Abstracts tagged "Disease-Modifying Antirheumatic Drugs (Dmards)"

Abstract Number: 2542 • ACR Convergence 2023
Impact of Concomitant Methotrexate on Disease Activity After Tapering Abatacept in Patients with Rheumatoid Arthritis: A Nationwide Cohort Study
Jun Won Park¹, Min Jung Kim², Hyoun-Ah Kim³, Jin Hyun Kim⁴ and Kichul Shin⁵, ¹Seoul National University Hospital, Seoul, South Korea, ²Seoul Metropolitan Government Boramae Medical center, Dongjak-gu, Seoul, South Korea, ³Ajou University School of Medicine, Suwon, South Korea, ⁴Chungnam National University College of Medicine, Daejeon, South Korea, ⁵Seoul Metropolitan Government- Seoul National University Boramae Medical Center, Seoul, South Korea
Background/Purpose: Recent randomized-controlled studies have suggested that tapering bDMARDs and/or csDMARDs after achieving sustained remission in patients with rheumatoid arthritis (RA) can be considered. However,…
Abstract Number: 0210 • ACR Convergence 2023
Longitudinal T Cell Responses to a Series of Four SARS-CoV-2 Vaccine Doses or COVID-19 in Patients on TNF Inhibitors
Hilde Ørbo¹, Asia-Sophia Wolf², Kristin Hammersbøen Bjørlykke³, Sarah E. Josefsson², Guri Solum², Ingrid Fadum Kjønstad⁴, Ingrid Jyssum¹, Ingrid Christensen¹, Anne Therese Tveter¹, Joseph Sexton¹, Grete B. Kro⁵, Gunnveig Grødeland⁶, Tore Kvien¹, Jørgen Jahnsen³, John Torgils Vaage⁷, Espen Haavardsholm¹, Sella Provan⁸, Hassen Kared⁹, Ludvig A. Munthe⁷, Kristin Kaasen Jørgensen³, Silje Watterdal Syversen¹, Siri Mjaaland² and Guro Goll¹, ¹Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, ²Norwegian Institute of Public Health, Oslo, Norway, ³Department of Gastroenterology, Akershus University Hospital, Oslo, Norway, ⁴National Institute of Public Health, Oslo, Norway, ⁵Department of Microbiology, Oslo University Hospital, Oslo, Norway, ⁶Department of Immunology, Oslo University Hospital, Oslo, Norway, ⁷Department of Immunology, Oslo University Hospital, Oslo, Norway, ⁸Diakonhjemmet Hospital, Oslo, Norway, ⁹Department of Immunology, Oslo University Hospital, Oslo, Norway
Background/Purpose: T cells are critical for control of viral infection with SARS-CoV-2, but knowledge is lacking on cellular immune responses following repeated vaccination and breakthrough…
Abstract Number: 0424 • ACR Convergence 2023
Real-World Effectiveness of Upadacitinib in Patients with Moderate/Severe Rheumatoid Arthritis: 6-Month Data from the Observational UPHOLD Study
Andrew Östör¹, Eugen Feist², Prodromos Sidiropoulos³, Jérôme Avouac⁴, Martin Rebella⁵, Rajaie Namas⁶, Bruno Frediani⁷, Song-Chou Hsieh⁸, Tianming Gao⁹, Nasser Khan¹⁰, Sander Strengholt¹¹, Ivan Lagunes-Galindo¹⁰ and Susan Attar¹², ¹Monash University & Emeritus Research; Australian National University, Melbourne, Australia, ²Helios Department of Rheumatology and Clinical Immunology, Vogelsang-Gommern, Germany, ³Faculty of Medicine, University of Crete, Heraklion, Greece, ⁴Service de Rhumatologie, Hôpital Cochin, AP-HP.Centre – Université Paris Cité, Paris, France, ⁵Departamento de Medicina, Facultad de Medicina, Universidad de la República; Unidad de Enfermedades Autoinmunes Sistémicas, MUCAM, Montevideo, Uruguay, ⁶Medical Subspecialties Institute, Division of Rheumatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, ⁷Santa Maria alle Scotte General Hospital, Siena, Italy, ⁸National Taiwan University Hospital, Taipei, Taiwan, ⁹AbbVie, Inc., North Chicago, IL, ¹⁰Pharmacovigilance and Patient Safety, AbbVie, Inc., North Chicago, IL, ¹¹AbbVie B.V., Mijdrecht, Utrecht, Netherlands, ¹²King Abdulaziz University, Jeddah, Saudi Arabia
Background/Purpose: The efficacy and safety of upadacitinib (UPA), an oral reversible Janus kinase inhibitor, have been shown in patients (pts) with moderate/severe RA in the…
Abstract Number: 0520 • ACR Convergence 2023
How Do Early Disease Activity and Early Clinical Response Associate with Long-Term Outcomes with Ixekizumab in Radiographic Axial Spondyloarthritis?
