A Study to Evaluate the Efficacy and Safety of Dapirolizumab Pegol in Study Participants With Moderately to Severely Active Systemic Lupus Erythematosus
- Conditions
- Systemic Lupus Erythematosus
- Interventions
- Other: PlaceboDrug: DZP
- Registration Number
- NCT04294667
- Lead Sponsor
- UCB Biopharma SRL
- Brief Summary
The purpose of this study is to evaluate the ability of dapirolizumab pegol (DZP) as an add-on treatment to standard of care (SOC) medication to achieve clinically relevant long term improvement of moderate to severe disease activity.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 321
-
Rescreening will be allowed once during the study in case there is new evidence for an inclusion criterion that was not fulfilled at the first screening or in case a study participant no longer meets an exclusion criterion or screening period exceeded the maximum duration due to delays in screening processes
-
Study participant must be ≥16 years of age, unless restricted by local regulation, at the time of signing the Informed Consent form (ICF)
-
Study participants who have moderate to severe disease activity due to either persisting active SLE or due to an acute worsening of SLE in the scope of frequent flaring/relapsing-remitting systemic lupus erythematosus (SLE) despite stable standard of care (SOC) medication defined as:
a. Diagnosed with SLE at least 24 weeks before the Screening Visit (Visit 1) study entry by a qualified physician b. Classified by 2019 SLE European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for SLE c. With serological evidence for SLE at Screening as demonstrated by at least 1 of the following: i) Evidence for anti-dsDNA (in central laboratory at Screening) ii) Either complement C3 < lower limit of normal (LLN) OR complement C4 <LLN OR elevated erythrocyte-bound complement C4d (where available) as measured by central laboratory iii) Antinuclear antibodies with a titer of at least 1:80 confirmed by central laboratory in combination with evidence of at least 1 of the following SLE typical autoantibodies:
- Anti-Smith (anti-Sm) antibodies (central laboratory) 2. Anti-Sjögren's syndrome antibody A (Anti-SSA) (Ro)/Anti-Sjögren's syndrome antibody B (anti-SSB) (La) autoantibodies (central laboratory) 3. Historic evidence for anti-dsDNA antibodies
d. Moderately to severely active defined as
-
British Isles Lupus Assessment Group Disease Activity Index 2004 (BILAG 2004) Grade B in ≥2 organ systems and/or a BILAG 2004 Grade A in ≥1 organ systems at Screening and Baseline Visit AND
-
Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) ≥6 at Screening Visit AND
-
SLEDAI-2K without labs ≥4 at Baseline Visit
e. Receiving the following SOC medication at stable dose:
- Antimalarial treatment in combination with corticosteroids and/or immunosuppressants or as stand-alone treatment if justified OR Treatment with corticosteroids and/or immunosuppressants if anti-malarial treatment is not possible
- Study participant has any medical or psychiatric condition (including conditions due to neuropsychiatric systemic lupus erythematosus (SLE)) that, in the opinion of the Investigator, could jeopardize or would compromise the study participant's ability to participate in this study. This includes study participants with a life threatening condition
- Study participant has a history of an anaphylactic reaction to parenteral administration of contrast agents, human or murine proteins, or monoclonal antibodies
- Study participant has a history of malignancy, except the following treated cancers: cervical carcinoma in situ, basal cell carcinoma, or dermatological squamous cell carcinoma
- Study participant has an increased risk for thromboembolic events due to an ongoing heart disease or due to a medical device, including but not limited to vascular graft, valvular heart disease, atrial fibrillation, or a heart rhythm disorder
- Study participant has evidence of human immunodeficiency virus (HIV) infection, agammaglobulinemias, T-cell deficiencies, or human T-cell lymphotropic virus-1 infection
- Study participant had a reactivated latent infection (example, cytomegalovirus, herpes simplex virus, or herpes zoster infection) or opportunistic infection (including but not limited to, pneumocystis, cytomegalovirus, or severe herpes zoster infection) within 12 weeks prior to the first study medication infusion (Visit 2), or is currently receiving suppressive therapy for an opportunistic infection
- Study participants who have received live/live attenuated vaccines within 6 weeks prior to the first study medication infusion
