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To Assess Efficacy and Safety of Batoclimab in Adult Participants With Active CIDP

Primary Purpose

Chronic Inflammatory Demyelinating Polyneuropathy

Status
Recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Batoclimab 680 milligrams (mg) subcutaneous (SC) weekly
Batoclimab 340 mg SC weekly
Placebo
Sponsored by
Immunovant Sciences GmbH
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Inflammatory Demyelinating Polyneuropathy focused on measuring Chronic Inflammatory Demyelinating Polyneuropathy, IMVT-1401, Monoclonal antibody, Autoimmune disorders

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Are >= 18 years at the Screening Visit.
  • Have met clinical diagnostic criteria for typical CIDP, or one of the following CIDP variants: multifocal CIDP, focal CIDP, or motor CIDP in accordance with the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) Guideline on the Diagnosis and Treatment of CIDP. Clinical criteria for typical CIDP and variants are as follows (either criteria must be met):

    1. Typical CIDP: All the following:

      • Progressive or relapsing, symmetric, proximal, and distal muscle weakness of upper and lower limbs, and sensory involvement of at least two limbs (at any point in the disease course)
      • Developing over at least 8 weeks
      • Absent or reduced tendon reflexes in all limbs
    2. CIDP variants: One of the following, but otherwise as in typical CIDP (tendon reflexes may be normal in unaffected limbs):

      • Multifocal CIDP: documented sensory loss and muscle weakness in a multifocal pattern, usually asymmetric, upper limb predominant
      • Focal CIDP: sensory loss and muscle weakness in only one limb
      • Motor CIDP: motor symptoms and signs without sensory involvement
  • Have electrodiagnostic test results supporting the diagnosis of CIDP in accordance with the EAN/PNS Guideline on the Diagnosis and Treatment of CIDP (either criteria must be met):

    1. Motor nerve conduction criteria strongly supportive of demyelination.
    2. Motor nerve conduction criteria weakly supportive of demyelination and 2 or more of the following additional diagnostic criteria:

      • Objective improvement to an empiric trial of therapy with immunoglobulin treatment, plasma exchange (PLEX) or corticosteroids.
      • Diagnostic imaging by ultrasound or magnetic resonance imaging (MRI) supporting the diagnosis of CIDP by demonstrating nerve enlargement.
      • Cerebrospinal fluid (CSF) demonstrating albuminocytologic dissociation (i.e., elevated CSF protein level [defined as > 70 milligrams per deciliter {mg/dL} or more than 10 mg/dL greater than years of age for those aged 60 years and over] with normal CSF white blood cell [WBC] level).
      • Nerve biopsy demonstrating features supporting the diagnosis of CIDP such as edema, demyelination, and/or onion bulb formation.

Additional inclusion criteria are defined in the protocol.

Exclusion Criteria:

  • Have presence of immunoglobulin M (IgM) paraproteinemia with or without anti-myelin-associated-glycoprotein antibodies.
  • Have Distal CIDP, Sensory CIDP or are suspected of having a diagnosis of auto-immune nodopathy in accordance with the EAN/PNS Guideline on the Diagnosis and Treatment of CIDP.
  • Have polyneuropathy of causes other than CIDP including but not limited to:

    1. Multifocal motor neuropathy
    2. Hereditary demyelinating neuropathy
    3. Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin change syndromes (i.e., POEMS)
    4. Lumbosacral radiculoplexus neuropathy
    5. Systemic illnesses including vitamin deficiency syndromes and paraneoplastic neuropathies
    6. Drug- or toxin-induced
  • Have diabetes mellitus (DM) and meets any of the following criteria:

    1. Diagnosis of DM pre-dates the diagnosis of CIDP
    2. Has ever required daily insulin therapy
    3. Duration of DM is 5 years or greater
    4. Has evidence of microvascular complications of DM including retinopathy or nephropathy
  • Have a history of myelopathy or evidence of central demyelination.
  • Are receiving chronic oral corticosteroids monotherapy at a dose > 40 mg/day or < 20 mg/day prednisolone/prednisone or its equivalent at the Screening Visit.
  • Are receiving chronic oral corticosteroid at a dose > 10 mg/day prednisone or equivalent in combination with immunoglobulin therapy or PLEX at the Screening Visit.

Additional exclusion criteria are defined in the protocol.