Sofia Ramiro¹, Cedric Lukas², Louis Bessette³, Pendleton Wickersham⁴, Soyi Liu-Leage⁵, Tommaso Panni⁵, Rebecca Bolce⁵, Boris Janos⁵, Michael Nissen⁶ and James Cheng-Chung Wei⁷, ¹Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²CHU Montpellier, Montpellier, France, ³Centre de l'Ostéoporose et de Rhumatologie de Québec, Quebec City, QC, Canada, ⁴Arthritis Associates PA, San Antonio, TX, ⁵Eli Lilly and Company, Indianapolis, IN, ⁶Geneva University Hospitals, Geneva, Switzerland, ⁷Chung Shan Medical University Hospital, Department of Rheumatology, Taichung, Taiwan
Background/Purpose: The ASAS-EULAR recommendations for the management of axial spondyloarthritis (axSpA) advise that a patient be assessed for biological disease-modifying anti-rheumatic drug (bDMARD) treatment response…
Abstract Number: 1070 • ACR Convergence 2023
Safety of DMARDs in Rheumatologic Immune-related Adverse Events Associated with Immune Checkpoint Inhibitors: Data from a Monocentric Cohort in Hospices Civils De Lyon
Julien Seiller¹, Emmanuel Massy², Julien Peron³ and Cyrille Confavreux², ¹Centre Expert des Métastases Osseuses (CEMOS) - Service de Rhumatologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université de Lyon, Lyon, France, ²Centre Expert des Métastases Osseuses (CEMOS) - Service de Rhumatologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université de Lyon, INSERM UMR 1033-LYOS, Lyon, France, ³Service d’oncologie médicale. Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Université de Lyon, INSERM U1290, Lyon, France
Background/Purpose: Since Immune Checkpoint Inhibitors (ICI) revolution, oncologists face immune-related adverse events (irAEs) including rheumatologic irAEs with inflammatory arthritis. Treatment of rheumatologic irAE can be…
Abstract Number: 1372 • ACR Convergence 2023
Obinutuzumab Efficacy and Tolerance in Patients with Auto-Immune Diseases Immunized Against Rituximab
Mathilde Pezot¹, Gaetane Nocturne², Rakiba Belkhir¹, Julien Henry¹, Stephan Pavy¹, Raphaele Seror³, Xavier Mariette⁴ and Samuel Bitoun⁵, ¹Rheumatology Department, Université Paris-Saclay, INSERM U1184, Hôpital Bicêtre, APHP, FHU CARE, Le Kremlin-Bicêtre, France, ²APHP, Le Kremlin-Bicêtre, France, ³University Hospital Paris Saclay, Le Kremlin-Bicêtre, France, ⁴Université Paris-Saclay, Le Kremlin-Bicêtre, France, ⁵CHU Bicêtre APHP, Le Kremlin-Bicêtre, France
Background/Purpose: Among patients with auto-immune diseases (AID) treated with Rituximab (RTX), anti-drug antibodies (ADAb) leading to inefficacy and infusion reactions (Wincup and al., Ann Rheum…
Abstract Number: 1779 • ACR Convergence 2023
A Novel Inhibitory Pathway of Synovial Inflammation Exerted by Glucocorticoids and TNF Inhibitors Through LAG-3 Up-Regulation
Smadar Gertel¹, Victoria Furer¹, Ari Polachek¹ and Ori Elkayam², ¹Tel Aviv Sourasky Medical center, Tel Aviv, Israel, ²Tel Aviv Medical Center, Tel Aviv, Israel
