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Sandborn WJ, D'Haens GR, Reinisch W, Panés J, Chan D, Gonzalez S, Weisel K, Germinaro M, Frustaci ME, Yang Z, Adedokun OJ, Han C, Panaccione R, Hisamatsu T, Danese S, Rubin DT, Sands BE, Afzali A, Andrews JM, Feagan BG. Guselkumab for the Treatment of Crohn's Disease: Induction Results From the Phase 2 GALAXI-1 Study. Gastroenterology 2022; 162:1650-1664.e8. [PMID: 35134323 DOI: 10.1053/j.gastro.2022.01.047] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Guselkumab, a selective p19 interleukin-23 antagonist, is approved for the treatment of plaque psoriasis and psoriatic arthritis. This study evaluated the efficacy and safety of guselkumab in patients with moderately to severely active Crohn's disease with inadequate response or intolerance to conventional or biologic therapy. METHODS GALAXI-1, a phase 2, double-blind, placebo-controlled study, randomized patients 1:1:1:1:1 to intravenous guselkumab 200 mg, 600 mg, or 1200 mg at weeks 0, 4, and 8; intravenous ustekinumab approximately 6 mg/kg at week 0 and 90 mg subcutaneously at week 8; or placebo. Change from baseline in Crohn's Disease Activity Index score (primary end point), clinical remission, clinical response, Patient Reported Outcomes-2 remission, clinical-biomarker response, endoscopic response (major secondary end points), and safety in guselkumab-treated patients vs placebo were evaluated through week 12. Ustekinumab was a reference arm. RESULTS Of 309 patients evaluated, approximately 50% had disease refractory to prior biologic therapy. At week 12, significantly greater reductions in Crohn's Disease Activity Index from baseline (least squares means: 200 mg: -160.4, 600 mg: -138.9, and 1200 mg: -144.9 vs placebo: -36.2; all, P < .05) and significantly greater proportions of patients achieved clinical remission in each guselkumab group vs placebo (Crohn's Disease Activity Index <150; 57.4%, 55.6%, and 45.9% vs 16.4%; all, P < .05). Greater proportions of patients receiving guselkumab achieved clinical response, Patient Reported Outcomes-2 remission, clinical-biomarker response, and endoscopic response at week 12 vs placebo. Efficacy of ustekinumab vs placebo was also demonstrated. Safety event rates were generally similar across treatment groups. CONCLUSIONS At week 12, all 3 dose regimens of guselkumab induced greater clinical and endoscopic improvements vs placebo, with a favorable safety profile. CLINICALTRIALS gov, Number: NCT03466411.
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Affiliation(s)
| | - Geert R D'Haens
- Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Julián Panés
- Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, Biomedical Research Centers on Hepatic and Digestive Diseases, Barcelona, Spain
| | - Daphne Chan
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania
| | - Susana Gonzalez
- Janssen Research and Development, LLC, Spring House, Pennsylvania
| | - Kathleen Weisel
- Janssen Research and Development, LLC, Spring House, Pennsylvania
| | | | | | - Zijiang Yang
- Janssen Research and Development, LLC, Spring House, Pennsylvania
| | | | | | | | | | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anita Afzali
- The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jane M Andrews
- Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia
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2
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Nalinbenjapun S, Ovatlarnporn C. Chitosan-5-aminosalicylic acid conjugates for colon-specific drug delivery: Methods of preparation and in vitro evaluations. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2019.101397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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3
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Chaparro M, Aterido A, Guerra I, Iborra M, Cabriada JL, Bujanda L, Taxonera C, García-Sánchez V, Marín-Jiménez I, Barreiro-de Acosta M, Vera I, Martín-Arranz MD, Hernández-Breijo B, Mesonero F, Sempere L, Gomollón F, Hinojosa J, Bermejo F, Beltrán B, Rodríguez-Pescador A, Banales JM, Olivares D, Aguilar-Melero P, Menchén L, Ferreiro-Iglesias R, Blazquez Gómez I, Benitez García B, Guijarro LG, Marin AC, Bernardo D, Marsal S, Julia A, Gisbert JP. Functional rare variants influence the clinical response to anti-TNF therapy in Crohn's disease. Therap Adv Gastroenterol 2019; 12:1756284819867848. [PMID: 31598133 PMCID: PMC6764039 DOI: 10.1177/1756284819867848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/28/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The effect of low-frequency functional variation on anti-tumor necrosis factor alpha (TNF) response in Crohn's disease (CD) patients remains unexplored. The objective of this study was to investigate the impact of functional rare variants in clinical response to anti-TNF therapy in CD. METHODS CD anti-TNF naïve patients starting anti-TNF treatment due to active disease [Crohn's Disease Activity Index (CDAI > 150)] were included. The whole genome was sequenced using the Illumina Hiseq4000 platform. Clinical response was defined as a CDAI score <150 at week 14 of