Efficacy and Safety of Alogliptin Plus Metformin Compared to Glipizide Plus Metformin in Patients With Type 2 Diabetes Mellitus

Overview[ - collapse ][ - ]

Purpose The purpose of this study is to determine the safety and effectiveness of adding alogliptin, once daily (QD), compared to glipizide with metformin in diabetic patients.
ConditionType 2 Diabetes Mellitus
InterventionDrug: Alogliptin
Drug: Metformin
Drug: Glipizide
PhasePhase 3
SponsorTakeda
Responsible PartyTakeda
ClinicalTrials.gov IdentifierNCT00856284
First ReceivedMarch 4, 2009
Last UpdatedSeptember 25, 2013
Last verifiedSeptember 2013

Tracking Information[ + expand ][ + ]

First Received DateMarch 4, 2009
Last Updated DateSeptember 25, 2013
Start DateMarch 2009
Estimated Primary Completion DateOctober 2012
Current Primary Outcome Measures
  • Change From Baseline in Glycosylated Hemoglobin (HbA1c) at Week 52 [Time Frame: Baseline and Week 52] [Designated as safety issue: No]The change from Baseline to Week 52 in HbA1c (the concentration of glucose bound to hemoglobin as a percent of the absolute maximum that can be bound). The least squares (LS) means are from an analysis of covariance (ANCOVA) model with treatment, study schedule, and geographic region as class variables, and Baseline metformin dose and Baseline HbA1c as covariates.
  • Change From Baseline in Glycosylated Hemoglobin (HbA1c) at Week 104 [Time Frame: Baseline and Week 104] [Designated as safety issue: No]The change from Baseline to Week 104 in HbA1c (the concentration of glucose bound to hemoglobin as a percent of the absolute maximum that can be bound). The least squares (LS) means are from an analysis of covariance (ANCOVA) model with treatment, study schedule, and geographic region as class variables, and Baseline metformin dose and Baseline HbA1c as covariates.
Current Secondary Outcome Measures
  • Change From Baseline in Glycosylated Hemoglobin at Other Time Points [Time Frame: Baseline and Weeks 4, 8, 12, 16, 20, 26, 39, 65, 78, and 91.] [Designated as safety issue: No]The change from Baseline over time in HbA1c (the concentration of glucose bound to hemoglobin as a percent of the absolute maximum that can be bound). LS means are from an ANCOVA model with treatment, study schedule, and geographic region as class variables, and Baseline metformin dose and Baseline HbA1c as covariates.
  • Change From Baseline in Fasting Plasma Glucose Over Time [Time Frame: Baseline and Weeks 2, 4, 8, 12, 16, 20, 26, 39, 52, 65, 78, 91, and 104.] [Designated as safety issue: No]The change from Baseline in fasting plasma glucose (FPG) was assessed at Weeks 2, 4, 8, 12, 16, 20, 26, 39, 52, 65, 78, 91, and 104. LS means are from an ANCOVA model with treatment, study schedule, and geographic region as class variables, and Baseline FPG and Baseline metformin dose as covariates.
  • Percentage of Participants With Glycosylated Hemoglobin Less Than or Equal to 6.5% [Time Frame: Weeks 26, 52, 78, and 104.] [Designated as safety issue: No]The percentage of participants with HbA1c less than or equal to 6.5% at Weeks 26, 52, 78, and 104. Participants who did not complete the scheduled Week 104 visit were assessed based on their response at the time of discontinuation.
  • Percentage of Participants With Glycosylated Hemoglobin Less Than or Equal to 7.0% [Time Frame: Weeks 26, 52, 78, and 104.] [Designated as safety issue: No]Percentage of participants with HbA1c ≤ 7.0% at Weeks 26, 52, 78, and 104. Participants who did not complete the scheduled Week 104 visit were assessed based on their response at the time of discontinuation.
  • Change From Baseline in Body Weight Over Time [Time Frame: Baseline and Weeks 12, 26, 39, 52, 65, 78, 91, and 104.] [Designated as safety issue: No]LS Means are from an ANCOVA model with treatment, study schedule and geographic region as class variables, and Baseline weight and Baseline metformin dose as covariates.

