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Pharmacy World & Science

, Volume 31, Issue 5, pp 509–516 | Cite as

Current issues around the pharmacotherapy of ADHD in children and adults

  • Willemijn M. MeijerEmail author
  • Adrianne Faber
  • Els van den Ban
  • Hilde Tobi
Commentary

Abstract

Background New drugs and new formulations enter the growing market for ADHD medication. The growing awareness of possible persistence of ADHD impairment beyond childhood and adolescence resulting in increased pharmacotherapy of ADHD in adults, is also a good reason for making an inventory of the what is generally known about pharmacotherapy in ADHD. Aim To discuss current issues in the possible pharmacotherapy treatment of ADHD in children, adolescents and adults with respect to the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used. Methods A search of the literature with an emphasis on the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used in pharmacotherapy. Results According to the guidelines, the treatment of ADHD in children consists of psychosocial interventions in combination with pharmacotherapy when needed. Stimulants are the first-choice drugs in the pharmacological treatment of ADHD in children despite a number of well known and frequently reported side effects like sleep disorders and loss of appetite. With regard to the treatment of adults, stimulant treatment was recommended as the first-choice pharmacotherapy in the single guideline available. Both in children and adults, there appears to be an additional though limited role for the nonadrenergic drug atomoxetine. The increase of ADHD medication use, in children, adolescents and in adults, can not only be interpreted as a sign of overdiagnosis of ADHD. Despite the frequent use of stimulants, there is still a lack of clarity on the effects of long-term use on growth and nutritional status of children. Cardiovascular effects of both stimulants and atomoxetine are rare but can be severe. The literature suggests that atomoxetine may be associated with suicidal ideation in children. Conclusion Although pharmacotherapy is increasing common in the treatment of ADHD in both children and adults, there are still a lot of questions about side effects and how best to counter them. This suggests an important role for close monitoring of children and adults treated with stimulants or atomoxetine.

Keywords

Adults Attention deficit hyperactivity disorder Children and adolescents Pharmacotherapy 

Notes

Conflicts of interest statement

Willemijn Meijer is an employee of PHARMO Institute. This research institute performs financially supported studies for several pharmaceutical companies. For this publication no relations apply.

In the past Adrianne Faber received a limited research grant from Janssen-Cilag. For this publication no relations apply.

Els van den Ban received following financial supports: from Janssen-Cilag for lecture, reimbursed travel to convention; from Ely-Lilly for scientific research (no personal grant), lecture, advisory board, reimbursed travel to convention; from UCB Pharma for advisory board, reimbursed travel to convention: from Eurosept for lecture (no personal grant), reimbursed travel to convention. For this publication no relations apply.

Hilde Tobi received financial support from Janssen-Cilag for other research projects. For this publication no relations apply.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

