A Study of Vedolizumab With and Without Upadacitinib in Adults With Crohn's Disease
- Conditions
- Crohn's Disease
- Interventions
- Registration Number
- NCT06227910
- Lead Sponsor
- Takeda
- Brief Summary
The main aim of this study is to learn whether vedolizumab and upadacitinib given together (also called dual targeted therapy or DTT) reduces bowel inflammation and ulcers in the bowel compared to vedolizumab only (also called monotherapy) in adults with moderately or severely active Crohn's Disease (CD) after 12 weeks of treatment. Other aims are to learn how safe and effective DTT is compared to monotherapy for these participants.
All participants will receive DTT (either vedolizumab and upadacitinib or vedolizumab and placebo) for 12 weeks. Participants responding to the treatment will then receive vedolizumab only (monotherapy) for an additional 40 weeks.
During the study, participants will visit their study clinic 15 times.
- Detailed Description
The drug being tested in this study is vedolizumab. Vedolizumab is being tested to treat people with moderately to severely active CD. The study will look at the efficacy and safety of vedolizumab with and without upadacitinib. The study will enroll approximately 396 patients. Participants will be assigned in a 1:1 ratio to one of the two treatment groups in the 12-week Induction Period:
* Induction Period: Vedolizumab + Upadacitinib
* Induction Period: Vedolizumab + Placebo
Participants who achieve a Crohn's disease activity index (CDAI) reduction of ≥70 points from baseline at Week 12 will progress into the 40-week Maintenance Period of the study to receive vedolizumab monotherapy. Participants will be followed for a further 18-week safety follow-up period up to Week 70.
This multi-center trial will be conducted worldwide. The overall time to participate in this study is approximately 70 weeks.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 396
- The participant has a diagnosis of CD established at least 3 months before screening by clinical and endoscopic evidence and corroborated by a histopathology report.
- The participant has a confirmed diagnosis of moderately to severely active CD as assessed by CDAI of 220-450.
- The participant has evidence of mucosal inflammation based on the SES-CD: SES-CD score (excluding the presence of narrowing component) of ≥6 (or ≥4 for participants with isolated ileal disease), as confirmed by a central reader.
- The participant has demonstrated an inadequate response to, loss of response to, or intolerance to corticosteroids, immunomodulators, or biologic therapy.
- The participant has a current diagnosis of ulcerative colitis or indeterminate colitis.
- The participant has previously failed >2 classes of either biological or small molecule therapy for CD.
- The participant has infection(s) requiring treatment with IV anti-infectives within 30 days prior to baseline or oral/intramuscular anti-infectives within 14 days prior to baseline.
- The participant has evidence of an active infection during the screening period, or clinically significant infection within 30 days prior to screening, or ongoing chronic infection.
- The participant has a history of recurrent or disseminated (including a single episode) herpes zoster, or disseminated (including a single episode) herpes simplex.
- The participant has any of the following ongoing known complications of CD: abscess (abdominal or peri-anal); symptomatic bowel strictures; 2 entire missing segments of the following 5 segments: terminal ileum, right colon, transverse colon, sigmoid and left colon, and rectum; fulminant colitis; toxic megacolon; or any other manifestation that might require surgery while enrolled in the study.
- The participant has an ostomy or ileoanal pouch.
- The participant has severe renal impairment, defined as an estimated glomerular filtration rate of <30 milliliters per minute per 1.73 square meters (mL/min/1.73 m^2).