Descriptive Information[ + expand ][ + ]

Brief TitleEfficacy and Safety of Alogliptin Plus Metformin Compared to Glipizide Plus Metformin in Patients With Type 2 Diabetes Mellitus
Official TitleA Multicenter, Randomized, Double-Blind, Active-Controlled Study to Evaluate the Durability of the Efficacy and Safety of Alogliptin Compared to Glipizide When Used in Combination With Metformin in Subjects With Type 2 Diabetes
Brief Summary
The purpose of this study is to determine the safety and effectiveness of adding alogliptin,
once daily (QD), compared to glipizide with metformin in diabetic patients.
Detailed Description
For patients diagnosed with type 2 diabetes mellitus, metformin is the usual first-line
therapy in addition to diet control and exercise. For those patients with inadequate
glycemic control with metformin monotherapy or experiencing serious side effects of
metformin, sulfonylurea is a popular choice as a second-line oral antidiabetic treatment.

Alogliptin is a dipeptidyl peptidase-4 inhibitor currently being developed by Takeda for use
in patients with type 2 diabetes mellitus.

This study is designed to further explore the durability of efficacy and safety of
alogliptin compared to glipizide in type 2 diabetes mellitus patients whose blood sugar
level is inadequately controlled with metformin therapy.

The duration of this study will be approximately 2 years.
Study TypeInterventional
Study PhasePhase 3
Study DesignAllocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
ConditionType 2 Diabetes Mellitus
InterventionDrug: Alogliptin
Alogliptin tablets
Other Names:
  • SYR-322
  • Nesina
Drug: Metformin
Metformin tablets
Other Names:
GlucophageDrug: Glipizide
Glipizide tablets
Other Names:
Glucotrol
Study Arm (s)
  • Experimental: Metformin + Alogliptin 12.5 mg
    Alogliptin 12.5 mg, tablets, orally, once daily and the maximum tolerated dose of metformin (1500 mg to 3300 mg daily) for up to 104 weeks.
  • Experimental: Metformin + Alogliptin 25 mg
    Alogliptin 25 mg, tablets, orally, once daily and the maximum tolerated dose of metformin (1500 mg to 3300 mg daily) for up to 104 weeks.
  • Active Comparator: Metformin + Glipizide
    Glipizide 5 mg, tablets, orally, once daily and the maximum tolerated dose of metformin (1500 mg to 3300 mg daily) for up to 104 weeks. After at least 2 weeks of treatment but prior to Week 20, participants with persistent hyperglycemia (fasting plasma glucose ≥250 mg/dL) underwent a dose titration of glipizide up to 20 mg in 5-mg increments in 4-week intervals.

Recruitment Information[ + expand ][ + ]

Recruitment StatusCompleted
Estimated Enrollment2639
Estimated Completion DateOctober 2012
Estimated Primary Completion DateOctober 2012
Eligibility Criteria
Inclusion Criteria:

- Has a diagnosis of type 2 diabetes mellitus.

- Must meet one of the following:

- Has been inadequately controlled on a stable daily dose of ≥1500 mg (or
documented maximum tolerated dose) of metformin for at least 2 months prior to
Screening.

- Has been inadequately controlled (as defined by a glycosylated hemoglobin 7.5 -
10%, inclusive) on metformin <1500 mg without documented maximum tolerated dose.

- No treatment with antidiabetic agents other than metformin within 2 months prior to
Screening (for Schedule A)/Pre-Screening (for Schedule B).

- Has body mass index within 23 kg/m^2 and 45 kg/m^2 unless the patient is Asian or of
Asian descent, for whom the allowable body mass index will be ≥ 20 kg/m^2 and ≤ 35
kg/m^2, inclusive.

- Has fasting C-peptide concentration at least 0.8 ng.

- If regularly using non-excluded medications, must be on a stable dose at least 4
weeks prior to Screening/Pre-screening.

- Females of childbearing potential who are sexually active must agree to use adequate
contraception, and can neither be pregnant, lactating or intends to donate ova from
Screening throughout the duration of the study.

- Must be able and willing to monitor their blood glucose concentrations with a home
monitor, and comply with protocol requirements including scheduled clinic
appointments.

Exclusion Criteria:

- Systolic blood pressure greater than or equal to 150 mmHg and/or diastolic pressure
greater than or equal to 90.

- Hemoglobin less than or equal to 12 g/dL for males and less than or equal to 10 g/dL
for females at Screening Visit.

