Study of Sotatercept in Newly Diagnosed Intermediate- and High-Risk PAH Participants (MK-7962-005/A011-13)

Phase 3

Completed

• Conditions: Pulmonary Arterial Hypertension
• Interventions: Other: Placebo; Drug: Sotatercept

• Registration Number: NCT04811092
• Lead Sponsor: Acceleron Pharma, Inc., a wholly-owned subsidiary of Merck & Co., Inc., Rahway, NJ USA

Brief Summary

The objective of this study is to evaluate the effects of sotatercept (MK-7962, formerly called ACE-011) treatment (plus background pulmonary arterial hypertension (PAH) therapy) versus placebo (plus background PAH therapy) on time to clinical worsening (TTCW) in participants who are newly diagnosed with PAH and are at intermediate or high risk of disease progression.

Detailed Description

This is a phase 3, randomized, double-blind, placebo-controlled study to evaluate sotatercept when added to background PAH therapy in newly diagnosed intermediate- or high risk PAH participants.

Participants enrolled in the study will have a diagnosis within 12 months of study screening of symptomatic PAH (World Health Organization (WHO) Group 1, classified as functional class (FC) II or III) and presentation of idiopathic or heritable PAH, PAH associated with connective tissue diseases (CTD), drug- or toxin- induced PAH, post shunt correction PAH, or PAH presenting at least 1 year following the correction of congenital heart defects.

As of Amendment 11, this study will be closed so that all eligible participants can receive sotatercept either on the MK-7962-004 extension study (SOTERIA, NCT04796337,) or by commercial access, if available. All eligible participants will complete the end of treatment visit before enrollment in the extension study or initiation of commercial product. Participants not enrolling into the extension study or initiating commercial product will complete the end of study visit.

Study Timeline

• Study First Submitted: 2021-03-16
• Study First Submitted QC: 2021-03-19
• Study First Posted: 2021-03-23
• Study Start: 2022-03-18
• Primary Completion: 2025-04-03
• Study Completion: 2025-04-03
• Status Verified: 2025-05
• Last Update Submitted: 2025-05-09
• Last Update Posted: 2025-05-13

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 321

Inclusion Criteria

Eligible participants must meet all of the following criteria to be enrolled in the study:

1. Age ≥ 18 years

2. Documented diagnostic right heart catheterization (RHC) within 12 months of screening documenting a minimum PVR of ≥ 4 Wood units and pulmonary capillary wedge pressure (PCWP) or left ventricular end-diastolic pressure (LVEDP) of ≤ 15 mmHg, with the diagnosis of WHO PAH Group 1 in any of the following subtypes:

   • Idiopathic PAH
   • Heritable PAH
   • Drug/toxin-induced PAH
   • PAH associated with connective tissue disease
   • PAH associated with simple, congenital systemic to pulmonary shunts at least 1 year following repair

3. Symptomatic PAH classified as WHO FC II or III

4. Either Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) Lite 2 Risk Score ≥ 6 or Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) 2.0 risk score ≥2 (intermediate to-low-risk or above)

5. Diagnosis of PAH within 12 months of screening and on stable doses of a double or triple combination of background PAH therapies and diuretics (if any) for at least 90 days prior to screening

6. Six-minute walk distance ≥ 150 m repeated twice at screening at least 4 hours apart, but no longer than 1 week apart, and both values are within 15% of each other (calculated from the highest value)

7. Females of childbearing potential must meet the following criteria:

   • Have 2 negative urine or serum pregnancy tests as verified by the investigator prior to starting study drug administration; she must agree to ongoing urine or serum pregnancy testing during the course of the study and until 8 weeks after the last dose of the study drug
   • If sexually active with a male partner, have used highly effective contraception without interruption, for at least 28 days prior to starting the investigational product AND agreed to use the same highly effective contraception in combination with a barrier method during the study (including dose interruptions) and for 16 weeks (112 days) after discontinuation of study treatment
   • Refrain from breastfeeding a child or donating blood, eggs, or ovum for the duration of the study and for at least 16 weeks (112 days) after the last dose of study treatment

