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Low-dose Recombinant Human IL-2 for the Treatment of Rheumatoid Arthritis

Primary Purpose

Rheumatoid Arthritis

Status
Completed
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
hrIL-2 active
hrIL-2 placebo
MTX
Folic Acid
Loxoprofen
Sponsored by
Peking University People's Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Rheumatoid Arthritis

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female ≥18 and ≤70 years of age at time of screening
  • Diagnosed with rheumatoid arthritis
  • Must have active disease with DMARDs (Disease Modifying Anti-Rheumatic Drugs) except MTX, the doses had been stable for at least 3 months before baseline
  • Moderate or severe rheumatoid arthritis during screening, as defined by a disease activity score (28 joint) calculated using the C-reactive protein formula (DAS28-ESR) > 3.2
  • Have given written informed consent

Exclusion Criteria:

  • Patient presenting or having a history of other inflammatory joint disease
  • Patient with ongoing or previous Stevens-Johnson syndrome, toxic epidermal necrolysis or erythema multiforme
  • Patient with significantly impaired bone marrow function or significant anaemia, leucopenia or thrombocytopenia due to causes or other than active rheumatoid arthritis
  • Persistent infection or severe infection within 3 months before enrollment,
  • Uncontrolled hypertension, uncontrolled diabetes, unstable ischemic heart disease, active inflammatory bowel disease, active peptic ulcer disease, terminal illness or other medical condition which, in the opinion of the investigator, would put the patient at risk to participate in the study,
  • Clinically relevant cardiovascular, hepatic, neurological, endocrine, or other major systemic disease making implementation of the protocol or interpretation of the study results difficult
  • Severe hypoproteinemia (e.g., in case of severe liver disease or nephrotic syndrome) with serum albumin < 30 g/L
  • Moderate or severe impairment of renal function, as known by serum creatinine > 133μmol/L (or 1.5 mg/dl)
  • Patient with history of recent and clinically significant drug or alcohol abuse
  • Impairment of liver function or persisting ALT (SGPT) elevations of more than 2-fold the upper limit of normal
  • Known HIV positive status
  • Known positive serology for hepatitis B or C
  • Patient with hypersensitivity to any of the excipients in the tablets of methotrexate
  • Pregnancy
  • Breastfeeding
  • Women of childbearing potential, except if they fulfill specific conditions,
  • Men wishing to father children during the course of the study or within the 24 months thereafter (or 3 month with the washout procedure)
  • Patient with a congenital or acquired severe immuno-deficiency, a history of cancer or lymphoproliferative disease, or any patient who has received total lymphoid irradiation.
  • Enrollment in any other clinical trial involving off-label use of an investigational drug or device, or enrollment in any other type of medical research
  • Any active infection (including chronic or localized infections) for which anti-infectives were indicated within 28 days prior to first investigational product dose
  • BMI(body mass index) under 18.5 kg/m2 or more than 30 kg/m2
  • The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Sites / Locations

  • Department of Rheumatology and Immunology, Peking University People's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Experimental

Placebo Comparator

Arm Description

hrIL-2 active (1 million U doses of hrIL-2s.c.injection) MTX Folic acid Loxoprofen

hrIL-2 placebo (1 million U doses of placebo s.c.injection) MTX Folic acid Loxoprofen

