skin if fully resected, and Ductal Carcinoma In Situ).
Clinically significant abnormalities detected on ECG of either rhythm or conduction, a QT interval corrected for heart rate using Fridericia's formula (QTcF) >450 ms, or a known long QT syndrome. Patients with implantable cardiovascular devices (e.g. pacemaker) affecting the QT interval time may be enrolled in the study based upon investigator judgment following cardiologist consultation if deemed necessary, and only after discussion with the medical monitor.
Acute IPF exacerbation within 6 months prior to screening and/or during the screening period. The definition of an acute IPF exacerbation is as follows: Previous or concurrent diagnosis of IPF; Acute worsening or development of dyspnea typically < 1 month duration; Computed tomography with new bilateral ground-glass opacity and/or consolidation superimposed on a background pattern consistent with usual interstitial pneumonia pattern and deterioration not fully explained by cardiac failure or fluid overload.
Lower respiratory tract infection requiring treatment within 4 weeks prior to screening and/or during the screening period.
Interstitial lung disease associated with known primary diseases (e.g. sarcoidosis and amyloidosis), exposures (e.g. radiation, silica, asbestos, and coal dust), or drugs (e.g. amiodarone).
Diagnosis of severe pulmonary hypertension (investigator determined).
Unstable cardiovascular, pulmonary (other than IPF), or other disease within 6 months prior to screening or during the screening period (e.g. acute coronary disease, heart failure, and stroke).
Had gastric perforation within 3 months prior to screening or during screening, and/or underwent major surgery within 3 months prior to screening, during screening or have major surgery planned during the study period.
History of nintedanib-related increase in ALT and/or AST of >5 x upper limit of the normal range (ULN) and increased susceptibility to elevated LFT; moderate to severe hepatic impairment (Child-Pugh B or C) and/or abnormal liver function test (LFT) at screening, defined as aspartate aminotransferase (AST), and/or alanine aminotransferase (ALT), and/or total bilirubin ≥1.5 x upper limit of the normal range (ULN), and/or gamma glutamyl transferase (GGT) ≥3 x ULN. Retesting is allowed once for abnormal LFT.
Abnormal renal function defined as estimated creatinine clearance, calculated according to Cockcroft-Gault calculation (CCr) <30 mL/min. Retesting is allowed once.
Use of any of the following therapies within 4 weeks prior to screening and during the screening period, or planned during the study: warfarin, imatinib, ambrisentan, azathioprine, cyclophosphamide, cyclosporine A, bosentan, methotrexate, sildenafil (except for occasional use), prednisone at steady dose >10 mg/day or equivalent.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Participants received GLPG1690 (ziritaxestat) matching placebo tablets orally, once daily (mean treatment duration was 346.2 days). Standard of care included either pirfenidone or nintedanib at a stable dose for at least 2 months before screening, and during screening; or neither pirfenidone or nintedanib (for any reason).
GLPG1690, 600 milligrams (mg)	GLPG1690	Participants received GLPG1690 (ziritaxestat) 600 mg as film-coated tablet orally, once daily (mean treatment duration was 332.9 days). Standard of care included either pirfenidone or nintedanib at a stable dose for at least 2 months before screening, and during screening; or neither pirfenidone or nintedanib (for any reason).
GLPG1690, 200 mg	GLPG1690	Participants received GLPG1690 (ziritaxestat) 200 mg as film-coated tablet orally, once daily (mean treatment duration was 336.9 days). Standard of care included either pirfenidone or nintedanib at a stable dose for at least 2 months before screening, and during screening; or neither pirfenidone or nintedanib (for any reason).

Primary Outcome Measures

Name	Time	Method
Annual Rate of Decline in Forced Vital Capacity (FVC) up to Week 52	Baseline up to week 52	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants With All Cause Mortality or Hospitalization for Non-elective Lung Transplant Until EoS	Up to EoS (week 125)	Percentage of participants with all-cause mortality or hospitalization for non-elective lung transplant were reported for this measure.
Change From Baseline in FVC at Week 100	Baseline, week 100	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percentage of Participants With Respiratory-Related Hospitalization Until End of Study (EoS)	Up to EoS (week 125)	Percentage of participants with respiratory related to hospitalization were reported in this measure.