Sites / Locations

  • Site Number -1618Recruiting
  • Site Number -1600Recruiting
  • Site Number -1617Recruiting
  • Site Number -1620Recruiting
  • Site Number -1607Recruiting
  • Site Number -1601Recruiting
  • Site Number -6341Recruiting
  • Site Number -6302Recruiting
  • Site Number -6305Recruiting
  • Site Number -6306Recruiting
  • Site Number -6491Recruiting
  • Site Number -3203Recruiting
  • Site Number -4891Recruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm 9

Arm 10

Arm 11

Arm 12

Arm 13

Arm 14

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Treatment Period 1: Cohort A, Dose 1

Treatment Period 1: Cohort A, Dose 2

Treatment Period 1: Cohort B, Dose 1

Treatment Period 1: Cohort B, Dose 2

Treatment Period 1: Cohort C, Dose 1

Treatment Period 1: Cohort C, Dose 2

Withdrawal Period 2: Cohort A, Dose 1

Withdrawal Period 2: Cohort A, Dose 2

Withdrawal Period 2: Cohort B, Dose 1

Withdrawal Period 2: Cohort B, Dose 2

Withdrawal Period 2: Cohort C, Dose 1

Withdrawal Period 2: Cohort C, Dose 2

LTE Phase: With Relapse in Period 2: Dose 1 and Dose 2

LTE Phase: Without Relapse in Period 2: Dose 2

Arm Description

Outcomes

Primary Outcome Measures

Period 2, Cohort A: Percentage of participants who remain relapse-free at Week 36
Relapse is defined as a worsening (increase) of >= 1 point on the adjusted inflammatory neuropathy cause and treatment (Adj INCAT) score at any time point during Period 2 relative to Period 2 Baseline which is sustained at a Follow-Up visit 1 week later.

Secondary Outcome Measures

Period 2, Cohort A: Time to first relapse relative to Period 2 Baseline
Period 2, Cohort A: Change from Baseline in Adj INCAT score
The INCAT disability scale is a widely used and validated efficacy assessment of neurologic dysfunction in CIDP. Upper and lower limb dysfunction are each separately assessed on a scale of 0-5 and the results are summed together for a total composite score of 0-10. Higher scores represent greater disability. The Adj INCAT disability score is identical to the INCAT disability score with the exception that changes in upper limb function from 0 (normal) to 1 (minor symptoms) and vice versa are excluded since minor symptoms in the fingers, which are implied by an upper limb score of 1, are not considered clinically significant in all participants. The Adj INCAT disability score will be used for participant selection and measurement of clinical response.
Period 2, Cohort A: Change from Baseline in Inflammatory Rasch-built Overall Disability Scale (I-RODS)
The I-RODS for immune-mediated peripheral neuropathies is a patient-based linearly weighted scale that captures activity and social participation limitations in patients with CIDP. The assessment consists of a 24-question instrument that addresses upper and lower limb tasks that range in difficulty from reading a book and eating to standing and running. Answers are scored on a scale of 0-2 (complete disability to no disability) and the raw scores are then transformed into a final score ranging from 0-100.
Period 2, Cohort A: Change from Baseline in Mean grip strength
Mean Grip strength provides an objective, quantitative and immediate assessment of strength impairment. The Jamar dynamometer and the Martin vigorimeter are both commonly used to assess mean grip strength.
Period 2, Cohort A: Change from Baseline in Medical Research Council (MRC) Sum Score
The MRC sum score is a standardized methodology for objectively assessing and reporting muscle function. Six muscle groups are assessed bilaterally, and each scored on a scale of 0 (no visible contraction) to 5 (normal) yielding a sum ranging from 0 (paralysis) to 60 (normal strength). Higher scores indicate normal muscle strength.
Period 2, Cohort A: Change from Baseline in Overall Neuropathy Limitations Scale (ONLS)
The ONLS is a scale that focuses on upper and lower limb functions and was designed to assess the limitations of participants with immune-mediated peripheral neuropathies. This scale is completed by adding the total of the arm grade from zero point ( less limitation ) to 5 points ( most limitation ) and leg grade from zero point ( less limitation) to 7 points (more limitation) yielding a total score of 0 (no disability) to 12 (maximum disability). Lower values in the ONLS indicate a better clinical condition.
Period 2, Cohorts A and B combined: Change from Baseline in Adj INCAT score
Period 2, Cohorts A and B combined: Change from Baseline in I-RODS
Period 2, Cohorts A and B combined: Change from Baseline in Mean Grip Strength
Period 2, Cohorts A and B combined: Change from Baseline in MRC sum score
Period 2, Cohorts A and B combined: Change from Baseline in ONLS
Period 2, All Cohorts combined: Percentage of participants who remain relapse-free at Week 36
Periods 1, 2, and LTE phase: Number of participants with Treatment-emergent adverse events (TEAEs), Serious adverse events (SAEs), Adverse events (AEs) leading to study discontinuation