Outcomes

Primary Outcome Measures

Percentage of Participants Achieving DAS28 Remission.
DAS 28 remission is defined by a disease activity score (28 joint) calculated using the erythrocyte sedimentation rate (DAS28-ESR) of less than 2.6
Percentage of Participants Meeting the American College of Rheumatology 20% Response Criteria
The assessments are based on a 20% or greater improvement from Baseline in the number of tender joints, a 20%, or more improvement in the number of swollen joints, and a 20% or greater improvement in 3 of the 5 remaining core set measures: Patient's Global Assessment of Disease Activity (PtGADA), Physician's Global Assessment of Disease Activity (PhGADA), Patient's Assessment of Arthritis Pain (PtAAP), physical function as assessed by the Health Assessment Questionnaire - Disability Index (HAQ-DI) and C-Reactive Protein (CRP).
The Change From Baseline of Clinical Disease Activity Index (CDAI)
Clinical Disease Activity Index(CDAI), the minimum is 0, the maximum is 76. higher scores mean a worse outcome. The change of from baseline of CDAI, the minimum is -76, the maximum is 76. higher scores mean a worse outcome.
The Change From Baseline of Simplified Disease Activity Index (SDAI)
Simplified Disease Activity Index(SDAI). the minimum is 0, the maximum is 96. higher scores mean worse outcome. The change from baseline of SDAI. the minimum is -96, the maximum is 96. higher scores mean worse outcome.

Secondary Outcome Measures

Number of Participants With Adverse Events
adverse events includes injection site reactions, influenza-like symptoms, infection, fever, tumor, cardiovascular event, drug-induced liver and kidney damage.
Percentage of CD4+ Treg Cells
analysis regulatory CD4+ T(Treg) cells before and during IL-2 treatment. P values<0.05 are considered statistically significant.
Percentage of Participants Achieving DAS28 Low Disease Activity.
Low disease activity is defined by a disease activity score (28 joint) calculated using the erythrocyte sedimentation rate (DAS28-ESR) of less than 3.2
Percentage of Participants Achieving a Good or Moderate European League Against Rheumatism (EULAR) Response
Good response is defined as: DAS28-ESR ≤ 3.2 and decrease from Baseline by > 1.2. moderate response is defined as achievement of one of the following: DAS28-ESR ≤ 3.2 and decrease from Baseline > 0.6 and ≤ 1.2 DAS28-ESR > 3.2 and ≤ 5.1 and decrease from Baseline > 0.6 DAS28-ESR > 5.1 and decrease from Baseline >1.2.
Percentage of Participants Meeting the American College of Rheumatology 50% Response Criteria
The assessments are based on a 50% or greater improvement from Baseline in the number of tender joints, a 50%, or more improvement in the number of swollen joints, and a 50% or greater improvement in 3 of the 5 remaining core set measures: Patient's Global Assessment of Disease Activity (PtGADA), Physician's Global Assessment of Disease Activity (PhGADA), Patient's Assessment of Arthritis Pain (PtAAP), physical function as assessed by the Health Assessment Questionnaire - Disability Index (HAQ-DI) and C-Reactive Protein (CRP).
Percentage of Participants Meeting the American College of Rheumatology 70% Response Criteria