Percentage of Participants Hospitalized for Non-Elective Lung Transplant Until EoS	Up to EoS (week 125)	Percentage of Participants who were hospitalized for lung transplant were reported for this measure.
Annual Rate of Decline of FVC Until EoS	Baseline up to EoS (week 125)	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percentage of Participants With Disease Progression Until EoS	Up to EoS (week 125)	Disease progression was defined as the composite occurrence of \>=10% absolute decline in percent predicted %FVC or all-cause mortality. FVC (in mL\]) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
FVC at Week 100	Week 100	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percent Change From Baseline in FVC at Week 100	Baseline, week 100	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percentage of Participants With Absolute Categorical Change From Baseline in Percent FVC at Week 52: FVC Change Within ≤10	Baseline, week 52	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percentage of Participants With Disease Progression Up to 52 Weeks	Up to week 52	Disease progression was defined as the composite occurrence of more than or equal to (\>=)10 percent (%) absolute decline in percent predicted forced vital capacity (%FVC) or all-cause mortality. FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percentage of Participants With All Cause Hospitalization Until EoS	Up to EoS (week 125)	Percentage of participants with all cause hospitalization was reported for this measure.
Percentage of Participants With Respiratory Related Mortality Until EoS	Up to EoS (week 125)	Percentage of participants with respiratory related mortality until end of study were reported for this study.
Percentage of Participants With All-Cause Mortality or Respiratory-Related Hospitalizations Until EoS	Up to EoS (week 125)	Percentage of participants with all-cause mortality or respiratory related hospitalization were reported for this measure.
FVC at Week 52	Week 52	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Change From Baseline in St.George's Respiratory Questionnaire (SGRQ) Total Score at Week 52	Baseline, week 52	SGRQ is a 50-item paper questionnaire designed to measure and quantify the impact of chronic respiratory disease on health-related quality of life (QOL) and well-being, split into 3 domains: symptoms score assessing the frequency and severity of respiratory symptoms (Items 1-8), activity score assessing the effects of breathlessness on mobility and physical activity (Items 11-17 and 36 to 44), and impacts score assessing the psychosocial impact of the disease (Items 9-10, 18-35 and 45-50). Each item has a specific weight. Domain scores = 100 \* summed weights from positive items in that component/sum of maximum weights for all non-missing items in that component Total score = 100 \* summed weights from positive items in the questionnaire/sum of maximum weights for all non-missing items in the questionnaire Scores were weighted such that each domain score ranged from 0 to 100 and the total score ranged from 0 to 100, with higher scores indicating the poorer health-related QOL.
Percentage of Participants With Acute Idiopathic Pulmonary Fibrosis (IPF) Exacerbation Until EoS	Up to EoS (week 125)	Percentage of participants with acute IPF exacerbation until end of study were reported for this measure.
Percent Change From Baseline in FVC at Week 52	Baseline, week 52	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percentage of Participants With Absolute Categorical Change From Baseline in Percent FVC at Week 100: FVC Change Within ≤5	Baseline, week 100	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Change From Baseline in St. George's Respiratory Questionnaire (SGRQ) Total Score at Week 100	Baseline, week 100	SGRQ is a 50-item paper questionnaire designed to measure and quantify the impact of chronic respiratory disease on health-related quality of life (QOL) and well-being, split into 3 domains: symptoms score assessing the frequency and severity of respiratory symptoms (Items 1-8), activity score assessing the effects of breathlessness on mobility and physical activity (Items 11-17 and 36 to 44), and impacts score assessing the psychosocial impact of the disease (Items 9-10, 18-35 and 45-50). Each item has a specific weight. Domain scores = 100 \* summed weights from positive items in that component/sum of maximum weights for all non-missing items in that component Total score = 100 \* summed weights from positive items in the questionnaire/sum of maximum weights for all non-missing items in the questionnaire Scores were weighted such that each domain score ranged from 0 to 100 and the total score ranged from 0 to 100, with higher scores indicating the poorer health-related QOL.