anti-TNF treatment. Low-frequency variants were annotated and classified according to their damaging potential. The whole genome of CD patients was screened to identify homozygous loss-of-function (LoF) variants. The TNF signaling pathway was tested for overabundance of damaging variants using the SKAT-O method. Functional implication of the associated rare variation was evaluated using cell-type epigenetic enrichment analyses. RESULTS A total of 41 consecutive CD patients were included; 3250 functional rare variants were identified (2682 damaging and 568 LoF variants). Two homozygous LoF mutations were found in HLA-B and HLA-DRB1 genes associated with lack of response and remission, respectively. Genome-wide LoF variants were enriched in epigenetic marks specific for the gastrointestinal tissue (colon, p = 4.11e-4; duodenum, p = 0.011). The burden of damaging variation in the TNF signaling pathway was associated with response to anti-TNF therapy (p = 0.016); damaging variants were enriched in epigenetic marks from CD8+ (p = 6.01e-4) and CD4+ (p = 0.032) T cells. CONCLUSIONS Functional rare variants are involved in the response to anti-TNF therapy in CD. Cell-type enrichment analysis suggests that the gut mucosa and CD8+ T cells are the main mediators of this response.
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Affiliation(s)
| | | | - Iván Guerra
- Gastroenterology Unit, Hospital Universitario de
Fuenlabrada, Instituto de Investigación de Hospital La Paz (IdiPaz), Madrid,
Spain
| | | | - Jose Luis Cabriada
- Gastroenterology Unit, Hospital Universitario de
Galdakano, Vizcaya, Spain
| | | | - Carlos Taxonera
- Gastroenterology Unit, Hospital Universitario
Clínico San Carlos and IdISSC, Madrid, Spain
| | | | - Ignacio Marín-Jiménez
- Gastroenterology Unit, Hospital Universitario
Gregorio Marañón e IiSGM, Madrid, Spain
| | | | - Isabel Vera
- Gastroenterology Unit, Hospital Universitario
Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Borja Hernández-Breijo
- Universidad de Alcalá, Alcalá de Henares,
Spain,Immuno-Rheumatology Research Group. IdiPaz.
Hospital Universitario La Paz, Madrid, Spain
| | - Francisco Mesonero
- Gastroenterology Unit, Hospital Universitario
Ramón y Cajal, Madrid, Spain
| | - Laura Sempere
- Gastroenterology Unit, Hospital Universitario
Alicante, Alicante, Spain
| | | | - Joaquín Hinojosa
- Gastroenterology Unit, Hospital Universitario
Manises, Valencia, Spain
| | - Fernando Bermejo
- Gastroenterology Unit, Hospital Universitario
de Fuenlabrada, Instituto de Investigación de Hospital La Paz (IdiPaz),
Madrid, Spain
| | | | | | | | - David Olivares
- Gastroenterology Unit, Hospital Universitario
Clínico San Carlos and IdISSC, Madrid, Spain
| | - Patricia Aguilar-Melero
- Gastroenterology Unit, Instituto Maimónides de
Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina
Sofía/Universidad de Córdoba, Spain
| | - Luis Menchén
- Gastroenterology Unit, Hospital Universitario
Gregorio Marañón e IiSGM, Madrid, Spain
| | - Rocío Ferreiro-Iglesias
- Gastroenterology Unit, Hospital Universitario
Clínico de Santiago, Santiago de Compostela, Spain
| | - Isabel Blazquez Gómez
- Gastroenterology Unit, Hospital Universitario
Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | | | - Sara Marsal
- Rheumatology Research Group, Vall d’Hebron
Research Institute, Barcelona, Spain
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Romero-Cara P, Torres-Moreno D, Pedregosa J, Vílchez JA, García-Simón MS, Ruiz-Merino G, Morán-Sanchez S, Conesa-Zamora P. A FCGR3A Polymorphism Predicts Anti-drug Antibodies in Chronic Inflammatory Bowel Disease Patients Treated With Anti-TNF. Int J Med Sci 2018; 15:10-15. [PMID: 29333082 PMCID: PMC5765734 DOI: 10.7150/ijms.22812] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/30/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The production of anti-drug antibodies (ADAs) against IgG monoclonal antibodies (mAbs) targeting tumour necrosis factor (TNF) is an important cause of loss of response to anti-TNF mAbs in patients with inflammatory bowel diseases (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC). Since receptors for the Fc portion of IgG (FCGRs) are involved in the degradation of IgG complexes, we hypothesised that a polymorphism in FCGR3A (V158F; rs396991) gene could be involved in anti-TNF ADA generation and treatment resistance. MATERIAL AND METHODS A cohort of 103 IBD patients (80 CD, 23 UC) were genotyped and serum level of both anti-TNFs (infliximab or adalimumab) and ADA against them were measured. RESULTS No significant differences were observed between ADA occurrence or V158F genotype and type of disease or the kind of anti-TNF administrated. Interestingly, VV genotype correlated with patients producing ADA (VV: 37.5% vs. FV: 10.6% or FF: 5%; p=0.004) and was an independent predictor of this event after multivariate analysis. Moreover, VV genotype also correlated with those patients receiving anti-TNF dose intensification (p=0.03). CONCLUSION FCGR3A V158F polymorphism seems to be associated with ADA production against mAbs and it could be taken into account when considering the dose and type of anti-TNF in IBD patients.
