Ignite Creation Date:
2025-12-25 @ 1:25 AM
Ignite Modification Date:
2026-03-01 @ 3:41 AM
Study NCT ID:
NCT02626793
Status:
COMPLETED
Last Update Posted:
2022-02-08
First Post:
2015-07-29
Is NOT Gene Therapy:
True
Has Adverse Events:
False
Brief Title:
A Study of Otezla® in Patients With Plaque Psoriasis Under Routine Conditions
Sponsor:
Organization:
Raw JSON
{'hasResults': False, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D011565', 'term': 'Psoriasis'}], 'ancestors': [{'id': 'D017444', 'term': 'Skin Diseases, Papulosquamous'}, {'id': 'D012871', 'term': 'Skin Diseases'}, {'id': 'D017437', 'term': 'Skin and Connective Tissue Diseases'}]}}, 'protocolSection': {'designModule': {'studyType': 'OBSERVATIONAL', 'designInfo': {'timePerspective': 'PROSPECTIVE', 'observationalModel': 'COHORT'}, 'enrollmentInfo': {'type': 'ACTUAL', 'count': 391}, 'patientRegistry': False}, 'statusModule': {'overallStatus': 'COMPLETED', 'startDateStruct': {'date': '2015-08-03', 'type': 'ACTUAL'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2022-02', 'completionDateStruct': {'date': '2018-06-14', 'type': 'ACTUAL'}, 'lastUpdateSubmitDate': '2022-02-04', 'studyFirstSubmitDate': '2015-07-29', 'studyFirstSubmitQcDate': '2015-12-08', 'lastUpdatePostDateStruct': {'date': '2022-02-08', 'type': 'ACTUAL'}, 'studyFirstPostDateStruct': {'date': '2015-12-10', 'type': 'ESTIMATED'}, 'primaryCompletionDateStruct': {'date': '2017-06-08', 'type': 'ACTUAL'}}, 'outcomesModule': {'primaryOutcomes': [{'measure': 'Change from baseline in the Dermatology Life Quality Index (DLQI) ≤ 5 or improvement in DLQI by ≥ 5 points at Visit 2 from baseline', 'timeFrame': 'Approximately 4 months', 'description': 'DLQI is a simple, compact, and practical questionnaire for use in a dermatology clinical setting to assess limitations related to the impact of skin disease. The instrument contains ten items dealing with the participant\'s skin. With the exception of Item Number 7, the participant responds on a four-point scale, ranging from "Very Much" (score 3) to "Not at All" or "Not relevant" (score 0). Item Number 7 is a multi-part item, the first part of which ascertains whether the participant\'s skin prevented them from working or studying (Yes or No, scores 3 or 0 respectively), and if "No," then the participant is asked how much of a problem the skin has been at work or study over the past week, with response alternatives being "A lot," "A little," or "Not at all" (scores 2, 1, or 0 respectively). The DLQI total score is derived by summing all item scores, which has a possible range of 0 to 30, with 30 corresponding to the worst quality of life, and 0 corresponding to the best.'}], 'secondaryOutcomes': [{'measure': 'Change from Baseline in the Dermatology Life Quality Index (DLQI) ≤ 5 or improvement in DLQI by ≥ 5 points at all other visits from baseline.', 'timeFrame': 'Up to approximately 52 weeks', 'description': 'DLQI is a simple, compact, and practical questionnaire for use in a dermatology clinical setting to assess limitations related to the impact of skin disease. The instrument contains ten items dealing with the participant\'s skin. With the exception of Item Number 7, the participant responds on a four-point scale, ranging from "Very Much" (score 3) to "Not at All" or "Not relevant" (score 0). Item Number 7 is a multi-part item, the first part of which ascertains whether the participant\'s skin prevented them from working or studying (Yes or No, scores 3 or 0 respectively), and if "No," then the participant is asked how much of a problem the skin has been at work or study over the past week, with response alternatives being "A lot," "A little," or "Not at all" (scores 2, 1, or 0 respectively). The DLQI total score is derived by summing all item scores, which has a possible range of 0 to 30, with 30 corresponding to the worst quality of life, and 0 corresponding to the best.'