Background/Purpose: Psoriatic arthritis (PsA) is a chronic immune-mediated condition that results in systemic musculoskeletal (MSK) inflammation, including peripheral synovitis, enthesitis and axial involvement. Glucocorticoids (GCs)…
Abstract Number: 2173 • ACR Convergence 2023
Window of Opportunity in the Treatment of Rheumatoid Arthritis-Interstitial Lung Disease with Abatacept. National Multicenter Study of 509 Patients
Ana Serrano-Combarro¹, Belén Atienza-Mateo², libe Ibarrola-Paino³, Ivette Casafont-Sole⁴, Rafael Benito Melero-Gonzalez⁵, Alba Perez Linaza⁶, Santos Castañeda⁷, Rafaela Ortega Castro⁸, Natalia Mena Vazquez⁹, Nuria Vegas Revenga¹⁰, Lucia Cristina Dominguez Casas¹¹, Cilia Peralta¹², Trinidad Pérez-Sandoval¹³, Lorena Perez-Albadalejo¹⁴, Ruben Lopez-Sanchez¹⁵, MARIA GUADALUPE MANZANO CANABAL¹⁶, Anahy Maria Brandy-Garcia¹⁷, Patricia Lopez-Viejo¹⁸, Gema Bonilla¹⁹, Olga Maiz-Alonso²⁰, Carmen carrasco-Cubero²¹, Marta Garijo Bufort²², Mireia Moreno²³, Ana Urruticoechea²⁴, Sergio Ordonez-Palau²⁵, Carmen Gonzalez-Montagut Gomez²⁶, andrea Garcia-Valle²⁷, Juan Ramon De Dios Jimenez De Aber²⁸, Fernando Lozano²⁹, Tomás Vazquez-Rodriguez³⁰, Maria Martin-Lopez³¹, Juan Maria Blanco-Madrigal³², Delia Fernández-Lozano³³, Ignacio Brana Abascal³⁴, Jesus Loarce-Martos³⁵, Emilio Giner-Serret³⁶, Virginia Ruiz-Esquide³⁷, Clara ventin-Rodriguez³⁸, Marina Rodriguez-lopez³⁹, Pablo Andujar-Brazal⁴⁰, Julia Fernandez-Melon⁴¹, Lilian Maria Lopez⁴², carlos Fernandez-Diaz⁴³, Javier Loricera⁴⁴, Ivan Ferraz Amaro⁴⁵, Diego Ferrer⁴⁶, Ricardo Blanco⁴⁷ and On behalf of the Collaborative Group Members⁴⁸, ¹Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain, ²Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ³Hospital Universitario de Navarra, Pamplona, Spain, ⁴Hospital Universitari Germans Trias i Pujol, Badalona, Spain, ⁵CHU Vigo, O Carballino, Spain, ⁶SERV. REUMATOLOGIA, Cadiz, Spain, ⁷Hospital Universitario de la Princesa, Madrid, Spain, ⁸Hospital Reina Sofía, Cordoba, Spain, ⁹IBIMA, Málaga, Spain, ¹⁰Hospital Galdakao- Usansolo, Galdakao, Spain, ¹¹Hospital Universtario San Agustin, Oviedo, Spain, ¹²Hospital Clínico Lozano Blesa, Zaragoza, Spain, ¹³Hospital de León, León, Spain, ¹⁴Division of Rheumatology, Hospital Universitario de Jaén, Jaén, Spain, ¹⁵Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain, ¹⁶CAZA, Salamanca, Spain, ¹⁷Hospital Germans Trias i Pujol, Badalona, Spain, ¹⁸Division of Rheumatology, Hospital Severo Ochoa, Leganéz, Spain, ¹⁹Department of Rheumatology, Hospital Clínico Universitario La Paz, Madrid, Spain, ²⁰University Hospital Donostia, San Sebastian, Spain, ²¹Department of Rheumatology, Hospital Universitario de Badajoz, Badajoz, Spain, ²²Hospital de Sagunto, Valencia, Spain, ²³Parc Tauli Hospital Universitari, I3PT(UAB), Barcelona, Spain, ²⁴Hospital Can Misses, Ibiza, Spain, ²⁵H. Arnau de Vilanova, Lleida, Spain, ²⁶H. Clínico Universitario de Valladolid, Valladolid, Spain, ²⁷Division of Rheumatology, Complejo Asistencial Universitario de Palencia, Palencia, Spain, ²⁸Hospital