- Study participant has clinically significant active or latent infection
- Study participant has a mixed connective tissue disease, scleroderma, and/or overlap syndrome of these diseases with SLE
- Study participant takes any protocol defined prohibited concomitant medication
- Study participant has previously been randomized within this study or participant has previously been assigned to treatment with dapirolizumab pegol (DZP) in a study evaluating DZP
- Study participant has participated in another study of an IMP within the previous 12 weeks or 5 half-lives of the investigational medicinal product (IMP) whatever is longer or is currently participating in another study of an IMP
- Study participant has chronic kidney failure stage 4, manifested by estimated glomerular filtration rate <30mL/min/1.73m^2, or serum creatinine >2.5 mg/dL, or participant has proteinuria >3 g/day, or protein: creatinine ratio >340 mg/mmol at the Screening Visit
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Placebo Subjects will receive placebo througout the Treatment Period. Dapirolizumab pegol DZP Subjects will receive dapriolizumab pegol througout the Treatment Period.
- Primary Outcome Measures
Name Time Method Percentage of Participants With Achievement of BILAG 2004-based Composite Lupus Assessment (BICLA) Response at Week 48 Week 48 Study participants were considered to be a BILAG 2004-based Composite Lupus Assessment (BICLA) responder if all of the following were fulfilled:
* British Isles Lupus Assessment Group Disease Activity Index 2004 (BILAG 2004) improvement without worsening (A scores at Baseline improved to B, C or D; B scores improved to C or D; no new A scores and less than or equal to \[≤\] 1 new B.); Here, score A ("Active"): Severely active disease; score B ("Beware"): Moderately active disease; score C ("Contentment"): Mild stable disease; score D ("Discount"): Inactive now but previously active; and
* No worsening in the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) total score compared to Baseline Visit (defined as no increase in SLEDAI-2K total score); and
* No worsening in the Physician's Global Assessment of Disease (PGA) compared to Baseline Visit defined as \[≤\] 10 millimeter (mm) increase on a 100 mm visual analog scale (VAS).
- Secondary Outcome Measures
Name Time Method Percentage of Participants With Achievement of BICLA Response at Week 24 Week 24 Study participants were considered to be a BICLA responder if all of the following were fulfilled:
* BILAG 2004 improvement without worsening (A scores at Baseline improved to B, C or D; B scores improved to C or D; no new A scores and ≤ 1 new B.); Here, score A ("Active"): Severely active disease; score B ("Beware"): Moderately active disease; score C ("Contentment"): Mild stable disease; score D ("Discount"): Inactive now but previously active; and
* No worsening in the SLEDAI-2K total score compared to Baseline Visit (defined as no increase in SLEDAI-2K total score); and
* No worsening in the PGA compared to Baseline Visit defined as ≤ 10 mm increase on a 100 mm VAS.Percentage of Participants With Achievement of BICLA Response at Week 12 Week 12 Study participants were considered to be a BICLA responder if all of the following were fulfilled:
* BILAG 2004 improvement without worsening (A scores at Baseline improved to B, C or D; B scores improved to C or D; no new A scores and ≤ 1 new B.); Here, score A ("Active"): Severely active disease; score B ("Beware"): Moderately active disease; score C ("Contentment"): Mild stable disease; score D ("Discount"): Inactive now but previously active and
* No worsening in the SLEDAI-2K total score compared to Baseline Visit (defined as no increase in SLEDAI-2K total score); and
* No worsening in the PGA compared to Baseline Visit defined as ≤ 10 mm increase on a 100 mm VAS.Percentage of Participants With Achievement of Prevention of Severe British Isles Lupus Assessment Group (BILAG) Flares (Severe BILAG Flare-free) Through Week 48 During Treatment Period up to Week 48 A severe BILAG flare was defined as a british isles lupus assessment group disease activity index 2004 (BILAG 2004) Grade A in any system due to individual items that were new or worse qualifying for the Grade A. Determination of items that were new or worse and were qualifying for the Grade A were according to the supplementary information for the numerical scoring of the BILAG-2004 index. Here, Grade A ("Active"): Severely active disease (sufficient to require systemic immunosuppressant or anticoagulant therapy.