- The participant has severe (Child-Pugh C) hepatic impairment.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Double-blind Induction Phase: Vedolizumab + Upadacitinib Vedolizumab Participants will receive vedolizumab 300 mg intravenous (IV) infusion at Weeks 0, 2, 6 and 10 along with upadacitinib 45 mg, orally, once daily (QD) for 12 weeks. Double-blind Induction Phase: Vedolizumab + Upadacitinib Upadacitinib Participants will receive vedolizumab 300 mg intravenous (IV) infusion at Weeks 0, 2, 6 and 10 along with upadacitinib 45 mg, orally, once daily (QD) for 12 weeks. Double-blind Induction Phase: Vedolizumab + Placebo Vedolizumab Participants will receive vedolizumab IV 300 mg infusion, at Weeks 0, 2, 6 and 10 along with upadacitinib matched placebo, orally, QD for 12 weeks. Double-blind Induction Phase: Vedolizumab + Placebo Placebo Participants will receive vedolizumab IV 300 mg infusion, at Weeks 0, 2, 6 and 10 along with upadacitinib matched placebo, orally, QD for 12 weeks. Main Study Maintenance Phase: Vedolizumab Monotherapy Vedolizumab Participants who achieve a CDAI reduction of \>=70 points from baseline at Week 12 will receive vedolizumab 300 mg IV infusion (monotherapy), every 8 weeks (Q8W) starting at Week 14 to 52. The Q8W vedolizumab monotherapy may be escalated to Q4W at the investigator's discretion.
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving Clinical Remission Based on the CDAI at Week 12 Week 12 Clinical remission is defined as a CDAI score of \<150 points. CDAI assesses CD based on clinical signs such as number of liquid or very soft stools, abdominal pain, general wellbeing, extra-intestinal manifestations of CD, antidiarrheal use, presence of abdominal mass, hematocrit, and body weight. CDAI consists of eight factors, each summed after adjustment with a weighting factor. Total score ranges from 0 to 600 points. Higher scores indicate more severity.
Percentage of Participants Exhibiting an Endoscopic Response Based on Simple Endoscopic Score for CD (SES-CD) at Week 12 Week 12 Endoscopic response as per SES-CD is defined as SES-CD reduction by \>=50% from Baseline as scored by a central reviewer. SES-CD evaluates 4 endoscopic variables (ulcer size, percentage of the surface area that is ulcerated, percentage of the surface area affected, and presence and type of narrowings in 5 colonic segments evaluated during ileocolonoscopy (ileum, right colon, transverse colon, left colon, and rectum). Each variable is coded from 0 to 3 based on severity, where 0 is none or not severe and 3 is the most severe case, with the sum of the scores for each variable ranging from 0 to 15, except for presence of narrowing. Presence of narrowing ranges from 0 to 11 since a severity of 3 represents a narrowing which a colonoscope cannot be passed and, thus, can only be observed once among the bowel segments. The overall SES-CD score ranges from 0 to 56 and is the sum of 4 variables across 5 bowel segments. Higher scores indicate more severe disease.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Achieving Endoscopic Remission Based on SES-CD at Week 52 Week 52 Endoscopic remission as per SES-CD is defined as SES-CD score of \<=4 with no mucosal ulceration in the colon or ileum as assessed by centrally read video ileocolonoscopy. SES-CD evaluates 4 endoscopic variables (ulcer size, percentage of surface area (SA) that is ulcerated, percentage of SA affected, and presence and type of narrowings in 5 colonic segments evaluated during ileocolonoscopy. Each variable is coded from 0 to 3 based on severity, where 0 is none or not severe and 3 is most severe case, with sum of scores for each variable ranging from 0 to 15, except for presence of narrowing. Presence of narrowing ranges from 0 to 11 since a severity of 3 represents a narrowing which a colonoscope cannot be passed and, thus, can only be observed once among the bowel segments. The overall SES-CD score ranges from 0 to 56 and is sum of 4 variables across 5 bowel segments. Higher scores indicate more severe disease.
