REGENCY: A Study To Evaluate The Efficacy And Safety Of Obinutuzumab In Patients With ISN/RPS 2003 Class III Or IV Lupus Nephritis

Sponsor

Hoffmann-La Roche (Industry)

Overall Status

Recruiting

CT.gov ID

NCT04221477

Collaborator

(none)

252

Enrollment

147

Locations

Arms

92.3

Anticipated Duration (Months)

1.7

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study will evaluate the efficacy, safety, and pharmacokinetics of obinutuzumab compared with placebo in patients with International Society of Nephrology/Renal Pathology Society (ISN/RPS) class III or IV lupus nephritis (LN) when added on to standard-of-care therapy consisting of mycophenolate mofetil (MMF) and corticosteroids.

Condition or Disease	Intervention/Treatment	Phase
Lupus Nephritis	Drug: Obinutuzumab Drug: MMF Drug: Prednisone Drug: Placebo Drug: Methylprednisolone Drug: Acetaminophen Drug: Diphenhydramine	Phase 3

Study Design

Study Type:

Interventional

Anticipated Enrollment :

252 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Participant, Investigator)

Primary Purpose:

Treatment

Official Title:

A Phase III, Randomized, Double-Blind, Placebo-Controlled, Multicenter Study To Evaluate The Efficacy And Safety Of Obinutuzumab In Patients With ISN/RPS 2003 Class III Or IV Lupus Nephritis (REGENCY)

Actual Study Start Date :

Aug 10, 2020

Anticipated Primary Completion Date :

May 30, 2024

Anticipated Study Completion Date :

Apr 18, 2028

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Obinutuzumab Participants will be randomized into 2 groups. Group 1 will receive obinutuzumab 1000 mg IV at baseline and Weeks 2, 24, 26, 50, and 52 plus MMF and oral prednisone. Group 2 receive obinutuzumab 1000 mg IV at baseline and Weeks 2, 24, 26, and 52 plus MMF and oral prednisone. Group 2 participants will receive a placebo infusion at their Week 50 visit. Participants with an adequate response at Week 76 will continue receiving blinded obinutuzumab infusions every 6 months starting at Week 80. Participants without an adequate response at Week 76 may be eligible for open-label obinutuzumab starting at Week 80.	Drug: Obinutuzumab Obinutuzumab will be administered by IV infusion at a dose of 1000 mg at Baseline and Weeks 2, 24, 26, 50 (group 2: placebo), and 52 and subsequently from Week 80 and every 6 months thereafter, based on response. Other Names: Gazyva, GA101, RO5072759 Drug: MMF MMF willl be administered at a target dose of 2.0 - 2.5 g/day in divided doses through Week 80. Drug: Prednisone Prednisone 0.5 mg/kg/day (maximum 60 mg/day) will be started on Day 2. Beginning on Day 15, prednisone will be tapered to 5 mg/day and continued until Week 80. Drug: Methylprednisolone Methylprednisolone 80 mg IV will be administered as predmedication prior to infusions. Drug: Acetaminophen Acetaminophen 650-1000 mg will be administered as premedication prior to infusions. Drug: Diphenhydramine Diphenhydramine 50 mg will be administered as premedication prior to infusions.
Placebo Comparator: Placebo Placebo participants will receive obinutuzumab matched placebo at baseline and Weeks 2, 24, 26, 50, and 52 plus MMF and oral prednisone. Participants with an adequate response at Week 76 will continue receiving blinded obinutuzumab infusions every 6 months starting at Week 80. Participants without an adequate response at Week 76 may be eligible for open-label obinutuzumab starting at Week 80.	Drug: Obinutuzumab Obinutuzumab will be administered by IV infusion at a dose of 1000 mg at Baseline and Weeks 2, 24, 26, 50 (group 2: placebo), and 52 and subsequently from Week 80 and every 6 months thereafter, based on response. Other Names: Gazyva, GA101, RO5072759 Drug: MMF MMF willl be administered at a target dose of 2.0 - 2.5 g/day in divided doses through Week 80. Drug: Prednisone Prednisone 0.5 mg/kg/day (maximum 60 mg/day) will be started on Day 2. Beginning on Day 15, prednisone will be tapered to 5 mg/day and continued until Week 80. Drug: Placebo Placebo matching obinutuzumab will be administered by IV infusion at baseline and Weeks 0, 2, 24, 26, 50 and 52 and subsequently from Week 80 and every 6 months thereafter based on response. Drug: Methylprednisolone Methylprednisolone 80 mg IV will be administered as predmedication prior to infusions. Drug: Acetaminophen Acetaminophen 650-1000 mg will be administered as premedication prior to infusions. Drug: Diphenhydramine Diphenhydramine 50 mg will be administered as premedication prior to infusions.