Full Information

First Posted
October 12, 2022
Last Updated
August 7, 2023
Sponsor
Immunovant Sciences GmbH
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1. Study Identification

Unique Protocol Identification Number
NCT05581199
Brief Title
To Assess Efficacy and Safety of Batoclimab in Adult Participants With Active CIDP
Official Title
A Phase 2b, Multi-center, Randomized, Quadruple-blind, Placebo-controlled Study of Batoclimab Treatment in Adult Participants With Active Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 15, 2022 (Actual)
Primary Completion Date
January 2026 (Anticipated)
Study Completion Date
January 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Immunovant Sciences GmbH

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a multi-center, randomized, quadruple-blind, placebo-controlled study to evaluate the efficacy and safety of batoclimab in adult participants with active CIDP. The study includes a 4-week Screening Phase, an up to 12-week Washout Phase, a 12-week Randomized Treatment Phase (Period 1), an up to 24-week Randomized Withdrawal Phase (Period 2), a 4-week Safety follow-up for participants not entering Long-Term Extension (LTE), and a 52-week LTE Phase. The total study duration will be up to 104 weeks. Eligible participants will be assigned to one of three cohorts (A, B, C) based upon their CIDP treatment at the time of screening.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Inflammatory Demyelinating Polyneuropathy
Keywords
Chronic Inflammatory Demyelinating Polyneuropathy, IMVT-1401, Monoclonal antibody, Autoimmune disorders