}, {'measure': 'Change in the Physician Global Assessment (PGA) Score', 'timeFrame': 'Up to approximately 52 weeks', 'description': 'The PGA is a 5-point scale ranging from 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), to 4 (severe), incorporating an assessment of the severity of the Plaque-Psoriasis.'}, {'measure': 'Percent Change in Percent of Affected Body Surface Area (BSA)', 'timeFrame': 'Up to approximately 52 weeks', 'description': 'BSA is a measurement of involved skin. The overall BSA affected by psoriasis is estimated based on the palm area of the participant\'s hand (entire palmer surface or "handprint" excluding DIPs), which equates to approximately 1% of total body surface area.'}, {'measure': 'Percent Change in the Psoriasis Area Severity Index (PASI) Score', 'timeFrame': 'Up to approximately 52 weeks', 'description': 'Psoriasis Area Severity Index (PASI) scores range from 0 to 72, with higher scores reflecting greater disease severity. Erythema, thickness, and scaling are scored on a scale of 0 (none) to 4 (very severe) on 4 anatomic regions of the body: head, trunk, upper limbs, and lower limbs. Degree of involvement on each of the 4 anatomic regions is scored on a scale of 0 (no involvement) to 6 (90% to 100% involvement). The total qualitative score (sum of erythema, thickness, and scaling scores) is multiplied by the degree of involvement for each anatomic region and then multiplied by a constant. These values for each anatomic region are summed to yield the PASI score.'}, {'measure': "Change in the Patient's Global Assessment (PaGA)", 'timeFrame': 'Up to approximately 52 weeks', 'description': 'The PaGA is a 5-point scale ranging from 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), to 4 (severe), incorporating an assessment of the severity of the Plaque-Psoriasis by the patient.'}, {'measure': 'Patient Preference Questionnaire (PPQ)', 'timeFrame': 'Approximately 4 months', 'description': 'PPQ is a questionnaire consisting of 5 questions. PPQ asks the patient for his preference of the actual therapy versus the previous systemic therapy.'}, {'measure': 'Patient Satisfaction (Systemic Therapy Adherence Questionnaire, STAQ)', 'timeFrame': 'Approximately 13 months', 'description': 'STAQ; patient questionnaire on patient benefit, communication physician/patient, patient knowledge, and treatment satisfaction with the current systemic treatment (38 questions).'}, {'measure': 'Change in Pain (Visual Analogue Scale; VAS)', 'timeFrame': 'Up to approximately 52 weeks', 'description': 'The Pain Visual Analog Scores (VAS) is used to measure the amount of pain a participant experiences. Participants are asked: How much pain do you actually experience? All VAS values range from 0 to 100. Higher scores correspond to more severe symptom or disease.'}, {'measure': 'Adverse Events (AEs)', 'timeFrame': 'Up to approximately 52 weeks', 'description': "All Serious Adverse Events (SAEs), irrespective of relationship to Apremilast, and all non-serious AEs considered at least possibly related to Apremilast administration \\[non-serious adverse drug reactions (NS ADRs)\\], must be recorded within 24 hours of the physician's knowledge to the Sponsors' Drug Safety Department. AEs will be reported by the sponsor as required to Regulatory Authorities and Ethics Committees as applicable, in accordance with the national requirements for marketing authorization holders."}, {'measure': 'Change in Itch (Pruritus) (Visual Analogue Scale; VAS)', 'timeFrame': 'Up to approximately 52 weeks', 'description': 'The Itch Visual Analog Scores (VAS) is used to measure the amount of itch a participant experiences. Participants are asked: How much itch do you actually experience? All VAS values range from 0 to 100. Higher scores correspond to more severe symptom or disease.'