Arm

Intervention/Treatment

Experimental: Obinutuzumab

Participants will be randomized into 2 groups. Group 1 will receive obinutuzumab 1000 mg IV at baseline and Weeks 2, 24, 26, 50, and 52 plus MMF and oral prednisone. Group 2 receive obinutuzumab 1000 mg IV at baseline and Weeks 2, 24, 26, and 52 plus MMF and oral prednisone. Group 2 participants will receive a placebo infusion at their Week 50 visit. Participants with an adequate response at Week 76 will continue receiving blinded obinutuzumab infusions every 6 months starting at Week 80. Participants without an adequate response at Week 76 may be eligible for open-label obinutuzumab starting at Week 80.

Drug: Obinutuzumab

Obinutuzumab will be administered by IV infusion at a dose of 1000 mg at Baseline and Weeks 2, 24, 26, 50 (group 2: placebo), and 52 and subsequently from Week 80 and every 6 months thereafter, based on response.

Other Names:

Gazyva, GA101, RO5072759

Drug: MMF

MMF willl be administered at a target dose of 2.0 - 2.5 g/day in divided doses through Week 80.

Drug: Prednisone

Prednisone 0.5 mg/kg/day (maximum 60 mg/day) will be started on Day 2. Beginning on Day 15, prednisone will be tapered to 5 mg/day and continued until Week 80.

Drug: Methylprednisolone

Methylprednisolone 80 mg IV will be administered as predmedication prior to infusions.

Drug: Acetaminophen

Acetaminophen 650-1000 mg will be administered as premedication prior to infusions.

Drug: Diphenhydramine

Diphenhydramine 50 mg will be administered as premedication prior to infusions.

Placebo Comparator: Placebo

Placebo participants will receive obinutuzumab matched placebo at baseline and Weeks 2, 24, 26, 50, and 52 plus MMF and oral prednisone. Participants with an adequate response at Week 76 will continue receiving blinded obinutuzumab infusions every 6 months starting at Week 80. Participants without an adequate response at Week 76 may be eligible for open-label obinutuzumab starting at Week 80.

Drug: Obinutuzumab

Other Names:

Gazyva, GA101, RO5072759

Drug: MMF

MMF willl be administered at a target dose of 2.0 - 2.5 g/day in divided doses through Week 80.

Drug: Prednisone

Prednisone 0.5 mg/kg/day (maximum 60 mg/day) will be started on Day 2. Beginning on Day 15, prednisone will be tapered to 5 mg/day and continued until Week 80.

Drug: Placebo

Placebo matching obinutuzumab will be administered by IV infusion at baseline and Weeks 0, 2, 24, 26, 50 and 52 and subsequently from Week 80 and every 6 months thereafter based on response.

Drug: Methylprednisolone

Methylprednisolone 80 mg IV will be administered as predmedication prior to infusions.

Drug: Acetaminophen

Acetaminophen 650-1000 mg will be administered as premedication prior to infusions.

Drug: Diphenhydramine

Diphenhydramine 50 mg will be administered as premedication prior to infusions.

Outcome Measures

Primary Outcome Measures

Percentage of Participants with Complete Renal Response (CRR) [At Week 76]

