AXIOMATIC-SSP: A Study on BMS-986177 for the Prevention of a Stroke in Patients Receiving Aspirin and Clopidogrel

Sponsor

Bristol-Myers Squibb (Industry)

Overall Status

Active, not recruiting

CT.gov ID

NCT03766581

Collaborator

Janssen, LP (Industry)

2,366

Enrollment

419

Locations

Arms

38.6

Anticipated Duration (Months)

5.6

Patients Per Site

0.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this clinical study is to determine whether the addition of an oral Factor XIa Inhibitor to Aspirin and Clopidogrel is more effective than standard therapy in secondary stroke prevention.

Condition or Disease	Intervention/Treatment	Phase
Acute Ischemic Stroke Transient Ischemic Attack (TIA)	Drug: BMS-986177 Other: Placebo Drug: Clopidogrel Drug: Aspirin	Phase 2

Study Design

Study Type:

Interventional

Actual Enrollment :

2366 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Primary Purpose:

Prevention

Official Title:

A Global, Phase 2, Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study of BMS-986177, an Oral Factor XIa Inhibitor, for the Prevention of New Ischemic Stroke or New Covert Brain Infarction in Patients Receiving Aspirin and Clopidogrel Following Acute Ischemic Stroke or Transient Ischemic Attack (TIA)

Actual Study Start Date :

Jan 27, 2019

Anticipated Primary Completion Date :

Apr 9, 2022

Anticipated Study Completion Date :

Apr 16, 2022

Arms and Interventions

Arm	Intervention/Treatment
Placebo Comparator: BMS-986177 Placebo Specified Dose on Specified Days	Other: Placebo Oral Administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration
Experimental: Dose 1: BMS-986177 + Aspirin + Clopidogrel Specified Dose on Specified Days	Drug: BMS-986177 Oral administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration
Experimental: Dose 2: BMS-986177 + Aspirin + Clopidogrel Specified Dose on Specified Days	Drug: BMS-986177 Oral administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration
Experimental: Dose 3: BMS-986177 + Aspirin + Clopidogrel Specified Dose on Specified Days	Drug: BMS-986177 Oral administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration
Experimental: Dose 4: BMS-986177 + Aspirin + Clopidogrel Specified Dose on Specified Days	Drug: BMS-986177 Oral administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration
Experimental: Dose 5: BMS-986177 + Aspirin + Clopidogrel Specified Dose on Specified Days	Drug: BMS-986177 Oral administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration
Experimental: Dose 6: BMS-986177 + Aspirin + Clopidogrel Specified Dose on Specified Days	Drug: BMS-986177 Oral administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration
Experimental: Dose 7: BMS-986177 + Aspirin + Clopidogrel Specified Dose on Specified Days	Drug: BMS-986177 Oral administration Drug: Clopidogrel Oral administration Drug: Aspirin Oral administration

Outcome Measures

Primary Outcome Measures

Composite of new ischemic stroke during the treatment period and new covert brain infarction (FLAIR + DWI) detected by MRI [Up to 90 days]

