Ta strona została przetłumaczona automatycznie i dokładność tłumaczenia nie jest gwarantowana. Proszę odnieść się do angielska wersja za tekst źródłowy.

An Open-Label, Prospective Study to Assess the Safety and Effectiveness of Adalimumab in Patients With Moderate to Severe Plaque Psoriasis in the Russian Federation

22 września 2014 zaktualizowane przez: AbbVie (prior sponsor, Abbott)

An Open-Label, Prospective Study to Assess the Safety and Effectiveness of Adalimumab (Humira®) in Patients With Moderate to Severe Plaque Psoriasis in the Russian Federation

This is an open-label study designed to establish the safety and effectiveness of adalimumab in the treatment of moderate to severe plaque psoriasis after 24 weeks of treatment.

Przegląd badań

Status

Zakończony

Interwencja / Leczenie

Szczegółowy opis

During the treatment period, participants will receive an initial adalimumab 80 milligram (mg) subcutaneous (sc) dose, followed by adalimumab 40 mg sc every other week starting one week after initial dose. Safety and effectiveness assessments will be completed at Baseline, Week 2, Week 4, Week 8, Week 12, Week 16 and Week 24. Participants may discontinue adalimumab treatment at any time during study participation. Participants that end study participation early will have a Premature Discontinuation visit. All participants who do not initiate commercial Humira® will have a follow-up phone call 70 days after the last administration of study drug to obtain information on any new or ongoing Adverse Events (AEs). The 70-day follow-up phone call will not be required for any participant that initiates adalimumab therapy not supplied in the context of the clinical trial after the end of study participation.

Typ studiów

Interwencyjne

Zapisy (Rzeczywisty)

50

Faza

  • Faza 4

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

      • Ekaterinburg, Federacja Rosyjska, 620076
        • Site Reference ID/Investigator# 67547
      • Kazan, Federacja Rosyjska, 420012
        • Site Reference ID/Investigator# 78433
      • Moscow, Federacja Rosyjska, 107076
        • Site Reference ID/Investigator# 67542
      • Saratov, Federacja Rosyjska, 410028
        • Site Reference ID/Investigator# 67546
      • Smolensk, Federacja Rosyjska, 214018
        • Site Reference ID/Investigator# 78417
      • St. Petersburg, Federacja Rosyjska, 190013
        • Site Reference ID/Investigator# 78413
      • St. Petersburg, Federacja Rosyjska, 194044
        • Site Reference ID/Investigator# 67545

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

18 lat i starsze (Dorosły, Starszy dorosły)

Akceptuje zdrowych ochotników

Nie

Płeć kwalifikująca się do nauki

Wszystko

Opis

Inclusion Criteria:

A patient will be eligible for study participation if he/she meets the following criteria:

  1. Male and female patients ≥ 18 years of age.
  2. Clinical diagnosis of psoriasis for at least 6 months as determined by patient interview of his/her medical history and confirmation of diagnosis through physical examination by the investigator.
  3. Stable plaque psoriasis for at least 2 months before Screening and Baseline visits as determined by patient interview of his/her medical history.
  4. Moderate to severe plaque psoriasis defined by ≥ 10% Body Surface Area (BSA) involvement at the Baseline visit.
  5. PASI (Psoriasis Area and Severity Index) score ≥ 10 at the Baseline visit.

Exclusion Criteria:

  1. Diagnosis of erythrodermic psoriasis, pustular psoriasis, medication induced or medication-exacerbated psoriasis or new onset of guttate psoriasis.
  2. Diagnosis of other active skin diseases or skin infections (bacterial, fungal, or viral) that may interfere with evaluation of psoriasis.
  3. Patient who cannot discontinue topical therapies for the treatment of psoriasis such as corticosteroids, vitamin D analogs, or retinoids at least 14 days prior to the Baseline (Week 0) visit and during the study. Participants are allowed to use:

    • Shampoos that contain no corticosteroid;
    • Bland (without beta or alpha hydroxy acids or containing no psoriasis treatment) emollients;
    • Low potency topical corticosteroids on the palms, soles, face, inframammary area, and groin only.
  4. Patient who cannot avoid UVB (Ultraviolet-B) phototherapy for at least 14 days prior to the Baseline (Week 0) visit and during the study.
  5. Patient who cannot avoid PUVA (psoralen + ultraviolet A) phototherapy for at least 28 days prior to the Baseline (Week 0) visit and during the study.