Percentage of Participants With All Cause Mortality, Hospitalization for Non-elective Lung Transplant or Hospitalization for Qualifying for Lung Transplant Until EoS	Up to EoS (week 125)	Percentage of participants with all-cause mortality or hospitalization for qualifying for lung transplant were reported for this measure.
Percentage of Participants With All-Cause Mortality or Hospitalization That Meets >=10% Absolute Decline in %FVC or Respiratory-Related Hospitalization Until EoS	Up to EoS (week 125)	Percentage of participants with all-cause mortality or respiratory related hospitalization that meets \>=10% absolute decline in %FVC or respiratory-related hospitalization were reported for this measure.
Change From Baseline in FVC at Week 52	Baseline, week 52	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Changes From Baseline in EuroQOL 5-Dimensions Questionnaire at Week 52 and Week 100	Baseline, week 52, week 100	EuroQol outcome measurements was a printed 20 centimeter (cm) EQ visual analogue scale (EQ VAS) that appears somewhat like a thermometer, on which a score from 0 (worst imaginable health state or death) to 100 (best imaginable health state) was marked by the participant (or, when necessary, their proxy) with the scale in view.
Percentage of Participants With Absolute Categorical Change From Baseline in Percent FVC at Week 52: FVC Change Within ≤5	Baseline, week 52	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Percentage of Participants With Absolute Categorical Change From Baseline in Percent FVC at Week 100: FVC Change Within ≤10	Baseline, week 100	FVC (in mL) is the maximum amount of air exhaled from lungs by a participant after taking their deepest possible breath, as measured by spirometry.
Change From Baseline in Visual Analogue Score (VAS): Urge to Cough at Week 52 and Week 100	Baseline, week 52, week 100	Urge to Cough was assessed using VAS score, ranged from 0 (no urge to cough) to 100 mm (highest urge to cough).
Changes From Baseline in King's Brief Interstitial Lung Disease (K-BILD) at Week 52 and Week 100	Baseline, week 52, week 100	The King's Brief Interstitial Lung Disease questionnaire (K-BILD) was specifically developed to analyze the health status of participants with OLD, the questionnaire consists of of 15 items (assessed by participants on scale ranging from 1 to 7, where 1 and 7 represents worst and best health status). Items are compiled into 3 domains: breathlessness and activities (range: 0-21), psychological (range: 0-34), and chest symptoms (range: 0-8). To score the K-BILD, the Likert response scale weightings for individual items are combined and scores are transformed to a range of 0-100 by using logit values (higher scores indicate better health status).
Area Under The Concentration Time Curve of Ziritaxtestat	Sparse samples collected on day 1 pre-dose, day 85 post-dose, day 237 post-dose, day 183 pre-dose, day 365 pre-dose	Area under the concentration time curve of ziritaxtestat was reported
Changes From Baseline in Leicester Cough Questionnaire (LCQ) Total Score and Individual Domain Score at Week 52 and Week 100	Baseline, week 52, week 100	Cough was evaluated using the LCQ. The LCQ is a 19-item questionnaire split into three domains: physical, psychological, and social. Scores were calculated by domain (range from 1 to 7) and then the total score was calculated by adding the individual domain score. Total score ranged from 3 to 21, with higher scores indicated a better health status.
Changes From Baseline in Visual Analogue Score (VAS): Cough at Week 52 and Week 100	Baseline, week 52, week 100	Cough was assessed using VAS score, ranged from 0 (no cough) to 100 millimeter (mm) (worst possible cough).
Change From Baseline in Functional Exercise Capacity, Assessed by The 6-Minute Walk Test (6MWT) Distance, at Week 52 and Week 100	Baseline, week 52, week 100	The 6MWT depicts the total distance covered by a participant during 6 minutes walking.
Percentage of Participants With Treatment Emergent Adverse Events (TEAEs) and Serious TEAEs	Baseline up to EoS (up to Week 125)	Safety was assessed by adverse events (AEs), which included abnormalities identified during a medical test (e.g. laboratory tests, vital signs, electrocardiogram, etc.) if the abnormality induced clinical signs or symptoms, needed active intervention, interruption or discontinuation of study drug or was clinically significant. A Treatment emergent AE (TEAE) was defined as any AE that started or worsened after the first dose of study drug up to 30 days after the last dose of study drug. AEs were considered serious (SAEs) if the AE resulted in death, was life-threatening, resulted in persistent or significant disability/incapacity or substantial disruption of the ability to conduct normal life functions, resulted in congenital anomaly, or birth defect or required inpatient hospitalization or led to prolongation of hospitalization.