}, {'measure': "Change in Scalp Involvement -Physician's Global Assessment (PGA)", 'timeFrame': 'Up to approximately 52 weeks', 'description': "PGA: 5-point scale for the physician's global assessment of the severity of scalp psoriasis."}, {'measure': "Change in Scalp Involvement - Patient's Global Assessment (PaGA)", 'timeFrame': 'Up to approximately 52 weeks', 'description': "PaGA: 5-point scale for the patient's global assessment of the severity of scalp psoriasis."}, {'measure': 'Change in Nail Involvement - Target Nail Psoriasis Severity Index (NAPSI)', 'timeFrame': 'Up to approximately 52 weeks', 'description': 'NAPSI: Assessment of target fingernail for nail bed and nail matrix involvement, each can be scored 0-4. Total score ranges from 0-8.'}, {'measure': "Change in Nail Involvement Fingernail - Patient's Global Assessment (PaGA)", 'timeFrame': 'Up to approximately 52 weeks', 'description': "Fingernail Patient Global Assessment ; 5-point scale on the patient's global assessment of the fingernail involvement, substituted with a 0-100 Visual analog scale (VAS) for the assessment of the impairment caused by this nail involvement."}, {'measure': "Change in Palmoplantar involvement - Palmoplantar physician's global assessment (PGA)", 'timeFrame': 'Up to approximately 52 weeks', 'description': "PGA: 5-point scale for the physician's global assessment of the severity of palmoplantar involvement."}, {'measure': "Change in Palmoplantar involvement - Palmoplantar patient's global assessment (PaGA)", 'timeFrame': 'Up to approximately 52 weeks', 'description': "PaGA: 5-point scale for the patient's global assessment of the severity of palmoplantar involvement."}]}, 'oversightModule': {'oversightHasDmc': False, 'isFdaRegulatedDrug': False, 'isFdaRegulatedDevice': False}, 'conditionsModule': {'keywords': ['Plaque psoriasis', 'Apremilast', 'Otezla®', 'LAPIS-Pso', 'Observational', 'CC-10004', 'non-interventional', 'Germany'], 'conditions': ['Psoriasis']}, 'referencesModule': {'references': [{'pmid': '34913153', 'type': 'DERIVED', 'citation': 'Reich K, Korge B, Magnolo N, Manasterski M, Schwichtenberg U, Staubach-Renz P, Kaiser S, Roemmler-Zehrer J, Gomez NN, Lorenz-Baath K. Quality-of-Life Outcomes, Effectiveness and Tolerability of Apremilast in Patients with Plaque Psoriasis and Routine German Dermatology Care: Results from LAPIS-PSO. Dermatol Ther (Heidelb). 2022 Jan;12(1):203-221. doi: 10.1007/s13555-021-00658-x. Epub 2021 Dec 15.'}], 'seeAlsoLinks': [{'url': 'https://clinicaltrials.gov/ct2/show/NCT02626793?term=CC-10004-PPSO-002&rank=1', 'label': 'Expanded Access for CC-10004'}]}, 'descriptionModule': {'briefSummary': "The objective of this NIS is the collection of data on the utilization of Apremilast under routine conditions in Germany. Patients' quality-of-life and treatment satisfaction on treatment with Apremilast in daily practice will be documented. Moreover, physician's and patient's assessments of the effectiveness and safety of Apremilast will be recorded. FPI was 3rd August 2015, LPO was 14th of June 2018. A total of 391 patients have been enrolled.", 'detailedDescription': 'The objective of this NIS (according to section 4(23) of the German Medicinal Products Act) is the documentation of data on the effectiveness and tolerability of an Apremilast treatment under routine clinical conditions in German patients with plaque psoriasis.\n\nThis NIS is intended to reflect the apremilast treatment of patients with plaque psoriasis who have received at least one prior conventional, systemic therapy or, if a contraindication is present, did not receive a systemic therapy so far, and who were diagnosed by their treating physicians to be eligible for an apremilast treatment. The treatment of Apremilast will be documented for a period of approximately 52 weeks.'