- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02878161
Predictability Studies on the Efficacy of TNF-α Inhibitors in Chinese RA From "Real World"
Screening Protein Predictive of Response to Tumor Necrosis Factor-α Inhibitors Treatment in Chinese Rheumatoid Arthritis From "Real World" and Investigating Its Mechanism Through Signal Pathway
Study Overview
Status
Conditions
Detailed Description
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- signed the consents voluntarily
- age between 18-75 years old
patients were meet the American College of Rheumatology(ACR)
- European League Against Rheumatism(EULAR) 2009 diagnostic criteria (total scores beyond 6)
- for severe RA patients DAS28-CRP≥5.1
- The participants receiving Infliximab plus Methotrexate will be invited to enroll the study.
- The participants receiving Etanercept plus Methotrexate will be invited to enroll the study.
- The participants receiving Adalimumab plus Methotrexate will be invited to enroll the study.
Exclusion Criteria:
- The patient have the disease history or the disease of cardiovascular, respiratory system, liver, gastrointestinal tract, endocrine, hematology, neurology or psychiatric disturbance, and investigator believe that there are some risks for patients with these disease history or disease when use study drugs, or these disease history or disease will disturb the interpret of data
- Patients with cancer in situ or exist the possibility of cancer malignancies
- Basically or completely loss of mobility, lack self-care ability, such as rely on a wheelchair or bed-ridden .
- Experimental examination display any of the following:
Aspartate aminotransferase or alanine aminotransferase>1.5 times of the upper limit of the normal value Total bilirubin>1.5 times of the upper limit of the normal value Total white blood cells <2500 cells/L absolute neutrophil count <1200 cells/L lymphocyte count <750 cells/L platelet<100000/L
- Patients with symptomatic herpes simplex
- Latent tuberculosis signal (PPD+++ OR T-SPOT>5 )
- Positive result of the hepatitis B virus (HBV):
HBsAg + Or HBeAg + Or HBeAg + Or HBcAb + Or HBV DNA +
- hepatitis C virus(HCV)+ or HCV RNA +
- HIV infection or HIV+
- 1 months before join the group, from a clinical point of view,patients have a serious infection caused by the virus, bacteria, fungi, or parasites
- Pregnancy 、 location 、prepare for conceive in one years or there is risk to impregnate their partners
- Patients received any biological therapies for 6 months, or participated any other clinical trials of new drugs
- A history of drug allergy
- A history of heavy drink
- vaccinate the live vaccine recently
Study Plan
How is the study designed?
Design Details
- Primary Purpose: BASIC_SCIENCE
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: A group
Infliximab plus Methotrexate , Leflunomide and NSAIDs and Glucocorticoids are permitted but not necessary included.
|
Methotrexate will be received orally with dosage of 10mg/ week for every patient and MTX dose must be stable for at least 4 weeks.
Other Names:
infliximab :intravenous injection 200mg,every times,0,2,6,14week ,4 times)
Other Names:
LEF will be permitted if patient had received for 1 month before enrollment and will not be changed for 14 weeks.
Other Names:
NSAIDs will be allowed if patient had received for 1 month before enrollment and will not be changed for 14 weeks.
Other Names:
Glucocorticoids (prednisone less than 10mg/day, or equal dosage of other similar drugs) will be permitted if the patient had received for 1 month before enrollment and the dosage will not be changed during the period.
Other Names:
|
EXPERIMENTAL: B group
Etanercept plus Methotrexate , Leflunomide and NSAIDs and Glucocorticoids are permitted but not necessary included.
|
Methotrexate will be received orally with dosage of 10mg/ week for every patient and MTX dose must be stable for at least 4 weeks.
Other Names:
LEF will be permitted if patient had received for 1 month before enrollment and will not be changed for 14 weeks.
Other Names:
NSAIDs will be allowed if patient had received for 1 month before enrollment and will not be changed for 14 weeks.
Other Names:
Glucocorticoids (prednisone less than 10mg/day, or equal dosage of other similar drugs) will be permitted if the patient had received for 1 month before enrollment and the dosage will not be changed during the period.
Other Names:
Etanercept :hypodermic injection,25mg/twice a week
Other Names:
|
EXPERIMENTAL: C group
Adalimumab plus Methotrexate , Leflunomide and NSAIDs and Glucocorticoids are permitted but not necessary included.
|
Methotrexate will be received orally with dosage of 10mg/ week for every patient and MTX dose must be stable for at least 4 weeks.
Other Names:
LEF will be permitted if patient had received for 1 month before enrollment and will not be changed for 14 weeks.