Secondary Outcome Measures

Event rate based on bleeding according to Bleeding Academic Research Consortium (BARC) Type 3 and 5 [Up to 90 days]
Event rate based on BARC, International Society on Thrombosis and Hemostasis (ISTH) and Platelet Inhibition and Patient Outcomes (PLATO)-defined criteria [Up to 90 days]
Rate of the composite of new ischemic stroke and new covert brain infarction during the treatment period [Up to 90 days]
Location of new FLAIR + DWI lesions [Up to 90 days]
Number of new FLAIR + DWI lesions [Up to 90 days]
Volume of new FLAIR + DWI lesions [Up to 90 days]
Event rates for new ischemic, non-fatal stroke, non-fatal myocardial infarction and all-cause death during the treatment period [Up to 90 days]
Assessment of Stroke Severity by the National Institutes of Health Stroke Scale (NIHSS) [Day 21 and Day 90]
Assessment of Neurological function by the modified Rankin Scale (mRS) [Day 21 and Day 90]
Assessment of Cognitive function as by the Montreal Cognitive Assessment (MoCA) [Day 21 and Day 90]
Incidence of Adverse Events (AEs) [First dose up to 97 days]
Incidence of Serious Adverse Events (SAEs) [First dose up to 97 days]
Change from Baseline in Heart Rate [Up to 90 Days]
Change from Baseline in Blood Pressure [Up to 90 Days]
Change from Baseline in Respiratory Rate [Up to 90 Days]
Change from Baseline in Body Temperature [Up to 90 Days]
Incidence of Abnormalities in Physical Examination [Up to 90 days]
Incidence of Electrocardiogram (ECG) abnormalities [Up to 90 Days]
Change from baseline in Clinical Laboratory Value of blood [Up to 90 Days]
Change from baseline in Clinical Laboratory Value of Urine [Up to 90 Days]
Change from baseline in Clinical Laboratory Value of Blood Serum [Up to 90 Days]
Change from Baseline in Estimated Clearance (CL) [Up to 90 Days]
Change from Baseline in Volume of Distribution (Vd) [Up to 90 days]
Percent change from baseline in aPTT clotting activity during treatment [Up to 90 Days]
Percent change from baseline in Factor XI clotting activity during treatment [Up to 90 Days]

Eligibility Criteria

Criteria

Ages Eligible for Study:

40 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male and Female ≥40 years of age
Acute Ischemic Stroke or Transient Ischemic Attack
Intracranial or Extracranial Atherosclerotic Plaque proximal to the affected brain area

Exclusion Criteria:

Predicted inability to swallow study medication
Any condition that, in the opinion of the Investigator, contraindicates anticoagulant therapy or would have an unacceptable risk of bleeding
Use of thrombolytic therapy or mechanical thrombectomy for treatment of index stroke

