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Phytochemicals targeting JAK/STAT pathway in the treatment of rheumatoid arthritis: Is there a future? Biochem Pharmacol 2022; 197:114929. [DOI: 10.1016/j.bcp.2022.114929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022]
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Alpay-Kanitez N, Pehlivan Ö, Omma A, Can-Sandikçi S, Girgin S, İçaçan OC, Çelik S, Bes C. Favorable retention rates and safety of conventional anti-rheumatic drugs in older patients with rheumatoid arthritis. Medicine (Baltimore) 2020; 99:e19696. [PMID: 32311948 PMCID: PMC7220761 DOI: 10.1097/md.0000000000019696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Physicians are challenged by the recognition and treatment of older patients with rheumatoid arthritis (RA). The aim of this case-control study was to evaluate the retention and safety of conventional disease-modifying anti-rheumatic drugs in older patients with RA.In this observational case-control study, we assessed older patients with RA (≥65 years) who were diagnosed in 3 different rheumatology centers from Turkey. Patients were divided as to those aged ≥65 years (elderly rheumatoid arthritis [ERA]) and those aged <65 years (young rheumatoid arthritis [YRA]) at the time of conventional DMARD treatment initiation. The Mann-Whitney U test was used for the comparison of 2 non-normally distributed groups. The Chi-square (χ) test was used for categorical variables. Survival analysis were performed using the Kaplan-Meier method.Four hundred eighteen patients with RA (296 females [71%]) were included from January 2010 to January 2018. The age of treatment onset of 190 (47%) patients was in the elderly period and they were included in the ERA group. In the analysis of drug retention rates, there was no significant difference between the ERA and YRA groups for each conventional DMARD (methotrexate 71.2% in ERA, 62.7% in YRA, P = .817; hydroxychloroquine 82.9% in ERA, 78.8% in YRA, P = .899; leflunomide 81.4% in ERA, 84.4% in YRA, P = .205; sulfasalazine 37.5% in ERA, 40.9% in YRA, P = .380). The adverse event data were also similar in both groups.The drug retention and adverse effect rates in older patients with RA using conventional DMARDS are similar to the rates in young patients with RA.
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Affiliation(s)
- Nilüfer Alpay-Kanitez
- Department of Internal Medicine, Division of Rheumatology, Koç University School of Medicine, Health Sciences University
| | - Özlem Pehlivan
- Department of Internal Medicine, Division of Rheumatology, Ümraniye Training and Research Hospital, Health Sciences University, Istanbul
| | - Ahmet Omma
- Department of Internal Medicine, Division of Rheumatology, Ankara Numune Training and Research Hospital, Health Sciences University, Ankara
| | - Sevinç Can-Sandikçi
- Department of Internal Medicine, Division of Rheumatology, Ankara Numune Training and Research Hospital, Health Sciences University, Ankara
| | - Sinem Girgin
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ozan Cemal İçaçan
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Selda Çelik
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Cemal Bes
- Department of Internal Medicine, Division of Rheumatology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Ishiguro N, Shibata K, Yoshimura A, Ikeuchi S, Ishii M. Factors influencing physician decisions to discontinue treatment after onset of liver dysfunction: Post-hoc analysis of an all-case post-marketing surveillance study of iguratimod. Mod Rheumatol 2019; 30:633-639. [PMID: 31403345 DOI: 10.1080/14397595.2019.1649229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Adverse drug reactions (ADRs) related to liver dysfunction are a common problem in patients with rheumatoid arthritis (RA) receiving iguratimod, but which patient subgroups go on to discontinue iguratimod treatment is unclear. A post-hoc analysis of a post-marketing surveillance study was performed to investigate factors influencing treatment continuation after the onset of liver dysfunction.Methods: Types of ADR were compared between patients in whom iguratimod treatment was discontinued or continued in accordance with the judgment of the patient's physician after the patient developed liver dysfunction as an ADR. Stepwise logistic regression analysis was also conducted to investigate factors associated with treatment discontinuation.Results: The multivariate analysis found that concomitant use of methotrexate (MTX) at >8 mg/week (vs. no use) was associated with a significantly lower risk of discontinuation (OR: 0.136; 95%CI: 0.030-0.620), and previous treatment with MTX (vs. no use) was associated with a significantly higher discontinuation risk (OR: 4.045; 95%CI: 1.098-14.908).Conclusion: Although concomitant use of MTX during iguratimod treatment does not appear to influence treatment discontinuation due to abnormal liver function, liver function tests are of importance to continued treatment in patients receiving iguratimod who have a history of MTX use.