Maximum Observed Plasma Concentration (Cmax) of Ziritaxtestat	Sparse samples collected on day 1 pre-dose, day 85 post-dose, day 237 post-dose, day 183 pre-dose, day 365 pre-dose	Maximum Observed Plasma Concentration of Ziritaxtestat was reported.
Change From Baseline in Diffusing Capacity of Lung for Carbon Monoxide (DLCO) (Corrected for Hemoglobin [Hb]) at Week 52 and Week 100	Baseline, week 52 and week 100	Change from baseline in diffusing capacity of the lung for carbon monoxide (percent predicted hemoglobin level corrected) was reported for this measure. mmol/min/kPa: Millimole per minute per kilopascal

Trial Locations

Locations (132): St. Francis Medical Institute
🇺🇸
Clearwater, Florida, United States
Emory University
🇺🇸
Atlanta, Georgia, United States
Piedmont Healthcare
🇺🇸
Atlanta, Georgia, United States
Cardio Pulmonary Associates
🇺🇸
Chesterfield, Missouri, United States
University of Chicago Medical Center
🇺🇸
Chicago, Illinois, United States
Brigham and Womens Hospital
🇺🇸
Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
🇺🇸
Boston, Massachusetts, United States
University of Pittsburgh Medical Center
🇺🇸
Pittsburgh, Pennsylvania, United States
Tüdőgyógyintézet Törökbálint
🇭🇺
Törökbálint, Hungary
Kaplan Medical Center
🇮🇱
Reẖovot, Israel
Lady Davis Carmel Medical Center
🇮🇱
Haifa, Israel
Kobe City Medical Center General Hospital
🇯🇵
Hyōgo, Japan
Nagoya University Hospital
🇯🇵
Nagoya, Japan
Japanese Red Cross Okayama Hospital
🇯🇵
Okayama, Japan
University of Miami
🇺🇸
Miami, Florida, United States
Hospital Zonal Especializado de Agudos y Crónicos Dr. Antonio A. Cetrangolo
🇦🇷
Luján, Argentina
Hôpital Nord AP-HM
🇫🇷
Marseille, France
Lovelace Scientific Resources Inc
🇺🇸
Albuquerque, New Mexico, United States
Albany Medical Center
🇺🇸
Albany, New York, United States
Temple Lung Center
🇺🇸
Philadelphia, Pennsylvania, United States
Università Cattolica Del S Cuore
🇮🇹
Roma, Italy
Azienda Ospedaliera Universitaria Senese
🇮🇹
Siena, Italy
Tokyo Medical University Hospital
🇯🇵
Shinjuku-Ku, Japan
Center Hospital of the National Center for Global Health and Medicine
🇯🇵
Tokyo, Japan
PULMAG Arkadiusz Brodowski, Grzegorz Gasior S. C.