- Alanine aminotransferase greater than or equal to 2.5 times the upper limit of normal
at Screening Visit.

- Serum creatinine greater than or equal to 1.5 mg/dL for males and 1.4 for females, or
calculated creatinine clearance less than 60 L/min.

- Males intending to impregnate others or donate sperm before, during or within 1 month
after participating in the study.

- A history of cancer other than squamous or basal cell carcinoma of the skin that has
not been in full remission for at least 5 years.

- A history of laser treatment for diabetic retinopathy within 6 months of screening.

- Treated for diabetic gastric paresis, gastric banding, or gastric bypass.

- New York Heart Association Class III or IV heart failure.

- History of coronary angioplasty, coronary stent placement, coronary bypass surgery,
myocardial infarction, stroke or transient ischemic attack within 3 months prior to
screening.

- Known history of human immunodeficiency virus, hepatitis B or C.

- Alcohol or substance abuse within 2 years prior to screening.

- Is required to take or intends to continue taking any disallowed medication, any
prescription medication, herbal treatment or over-the counter medication that may
interfere with evaluation of the study medication, including:

- Any investigational drug within 30 days

- Any investigational diabetic drug within 3 months

- Any antidiabetic drug in the dipeptidyl peptidase-4 inhibitors or glucagon-like
peptide-1 mimetics classes within 90 days prior to Screening other than
metformin

- Prior treatment with alogliptin.

- Weight-loss drugs

- Oral or systemically injected glucocorticoids

- A hypersensitivity allergy or anaphylactic reaction to any dipeptidyl peptidase-4
drug, metformin or glipizide.

- Has a documented history or concurrent signs of significant thyroid disease (eg,
autoimmune thyroid diseases such as Graves disease and Hashimoto thyroiditis or
active thyroid nodules).
GenderBoth
Ages18 Years
Accepts Healthy VolunteersNo
ContactsNot Provided
Location CountriesUnited States, Argentina, Australia, Austria, Brazil, Canada, Chile, Germany, Guatemala, Hong Kong, Hungary, India, Israel, Italy, Korea, Republic of, Latvia, Lithuania, Malaysia, Mexico, New Zealand, Peru, Philippines, Poland, Romania, Russian Federation, Singapore, South Africa, Spain, Thailand, Ukraine, United Kingdom

Administrative Information[ + expand ][ + ]

NCT Number NCT00856284
Other Study ID NumbersSYR-322_305
Has Data Monitoring CommitteeYes
Information Provided ByTakeda
Study SponsorTakeda
CollaboratorsNot Provided
Investigators Study Director: Medical Director, Clinical Science Takeda
Verification DateSeptember 2013

Locations[ + expand ][ + ]