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Affiliation(s)
- Patricia Romero-Cara
- Gastroenterology Department, Santa Lucía General University Hospital (HGUSL), C/ Mezquita sn, 30202 Cartagena, Spain
| | - Daniel Torres-Moreno
- Pathology Department, HGUSL, Cartagena, Spain.,Institute for Biohealth Research from Murcia (IMIB), Cartagena, Spain
| | - José Pedregosa
- Clinical Analysis Department, HGUSL. Instituto Murciano de Investigaciones Biosanitarias (IMIB-Arrixaca), Murcia, Spain
| | - Juan Antonio Vílchez
- Clinical Analysis Department, HGUSL. Instituto Murciano de Investigaciones Biosanitarias (IMIB-Arrixaca), Murcia, Spain
| | - María Sergia García-Simón
- Pharmacy Department, HGUSL, Cartagena, Spain.,Faculty of Health Sciences. Catholic University from Murcia (UCAM), Murcia, Spain
| | - Guadalupe Ruiz-Merino
- Institute for Biohealth Research from Murcia (IMIB), Cartagena, Spain.,Statistical Unit, Fundación para la Formación e Investigación Sanitarias (FFIS), C/ Luis Fontes Pagán 9, 30003 Murcia, Spain
| | - Senador Morán-Sanchez
- Gastroenterology Department, Santa Lucía General University Hospital (HGUSL), C/ Mezquita sn, 30202 Cartagena, Spain.,Faculty of Health Sciences. Catholic University from Murcia (UCAM), Murcia, Spain
| | - Pablo Conesa-Zamora
- Institute for Biohealth Research from Murcia (IMIB), Cartagena, Spain.,Clinical Analysis Department, HGUSL. Instituto Murciano de Investigaciones Biosanitarias (IMIB-Arrixaca), Murcia, Spain.,Pharmacy Department, HGUSL, Cartagena, Spain
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5
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Hwang YH, Kim DG, Li W, Yang HJ, Yim NH, Ma JY. Anti-inflammatory effects of Forsythia suspensa in dextran sulfate sodium-induced colitis. JOURNAL OF ETHNOPHARMACOLOGY 2017; 206:73-77. [PMID: 28502906 DOI: 10.1016/j.jep.2017.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/25/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Forsythia suspensa Fructus (FS) is used to treat various inflammatory disorders in traditional Oriental medicine, including gastrointestinal diseases, but its therapeutic potential in ulcerative colitis is unclear. Thus, we investigated any potential therapeutic effects of FS against intestinal inflammation and the bioactive constituents in FS. MATERIALS AND METHODS After the induction of colitis using 3% dextran sulfate sodium, FS (100mg/kg/day) was administered orally during the experimental period. We evaluated body weight, bloody diarrhea, colon length, and pro-inflammatory cytokine levels. Subsequently, the bioactive constituents of FS were identified using UPLC/MS/MS. RESULTS FS significantly decreased the body weight loss, colon length shortening, and tumor necrosis factor-α and interleukin-6 elevations induced by colitis compared with the negative control (P < 0.05). Moreover, FS improved the colitis-induced histopathological damage to the colon, including epithelial necrosis, infiltration of inflammatory cells, ulceration, and submucosal edema. In phytochemical analyses, 7 flavonoids, 9 lignans, 13 phenolics, and 2 triterpenes were identified by comparison with the retention times and mass fragmentations of authentic standards. CONCLUSIONS We demonstrated beneficial effects of FS and its constituents, suggesting their potential for treatment of intestinal inflammation. These data could provide useful information for managing ulcerative colitis.