🇵🇱
Katowice, Poland
SPZOZ Uniwersytecki Szpital Kliniczny nr 1 im Norberta Barlickiego Uniwersytetu Medycznego w Lodzi
🇵🇱
Łódź, Poland
University of Minnesota Medical Center
🇺🇸
Minneapolis, Minnesota, United States
University of Alabama at Birmingham
🇺🇸
Birmingham, Alabama, United States
UC Davis Medical Center
🇺🇸
Sacramento, California, United States
University of Michigan Health System (UMHS)
🇺🇸
Ann Arbor, Michigan, United States
Arizona Pulmonary Specialists
🇺🇸
Phoenix, Arizona, United States
Keck School of Medicine of USC
🇺🇸
Los Angeles, California, United States
Cedars Sinai Medical Center
🇺🇸
Los Angeles, California, United States
University of California, San Francisco Medical Center
🇺🇸
San Francisco, California, United States
Renstar Medical Research
🇺🇸
Ocala, Florida, United States
Central Florida Pulmonary Group PA
🇺🇸
Orlando, Florida, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
Spectrum Health Medical Group
🇺🇸
Grand Rapids, Michigan, United States
Columbia University Medical Center
🇺🇸
New York, New York, United States
Ohio State University
🇺🇸
Columbus, Ohio, United States
Mercy Health - St. Vincent Medical Center
🇺🇸
Toledo, Ohio, United States
Medical University of South Carolina - PPDS
🇺🇸
Charleston, South Carolina, United States
University of Vermont
🇺🇸
Burlington, Vermont, United States
Inova Fairfax Hospital
🇺🇸
Falls Church, Virginia, United States
Centro Médico Dra de Salvo
🇦🇷
Buenos Aires, Argentina
CEMER Centro Médico de Enfermedades Respiratorias
🇦🇷
Florida, Argentina
Hospital Privado Centro Médico de Córdoba
🇦🇷
Córdoba, Argentina
Instituto de Investigaciones Clínicas Mar Del Plata
🇦🇷
Mar Del Plata, Argentina
Fundacion Scherbovsky
🇦🇷
Mendoza, Argentina
Hôtel Dieu Du Centre Hospitalier de L'université de Montréal
🇨🇦
Montréal, Canada
South Health Campus
🇨🇦
Calgary, Canada
Institut Universitaire de Cardiologie et de Pneumologie
🇨🇦
Québec, Canada
McGill University Health Centre Research Institute
🇨🇦
Montréal, Canada
Toronto General Hospital
🇨🇦
Toronto, Canada
Vancouver General Hospital
🇨🇦
Vancouver, Canada
Pacific Lung Research Center
🇨🇦
Vancouver, Canada
Centre Hospitalier Regional Universitaire Montpellier
🇫🇷
Montpellier, France
Dr Anil Dhar Professional Medicine Corporation
🇨🇦
Windsor, Canada
CHU de Reims
🇫🇷
Reims, France
Praxis Dr. med. Claus Keller
🇩🇪
Frankfurt, Germany
Groupe Hospitalier Bichat Claude Bernard
🇫🇷
Paris, France
Ruhrlandklinik
🇩🇪
Essen, Germany
Universitätsmedizin Greifswald Klinik und Poliklinik für Innere Medizin B
🇩🇪
Greifswald, Germany
Pneumologisches Forschungsinstitut
🇩🇪
Großhansdorf, Germany
Lungenfachklinik Immenhausen
🇩🇪
Immenhausen, Germany
Kliniken der Stadt Koln GmbH
🇩🇪
Köln, Germany
Semmelweis Egyetem
🇭🇺
Budapest, Hungary
Krankenhaus Bethanien - Klinik für Pneumologie und Allergologie
🇩🇪
Solingen, Germany
Veszprem Megyei Tudogyogyintezet
🇭🇺
Farkasgyepű, Hungary
Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktató Kórház
🇭🇺
Miskolc, Hungary
Barzilai Medical Center
🇮🇱
Ashkelon, Israel
Hadassah University Hospital Ein Kerem
🇮🇱
Jerusalem, Israel
Meir Medical Center
🇮🇱
Kfar Saba, Israel
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona-Umberto I G.M. Lancisi G. Salesi
🇮🇹
Ancona, Italy
Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele
🇮🇹
Catania, Sicilia, Italy
Rabin Medical Center - PPDS
🇮🇱
Petah tikva, Israel
Presidio Ospedaliero GB Morgagni L Pierantoni
🇮🇹
Forlì, Italy
Ospedale S. Giuseppe Multimedica
🇮🇹
Milano, Italy
National Hospital Organization Ibarakihigashi National Hospital
🇯🇵
Naka, Ibaraki, Japan
Tenryu Hospital
🇯🇵
Hamamatsu, Shizuoka, Japan
National Hospital Organization Himeji Medical Center
🇯🇵
Himeji, Japan
National Hospital Organization Kyushu Medical Center
🇯🇵
Fukuoka, Japan
Fukuoka University Hospital
🇯🇵
Fukuoka, Japan
Juntendo University Hospital
🇯🇵
Bunkyo, Japan
NHO Okinawa Hospital
🇯🇵
Ginowan, Japan
Hamamatsu University School of Medicine
🇯🇵
Hamamatsu, Japan
Saiseikai Kumamoto Hospital
🇯🇵
Kumamoto, Japan
Nagasaki University Hospital
🇯🇵
Nagasaki, Japan
Hiroshima Prefectural Hospital
🇯🇵
Hiroshima, Japan
National Hospital Organization Kinki-Chuo Chest Medical Center
🇯🇵
Sakai, Japan
Tohoku Medical and Pharmaceutical Hospital
🇯🇵
Sendai, Japan
Tosei General Hospital
🇯🇵
Seto, Japan
Kanagawa Cardiovascular and Respiratory Center
🇯🇵
Yokohama, Japan
Tokushima University Hospital
🇯🇵
Tokushima, Japan
Seoul National University Bundang Hospital
🇰🇷
Seongnam-si, Gyeonggi-do, Korea, Republic of
Soon Chun Hyang University Hospital Bucheon
🇰🇷
Bucheon, Gyeonggi-do, Korea, Republic of
Gachon University Gil Medical Center
🇰🇷
Incheon, Korea, Republic of
Instituto Nacional De Enfermedades (INER)
🇲🇽
Ciudad de mexico, Mexico
Centro de Investigación Medico Biologica y de Terapia Avanzada S.C.