8. Male participants must meet the following criteria:

   • Agree to use a condom, defined as a male latex condom or nonlatex condom NOT made out of natural (animal) membrane (e.g., polyurethane), during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions, and for at least 16 weeks (112 days) following investigational product discontinuation, even if he has undergone a successful vasectomy
   • Refrain from donating blood or sperm for the duration of the study and for 16 weeks (112 days) after the last dose of study treatment

9. Ability to adhere to study visit schedule and understand and comply with all protocol requirements

10. Ability to understand and provide written informed consent

Exclusion Criteria

Participants will be excluded from the study if any of the following criteria are met:

1. Diagnosis of pulmonary hypertension (PH) WHO Groups 2, 3, 4, or 5

2. Diagnosis of the following PAH Group 1 subtypes: human immunodeficiency virus (HIV)-associated PAH and PAH associated with portal hypertension, schistosomiasis-associated PAH, pulmonary veno occlusive disease, and pulmonary capillary hemangiomatosis

3. Hemoglobin at screening above gender-specific upper limit of normal (ULN), per local laboratory test

4. Uncontrolled systemic hypertension as evidenced by sitting systolic blood pressure (BP) > 180 mmHg or sitting diastolic BP > 110 mmHg during the Screening Visit after a period of rest

5. Baseline systolic BP < 90 mmHg at screening

6. Pregnant or breastfeeding women

7. Any of the following clinical laboratory values at the Screening Visit:

   • Estimated glomerular filtration rate < 30 mL/min/1.73 m2 (as defined by MDRD equation)
   • Serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels > 3 × ULN
   • Platelet count < 50,000/mm3 (< 50.0 × 109 /L)

8. Currently enrolled in or have completed any other investigational product study within 30 days for small molecule drugs or within 5 half-lives for investigational biologics prior to the date of documented informed consent

9. Known allergic reaction to sotatercept (ACE-011), its excipients, or luspatercept

10. History of pneumonectomy

11. Pulmonary function test values of forced vital capacity < 60% predicted within 1 year prior to the Screening Visit

12. Stopped receiving any PH chronic general supportive therapy (e.g., diuretics, oxygen, anticoagulants, and digoxin) within 60 days prior to the Screening Visit

13. Initiation of an exercise program for cardiopulmonary rehabilitation within 90 days prior to the Screening Visit or planned initiation during the study (participants who are stable in the maintenance phase of a program and who will continue for the duration of the study are eligible)

14. Untreated more than mild obstructive sleep apnea

15. History of known pericardial constriction

16. History of restrictive or congestive cardiomyopathy

17. History of atrial septostomy within 180 days prior to the Screening Visit

18. Electrocardiogram with Fridericia's corrected QT interval > 500 ms during the Screening Period

19. Personal or family history of long QT syndrome or sudden cardiac death

20. Left ventricular ejection fraction < 50% on historical echocardiogram (ECHO) within 1 year prior to the Screening Visit

21. Any current or prior history of symptomatic coronary disease (prior myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, or cardiac anginal chest pain) in the past 6 months prior to the Screening Visit

22. Cerebrovascular accident within 3 months prior to the Screening Visit

23. Acutely decompensated heart failure within 30 days prior to the Screening Visit, as per investigator assessment

24. Significant (≥ 2+ regurgitation) mitral regurgitation or aortic regurgitation valvular disease

25. Received intravenous inotropes (e.g., dobutamine, dopamine, norepinephrine, and vasopressin) within 30 days prior to the Screening Visit

26. Has an active malignancy with the exception of fully excised or treated basal cell carcinoma, cervical carcinoma in-situ, or prostate cancer that is not currently or expected, during the study, to be treated with radiation therapy, chemotherapy, and/or surgical intervention, or hormonal treatment