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Nie dotyczy
  • Model interwencyjny: Zadanie dla jednej grupy
  • Maskowanie: Brak (otwarta etykieta)

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Inny: Adalimumab
Participants received an initial adalimumab 80 mg subcutaneous dose, followed by adalimumab 40 mg subcutaneous every other week starting one week after the initial dose for up to 24 weeks.
Inne nazwy:
  • ABT-D2E7
  • Humira

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Percentage of Participants Achieving a Psoriasis Area and Severity Index 75 (PASI 75) Response at Week 24
Ramy czasowe: Baseline and Week 24
The percentage of participants with a ≥ 75% reduction (improvement) in Psoriasis Area and Severity Index (PASI) score from Baseline. PASI is a combination of the intensity of psoriasis, assessed by the erythema (reddening), induration (plaque thickness) and desquamation (scaling) on a scale from no symptoms (0), slight (1), moderate (2), marked (3) or very marked (4), together with the percentage of the area affected, rated on a scale from 0 to 6. PASI scoring is performed at four body areas, the head, arms, trunk, and legs. The total PASI score ranges from 0 to 72. The higher the total score, the more severe the disease.
Baseline and Week 24

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
Percentage of Participants Achieving a Physician's Global Assessment of Clear
Ramy czasowe: Weeks 2, 4, 8, 12, 16 and 24

The Physician's Global Assessment (PGA) is a 6-point scale used to measure the severity of disease at the time of the qualified investigator's evaluation of the participant. The degree of overall lesion severity was evaluated using the following categories:

  • 0: No evidence of scaling, erythema, or plaque elevation, overall score of cleared;
  • 1: Occasional fine scale over <5% of lesions, faint erythema, minimal plaque elevation, overall score of minimal;
  • 2: Fine scale dominates, light red coloration, mild plaque elevation, overall score of mild;
  • 3: Course scale dominates, moderate red coloration, moderate plaque elevation, overall score of moderate;
  • 4: Thick non-tenacious scale dominates, bright red coloration, marked plaque elevation, overall score of marked;
  • 5: Very thick tenacious scale predominates, dusky to deep red coloration, severe plaque elevation, overall score of severe.

The percentage of participants achieving a PGA score of clear (0) is reported.

Weeks 2, 4, 8, 12, 16 and 24
Percentage of Participants Achieving a Physician's Global Assessment of Clear or Minimal
Ramy czasowe: Weeks 2, 4, 8, 12, 16 and 24

The Physician's Global Assessment (PGA) is a 6-point scale used to measure the severity of disease at the time of the qualified investigator's evaluation of the participant. The degree of overall lesion severity was evaluated using the following categories:

  • 0: No evidence of scaling, erythema, or plaque elevation, overall score of cleared;
  • 1: Occasional fine scale over <5% of lesions, faint erythema, minimal plaque elevation, overall score of minimal;
  • 2: Fine scale dominates, light red coloration, mild plaque elevation, overall score of mild;
  • 3: Course scale dominates, moderate red coloration, moderate plaque elevation, overall score of moderate;
  • 4: Thick non-tenacious scale dominates, bright red coloration, marked plaque elevation, overall score of marked;
  • 5: Very thick tenacious scale predominates, dusky to deep red coloration, severe plaque elevation, overall score of severe.

The percentage of participants achieving a PGA score of clear (0) or minimal (1) is reported.

Weeks 2, 4, 8, 12, 16 and 24
Percentage of Participants Achieving a One Grade Improvement in Physician's Global Assessment (PGA)
Ramy czasowe: Baseline and Weeks 2, 4, 8, 12, 16 and 24

The PGA is a 6-point scale used to measure the severity of disease at the time of the qualified investigator's evaluation of the participant. The degree of overall lesion severity was evaluated using the following categories:

  • 0: No evidence of scaling, erythema, or plaque elevation, overall score of cleared;
  • 1: Occasional fine scale over <5% of lesions, faint erythema, minimal plaque elevation, overall score of minimal;
  • 2: Fine scale dominates, light red coloration, mild plaque elevation, overall score of mild;
  • 3: Course scale dominates, moderate red coloration, moderate plaque elevation, overall score of moderate;
  • 4: Thick non-tenacious scale dominates, bright red coloration, marked plaque elevation, overall score of marked;
  • 5: Very thick tenacious scale predominates, dusky to deep red coloration, severe plaque elevation, overall score of severe.

The percentage of participants achieving a shift from Baseline to a less severe category is reported.