🇲🇽
Guadalajara, Mexico
Hospital Universitatorio Dr. Jose Eleuterio González
🇲🇽
Monterrey, Mexico
VU Medisch Centrum
🇳🇱
Amsterdam, Netherlands
Unidad de Investigación Clínica En Medicina SC
🇲🇽
Monterrey, Mexico
OLVG locatie Oost
🇳🇱
Amsterdam, Netherlands
Martini Ziekenhuis
🇳🇱
Groningen, Netherlands
Zuyderland Medisch Centrum
🇳🇱
Heerlen, Netherlands
NZ Respiratory & Sleep Institute
🇳🇿
Auckland, New Zealand
Erasmus MC
🇳🇱
Rotterdam, Netherlands
St. Antonius Ziekenhuis
🇳🇱
Nieuwegein, Netherlands
Greenlane Clinical Centre
🇳🇿
Auckland, New Zealand
Christchurch Hospital
🇳🇿
Christchurch, New Zealand
Centrum Medycyny Oddechowej Mroz sp. j.
🇵🇱
Białystok, Poland
Waikato Hospital
🇳🇿
Hamilton, New Zealand
Uniwersyteckie Centrum Kliniczne - PPDS
🇵🇱
Gdańsk, Poland
SP ZOZ Szpital Uniwersytecki w Krakowie
🇵🇱
Kraków, Poland
GRAŻYNA JASIENIAK-PINIS ATOPIA Niepubliczny Zakład Opieki Zdrowotnej Poradnie Specjalistyczne
🇵🇱
Kraków, Poland
ETG Lublin
🇵🇱
Lublin, Poland
ETG Warszawa
🇵🇱
Warszawa, Poland
Tygerberg Hospital
🇿🇦
Cape Town, South Africa
Dr Ismail Abdullah Private Practice
🇿🇦
Cape Town, South Africa
University of Cape Town Lung Institute (UCTLI)
🇿🇦
Cape Town, South Africa
Milpark Hospital
🇿🇦
Johannesburg, South Africa
Ethekwini Hospital
🇿🇦
Durban, South Africa
Gateway Private Hospital
🇿🇦
Durban, South Africa
Dartmouth Hitchcock Medical Center
🇺🇸
Lebanon, New Hampshire, United States
Duke University Medical Center
🇺🇸
Durham, North Carolina, United States
Asan Medical Center - PPDS
🇰🇷
Seoul, Korea, Republic of
Samsung Medical Center
🇰🇷
Seoul, Korea, Republic of
Soon Chun Hyang University Hospital Seoul
🇰🇷
Seoul, Korea, Republic of
University of Arizona College of Medicine
🇺🇸
Tucson, Arizona, United States
Atlantic Respiratory Institute
🇺🇸
Summit, New Jersey, United States
Thomas Jefferson University
🇺🇸
Philadelphia, Pennsylvania, United States
University of Kansas Medical Center
🇺🇸
Kansas City, Kansas, United States