Percentage of Participants Exhibiting Corticosteroid-free Clinical Remission in Participants who Were Taking Corticosteroids at Baseline Based on the CDAI at Week 52 Week 52 Percentage of participants using oral corticosteroids at Baseline who have discontinued corticosteroids and are in clinical remission at Week 52 per CDAI will be reported. Clinical remission is defined as a CDAI score of \<150 points. CDAI assesses CD based on clinical signs such as number of liquid or very soft stools, abdominal pain, general wellbeing, extra-intestinal manifestations of CD, antidiarrheal use, presence of abdominal mass, hematocrit, and body weight. CDAI consist of eight factors, each summed after adjustment with a weighting factor. Total score ranges from 0 to 600 points. Higher scores indicate more severity.
Percentage of Participants Exhibiting a Clinical Response Based on the CDAI at Week 52 Week 52 Clinical response is defined as \>=100-point decrease from Baseline in CDAI score. CDAI assesses CD based on clinical signs such as number of liquid or very soft stools, abdominal pain, general wellbeing, extra-intestinal manifestations of CD, antidiarrheal use, presence of abdominal mass, hematocrit, and body weight. CDAI consist of eight factors, each summed after adjustment with a weighting factor. Total score ranges from 0 to 600 points. Higher scores indicate more severity.
Percentage of Participants Achieving 2-item Patient-reported Outcome Measure (PRO2) Based Clinical Remission at Week 12 Week 12 Clinical remission based on PRO2 is defined as 7-day average of very soft or liquid stool frequency (SF) \<=2.8, 7-day average of abdominal pain (AP) score \<=1.0, and neither worse than baseline. The PRO2 is comprised of the stool frequency and abdominal pain components of the CDAI.
Percentage of Participants Achieving Endoscopic Remission Based on SES-CD at Week 12 Week 12 Endoscopic remission as per SES-CD is defined as SES-CD score of ≤4 with no mucosal ulceration in the colon or ileum as assessed by centrally read video ileocolonoscopy. SES-CD evaluates 4 endoscopic variables (ulcer size, percentage of surface area (SA) that is ulcerated, percentage of SA affected, and presence and type of narrowings in 5 colonic segments evaluated during ileocolonoscopy. Each variable is coded from 0 to 3 based on severity, where 0 is none or not severe and 3 is most severe case, with sum of scores for each variable ranging from 0 to 15, except for presence of narrowing. Presence of narrowing ranges from 0 to 11 since a severity of 3 represents a narrowing which a colonoscope cannot be passed and, thus, can only be observed once among the bowel segments. The overall SES-CD score ranges from 0 to 56 and is sum of 4 variables across 5 bowel segments. Higher scores indicate more severe disease.
Percentage of Participants Exhibiting Corticosteroid-free Clinical Remission in Participants who Were Taking Corticosteroids at Baseline Based on the CDAI at Week 12 Week 12 Percentage of participants using oral corticosteroids at Baseline who have discontinued corticosteroids and are in clinical remission per CDAI at Week 12 will be reported. Clinical remission is defined as a CDAI score of \<150 points. CDAI assesses CD based on clinical signs such as number of liquid or very soft stools, abdominal pain, general wellbeing, extra-intestinal manifestations of CD, antidiarrheal use, presence of abdominal mass, hematocrit, and body weight. CDAI consist of eight factors, each summed after adjustment with a weighting factor. Total score ranges from 0 to 600 points. Higher scores indicate more severity.
Percentage of Participants Exhibiting a Clinical Response Based on the CDAI at Week 12 Week 12 Clinical response is defined as \>=100-point decrease from Baseline in CDAI score. CDAI assesses CD based on clinical signs such as number of liquid or very soft stools, abdominal pain, general wellbeing, extra-intestinal manifestations of CD, antidiarrheal use, presence of abdominal mass, hematocrit, and body weight. CDAI consist of eight factors, each summed after adjustment with a weighting factor. Total score ranges from 0 to 600 points. Higher scores indicate more severity.
Percentage of Participants Achieving Clinical Remission Based on the CDAI at Week 52 Week 52 Clinical remission is defined as a CDAI score of \<150 points. CDAI assesses CD based on clinical signs such as number of liquid or very soft stools, abdominal pain, general wellbeing, extra-intestinal manifestations of CD, antidiarrheal use, presence of abdominal mass, hematocrit, and body weight. CDAI consists of eight factors, each summed after adjustment with a weighting factor. Total score ranges from 0 to 600 points. Higher scores indicate more severity.