References

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: Author: American Psychiatric Association; 1994.Google Scholar
  2. 2.
    Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association. J Am Med Assoc. 1998;279(14):1100–7. doi: 10.1001/jama.279.14.1100.CrossRefGoogle Scholar
  3. 3.
    Mental Health in the United States. Prevalence of diagnosis, medication treatment for attention-deficit/hyperactivity disorder––United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;4(34):842–7.Google Scholar
  4. 4.
    Barkley R. Attention-deficit hyperactivity disorder. A handbook for diagnosis and treatment. 3rd ed. New York: The Guilford Press; 2006.Google Scholar
  5. 5.
    Bren L. ADHD: not just for kids anymore. FDA Consum. 2004;38(6):14–20.PubMedGoogle Scholar
  6. 6.
    Weiss M, Murray C. Assessment and management of attention-deficit hyperactivity disorder in adults. CMAJ. 2003;168(6):715–22.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Wender PH, Wolf LE, Wasserstein J. Adults with ADHD. An overview. Ann N Y Acad Sci. 2001;931:1–16.CrossRefPubMedGoogle Scholar
  8. 8.
    Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, et al. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry. 2005;57(11):1442–51. doi: 10.1016/j.biopsych.2005.04.001.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rasmussen P, Gillberg C. Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. J Am Acad Child Adolesc Psychiatry. 2000;39(11):1424–31. doi: 10.1097/00004583-200011000-00017.CrossRefPubMedGoogle Scholar
  10. 10.
    Riccio CA, Wolfe M, Davis B, Romine C, George C, Lee D. Attention deficit hyperactivity disorder: manifestation in adulthood. Arch Clin Neuropsychol. 2005;20(2):249–69. doi: 10.1016/j.acn.2004.07.005.CrossRefPubMedGoogle Scholar
  11. 11.
    Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157(5):816–8. doi: 10.1176/appi.ajp.157.5.816.CrossRefPubMedGoogle Scholar
  12. 12.
    de Graaf R, Kessler RC, Fayyad J, Ten Have M, Alonso J, Angermeyer M, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med. 2008;65:835–42.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007;190:402–9. doi: 10.1192/bjp.bp.106.034389.CrossRefPubMedGoogle Scholar
  14. 14.
    Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–23. doi: 10.1176/appi.ajp.163.4.716.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP. Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med. 2005;35(6):817–27. doi: 10.1017/S003329170400337X.CrossRefPubMedGoogle Scholar
  16. 16.
    Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD). NIH Consens Statement. 1998;16(2):1–37.Google Scholar
  17. 17.
    American Academy of Pediatrics. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics. 2000;105(5):1158–70. doi: 10.1542/peds.105.5.1158.CrossRefGoogle Scholar
  18. 18.
    American Academy of Pediatrics. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics. 2001;108(4):1033–44. doi: 10.1542/peds.108.4.1033.CrossRefGoogle Scholar
  19. 19.
    Taylor E, Dopfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, et al. European clinical guidelines for hyperkinetic disorder—first upgrade. Eur Child Adolesc Psychiatry. 2004;13 Suppl 1:I7–30. doi: 10.1007/s00787-004-1002-x.PubMedGoogle Scholar
  20. 20.
    Kutcher S, Aman M, Brooks SJ, Buitelaar J, van Daalen E, Fegert J, et al. International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): clinical implications and treatment practice suggestions. Eur Neuropsychopharmacol. 2004;14(1):11–28. doi: 10.1016/S0924-977X(03)00045-2.CrossRefPubMedGoogle Scholar
  21. 21.
    Multidisciplinaire richtlijn ADHD: richtlijn voor de diagnostiek en behandeling van ADHD bij kinderen en jeugdigen. Utrecht: Trimbos-instituut. 2005.Google Scholar
  22. 22.
    Spencer T, Biederman J, Wilens T, Harding M, O’Donnell D, Griffin S. Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle. J Am Acad Child Adolesc Psychiatry. 1996;35(4):409–32. doi: 10.1097/00004583-199604000-00008.CrossRefPubMedGoogle Scholar
  23. 23.
    Schachter HM, Pham B, King J, Langford S, Moher D. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ. 2001;165(11):1475–88.PubMedPubMedCentralGoogle Scholar
  24. 24.
    A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal treatment study of children with ADHD. Arch Gen Psychiatry. 1999;56(12):1073–86. doi: 10.1001/archpsyc.56.12.1073.CrossRefGoogle Scholar
  25. 25.
