ACR Meeting Abstracts

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Abstracts tagged "Biologic drugs"

  • Abstract Number: 2398 • 2019 ACR/ARP Annual Meeting

    Prevalence of Anxiety and Depression in a Cohort of Patients with Rheumatic Diseases on Biological Infusions

    Alexander Peck1, Ella Starobinska 2, Gilbert Ortega 1, Jaclyn Leong 1, Travis Maestas 1, Phan Saligrama 1, Jawad Bilal 1 and Dominick Sudano 3, 1University of Arizona College of Medicine, Tucson, AZ, 2University of Arizona College of Medicine, Tucson, AL, 3Banner University Medical Center Tucson, Tucson

    Background/Purpose: Studies have shown an increased prevalence of psychologic disorders in rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis, compared to…
  • Abstract Number: 2406 • 2019 ACR/ARP Annual Meeting

    Hepatobiliary Events in >5000 Patients with Inflammatory Arthritis Treated with Biosimilar or Originator Etanercept in Routine Care, Results from the Danish Nationwide DANBIO Registry

    Bente Glintborg 1, Stylianos Georgiadis 2, Mette Nørgaard 3, Frank Mehnert 3, Kathrine Lederballe Grøn 1, Niels Steen Krogh 4 and Merete Lund Hetland1, 1DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark, 2DANBIO registry and Copenhagen Center for Arthritis Research, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, 4Zitelab / DANBIO, Copenhagen, Denmark

    Background/Purpose: Marketing of biosimilar biological drugs may significantly reduce drug costs if comparable safety and efficacy of originator and the biosimilar can be documented. In…
  • Abstract Number: 205 • 2019 ACR/ARP Annual Meeting

    Does a Mandatory Non-medical Switch from Originator to Biosimilar Etanercept Lead to Increase in Healthcare Use and Costs? A Danish Register-based Study of 1620 Patients with Inflammatory Arthritis

    Bente Glintborg 1, Rikke Ibsen 2, Rebekka Elisabeth Qwist Bilbo 3, Merete Lund Hetland1 and Jakob Kjellberg 3, 1DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark, 2i2minds, Aarhus, Denmark, 3VIVE, The Danish Centre for Social Science Research, Copenhagen, Denmark

    Background/Purpose: Marketing of cheaper biosimilar biological agents has created financial incentives for switching from the corresponding originator drugs (=non-medical switch). The economic benefit might potentially…
  • Abstract Number: 2464 • 2019 ACR/ARP Annual Meeting

    Multidisciplinary Unit of Psoriatic Arthritis: Clinical Results

    Clara Pérez-Velásquez1, Oihane Ibarguengoitia-Barrena 2, David Montero-Seisdedos 2, Lucía Vega-Alvarez 2, Carmen García-Gómez 1, Eva Galindez-Agirregoikoa 3, Silvia Pérez-Barrio 4, María Esther Ruiz-Lucea 2, Ignacio Torre-Salaberri 2, Ana Rosa Intxaurbe-Pellejero 2, Olaia Fernandez-Berrizbeitia 1, Juan María Blanco-Madrigal 2, Eduardo Cuende-Quintana 2, Itziar Calvo-Zorrilla 2, Iñigo Gorostiza-Hormaeche 5, Natalia Andrea Rivera-García 2, María Jesus Allande-López-Linares 2, Helena Ugarte-Zuazo 2 and María García-Vivar 1, 1University Hospital of Basurto, Bilbao, Pais Vasco, Spain, 2Rheumatology Unit, Basurto University Hospital, Bilbao, Spain, Bilbao, Spain, 3Hospital de Basurto, Bilbao, Pais Vasco, Spain, 4University Hospital of Basurto, Dermatology Department, Bilbao, Pais Vasco, Spain, 5Investigation Unit, Basurto University Hospital, Bilbao, Spain, Bilbao, Spain

    Background/Purpose: The multidisciplinary unit of psoriatic arthritis (PsA) are attractive to improve the early diagnosis and optimize the management of complex patients with PsA. There…
  • Abstract Number: 248 • 2019 ACR/ARP Annual Meeting

    Adherence to Biologic Disease-modifying Anti-rheumatic Drugs (DMARDs) —a Comparison of Long-term Adherence Among Patients with Various Inflammatory Conditions by Primary Dispensing Channel