Percentage of Participants Exhibiting an Endoscopic Response Based on SES-CD at Week 52 Week 52 Endoscopic response as per SES-CD is defined as SES-CD reduction by \>=50% from Baseline as scored by a central reviewer. SES-CD evaluates 4 endoscopic variables (ulcer size, percentage of the surface area that is ulcerated, percentage of the surface area affected, and presence and type of narrowings in 5 colonic segments evaluated during ileocolonoscopy (ileum, right colon, transverse colon, left colon, and rectum). Each variable is coded from 0 to 3 based on severity, where 0 is none or not severe and 3 is the most severe case, with the sum of the scores for each variable ranging from 0 to 15, except for presence of narrowing. Presence of narrowing ranges from 0 to 11 since a severity of 3 represents a narrowing which a colonoscope cannot be passed and, thus, can only be observed once among the bowel segments. The overall SES-CD score ranges from 0 to 56 and is the sum of 4 variables across 5 bowel segments. Higher scores indicate more severe disease.
Percentage of Participants Achieving 2-item PRO2 Based Clinical Remission at Week 52 Week 52 Clinical remission based on PRO2 is defined as 7-day average of very soft or liquid stool frequency (SF) \<=2.8, 7-day average of abdominal pain (AP) score \<=1.0, and neither worse than baseline. The PRO2 is comprised of the stool frequency and abdominal pain components of the CDAI.
Trial Locations
- Locations (138)
UCSD Medical Center
🇺🇸La Jolla, California, United States
Keck Medicine Of USC - USC Healthcare Center 1
🇺🇸Los Angeles, California, United States
Peak Gastroenterology Associates
🇺🇸Colorado Springs, Colorado, United States
GI PROS, Inc.
🇺🇸Naples, Florida, United States
Orlando Health Ambulatory Care Center
🇺🇸Orlando, Florida, United States
USF Health Morsani Center for Advanced Healthcare
🇺🇸Tampa, Florida, United States
Indiana University (IU) Health University Hospital
🇺🇸Indianapolis, Indiana, United States
University of Kentucky
🇺🇸Lexington, Kentucky, United States
Mount Sinai Hospital - The Susan and Leonard Feinstein Inflammatory Bowel Disease (IBD) Clinical Center
🇺🇸New York, New York, United States
Columbia University Medical Center, New York-Presbyterian Hospital
🇺🇸New York, New York, United States
Lenox Hill Hospital Northwell Health
🇺🇸New York, New York, United States
Gastroenterology Associates
🇺🇸Greenville, South Carolina, United States
Rapid City Medical Center
🇺🇸Rapid City, South Dakota, United States
Southern Star Research Institute, LLC
🇺🇸San Antonio, Texas, United States
Tyler Research Institute, LLC
🇺🇸Tyler, Texas, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Swedish Cancer Institute
🇺🇸Seattle, Washington, United States
University of Washington Medical Center - Montlake
🇺🇸Seattle, Washington, United States
Medical College of Wisconsin Cancer Center - Froedtert Hospital
🇺🇸Milwaukee, Wisconsin, United States
Medical University Innsbruck
🇦🇹Innsbruck, Tyrol, Austria