de Araba, Alava, Spain, ²⁹Hospital Universitario 12 de Octubre, Madrid, Spain, ³⁰Rheumatology, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain, ³¹Hospital 12 de Octubre, Madrid, Spain, ³²Division of Rheumatology, H. Universitario de Basurto, Bilbao, Spain, ³³Hospital de Mérida, Merida, Spain, ³⁴Division of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain, ³⁵Ramón y Cajal University Hospital, Madrid, Spain, ³⁶Hospital Royo Villanova, Teruel, Spain, ³⁷Hospital Clinic, Rheumatology, Barcelona, Spain, ³⁸Division of Rheumatology, Hospital Universitario de A Coruña, A Coruña, Spain, ³⁹Division of Rheumatology, Hospital Clínico Universitario de Santiago, La Coruna, Spain, ⁴⁰Division of Rheumatology, Hospital Universitario Doctor Peset, Valencia, Spain, ⁴¹Division of Rheumatology, Hospital Universitario Son Espases, Palma de Mallorca, Spain, ⁴²Division of Rheumatology, Hospital Universitario Son Llàtzer, Mallorca, Spain, ⁴³Division of Rheumatology, Hospital Universitario Reina Sofía, Murcia, Spain, ⁴⁴Hospital Universitario Marqués de Valdecilla, Santander, Spain, ⁴⁵Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ⁴⁶Division of Pneumology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ⁴⁷Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ⁴⁸Spanish Collaborative Group of Interstitial Lung Disease Associated with Rheumatoid Arthritis, Spain, Spain
Background/Purpose: Interstitial lung disease (ILD) is a severe complication of rheumatoid arthritis (RA). Abatacept (ABA) has demonstrated efficacy in the treatment of RA-ILD, especially if…
Abstract Number: 2543 • ACR Convergence 2023
Clinical and Radiographic Results of Tapering and Withdrawing CsDMARDs versus Stable Treatment in Patients with Rheumatoid Arthritis in Remission: 3-year Results from a Randomized Controlled Trial
Kaja Eriksrud Kjørholt¹, Nina Paulshus Sundlisæter¹, Anna-Birgitte Aga¹, Joseph Sexton¹, Inge Olsen², Hallvard Fremstad³, Cristina Spada⁴, Tor Magne Madland⁵, Christian A Høili⁶, Gunnstein Bakland⁷, Åse Lexberg⁸, Inger Johanne Widding Hansen⁹, Inger Myrnes Hansen¹⁰, Hilde Haukland¹¹, Maud-Kristine Aga Ljoså¹², Ellen Moholt¹, Till Uhlig¹, Tore Kvien¹, Daniel Solomon¹³, Désirée van der Heijde¹⁴, Espen Haavardsholm¹ and Siri Lillegraven¹, ¹Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, ²Oslo University Hospital, Oslo, Norway, ³Møre og Romsdal Hospital Trust, Ålesund, Norway, ⁴Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway, ⁵Haukeland University Hospital, Bergen, Norway, ⁶Østfold Hospital Trust, Moss, Norway, ⁷University Hospital of North Norway, Tromsø, Norway, ⁸Drammen Hospital, Vestre Viken HF, Drammen, Norway, ⁹Sørlandet Hospital HF, Kristiansand, Norway, ¹⁰Helgeland Hospital Trust Mo i Rana, Mo i Rana, Norway, ¹¹Martina Hansens Hospital, Bærum, Norway, ¹²Ålesund Hospital, Ålesund, Norway, ¹³Brigham and Women's Hospital, Newton, MA, ¹⁴Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