Baseline and Weeks 2, 4, 8, 12, 16 and 24
Percentage of Participants Achieving a PASI 50 Response
Ramy czasowe: Baseline and Weeks 2, 4, 8, 12, 16, and 24
The percentage of participants with a ≥ 50% reduction (improvement) in Psoriasis Area and Severity Index (PASI) score from Baseline. PASI is a combination of the intensity of psoriasis, assessed by the erythema (reddening), induration (plaque thickness) and desquamation (scaling) on a scale from no symptoms (0), slight (1), moderate (2), marked (3) or very marked (4), together with the percentage of the area affected, rated on a scale from 0 to 6. PASI scoring is performed at four body areas, the head, arms, trunk, and legs. The total PASI score ranges from 0 to 72. The higher the total score, the more severe the disease.
Baseline and Weeks 2, 4, 8, 12, 16, and 24
Percentage of Participants Achieving a PASI 75 Response
Ramy czasowe: Baseline and Weeks 2, 4, 8, 12, and 16
The percentage of participants with a ≥ 75% reduction (improvement) in Psoriasis Area and Severity Index (PASI) score from Baseline. PASI is a combination of the intensity of psoriasis, assessed by the erythema (reddening), induration (plaque thickness) and desquamation (scaling) on a scale from no symptoms (0), slight (1), moderate (2), marked (3) or very marked (4), together with the percentage of the area affected, rated on a scale from 0 to 6. PASI scoring is performed at four body areas, the head, arms, trunk, and legs. The total PASI score ranges from 0 to 72. The higher the total score, the more severe the disease.
Baseline and Weeks 2, 4, 8, 12, and 16
Percentage of Participants Achieving a PASI 90 Response
Ramy czasowe: Baseline and Weeks 2, 4, 8, 12, 16, and 24
The percentage of participants with a ≥ 90% reduction (improvement) in Psoriasis Area and Severity Index (PASI) score from Baseline. PASI is a combination of the intensity of psoriasis, assessed by the erythema (reddening), induration (plaque thickness) and desquamation (scaling) on a scale from no symptoms (0), slight (1), moderate (2), marked (3) or very marked (4), together with the percentage of the area affected, rated on a scale from 0 to 6. PASI scoring is performed at four body areas, the head, arms, trunk, and legs. The total PASI score ranges from 0 to 72. The higher the total score, the more severe the disease.
Baseline and Weeks 2, 4, 8, 12, 16, and 24
Percentage of Participants Achieving a PASI 100 Response
Ramy czasowe: Baseline and Weeks 2, 4, 8, 12, 16, and 24
The percentage of participants with a 100% reduction (improvement) in Psoriasis Area and Severity Index (PASI) score from Baseline. PASI is a combination of the intensity of psoriasis, assessed by the erythema (reddening), induration (plaque thickness) and desquamation (scaling) on a scale from no symptoms (0), slight (1), moderate (2), marked (3) or very marked (4), together with the percentage of the area affected, rated on a scale from 0 to 6. PASI scoring is performed at four body areas, the head, arms, trunk, and legs. The total PASI score ranges from 0 to 72. The higher the total score, the more severe the disease.
Baseline and Weeks 2, 4, 8, 12, 16, and 24
Percent Change From Baseline in Psoriasis Area and Severity Index (PASI) Score
Ramy czasowe: Baseline and Weeks 2, 4, 8, 12, 16, and 24

PASI is a combination of the intensity of psoriasis, assessed by the erythema (reddening), induration (plaque thickness) and desquamation (scaling) on a scale from no symptoms (0), slight (1), moderate (2), marked (3) or very marked (4), together with the percentage of the area affected, rated on a scale from 0 to 6. PASI scoring is performed at four body areas, the head, arms, trunk, and legs. The total PASI score ranges from 0 to 72. The higher the total score, the more severe the disease.

Change from Baseline is presented as a percentage of the Baseline value: Post-baseline value - Baseline value / Baseline value * 100. A negative change from Baseline indicates improvement.

Baseline and Weeks 2, 4, 8, 12, 16, and 24
Percent Change From Baseline in Dermatology Life Quality Index (DLQI)
Ramy czasowe: Baseline and Weeks 8, 12, and 24
The DLQI questionnaire asks participants to evaluate the degree that psoriasis has affected their quality of life in the last week, and includes the following parameters: symptoms and feelings, daily activities, leisure activities, work or school activities, personal relationships and treatment related feelings. Participants answer 10 questions on a scale from 0 (not at all) to 3 (very much); the range of the total score is 0 to 30. A score of 21 to 30 means an extremely large effect on the participant's life whereas 0-1 means that the disease has no effect at all. Change from Baseline is presented as a percentage of the Baseline value: Post-baseline value - Baseline value / Baseline value * 100. A negative change from Baseline indicates improvement.
Baseline and Weeks 8, 12, and 24
Percent Change From Baseline in Nail Psoriasis Severity Index (NAPSI)
Ramy czasowe: Baseline and Week 24

NAPSI grades nails for both nail matrix psoriasis and nail bed psoriasis. The most affected fingernail was determined at Baseline and used for the analysis.