Other protocol defined inclusion/exclusion criteria could apply

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham: The Kirklin Clinic	Birmingham	Alabama	United States	35233
2	Glendale Adventist Medical Center	Glendale	California	United States	91206
3	Long Beach Memorial Medical Center	Long Beach	California	United States	90806
4	Kaiser Permanente Los Angeles Medical Center	Los Angeles	California	United States	90027
5	UCLA Ronald Reagan University of California Los Angeles Medical Center	Los Angeles	California	United States	90095
6	UC Davis Health	Sacramento	California	United States	95817
7	Stanford Stroke Center	Stanford	California	United States	94305
8	Harbor UCLA Medical Center	Torrance	California	United States	90502
9	Christiana Care Health System	Newark	Delaware	United States	19718
10	UF Health Neurovascular Hospital	Gainesville	Florida	United States	32610
11	Sarasota Memorial Hospital	Sarasota	Florida	United States	34239
12	University of South Florida	Tampa	Florida	United States	33606
13	Augusta University	Augusta	Georgia	United States	30912
14	The Queens Medical Center	Honolulu	Hawaii	United States	96813
15	University of Illinois at Chicago	Chicago	Illinois	United States	60612
16	University of Illinois Hospital & Health Sciences System	Chicago	Illinois	United States	60612
17	Alexian Brothers Health System	Elk Grove Village	Illinois	United States	60007
18	Mercyhealth Javon Bea Hospital- Riverside	Rockford	Illinois	United States	61114
19	University of Louisville Hospital	Louisville	Kentucky	United States	40202
20	Ochsner Clinic Foundation	New Orleans	Louisiana	United States	70121
21	Sinai Hospital of Baltimore	Baltimore	Maryland	United States	21215
22	Local Institution	Boston	Massachusetts	United States	02118
23	Beth Israel Deaconess Medical Center	Boston	Massachusetts	United States	02215
24	Local Institution	Detroit	Michigan	United States	48201
25	Henry Ford Hospital	Detroit	Michigan	United States	48202
26	Local Institution	Detroit	Michigan	United States	48235
27	Ascension Providence Hospital - Novi Campus	Farmington Hills	Michigan	United States	48334
28	Local Institution	Minneapolis	Minnesota	United States	55415
29	Local Institution	Kansas City	Missouri	United States	64111
30	Local Institution	Saint Louis	Missouri	United States	63104
31	Barnes Jewish Hospital	Saint Louis	Missouri	United States	63110
32	Washington University School Of Medicine	Saint Louis	Missouri	United States	63110
33	Advanced Neurology Specialists PLLC	Great Falls	Montana	United States	59405
34	Cooper University Hospital	Camden	New Jersey	United States	08103
35	Robert Wood Johnson Medical School	New Brunswick	New Jersey	United States	08901
36	SUNY Downstate Health Science University	Brooklyn	New York	United States	11203
37	Local Institution	Buffalo	New York	United States	14202
38	Local Institution	New York	New York	United States	10016
39	Columbia University Medical Center	New York	New York	United States	10032
40	Duke University Medical Center	Butner	North Carolina	United States	27509-1626
41	University of North Carolina at Chapel Hill	Chapel Hill	North Carolina	United States	27599
42	Guilford Neurologic Research, PA	Greensboro	North Carolina	United States	27405
43	Local Institution	Winston-Salem	North Carolina	United States	27157
44	University Hospitals Cleveland Medical Center	Cleveland	Ohio	United States	44106-5055
45	The Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
46	The Ohio State University Wexner Medical Center	Columbus	Ohio	United States	43210
47	INTEGRIS Baptist Medical Center	Oklahoma City	Oklahoma	United States	73112
48	Oregon Health and Science University	Portland	Oregon	United States	97239
49	Abington Memorial Hospital	Abington	Pennsylvania	United States	19001
50	Local Institution	Allentown	Pennsylvania	United States	18103-6381