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
240 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment Period 1: Cohort A, Dose 1
Arm Type
Experimental
Arm Title
Treatment Period 1: Cohort A, Dose 2
Arm Type
Experimental
Arm Title
Treatment Period 1: Cohort B, Dose 1
Arm Type
Experimental
Arm Title
Treatment Period 1: Cohort B, Dose 2
Arm Type
Experimental
Arm Title
Treatment Period 1: Cohort C, Dose 1
Arm Type
Experimental
Arm Title
Treatment Period 1: Cohort C, Dose 2
Arm Type
Experimental
Arm Title
Withdrawal Period 2: Cohort A, Dose 1
Arm Type
Experimental
Arm Title
Withdrawal Period 2: Cohort A, Dose 2
Arm Type
Experimental
Arm Title
Withdrawal Period 2: Cohort B, Dose 1
Arm Type
Experimental
Arm Title
Withdrawal Period 2: Cohort B, Dose 2
Arm Type
Experimental
Arm Title
Withdrawal Period 2: Cohort C, Dose 1
Arm Type
Experimental
Arm Title
Withdrawal Period 2: Cohort C, Dose 2
Arm Type
Experimental
Arm Title
LTE Phase: With Relapse in Period 2: Dose 1 and Dose 2
Arm Type
Experimental
Arm Title
LTE Phase: Without Relapse in Period 2: Dose 2
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Batoclimab 680 milligrams (mg) subcutaneous (SC) weekly
Other Intervention Name(s)
IMVT-1401
Intervention Description
Batoclimab is a fully human anti-neonatal fragment crystallizable receptor (FcRn) monoclonal antibody
Intervention Type
Drug
Intervention Name(s)
Batoclimab 340 mg SC weekly
Other Intervention Name(s)
IMVT-1401
Intervention Description
Batoclimab is a fully human anti-neonatal fragment crystallizable receptor (FcRn) monoclonal antibody
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matching placebo SC
Primary Outcome Measure Information:
Title
Period 2, Cohort A: Percentage of participants who remain relapse-free at Week 36
Description
Relapse is defined as a worsening (increase) of >= 1 point on the adjusted inflammatory neuropathy cause and treatment (Adj INCAT) score at any time point during Period 2 relative to Period 2 Baseline which is sustained at a Follow-Up visit 1 week later.
Time Frame
Week 36
Secondary Outcome Measure Information:
Title
Period 2, Cohort A: Time to first relapse relative to Period 2 Baseline
Time Frame
Baseline (Week 12) to Week 36
Title
Period 2, Cohort A: Change from Baseline in Adj INCAT score
Description
The INCAT disability scale is a widely used and validated efficacy assessment of neurologic dysfunction in CIDP. Upper and lower limb dysfunction are each separately assessed on a scale of 0-5 and the results are summed together for a total composite score of 0-10. Higher scores represent greater disability. The Adj INCAT disability score is identical to the INCAT disability score with the exception that changes in upper limb function from 0 (normal) to 1 (minor symptoms) and vice versa are excluded since minor symptoms in the fingers, which are implied by an upper limb score of 1, are not considered clinically significant in all participants. The Adj INCAT disability score will be used for participant selection and measurement of clinical response.
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohort A: Change from Baseline in Inflammatory Rasch-built Overall Disability Scale (I-RODS)
Description
The I-RODS for immune-mediated peripheral neuropathies is a patient-based linearly weighted scale that captures activity and social participation limitations in patients with CIDP. The assessment consists of a 24-question instrument that addresses upper and lower limb tasks that range in difficulty from reading a book and eating to standing and running. Answers are scored on a scale of 0-2 (complete disability to no disability) and the raw scores are then transformed into a final score ranging from 0-100.
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohort A: Change from Baseline in Mean grip strength
Description
Mean Grip strength provides an objective, quantitative and immediate assessment of strength impairment. The Jamar dynamometer and the Martin vigorimeter are both commonly used to assess mean grip strength.
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohort A: Change from Baseline in Medical Research Council (MRC) Sum Score
Description
The MRC sum score is a standardized methodology for objectively assessing and reporting muscle function. Six muscle groups are assessed bilaterally, and each scored on a scale of 0 (no visible contraction) to 5 (normal) yielding a sum ranging from 0 (paralysis) to 60 (normal strength). Higher scores indicate normal muscle strength.
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohort A: Change from Baseline in Overall Neuropathy Limitations Scale (ONLS)
Description
The ONLS is a scale that focuses on upper and lower limb functions and was designed to assess the limitations of participants with immune-mediated peripheral neuropathies. This scale is completed by adding the total of the arm grade from zero point ( less limitation ) to 5 points ( most limitation ) and leg grade from zero point ( less limitation) to 7 points (more limitation) yielding a total score of 0 (no disability) to 12 (maximum disability). Lower values in the ONLS indicate a better clinical condition.
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohorts A and B combined: Change from Baseline in Adj INCAT score
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohorts A and B combined: Change from Baseline in I-RODS
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohorts A and B combined: Change from Baseline in Mean Grip Strength
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohorts A and B combined: Change from Baseline in MRC sum score
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, Cohorts A and B combined: Change from Baseline in ONLS
Time Frame
Baseline (Week 12) and up to Week 36
Title
Period 2, All Cohorts combined: Percentage of participants who remain relapse-free at Week 36
Time Frame
Week 36
Title
Periods 1, 2, and LTE phase: Number of participants with Treatment-emergent adverse events (TEAEs), Serious adverse events (SAEs), Adverse events (AEs) leading to study discontinuation