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Affiliation(s)
- Naoki Ishiguro
- Department of Orthopaedic Surgery, Graduate School & Faculty of Medicine, Nagoya University, Nagoya, Japan
| | - Kai Shibata
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
| | - Akiko Yoshimura
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
| | - Satoshi Ikeuchi
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
| | - Mika Ishii
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
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Park EY, Lee SG, Park EK, Koo DW, Park JH, Kim GT, Tag HS, Kim HO, Suh YS. Drug survival and the associated predictors in South Korean patients with rheumatoid arthritis receiving tacrolimus. Korean J Intern Med 2018; 33:193-202. [PMID: 27048254 PMCID: PMC5768536 DOI: 10.3904/kjim.2015.385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 12/21/2015] [Accepted: 12/28/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To investigate the drug survival rate of tacrolimus (TAC) and analyze the potential predictors of this rate in patients with rheumatoid arthritis (RA) in routine care. METHODS2018-01-16 In this retrospective longitudinal study, we enrolled 102 RA patients treated with TAC from April 2009 to January 2014 at a tertiary center in South Korea. The causes of TAC discontinuation were classified as lack of efficacy (LOE), adverse events (AEs), and others. The drug survival rate was estimated using the Kaplan-Meier method and the predictors of this rate were identified by Cox-regression analyses. RESULTS TAC was discontinued in 27 of 102 RA patients (26.5%). The overall 1-, 2-, 3-, and 4-year TAC continuation rates were 81.8%, 78.4%, 74.2%, and 69.1%, respectively and the median follow-up period from the start of TAC was 32.5 months. The number of TAC discontinuations due to LOE, AEs, and others were 15 (55.6%), 11 (40.7 %), and 1 (3.7%), respectively. The baseline high disease activity was a significant risk factor for TAC discontinuation after adjusting for confounding factors (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.16 to 5.35; p = 0.019). In addition, underlying interstitial lung disease was significantly associated with TAC withdrawal due to AEs (HR, 3.49; 95% CI, 1.06 to 11.46; p = 0.039). CONCLUSIONS In our study, TAC showed a good overall survival rate in patients with RA in real clinical practice. This suggests that the long-term TAC therapy has a favorable efficacy and safety profile for treating RA.
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Affiliation(s)
- Eun-Young Park
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Seung-Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Correspondence to Seung-Geun Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7580 Fax: +82-51-241-7580 E-mail:
| | - Eun-Kyoung Park
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Dong-Wan Koo
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Ji-Heh Park
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Geun-Tae Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hee-Sang Tag
- Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hyun-Ok Kim
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young-Sun Suh
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
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Rodriguez-Rodriguez L, Ivorra-Cortes J, Carmona FD, Martín J, Balsa A, van Steenbergen HW, van der Helm-van Mil AHM, González-Álvaro I, Fernandez-Gutiérrez B. PTGER4 gene variant rs76523431 is a candidate risk factor for radiological joint damage in rheumatoid arthritis patients: a genetic study of six cohorts. Arthritis Res Ther 2015; 17:306. [PMID: 26538147 PMCID: PMC4634155 DOI: 10.1186/s13075-015-0830-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/20/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction Prostaglandin E receptor 4 (PTGER4) is implicated in immune regulation and bone metabolism. The aim of this study was to analyze its role in radiological joint damage in rheumatoid arthritis (RA). Methods Six independent cohorts of patients with RA of European or North American descent were included, comprising 1789 patients with 5083 sets of X-rays. The Hospital Clínico San Carlos Rheumatoid Arthritis, Princesa Early Arthritis Register Longitudinal study, and Hospital Universitario de La Paz early arthritis (Spain) cohorts were used as discovery cohorts, and the Leiden Early Arthritis Clinic (The Netherlands), Wichita (United States), and National Databank for Rheumatic Diseases (United States and Canada) cohorts as replication cohorts. First, the PTGER4 rs6896969 single-nucleotide polymorphism (SNP) was genotyped using TaqMan assays and available Illumina Immunochip data and studied in the discovery and replication cohorts. Second, the PTGER4 gene and adjacent regions were analyzed using Immunochip genotyping data in the discovery cohorts. On the basis of pooled p values, linkage disequilibrium structure of the region, and location in regions with transcriptional properties, SNPs were selected for replication. The results from discovery, replication, and overall cohorts were pooled using inverse-variance–weighted meta-analysis. Influence of the polymorphisms on the overall radiological damage (constant effect) and on damage progression over time (time-varying effect) was analyzed. Results The rs6896969 polymorphism showed a significant association with radiological damage in the constant effect pooled analysis of the discovery cohorts, although no significant association was observed in the replication cohorts or the overall pooled analysis. Regarding the analysis of the PTGER4 region, 976 variants were analyzed in the discovery cohorts. From the constant and time-varying effect analyses, 12 and 20 SNPs, respectively, were selected for replication. Only the rs76523431 variant showed a significant association with radiographic progression in the time-varying effect pooled analysis of the discovery, replication, and overall cohorts. The overall pooled effect size was 1.10 (95 % confidence interval 1.05–1.14, p = 2.10 × 10−5), meaning that radiographic yearly progression was 10 % greater for each copy of the minor allele. Conclusions The PTGER4 gene is a candidate risk factor for radiological progression in RA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0830-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis Rodriguez-Rodriguez
- Rheumatology Department and Heath Research Institute (IdISSC), Hospital Clinico San Carlos, c/o Prof. Martin Lagos s/n, 28040, Madrid, Spain.