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Affiliation(s)
- Youn-Hwan Hwang
- KM Application Center, Korea Institute of Oriental Medicine, South Korea.
| | - Dong-Gun Kim
- KM Application Center, Korea Institute of Oriental Medicine, South Korea.
| | - Wei Li
- KM Application Center, Korea Institute of Oriental Medicine, South Korea.
| | - Hye Jin Yang
- KM Application Center, Korea Institute of Oriental Medicine, South Korea.
| | - Nam-Hui Yim
- KM Application Center, Korea Institute of Oriental Medicine, South Korea.
| | - Jin Yeul Ma
- KM Application Center, Korea Institute of Oriental Medicine, South Korea.
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Rufini S, Ciccacci C, Novelli G, Borgiani P. Pharmacogenetics of inflammatory bowel disease: a focus on Crohn's disease. Pharmacogenomics 2017; 18:1095-1114. [PMID: 28686143 DOI: 10.2217/pgs-2017-0068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Crohn's disease is an inflammatory bowel disease showing a high heterogeneity in phenotype and a strong genetic component. The treatment is complex, due to different severity of clinical parameters and to the fact that therapies only permit to control symptoms and to induce remission for short periods. Moreover, all categories of drugs present a great interindividual variability both in terms of efficacy and side effects appearance. For this reason, the identification of specific genomic biomarkers involved in drugs response will be of great clinical utility in order to foresee drug's efficacy and to prevent adverse reactions, permitting a more personalized therapeutic approach. In this review, we focus the attention on the pharmacogenetic studies regarding drugs commonly utilized in Crohn's disease treatment.
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Affiliation(s)
- Sara Rufini
- Department of Biomedicine & Prevention, Genetics Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Cinzia Ciccacci
- Department of Biomedicine & Prevention, Genetics Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine & Prevention, Genetics Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Borgiani
- Department of Biomedicine & Prevention, Genetics Unit, University of Rome "Tor Vergata", Rome, Italy
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Shwaartz C, Fields AC, Sobrero M, Cohen BD, Divino CM. Effect of Anti-TNF Agents on Postoperative Outcomes in Inflammatory Bowel Disease Patients: a Single Institution Experience. J Gastrointest Surg 2016; 20:1636-42. [PMID: 27405310 DOI: 10.1007/s11605-016-3194-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/15/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anti-tumor necrosis factor (TNF) agents have been an integral part in the treatment of inflammatory bowel disease. However, a subset of inflammatory bowel disease patients ultimately requires surgery and up to 30 % of them have undergone treatment with anti-TNF agents. Studies assessing the effect of anti-TNF agents on postoperative outcomes have been inconsistent. The aim of this study is to assess postoperative morbidity in inflammatory bowel disease patients who underwent surgery with anti-TNF therapy prior to surgery. METHODS This is a retrospective review of 282 patients with inflammatory bowel disease undergoing intestinal surgery between 2013 and 2015 at the Mount Sinai Hospital. Patients were divided into two groups based on treatment with anti-TNF agents (infliximab, adalimumab, certolizumab) within 8 weeks of surgery. Thirty-day postoperative outcomes were recorded. Univariate and multivariate statistical analyses were carried out. RESULTS Seventy-three patients were treated with anti-TNF therapy within 8 weeks of surgery while 209 patients did not have exposure. Thirty-day anastomotic leak, intra-abdominal abscess, wound infection, extra-abdominal infection, readmission, and mortality rates were not significantly different between the two groups. CONCLUSIONS The use of anti-TNF medications in inflammatory bowel disease patients within 2 months of intestinal surgery is not associated with an increased risk of 30-day postoperative complications.
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Affiliation(s)
- Chaya Shwaartz
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Adam C Fields
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Maximiliano Sobrero
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Brian D Cohen
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA
| | - Celia M Divino
- Department of Surgery, Division of General Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1041, New York, NY, 10029, USA.