Time Frame
Day 1 (Period 1) up to Week 52 of LTE phase (Week L52); overall timeframe of up to 88 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Are >= 18 years at the Screening Visit. Have met clinical diagnostic criteria for typical CIDP, or one of the following CIDP variants: multifocal CIDP, focal CIDP, or motor CIDP in accordance with the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) Guideline on the Diagnosis and Treatment of CIDP. Clinical criteria for typical CIDP and variants are as follows (either criteria must be met): Typical CIDP: All the following: Progressive or relapsing, symmetric, proximal, and distal muscle weakness of upper and lower limbs, and sensory involvement of at least two limbs (at any point in the disease course) Developing over at least 8 weeks Absent or reduced tendon reflexes in all limbs CIDP variants: One of the following, but otherwise as in typical CIDP (tendon reflexes may be normal in unaffected limbs): Multifocal CIDP: documented sensory loss and muscle weakness in a multifocal pattern, usually asymmetric, upper limb predominant Focal CIDP: sensory loss and muscle weakness in only one limb Motor CIDP: motor symptoms and signs without sensory involvement Have electrodiagnostic test results supporting the diagnosis of CIDP in accordance with the EAN/PNS Guideline on the Diagnosis and Treatment of CIDP (either criteria must be met): Motor nerve conduction criteria strongly supportive of demyelination. Motor nerve conduction criteria weakly supportive of demyelination and 2 or more of the following additional diagnostic criteria: Objective improvement to an empiric trial of therapy with immunoglobulin treatment, plasma exchange (PLEX) or corticosteroids. Diagnostic imaging by ultrasound or magnetic resonance imaging (MRI) supporting the diagnosis of CIDP by demonstrating nerve enlargement. Cerebrospinal fluid (CSF) demonstrating albuminocytologic dissociation (i.e., elevated CSF protein level [defined as > 70 milligrams per deciliter {mg/dL} or more than 10 mg/dL greater than years of age for those aged 60 years and over] with normal CSF white blood cell [WBC] level). Nerve biopsy demonstrating features supporting the diagnosis of CIDP such as edema, demyelination, and/or onion bulb formation. Additional inclusion criteria are defined in the protocol. Exclusion Criteria: Have presence of immunoglobulin M (IgM) paraproteinemia with or without anti-myelin-associated-glycoprotein antibodies. Have Distal CIDP, Sensory CIDP or are suspected of having a diagnosis of auto-immune nodopathy in accordance with the EAN/PNS Guideline on the Diagnosis and Treatment of CIDP. Have polyneuropathy of causes other than CIDP including but not limited to: Multifocal motor neuropathy Hereditary demyelinating neuropathy Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin change syndromes (i.e., POEMS) Lumbosacral radiculoplexus neuropathy Systemic illnesses including vitamin deficiency syndromes and paraneoplastic neuropathies Drug- or toxin-induced Have diabetes mellitus (DM) and meets any of the following criteria: Diagnosis of DM pre-dates the diagnosis of CIDP Has ever required daily insulin therapy Duration of DM is 5 years or greater Has evidence of microvascular complications of DM including retinopathy or nephropathy Have a history of myelopathy or evidence of central demyelination. Are receiving chronic oral corticosteroids monotherapy at a dose > 40 mg/day or < 20 mg/day prednisolone/prednisone or its equivalent at the Screening Visit. Are receiving chronic oral corticosteroid at a dose > 10 mg/day prednisone or equivalent in combination with immunoglobulin therapy or PLEX at the Screening Visit. Additional exclusion criteria are defined in the protocol.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Central Study Contact
Phone
18007970414
Email
clinicaltrials@immunovant.com
Facility Information:
Facility Name
Site Number -1618
City
Carlsbad
State/Province
California
ZIP/Postal Code
92011
Country
United States
Individual Site Status
Recruiting
Facility Name
Site Number -1600
City
Boca Raton
State/Province
Florida
ZIP/Postal Code
33487
Country
United States
Individual Site Status
Recruiting
Facility Name
Site Number -1617
City
Ormond Beach
State/Province
Florida
ZIP/Postal Code
32174
Country
United States
Individual Site Status
Recruiting
Facility Name
Site Number -1620
City
Port Charlotte
State/Province
Florida
ZIP/Postal Code
33952
Country
United States
Individual Site Status
Recruiting
Facility Name
Site Number -1607
City
O'Fallon
State/Province
Illinois
ZIP/Postal Code
62269
Country
United States
Individual Site Status
Recruiting
Facility Name
Site Number -1601
City
Austin
State/Province
Texas
ZIP/Postal Code
78759
Country
United States
Individual Site Status
Recruiting
Facility Name
Site Number -6341
City
Patras
State/Province
Achaïa
ZIP/Postal Code
265 04
Country
Greece
Individual Site Status
Recruiting
Facility Name
Site Number -6302
City
Gussago
State/Province
Brescia
ZIP/Postal Code
25084
Country
Italy
Individual Site Status
Recruiting
Facility Name
Site Number -6305
City
Bologna
State/Province
Emilia-Romagna
ZIP/Postal Code
40139
Country
Italy
Individual Site Status
Recruiting
Facility Name
Site Number -6306
City
Roma
State/Province
Lazio
ZIP/Postal Code
00189
Country
Italy
Individual Site Status
Recruiting
Facility Name
Site Number -6491
City
Oslo
ZIP/Postal Code
00424
Country
Norway
Individual Site Status
Recruiting
Facility Name
Site Number -3203
City
Bydgoszcz
State/Province
Województwo Kujawsko-pomorskie
ZIP/Postal Code
85-796
Country
Poland
Individual Site Status
Recruiting
Facility Name
Site Number -4891
City
Göteborg
State/Province
Vastra Gotalands Lan
ZIP/Postal Code
413 45
Country
Sweden
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No

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To Assess Efficacy and Safety of Batoclimab in Adult Participants With Active CIDP

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