Percentage of Participants With Achievement of Lupus Low Disease Activity State (LLDAS) in ≥50% of Post-Baseline Visits Through Week 48 During Treatment Period up to Week 48 The LLDAS includes domains that capture the absence of organ-threatening disease activity and harmful treatment burden. The LLDAS is defined as:
* SLEDAI-2K score was ≤4 with no activity in major organ systems.
* No new and/or worsening disease activity defined as no SLEDAI-2K component documented as present that was not documented present at the previous visit.
* PGA ≤ 33 mm.
* Prednisone equivalent systemic dose for systemic lupus erythematosus (SLE) indication ≤ 7.5 mg per day.
* Stable standard maintenance doses of immunosuppressive drugs as allowed by protocol, defined as no increase in dose in the past 12 weeks and no dose higher than allowed as per protocol.Change From Baseline in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) at Week 48 From Baseline (Day 1) to Week 48 The SLEDAI-2K is a global index which includes 24 clinical and laboratory variables such as antibodies, renal, and hematological components measured 30 days before, and at the timepoint of assessment. The variables were weighted by the type of manifestation, but not by severity or dynamic of the individual item. The SLEDAI-2K includes scoring for antibodies (anti-dsDNA positive or negative) and low complement, as well as some renal and hematologic parameters. The total score falls between 0 and 105, with higher scores representing increased disease activity. Mixed effects models for repeated measurements (MMRM).
Percentage of Participants With Achievement of BILAG Improvement Without Worsening at Week 48 Week 48 The BILAG improvement without worsening defined as A scores at Baseline improved to B, C or D; B scores improved to C or D; no new A scores and ≤1 new B Score. Here, score A ("Active"): Severely active disease (sufficient to require systemic immunosuppressant or anticoagulant therapy; score B ("Beware"): Moderately active disease (requires low dose or local immunosuppressant therapy or symptomatic therapy; score C ("Contentment"): Mild stable disease (no indication for changes in treatment); score D ("Discount"): Inactive now but previously active.
Change From Baseline in Physician's Global Assessment (PGA) at Week 48 From Baseline (Day 1) to Week 48 The PGA is a measure of systemic lupus erythematosus (SLE) signs and symptoms by the physician using a visual analog scale of 0 to 100mm, Where 0 indicate "very good", asymptomatic, and no limitation of normal activity and 100 indicate "severe disease".
Percentage of Participants With Achievement of Systemic Lupus Erythematosus Responder Index Response - 4 (SRI-4) Response at Week 48 Week 48 The SRI-4 define responders as meeting all of the following criteria:
* Reduction in SLEDAI-2K score of ≥ 4.
* No shift from BILAG 2004 Grade B, C, D, or E to A post-Baseline. Here, Grade A ("Active"): Severely active disease; Grade B ("Beware"): Moderately active disease; Grade C ("Contentment"): Mild stable disease; Grade D ("Discount"): Inactive now but previously active; Grade E ("Excluded"): Never affected.
* No more than 1 shift from BILAG 2004 Grade C, D, or E to B post-Baseline.