United States, Alabama
Montgomery, Alabama, United States
United States, Alabama
Muscle Shoals, Alabama, United States
United States, Alabama
Pell City, Alabama, United States
United States, Arizona
Mesa, Arizona, United States
United States, Arizona
Peoria, Arizona, United States
United States, Arizona
Phoenix, Arizona, United States
United States, Arizona
Sierra Vista, Arizona, United States
United States, Arizona
Tempe, Arizona, United States
United States, Arizona
Tucson, Arizona, United States
United States, California
Anaheim, California, United States
United States, California
Artesia, California, United States
United States, California
Chico, California, United States
United States, California
Los Alamitos, California, United States
United States, California
Mission Viejo, California, United States
United States, California
National City, California, United States
United States, California
Northridge, California, United States
United States, California
Pismo Beach, California, United States
United States, California
Riverside, California, United States
United States, California
Roseville, California, United States
United States, California
Sacramento, California, United States
United States, California
San Diego, California, United States
United States, California
Santa Monica, California, United States
United States, California
Tustin, California, United States
United States, Colorado
Arvada, Colorado, United States
United States, Colorado
Colorado Springs, Colorado, United States
United States, Connecticut
Ridgefield, Connecticut, United States
United States, Connecticut
Waterbury, Connecticut, United States
United States, Florida
Brooksville, Florida, United States
United States, Florida
New Port Richey, Florida, United States
United States, Florida
North Miami Beach, Florida, United States
United States, Florida
Ocala, Florida, United States
United States, Florida
Opa Locka, Florida, United States
United States, Florida
Orlando, Florida, United States
United States, Georgia
Augusta, Georgia, United States
United States, Georgia
Savannah, Georgia, United States
United States, Illinois
Addison, Illinois, United States
United States, Illinois
Chicago, Illinois, United States
United States, Indiana
Bloomington, Indiana, United States
United States, Indiana
Evansville, Indiana, United States
United States, Indiana
Indianapolis, Indiana, United States
United States, Indiana
Mishawaka, Indiana, United States
United States, Indiana
South Bend, Indiana, United States
United States, Kentucky
Lexington, Kentucky, United States
United States, Kentucky
Munfordville, Kentucky, United States
United States, Louisiana
Marrero, Louisiana, United States
United States, Maine
Bangor, Maine, United States
United States, Maryland
Elkridge, Maryland, United States
United States, Maryland
Oxon Hill, Maryland, United States
United States, Massachusetts
North Dartmouth, Massachusetts, United States
United States, Michigan
Ann Arbor, Michigan, United States
United States, Michigan
Flint, Michigan, United States
United States, Mississippi
Picayune, Mississippi, United States
United States, Missouri
Springfield, Missouri, United States
United States, Missouri
St Peters, Missouri, United States
United States, Missouri
St. Louis, Missouri, United States
United States, Nebraska
Omaha, Nebraska, United States
United States, Nevada
Las Vegas, Nevada, United States
United States, New Mexico
Albuquerque, New Mexico, United States
United States, New York
New Windsor, New York, United States
United States, New York
New York, New York, United States
United States, New York
Rochester, New York, United States
United States, North Dakota
Fargo, North Dakota, United States
United States, Ohio
Beachwood, Ohio, United States
United States, Ohio
Cincinnati, Ohio, United States
United States, Ohio
Dayton, Ohio, United States
United States, Ohio
Willoughby Hills, Ohio, United States
United States, Ohio
Zanesville, Ohio, United States
United States, Oklahoma
Norman, Oklahoma, United States
United States, Oklahoma
Oklahoma City, Oklahoma, United States
United States, Oregon