The assessments are based on a 70% or greater improvement from Baseline in the number of tender joints, a 70%, or more improvement in the number of swollen joints, and a 70% or greater improvement in 3 of the 5 remaining core set measures: Patient's Global Assessment of Disease Activity (PtGADA), Physician's Global Assessment of Disease Activity (PhGADA), Patient's Assessment of Arthritis Pain (PtAAP), physical function as assessed by the Health Assessment Questionnaire - Disability Index (HAQ-DI) and C-Reactive Protein (CRP).
Percentage of Participants Meeting the 2011 American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) Remission Criteria Simplified for Clinical Practice
The 2011 ACR/EULAR remission criteria simplified for clinical practice is defined as:Tender Joint Count (TJC) ≤ 1, Swollen Joint Count (SJC) ≤ 1 and Patient's Global Assessment of Disease Activity (PtGADA) ≤ 1.
The Change From Baseline of a Health Assessment Questionnaire- Disability Index (HAQ-DI)
The domains of the HAQ-DI are dressing and grooming, arising, eating, walking, hygiene, reach, grip and common daily activities. The total score ranges from 0 to 3 with lower scores meaning lower disability. The change from baseline of HAQ-DI, minimum is -3, the maximum is 3. higher scores mean a worse outcome.
The Scores of SF-36 Quetionnaire
Score ranging from 0 to 100 with higher scores a better outcome.
Work Productivity Survey - Rheumatoid Arthritis [WPS-RA]
The Arthritis interference in the last month with work productivity is measured on a scale that ranges from 0 (no interference) to 10 (complete interference). The Arthritis interference in the last month with household work productivity is measured on a scale that ranges from 0 (no interference) to 10 (complete interference).higher scores mean a worse outcome.
Erythrocyte Sedimentation Rate (ESR)
C Reactive Protein (CRP)
The Change From Baseline of Patient's Global Assessment of Disease Activity (PtGADA)
VAS score from 0 to 100 for Patient's Global Assessment of Disease Activity Higher scores mean a worse outcome. The change from baseline of PtGADA, the minimum is -100, the maximum is 100. Higher scores mean a worse outcome.
The Change From Baseline of Physician's Global Assessment of Disease Activity (PhGADA)
VAS score from 0 to 100 for Physician's Global Assessment of Disease Activity higher scores mean a worse outcome. The change from baseline, the minimum is -100, the maximum is 100.
The Change From Baseline of Patient's Assessment of Arthritis Pain (PtAAP)
VAS score from 0 to 100 for Patient's Assessment of Arthritis Pain higher scores mean a worse outcome. The change from baseline of PtAAP, the minimum is -100, the maximum is 100.
Work Productivity Survey - Rheumatoid Arthritis [WPS-RA]-2
In the last month, number of work days missed, number of work days with reduced productivity. In the last month, number of days with no household work, number of days with reduced household work productivity, number of days with hired outside help, number of days missed of family/social/leisure activities in the last month.higher scores mean a worse outcome.