    Caroline Swift 1, Yvonne Viteri2, Gail Bridges 3, Mary Dorholt 4 and Monal Kohli 5, 1Express Scripts, St. Louis, MO, 2Accredo, Northvale, NJ, 3Accredo, Memphis, TN, 4Accredo, Maple Grove, MN, 5Express Scripts, Franklin Lakes, NJ

    Background/Purpose: Medication adherence to biologic DMARDs has been associated with optimal clinical outcomes. Adherence varies with primary dispensing channel among rheumatoid arthritis patients. Prior studies…
  • Abstract Number: 2731 • 2019 ACR/ARP Annual Meeting

    Decomposition Analysis of Spending and Price Trends for Biologic Anti-Rheumatic Drugs in Medicare and Medicaid

    Natalie McCormick1, Zachary Wallace 2, Chana Sacks 3, John Hsu 4 and Hyon K. Choi 5, 1Massachusetts General Hospital and Harvard Medical School, Boston, MA, 2Massachusetts General Hospital, Boston, 3Department of General Internal Medicine, Massachusetts General Hospital; Department of Medicine, Harvard Medical School, Boston, MA, 4Mongan Institute, Massachusetts General Hospital; Department of Health Care Policy, Harvard Medical School, Boston, MA, 5Massachusetts General Hospital, Boston, MA

    Background/Purpose: Billions of public dollars are spent each year on biologic disease-modifying anti-rheumatic drugs (bDMARDs), but the drivers of bDMARD spending and per-patient cost increases…
  • Abstract Number: 276 • 2019 ACR/ARP Annual Meeting

    Effectiveness of Screening by Nurse with Predetermined Questionnaire on Infections Before Administration of Intravenous Biologics in Patients with Rheumatoid Arthritis

    Sayaka Furukawa1, Sho Fukui 1, Sakura Tamaki 2, Tomoko Nakasone 3 and Masato Okada 4, 1St.Luke's International Hospital, Chuo-ku, Tokyo, Japan, 2St. Luke's International Hospital, Chuo-ku, Japan, 3St. Luke's International Hospital, Chuo-ku, Tokyo, Japan, 4St. Luke's International Hospital, Tokyo, Japan

    Background/Purpose: Biologics are widely used as treatment for rheumatoid arthritis (RA), and pre-administration screening of active infection is imperative for the safety use. There is…
  • Abstract Number: 2826 • 2019 ACR/ARP Annual Meeting

    Risk of Serious Infections in Tofacitinib versus Other Biologic Drug Initiators in Patients with Rheumatoid Arthritis: A Multi-database Cohort Study

    Ajinkya Pawar 1, Rishi Desai 1, Nileesa Gautam 1 and Seoyoung C. Kim2, 1Brigham and Women's hospital, Boston, 2Brigham and Women’s Hospital and Harvard Medical School, Boston

    Background/Purpose: It is well-known that biologic or targeted synthetic DMARDs increase the risk of serious infections (SIs), but few studies have directly compared the risk…
  • Abstract Number: 549 • 2019 ACR/ARP Annual Meeting

    US Rheumatologists’ Beliefs and Knowledge About Biosimilars – an Ongoing Survey

    Allan Gibofsky1, Dorothy McCabe 2 and Sam Badawi 2, 1Weill Cornell Medical College, New York, NY, 2Boehringer Ingelheim, Ridgefield, CT

    Background/Purpose: A systematic review of survey literature from 2014-2018 found that clinicians in the US and Europe are cautious about biosimilar use (JMCP; 2019;25:102). We…
  • Abstract Number: 2911 • 2019 ACR/ARP Annual Meeting

    A Randomised, Open Labelled Clinical Trial to Investigate Synovial Mechanisms Determining Response – Resistance to Rituximab versus Tocilizumab in Rheumatoid Arthritis Patients Failing TNF Inhibitor Therapy