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo plus background PAH therapy	Placebo	Administered subcutaneously (SC) every 21 days plus background PAH therapy
Sotatercept plus background PAH therapy	Sotatercept	Administered at a starting dose of 0.3 mg/kg, with a target dose of 0.7 mg/kg, subcutaneously (SC) every 21 days plus background PAH therapy

Primary Outcome Measures

Name	Time	Method
Time to Clinical Worsening	Up to ~36 months	Time to clinical worsening is defined as time from randomization to the first confirmed morbidity event or death. Clinical worsening events are defined as all-cause death, non-planned PAH-related hospitalization of ≥ 24 hours in duration, atrial septostomy, lung transplant and deterioration in performance in 6-minute walk test from baseline combined with one of the following conditions: worsening of WHO functional class from baseline, signs/symptoms of increased right heart failure, addition of a background PAH therapy or change in the background PAH therapy delivery route to parenteral. All events will be adjudicated by a blinded, independent committee of clinical experts.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants Achieving the Multicomponent Improvement Endpoint of 6-Minute Walk Distance (6MWD), N-terminal prohormone Btype natriuretic peptide (NT-ProBNP) and World Health Organization (WHO) Functional Class (FC)	Baseline and Week 24	Multicomponent improvement endpoint measured by the percentage of participants achieving all of the following at Week 24 relative to baseline: * Improvement in 6MWD; * Improvement or maintenance/achievement of NT-proBNP; * Improvement in WHO FC or maintenance of WHO FC II
Percentage of Participants who Achieved a Low Registry to Evaluate Early and Long Term PAH Disease Management (REVEAL) Lite 2 Risk Score	Baseline and Week 24	The REVEAL Lite 2 uses renal insufficiency (by estimated glomerular filtration rate (eGFR)), WHO FC, systolic blood pressure (SBP) and heart rate, 6MWD, and NT-proBNP to determine the total risk score. The scores (range: 1-14) can be defined as: low risk as a score of ≤5, intermediate risk as a score of 6 or 7, and high risk as a score of ≥8 for the survival rates.
Percentage of Participants who Maintain or Achieve a Low Simplified French Risk Score	Baseline and Week 24	The simplified French Risk Score uses WHO FC, 6MWD, and NT-proBNP to determine the total risk score. A low risk score can be defined as attaining or maintaining all three low-risk criteria: WHO FC I or II, 6MWD \> 440m, and NT-proBNP \< 300 ng/L. The percentage of participants who maintain or achieve a low risk score at Week 24 versus baseline using the simplified French Risk score calculator will be reported.
Change from Baseline in NT-proBNP Levels	Baseline and Week 24	Blood samples will be collected at baseline and at Week 24 to measure NT-proBNP blood concentration.
Percentage of Participants who Improve in WHO FC or Maintain WHO FC II at 24 Weeks from Baseline	Baseline and Week 24	The severity of an individual's PAH symptoms was graded using the WHO FC system. WHO functional classification for PAH range from Class I (no limitation in physical activity, no dyspnea with normal activity), Class II (slight limitation of physical activity), Class III (marked limitation of physical activity) and Class IV (cannot perform a physical activity without any symptoms, dyspnea at rest). The change from baseline in WHO FC is classified into "Improved", "No change" and "Worsened". Improvement = reduction in FC, worsened = increase in FC and no change = no change in FC.
Change from Baseline in 6MWD	Baseline and Week 24	The 6MWD tests the distance walked in 6 minutes as a measure of functional capacity. Change from baseline in 6MWD at Week 24 will be reported.
Overall Survival (OS)	Up to ~36 Months	Overall survival is defined as the time from randomization to date of death due to any cause.
Change from Baseline in the Physical Impacts Domain Score of Pulmonary Arterial Hypertension Symptoms and Impact (PAH-SYMPACT)®	Baseline and Week 24	PAH SYMPACT is a self-rating questionnaire to assess symptoms and their physical and cognitive/emotional impact. The PAH-SYMPACT® questionnaire consists of consists of 16 symptom and 25 impact items. A higher score indicates worse symptoms. Change from baseline in responses in PAH-SYMPACT questionnaire at Week 24 will be reported.
Change from Baseline in the Cardiopulmonary Symptoms Domain Score of PAH-SYMPACT®	Baseline and Week 24	PAH SYMPACT is a self-rating questionnaire to assess symptoms and their physical and cognitive/emotional impact. The PAH-SYMPACT® questionnaire consists of consists of 16 symptom and 25 impact items. A higher score indicates worse symptoms. Change from baseline in responses in PAH-SYMPACT questionnaire at Week 24 will be reported.
Change from Baseline in the Cognitive/Emotional Impacts Domain Score of PAH-SYMPACT®	Baseline and Week 24	PAH SYMPACT is a self-rating questionnaire to assess symptoms and their physical and cognitive/emotional impact. The PAH-SYMPACT® questionnaire consists of consists of 16 symptom and 25 impact items. A higher score indicates worse symptoms. Change from baseline in responses in PAH-SYMPACT questionnaire at Week 24 will be reported
Number of Participants who Experience an Adverse Event (AE)	Up to ~36 Months	An AE is any untoward medical occurrence in a clinical investigation participant administered a study drug, which does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of the study drug whether or not it is considered related to the study drug. The number of participants who experienced an AE are presented.
Number of Participants who Discontinued Study Treatment due to AEs	Up to ~34 months	An AE is any untoward medical occurrence in a clinical investigation participant administered a study drug, which does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of the study drug whether or not it is considered related to the study drug. The number of participants who discontinued study treatment due to an AE are presented.
Incidence of Anti-drug Antibodies (ADAs) to Sotatercept	Up to ~36 Months	Blood samples collected at designated timepoints will be used to determine the ADA response to Sotatercept. The incidence of ADAs to Sotatercept over time will be presented.