51	Local Institution	Camp Hill	Pennsylvania	United States	17011
52	UPMC Hamot	Erie	Pennsylvania	United States	16550-0001
53	Hospital of The University of Pennsylvania	Philadelphia	Pennsylvania	United States	19104
54	Temple University Hospital	Philadelphia	Pennsylvania	United States	19140
55	WellSpan York Hospital	York	Pennsylvania	United States	17403
56	Prisma Health-Midlands	Columbia	South Carolina	United States	29203
57	Vanderbilt University Medical Center	Nashville	Tennessee	United States	37232
58	Dell Seton Medical School at The University of Texas - Stroke Institute	Austin	Texas	United States	78701
59	Neurology Consultants of Dallas, PA	Dallas	Texas	United States	75321
60	Local Institution	Dallas	Texas	United States	75390-88520
61	University Medical center of El Paso	El Paso	Texas	United States	79905
62	Methodist Neurological Institute	Houston	Texas	United States	77030
63	University of Texas Health Science Center at Houston	Houston	Texas	United States	77030
64	Baylor Scott and White Research Institute	Temple	Texas	United States	76508
65	Local Institution	Richmond	Virginia	United States	23298
66	Local Institution	Milwaukee	Wisconsin	United States	53226
67	Local Institution	Caba	Buenos Aires	Argentina	1115
68	Local Institution	Caba	Buenos Aires	Argentina	C1199ABB
69	Local Institution	Caba	Buenos Aires	Argentina	C1428AQK
70	Local Institution	Ciudad Autonoma de Buenos Aires	Buenos Aires	Argentina	C1180AAX
71	Local Institution	Lomas de Zamora	Buenos Aires	Argentina	1832
72	Local Institution	Buenos Aires		Argentina	1437
73	Local Institution	Buenos Aires		Argentina	C1425DND
74	Local Institution	Buenos Aires		Argentina	C1425
75	Local Institution	Santa Fe		Argentina	3000
76	Local Institution	Randwick	New South Wales	Australia	2031
77	Local Institution	Sydney	New South Wales	Australia	2170
78	Local Institution	Southport	Queensland	Australia	4215
79	Local Institution	Adelaide	South Australia	Australia	5000
80	Local Institution	Launceston	Tasmania	Australia	7250
81	Local Institution	Clayton	Victoria	Australia	3168
82	Local Institution	Heidelberg	Victoria	Australia	3084
83	Local Institution	Murdoch	Western Australia	Australia	6150
84	Local Institution	Klagenfurt Am Woerthersee		Austria	9020
85	Local Institution	St. Pölten		Austria	3100
86	Local Institution	Vocklabruck		Austria	4840
87	Local Institution	Wien		Austria	1160
88	Local Institution - 0192	Yvoir	Namur	Belgium	5530
89	Local Institution	Brasschaat		Belgium	2930
90	Local Institution	Bruges		Belgium	8000
91	Local Institution	Brussels		Belgium	1020
92	Local Institution	Brussels		Belgium	1200
93	Local Institution	Brussel		Belgium	1090
94	Local Institution	Bruxelles		Belgium	1070
95	Local Institution	Edegem		Belgium	2650
96	Local Institution	Gent		Belgium	9000
97	Local Institution	Kortrijk		Belgium	8500
98	Local Institution	Leuven		Belgium	3000
99	Local Institution	Liege		Belgium	4000
100	Local Institution	Fortaleza	Ceara	Brazil	60175-295
101	Local Institution	Uberaba	Minas Gerais	Brazil	38025-260
102	Local Institution	Curitiba	Parana	Brazil	80060-900
103	Local Institution	Porto Alegre	Rio Grande Do Sul	Brazil	90035-903
104	Local Institution	Joinville	Santa Catarina	Brazil	89202 165
105	Local Institution	Botucatu	SAO Paulo	Brazil	18618-686
106	Local Institution	Campinas	SAO Paulo	Brazil	13083-970
107	Local Institution	Ribeirao Preto	SAO Paulo	Brazil	14051-140
108	Local Institution	Santo Andre	SAO Paulo	Brazil	09030-010
109	Local Institution	São Paulo	SAO Paulo	Brazil	01221-020
110	Local Institution	São Paulo	SAO Paulo	Brazil	04024-002
111	Local Institution	Calgary	Alberta	Canada	T2N 4N1
112	Local Institution	Edmonton	Alberta	Canada	T6G 2G3
113	Local Institution	Lethbridge	Alberta	Canada	T1J 0N9
114	Local Institution	New Westminster	British Columbia	Canada	V3L 0E3