Medizinische Universitaet Wien - Allgemeines Krankenhaus der Stadt Wien (AKH) - Universitaetsklinik fuer Innere Medizin III
🇦🇹Wien, Vienna, Austria
Johannes Kepler Universitat Linz (JKU)
🇦🇹Linz, Austria
Landeskrankenhaus Salzburg, Innere Medizin I, Labor im Erdgeschoss
🇦🇹Salzburg, Austria
Krankenhaus der Barmherzigen Brueder Wien
🇦🇹Wien, Austria
Hopital Universitaire de Bruxelles/ Academisch Ziekenhuis Brussel
🇧🇪Brussel, Anderlecht, Belgium
Imelda GI Clinical Research Center
🇧🇪Bonheiden, Belgium
Universitair Ziekenhuis Gent
🇧🇪Gent, Belgium
University Hospitals Leuven
🇧🇪Leuven, Belgium
Centre Hospitalier Chretien MontLegia
🇧🇪Liege, Belgium
Hospital Universitario Cajuru
🇧🇷Curitiba, Parana, Brazil
Faculdade de Medicina de Botucatu
🇧🇷Botucatu, Sao Paulo, Brazil
Centro de Estudos Clinico do Interior Paulista - CECIP
🇧🇷Jau, Sao Paulo, Brazil
Pesquisare Saude
🇧🇷Santo Andre, Sao Paulo, Brazil
Universidade Federal do Rio de Janeiro (UFRJ)-Hospital Universitario Clementino Fraga Filho (HUCFF)
🇧🇷Rio De Janeiro, Brazil
Hospital das Clinicas of the University of Sao Paulo (Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC/FMUSP))
🇧🇷Sao Paulo, Brazil
Unidade de Pesquisa Clinica UPC Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo
🇧🇷Sao Paulo, Brazil
Heritage Medical Research Clinic - University Of Calgary
🇨🇦Calgary, Alberta, Canada
University of Manitoba-Winnipeg Regional Health Authority-Health Sciences Centre
🇨🇦Winnipeg, Manitoba, Canada
Dalhousie University
🇨🇦Halifax, Nova Scotia, Canada
Barrie GI Associates
🇨🇦Barrie, Ontario, Canada
McMaster University - Farncombe Family Digestive Health Research Institute (FFDHRI)
🇨🇦Hamilton, Ontario, Canada
Taunton Surgical Centre-Oshawa Clinic
🇨🇦Oshawa, Ontario, Canada
Toronto Immune and Digestive Health Institute (TIDHI)
🇨🇦Toronto, Ontario, Canada
Toronto Digestive Disease Associates
🇨🇦Vaughan, Ontario, Canada
Centre Hospitalier de l'Universite de Montreal
🇨🇦Montreal, Quebec, Canada
Poliklinika Borzan d.o.o.
🇭🇷Osijek, Croatia
Clinical Hospital Center Rijeka
🇭🇷Rijeka, Croatia
University Hospital Centre Sestre Milosrdnice
🇭🇷Zagreb, Croatia
Nemocnice Ceske Budejovice, a.s.
🇨🇿Ceske Budejovice, Czechia
Fakultni Nemocnice Hradec Kralove
🇨🇿Hradec Kralove, Czechia
Hepato-Gastroenterologie HK, s.r.o.
🇨🇿Hradec Kralove, Czechia
IBD Clinical and Research centre
🇨🇿Prague, Czechia
Aalborg Hospital
🇩🇰Aalborg, Denmark
Hvidovre Hospital Medicinsk Gastroenterologisk Afdeling
🇩🇰Hvidovre, Denmark
CHU d'Amiens-Picardie - Hopital SUD
🇫🇷Amiens Cedex 01, France
Hopital Huriez - CHRU de Lille
🇫🇷Lille Cedex, France
Chu - Hopital Nord
🇫🇷Marseille Cedex 20, France
Centre Hospitalier Universitaire de Nantes (CHU de Nantes) - Hopital Hotel Dieu
🇫🇷Nantes, France
Centre Hospitalier Universitaire de Bordeaux - Hopital Haut-Leveque
🇫🇷Pessac, France
CHU St Etienne Hopital Nord
🇫🇷Saint Etienne, France
Centre Hospitalier Universitaire (CHU) de Toulouse - Hopital Rangueil
🇫🇷Toulouse cedex 09, France
Centre Hospitalier Regional Universitaire de Nancy, Hopital Brabois
🇫🇷Vandoeuvre les Nancy, France
Krankenhaus Waldfriede e.V.