Trial Locations

Locations (152)

Arizona Pulmonary Specialists ( Site 1010); 🇺🇸 Scottsdale, Arizona, United States

University of Arizona ( Site 1006); 🇺🇸 Tucson, Arizona, United States

University of California San Diego ( Site 1002); 🇺🇸 La Jolla, California, United States

UCLA Medical Center ( Site 1068); 🇺🇸 Los Angeles, California, United States

University of California Irvine ( Site 1086); 🇺🇸 Orange, California, United States

Santa Barbara Pulmonary Associates ( Site 1060); 🇺🇸 Santa Barbara, California, United States

University of California Davis Medical Center ( Site 1064); 🇺🇸 Sherman Oaks, California, United States

University of Colorado Hospital ( Site 1013); 🇺🇸 Aurora, Colorado, United States

AdventHealth Medical Group Advanced Lung Disease ( Site 1058); 🇺🇸 Orlando, Florida, United States

University of Iowa Hospital and Clinics ( Site 1050); 🇺🇸 Iowa City, Iowa, United States

Johns Hopkins Hospital ( Site 1036); 🇺🇸 Baltimore, Maryland, United States

Tufts Medical Center - PPDS ( Site 1014); 🇺🇸 Boston, Massachusetts, United States

Boston Medical Center ( Site 1012); 🇺🇸 Boston, Massachusetts, United States

University of Michigan ( Site 1011); 🇺🇸 Ann Arbor, Michigan, United States

University of Kansas Medical Center ( Site 1020); 🇺🇸 Kansas City, Missouri, United States

Washington University School of Medicine ( Site 1022); 🇺🇸 Saint Louis, Missouri, United States

University of New Mexico, Health Sciences Center ( Site 1048); 🇺🇸 Albuquerque, New Mexico, United States

NYU Langone Health ( Site 1052); 🇺🇸 New York, New York, United States

University of North Carolina at Chapel Hill ( Site 1042); 🇺🇸 Chapel Hill, North Carolina, United States