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Thakur BK, Saha P, Banik G, Saha DR, Grover S, Batish VK, Das S. Live and heat-killed probiotic Lactobacillus casei Lbs2 protects from experimental colitis through Toll-like receptor 2-dependent induction of T-regulatory response. Int Immunopharmacol 2016; 36:39-50. [DOI: 10.1016/j.intimp.2016.03.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/26/2016] [Accepted: 03/28/2016] [Indexed: 02/07/2023]
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Hahn L, Beggs A, Wahaib K, Kodali L, Kirkwood V. Vedolizumab: An integrin-receptor antagonist for treatment of Crohn's disease and ulcerative colitis. Am J Health Syst Pharm 2016. [PMID: 26195652 DOI: 10.2146/ajhp140449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The pharmacology, pharmacokinetics, safety, efficacy, and dosing recommendations of vedolizumab, an integrin-receptor antagonist for the treatment of Crohn's disease (CD) and ulcerative colitis (UC), are reviewed. SUMMARY Vedolizumab is an integrin-receptor antagonist for the treatment of CD and UC in adults with moderately to severely active disease who have had an inadequate response with, lost response to, or were intolerant to anti-tumor necrosis factor (TNF) agents or immunomodulators or had an inadequate response with, were intolerant to, or demonstrated dependence on corticosteroids. Phase III clinical trials have demonstrated efficacy in achieving remission as induction and maintenance therapy in CD and UC. Remission was also achieved at week 10 in patients with CD in whom previous treatment with anti-TNF agents had failed. Adverse effects of vedolizumab include nasopharyngitis, headache, arthralgia, nausea, pyrexia, upper respiratory tract infection, fatigue, cough, bronchitis, influenza, back pain, rash, pruritus, sinusitis, oropharyngeal pain, and pain in the extremities. To date, no cases of progressive multifocal leukoencephalopathy (PML) have been reported. The recommended dose of vedolizumab in adults with UC or CD is 300 mg administered via intravenous infusion at zero, two, and six weeks, followed by every eight weeks. The average wholesale unit price is $5782.80, but a patient assistance program is available. CONCLUSION Vedolizumab is a new alternative for patients with moderate-to-severe UC or CD, as well as patients who have not responded to anti-TNF agents. The current safety profile and lack of reported PML make it a promising addition to the treatment of these conditions.
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Affiliation(s)
- Lindsay Hahn
- Lindsay Hahn, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Ashton Beggs, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; Kristy Wahaib, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Leela Kodali, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; and Vanessa Kirkwood is a Pharm.D. student, College of Pharmacy, Belmont University, Nashville, TN
| | - Ashton Beggs
- Lindsay Hahn, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Ashton Beggs, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; Kristy Wahaib, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Leela Kodali, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; and Vanessa Kirkwood is a Pharm.D. student, College of Pharmacy, Belmont University, Nashville, TN
| | - Kristy Wahaib
- Lindsay Hahn, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Ashton Beggs, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; Kristy Wahaib, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Leela Kodali, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; and Vanessa Kirkwood is a Pharm.D. student, College of Pharmacy, Belmont University, Nashville, TN
| | - Leela Kodali
- Lindsay Hahn, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Ashton Beggs, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; Kristy Wahaib, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Leela Kodali, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; and Vanessa Kirkwood is a Pharm.D. student, College of Pharmacy, Belmont University, Nashville, TN
| | - Vanessa Kirkwood
- Lindsay Hahn, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Ashton Beggs, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; Kristy Wahaib, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; Leela Kodali, Pharm.D., BCACP, is Assistant Professor of Pharmacy Practice; and Vanessa Kirkwood is a Pharm.D. student, College of Pharmacy, Belmont University, Nashville, TN
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Hosseini-Carroll P, Mutyala M, Seth A, Nageeb S, Soliman D, Boktor M, Sheth A, Chapman J, Morris J, Jordan P, Manas K, Becker F, Alexander JS. Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management. World J Gastrointest Pharmacol Ther 2015; 6:156-71. [PMID: 26558150 PMCID: PMC4635156 DOI: 10.4292/wjgpt.v6.i4.156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/30/2015] [Accepted: 08/29/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pregnancy as well as post-partum. This current review discusses current concerns and recommendations for pregnancy during IBD and is intended for gastroenterologists, general practitioners and IBD patients intending to become, (or already) pregnant, and their families. We have addressed patterns of IBD inheritance, effects of IBD on fertility and conception (in both men and women), the effects of IBD disease activity on maintenance of pregnancy and outcomes, risks of diagnostic procedures during pregnancy and potential risks and complications associated with different classes of IBD therapeutics. We also have evaluated the clinical experience using "top-down" care with biologics, which is currently the standard care at our institution. Post-partum care and breastfeeding recommendations are also addressed.