Other Names:
NSAIDs will be allowed if patient had received for 1 month before enrollment and will not be changed for 14 weeks.
Other Names:
Glucocorticoids (prednisone less than 10mg/day, or equal dosage of other similar drugs) will be permitted if the patient had received for 1 month before enrollment and the dosage will not be changed during the period.
Other Names:
Adalimumab:hypodermic injection,40mg/twice a week
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
EULAR (European League Against Rheumatism) response will be assessed among patients of 3 groups
Time Frame: Baseline, Weeks 14
|
EULAR (European League Against Rheumatism) response is based on changes of DAS28-CRP. The following good, moderate and no response are defined based on changes of DAS28-CRP from baseline to weeks 14: >1.2 units are good response; 0.6-1.2 units are moderate response; ≤0.6 units are no response. The DAS28-CRP will be calculated at every visit within the clinical database. The components of the DAS28-CRP score assessment are: Tender/Painful Joint Count (28); Swollen Joint Count (28), hsCRP, and the Subject General Health VAS assessment. This efficacy measurement will be made at baseline and weeks 14. |
Baseline, Weeks 14
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The changes of TNF level with different EULAR response will be assessed among patients of 3 groups.
Time Frame: Baseline, Weeks 14
|
The TNF level assessment is a direct measurement using ELISA by testing patients' serum. This measurement will be made at baseline and weeks 14. The classification of EULAR response and the calculation of DAS28-CRP are based on above of Primary Outcome Measure. |
Baseline, Weeks 14
|
The changes of Interest proteins with different EULAR response will be assessed among patients of 3 group.
Time Frame: Baseline, Weeks 14
|
Interest proteins will be screened by iTRAQ (isobaric tags for relative and absolute quantitation). This measurement will be made at baseline and weeks 14 by comparing part of patients with good response or no response. Interest proteins being screened will be verified by Western Blot among all patients of 3 groups. The classification of EULAR response and the calculation of DAS28-CRP are based on above of Primary Outcome Measure. |
Baseline, Weeks 14
|
The SNP (Single nucleotide polymorphism) of gene about TNF with different EULAR response will be assessed among patients of 3 groups.
Time Frame: Weeks 14
|
SNP of TNF gene will be tested by PCR-RFLP (Polymerase Chain Reaction -Restriction Fragment Length Polymorphism). This measurement will be made at weeks 14 among all 3 groups' patients. The classification of EULAR response and the calculation of DAS28-CRP are based on above of Primary Outcome Measure. |
Weeks 14
|
The SNP of gene about interest proteins with different EULAR response will be assessed among patients of 3 groups.
Time Frame: Weeks 14
|
SNP of gene about interest proteins will tested by PCR-HRM(Polymerase Chain Reaction-high resolution melting). This measurement will be made at weeks 14 among all 3 groups' patients. Interest proteins are screened and verified on above of Secondary Outcome Measure. The classification of EULAR response and the calculation of DAS28-CRP are based on above of Primary Outcome Measure. |
Weeks 14
|
Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- van Vollenhoven RF. Switching between anti-tumour necrosis factors: trying to get a handle on a complex issue. Ann Rheum Dis. 2007 Jul;66(7):849-51. doi: 10.1136/ard.2007.069872.
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- Miossec P, Verweij CL, Klareskog L, Pitzalis C, Barton A, Lekkerkerker F, Reiter S, Laslop A, Breedveld F, Abadie E, Flamion B, Dere W, Mpofu S, Goel N, Ethgen D, Mitlak B, Ormarsdottir S, Rao R, Tsouderos Y, Reginster JY; Group for Respect of Ethics and Excellence in Science (GREES). Biomarkers and personalised medicine in rheumatoid arthritis: a proposal for interactions between academia, industry and regulatory bodies. Ann Rheum Dis. 2011 Oct;70(10):1713-8. doi: 10.1136/ard.2011.154252. Epub 2011 Jul 22.
- Zeng Z, Duan Z, Zhang T, Wang S, Li G, Gao J, Ye D, Xu S, Xu J, Zhang L, Pan F. Association between tumor necrosis factor-alpha (TNF-alpha) promoter -308 G/A and response to TNF-alpha blockers in rheumatoid arthritis: a meta-analysis. Mod Rheumatol. 2013 May;23(3):489-95. doi: 10.1007/s10165-012-0699-5. Epub 2012 Jul 4.
- Kang CP, Lee KW, Yoo DH, Kang C, Bae SC. The influence of a polymorphism at position -857 of the tumour necrosis factor alpha gene on clinical response to etanercept therapy in rheumatoid arthritis. Rheumatology (Oxford). 2005 Apr;44(4):547-52. doi: 10.1093/rheumatology/keh550. Epub 2005 Feb 3.