115	Local Institution	Vancouver	British Columbia	Canada	V5Z 1M9
116	Local Institution	Hamilton	Ontario	Canada	L8L 2X2
117	Local Institution	Kingston	Ontario	Canada	K7L 2V7
118	Local Institution	London	Ontario	Canada	N6A 5A5
119	Local Institution	Toronto	Ontario	Canada	M4N 3M5
120	Local Institution	Toronto	Ontario	Canada	M5B 1W8
121	Local Institution	Chicoutimi	Quebec	Canada	G7H 5H6
122	Local Institution	Greenfield Park	Quebec	Canada	J4V 2H1
123	Local Institution	Montreal	Quebec	Canada	H4A3J1
124	Local Institution	Quebec		Canada	G1J 1Z4
125	Local Institution	Valdivia	Los Rios	Chile	5090145
126	Local Institution	Vina del Mar	Valparaiso	Chile	2520997
127	Local Institution	Los Angeles		Chile	441055
128	Local Institution	Beijing	Beijing	China	100070
129	Local Institution	Guangzhou	Guangdong	China	510080
130	Local Institution	Haikou	Hainan	China	570311
131	Local Institution	Daqing	Heilongjiang	China	163001
132	Local Institution	Zhengzhou	Henan	China	450052
133	Local Institution	Nantong	Jiangsu	China	226001
134	Local Institution	Yangzhou	Jiangsu	China	225001
135	Local Institution	Changchun	Jilin	China	130021
136	Local Institution	Shenyang	Liaoning	China	110016
137	Local Institution	Qingdao	Shandong	China	266000
138	Local Institution	YanTai	Shandong	China	264000
139	Local Institution	Wenzhou	Zhejiang	China	325000
140	Local Institution	Brno		Czechia	656 91
141	Local Institution	Ceske Budejovice		Czechia	370 87
142	Local Institution	Jihlava		Czechia	586 33
143	Local Institution	Olomouc		Czechia	77520
144	Local Institution	Ostrava		Czechia	703 00
145	Local Institution	Praha 2		Czechia	128 21
146	Local Institution	Aalborg		Denmark	9000
147	Local Institution	Aarhus N		Denmark	8200
148	Local Institution	Copenhagen		Denmark	2400
149	Local Institution	Glostrup		Denmark	2600
150	Local Institution	Herlev		Denmark	2730
151	Local Institution - 0111	Helsinki	Etelä-Suomen Lääni	Finland	00290
152	Local Institution	Lappeenranta		Finland	53130
153	Local Institution	Turku		Finland	FI-20520
154	Local Institution	Bordeaux		France	33000
155	Local Institution	Bourg-en-Bresse		France	01012
156	Local Institution	Brest		France	29200
157	Local Institution	Caen		France	14033
158	Local Institution	Créteil		France	94010
159	Local Institution	Lille		France	59037
160	Local Institution	Limoges Cedex		France	87042
161	Local Institution	Marseille		France	13385
162	Local Institution	Montpellier Cedex 5		France	34295
163	Local Institution	Nancy		France	54035
164	Local Institution	Nimes		France	30029
165	Local Institution	Paris cedex 10		France	75475
166	Local Institution	Paris		France	75013
167	Local Institution	Paris		France	75018
168	Local Institution	Paris		France	75019
169	Local Institution	Rouen Cedex		France	76031
170	Local Institution	Toulouse Cedex 9		France	31059
171	Local Institution	Altenburg		Germany	04600
172	Local Institution	Berlin		Germany	12203
173	Local Institution	Berlin		Germany	12351
174	Local Institution	Bielefeld		Germany	33617
175	Local Institution	Bonn		Germany	53127
176	Local Institution	Bremen		Germany	28755
177	Local Institution	Dresden		Germany	01307
178	Local Institution	Erlangen		Germany	91054
179	Local Institution	Essen		Germany	45131
180	Local Institution	Frankfurt Am Maim		Germany	65929
181	Local Institution	Frankfurt am Main		Germany	60528
182	Local Institution	Gießen		Germany	35392
183	Local Institution - 0056	Hamburg		Germany	20246
184	Local Institution	Hamburg		Germany	22043
185	Local Institution	Hamburg		Germany	22763
186	Local Institution	Hannover		Germany	D30625
187	Local Institution	Heidelberg		Germany	69120
188	Local Institution	Leipzig		Germany	04103
189	Local Institution	Lübeck		Germany	23538
190	Local Institution	Magdeburg		Germany	39120
191	Local Institution	Minden		Germany	32429
192	Local Institution	Munster		Germany	48149