Secondary Outcome Measures

Percentage of Participants who Achieve a Proteinuric Response [At Week 76]
Percentage of Participants who Achieve an Overall Renal Response (ORR), Defined as Achievement of Either CRR or Partial Renal Response (PRR) [At Week 50]
Percentage of Participants who Experience Death or Renal-related Events [From baseline to Week 76]
Mean Change in Estimated Glomerular Filtration Rate (eGFR) [From baseline to Week 76]
Change in Anti-dsDNA Titer [From baseline to Week 50]
Change in Complement C3 [From baseline to Week 50]
Change in Systematic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) [From baseline to Week 76]
Time to Onset of CRR [From baseline to Week 76]
Change in Fatigue (FACIT-F) Scale [From baseline to Week 76]
Percentage of Participants who Achieve CRR with Serum Creatinine Criteria [At Week 76]
Percentage of Participants with Adverse Events According to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0 [From baseline to Week 76]
Percentage of Participants with Adverse Events of Special Interest (Infusion Related Reactions, Neutropenia, Infections, Thrombocytopenia) [From baseline to Week 76]
Maximum Serum Concentration of Obinutuzumab [Baseline, Week 2, 4, 12, 26, 36, 50, 52, 64, 76 and early study discontinuation]
Percentage of Participants with Anti-Drug Antibodies (ADAs) at Baseline and ADAs Post-Treatment [From baseline to Week 76]
Change from Baseline in Total Peripheral B-Cell Count [Baseline, Week 4, 12, 24, 50 and 76]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 75 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Key Inclusion Criteria:

Diagnosis of active or active/chronic ISN/RPS 2003 Class III or IV proliferative LN as evidenced by renal biopsy performed within 6 months. Participants may co-exhibit Class V disease in addition to either Class III or Class IV disease
Urine protein to creatinine ratio greater than or equal to (>/=) 1 on a 24-hour collection
Other inclusion criteria may apply

Key Exclusion Criteria:

Pregnancy or breastfeeding
Severe renal impairment or the need for dialysis or renal transplantation
Receipt of an excluded therapy, including any anti-CD20 therapy less than 9 months prior to screening or during screening; or cyclophosphamide, tacrolimus, ciclosporin, or voclosporin during the 2 months prior to screening or during screening
Significant or uncontrolled medical disease which, in the investigator's opinion, would preclude patient participation
Known active infection of any kind or recent major episode of infection
Intolerance or contraindication to study therapies
Other exclusion criteria may apply