The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital ( Site 1001); 🇺🇸 Cincinnati, Ohio, United States

University of Cincinnati ( Site 1035); 🇺🇸 Cincinnati, Ohio, United States

The Cleveland Clinic Foundation Taussig Cancer Center ( Site 1065); 🇺🇸 Cleveland, Ohio, United States

Nazih Zuhdi Transplantation Institute ( Site 1084); 🇺🇸 Oklahoma City, Oklahoma, United States

Oregon Health & Science University ( Site 1054); 🇺🇸 Portland, Oregon, United States

Medical University of South Carolina ( Site 1003); 🇺🇸 Charleston, South Carolina, United States

Vanderbilt University Medical Center ( Site 1027); 🇺🇸 Nashville, Tennessee, United States

University of Texas Southwestern Medical Center ( Site 1038); 🇺🇸 Dallas, Texas, United States

University of Utah ( Site 1049); 🇺🇸 Salt Lake City, Utah, United States

Cardiologia Palermo ( Site 1911); 🇦🇷 Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina

Centro Medico Dra De Salvo ( Site 1904); 🇦🇷 Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina

Hospital Universitario Austral ( Site 1901); 🇦🇷 Pilar, Buenos Aires, Argentina

Instituto de Investigaciones Clinicas Quilmes ( Site 1903); 🇦🇷 Quilmes, Buenos Aires, Argentina

Instituto De Enfermedades Respiratorias E Investigacion Medica ( Site 1910); 🇦🇷 Villa Vatteone, Buenos Aires, Argentina

Instituto Médico DAMIC ( Site 1909); 🇦🇷 Córdoba, Cordoba, Argentina

Instituto Medico Rio Cuarto ( Site 1907); 🇦🇷 Rio Cuarto, Cordoba, Argentina

Hospital Provincial del Centenario ( Site 1912); 🇦🇷 Rosario, Santa Fe, Argentina

Instituto Cardiovascular de Rosario ( Site 1906); 🇦🇷 Rosario, Santa Fe, Argentina

Sanatorio Parque ( Site 1905); 🇦🇷 Rosario, Santa Fe, Argentina

Sanatorio Allende ( Site 1908); 🇦🇷 Cordoba, Argentina

Hospital Provincial Dr. Jose M. Cullen ( Site 1902); 🇦🇷 Santa Fe, Argentina

Royal Prince Alfred Hospital ( Site 1106); 🇦🇺 Camperdown, New South Wales, Australia

John Hunter Hospital ( Site 1101); 🇦🇺 Newcastle, New South Wales, Australia

Prince Charles Hospital ( Site 1104); 🇦🇺 Chermside, Queensland, Australia

Princess Alexandra Hospital ( Site 1108); 🇦🇺 Woolloongabba, Queensland, Australia

Royal Adelaide Hospital ( Site 1109); 🇦🇺 Adelaide, South Australia, Australia

Royal Hobart Hospital ( Site 1107); 🇦🇺 Hobart, Tasmania, Australia

Fiona Stanley Hospital ( Site 1103); 🇦🇺 Murdoch, Western Australia, Australia

Ordensklinikum Linz GmbH Elisabethinen ( Site 2002); 🇦🇹 Linz, Oberosterreich, Austria

Medizinische Universität Graz ( Site 2003); 🇦🇹 Graz, Steiermark, Austria

Medizinische Universitat Innsbruck ( Site 2004); 🇦🇹 Innsbruck, Tirol, Austria

Medizinische Universitat Wien ( Site 2001); 🇦🇹 Vienna, Wien, Austria

Hopital Erasme ( Site 1402); 🇧🇪 Anderlecht, Bruxelles-Capitale, Region De, Belgium

UZ Gasthuisberg ( Site 1401); 🇧🇪 Leuven, Vlaams-Brabant, Belgium

Hospital Madre Teresa ( Site 1804); 🇧🇷 Belo Horizonte, Minas Gerais, Brazil

Irmandade da Santa Casa de Misericordia de Porto Alegre ( Site 1805); 🇧🇷 Porto Alegre, Rio Grande Do Sul, Brazil