🇩🇪Berlin, Germany
Agaplesion Markus Krankenhaus
🇩🇪Frankfurt Am Main, Germany
Studiengesellschaft BSF
🇩🇪Halle, Germany
Universitaetsklinikum Jena
🇩🇪Jena, Germany
AO Ordine Mauriziano di Torino
🇮🇹Torino, Italy
Universitaetsklinikum Schleswig-Holstein, UKSH-Campus Kiel
🇩🇪Kiel, Germany
St. Marien- und St. Annastiftskrankenhaus
🇩🇪Ludwigshafen, Germany
Universitaetsklinikum Mannheim (Umm) - Ii Medizinische Klinik
🇩🇪Mannheim, Germany
University of Athens School of Medicine, Alexandra General Hospital
🇬🇷Athens, Attiki, Greece
Metaxa Cancer Hospital
🇬🇷Piraeus, Attiki, Greece
University Hospital of Heraklion
🇬🇷Heraklion, Crete, Greece
Central Hospital of Northern Pest - Military Hospital
🇭🇺Budapest, Hungary
Semmelweis Egyetem
🇭🇺Budapest, Hungary
Szegedi Tudomanyegyetem Altalanos Orvostudomanyi Kar Szent-Gyorgyi Albert Klinikai Kozpont, I.Sz. Belogyaszati Klinika
🇭🇺Szeged, Hungary
Adelaide, Meath and National Children's Hospital
🇮🇪Dublin, Ireland
University College Dublin (UCD) - St. Vincent's University Hospital (SVUH)
🇮🇪Dublin, Ireland
Beaumont Hospital
🇮🇪Dublin, Ireland
Soroka Medical Center
🇮🇱Be'er Sheva, Israel
Rambam Health Care Campus (RHCC)
🇮🇱Haifa, Israel
Meir Medical Center
🇮🇱Kfar-Saba, Israel
Rabin Medical Center - Beilinson Campus (Beilinson and Hasharon Hospital)
🇮🇱Petach Tikva, Israel
The Tel Aviv Sourasky Medical Center
🇮🇱Tel-Aviv, Israel
Ospedale San Raffaele (HSR) Instituto Scientifico Universitario San Raffaele
🇮🇹Milano, Italy
Azienda Ospedaliero Universitaria Federico II di Napoli
🇮🇹Naples, Italy
A. Gemelli University Hospital, Catholic University of the Sacred Heart
🇮🇹Roma, Italy
Humanitas Clinical And Research Institute
🇮🇹Rozzano, Italy
Fondazione IRCSS Casa Sollievo Della Sofferenza
🇮🇹San Giovanni Rotondo, Italy
Inje University Haeundae Paik Hospital
🇰🇷Busan, Korea, Republic of
Yeungnam University Medical Center
🇰🇷Daegu, Korea, Republic of
The Catholic University of Korea, Daejeon St.Mary's Hospital
🇰🇷Daejeon, Korea, Republic of
Kyung Hee University Hospital
🇰🇷Seoul, Korea, Republic of
Severance Hospital, Yonsei University Health System
🇰🇷Seoul, Korea, Republic of
The Catholic University of Korea, Seoul St. Mary's Hospital
🇰🇷Seoul, Korea, Republic of
Chung-Ang University Hospital
🇰🇷Seoul, Korea, Republic of
The Catholic University Of Korea, St. Vincent's Hospital
🇰🇷Suwon-si, Korea, Republic of
Amsterdam UMC Research BV
🇳🇱Amsterdam, Netherlands
Radboud University Medical Center
🇳🇱Nijmegen, Netherlands
Erasmus Medisch Centrum
🇳🇱Rotterdam, Netherlands
Elisabeth TweeSteden Ziekenhuis (ETZ)
🇳🇱Tilburg, Netherlands
Vestre Viken HF - Baerum Sykehus
🇳🇴Drammen, Gjettum, Norway
Haukeland Universitetssjukehus (Haukeland University Hospital)
🇳🇴Bergen, Norway
Akershus University Hospital
🇳🇴Lorenskog, Norway
Oslo Universitetssykehus HF, Ulleval
🇳🇴Oslo, Norway
Oddzial Kliniczny Gastroenterologii Ogolnej i Onkologicznej SPZOZ Uniwersytecki Szpital Kliniczny Nr 1 im. Barlickiego Uniwersytetu Medycznego w Lodzi
🇵🇱Lodz, Poland
Samodzielny Publiczny Szpital Kliniczny Im. H. Swiecickiego Um
🇵🇱Poznan, Poland
H-T. Centrum Medyczne Sp. z o.o. Sp.k.