Medford, Oregon, United States
United States, Pennsylvania
Havertown, Pennsylvania, United States
United States, Pennsylvania
Norristown, Pennsylvania, United States
United States, Pennsylvania
Philadelphia, Pennsylvania, United States
United States, Pennsylvania
Pittsburgh, Pennsylvania, United States
United States, Pennsylvania
Tipton, Pennsylvania, United States
United States, South Carolina
Anderson, South Carolina, United States
United States, South Carolina
Charleston, South Carolina, United States
United States, South Carolina
Greer, South Carolina, United States
United States, South Dakota
Rapid City, South Dakota, United States
United States, Tennessee
New Tazewell, Tennessee, United States
United States, Texas
Arlington, Texas, United States
United States, Texas
Carrollton, Texas, United States
United States, Texas
Dallas, Texas, United States
United States, Texas
Fort Worth, Texas, United States
United States, Texas
Houston, Texas, United States
United States, Texas
Hurst, Texas, United States
United States, Texas
Katy, Texas, United States
United States, Texas
San Antonio, Texas, United States
United States, Texas
Spring, Texas, United States
United States, Texas
Temple, Texas, United States
United States, Utah
Midvale, Utah, United States
United States, Virginia
Hampton, Virginia, United States
United States, West Virginia
Lewisburg, West Virginia, United States
United States, Wisconsin
Milwaukee, Wisconsin, United States
Argentina
Mar del Plata, Argentina
Australia, Australian Capital Territory
Garran, Australian Capital Territory, Australia
Australia, New South Wales
Wollongong, New South Wales, Australia
Australia, Queensland
Herston, Queensland, Australia
Australia, Western Australia
Nedlands, Western Australia, Australia
Austria
Graz, Austria
Austria
Salzburg, Austria
Brazil, Pernambuco
Recife, Pernambuco, Brazil
Brazil, Planalto Central
Brasília - DF, Planalto Central, Brazil
Brazil, São Paulo
Mogi das Cruzes, São Paulo, Brazil
Brazil
Fortaleza, Brazil
Brazil
São Paulo, Brazil
Canada, Newfoundland and Labrador
St. John's, Newfoundland and Labrador, Canada
Canada, Ontario
Brampton, Ontario, Canada
Canada, Ontario
Collingwood, Ontario, Canada
Canada, Ontario
Corunna, Ontario, Canada
Canada, Ontario
Etobichoke, Ontario, Canada
Canada, Ontario
Etobicoke, Ontario, Canada
Canada, Ontario
Mississauga, Ontario, Canada
Canada, Ontario
Smith Falls, Ontario, Canada
Canada, Ontario
Smiths Falls, Ontario, Canada
Canada, Ontario
Toronto, Ontario, Canada
Canada, Quebec
Granby, Quebec, Canada
Canada, Quebec
Montreal, Quebec, Canada
Chile, Santiago
Providencia, Santiago, Chile
Chile
Santiago, Chile
Germany, Brandenburg
Potsdam, Brandenburg, Germany
Germany, Hesse
Kelkheim, Hesse, Germany
Germany, Hesse
Offenbach, Hesse, Germany
Germany, North Rhine-Westphalia
Münster, North Rhine-Westphalia, Germany
Germany, Rhineland-Palatinate
Mainz, Rhineland-Palatinate, Germany
Germany, Rhineland-Palatinate
Neuwied, Rhineland-Palatinate, Germany
Germany, Rhineland-Palatinate
Rhaunen, Rhineland-Palatinate, Germany
Guatemala
Guatemala City, Guatemala
Hong Kong, Kowloon
Wong Tai Sin, Kowloon, Hong Kong
Hong Kong, Southern District
Pok Fu Lam, Southern District, Hong Kong
Hong Kong
Kowloon, Hong Kong
Hungary, Baranya
Pécs, Baranya, Hungary
Hungary, Borsod-Abaúj-Zemplén
Miskolc, Borsod-Abaúj-Zemplén, Hungary
Hungary, Bács-Kiskun
Kalocsa, Bács-Kiskun, Hungary
Hungary, Békés
Gyula, Békés, Hungary
Hungary, Csongrád
Makó, Csongrád, Hungary
Hungary, Csongrád
Szentes, Csongrád, Hungary
Hungary, Szabolcs-Szatmár-Bereg
Nyíregyháza, Szabolcs-Szatmár-Bereg, Hungary
Hungary, Zala
Zalaegerszeg, Zala, Hungary
Hungary
Budapest, Hungary
India, Andhra Pradesh
Hyderabad, Andhra Pradesh, India
India, Bihar
Patna, Bihar, India
India, Haryana
Karnal, Haryana, India
India, Karnataka
Bangalore, Karnataka, India
India, Karnataka
Belgaum, Karnataka, India
India, Madhya Pradesh
Bhopal, Madhya Pradesh, India
India, Maharashtra
Mumbai, Maharashtra, India
India, Tamil Nadu
Trichy, Tamil Nadu, India
Israel, Center District
Kfar-Saba, Center District, Israel
Israel, Central District
Kfar Saba, Central District, Israel