193	Local Institution	Osnabruck		Germany	49076
194	Local Institution	Regensburg		Germany	93053
195	Local Institution	Sande		Germany	26452
196	Local Institution	Siegen		Germany	57076
197	Local Institution	Sindelfingen		Germany	71065
198	Local Institution	Tubingen		Germany	72076
199	Local Institution	Ulm		Germany	89081
200	Local Institution - 0438	Athina	Attiki	Greece	115 21
201	Local Institution	Athens		Greece	106 76
202	Local Institution	Athens		Greece	11525
203	Local Institution	Athens		Greece	11526
204	Local Institution - 0373	Athens		Greece	11527
205	Local Institution	Athens		Greece	11527
206	Local Institution	Athens		Greece	11528
207	Local Institution	Athens		Greece	12461
208	Local Institution	Crete		Greece	71110
209	Local Institution - 0333	Ioannina		Greece	45110
210	Local Institution - 0365	Ioannina		Greece	45110
211	Local Institution	Ioannina		Greece	45445
212	Local Institution	Larissa,		Greece	41110
213	Local Institution	Larissa		Greece	41110
214	Local Institution	Larissa		Greece	41221
215	Local Institution	Neo Faliro		Greece	18547
216	Local Institution	Patras		Greece	26500
217	Local Institution	Pireaus		Greece	18536
218	Local Institution	Thessaloniki		Greece	54621
219	Local Institution	Thessaloniki		Greece	54636
220	Local Institution	Thessaloniki		Greece	54642
221	Local Institution	Thessaloniki		Greece	56403
222	Local Institution	Thessaloniki		Greece	57010
223	Local Institution	Hong Kong		Hong Kong
224	Local Institution	Budapest		Hungary	1083
225	Local Institution	Budapest		Hungary	1106
226	Local Institution	Budapest		Hungary	1134
227	Local Institution	Budapest		Hungary	1145
228	Local Institution	Debrecen		Hungary	4032
229	Local Institution	Gyor		Hungary	9024
230	Local Institution	Kistarcsa		Hungary	02143
231	Local Institution	Kisvárda		Hungary	4600
232	Local Institution	Miskolc		Hungary	3526
233	Local Institution	Nyíregyháza		Hungary	4400
234	Local Institution	Pecs		Hungary	7624
235	Local Institution - 0133	Szeged		Hungary	6725
236	Local Institution	Zalaegerszeg		Hungary	8900
237	Local Institution	Beer-Sheva		Israel	85025
238	Local Institution	Haifa		Israel	31096
239	Local Institution	Haifa		Israel	34362
240	Local Institution	Jerusalem		Israel	91031
241	Local Institution	Jerusalem		Israel	91120
242	Local Institution	Nahariya		Israel	22100
243	Local Institution	Petach Tikva		Israel	4941492
244	Local Institution	Ramat-Gan		Israel	52621
245	Local Institution	Tel Aviv		Israel	64239
246	Local Institution - 0151	Ancona	Marche	Italy	60020
247	Local Institution	Bologna		Italy	40133
248	Local Institution	Cagliari		Italy	09134
249	Local Institution	Genova		Italy	16132
250	Local Institution	Milano		Italy	20132
251	Local Institution	Modena		Italy	1355-41126
252	Local Institution	Negrar		Italy	37024
253	Local Institution	Pavia		Italy	27100
254	Local Institution	Perugia		Italy	06012
255	Local Institution	Perugia		Italy	06129
256	Local Institution	Roma		Italy	00161
257	Local Institution	Rome		Italy	00152
258	Local Institution	Verona		Italy	37126
259	Local Institution	Vibo Valentia		Italy	89900
260	Local Institution	Kasugai	Aichi	Japan	487-0016
261	Local Institution	Nagoya-shi	Aichi	Japan	4600001
262	Local Institution	Toyoake Shi	Aichi	Japan	4701192
263	Local Institution	Toyohashi-shi	Aichi	Japan	440-8510
264	Local Institution	Toyota-shi	Aichi	Japan	471-8513
265	Local Institution	Sakura-shi	Chiba	Japan	285-8741
266	Local Institution	Chikushino-shi	Fukuoka	Japan	818-8516
267	Local Institution	Kasuga-shi	Fukuoka	Japan	816-0864
268	Local Institution	Kitakyushu-shi	Fukuoka	Japan	802-8555
269	Local Institution	Kitakyushu-shi	Fukuoka	Japan	8058508
270	Local Institution	Kitakyushu	Fukuoka	Japan	800-0296
271	Local Institution	Koga-shi	Fukuoka	Japan	811-3113
272	Local Institution	Kurume City	Fukuoka	Japan	830-8577