    Frances humby 1, Maya H. Buch 2, Patrick Durez 3, Myles Lewis 1, Michele Bombardieri 1, Hasan Rizvi 4, Stephen Kelly 4, Liliane Fosatti 1, Rebecca Hands 1, Giovanni Giorli 1, Arti Mahto 1, Carlomaurizio Montecucco 5, Bernard Lauwerys 6, Vasco Romao 7, Arthur Pratt 8, Serena Bugatti 9, Nora Ng 10, Felice Rivellese 1, Pauline Ho 11, Mattia Bellan 12, Mattia Congia 13, Patrick Verschueren 14, Pier Paolo Sainaghi 12, Nagui Gendi 15, Bhaskar Dasgupta 16, Alberto Cauli 17, Piero Reynolds 18, Juan Cañete 19, Robert J. Moots 20, Peter Taylor 21, Christopher Edwards 22, John Isaacs 8, Peter Sasieni 23, João Eurico Fonseca 24, Ernest Choy 25 and Costantino Pitzalis26, 1Queen Mary University of London, London, United Kingdom, 2University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom, 3Pôle de Recherche en Rhumatologie, Institut de Recherche Expérimentale et Clinique, UCL Saint-Luc, Brussels, Belgium, 4Barts Health NHS Trust, London, United Kingdom, 5Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy, Pavia, Italy, 6University of Louvain, Louvain, Belgium, 7University of Lisbon, Lisbon, Portugal, 8University of Newcastle, Newcastle, United Kingdom, 9University of Pavia, Pavia, Italy, 10Guys and St Thomas NHS Trust, London, United Kingdom, 11University of Manchester, Manchester, United Kingdom, 12University of Novara, Novara, Italy, 13University of Cagliari, Cagliari, Italy, 14University of Leuven, Leuven, Belgium, 15Basildon Hospital NHS Trust, Basildon, United Kingdom, 16Southend University Hospital, NHS Foundation Trust, Westcliff-on-Sea, United Kingdom, 17Rheumatology Unit, University Clinic AOU and University of Cagliari, Cagliari, Italy, 18Homerton University NHS Trust, London, United Kingdom, 19Rheumatology Department, Hospital Clínic and IDIBAPS,, Barcelona, Spain, 20Institute of Ageing and Chronic Disease, Liverpool, United Kingdom, 21University of Oxford, Oxford, United Kingdom, 22University of Southampton, Southampton, United Kingdom, 23Kings College London, London, United Kingdom, 24Rheumatology and Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa; Centro Académico de Medicina de Lisboa; Lisbon, Portugal., Lisbon, Portugal, 25Cardiff University School of Medicine, Cardiff, United Kingdom, 26Centre for Experimental Medicine & Rheumatology, Queen Mary University of London, London, United Kingdom

    Background/Purpose: Although biologic therapies have transformed the outlook for rheumatoid arthritis (RA), the lack of a major treatment response in over 50% of patients, the…
  • Abstract Number: 824 • 2019 ACR/ARP Annual Meeting

    Results from a Randomized Controlled Trial of the Safety of the Live Varicella Vaccine in TNF-Treated Patients

    Jeffrey Curtis1, S Louis Bridges 2, Stacey S Cofield 2, John Bassler 1, Theresa Ford 3, Stephen Lindsey 4, Alan Kivitz 5, Ilhem Messaoudi 6, Kaleb Michaud 7, Joseph Huffstutter 8, Ted Mikuls 9, David Ridley 10, William Shergy 11, Sarah Siegel 12 and Kevin Winthrop 13, 1University of Alabama at Birmingham, Birmingham, AL, 2University of Alabama at Birmingham, Birmingham, 3North Georgia Rheumatology Group, PC, Lawrenceville, GA, 4Ochsner Clinic Foundation, Baton Rouge, LA, 5Altoona Center for Clinical Research, Duncansville, PA, 6University of California Irvine, Irvine, CA, 7University of Nebraska Medical Center, Omaha, NE, 8Arthritis Associates, Hixon, TN, 9VA Nebraska-Western IA Health Care System & University of Nebraska Medical Center, Omaha, NE, 10St. Paul Rheumatology, Eagan, MN, 11Rheumatology Associates of North Alabama, Huntsville, AL, 12Oregon Health Science University, Portland, OR, 13Oregon Health and Science University, Portland, OR

    Background/Purpose: There has been minimal evaluation of the safety of live virus vaccines in patients receiving biologic therapies who may be immunocompromised. The Varicella Zoster…
  • Abstract Number: 835 • 2019 ACR/ARP Annual Meeting

    High Baseline Patient’s Compared with Evaluator’s Global Assessment Is Associated with Lower Retention and Remission Rates of First TNF Inhibitor in Psoriatic Arthritis Patients – Data from the EuroSpA Research Collaboration Network