Full Information

First Posted
June 4, 2015
Last Updated
July 31, 2019
Sponsor
Peking University People's Hospital
Collaborators
Monash University, Beijing ShuangLu Pharmaceutical Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02467504
Brief Title
Low-dose Recombinant Human IL-2 for the Treatment of Rheumatoid Arthritis
Official Title
A Randomized, Double Blind, Placebo-controlled Pilot-study to Evaluate Efficacy and Safety of Low-dose hrIL-2 in the Treatment of Methotrexate (MTX)-Naive Patients With Rheumatoid Arthritis
Study Type
Interventional

2. Study Status

Record Verification Date
May 2019
Overall Recruitment Status
Completed
Study Start Date
July 1, 2015 (Actual)
Primary Completion Date
January 15, 2017 (Actual)
Study Completion Date
August 31, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Peking University People's Hospital
Collaborators
Monash University, Beijing ShuangLu Pharmaceutical Co., Ltd.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease, characterized by symmetric poly-arthritis usually involving the small joints of the hands and feet. In addition, various extra-joint manifestations may develop. Several immunomodulating agents have been attempted in the treatment of RA without achieving satisfactory results. Dysfunction of regulatory T (Treg) cells has been detected in diverse autoimmune diseases, which can be promoted by interleukin-2 (IL-2). The investigators hypothesized that low-dose IL-2 could be a novel therapy in active RA patients. This clinical study will test the efficacy and safety of low dose IL-2 treatment in RA. The investigators perform a single-centre, double-blind pilot trial with hrIL-2 in RA. The investigators evaluate the effectiveness and safeness of low-dose hrIL-2 for RA by randomized controlled study (hrIL-2 (N = 23) + Methotrexate (MTX)+ Loxoprofen versus placebo+MTX + Loxoprofen group (N = 24)).
Detailed Description
Each RA patients (n=47) with DAS>3.2 received low-dose IL-2+MTX+ Loxoprofen or placebo+MTX + Loxoprofen (active group: placebo group =1:1, 1 million units every other day subcutaneously (hrIL-2 1×106, ip, Qod) for a period of 14 days. After a 14-day rest, another cycle started) for 3 cycles. The end points were safety and clinical and immunologic response.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Rheumatoid Arthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
47 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Experimental
Arm Type
Active Comparator
Arm Description
hrIL-2 active (1 million U doses of hrIL-2s.c.injection) MTX Folic acid Loxoprofen
Arm Title
Placebo Comparator
Arm Type
Placebo Comparator
Arm Description
hrIL-2 placebo (1 million U doses of placebo s.c.injection) MTX Folic acid Loxoprofen
Intervention Type
Drug
Intervention Name(s)
hrIL-2 active
Other Intervention Name(s)
Human recombinant IL-2
Intervention Description
hrIL-2 active (1 million U doses of hrIL-2s.c.injection)
Intervention Type
Drug
Intervention Name(s)
hrIL-2 placebo
Other Intervention Name(s)
placebo
Intervention Description
hrIL-2 placebo (1 million U doses of hrIL-2 placebo s.c.injection)
Intervention Type
Drug
Intervention Name(s)
MTX
Intervention Description
Methotrexate (oral administration)
Intervention Type
Drug
Intervention Name(s)
Folic Acid
Intervention Description
Folic Acid (oral administration)
Intervention Type
Drug
Intervention Name(s)
Loxoprofen
Intervention Description
Loxoprofen (oral administration)
Primary Outcome Measure Information:
Title
Percentage of Participants Achieving DAS28 Remission.
Description
DAS 28 remission is defined by a disease activity score (28 joint) calculated using the erythrocyte sedimentation rate (DAS28-ESR) of less than 2.6
Time Frame
week 24
Title
Percentage of Participants Meeting the American College of Rheumatology 20% Response Criteria
Description
The assessments are based on a 20% or greater improvement from Baseline in the number of tender joints, a 20%, or more improvement in the number of swollen joints, and a 20% or greater improvement in 3 of the 5 remaining core set measures: Patient's Global Assessment of Disease Activity (PtGADA), Physician's Global Assessment of Disease Activity (PhGADA), Patient's Assessment of Arthritis Pain (PtAAP), physical function as assessed by the Health Assessment Questionnaire - Disability Index (HAQ-DI) and C-Reactive Protein (CRP).
Time Frame
week 12, week 24
Title
The Change From Baseline of Clinical Disease Activity Index (CDAI)
Description
Clinical Disease Activity Index(CDAI), the minimum is 0, the maximum is 76. higher scores mean a worse outcome. The change of from baseline of CDAI, the minimum is -76, the maximum is 76. higher scores mean a worse outcome.
Time Frame
week 12, week 24
Title
The Change From Baseline of Simplified Disease Activity Index (SDAI)
Description