}, 'eligibilityModule': {'sex': 'ALL', 'stdAges': ['ADULT', 'OLDER_ADULT'], 'minimumAge': '18 Years', 'samplingMethod': 'NON_PROBABILITY_SAMPLE', 'studyPopulation': 'A total of 500 patients with moderate to severe plaque psoriasis are planned to be enrolled in this NIS. In- and exclusion criteria are derived from the Summary of product characteristics (SmPC) of Apremilast.', 'healthyVolunteers': False, 'eligibilityCriteria': 'Inclusion Criteria:\n\n* The decision for a therapy with Apremilast was made before enrolment and independent of this study.\n* Patient ≥ 18 years of age\n* Diagnosis of moderate to severe plaque psoriasis\n* Inadequate response or intolerance to a previous systemic treatment, or contraindication for systemic therapies.\n* Written informed consent by the patient for data recording, statistical analysis, filing and forwarding of the data\n\nExclusion Criteria:\n\n* Pregnancy\n* Hypersensitivity to apremilast or any of the excipients of the film-coated tablet\n* Other criteria according to the Summary of product characteristics (SmPC).'}, 'identificationModule': {'nctId': 'NCT02626793', 'briefTitle': 'A Study of Otezla® in Patients With Plaque Psoriasis Under Routine Conditions', 'organization': {'class': 'INDUSTRY', 'fullName': 'Amgen'}, 'officialTitle': 'Long-term Documentation of the Utilization of Otezla® in Patients With Plaque Psoriasis Under Routine Conditions (LAPIS-Pso)', 'orgStudyIdInfo': {'id': 'CC-10004-PPSO-002'}}, 'armsInterventionsModule': {'armGroups': [{'label': 'Patients with ≤ 1 conventional, systemic pre-treatment', 'description': 'After failure (inadequate response/intolerance) to or contraindication for ≤ 1 conventional, systemic pre-treatment'}, {'label': 'Patients with > 1 conventional, systemic pre-treatment', 'description': 'After failure (inadequate response/intolerance) to or contraindication for \\> 1 conventional, systemic pre-treatment'}]}, 'contactsLocationsModule': {'locations': [{'zip': '89143', 'city': 'Blaubeuren Abbey', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Gertraud Krähn-Senftleben', 'geoPoint': {'lat': 48.41215, 'lon': 9.78427}}, {'zip': '89134', 'city': 'Blaustein', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Ralf-Uwe Peter', 'geoPoint': {'lat': 48.41658, 'lon': 9.91744}}, {'zip': '73728', 'city': 'Esslingen am Neckar', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Regina Renner', 'geoPoint': {'lat': 48.73961, 'lon': 9.30473}}, {'zip': '69120', 'city': 'Heidelberg', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Universitätsklinikum Heidelberg - Hautklinik', 'geoPoint': {'lat': 49.40768, 'lon': 8.69079}}, {'zip': '76133', 'city': 'Karlsruhe', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Ina Reitenbach-Blindt', 'geoPoint': {'lat': 49.00937, 'lon': 8.40444}}, {'zip': '76133', 'city': 'Karlsruhe', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Kaiserstraße 231-233', 'geoPoint': {'lat': 49.00937, 'lon': 8.40444}}, {'zip': '76133', 'city': 'Karlsruhe', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Naomi Gerhardus', 'geoPoint': {'lat': 49.00937, 'lon': 8.40444}}, {'zip': '76149', 'city': 'Karlsruhe', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Johannes Glutsch', 'geoPoint': {'lat': 49.00937, 'lon': 8.40444}}, {'zip': '89129', 'city': 'Langenau', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Beate Schwarz', 'geoPoint': {'lat': 48.49616, 'lon': 10.11849}}, {'zip': '68167', 'city': 'Mannheim', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Astrid Schmieder', 'geoPoint': {'lat': 49.4891, 'lon': 8.46694}}, {'zip': '78549', 'city': 'Spaichingen', 'state': 'Baden-Wurttemberg', 'country': 'Germany', 'facility': 'Katharina Wroblewska', 'geoPoint': {'lat': 48.07477, 'lon': 8.73508}}, {'zip': '91054', 'city': 'Erlangen', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Michael Sticherling', 'geoPoint': {'lat': 49.59099, 'lon': 11.00783}}, {'zip': '85354', 'city': 