    Brigitte Michelsen1, Lykke Midtbøll Ørnbjerg 2, Herman Mann 3, Tore Kvien 4, Michael J. Nissen 5, Maria José Santos 6, Dan Nordström 7, Lennart Jacobsson 8, Ziga Rotar 9, Bjorn Gudbjornsson 10, Süleyman Serdar Koca 11, Catalin Codreanu 12, Manuel Pombo-Suarez 13, Irene van der Horst-Bruinsma 14, Anne Gitte Loft 15, Karel Pavelka 3, Eirik Kristianslund 16, Burkhard Moeller 17, Elsa Vieira-Sousa 18, Anna Mari Hokkanen 19, Ulf Lindström 20, Matija Tomsic 21, Thorvardur J Love 22, Abdurrahman Tufan 23, Ruxandra IONESCU 24, Carlos Sánchez-Piedra 25, Marleen van de Sande 26, Gary Macfarlane 27, Florenzo Iannone 28, Lise Hyldstrup 2, Mikkel Østergaard 29 and Merete Lund Hetland 30, 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Denmark/ Hospital of Southern Norway Trust, Kristiansand, Norway/ Diakonhjemmet Hospital, Oslo, Norway, Oslo, Norway, 2Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Denmark, Copenhagen, Denmark, 3Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Prague, Czech Republic, Prague 2, Czech Republic, 4Diakonhjemmet Hospital, Dept. of Rheumatology / University of Oslo, Faculty of Medicine, Oslo, Norway, 5University Hospital Geneva, Geneva, Switzerland, 6Rheumatology department, Hospital Garcia de Orta, Almada, Portugal, 7Department of Medicine, ROB-FIN, Helsinki University Hospital and Helsinki University, Helsinki, Finland., Helsinki, Finland, 8Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,, Gothenburg, Sweden, 9UMC LJUBLJANA, DPT. OF RHEUMATOLOGY, LJUBLJANA, Slovenia, 10Centre for Rheumatology Research, Landspitali and Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 11Fırat University School of Medicine Division of Rheumatology, Elazığ, Turkey, 12Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania., Bucharest, Romania, 13Unit Research, Spanish Society of Rheumatology, Madrid, Spain, 14Amsterdam University Medical Center, Amsterdam, Netherlands, 15Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, Århus, Denmark, 16Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway., Oslo, Norway, 17University Hospital Bern, Bern, Switzerland, 18Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, EPE | Rheumatology Research Unit, Instituto de Medicina Molecular - Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, Portugal,, Lisbon, Portugal, 19Helsinki University Hospital, Helsinki, Finland, 20University of Gothenburg, Gothenburg, Sweden, 21Department of Rheumatology, University Medical Center Ljubljana, Slovenia, Ljubljana, Slovenia, 22Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 23Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey, Ankara, Turkey, 24SPITALUL CLINIC SFANTA MARIA, Bucharest, 25Research Unit, Spanish Society of Rheumatology, Madrid, Spain, 26Amsterdam UMC, Amsterdam, Netherlands, 27University of Aberdeen, Aberdeen, United Kingdom, 28Department of Emergency and Transplantation , Rheumatology Unit, University Hospital of Bari, Bari, Italy., Bari, Italy, 29Copenhagen Center for Arthritis Research, University of Copenhagen, Copenhagen, Denmark, 30DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark

    Background/Purpose: Discordance between baseline patient’s and evaluator’s global assessment of disease activity is common1 and may reduce the likelihood of remission following tumor necrosis factor…
  • Abstract Number: 837 • 2019 ACR/ARP Annual Meeting

    Does Discordance Between Baseline Patient’s and Evaluator’s Global Assessment of Disease Activity Impact Retention and Remission Rates of a First TNF Inhibitor in Patients with Axial Spondyloarthritis? Data from the EuroSpA Research Collaboration Network