273	Local Institution	Aizuwakamatsu-shi	Fukushima	Japan	9658585
274	Local Institution	Takayama-shi	Gifu	Japan	506-8550
275	Local Institution	Isesaki-shi	Gunma	Japan	3720006
276	Local Institution	Aki-gun	Hiroshima	Japan	735-8585
277	Local Institution	Higashihiroshima-shi	Hiroshima	Japan	739-0041
278	Local Institution	Hiroshima-shi	Hiroshima	Japan	731-0293
279	Local Institution	Kobe-City	Hyogo	Japan	650-0047
280	Local Institution	Kanazawa	Ishikawa	Japan	920-8650
281	Local Institution	Komatsu	Ishikawa	Japan	923-8560
282	Local Institution	Kagoshima-shi	Kagoshima	Japan	890-8760
283	Local Institution	Kawasaki-city	Kanagawa	Japan	216-8511
284	Local Institution	Kawasaki	Kanagawa	Japan	211-0063
285	Local Institution	Sendai-shi	Miyagi	Japan	982-8523
286	Local Institution	Sendai	Miyagi	Japan	9838520
287	Local Institution	Nagasaki-shi	Nagasaki	Japan	8528501
288	Local Institution	Izumisano-shi	Osaka	Japan	5988577
289	Local Institution	Kishiwada	Osaka	Japan	596-8522
290	Local Institution	Matsubara	Osaka	Japan	580-0032
291	Local Institution	Sakai-shi	Osaka	Japan	590-0064
292	Local Institution	Suita-shi	Osaka	Japan	5650871
293	Local Institution	Suita	Osaka	Japan	5648565
294	Local Institution	Hidaka	Saitama	Japan	858+6
295	Local Institution	Shimotsuke-shi	Tochigi	Japan	3290498
296	Local Institution	Bunkyo-ku	Tokyo	Japan	113-8603
297	Local Institution	Hachioji	Tokyo	Japan	192-0032
298	Local Institution	Meguro-ku	Tokyo	Japan	1528902
299	Local Institution	Minato-ku	Tokyo	Japan	1058471
300	Local Institution	Minato-ku	Tokyo	Japan	108-0073
301	Local Institution	Mitaka-shi	Tokyo	Japan	181-8611
302	Local Institution - 0298	Shinagawa-ku	Tokyo	Japan	141-8625
303	Local Institution	Shinjuku-Ku	Tokyo	Japan	1608582
304	Local Institution	Tachikawa-shi	Tokyo	Japan	1900014
305	Local Institution	Shimonoseki-Shi	Yamaguchi	Japan	752-8510
306	Local Institution	Fukuoka		Japan	810-0001
307	Local Institution	Fukuoka		Japan	810-8563
308	Local Institution	Kyoto		Japan	6008558
309	Local Institution	Osaka		Japan	533-0024
310	Local Institution	Osaka		Japan	540-0006
311	Local Institution	Osaka		Japan	558-8558
312	Local Institution	Saga		Japan	849-8501
313	Local Institution - 0094	Goyang-si	Gyeonggido	Korea, Republic of	10380
314	Local Institution	Anyang		Korea, Republic of	431-070
315	Local Institution	Busan		Korea, Republic of	49201
316	Local Institution	Busan		Korea, Republic of	49241
317	Local Institution	Daegu		Korea, Republic of	41944
318	Local Institution	Daegu		Korea, Republic of	42415
319	Local Institution	Daegu		Korea, Republic of	700-712
320	Local Institution	Gwangju		Korea, Republic of	61469
321	Local Institution	Incheon		Korea, Republic of	22332
322	Local Institution	Seongnam-si		Korea, Republic of	13620
323	Local Institution	Seoul		Korea, Republic of	01830
324	Local Institution	Seoul		Korea, Republic of	02447
325	Local Institution	Seoul		Korea, Republic of	03080
326	Local Institution	Seoul		Korea, Republic of	03722
327	Local Institution	Seoul		Korea, Republic of	04763
328	Local Institution	Seoul		Korea, Republic of	05505
329	Local Institution	Seoul		Korea, Republic of	06273
330	Local Institution	Seoul		Korea, Republic of	06351
331	Local Institution	Seoul		Korea, Republic of	07061
332	Local Institution	Seoul		Korea, Republic of	08308
333	Local Institution	Ciudad de Mexico	Distrito Federal	Mexico	14080
334	Local Institution	Mexico	Distrito Federal	Mexico	14269
335	Local Institution	Guadalajara	Jalisco	Mexico	44670
336	Local Institution	Monterrey	Nuevo LEON	Mexico	64460
337	Local Institution	Culiacan	Sinaloa	Mexico	80020
338	Local Institution	Durango		Mexico	34217
339	Local Institution	Bergen		Norway	5021
340	Local Institution	Grålum		Norway	1714
341	Local Institution	Kristiansand		Norway	4604
342	Local Institution	Lørenskog		Norway	1478
343	Local Institution	Oslo		Norway	0424