    National Institute of Mental Health. Multimodal treatment study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics. 2004;113(4):754–61. doi: 10.1542/peds.113.4.754.CrossRefGoogle Scholar
  26. 26.
    Jensen PS, Arnold LE, Swanson JM, Vitiello B, Abikoff HB, Greenhill LL, et al. 3-Year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry. 2007;46(8):989–1002. doi: 10.1097/CHI.0b013e3180686d48.CrossRefPubMedGoogle Scholar
  27. 27.
    Newcorn JH, Kratochvil CJ, Allen AJ, Casat CD, Ruff DD, Moore RJ, et al. Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response. Am J Psychiatry. 2008;165(6):721–30. doi: 10.1176/appi.ajp.2007.05091676.CrossRefPubMedGoogle Scholar
  28. 28.
    Nutt DJ, Fone K, Asherson P, Bramble D, Hill P, Matthews K, et al. Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2007;21(1):10–41. doi: 10.1177/0269881106073219.CrossRefPubMedGoogle Scholar
  29. 29.
    Wilens TE. Drug therapy for adults with attention-deficit hyperactivity disorder. Drugs. 2003;63(22):2395–411. doi: 10.2165/00003495-200363220-00002.CrossRefPubMedGoogle Scholar
  30. 30.
    Safer DJ, Zito JM, Fine EM. Increased methylphenidate usage for attention deficit disorder in the 1990s. Pediatrics. 1996;98(6 Pt 1):1084–8.PubMedGoogle Scholar
  31. 31.
    Zito JM, Safer DJ, Dos Reis S, Gardner JF, Boles M, Lynch F. Trends in the prescribing of psychotropic medications to preschoolers. J Am Med Assoc. 2000;283(8):1025–30. doi: 10.1001/jama.283.8.1025.CrossRefGoogle Scholar
  32. 32.
    Schirm E, Tobi H, Zito JM, de Jong-van den Berg LT. Psychotropic medication in children: a study from the Netherlands. Pediatrics. 2001;108(2):E25. doi: 10.1542/peds.108.2.e25.
  33. 33.
    Miller AR, Lalonde CE, McGrail KM, Armstrong RW. Prescription of methylphenidate to children and youth, 1990–1996. CMAJ. 2001;165(11):1489–94.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Reid R, Hakendorf P, Prosser B. Use of psychostimulant medication for ADHD in South Australia. J Am Acad Child Adolesc Psychiatry. 2002;41(8):906–13. doi: 10.1097/00004583-200208000-00008.CrossRefPubMedGoogle Scholar
  35. 35.
    Zito JM, Safer DJ, Dos Reis S, Gardner JF, Magder L, Soeken K, et al. Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med. 2003;157(1):17–25.CrossRefPubMedGoogle Scholar
  36. 36.
    Castle L, Aubert RE, Verbrugge RR, Khalid M, Epstein RS. Trends in medication treatment for ADHD. J Atten Disord. 2007;10(4):335–42. doi: 10.1177/1087054707299597.CrossRefPubMedGoogle Scholar
  37. 37.
    Faber A, den Berg LT, van den Berg PB, Tobi H. Psychotropic co-medication among stimulant-treated children in the Netherlands. J Child Adolesc Psychopharmacol. 2005;15(1):38–43. doi: 10.1089/cap.2005.15.38.CrossRefPubMedGoogle Scholar
  38. 38.
    Hugtenburg JG, Heerdink ER, Egberts AC. Increased psychotropic drug consumption by children in the Netherlands during 1995–2001 is caused by increased use of methylphenidate by boys. Eur J Clin Pharmacol. 2004;60(5):377–9. doi: 10.1007/s00228-004-0765-9.CrossRefPubMedGoogle Scholar
  39. 39.
    Coghill D. Use of stimulants for attention deficit hyperactivity disorder: FOR. BMJ. 2004;329(7471):907–8. doi: 10.1136/bmj.329.7471.907.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Marcovitch H. Use of stimulants for attention deficit hyperactivity disorder: AGAINST. BMJ. 2004;329(7471):908–9. doi: 10.1136/bmj.329.7471.908.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Buitelaar JK, Rothenberger A. Foreword—ADHD in the scientific and political context. Eur Child Adolesc Psychiatry. 2004;13 Suppl 1:I1–6.PubMedGoogle Scholar
  42. 42.
    Safer DJ. Are stimulants overprescribed for youths with ADHD? Ann Clin Psychiatry. 2000;12(1):55–62.CrossRefPubMedGoogle Scholar
  43. 43.
    Buitelaar JK. Discussion of attention deficit-hyperactivity disorder (ADHD): facts, opinions and emotions. Ned Tijdschr Geneeskd. 2001;145(31):1485–9. PubMedGoogle Scholar
  44. 44.
    Rey JM, Sawyer MG. Are psychostimulant drugs being used appropriately to treat child and adolescent disorders? Br J Psychiatry. 2003;182:284–6. doi: 10.1192/bjp.182.4.284.CrossRefPubMedGoogle Scholar
  45. 45.
    Accardo P, Blondis TA. What’s all the fuss about Ritalin? J Pediatr. 2001;138(1):6–9. doi: 10.1067/mpd.2001.111505.CrossRefPubMedGoogle Scholar
  46. 46.
    Biederman J, Wilens T, Mick E, Spencer T, Faraone SV. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics. 1999;104(2):e20. doi: 10.1542/peds.104.2.e20.CrossRefPubMedGoogle Scholar
  47. 47.