| | - Jose Ivorra-Cortes
- Rheumatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - F David Carmona
- Instituto de Parasitología y Biomedicina 'López-Neyra', CSIC, Granada, Spain.
| | - Javier Martín
- Instituto de Parasitología y Biomedicina 'López-Neyra', CSIC, Granada, Spain.
| | - Alejandro Balsa
- Rheumatology Department and Heath Research Institute (Idipaz), Hospital Universitario de La Paz, Madrid, Spain.
| | | | | | - Isidoro González-Álvaro
- Rheumatology Service and Heath Research Institute (IP), Hospital Universitario de La Princesa, Madrid, Spain.
| | - Benjamín Fernandez-Gutiérrez
- Rheumatology Department and Heath Research Institute (IdISSC), Hospital Clinico San Carlos, c/o Prof. Martin Lagos s/n, 28040, Madrid, Spain.
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van Steenbergen HW, Raychaudhuri S, Rodríguez-Rodríguez L, Rantapää-Dahlqvist S, Berglin E, Toes REM, Huizinga TWJ, Fernández-Gutiérrez B, Gregersen PK, van der Helm-van Mil AHM. Association of valine and leucine at HLA-DRB1 position 11 with radiographic progression in rheumatoid arthritis, independent of the shared epitope alleles but not independent of anti-citrullinated protein antibodies. Arthritis Rheumatol 2015; 67:877-86. [PMID: 25580908 DOI: 10.1002/art.39018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/30/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE For decades it has been known that the HLA-DRB1 shared epitope (SE) alleles are associated with an increased risk of development and progression of rheumatoid arthritis (RA). Recently, the following variations in the peptide-binding grooves of HLA molecules that predispose to RA development have been identified: Val and Leu at HLA-DRB1 position 11, Asp at HLA-B position 9, and Phe at HLA-DPB1 position 9. This study was undertaken to investigate whether these variants are also associated with radiographic progression in RA, independent of SE and anti-citrullinated protein antibody (ACPA) status. METHODS A total of 4,911 radiograph sets from 1,878 RA patients included in the Leiden Early Arthritis Clinic (The Netherlands), Umeå (Sweden), Hospital Clinico San Carlos-Rheumatoid Arthritis (Spain), and National Data Bank for Rheumatic Diseases (US) cohorts were studied. HLA was imputed using single-nucleotide polymorphism data from an Immunochip, and the amino acids listed above were tested in relation to radiographic progression per cohort using an additive model. Results from the 4 cohorts were combined in inverse-variance weighted meta-analyses using a fixed-effects model. Analyses were conditioned on SE and ACPA status. RESULTS Val and Leu at HLA-DRB1 position 11 were associated with more radiographic progression (meta-analysis P = 5.11 × 10(-7)); this effect was independent of SE status (meta-analysis P = 0.022) but not independent of ACPA status. Phe at HLA-DPB1 position 9 was associated with more severe radiographic progression (meta-analysis P = 0.024), though not independent of SE status. Asp at HLA-B position 9 was not associated with radiographic progression. CONCLUSION Val and Leu at HLA-DRB1 position 11 conferred a risk of a higher rate of radiographic progression independent of SE status but not independent of ACPA status. These findings support the relevance of these amino acids at position 11.