- Miceli-Richard C, Comets E, Verstuyft C, Tamouza R, Loiseau P, Ravaud P, Kupper H, Becquemont L, Charron D, Mariette X. A single tumour necrosis factor haplotype influences the response to adalimumab in rheumatoid arthritis. Ann Rheum Dis. 2008 Apr;67(4):478-84. doi: 10.1136/ard.2007.074104. Epub 2007 Aug 2.
- Nishimoto T, Seta N, Anan R, Yamamoto T, Kaneko Y, Takeuchi T, Kuwana M. A single nucleotide polymorphism of TRAF1 predicts the clinical response to anti-TNF treatment in Japanese patients with rheumatoid arthritis. Clin Exp Rheumatol. 2014 Mar-Apr;32(2):211-7. Epub 2013 Dec 9.
- Potter C, Hyrich KL, Tracey A, Lunt M, Plant D, Symmons DP, Thomson W, Worthington J, Emery P, Morgan AW, Wilson AG, Isaacs J, Barton A; BRAGGSS. Association of rheumatoid factor and anti-cyclic citrullinated peptide positivity, but not carriage of shared epitope or PTPN22 susceptibility variants, with anti-tumour necrosis factor response in rheumatoid arthritis. Ann Rheum Dis. 2009 Jan;68(1):69-74. doi: 10.1136/ard.2007.084715. Epub 2008 Mar 28. Erratum In: Ann Rheum Dis. 2011 Aug;70(8):1519.
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- Davila-Fajardo CL, Marquez A, Pascual-Salcedo D, Moreno Ramos MJ, Garcia-Portales R, Magro C, Alegre-Sancho JJ, Balsa A, Cabeza-Barrera J, Raya E, Martin J. Confirmation of -174G/C interleukin-6 gene promoter polymorphism as a genetic marker predicting antitumor necrosis factor treatment outcome. Pharmacogenet Genomics. 2014 Jan;24(1):1-5. doi: 10.1097/FPC.0000000000000013.
- Coulthard LR, Taylor JC, Eyre S; Biologics in Rheumatoid Arthritis Genetics and Genomics; Robinson JI, Wilson AG, Isaacs JD, Hyrich K, Emery P, Barton A, Barrett JH, Morgan AW, McDermott MF. Genetic variants within the MAP kinase signalling network and anti-TNF treatment response in rheumatoid arthritis patients. Ann Rheum Dis. 2011 Jan;70(1):98-103. doi: 10.1136/ard.2010.133249. Epub 2010 Aug 30.
- Potter C, Cordell HJ, Barton A, Daly AK, Hyrich KL, Mann DA, Morgan AW, Wilson AG; Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate (BRAGGSS); Isaacs JD. Association between anti-tumour necrosis factor treatment response and genetic variants within the TLR and NFkappaB signalling pathways. Ann Rheum Dis. 2010 Jul;69(7):1315-20. doi: 10.1136/ard.2009.117309. Epub 2010 May 6.
- Tan RJ, Gibbons LJ, Potter C, Hyrich KL, Morgan AW, Wilson AG, Isaacs JD; BRAGGSS; Barton A. Investigation of rheumatoid arthritis susceptibility genes identifies association of AFF3 and CD226 variants with response to anti-tumour necrosis factor treatment. Ann Rheum Dis. 2010 Jun;69(6):1029-35. doi: 10.1136/ard.2009.118406. Epub 2010 May 5. Erratum In: Ann Rheum Dis. 2011 Aug;70(8):1519.
- Cui J, Saevarsdottir S, Thomson B, Padyukov L, van der Helm-van Mil AH, Nititham J, Hughes LB, de Vries N, Raychaudhuri S, Alfredsson L, Askling J, Wedren S, Ding B, Guiducci C, Wolbink GJ, Crusius JB, van der Horst-Bruinsma IE, Herenius M, Weinblatt ME, Shadick NA, Worthington J, Batliwalla F, Kern M, Morgan AW, Wilson AG, Isaacs JD, Hyrich K, Seldin MF, Moreland LW, Behrens TW, Allaart CF, Criswell LA, Huizinga TW, Tak PP, Bridges SL Jr, Toes RE, Barton A, Klareskog L, Gregersen PK, Karlson EW, Plenge RM. Rheumatoid arthritis risk allele PTPRC is also associated with response to anti-tumor necrosis factor alpha therapy. Arthritis Rheum. 2010 Jul;62(7):1849-61. doi: 10.1002/art.27457.