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham Medical Center	Birmingham	Alabama	United States	35233
2	Wallace Rheumatic Study Center	Beverly Hills	California	United States	90211
3	Kaiser Permanente - Fontana	Fontana	California	United States	92335
4	University of California San Diego	La Jolla	California	United States	92093
5	Stanford University Medical Center	Palo Alto	California	United States	94304
6	Kaiser Permanente - San Francisco Medical Center	San Francisco	California	United States	94118
7	Univ Colorado Health Sci Ctr	Aurora	Colorado	United States	80045
8	Yale Medical Group; Rheumatology	New Haven	Connecticut	United States	06520
9	Washington DC VA Med Center; Hematology	Washington	District of Columbia	United States	20422
10	Univ of Florida Coll of Med	Jacksonville	Florida	United States	32209
11	University of Miami Miller School of Medicine	Miami	Florida	United States	33136
12	Emory University	Atlanta	Georgia	United States	30322
13	Northwestern University	Chicago	Illinois	United States	60611
14	Tulane University Medical Center	New Orleans	Louisiana	United States	70112
15	Louisiana State University	Shreveport	Louisiana	United States	71103
16	Brigham and Women's Hospital	Boston	Massachusetts	United States	02115
17	Nephrology Research of Michigan	Saint Clair Shores	Michigan	United States	48081
18	University of Minnesota	Minneapolis	Minnesota	United States	55414-2959
19	Mayo Clinic - Rochester	Rochester	Minnesota	United States	55905
20	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
21	Jacobi Medical Center	Bronx	New York	United States	10461
22	SUNY Downstate Medical Center.	Brooklyn	New York	United States	11203
23	North Shore University Hospital	Manhasset	New York	United States	11030
24	NYU Langone Medical Center; Seligman Center for Advanced Therapeutics	New York	New York	United States	10016
25	Columbia Uni Medical Center; Nephrology	New York	New York	United States	10032
26	Columbia University Medical Center	New York	New York	United States	10032
27	AD-CARE, University of Rochester Medical Center	Rochester	New York	United States	14620
28	Metro Health Medical Center	Cleveland	Ohio	United States	44109
29	The Ohio State University Wexner Medical Center	Columbus	Ohio	United States	43212
30	STAT Research Inc	Dayton	Ohio	United States	45417
31	Oklahoma Medical Research Foundation	Oklahoma City	Oklahoma	United States	73104
32	Perelman Ctr for Advanced Med	Philadelphia	Pennsylvania	United States	19104
33	Piedmont Arthritis Clinic	Greenville	South Carolina	United States	29601
34	Georgia Nephrology	Chattanooga	Tennessee	United States	37404
35	Southeast Renal Research Institute	Chattanooga	Tennessee	United States	37404
36	University of Texas Southwestern	Dallas	Texas	United States	75390-8897
37	Texas Arthritis Center	El Paso	Texas	United States	79902
38	Southwest Rheumatology	Mesquite	Texas	United States	75150
39	Fort Bend Clinical Research	Sugar Land	Texas	United States	77479
40	University of Wisconsin School of Medicine and Public Health	Madison	Wisconsin	United States	53792
41	Organizacion Medica de Investigacion	Buenos Aires		Argentina	C1015ABO
42	Fundación Favaloro	Capital Federal		Argentina	C1093AAS
43	DOM Centro de Reumatología	Ciudad Autónoma de Buenos Aires		Argentina	C1111AAJ
44	Hospital Italiano de Buenos Aires; Rheumatology department	Ciudad Autónoma de Buenos Aires		Argentina	C1199ABD
45	Sanatorio Allende	Cordoba		Argentina	X5000JHQ
46	Sanatorio Parque S.A.	Rosario		Argentina	S2000QGB
47	CER San Juan Centro Polivalente de Asistencia e Investigacion Clinica	San Juan		Argentina	J5400DIL
48	Ser Servicos Especializados Em Reumatologia	Salvador	BA	Brazil	40150-150
49	Instituto Pro-Renal	Curitiba	PR	Brazil	80440-020
50	Edumed - Educação e Saúde SA	Curitiba	PR	Brazil	80440-080
51	Hospital das Clinicas - UFRGS	Porto Alegre	RS	Brazil	90035-903
52	Hospital das Clinicas - UNICAMP	Campinas	SP	Brazil	13083-887
53	Hospital das Clinicas - FMUSP Ribeirao Preto; Reumatologia	Ribeirao Preto	SP	Brazil	14051-140
54	Centro Multidisciplinar de Estudos Clínicos - CEMECX	Sao Bernardo Do Campo	SP	Brazil	09715-090