Nail matrix psoriasis consists of any of the following: pitting, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis is the presence or absence of onycholysis, splinter hemorrhages, oil drop (salman patch) discoloration or nail bed hyperkeratosis. Scoring for each is based on the following scale:

  • 0 = none;
  • 1 = present in 1/4 nail quadrants;
  • 2 = present in 2/4 nail quadrants;
  • 3 = present in 3/4 nail quadrants;
  • 4 = present in 4/4 nail quadrants.

The sum of these two scores is the total score for the nail, and ranges from 0 (no nail psoriasis) to 8 (psoriasis in 4/4 nail quadrants). Change from Baseline is presented as a percentage of the Baseline value, calculated as: Week 24 value - Baseline value / Baseline value * 100. A negative change from Baseline indicates improvement.

Baseline and Week 24

Inne miary wyników

Miara wyniku
Opis środka
Ramy czasowe
Change From Baseline in Hemoglobin
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Hematocrit
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events. The hematocrit measures the volume of red blood cells compared to the total blood volume (red blood cells and plasma).
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Red Blood Cell Count
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Blood Cell Counts
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Erythrocyte Sedimentation Rate
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Alanine Aminotransferase
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Aspartate Aminotransferase
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Alkaline Phosphatase
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Total Bilirubin
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Creatinine
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Blood Urea Nitrogen (BUN)
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Uric Acid
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Inorganic Phosphate
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Calcium, Sodium and Potassium
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Glucose
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Albumin
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Total Protein
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Cholesterol
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Triglycerides
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in High Sensitivity C-reactive Protein (hsCRP)
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Urine pH
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Urine Specific Gravity
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events. Specific gravity is a measure of the amount of material dissolved in the urine. Specific gravity is the ratio of the density (mass of a unit volume) of a substance to the density (mass of the same unit volume) of a reference substance.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Blood Pressure
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Pulse
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Respiratory Rate
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Weight
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Change From Baseline in Body Temperature
Ramy czasowe: Baseline and Week 24 (or Early Termination Visit)
Safety variables included laboratory data, vital signs and adverse events.
Baseline and Week 24 (or Early Termination Visit)
Number of Participants With Adverse Events (AEs)
Ramy czasowe: From the first dose of study drug until 70 days after the last dose (up to 33 weeks).

An AE is any untoward medical occurrence, which does not necessarily have a causal relationship with treatment.

The investigator rated the severity of each AE as either:

Mild: The AE is transient and easily tolerated; Moderate: The AE causes the participant discomfort and interrupts usual activities.

Severe: The AE causes considerable interference with usual activities and may be incapacitating or life-threatening.

A serious adverse event (SAE) is an AE that results in death, is life-threatening, results in or prolongs hospitalization, results in congenital anomaly, persistent or significant disability/incapacity, spontaneous or elective abortion, or requires intervention to prevent a serious outcome.

Drug-related AEs are those assessed by the investigator as either probably or possibly related.

Other malignancy excludes lymphoma, hepatosplenic T-cell lymphoma (HSTCL), leukemia, non-melanoma skin cancer (NMSC), and melanoma.

From the first dose of study drug until 70 days after the last dose (up to 33 weeks).

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Śledczy

  • Dyrektor Studium: Martin Okun, MD, AbbVie

Publikacje i pomocne linki

Osoba odpowiedzialna za wprowadzenie informacji o badaniu dobrowolnie udostępnia te publikacje. Mogą one dotyczyć wszystkiego, co jest związane z badaniem.

Przydatne linki

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów

1 maja 2012

Zakończenie podstawowe (Rzeczywisty)

1 września 2013

Ukończenie studiów (Rzeczywisty)

1 września 2013

Daty rejestracji na studia

Pierwszy przesłany

7 maja 2012

Pierwszy przesłany, który spełnia kryteria kontroli jakości

17 lipca 2012

Pierwszy wysłany (Oszacować)

19 lipca 2012

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Oszacować)

1 października 2014

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

22 września 2014

Ostatnia weryfikacja

1 września 2014

Więcej informacji

Terminy związane z tym badaniem

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

Badania kliniczne na Adalimumab

Subskrybuj