Hospital Sao Paulo ( Site 1806); 🇧🇷 São Paulo, Sao Paulo, Brazil

Instituto do Coracao - HCFMUSP ( Site 1803); 🇧🇷 Sao Paulo, Brazil

University of Alberta Hospital ( Site 2101); 🇨🇦 Edmonton, Alberta, Canada

St Boniface General Hospital ( Site 2106); 🇨🇦 Winnepeg, Manitoba, Canada

McMaster University - HSC ( Site 2105); 🇨🇦 Hamilton, Ontario, Canada

Sir Mortimer B Davis Jewish General Hospital ( Site 2103); 🇨🇦 Montreal, Quebec, Canada

Centro Cardiovascular Colombiano Clínica Santa María Clínica Cardio VID ( Site 3402); 🇨🇴 Medellin, Antioquia, Colombia

Fundacion Neumologica Colombiana ( Site 3403); 🇨🇴 Bogota, Cundinamarca, Colombia

Fundacion Valle Del Lili ( Site 3401); 🇨🇴 Santiago De Cali, Valle Del Cauca, Colombia

Centro Medico Imbanaco de Cali S.A ( Site 3404); 🇨🇴 Santiago de Cali, Valle Del Cauca, Colombia

University Hospital Centre Split city ( Site 3901); 🇭🇷 Split, Splitsko-dalmatinska Zupanija, Croatia

Klinicki Bolnicki Centar Zagreb ( Site 3902); 🇭🇷 Zagreb, Zagrebacka Zupanija, Croatia

Institut Klinicke a Experimentalni Mediciny ( Site 2202); 🇨🇿 Prague, Praha 4, Czechia

Vseobecna fakultni nemocnice v Praze ( Site 2201); 🇨🇿 Praha 2, Czechia

Rigshospitalet ( Site 3802); 🇩🇰 København Ø, Hovedstaden, Denmark

Aarhus Universitetshospital, Skejby ( Site 3801); 🇩🇰 Aarhus, Midtjylland, Denmark

Hopital Louis Pasteur ( Site 1311); 🇫🇷 Nice, Alpes-Maritimes, France

Hopital Louis Pradel ( Site 1317); 🇫🇷 Lyon, Auvergne, France

Hopitaux Universitaires de Strasbourg ( Site 1307); 🇫🇷 Strasbourg, Bas-Rhin, France

Hopital Cavale Blanche ( Site 1314); 🇫🇷 Brest, Bretagne, France

CHU Caen Normandie ( Site 1325); 🇫🇷 Caen, Calvados, France

CHU de Besancon ( Site 1303); 🇫🇷 Besançon, Doubs, France

Hopital Haut Leveque ( Site 1312); 🇫🇷 Bordeaux, Gironde, France

CHU de Toulouse - Hopital Larrey ( Site 1315); 🇫🇷 Toulouse, Haute-Garonne, France

C.H.U. de Tours - Hopital Bretonneau ( Site 1310); 🇫🇷 Tours, Indre-et-Loire, France

Hopital Nord Laennec ( Site 1309); 🇫🇷 Nantes, Loire-Atlantique, France

Centre Hospitalier Universitaire de Saint-Etienne ( Site 1302); 🇫🇷 Saint-Priest-en-Jarez, Loire, France

CHU Angers ( Site 1313); 🇫🇷 Angers, Maine-et-Loire, France

C.H.U. de Nancy. Hopital de Brabois Adultes ( Site 1308); 🇫🇷 Vandoeuvre Les Nancy, Meurthe-et-Moselle, France

CHU - Hopital de Bicetre ( Site 1304); 🇫🇷 Le Kremlin Bicetre, Val-de-Marne, France