'Freising', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Hjalmar Kurzen', 'geoPoint': {'lat': 48.40351, 'lon': 11.74876}}, {'zip': '82110', 'city': 'Germering', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Claus Jung', 'geoPoint': {'lat': 48.13392, 'lon': 11.3765}}, {'zip': '91217', 'city': 'Hersbruck', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Clarissa Allmacher', 'geoPoint': {'lat': 49.51083, 'lon': 11.43151}}, {'zip': '86381', 'city': 'Krumbach', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Ildiko Sugar-Bunk', 'geoPoint': {'lat': 48.24182, 'lon': 10.3632}}, {'zip': '80639', 'city': 'München', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Sabine Anders', 'geoPoint': {'lat': 48.69668, 'lon': 13.46314}}, {'zip': '80802', 'city': 'München', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Hortensia Pfannenstiel', 'geoPoint': {'lat': 48.69668, 'lon': 13.46314}}, {'zip': '80802', 'city': 'München', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Technische Universität München - Kilian Eyerich', 'geoPoint': {'lat': 48.69668, 'lon': 13.46314}}, {'zip': '93053', 'city': 'Regensburg', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Universitätsklinikum Regensburg', 'geoPoint': {'lat': 49.01513, 'lon': 12.10161}}, {'zip': '97070', 'city': 'Würzburg', 'state': 'Bavaria', 'country': 'Germany', 'facility': 'Andreas Eggert', 'geoPoint': {'lat': 49.79391, 'lon': 9.95121}}, {'zip': '14612', 'city': 'Falkensee', 'state': 'Brandenburg', 'country': 'Germany', 'facility': 'Lars Freitag', 'geoPoint': {'lat': 52.56014, 'lon': 13.0927}}, {'zip': '14532', 'city': 'Kleinmachnow', 'state': 'Brandenburg', 'country': 'Germany', 'facility': 'Förster-Funke-Allee 104', 'geoPoint': {'lat': 52.40786, 'lon': 13.22514}}, {'zip': '16303', 'city': 'Schwedt', 'state': 'Brandenburg', 'country': 'Germany', 'facility': 'Silke Thies', 'geoPoint': {'lat': 53.05963, 'lon': 14.28154}}, {'zip': '65343', 'city': 'Eltville', 'state': 'Hesse', 'country': 'Germany', 'facility': 'Christoph Hartl', 'geoPoint': {'lat': 50.02858, 'lon': 8.11754}}, {'zip': '60590', 'city': 'Frankfurt am Main', 'state': 'Hesse', 'country': 'Germany', 'facility': 'Universitätsklinikum Frankfurt, Klinik für Dermatologie, Venerologie und Allergologie', 'geoPoint': {'lat': 50.11552, 'lon': 8.68417}}, {'zip': '34613', 'city': 'Schwalmstadt', 'state': 'Hesse', 'country': 'Germany', 'facility': 'Pia Freyschmidt-Paul', 'geoPoint': {'lat': 50.93333, 'lon': 9.21667}}, {'zip': '38114', 'city': 'Braunschweig', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Jutta Ramaker-Brunke', 'geoPoint': {'lat': 52.26594, 'lon': 10.52673}}, {'zip': '21614', 'city': 'Buxtehude', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Andreas Kleinheinz', 'geoPoint': {'lat': 53.46994, 'lon': 9.68968}}, {'zip': '49661', 'city': 'Cloppenburg', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Marco Averbeck', 'geoPoint': {'lat': 52.84754, 'lon': 8.045}}, {'zip': '30159', 'city': 'Hanover', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Florian Schenck', 'geoPoint': {'lat': 52.37052, 'lon': 9.73322}}, {'zip': '30167', 'city': 'Hanover', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Ulrike Stein', 'geoPoint': {'lat': 52.37052, 'lon': 9.73322}}, {'zip': '31134', 'city': 'Hildesheim', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Holger Petering', 'geoPoint': {'lat': 52.15077, 'lon': 9.95112}}, {'zip': '37603', 'city': 'Holzminden', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Silke Reinecke', 'geoPoint': {'lat': 51.82798, 'lon': 9.4455}}, {'zip': '21335', 'city': 'Lüneburg', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Reinhard Knöll', 'geoPoint': {'lat': 53.2509, 'lon': 10.41409}}, {'zip': '49377', 'city': 'Vechta', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Christian Kock', 'geoPoint': {'lat': 52.72632, 'lon': 8.28598}}, {'zip': '21423', 'city': 