Simplified Disease Activity Index(SDAI). the minimum is 0, the maximum is 96. higher scores mean worse outcome. The change from baseline of SDAI. the minimum is -96, the maximum is 96. higher scores mean worse outcome.
Time Frame
week 12, week 24
Secondary Outcome Measure Information:
Title
Number of Participants With Adverse Events
Description
adverse events includes injection site reactions, influenza-like symptoms, infection, fever, tumor, cardiovascular event, drug-induced liver and kidney damage.
Time Frame
Up to week 24
Title
Percentage of CD4+ Treg Cells
Description
analysis regulatory CD4+ T(Treg) cells before and during IL-2 treatment. P values<0.05 are considered statistically significant.
Time Frame
week 12, week 24
Title
Percentage of Participants Achieving DAS28 Low Disease Activity.
Description
Low disease activity is defined by a disease activity score (28 joint) calculated using the erythrocyte sedimentation rate (DAS28-ESR) of less than 3.2
Time Frame
week 12, week 24
Title
Percentage of Participants Achieving a Good or Moderate European League Against Rheumatism (EULAR) Response
Description
Good response is defined as: DAS28-ESR ≤ 3.2 and decrease from Baseline by > 1.2. moderate response is defined as achievement of one of the following: DAS28-ESR ≤ 3.2 and decrease from Baseline > 0.6 and ≤ 1.2 DAS28-ESR > 3.2 and ≤ 5.1 and decrease from Baseline > 0.6 DAS28-ESR > 5.1 and decrease from Baseline >1.2.
Time Frame
week 12, week 24
Title
Percentage of Participants Meeting the American College of Rheumatology 50% Response Criteria
Description
The assessments are based on a 50% or greater improvement from Baseline in the number of tender joints, a 50%, or more improvement in the number of swollen joints, and a 50% or greater improvement in 3 of the 5 remaining core set measures: Patient's Global Assessment of Disease Activity (PtGADA), Physician's Global Assessment of Disease Activity (PhGADA), Patient's Assessment of Arthritis Pain (PtAAP), physical function as assessed by the Health Assessment Questionnaire - Disability Index (HAQ-DI) and C-Reactive Protein (CRP).
Time Frame
week 12, week 24
Title
Percentage of Participants Meeting the American College of Rheumatology 70% Response Criteria
Description
The assessments are based on a 70% or greater improvement from Baseline in the number of tender joints, a 70%, or more improvement in the number of swollen joints, and a 70% or greater improvement in 3 of the 5 remaining core set measures: Patient's Global Assessment of Disease Activity (PtGADA), Physician's Global Assessment of Disease Activity (PhGADA), Patient's Assessment of Arthritis Pain (PtAAP), physical function as assessed by the Health Assessment Questionnaire - Disability Index (HAQ-DI) and C-Reactive Protein (CRP).
Time Frame
week 12, week 24
Title
Percentage of Participants Meeting the 2011 American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) Remission Criteria Simplified for Clinical Practice
Description
The 2011 ACR/EULAR remission criteria simplified for clinical practice is defined as:Tender Joint Count (TJC) ≤ 1, Swollen Joint Count (SJC) ≤ 1 and Patient's Global Assessment of Disease Activity (PtGADA) ≤ 1.
Time Frame
week 12, week 24
Title
The Change From Baseline of a Health Assessment Questionnaire- Disability Index (HAQ-DI)
Description
The domains of the HAQ-DI are dressing and grooming, arising, eating, walking, hygiene, reach, grip and common daily activities. The total score ranges from 0 to 3 with lower scores meaning lower disability. The change from baseline of HAQ-DI, minimum is -3, the maximum is 3. higher scores mean a worse outcome.
Time Frame
week 12, week 24
Title
The Scores of SF-36 Quetionnaire
Description
Score ranging from 0 to 100 with higher scores a better outcome.
Time Frame
week 12, week 24
Title
Work Productivity Survey - Rheumatoid Arthritis [WPS-RA]
Description
The Arthritis interference in the last month with work productivity is measured on a scale that ranges from 0 (no interference) to 10 (complete interference). The Arthritis interference in the last month with household work productivity is measured on a scale that ranges from 0 (no interference) to 10 (complete interference).higher scores mean a worse outcome.
Time Frame
week 24
Title
Erythrocyte Sedimentation Rate (ESR)
Time Frame
week 12, week 24
Title
C Reactive Protein (CRP)
Time Frame
week 12, week 24
Title
The Change From Baseline of Patient's Global Assessment of Disease Activity (PtGADA)
Description
VAS score from 0 to 100 for Patient's Global Assessment of Disease Activity Higher scores mean a worse outcome. The change from baseline of PtGADA, the minimum is -100, the maximum is 100. Higher scores mean a worse outcome.
Time Frame
week 12, week 24
Title
The Change From Baseline of Physician's Global Assessment of Disease Activity (PhGADA)