CHU de Poitiers ( Site 1316); 🇫🇷 Poitiers, Vienne, France

Universitaetsklinikum Heidelberg ( Site 1509); 🇩🇪 Heidelberg, Baden-Wurttemberg, Germany

Krankenhaus Neuwittelsbach ( Site 1510); 🇩🇪 Muenchen, Bayern, Germany

Universitaetsklinik Regensburg ( Site 1503); 🇩🇪 Regensburg, Bayern, Germany

Medizinische Hochschule Hannover ( Site 1505); 🇩🇪 Hannover, Niedersachsen, Germany

Universitaetsklinikum Giessen und Marburg GmbH ( Site 1512); 🇩🇪 Bad Oeynhausen, Nordrhein-Westfalen, Germany

Uniklinik Köln ( Site 1511); 🇩🇪 Koln, Nordrhein-Westfalen, Germany

Universitatsklinikum des Saarlandes ( Site 1513); 🇩🇪 Homburg, Saarland, Germany

Universitaetsklinik und Poliklinik Halle/Saale ( Site 1502); 🇩🇪 Halle, Sachsen-Anhalt, Germany

Universitaetsklinikum Carl Gustav Carus ( Site 1501); 🇩🇪 Dresden, Sachsen, Germany

Universitatsklinikum Leipzig ( Site 1508); 🇩🇪 Leipzig, Sachsen, Germany

DRK Kliniken Berlin Westend ( Site 1507); 🇩🇪 Berlin, Germany

Onassis Cardiac Surgery Center ( Site 3602); 🇬🇷 Athens, Attiki, Greece

Evangelismos General Hospital of Athens ( Site 3605); 🇬🇷 Athina, Attiki, Greece

Attikon University General Hospital of Athens ( Site 3604); 🇬🇷 Haidari, Attiki, Greece

AHEPA University General Hospital of Thessaloniki ( Site 3601); 🇬🇷 Thessaloniki, Greece

Assuta Ashdod Medical Center ( Site 1710); 🇮🇱 Ashdod, Israel

Lady Davis Carmel Medical Center ( Site 1705); 🇮🇱 Haifa, Israel

Hadassah Medical Center ( Site 1711); 🇮🇱 Jerusalem, Israel

Sheba Medical Center ( Site 1701); 🇮🇱 Tel Hashomer, Israel

Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) ( Site 2405); 🇮🇹 Trieste, Friuli-Venezia Giulia, Italy

Ospedale S. Giuseppe Multimedica ( Site 2403); 🇮🇹 Milan, Lombardia, Italy

Azienda Ospedaliera San Gerardo di Monza ( Site 2406); 🇮🇹 Monza, Monza E Brianza, Italy

Azienda Ospedaliera R. N. V. Monaldi ( Site 2407); 🇮🇹 Napoli, Italy

La Sapienza-Università di Roma-Policlinico Umberto I ( Site 2402); 🇮🇹 Roma, Italy

Gachon University Gil Medical Center ( Site 3103); 🇰🇷 Namdong-Gu, Incheon, Korea, Republic of

Chonnam National University Hospital ( Site 3105); 🇰🇷 Gwangju, Kyonggi-do, Korea, Republic of

Samsung Medical Center ( Site 3106); 🇰🇷 Seuol, Seoul, Korea, Republic of

Seoul National University Hospital ( Site 3102); 🇰🇷 Seoul, Korea, Republic of

Severance Hospital Yonsei University Health System - PPDS ( Site 3101); 🇰🇷 Seoul, Korea, Republic of

The Catholic University of Korea St. Mary s Hospital ( Site 3104); 🇰🇷 Seoul, Korea, Republic of

Radboud University Nijmegen Medical Centre ( Site 2605); 🇳🇱 Nijmegen, Gelderland, Netherlands

Maastricht University Medical Center ( Site 2603); 🇳🇱 Maastricht, Limburg, Netherlands