'Winsen', 'state': 'Lower Saxony', 'country': 'Germany', 'facility': 'Gesundheitszentrum Winsen', 'geoPoint': {'lat': 53.35753, 'lon': 10.21282}}, {'zip': '18528', 'city': 'Bergen auf Rügen', 'state': 'Mecklenburg-Vorpommern', 'country': 'Germany', 'facility': 'Andreas Timmel', 'geoPoint': {'lat': 54.41823, 'lon': 13.43349}}, {'zip': '17034', 'city': 'Neubrandenburg', 'state': 'Mecklenburg-Vorpommern', 'country': 'Germany', 'facility': 'Raimund Paech', 'geoPoint': {'lat': 53.55735, 'lon': 13.26105}}, {'zip': '52062', 'city': 'Aachen', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Theaterplatz 9', 'geoPoint': {'lat': 50.77664, 'lon': 6.08342}}, {'zip': '33647', 'city': 'Bielefeld', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Isaak Effendy', 'geoPoint': {'lat': 52.03333, 'lon': 8.53333}}, {'zip': '47249', 'city': 'Duisburg', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Volker Riesopp', 'geoPoint': {'lat': 51.43247, 'lon': 6.76516}}, {'zip': '52349', 'city': 'Düren', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Bernhard Korge', 'geoPoint': {'lat': 50.80434, 'lon': 6.49299}}, {'zip': '40237', 'city': 'Düsseldorf', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Herderstr.71 b', 'geoPoint': {'lat': 51.22172, 'lon': 6.77616}}, {'zip': '52249', 'city': 'Eschweiler', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Dechant-Deckers-Straße 5-7', 'geoPoint': {'lat': 50.81854, 'lon': 6.27184}}, {'zip': '45147', 'city': 'Essen', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Universitätsklinikum Essen', 'geoPoint': {'lat': 51.45657, 'lon': 7.01228}}, {'zip': '53879', 'city': 'Euskirchen', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Christina Huerkamp', 'geoPoint': {'lat': 50.66057, 'lon': 6.78722}}, {'zip': '45883', 'city': 'Gelsenkirchen-Feldmark', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Sebastian Rotterdam'}, {'zip': '45964', 'city': 'Gladbeck', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Jörg Brinkmann', 'geoPoint': {'lat': 51.57077, 'lon': 6.98593}}, {'zip': '47533', 'city': 'Kleve', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Hautartzpraxis', 'geoPoint': {'lat': 51.78826, 'lon': 6.13865}}, {'zip': '32429', 'city': 'Minden', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Rudolf Stadler', 'geoPoint': {'lat': 52.28953, 'lon': 8.91455}}, {'zip': '41061', 'city': 'Mönchengladbach', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Rolf Ostendorf', 'geoPoint': {'lat': 51.18539, 'lon': 6.44172}}, {'zip': '48149', 'city': 'Münster', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Athanasios Tsianakas', 'geoPoint': {'lat': 51.96236, 'lon': 7.62571}}, {'zip': '53359', 'city': 'Rheinbach', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Stefanie Montag', 'geoPoint': {'lat': 50.62562, 'lon': 6.94911}}, {'zip': '52222', 'city': 'Stolberg', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Hautarztpraxis, Steinfeldstr. 5', 'geoPoint': {'lat': 50.77368, 'lon': 6.22595}}, {'zip': '42551', 'city': 'Velbert', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Oliver Mainusch', 'geoPoint': {'lat': 51.33537, 'lon': 7.04348}}, {'zip': '46485', 'city': 'Wesel', 'state': 'North Rhine-Westphalia', 'country': 'Germany', 'facility': 'Kurt-Kräcker-Str. 47', 'geoPoint': {'lat': 51.6669, 'lon': 6.62037}}, {'zip': '56626', 'city': 'Andernach', 'state': 'Rhineland-Palatinate', 'country': 'Germany', 'facility': 'Magnus Bell', 'geoPoint': {'lat': 50.43109, 'lon': 7.40425}}, {'zip': '56170', 'city': 'Bendorf', 'state': 'Rhineland-Palatinate', 'country': 'Germany', 'facility': 'Ulrich Blaese', 'geoPoint': {'lat': 50.42289, 'lon': 7.57924}}, {'zip': '56068', 'city': 'Koblenz', 'state': 'Rhineland-Palatinate', 'country': 'Germany', 'facility': 'Schloss Straße 17', 'geoPoint': {'lat': 50.35357, 'lon': 7.57883}}, {'zip': 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