Description
VAS score from 0 to 100 for Physician's Global Assessment of Disease Activity higher scores mean a worse outcome. The change from baseline, the minimum is -100, the maximum is 100.
Time Frame
week 12, week 24
Title
The Change From Baseline of Patient's Assessment of Arthritis Pain (PtAAP)
Description
VAS score from 0 to 100 for Patient's Assessment of Arthritis Pain higher scores mean a worse outcome. The change from baseline of PtAAP, the minimum is -100, the maximum is 100.
Time Frame
week 12, week 24
Title
Work Productivity Survey - Rheumatoid Arthritis [WPS-RA]-2
Description
In the last month, number of work days missed, number of work days with reduced productivity. In the last month, number of days with no household work, number of days with reduced household work productivity, number of days with hired outside help, number of days missed of family/social/leisure activities in the last month.higher scores mean a worse outcome.
Time Frame
week 24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female ≥18 and ≤70 years of age at time of screening Diagnosed with rheumatoid arthritis Must have active disease with DMARDs (Disease Modifying Anti-Rheumatic Drugs) except MTX, the doses had been stable for at least 3 months before baseline Moderate or severe rheumatoid arthritis during screening, as defined by a disease activity score (28 joint) calculated using the C-reactive protein formula (DAS28-ESR) > 3.2 Have given written informed consent Exclusion Criteria: Patient presenting or having a history of other inflammatory joint disease Patient with ongoing or previous Stevens-Johnson syndrome, toxic epidermal necrolysis or erythema multiforme Patient with significantly impaired bone marrow function or significant anaemia, leucopenia or thrombocytopenia due to causes or other than active rheumatoid arthritis Persistent infection or severe infection within 3 months before enrollment, Uncontrolled hypertension, uncontrolled diabetes, unstable ischemic heart disease, active inflammatory bowel disease, active peptic ulcer disease, terminal illness or other medical condition which, in the opinion of the investigator, would put the patient at risk to participate in the study, Clinically relevant cardiovascular, hepatic, neurological, endocrine, or other major systemic disease making implementation of the protocol or interpretation of the study results difficult Severe hypoproteinemia (e.g., in case of severe liver disease or nephrotic syndrome) with serum albumin < 30 g/L Moderate or severe impairment of renal function, as known by serum creatinine > 133μmol/L (or 1.5 mg/dl) Patient with history of recent and clinically significant drug or alcohol abuse Impairment of liver function or persisting ALT (SGPT) elevations of more than 2-fold the upper limit of normal Known HIV positive status Known positive serology for hepatitis B or C Patient with hypersensitivity to any of the excipients in the tablets of methotrexate Pregnancy Breastfeeding Women of childbearing potential, except if they fulfill specific conditions, Men wishing to father children during the course of the study or within the 24 months thereafter (or 3 month with the washout procedure) Patient with a congenital or acquired severe immuno-deficiency, a history of cancer or lymphoproliferative disease, or any patient who has received total lymphoid irradiation. Enrollment in any other clinical trial involving off-label use of an investigational drug or device, or enrollment in any other type of medical research Any active infection (including chronic or localized infections) for which anti-infectives were indicated within 28 days prior to first investigational product dose BMI(body mass index) under 18.5 kg/m2 or more than 30 kg/m2 The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Zhanguo Li, MD PhD
Organizational Affiliation
Peking University Institute of Rheuamotology and Immunology
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Rheumatology and Immunology, Peking University People's Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100044
Country
China

12. IPD Sharing Statement

Citations:
PubMed Identifier
35250032
Citation
Zhang X, Miao M, Zhang R, Liu X, Zhao X, Shao M, Liu T, Jin Y, Chen J, Liu H, Zhang X, Li Y, Zhou Y, Yang Y, Li R, Yao H, Liu Y, Li C, Li Y, Ren L, Su Y, Sun X, He J, Li Z. Efficacy and safety of low-dose interleukin-2 in combination with methotrexate in patients with active rheumatoid arthritis: a randomized, double-blind, placebo-controlled phase 2 trial. Signal Transduct Target Ther. 2022 Mar 7;7(1):67. doi: 10.1038/s41392-022-00887-2.
Results Reference
derived

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Low-dose Recombinant Human IL-2 for the Treatment of Rheumatoid Arthritis

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