55	Hospital das Clinicas - FMUSP	Sao Paulo	SP	Brazil	05403-900
56	Nexus Clinical Research Inc.	St. John's	Newfoundland and Labrador	Canada	A1A 5E8
57	Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex	Toronto	Ontario	Canada	M5T 3L9
58	Clinica De La Costa	Barranquilla		Colombia	080020
59	Hospital Universitario San Ignacio	Bogota		Colombia	000472
60	Sociedad de Cirugia de Bogota Hospital San Jose	Bogotá		Colombia	111411
61	FOSCAL	Floridablanca		Colombia
62	Hospital Pablo Tobon Uribe	Medellin		Colombia	050034
63	HOPITAL HENRI MONDOR; SERVICE DE Nephrologie	Creteil		France	94010
64	CHU de Martinique- Hôpital P. Zobda-Quitman; Service de Rhumatlogie- Médecine interne 5D	FORT DE France		France	97261
65	Hopital Claude Huriez; Internal Medicine	Lille		France	59037
66	Hopital Europeen	Marseille		France	13003
67	Groupe Hospitalier Pitie-Salpetriere; Service de Medecine Interne Ii	Paris		France	75651
68	Hopital Bichat Claude Bernard; Nephrologie	Paris		France	75877
69	Hopital Sud ; Nephrologie Hemodialyse	Salouel		France	80480
70	Hopital Universitaire; Nephrologie Clinique Medicale B	Strasbourg		France	67091
71	Hopital Rangueil; Service de Nephrologie & D'Immunologie Clinique	Toulouse		France	31059
72	Charité Campus Mitte, Med.Klinik, Rheumatologie und Klinische Immunologie	Berlin		Germany	10117
73	Städtisches Klinik Dresden-Friedrichstadt; I. Medizinische Klinik	Dresden		Germany	01067
74	Universitätsklinikum "Carl Gustav Carus"; Medizinische Klinik III	Dresden		Germany	01307
75	Universitätsklinikum Freiburg	Freiburg		Germany	79106
76	Universitatsklinikum Schleswig Holstein; Klinik fur Allgemeine Innere Medizin	Kiel		Germany	24105
77	Universitaetsmedizin Johannes Gutenberg; Rheumatologie	Mainz		Germany	55131
78	Universitätskrankenhaus Tübingen; Innere Medizin / Hämatologie und Internistische Onkologie	Tübingen		Germany	72076
79	Rambam Health Care Campus	Haifa		Israel	3109600
80	Meir Medical Center	Kfar- Saba		Israel	4428164
81	Rabin MC- Belinson campus	Petach Tikva		Israel	4941492
82	Chaim Sheba Medical Center; Rheumatology	Ramat-Gan		Israel	5262100
83	Sourasky Medical Centre	Tel-Aviv		Israel	6423906
84	Ospedale Policlinico San Martino	Genova	Liguria	Italy	16132
85	A.O. Spedali Civili Di Brescia-P.O. Spedali Civili; Nefrologia	Brescia	Lombardia	Italy	25123
86	Asst Degli Spedali Civili Di Brescia; Reumatologia Ed Immunologia Clinica	Brescia	Lombardia	Italy	25125
87	ASST Monza - Ospedale San Gerardo; Clinica Nefrologica	Monza	Lombardia	Italy	20900
88	Policlinico di Bari; Divisione di Nefrologia, Dialisi e Trapianto	Bari	Puglia	Italy	70124
89	Ospedale ARNAS - P.O."Civico e Benfratelli; UOC Nefrologia e Dialisi	Palermo	Sicilia	Italy	90127
90	Azienda Ospedaliera Universitaria Careggi	Florence	Toscana	Italy	50134
91	Azienda Ospedaliera di Padova; Dipartimento di Medicina - UOC di Reumatologia	Padova	Veneto	Italy	35128
92	Instituto Nacional de Ciencias Médicas Y de La Nutricion Zubirán	Mexico City		Mexico	Tlalpan 14000
93	Hospital General De Mexico; Rheumatology	Mexico, D.F.		Mexico	06726
94	Centro de Investigación y Tratamiento Reumatológico S.C.	Mexico, DF		Mexico	11850
95	Hospital Universitario; Dr. Jose Eleuterio Gonzalez	Monterrey		Mexico	64460
96	Hogar Clínica San Juan de Dios	Arequipa		Peru	04000
97	Hospital Nacional Edgardo Rebagliati Martins; Servicio de Reumatología	Lima		Peru	11
98	Servicio de Inmuno Reumatologia; Hospital Nacional Arzobispo Loayza	Lima		Peru	15082
99	Clínica San Juan Bautista CSJB; UNIDAD DE INVESTIGACION EN REUMATOLOGIA E INMUNOLOGIA CSJB	Lima		Peru	15431
100	Instituto del Cerebro y la Columna Vertebral SAC	Lima		Peru	Lima 18
101	Clinica Anglo Americana; Rheumatology	Lima		Peru
102	Instituto de Ginecología y Reproducción	Lima		Peru
103	Hospital Nacional Cayetano Heredia; Rheumatology	San Martin de Porres		Peru	15102
104	SPSK Nr 7 SUM w Katowicach Gornoslaskie CM im. prof. Leszka Gieca	Katowice		Poland	40-635
105	Szpital Specjalistyczny im Jozefa Dietla; Centrum Reumatologii, Immunologii i Rehabilitacji, I Oddzi	Krakow		Poland	31-121