VU Medisch Centrum ( Site 2601); 🇳🇱 Amsterdam, Noord-Holland, Netherlands

Erasmus MC ( Site 2604); 🇳🇱 Rotterdam, Zuid-Holland, Netherlands

Waikato District Health Board ( Site 2702); 🇳🇿 Hamilton, Waikato, New Zealand

Krakowski Szpital Specjalistyczny im. Jana Pawla II ( Site 2801); 🇵🇱 Krakow, Malopolskie, Poland

Instytut Gruzlicy i Chorob Pluc w Warszawie ( Site 2802); 🇵🇱 Warszawa, Mazowieckie, Poland

Hospital Garcia de Orta ( Site 3501); 🇵🇹 Almada, Setubal, Portugal

Centro Hospitalar E Universitário De Coimbra ( Site 3502); 🇵🇹 Coimbra, Portugal

Hospital Pulido Valente ( Site 3503); 🇵🇹 Lisboa, Portugal

Institute for pulmonary diseases of Vojvodina ( Site 2906); 🇷🇸 Sremska kamenica, Juznobacki Okrug, Serbia

University Clinical Center Nis ( Site 2904); 🇷🇸 Nis, Nisavski Okrug, Serbia

Clinical Center Kragujevac ( Site 2905); 🇷🇸 Kragujevac, Sumadijski Okrug, Serbia

Clinical Center of Serbia ( Site 2901); 🇷🇸 Beograd, Serbia

Hospital Universitario Marques de Valdecilla ( Site 1601); 🇪🇸 Santander, Cantabria, Spain

Hospital Universitario de Son Espases ( Site 1611); 🇪🇸 Palma de Mallorca, Islas Baleares, Spain

Hospital Universitario Puerta de Hierro (Majadahonda) ( Site 1604); 🇪🇸 Majadahonda, Madrid, Spain

Hospital Universitari Vall de Hebron ( Site 1605); 🇪🇸 Barcelona, Spain

Hospital Universitario 12 de Octubre ( Site 1603); 🇪🇸 Madrid, Spain

Hospital Universitario La Paz ( Site 1610); 🇪🇸 Madrid, Spain

Hospital Universitario de Salamanca - Complejo Asistencial Universitario de Salamanca ( Site 1608); 🇪🇸 Salamanca, Spain

Hospital Virgen de la Salud ( Site 1607); 🇪🇸 Toledo, Spain

Skanes Universitetssjukhus Lund ( Site 3203); 🇸🇪 Lund, Skane Lan, Sweden

Hjart-lungmedicin och klinisk fysiologi ( Site 3204); 🇸🇪 Uppsala, Uppsala Lan, Sweden

Norrlands Universitetssjukhus ( Site 3205); 🇸🇪 Umea, Vasterbottens Lan, Sweden

UniversitätsSpital Zürich ( Site 3301); 🇨🇭 Zurich, Switzerland

Kaohsiung Veterans General Hospital ( Site 3702); 🇨🇳 Kaohsiung, Taiwan

China Medical University Hospital ( Site 3701); 🇨🇳 Taichung, Taiwan

National Cheng Kung University Hospital ( Site 3703); 🇨🇳 Tainan, Taiwan

Papworth Hospital NHS Foundation Trust ( Site 1208); 🇬🇧 Cambrigge, Cambridgeshire, United Kingdom

Sheffield Teaching Hospital NHS Foundation Trust ( Site 1207); 🇬🇧 Sheffield, Derbyshire, United Kingdom

Golden Jubilee National Hospital ( Site 1204); 🇬🇧 Glasgow, Glasgow City, United Kingdom

Royal Free London NHS Foundation Trust ( Site 1202); 🇬🇧 London, London, City Of, United Kingdom

Royal Brompton Hospital ( Site 1206); 🇬🇧 London, London, City Of, United Kingdom

Imperial College Healthcare NHS Trust ( Site 1203); 🇬🇧 London, London, City Of, United Kingdom

Freeman Hospital ( Site 1205); 🇬🇧 Newcastle Upon Tyne, United Kingdom