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11
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Vedolizumab en el tratamiento de la enfermedad de Crohn. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:338-48. [DOI: 10.1016/j.gastrohep.2014.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/05/2014] [Indexed: 12/22/2022]
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Substance P mediates pro-inflammatory cytokine release form mesenteric adipocytes in Inflammatory Bowel Disease patients. Cell Mol Gastroenterol Hepatol 2015; 1:420-432. [PMID: 26543894 PMCID: PMC4629258 DOI: 10.1016/j.jcmgh.2015.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Substance P (SP), neurokinin-1 receptors (NK-1Rs) are expressed in mesenteric preadipocytes and SP binding activates proinflammatory signalling in these cells. We evaluated the expression levels of SP (Tac-1), NK-1R (Tacr-1), and NK-2R (Tacr-2) mRNA in preadipocytes isolated from patients with Inflammatory Bowel Disease (IBD) and examined their responsiveness to SP compared to control human mesenteric preadipocytes. The Aim of our study is to investigate the effects of the neuropeptide SP on cytokine expression in preadipocytes of IBD vs control patients and evaluate the potential effects of these cells on IBD pathophysiology via SP-NK-R interactions. METHODS Mesenteric fat was collected from control, Ulcerative colitis (UC) and Crohn's disease (CD) patients (n=10-11 per group). Preadipocytes were isolated, expanded in culture and exposed to substance P. Colon biopsies were obtained from control and IBD patients. RESULTS Tacr-1 and -2 mRNA were increased in IBD preadipocytes compared to controls, while Tac-1 mRNA was increased only in UC preadipocytes. SP differentially regulated the expression of inflammatory mediators in IBD preadipocytes compared to controls. Disease-dependent responses to SP were also observed between UC and CD preadipocytes. IL-17A mRNA expression and release increased after SP treatment in both CD and UC preadipocytes, while IL-17RA mRNA increased in colon biopsies from IBD patients. CONCLUSIONS Preadipocyte SP-NK-1R interactions during IBD may participate in IBD pathophysiology. The ability of human preadipocytes to release IL-17A in response to SP together with increased IL-17A receptor in IBD colon opens the possibility of a fat-colonic mucosa inflammatory loop that may be active during IBD.
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Eftekhari P, Glaubitz L, Breidert M, Neurath MF, Atreya R. Physiological intermolecular modification spectroscopy for the prediction of response to anti-tumor necrosis factor therapy in patients with inflammatory bowel diseases. Dig Dis 2014; 32:446-54. [PMID: 24969293 DOI: 10.1159/000358151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIMS Anti-tumor necrosis factor (TNF) antibodies have clinical efficiency only in a subgroup of patients with inflammatory bowel diseases (IBD). Prediction of clinical response is a critical clinical problem. Physiological intermolecular modification spectroscopy (PIMS) is a label-free technology performed in physiological conditions. PIMS enables real-time monitoring of dynamic molecular resonance of entire proteins and macromolecules of an individual. The aim of this study was to explore the capacity of PIMS to discriminate IBD patients regarding response to anti-TNF treatment. METHODS Protein extracts of peripheral blood mononuclear cells (PBMC) from 30 outpatients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) and treated with infliximab were subjected to PIMS analysis in a blinded transversal study. Total protein from each patient's PBMCs was challenged with infliximab. Dynamic changes in macromolecular interaction were registered while the temperature rose from -37 to 37°C. Individual macromolecular volume and molecular elasticity were determined for each patient. RESULTS Clinical data revealed that 67% of UC and 79% of CD patients responded to infliximab therapy during the 3-month study period based on their respective clinical activity score. These results confirm that PIMS data predicted response to anti-TNF therapy with an accuracy of 96%. CONCLUSION PIMS stratified IBD patients into two groups, responders and nonresponders, which correlated with the clinical efficacy of anti-TNF therapy. PIMS seems to be a powerful technology to adapt IBD treatment to the individual patient. Further studies with PIMS might enable to predict clinical response to biological treatment in IBD patients before the therapy is initiated.