344	Local Institution	Stavanger		Norway	4011
345	Local Institution	Bydgoszcz		Poland	85-094
346	Local Institution	Chelm		Poland	22-100
347	Local Institution	Gdansk		Poland	80-803
348	Local Institution	Grodzisk Mazowieciki		Poland	05-825
349	Local Institution	Katowice		Poland	40-635
350	Local Institution	Konskie		Poland	26-200
351	Local Institution	Lodz		Poland	93-113
352	Local Institution	Olsztyn		Poland	10-561
353	Local Institution	Sandomierz		Poland	27-600
354	Local Institution	Skarzysko-Kamienna		Poland	26-110
355	Local Institution	Walcz		Poland	78-600
356	Local Institution	Warszawa		Poland	02-097
357	Local Institution	Warszawa		Poland	02-957
358	Local Institution	Warszawa		Poland	04-141
359	Local Institution	Wejherowo		Poland	84-200
360	Local Institution	Barnaul		Russian Federation	656024
361	Local Institution	Kemerovo		Russian Federation	650002
362	Local Institution	Moscow		Russian Federation	117593
363	Local Institution	Moscow		Russian Federation	125367
364	Local Institution	Novosibirsk		Russian Federation	630087
365	Local Institution	Smolensk		Russian Federation	214018
366	Local Institution	St. Petersburg		Russian Federation	194354
367	Local Institution	Yaroslavl		Russian Federation	150030
368	Local Institution - 0372	León	Castilla Y León	Spain	24071
369	Local Institution	A Coruna		Spain	15006
370	Local Institution	Albacete		Spain	02006
371	Local Institution	Badalona		Spain	8916
372	Local Institution	Barcelona		Spain	08003
373	Local Institution	Barcelona		Spain	08035
374	Local Institution	Barcelona		Spain	08036
375	Local Institution	Córdoba		Spain	14004
376	Local Institution	Girona		Spain	17007
377	Local Institution	L'Hospitalet de Llobregat		Spain	08907
378	Local Institution	Lleida		Spain	25008
379	Local Institution	Madrid		Spain	28007
380	Local Institution	Madrid		Spain	28034
381	Local Institution	Madrid		Spain	28041
382	Local Institution	Madrid		Spain	28046
383	Local Institution	Sabadell, Barcelona		Spain	08208
384	Local Institution	San Sebastian		Spain	20014
385	Local Institution	Sant Joan Despi		Spain	08970
386	Local Institution	Santiago de Compostela		Spain	15706
387	Local Institution	Sevilla		Spain	41009
388	Local Institution	Sevilla		Spain	41013
389	Local Institution	Tarragona		Spain	43005
390	Local Institution	Terrassa		Spain	08222
391	Local Institution	Valencia		Spain	46026
392	Local Institution	Valladolid		Spain	47005
393	Local Institution	Vigo		Spain	36312
394	Local Institution - 0128	Malmö	Skane Lan	Sweden	SE-205 02
395	Local Institution	Göteborg		Sweden	SE-43146
396	Local Institution	Hassleholm		Sweden	28125
397	Local Institution	Umea		Sweden	901 87
398	Local Institution	Uppsala		Sweden	751 85
399	Local Institution	Aarau		Switzerland	5001
400	Local Institution	Basel		Switzerland	4031
401	Local Institution	Bern		Switzerland	3010
402	Local Institution	Geneve		Switzerland	1205
403	Local Institution	Lausanne		Switzerland	1011
404	Local Institution	Zurich		Switzerland	8032
405	Local Institution	Canterbury	Kent	United Kingdom	CT1 3NG
406	Local Institution	Aberdeen		United Kingdom	AB25 2ZD
407	Local Institution	Ashford		United Kingdom	TN24 0LZ
408	Local Institution	Bath		United Kingdom	BA1 3NG
409	Local Institution	Chester		United Kingdom	CH2 1UL
410	Local Institution	Edinburgh		United Kingdom	EH16 4SA
411	Local Institution	Glasgow		United Kingdom	G51 4TF
412	Local Institution	Lancashire		United Kingdom	BL9 7TD
413	Local Institution	London		United Kingdom	SE5 9RF
414	Local Institution	London		United Kingdom	W1T 7HA
415	Local Institution	Luton		United Kingdom	LU4 0DZ
416	Local Institution	Manchester		United Kingdom	M6 8HD
417	Local Institution	Nottingham		United Kingdom	NG5 1PB
418	Local Institution	Sheffield		United Kingdom	S10 2JF
419	Local Institution	Staffordshire		United Kingdom	ST4 6QG