* No worsening in the PGA compared to study entry defined as ≤ 10 mm increase on a 100 mm visual analog scale, equivalent to less than a 10 mm increase in the PGA compared to study entry score.Percentage of Participants With Achievement of Prevention of Moderate/Severe BILAG Flares (Moderate/Severe BILAG Flare-free) Through Week 48 During Treatment Period up to Week 48 Achievement of prevention of moderate/severe BILAG flares through Week 48 was defined as the percentage of participants with no moderate or severe flare through Week 48. A severe BILAG flare was defined as a BILAG 2004 Grade A in any system due to individual items that were new or worse qualifying for the Grade A. Determination of items that were new or worse and were qualifying for the Grade A, according to the supplementary information for the numerical scoring of the BILAG-2004 index. A moderate BILAG flare was defined as 2 or more BILAG 2004 Grade B due to individual items that were new or worse and were qualifying for the Grade B in any system. Determination of items that were new or worse qualifying for the Grade B, according to the supplementary information for the numerical scoring of the BILAG- 2004 index. Here, Grade A ("Active"): Severely active disease; Grade B ("Beware"): Moderately active disease.
Time to Severe BILAG Flare Through Week 48 During Treatment Period up to Week 48 Time to severe BILAG flare (the event) through Week 48 was defined as the time from randomization until the start of the event. A severe BILAG flare was defined as a BILAG 2004 Grade A in any system due to individual items that were new or worse qualifying for the Grade A. Determination of items that were new or worse and were qualifying for the Grade A, according to the supplementary information for the numerical scoring of the BILAG-2004 index. Here, Grade A ("Active"): Severely active disease.
Time to Moderate/Severe BILAG Flare Through Week 48 During Treatment Period up to Week 48 Time to moderate/severe BILAG flare (the event) through Week 48 was defined as the time from randomization until the start of the event. Moderate BILAG flare was defined as 2 or more BILAG 2004 Grade B due to individual items that were new or worse and were qualifying for the Grade B in any system. Determination of items that were new or worse qualifying for the Grade B, according to the supplementary information for the numerical scoring of the BILAG-2004 index. Severe BILAG flare was defined as a BILAG 2004 Grade A in any system due to individual items that were new or worse qualifying for the Grade A. Determination of items that were new or worse and are qualifying for the Grade A, according to the supplementary information for the numerical scoring of the BILAG-2004 index. Here, Grade A ("Active"): Severely active disease; Grade B ("Beware"): Moderately active disease.
Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) During the Study From Baseline (Day 1) until Safety Follow-Up (up to Week 54) An adverse event (AE) is any untoward medical occurrence in a patient or clinical study participant, temporally associated with the use of investigational medicinal product (IMP), whether or not considered related to the IMP. An AE could therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of IMP. Treatment-emergent AEs were those with onset date on or after the first administration of study drug, and up to 60 days after last dose.
Percentage of Participants With Serious Treatment-emergent Adverse Events During the Study From Baseline (Day 1) until Safety Follow-Up (up to Week 54) A serious adverse event (SAE) is defined as any untoward medical occurrence that, at any dose: Results in death; Is life-threatening, Requires in patient hospitalization or prolongation of existing hospitalization; Results in persistent disability/incapacity; Is a congenital anomaly/birth defect; and 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. Treatment-emergent AEs were those with onset date on or after the first administration of study drug, and up to 60 days after last dose.
Percentage of Participants With Treatment-emergent Adverse Events of Special Interest During the Study From Baseline (Day 1) until Safety Follow-Up (up to Week 54) An adverse event of special interest (AESIs) is any AE that a regulatory authority has mandated be reported on an expedited basis, regardless of the seriousness, expectedness, or relatedness of the AE to the administration of a product/compound.
Percentage of Participants With Treatment-emergent Adverse Events of Special Monitoring During the Study From Baseline (Day 1) until Safety Follow-Up (up to Week 54) An AE of special monitoring is a product-specific AEs, adverse reactions, or safety topics considered as requiring special monitoring by UCB.