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Affiliation(s)
- Pierre Eftekhari
- INOVIEM Scientific, Institut de Science et d'Ingénierie Supramoléculaires, CNRS UPR 3572, Strasbourg, France
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Liu X, Xu J, Mei Q, Han L, Huang J. Myosin light chain kinase inhibitor inhibits dextran sulfate sodium-induced colitis in mice. Dig Dis Sci 2013; 58:107-14. [PMID: 22777616 DOI: 10.1007/s10620-012-2304-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 06/25/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Myosin light chain kinase (MLCK) plays a central role in the mechanisms of barrier dysfunction, and intestinal epithelial MLCK protein expression is upregulated in active ulcerative colitis (UC). ML-7, a MLCK inhibitor, has been used in many MLCK studies. However, the effect of ML-7 has never been estimated in colitis models. The aim of this study was to determine whether ML-7 can treat UC. METHODS Experimental colitis was induced and ML-7 was administered by intraperitoneal injection. The disease activity index (DAI) scores were evaluated and colon tissue was collected for the assessment of histological changes, myeloperoxidase (MPO) activity, and tumor necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-13 and interleukin (IL)-17 levels. The small intestinal mucosa was ultrastructurally examined, epithelial MLCK protein expression and enzymatic activity were determined, and intestinal permeability was assayed using FITC-dextran 4000 (FD-4) and Evans blue (EB). RESULTS ML-7 was found to be significantly effective in reducing the DAI scores and histological index scores, and decreasing MPO activity and TNF-α, IFN-γ, IL-13 and IL-17 levels. The small intestinal epithelial MLCK protein expression and enzymatic activity were downregulated by ML-7. The epithelial cells and intercellular tight junctions were ameliorated, and the amount of FD-4 in blood and EB permeating into the intestine were decreased by ML-7 in colitis mice. CONCLUSIONS ML-7 has a significant anti-colitis effect in colitis mice. It is mainly associated with the inhibition of the epithelial MLCK protein expression, resulting in ameliorated intestinal mucosal permeability.
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Affiliation(s)
- Xiaochang Liu
- Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, The Key Laboratory of Digestive Diseases of Anhui Province, No. 218 Jixi Road, Hefei, Anhui, 230022, China
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Lacruz-Guzmán D, Torres-Moreno D, Pedrero F, Romero-Cara P, García-Tercero I, Trujillo-Santos J, Conesa-Zamora P. Influence of polymorphisms and TNF and IL1β serum concentration on the infliximab response in Crohn's disease and ulcerative colitis. Eur J Clin Pharmacol 2012; 69:431-8. [PMID: 22960943 DOI: 10.1007/s00228-012-1389-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 08/23/2012] [Indexed: 12/11/2022]
Abstract
AIM Inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC), are partially attributable to an increased secretion of proinflamatory cytokines, such as tumour necrosis factor (TNF) and interleukin-1β (IL1β), which play essential roles in the disease pathogenesis and are target molecules for specific therapy. Given the inter-individual variability in the response to the anti-TNF monoclonal antibody infliximab, the aim of our study was to explore the predictive value of TNF and/or IL1β as surrogate markers of infliximab response. METHODS Serial serum concentrations of TNF and IL1β and TNF promoter region and IL1B polymorphisms were determined in 47 patients (29 CD and 18 UC) receiving infliximab and correlated with treatment response. RESULTS Baseline serum concentrations of TNF and IL1β were higher in UC patients than in CD patients (p = 0.0097 and 0.0024, respectively). CD patients showing <0.64 pg/ml IL1β at baseline were more frequently responders than non-responders (p = 0.036), and the C allele of the IL1B polymorphism was associated with higher IL1β serum concentrations (p = 0.026) and with poorer clinical remission after 14 weeks of infliximab treatment. No significant association was found between serum TNF concentration or TNF polymorphism and patient response to infliximab. CONCLUSION This is the first study evaluating the pharmacogenetic role of the rs1143634 polymorphism of IL1B and TNF polymorphisms in infliximab-treated IBD patients. We found an association between the rs1143634 C allele and higher serum IL1β concentrations and a lower response to infliximab treatment in CD patients that warrants the interest of future studies in larger and independent series.
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Affiliation(s)
- Diana Lacruz-Guzmán
- Pharmacy Department, Santa Lucía General University Hospital, Cartagena, Spain.
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Pneumocystosis in a patient with Crohn's disease treated with combination therapy with adalimumab. J Crohns Colitis 2012; 6:483-7. [PMID: 22398055 DOI: 10.1016/j.crohns.2011.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 02/08/2023]
Abstract
Pneumocystis jirovecii pneumonia (PCP) is a potential complication of immunosuppression. Crohn's disease (CD) is an immune granulomatous disorder characterized by transmural inflammation that can affect any part of the gastrointestinal tract. Its treatment is based on steroids and immunosuppressants but in non-responders, biologic compounds such as anti-tumor necrosis factor alpha (TNF) antibodies have been used. Neutralization of TNF causes a decrease in the inflammatory response but increases susceptibility to opportunistic infections such as fungal infections. We report a young male with chronic diarrhea, fever and weight loss who was diagnosed with CD and began conventional treatment with immunosuppressants, but due to lack of response after several weeks, biologic therapy with adalimumab was initiated. Seven weeks later he developed persistent fever and upper respiratory symptoms. After chest CT, bronchoscopy and bronchial lavage, P. jirovecii was identified by silver staining and confirmed by immunofluorescence. To our knowledge this is the second case of pneumocystosis associated with the use of adalimumab in CD and the first reported Mexican case confirmed by microbiological and immunological studies in this setting.