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Abasolo L, Leon L, Rodriguez-Rodriguez L, Tobias A, Rosales Z, Maria Leal J, Castaño V, Vadillo C, Macarron P, Fontsere O, Jover JA. Safety of disease-modifying antirheumatic drugs and biologic agents for rheumatoid arthritis patients in real-life conditions. Semin Arthritis Rheum 2015; 44:506-513. [DOI: 10.1016/j.semarthrit.2014.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/10/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022]
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van Steenbergen HW, Rodríguez-Rodríguez L, Berglin E, Zhernakova A, Knevel R, Ivorra-Cortés J, Huizinga TWJ, Fernández-Gutiérrez B, Gregersen PK, Rantapää-Dahlqvist S, van der Helm-van Mil AHM. A genetic study on C5-TRAF1 and progression of joint damage in rheumatoid arthritis. Arthritis Res Ther 2015; 17:1. [PMID: 25566937 PMCID: PMC4318544 DOI: 10.1186/s13075-014-0514-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/23/2014] [Indexed: 01/26/2023] Open
Abstract
Introduction The severity of joint damage progression in rheumatoid arthritis (RA) is heritable. Several genetic variants have been identified, but together explain only part of the total genetic effect. Variants in Interleukin-6 (IL-6), Interleukin-10 (IL-10), C5-TRAF1, and Fc-receptor-like-3 (FCRL3) have been described to associate with radiographic progression, but results of different studies were incongruent. We aimed to clarify associations of these variants with radiographic progression by evaluating six independent cohorts. Methods In total 5,895 sets of radiographs of 2,493 RA-patients included in six different independent datasets from the Netherlands, Sweden, Spain and North-America were studied in relation to rs1800795 (IL-6), rs1800896 (IL-10), rs2900180 (C5-TRAF1) and rs7528684 (FCRL3). Associations were tested in the total RA-populations and in anti-citrullinated peptide antibodies (ACPA)-positive and ACPA-negative subgroups per cohort, followed by meta-analyses. Furthermore, the associated region C5-TRAF1 was fine-mapped in the ACPA-negative Dutch RA-patients. Results No associations were found for rs1800795 (IL-6), rs1800896 (IL-10) and rs7528684 (FCRL3) in the total RA-population and after stratification for ACPA. Rs2900180 in C5-TRAF1 was associated with radiographic progression in the ACPA-negative population (P-value meta-analysis = 5.85 × 10−7); the minor allele was associated with more radiographic progression. Fine-mapping revealed a region of 66Kb that was associated; the lowest P-value was for rs7021880 in TRAF1. The P-value for rs7021880 in meta-analysis was 6.35 × 10−8. Previous studies indicate that the region of rs7021880 was associated with RNA expression of TRAF1 and C5. Conclusion Variants in IL-6, IL-10 and FCRL3 were not associated with radiographic progression. Rs2900180 in C5-TRAF1 and linked variants in a 66Kb region were associated with radiographic progression in ACPA-negative RA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0514-0) contains supplementary material, which is available to authorized users.
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Hopkins AM, O'Doherty CE, Foster DJ, Upton RN, Proudman SM, Wiese MD. Individualization of leflunomide dosing in rheumatoid arthritis patients. Per Med 2014; 11:449-461. [PMID: 29783485 DOI: 10.2217/pme.14.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Leflunomide is largely considered to be a second-line treatment option for rheumatoid arthritis (RA). Those who fail to respond, tend to progress to treatment with expensive biological agents, which can also be associated with serious toxicities. Optimizing leflunomide treatment to meet the needs of individuals would hence be beneficial in terms of patient outcomes and health care expenditure. In this respect, therapeutic drug monitoring (TDM) may be useful, as plasma concentrations of leflunomide's active metabolite, teriflunomide, correlate with response to treatment, but are highly variable between patients. A number of pharmacogenetic markers have also been identified that influence response and toxicity. Incorporation of these findings into clinical practice could facilitate more efficient use of leflunomide.
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Affiliation(s)
- Ashley M Hopkins
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia.,University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Catherine E O'Doherty
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - David Jr Foster
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Richard N Upton
- University of South Australia, Australian Centre for Pharmacometrics, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
| | - Susanna M Proudman
- Royal Adelaide Hospital, Department of Rheumatology, North Terrace, Adelaide, South Australia, 5000, Australia.,Adelaide University, Discipline of Medicine, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Michael D Wiese
- University of South Australia, Sansom Institute for Health Research, School of Pharmacy & Medical Sciences, Frome Road, GPO Box 2471, Adelaide, South Australia, 5000, Australia
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