Trial Locations
- Locations (177)
Sl0043 50418
🇺🇸Colleyville, Texas, United States
Sl0043 40380
🇧🇬Sofia, Bulgaria
Sl0043 50257
🇺🇸La Jolla, California, United States
Sl0043 50383
🇺🇸Beverly Hills, California, United States
Sl0043 50378
🇺🇸Loma Linda, California, United States
Sl0043 50258
🇺🇸Los Angeles, California, United States
Sl0043 50340
🇺🇸Orange, California, United States
Sl0043 50331
🇺🇸Poway, California, United States
Sl0043 50239
🇺🇸Brandon, Florida, United States
Sl0043 50059
🇺🇸Ormond Beach, Florida, United States
Sl0043 50324
🇺🇸Plantation, Florida, United States
Sl0043 50240
🇺🇸Idaho Falls, Idaho, United States
Sl0043 50382
🇺🇸Atlanta, Georgia, United States
Sl0043 50368
🇺🇸Atlanta, Georgia, United States
Sl0043 50360
🇺🇸Skokie, Illinois, United States
Sl0043 50474
🇺🇸Hopkinsville, Kentucky, United States
Sl0043 50288
🇺🇸Cumberland, Maryland, United States
Sl0043 50015
🇺🇸Hagerstown, Maryland, United States
Sl0043 50333
🇺🇸Grand Blanc, Michigan, United States
Sl0043 50366
🇺🇸Canton, New York, United States
Sl0043 50010
🇺🇸Brooklyn, New York, United States
Sl0043 50334
🇺🇸New York, New York, United States
Sl0043 50266
🇺🇸Great Neck, New York, United States
Sl0043 50264
🇺🇸Manhasset, New York, United States
Sl0043 50077
🇺🇸New York, New York, United States
Sl0043 50238
🇺🇸Charlotte, North Carolina, United States
Sl0043 50241
🇺🇸Syracuse, New York, United States
Sl0043 50364
🇺🇸Philadelphia, Pennsylvania, United States
Sl0043 50147
🇺🇸Hershey, Pennsylvania, United States
Sl0043 50020
🇺🇸Duncansville, Pennsylvania, United States
Sl0043 50001
🇺🇸Jackson, Tennessee, United States
Sl0043 50263
🇺🇸Amarillo, Texas, United States
Sl0043 50338
🇺🇸Bellaire, Texas, United States
Sl0043 50057
🇺🇸Dallas, Texas, United States
Sl0043 50036
🇺🇸Mesquite, Texas, United States
Sl0043 50304
🇺🇸Dallas, Texas, United States
Sl0043 50050
🇺🇸Beckley, West Virginia, United States
Sl0043 50061
🇺🇸Spokane, Washington, United States
Sl0043 60002
🇦🇷Capital Federal, Argentina
Sl0043 60001
🇦🇷Ciudad Autonoma de Buenos Aire, Argentina
Sl0043 60029
🇦🇷Mendoza, Argentina
Sl0043 60011
🇦🇷San Juan, Argentina
Sl0043 60003
🇦🇷Quilmes, Argentina
Sl0043 30020
🇦🇺Parkville, Australia
Sl0043 30025
🇦🇺St Albans, Australia
Sl0043 40387
🇦🇹Wien, Austria
Sl0043 40123
🇧🇪Bruxelles, Belgium
Sl0043 40189
🇧🇬Plovdiv, Bulgaria
Sl0043 40522