- Krintel SB, Essioux L, Wool A, Johansen JS, Schreiber E, Zekharya T, Akiva P, Ostergaard M, Hetland ML. CD6 and syntaxin binding protein 6 variants and response to tumor necrosis factor alpha inhibitors in Danish patients with rheumatoid arthritis. PLoS One. 2012;7(6):e38539. doi: 10.1371/journal.pone.0038539. Epub 2012 Jun 7.
- Liu C, Batliwalla F, Li W, Lee A, Roubenoff R, Beckman E, Khalili H, Damle A, Kern M, Furie R, Dupuis J, Plenge RM, Coenen MJ, Behrens TW, Carulli JP, Gregersen PK. Genome-wide association scan identifies candidate polymorphisms associated with differential response to anti-TNF treatment in rheumatoid arthritis. Mol Med. 2008 Sep-Oct;14(9-10):575-81. doi: 10.2119/2008-00056.Liu.
- Cui J, Stahl EA, Saevarsdottir S, Miceli C, Diogo D, Trynka G, Raj T, Mirkov MU, Canhao H, Ikari K, Terao C, Okada Y, Wedren S, Askling J, Yamanaka H, Momohara S, Taniguchi A, Ohmura K, Matsuda F, Mimori T, Gupta N, Kuchroo M, Morgan AW, Isaacs JD, Wilson AG, Hyrich KL, Herenius M, Doorenspleet ME, Tak PP, Crusius JB, van der Horst-Bruinsma IE, Wolbink GJ, van Riel PL, van de Laar M, Guchelaar HJ, Shadick NA, Allaart CF, Huizinga TW, Toes RE, Kimberly RP, Bridges SL Jr, Criswell LA, Moreland LW, Fonseca JE, de Vries N, Stranger BE, De Jager PL, Raychaudhuri S, Weinblatt ME, Gregersen PK, Mariette X, Barton A, Padyukov L, Coenen MJ, Karlson EW, Plenge RM. Genome-wide association study and gene expression analysis identifies CD84 as a predictor of response to etanercept therapy in rheumatoid arthritis. PLoS Genet. 2013 Mar;9(3):e1003394. doi: 10.1371/journal.pgen.1003394. Epub 2013 Mar 28.
- Umicevic Mirkov M, Cui J, Vermeulen SH, Stahl EA, Toonen EJ, Makkinje RR, Lee AT, Huizinga TW, Allaart R, Barton A, Mariette X, Miceli CR, Criswell LA, Tak PP, de Vries N, Saevarsdottir S, Padyukov L, Bridges SL, van Schaardenburg DJ, Jansen TL, Dutmer EA, van de Laar MA, Barrera P, Radstake TR, van Riel PL, Scheffer H, Franke B, Brunner HG, Plenge RM, Gregersen PK, Guchelaar HJ, Coenen MJ. Genome-wide association analysis of anti-TNF drug response in patients with rheumatoid arthritis. Ann Rheum Dis. 2013 Aug;72(8):1375-81. doi: 10.1136/annrheumdis-2012-202405. Epub 2012 Dec 11.
- Marquez A, Ferreiro-Iglesias A, Davila-Fajardo CL, Montes A, Pascual-Salcedo D, Perez-Pampin E, Moreno-Ramos MJ, Garcia-Portales R, Navarro F, Moreira V, Magro C, Caliz R, Ferrer MA, Alegre-Sancho JJ, Joven B, Carreira P, Balsa A, Vasilopoulos Y, Sarafidou T, Cabeza-Barrera J, Narvaez J, Raya E, Canete JD, Fernandez-Nebro A, Ordonez Mdel C, de la Serna AR, Magallares B, Gomez-Reino JJ, Gonzalez A, Martin J. Lack of validation of genetic variants associated with anti-tumor necrosis factor therapy response in rheumatoid arthritis: a genome-wide association study replication and meta-analysis. Arthritis Res Ther. 2014 Mar 11;16(2):R66. doi: 10.1186/ar4504.
- Lindberg J, Wijbrandts CA, van Baarsen LG, Nader G, Klareskog L, Catrina A, Thurlings R, Vervoordeldonk M, Lundeberg J, Tak PP. The gene expression profile in the synovium as a predictor of the clinical response to infliximab treatment in rheumatoid arthritis. PLoS One. 2010 Jun 25;5(6):e11310. doi: 10.1371/journal.pone.0011310.
- Pachot A, Arnaud B, Marrote H, Cazalis MA, Diasparra J, Gouraud A, Mougin B, Miossec P. Increased tumor necrosis factor-alpha mRNA expression in whole blood from patients with rheumatoid arthritis: reduction after infliximab treatment does not predict response. J Rheumatol. 2007 Nov;34(11):2158-61. Epub 2007 Sep 15.