Background/Purpose: Tapering of disease-modifying antirheumatic drugs (DMARDs) to achieve drug-free remission is a potential goal for the growing group of patients with rheumatoid arthritis (RA)…
Abstract Number: 0211 • ACR Convergence 2023
COVID-19 Outcome and Association to Anti-Spike Antibody Levels in Patients on Immunosuppressive Therapy; A Prospective Cohort Study
Hilde Ørbo¹, Ingrid Jyssum¹, Joseph Sexton¹, Anne Therese Tveter¹, Ingrid Christensen¹, Kristin Hammersbøen Bjørlykke², Grete B. Kro³, Tore Kvien¹, Ludvig A. Munthe⁴, Gunnveig Grødeland⁵, Siri Mjaaland⁶, Espen Haavardsholm¹, John Torgils Vaage⁴, Kristin Kaasen Jørgensen², Sella Provan⁷, Silje Watterdal Syversen¹ and Guro Goll¹, ¹Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, ²Department of Gastroenterology, Akershus University Hospital, Oslo, Norway, ³Department of Microbiology, Oslo University Hospital, Oslo, Norway, ⁴Department of Immunology, Oslo University Hospital, Oslo, Norway, ⁵Department of Immunology, Oslo University Hospital, Oslo, Norway, ⁶Norwegian Institute of Public Health, Oslo, Norway, ⁷Diakonhjemmet Hospital, Oslo, Norway
Background/Purpose: Patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive therapies have attenuated vaccine responses and are prone to severe infections. Knowledge of COVID-19 outcome following…
Abstract Number: 0427 • ACR Convergence 2023
Molecular Characterization of Biologic and Targeted Synthetic DMARDs Effects Through Ex- vivo Studies in Rheumatoid Arthritis Immune Cells
Laura Muñoz-Barrera¹, Carlos Perez-Sanchez², Laura Romero-Zurita¹, Rafaela Ortega Castro³, Jerusalem Calvo⁴, Pilar Font Ugalde¹, Marta Rojas⁵, Ismael Sanchez-Pareja¹, Maria del Carmen Abalos-Aguilera⁶, Desiree Ruiz-Vilchez¹, Christian Merlo-Ruiz¹, Mª Angeles Aguirre⁷, Nuria Barbarroja⁸, Tomás Cerdó¹, Eduardo Collantes Estévez⁹, Marta Alarcon-Riquelme¹⁰, Alejandro Escudero Contreras⁴ and Chary Lopez-Pedrera¹¹, ¹IMIBIC/Reina Sofia Hospital/University of Cordoba, Córdoba, Spain, ²IMIBIC, Córdoba, Spain, ³Hospital Reina Sofía, Cordoba, Spain, ⁴Reina Sofia University Hospital, Córdoba, Spain, ⁵Hospital Universitario Reina Sofía, Cordoba, Spain, ⁶Rheumatology Department, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain, ⁷Reina Sofía University Hospital/ Rheumatology Department, Córdoba, Spain, ⁸University of Cordoba, Córdoba, Spain, ⁹Maimonides Biomedical Research Institute of Cordoba (IMIBIC)/University of Cordoba, Cordoba, Spain, ¹⁰Center for Genomics and Oncological Research (GENYO), Granada, Spain, ¹¹IMIBIC - Reina Sofia Hospital, Córdoba, Spain
Background/Purpose: Despite advances in rheumatoid arthritis (RA) treatment, a significant proportion of patients (10-30%) fail to respond to current medications, including biologics. A better characterization…
Abstract Number: 0530 • ACR Convergence 2023
Impact of Upadacitinib on Wearable Device-Measured Physical Activity in Patients with Ankylosing Spondylitis from the SELECT-AXIS 2 Trial