🇧🇬Plovdiv, Bulgaria
Sl0043 50374
🇨🇦Calgary, Canada
Sl0043 50337
🇨🇦Edmonton, Canada
Sl0043 50259
🇨🇦Rimouski, Canada
Sl0043 50045
🇨🇦Toronto, Canada
Sl0043 50044
🇨🇦Trois-rivieres, Canada
Sl0043 60021
🇨🇱Providencia, Santiago, Chile
Sl0043 60013
🇨🇴Barranquilla, Colombia
Sl0043 60030
🇨🇱Santiago, Chile
Sl0043 60019
🇨🇴Barranquilla, Colombia
Sl0043 40066
🇨🇿Praha 2, Czechia
Sl0043 40505
🇫🇷Paris Cedex 12, France
Sl0043 40386
🇩🇪Cologne, Germany
Sl0043 40506
🇫🇷Montpellier Cedex 5, France
Sl0043 40322
🇩🇪Dessau, Germany
Sl0043 40356
🇩🇪Dresden, Germany
Sl0043 40072
🇩🇪Freiburg, Germany
Sl0043 40024
🇩🇪Hanover, Germany
Sl0043 40027
🇩🇪Herne, Germany
Sl0043 40378
🇬🇷Athens, Greece
Sl0043 40078
🇩🇪Leipzig, Germany
Sl0043 40402
🇩🇪Tübingen, Germany
Sl0043 40377
🇬🇷Crete, Greece
Sl0043 40507
🇬🇷Larisa, Greece
Sl0043 40375
🇬🇷Thessaloniki, Greece
Sl0043 40413
🇭🇺Gyula, Hungary
Sl0043 40031
🇭🇺Szeged, Hungary
Sl0043 20141
🇰🇷Busan, Korea, Republic of
Sl0043 20106
🇰🇷Daejeon, Korea, Republic of
Sl0043 20108
🇰🇷Incheon, Korea, Republic of
Sl0043 20104
🇰🇷Seoul, Korea, Republic of
Sl0043 50317
🇲🇽Chihuahua, Mexico
Sl0043 50250
🇲🇽Cuernavaca, Mexico
Sl0043 50249
🇲🇽Guadalajara, Mexico
Sl0043 50271
🇲🇽Leon, Mexico
Sl0043 50252
🇲🇽Merida, Mexico
Sl0043 50251
🇲🇽Monterrey, Mexico
Sl0043 60026
🇵🇪Arequipa, Peru
Sl0043 60008
🇵🇪Lima, Peru
Sl0043 40490
🇵🇱Krakow, Poland
Sl0043 40502
🇵🇱Krakow, Poland
Sl0043 40037
🇵🇱Lublin, Poland
Sl0043 40151
🇵🇱Lublin, Poland
Sl0043 40483
🇵🇱Nadarzyn, Poland
Sl0043 40044
🇵🇱Poznan, Poland
Sl0043 40090
🇵🇱Poznan, Poland
Sl0043 40097
🇵🇱Warszawa, Poland
Sl0043 40394
🇵🇱Warszawa, Poland
Sl0043 40382
🇷🇴Galati, Romania
Sl0043 40383
🇷🇴Bucuresti, Romania
Sl0043 40466
🇷🇸Kragujevac, Serbia
Sl0043 40045
🇪🇸A Coruna, Spain
Sl0043 40160
🇪🇸Barcelona, Spain
Sl0043 40101
🇪🇸Sabadell, Spain
Sl0043 40341
🇪🇸Málaga, Spain
Sl0043 40521
🇪🇸Mérida, Spain
Sl0043 40400
🇪🇸Sevilla, Spain
Sl0043 20142
🇨🇳Taichung City, Taiwan
Sl0043 40099
🇪🇸Vigo, Spain
Sl0043 20113
🇨🇳Taichung City, Taiwan
Sl0043 20099
🇨🇳Taipei City, Taiwan
Sl0043 20082
🇨🇳Taoyuan City, Taiwan
Sl0043 50321
🇺🇸Morgantown, West Virginia, United States
Sl0043 40006
🇧🇬Plovdiv, Bulgaria
Sl0043 60015
🇨🇱Santiago de Chile, Chile
Sl0043 60007
🇨🇴Chia, Colombia
Sl0043 50328
🇺🇸Tucson, Arizona, United States
Sl0043 50341
🇺🇸Washington, District of Columbia, United States
Sl0043 50285