106	Uniwersytecki Szpital Kliniczny Nr 2 Im. Wam; Centralny Szpital Weteranow	Lodz		Poland	90-549
107	SPZOZ Centralny Szpital Klin; UM w Lodzi	Lodz		Poland	92-213
108	Samodzielny Publiczny Szpital Kliniczny nr 4 w Lublinie	Lublin		Poland	20-954
109	Twoja Przychodnia Centrum Medyczne Nowa Sol	Nowa Sól		Poland	67-100
110	Medyczne Centrum Hetmanska; Rheumatology	Poznan		Poland	60-218
111	Ortopedyczno-Rehabilitacyjny Szpital Kliniczny im. Wiktora Degi UM; Katedra i Klinika Reumatologii	Poznan		Poland	61-545
112	SPSK nr 2 Pomorskiej AM w Szczecinie; Klinika Nefrologii, Transplantologii i Chorob Wewnetrznych	Szczecin		Poland	70-111
113	SP Szpital Kliniczny nr 1 Pomorskiej Akademii Medycznej im. prof. Tadeusza Sokolowskiego	Szczecin		Poland	71-252
114	Szpital Kliniczny Dzieciatka Jezus; Klinika Med. Transplantacyjnej, Nefrologii i Chorob Wew	Warszawa		Poland	02-006
115	Rheuma Medicus Zaklad Opieki Zdrowotnej	Warszawa		Poland	02-118
116	Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji im. Prof. Eleonory Reicher	Warszawa		Poland	02-637
117	Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego we Wroclawiu	Wroclaw		Poland	50-556
118	SBEI HPE "The First St.Petersburg State Medical University n.a. acad. I.P.Pavlova"of MoH of RF	Sankt-peterburg	Leningrad	Russian Federation	197022
119	Federal State Budgetary Scientific Institution Research Institute of Rheumatology V.A. Nasonova	Moscow	Moskovskaja Oblast	Russian Federation	115522
120	"Kazan (Privolzhsky) Federal University"; Academic Hospital	Kazan	Tatarstan	Russian Federation	420043
121	SIH Kemerovo Regional Clinical Hospital; Neurology department	Kemerovo		Russian Federation	650061
122	SBIH of Moscow "City Clinical Hospital #20 of Moscow Healthcare Department"	Moscow		Russian Federation	129327
123	Limited Liability Company "Centre of Medical Common Practice"	Novosibirsk		Russian Federation	630091
124	Republican Hospital Named After V.A. Baranov	Petrozavodsk		Russian Federation	185019
125	Federal Centre of Heart, Blood and Endocrinology n.a. V.A.Almazov; Rheumatology Department	Saint-Petersburg		Russian Federation	197341
126	Regional Clinical Hospital	Saratov		Russian Federation	410053
127	Winelands Medical Research; Medical Research	Cape Town		South Africa	7600
128	Groote Schuur Hospital and University of Cape Town; E13 Renal Unit & J46 Dept of Medicine	Cape Town		South Africa	7925
129	Precise Clinical Solutions (Pty) Ltd	Chatsworth		South Africa	4092
130	Chris Hani Baragwanath Hospital	Johannesburg		South Africa	2013
131	Panaroma Medical Center; Clinical Trials Department	Panorama		South Africa	7500
132	Hospital Universitario Araba; Servicio de Reumatologia	Vitoria	Alava	Spain	01009
133	Hospital Universitari de Bellvitge; Servicio de Nefrologia	Hospitalet de Llobregat	Barcelona	Spain	08907
134	Complejo Hospitalario Universitario A Coruña (CHUAC); Servicio de Reumatologia	La Coruna	LA Coruña	Spain	15006
135	Complejo Hospitalario Universitario de Santiago (CHUS) ; Servicio de Medicina Interna	Santiago de Compostela	LA Coruña	Spain	15706
136	Hospital Regional Universitario de Malaga; Servicio de Reumatologia	Málaga	Malaga	Spain	29009
137	Hospital de Basurto; Servicio de Reumatologia	Bilbao	Vizcaya	Spain	48013
138	Hospital Universitario Vall d'Hebron; Servicio de Medicina Interna	Barcelona		Spain	08035
139	Hospital Clinic i Provincial; Servicio de Nefrologia	Barcelona		Spain	08036
140	Hospital Universitario Reina Sofia; Servicio de Nefrologia	Cordoba		Spain	14004
141	Hospital General Universitario Gregorio Marañon; Servicio de Reumatología	Madrid		Spain	28007
142	Hospital Ramon y Cajal ; Servicio de Reumatologia	Madrid		Spain	28034
143	Hospital Universitario 12 de Octubre; Servicio de Reumatologia	Madrid		Spain	28041
144	Cambridge University Hospitals NHS Foundation Trust - Addenbrookes Hospital	Cambridge		United Kingdom	CB2 0QQ
145	CHAPEL ALLERTON HOSPITAL; Unit of Musculoskeletal Disease	Leeds		United Kingdom	LS7 4SA
146	Royal Free Hospital; Centre for Nephrology	London		United Kingdom	NW3 2PF
147	St George's Hospital	London		United Kingdom	SW17 ORE