    Brigitte Michelsen1, Lykke Midtbøll Ørnbjerg 2, Anne Gitte Loft 3, Tore Kvien 4, Adrian Ciurea 5, Herman Mann 6, Kari K. Eklund 7, Ayten Yazici 8, Maria José Santos 9, Johan Askling 10, Ziga Rotar 11, Bjorn Gudbjornsson 12, Manuel Pombo-Suarez 13, Catalin Codreanu 14, Irene van der Horst-Bruinsma 15, Eirik Kristianslund 16, Michael J. Nissen 17, Karel Pavelka 6, Nina Trokovic 18, Nevsun Inanc 19, Elsa Vieira-Sousa 20, Daniela DiGuiseppe 21, Matija Tomsic 22, Arni Jon Geirsson 23, Ruxandra IONESCU 24, Marleen van de Sande 25, Florenzo Iannone 26, Carlos Sánchez-Piedra 27, Gareth Jones 28, Lise Hyldstrup 2, Merete Lund Hetland 29 and Mikkel Østergaard 30, 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Denmark/ Hospital of Southern Norway Trust, Kristiansand, Norway/ Diakonhjemmet Hospital, Oslo, Norway, Oslo, Norway, 2Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Denmark, Copenhagen, Denmark, 3Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, Århus, Denmark, 4Diakonhjemmet Hospital, Dept. of Rheumatology / University of Oslo, Faculty of Medicine, Oslo, Norway, 5University Hospital Zürich, Zürich, Switzerland, 6Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Prague, Czech Republic, Prague 2, Czech Republic, 7ROB-FIN registry, Department of Medicine, Helsinki University and University Hospital, Helsinki, Finland, 8Kocaeli University, Faculty of Medicine, Division of Rheumatology, Kocaeli, Kocaeli, Turkey, 9Rheumatology department, Hospital Garcia de Orta, Almada, Portugal, 10Karolinska Institutet, Stockholm, Sweden, 11UMC LJUBLJANA, DPT. OF RHEUMATOLOGY, LJUBLJANA, Slovenia, 12Centre for Rheumatology Research, Landspitali and Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 13Unit Research, Spanish Society of Rheumatology, Madrid, Spain, 14Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania., Bucharest, Romania, 15Amsterdam University Medical Center, Amsterdam, Netherlands, 16Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway., Oslo, Norway, 17University Hospital Geneva, Geneva, Switzerland, 18Helsinki University Central Hospital, Helsinki, Finland, 19Marmara University, Faculty of Medicine, Division of Rheumatology, Istanbul, Turkey, ISTANBUL, Turkey, 20Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, EPE | Rheumatology Research Unit, Instituto de Medicina Molecular - Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, Portugal,, Lisbon, Portugal, 21Clinical Epidemiology Division, Dept of Medicine Solna, Karolinska Institutet,, Stockholm, Sweden, 22Department of Rheumatology, University Medical Center Ljubljana, Slovenia, Ljubljana, Slovenia, 23Centre for Rheumatology Research, University Hospital and Faculty of Medicine, Reykjavik, Iceland, 24SPITALUL CLINIC SFANTA MARIA, Bucharest, 25Amsterdam UMC, Amsterdam, Netherlands, 26Department of Emergency and Transplantation , Rheumatology Unit, University Hospital of Bari, Bari, Italy., Bari, Italy, 27Research Unit, Spanish Society of Rheumatology, Madrid, Spain, 28University of Aberdeen, Aberdeen, United Kingdom, 29DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark, 30Copenhagen Center for Arthritis Research, University of Copenhagen, Copenhagen, Denmark

    Background/Purpose: Discordance between baseline patient’s and evaluator’s global assessment of disease activity is common.1 However, the impact of such discordance on retention and remission rates…
  • Abstract Number: 1138 • 2019 ACR/ARP Annual Meeting

    Outpatient Costs and Evaluation and Management (E&M) Expenditure Trends in Rheumatoid Arthritis (RA) Patients Treated with Biologic Therapies in US Community Practices

    Colin Edgerton1, Janna Radtchenko 2 and V. Michael Holers 3, 1Articularis Healthcare, Charleston, 2Trio Health, La Jolla, CA, 3University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA, Denver

    Background/Purpose: RA is an autoimmune disease affecting over 1.5 million Americans. Biologic disease-modifying antirheumatic drugs (bDMARDs) expanded treatment choices for RA patients (pts) in the…
  • Abstract Number: 1385 • 2019 ACR/ARP Annual Meeting

    Discontinuation of Oral Glucocorticoid After Initiation of Biological DMARDs Due to a Higher Dose of Methotrexate; A Retrospective Observational Study Based on Data from a Japanese Multicenter Registry Study

    Mochihito Suzuki1, Toshihisa Kojima 2, Nobunori Takahashi 2, Shuji Asai 2 and Naoki Ishiguro 2, 1Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Background/Purpose:  In the treatment of rheumatoid arthritis (RA), glucocorticoid that provide anti-inflammatory effects is an important drug. We recommend discontinuing of glucocorticoid as soon as…
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All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

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