🇺🇸Lake Charles, Louisiana, United States
Sl0043 60022
🇦🇷Quilmes, Argentina
Sl0043 60006
🇨🇴Bogota, Colombia
Sl0043 60016
🇨🇴Bucaramanga, Colombia
Sl0043 40501
🇬🇷Haidari - Athens, Greece
Sl0043 40499
🇭🇺Szekesfehervar, Hungary
Sl0043 50273
🇺🇸Las Vegas, Nevada, United States
Sl0043 60014
🇦🇷Tucuman, Argentina
Sl0043 60028
🇨🇴Medellín, Colombia
Sl0043 40411
🇭🇺Debrecen, Hungary
Sl0043 20182
🇵🇭Davao, Philippines
Sl0043 40388
🇦🇹Graz, Austria
Sl0043 40060
🇧🇪Liege, Belgium
Sl0043 40482
🇵🇱Bialystok, Poland
Sl0043 40392
🇷🇸Novi Sad, Serbia
Sl0043 60018
🇨🇱Santiago, Chile
Sl0043 60027
🇨🇴Bogota, Colombia
Sl0043 20111
🇵🇭Manila, Philippines
Sl0043 40098
🇵🇱Warszawa, Poland
Sl0043 40397
🇵🇱Wroclaw, Poland
Sl0043 60031
🇨🇴Monteria, Colombia
Sl0043 60023
🇵🇪Lima, Peru
Sl0043 20110
🇵🇭Angeles, Philippines
Sl0043 20181
🇵🇭Makati, Philippines
Sl0043 40481
🇵🇱Wroclaw, Poland
Sl0043 40464
🇷🇴Bucharest, Romania
Sl0043 40461
🇷🇸Belgrade, Serbia
Sl0043 40412
🇭🇺Budapest, Hungary
Sl0043 20095
🇨🇳Taipei, Taiwan
Sl0043 60009
🇵🇪Lima, Peru
Sl0043 40119
🇵🇱Bydgoszcz, Poland
Sl0043 40398
🇵🇱Katowice, Poland
Sl0043 40393
🇷🇸Belgrade, Serbia
Sl0043 40489
🇩🇰Odense, Denmark
Sl0043 40084
🇮🇹Catania, Italy
Sl0043 40472
🇮🇹Ferrara, Italy
Sl0043 40514
🇮🇹Genova, Italy
Sl0043 40291
🇮🇹Milano, Italy
Sl0043 40448
🇮🇹Milano, Italy
Sl0043 40471
🇮🇹Milano, Italy
Sl0043 40509
🇮🇹Padova, Italy
Sl0043 40492
🇮🇹Rozzano, Italy
Sl0043 40148
🇮🇹Roma, Italy
Sl0043 50140
🇺🇸Birmingham, Alabama, United States
Sl0043 50052
🇺🇸Phoenix, Arizona, United States
Sl0043 50122
🇺🇸Miami, Florida, United States
Sl0043 50275
🇺🇸La Palma, California, United States
Sl0043 50377
🇺🇸San Diego, California, United States
Sl0043 50219
🇺🇸Detroit, Michigan, United States
Sl0043 50330
🇺🇸Cincinnati, Ohio, United States
Sl0043 50316
🇺🇸San Leandro, California, United States
Sl0043 50339
🇺🇸Denver, Colorado, United States
Sl0043 50310
🇺🇸Chicago, Illinois, United States
Sl0043 50262
🇺🇸Oklahoma City, Oklahoma, United States
Sl0043 50365
🇺🇸Pittsburgh, Pennsylvania, United States
Sl0043 50267
🇺🇸Seattle, Washington, United States
Sl0043 50283
🇺🇸Tampa, Florida, United States
Sl0043 50329
🇺🇸Tampa, Florida, United States
Sl0043 50367
🇺🇸New Haven, Connecticut, United States
Sl0043 50362
🇺🇸Gainesville, Florida, United States
Sl0043 50179
🇺🇸Winston-Salem, North Carolina, United States