- Sekiguchi N, Kawauchi S, Furuya T, Inaba N, Matsuda K, Ando S, Ogasawara M, Aburatani H, Kameda H, Amano K, Abe T, Ito S, Takeuchi T. Messenger ribonucleic acid expression profile in peripheral blood cells from RA patients following treatment with an anti-TNF-alpha monoclonal antibody, infliximab. Rheumatology (Oxford). 2008 Jun;47(6):780-8. doi: 10.1093/rheumatology/ken083. Epub 2008 Apr 3.
- Julia A, Erra A, Palacio C, Tomas C, Sans X, Barcelo P, Marsal S. An eight-gene blood expression profile predicts the response to infliximab in rheumatoid arthritis. PLoS One. 2009 Oct 22;4(10):e7556. doi: 10.1371/journal.pone.0007556.
- Stuhlmuller B, Haupl T, Hernandez MM, Grutzkau A, Kuban RJ, Tandon N, Voss JW, Salfeld J, Kinne RW, Burmester GR. CD11c as a transcriptional biomarker to predict response to anti-TNF monotherapy with adalimumab in patients with rheumatoid arthritis. Clin Pharmacol Ther. 2010 Mar;87(3):311-21. doi: 10.1038/clpt.2009.244. Epub 2009 Dec 23.
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- Wright HL, Thomas HB, Moots RJ, Edwards SW. Interferon gene expression signature in rheumatoid arthritis neutrophils correlates with a good response to TNFi therapy. Rheumatology (Oxford). 2015 Jan;54(1):188-93. doi: 10.1093/rheumatology/keu299. Epub 2014 Aug 13.
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- Visvanathan S, Rahman MU, Keystone E, Genovese M, Klareskog L, Hsia E, Mack M, Buchanan J, Elashoff M, Wagner C. Association of serum markers with improvement in clinical response measures after treatment with golimumab in patients with active rheumatoid arthritis despite receiving methotrexate: results from the GO-FORWARD study. Arthritis Res Ther. 2010;12(6):R211. doi: 10.1186/ar3188. Epub 2010 Nov 17.
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Study record dates
Study Major Dates
Study Start
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Immune System Diseases
- Autoimmune Diseases
- Joint Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Connective Tissue Diseases
- Arthritis
- Arthritis, Rheumatoid
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Analgesics
- Sensory System Agents
- Analgesics, Non-Narcotic
- Antirheumatic Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antiemetics
- Gastrointestinal Agents
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Neuroprotective Agents
- Protective Agents
- Dermatologic Agents
- Reproductive Control Agents
- Abortifacient Agents, Nonsteroidal
- Abortifacient Agents
- Folic Acid Antagonists
- Methylprednisolone
- Etanercept
- Adalimumab
- Anti-Inflammatory Agents
- Prednisone
- Methotrexate
- Infliximab
- Leflunomide
- Anti-Inflammatory Agents, Non-Steroidal
- Glucocorticoids
Other Study ID Numbers
- XYEYY-GZ81571599-20160118-1
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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Assistance Publique - Hôpitaux de ParisSociete Francaise de RhumatologieRecruiting
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Amsterdam UMC, location VUmcEuropean CommissionCompletedRheumatoId ArthritisNetherlands, Germany, Portugal, Italy, Hungary, Romania, Slovakia
Clinical Trials on methotrexate(necessary)
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The First Affiliated Hospital of Soochow UniversityEnrolling by invitation
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Radboud University Medical CenterZonMw: The Netherlands Organisation for Health Research and DevelopmentCompletedPregnancy | Male Infertility | Female InfertilityNetherlands
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University of Central LancashireLancashire Care NHS Foundation TrustUnknownPrelabour Rupture of Membranes at TermUnited Kingdom
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University Hospital HeidelbergAstraZenecaRecruitingAcute Myocardial InfarctionGermany
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Sun Yat-Sen Memorial Hospital of Sun Yat-Sen UniversityRecruitingBreast Neoplasm FemaleChina
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Gregory GilotThe Cleveland Clinic; LifeNet HealthActive, not recruiting
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University of MalayaCompleted
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Vanderbilt University Medical CenterCompletedCrohn Disease | Rectal FistulaUnited States
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The Second Affiliated Hospital of Chongqing Medical...UnknownHepatitis B, Chronic | Sustained Virologic ResponseChina
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Hospital San Carlos, MadridHospital Universitario La Fe; Spanish Association of Surgeons (AEC); Complejo...Enrolling by invitationColon Cancer | Adult Patients | Intestinal Continuity (Anastomosis)Spain