🇵🇱Tychy, Poland
WIP Warsaw IBD Point Profesor Kierkus
🇵🇱Warsaw, Poland
Panstwowy Instytut Medyczny MSWiA
🇵🇱Warszawa, Poland
Unidade Local de Saude Coimbra
🇵🇹Coimbra, Portugal
Centro Hospitalar Universitario Lisboa Norte EPE
🇵🇹Lisboa, Portugal
Centro Hospitalar de Lisboa ocidental (CHLO), Hospital Egas Moniz
🇵🇹Lisbon, Portugal
University Clinical Centre - Ljubljana
🇸🇮Ljubljana, Slovenia
Hospital General Universitario Gregorio Maranon (HGUGM)
🇪🇸Madrid, Spain
Hospital Universitario La Paz
🇪🇸Madrid, Spain
Hospital Universitari Son Espases
🇪🇸Palma, Spain
Complejo Hospitalario de Navarra (CHN)
🇪🇸Pamplona, Spain
Complejo Hospitalario Universitario De Santiago De Compostela
🇪🇸Santiago de Compostela, Spain
Hospital Universitari I Politecnic La Fe
🇪🇸Valencia, Spain
Universitetssjukhuset i Linkoping, Endokrin- och magtarmmedicinska Kliniken (EM-Kliniken)
🇸🇪Linkoping, Sweden
Ersta sjukhus
🇸🇪Stockholm, Sweden
Karolinska Universitetssjukhuset - Hjartkliniken i Solna - Karolinska University Hospital
🇸🇪Stockholm, Sweden
Danderyds Sjukhus AB
🇸🇪Stockholm, Sweden
University Hospital Basel
🇨🇭Basel, Switzerland
University Hospital Bern (Inselspital)
🇨🇭Bern, Switzerland
Zentrum fur Gastroenterologie
🇨🇭Zurich, Switzerland
Universitatsspital Zurich
🇨🇭Zurich, Switzerland
Changhua Christian Hospital
🇨🇳Changhua City, Taiwan
Chung Shan Medical University Hospital
🇨🇳Taichung, Taiwan
Taichung Veterans General Hospital
🇨🇳Taichung, Taiwan
National Cheng Kung University Hospital
🇨🇳Tainan, Taiwan
National Defense Medical Center (NDMC) (Tri-Service General Hospital (TSGH)) - Neihu
🇨🇳Taipei, Taiwan
Chang Gung Memorial Foundation Linkou Chang Gung Memorial Hospital
🇨🇳Taoyuan City, Taiwan
St Thomas' Hospital - Guy's & St Thomas' NHS Foundation Trust
🇬🇧London, England, United Kingdom
The Royal London Hospital - Barts Health NHS Trust
🇬🇧London, Greater London, United Kingdom
Western General Hospital
🇬🇧Edinburgh, Lothian, United Kingdom
Queen Elizabeth University Hospital - NHS Greater Glasgow & Clyde - South Glasgow University Hospital Division
🇬🇧Glasgow, Scotland, United Kingdom