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Sezikli M, Akkan Cetinkaya Z, Güzelbulut F, Özgil Yetkin D. Metabolic Syndrome in Inflammatory Bowel Disease:
A Real Relationship or Just a Coincidence. Euroasian J Hepatogastroenterol 2012. [DOI: 10.5005/jp-journals-10018-1039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Buchanan J, Wordsworth S, Ahmad T, Perrin A, Vermeire S, Sans M, Taylor J, Jewell D. Managing the long term care of inflammatory bowel disease patients: The cost to European health care providers. J Crohns Colitis 2011; 5:301-16. [PMID: 21683300 DOI: 10.1016/j.crohns.2011.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory Bowel Disease (which includes Crohn's Disease and Ulcerative Colitis), is a chronic condition characterised by substantial morbidity. Inflammatory Bowel Disease patients are considered expensive to manage, hence accurate estimates of care costs are crucial to help healthcare providers plan clinical management. The aim of this study is to estimate the cost of care for Crohn's Disease and Ulcerative Colitis patients in the United Kingdom and Western mainland Europe. METHODS Decision models were built to simulate the natural disease history of Crohn's Disease and Ulcerative Colitis, informed by United Kingdom and European clinical pathways. A healthcare provider perspective was adopted, model inputs were informed by published sources and expert opinion, and UK healthcare costs were used (2008 prices). Cohorts of 25 year old patients presenting with symptoms of varying severity were modelled over ten years, and annual treatment costs calculated per patient. RESULTS The average annual cost of care per Crohn's Disease/Ulcerative Colitis patient was £631/£762 (United Kingdom) and £838/£796 (Europe). Most costs were incurred immediately following diagnosis, particularly in European Crohn's patients, reflecting the earlier use of more aggressive treatments. Surgery, hospitalisation, and the use of biological therapies and mesalazine (in Ulcerative Colitis) were key cost drivers. The total annual cost to the United Kingdom National Health Service of caring for Inflammatory Bowel Disease patients was estimated to be £131million. CONCLUSIONS This study confirms that Inflammatory Bowel Disease patients are expensive to manage and illustrates the importance of differentiating between alternative clinical management scenarios.
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Affiliation(s)
- James Buchanan
- Health Economics Research Centre, University of Oxford, Oxford, UK.
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Abstract
After infection, most antigen-specific memory T cells reside in nonlymphoid tissues. Tissue-specific programming during priming leads to directed migration of T cells to the appropriate tissue, which promotes the development of tissue-resident memory in organs such as intestinal mucosa and skin. Mechanisms that regulate the retention of tissue-resident memory T cells include transforming growth factor-β (TGF-β)-mediated induction of the E-cadherin receptor CD103 and downregulation of the chemokine receptor CCR7. These pathways enhance protection in internal organs, such as the nervous system, and in the barrier tissues--the mucosa and skin. Memory T cells that reside at these surfaces provide a first line of defense against subsequent infection, and defining the factors that regulate their development is critical to understanding organ-based immunity.
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Affiliation(s)
- Brian S Sheridan
- Center for Integrated Immunology and Vaccine Research, Department of Immunology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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Oikonomou KA, Kapsoritakis AN, Stefanidis I, Potamianos SP. Drug-induced nephrotoxicity in inflammatory bowel disease. Nephron Clin Pract 2011; 119:c89-94; discussion c96. [PMID: 21677443 DOI: 10.1159/000326682] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Conservative management of inflammatory bowel disease (IBD) is based on a combination of drugs, including aminosalicylates (ASAs), steroids, antibiotics, immunosuppressives and biologic agents. Although various side effects have been related to treatment regimens, drug-induced nephrotoxicity is rather uncommon. Furthermore, it is often underestimated since renal function deterioration may be attributed to the underlying disease. The nephrotoxicity of ASAs and cyclosporine A seems well established, but recent data have suggested a possible role of biologic agents such as infliximab and adalimubab in renal impairment. The aim of this review is to summarize the nephrotoxic effects of medical treatment as well as to express possible caveats in the administration of novel agents in IBD.
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Loftus EV. Progress in the diagnosis and treatment of inflammatory bowel disease. Gastroenterol Hepatol (N Y) 2011; 7:3-16. [PMID: 22457643 PMCID: PMC3061012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Edward V Loftus
- Professor of Medicine Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota
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