Israel, Central District
Matan, Central District, Israel
Israel, Central District
Petach Tikva, Central District, Israel
Israel, Haifa District
Hadera, Haifa District, Israel
Israel, Haifa District
Haifa, Haifa District, Israel
Israel, Northern District
Nahariya, Northern District, Israel
Israel, Northern District
Safed, Northern District, Israel
Israel, Southern District
Ashkelon, Southern District, Israel
Israel, Southern District
Be'er Sheva, Southern District, Israel
Israel, Tel Aviv
Holon, Tel Aviv, Israel
Israel, Tel Aviv
Tel- Aviv, Tel Aviv, Israel
Israel
Jerusalem, Israel
Israel
Zefat, Israel
Italy, Milan
Milano, Milan, Italy
Italy
Perugia, Italy
Italy
Pistoia, Italy
Korea, Republic of, Honam
Gwangju, Honam, Korea, Republic of
Korea, Republic of, Hoseo
Daejeon, Hoseo, Korea, Republic of
Korea, Republic of, Yeongnam
Daegu, Yeongnam, Korea, Republic of
Latvia
Daugavpils, Latvia
Latvia
Liepaja, Latvia
Latvia
Limbazi, Latvia
Latvia
Ogre, Latvia
Latvia
Riga, Latvia
Latvia
Talsi, Latvia
Latvia
Tukums, Latvia
Latvia
Valmiera, Latvia
Lithuania
Alytus, Lithuania
Lithuania
Kaunas, Lithuania
Lithuania
Kedainiai, Lithuania
Lithuania
Klaipeda, Lithuania
Lithuania
Palanga, Lithuania
Lithuania
Panevezys, Lithuania
Lithuania
Vilnius, Lithuania
Malaysia
Ipoh, Malaysia
Malaysia
Kajang, Malaysia
Malaysia
Kota Bahru, Malaysia
Malaysia
Kota Bharu, Malaysia
Malaysia
Kuala Terengganu, Malaysia
Malaysia
Kuantan, Malaysia
Malaysia
Melaka, Malaysia
Malaysia
Taiping, Malaysia
Mexico, Distrito Federal
Mexico, Distrito Federal, Mexico
Mexico, Edo de Mexico
Tlalnepantla, Edo de Mexico, Mexico
Mexico, Jalisco
Guadalajara, Jalisco, Mexico
Mexico, Nuevo Leon
Monterrey, Nuevo Leon, Mexico
Mexico
Huixquilucan Edo. de Mexico, Mexico
Mexico
Mexico City, Mexico
New Zealand
Auckland, New Zealand
New Zealand
Christchurch, New Zealand
New Zealand
Hamilton, New Zealand
New Zealand
Otahuhu, New Zealand
New Zealand
Palmerston North, New Zealand
New Zealand
Takapuna, New Zealand
New Zealand
Tauranga, New Zealand
New Zealand
Wellington, New Zealand
Peru, Lambayeque
Chiclayo, Lambayeque, Peru
Peru, San Juan de Miraflores
Lima, San Juan de Miraflores, Peru
Peru
Ica, Peru
Philippines
Manila, Philippines
Poland
Bytom, Poland
Poland
Gniewkowo, Poland
Poland
Krakow, Poland
Poland
Radom, Poland
Poland
Rzeszow, Poland
Poland
Tychy, Poland
Poland
Warszawa, Poland
Puerto Rico
Ponce, Puerto Rico
Puerto Rico
San Juan, Puerto Rico
Romania
Bacau, Romania
Romania
Bucharest, Romania
Romania
Galati, Romania
Romania
Oradea, Romania
Romania
Sibiu, Romania
Romania
Targu Mures, Romania
Russian Federation
Arkhangelsk, Russian Federation
Russian Federation
Irkutsk, Russian Federation
Russian Federation
Moscow, Russian Federation
Russian Federation
Samara, Russian Federation
Russian Federation
Smolensk, Russian Federation
Russian Federation
St Petersburg, Russian Federation
Russian Federation
Yaroslavl, Russian Federation
Singapore
Singapore, Singapore
South Africa, Eastern Cape
Port Elizabeth, Eastern Cape, South Africa
South Africa, Gauteng
Johannesburg, Gauteng, South Africa
South Africa, Gauteng
Pretoria, Gauteng, South Africa
South Africa, Kwazulu-Natal
Durban, Kwazulu-Natal, South Africa
South Africa, Kwazulu-Natal
Tongaat, Kwazulu-Natal, South Africa
South Africa, Western Cape
Cape Town, Western Cape, South Africa
Spain, Cataluña
Barcelona, Cataluña, Spain
Spain, Galicia
Santiago de Compostela, Galicia, Spain
Spain
Alicante, Spain
Thailand
Amphure Muang, Thailand
Thailand
Bangkok, Thailand
Thailand
Chiangmai, Thailand
Thailand
Khon Kaen, Thailand
Ukraine
Dnepropertovsk, Ukraine
Ukraine
Dnipropetrovsk, Ukraine
Ukraine
Donetsk, Ukraine
Ukraine
Kharkiv, Ukraine
Ukraine
Kyiv, Ukraine
Ukraine
Lviv, Ukraine
Ukraine
Vinnytsa, Ukraine
Ukraine
Vinnytsya, Ukraine
Ukraine
Zaporizhye, Ukraine
Ukraine
Zaporizhzhya, Ukraine
United Kingdom
Aintree-Liverpool, United Kingdom
United Kingdom
Bath, United Kingdom
United Kingdom
Bournemouth, United Kingdom
United Kingdom
Dundee, United Kingdom
United Kingdom
London, United Kingdom
United Kingdom
Stevenage, United Kingdom
United Kingdom
Swansea, United Kingdom