Jeffrey Curtis¹, Rebecca Grainger², Dan Webster³, Jie Shen⁴, Ana Biljan⁵, Anna Shmagel⁴, Peter Wung⁴ and Philip J. Mease⁶, ¹University of Alabama at Birmingham, Birmingham, AL, ²University of Otago, Wellington, New Zealand, ³AbbVie, Inc., Libertyville, IL, ⁴AbbVie, Inc., North Chicago, IL, ⁵AbbVie, Inc., Buffalo Grove, IL, ⁶Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, WA
Background/Purpose: Physical activity is associated with reduced pain, improved mobility and physical function in people with ankylosing spondylitis (AS) and plays a crucial role in…
Abstract Number: 1073 • ACR Convergence 2023
Risk of Inflammatory Central Nervous System Diseases Among New Users of Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs
Maximilian Casey¹, Sonia Pannu², Saffia Bajwa³, Ali Duarte-Garcia⁴ and Mike Putman⁵, ¹Medical College of Wisconsin, Milwaukee, WI, ²University School of Milwaukee, River Hills, WI, ³Medical College of Wisconsin, Wauwatosa, WI, ⁴Mayo Clinic, Rochester, MN, ⁵Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI
Background/Purpose: Inflammatory and demyelinating central nervous system (CNS) adverse events have been observed among new users of tumor necrosis factor (TNF) inhibitors. No studies to…
Abstract Number: 1416 • ACR Convergence 2023
Improvement of Work Absenteeism Following Start of Methotrexate Monotherapy in Newly-Diagnosed Psoriatic Arthritis
Ulf Lindström¹, Daniela Di Giuseppe², Sofia Exarchou³, Gerd-Marie Alenius⁴, Tor Olofsson⁵, Eva Klingberg¹, Lennart Jacobsson⁶, Johan Askling² and Johan Karlsson Wallman⁵, ¹University of Gothenburg, Gothenburg, Sweden, ²Karolinska Institutet, Stockholm, Sweden, ³Lund University, Åkarp, Sweden, ⁴Umeå University, Umeå, Sweden, ⁵Lund University and Skåne University Hospital, Lund, Sweden, ⁶University of Gothenburg, Malmö, Sweden
Background/Purpose: In many countries, methotrexate (MTX) monotherapy is the first-line disease-modifying anti-rheumatic drug (DMARD) therapy for psoriatic arthritis (PsA), despite that its efficacy in PsA…
Abstract Number: 1984 • ACR Convergence 2023
Therapeutic Effects of Pentosan Polysulfate Sodium on Clinical and Disease Modifying Outcomes in Subjects with Knee Osteoarthritis
Mukesh Ahuja¹, Donna Skerrett², Curtis Gravance³, Divya Navuru⁴, Ravi Krishnan⁵, Charles Inderjeeth⁶, Philip Bloom⁷ and Schnitzer Thomas⁸, ¹Paradigm Biopharmaceuticals, Oak Brook, IL, ²Paradigm Biopharmaceuticals, New York, NY, ³Paradigm Biopharmaceuticals, Melba, ID, ⁴Paradigm Biopharmaceuticals, Melbourne, Australia, ⁵Paradigm Biopharmaceuticals, Adelaide, Australia, ⁶University of Western Australia / Linear Clinical Research, Perth, Australia, ⁷Sportsmed Biologic, Melbourne, Australia, ⁸Northwestern University Feinberg School of Medicine, Chicago, IL
Background/Purpose: Osteoarthritis (OA) is an inflammatory joint disease, causing chronic pain, disability, and reduced quality of life. Affected joints may include the knee, hip, and…

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