    Barkley RA, Fischer M, Smallish L, Fletcher K. Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13-year prospective study. Pediatrics. 2003;111(1):97–109. doi: 10.1542/peds.111.1.97.CrossRefPubMedGoogle Scholar
  48. 48.
    Bogas S. “Diagnosis du jour?” Understanding attentional deficits can sharpen our treatment strategies. Fam Ther Networker. 1997;21:63–7.Google Scholar
  49. 49.
    Smelter RW, Rasch BW. Is attention deficit disorder becoming a desired diagnosis? Phi Delta Kappan. 1996;77:429–32.Google Scholar
  50. 50.
    Sciutto MJ, Eisenberg M. Evaluating the evidence for and against the overdiagnosis of ADHD. J Atten Disord. 2007;11(2):106–13. doi: 10.1177/1087054707300094.CrossRefPubMedGoogle Scholar
  51. 51.
    Faber A, Kalverdijk LJ, den Berg LT, Hugtenburg JG, Minderaa RB, Tobi H. Parents report on stimulant-treated children in the Netherlands: initiation of treatment and follow-up care. J Child Adolesc Psychopharmacol. 2006;16(4):432–40. doi: 10.1089/cap.2006.16.432.CrossRefPubMedGoogle Scholar
  52. 52.
    Biederman J, Mick E, Faraone SV, Braaten E, Doyle A, Spencer T, et al. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry. 2002;159(1):36–42. doi: 10.1176/appi.ajp.159.1.36.CrossRefPubMedGoogle Scholar
  53. 53.
    Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord. 2002;5(3):143–54. doi: 10.1177/108705470200500302.CrossRefPubMedGoogle Scholar
  54. 54.
    Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics. 2003;111(1):179–85. doi: 10.1542/peds.111.1.179.CrossRefPubMedGoogle Scholar
  55. 55.
    Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R, et al. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47(1):21–31. doi: 10.1097/chi.0b013e31815a56f1.CrossRefPubMedGoogle Scholar
  56. 56.
    Graham J, Coghill D. Adverse effects of pharmacotherapies for attention-deficit hyperactivity disorder: epidemiology, prevention and management. CNS Drugs. 2008;22(3):213–37. doi: 10.2165/00023210-200822030-00003.CrossRefPubMedGoogle Scholar
  57. 57.
    Cortese S, Konofal E, Yateman N, Mouren MC, Lecendreux M. Sleep and alertness in children with attention-deficit/hyperactivity disorder: a systematic review of the literature. Sleep. 2006;29(4):504–11.PubMedGoogle Scholar
  58. 58.
    Van der Heijden KB, Smits MG, Van Someren EJ, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry. 2007;46(2):233–41. doi: 10.1097/01.chi.0000246055.76167.0d.CrossRefPubMedGoogle Scholar
  59. 59.
    Zachor DA, Roberts AW, Hodgens JB, Isaacs JS, Merrick J. Effects of long-term psychostimulant medication on growth of children with ADHD. Res Dev Disabil. 2006;27(2):162–74. doi: 10.1016/j.ridd.2004.12.004.CrossRefPubMedGoogle Scholar
  60. 60.
    Faraone SV, Biederman J, Morley CP, Spencer TJ. Effect of stimulants on height and weight: a review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47(9):994–1009. doi: 10.1097/CHI.0b013e31817e0ea7.PubMedGoogle Scholar
  61. 61.
    Poulton A. Growth on stimulant medication; clarifying the confusion: a review. Arch Dis Child. 2005;90(8):801–6. doi: 10.1136/adc.2004.056952.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Charach A, Figueroa M, Chen S, Ickowicz A, Schachar R. Stimulant treatment over 5 years: effects on growth. J Am Acad Child Adolesc Psychiatry. 2006;45(4):415–21. doi: 10.1097/01.chi.0000199026.91699.20.CrossRefPubMedGoogle Scholar
  63. 63.
    Spencer TJ, Faraone SV, Biederman J, Lerner M, Cooper KM, Zimmerman B. Does prolonged therapy with a long-acting stimulant suppress growth in children with ADHD? J Am Acad Child Adolesc Psychiatry. 2006;45(5):527–37. doi: 10.1097/01.chi.0000205710.01690.d4.CrossRefPubMedGoogle Scholar
  64. 64.
    Pliszka SR, Matthews TL, Braslow KJ, Watson MA. Comparative effects of methylphenidate and mixed salts amphetamine on height and weight in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45(5):520–6. doi: 10.1097/01.chi.0000205702.48324.fd.CrossRefPubMedGoogle Scholar
  65. 65.
    Rapport MD, Moffitt C. Attention deficit/hyperactivity disorder and methylphenidate. A review of height/weight, cardiovascular, and somatic complaint side effects. Clin Psychol Rev. 2002;22(8):1107–31.CrossRefPubMedGoogle Scholar
  66. 66.
    Wernicke JF, Faries D, Girod D, Brown J, Gao H, Kelsey D, et al. Cardiovascular effects of atomoxetine in children, adolescents, and adults. Drug Saf. 2003;26(10):729–40. doi: 10.2165/00002018-200326100-00006.CrossRefPubMedGoogle Scholar
  67. 67.
  68. 68.
    Wooltorton E. Suicidal ideation among children taking atomoxetine (Strattera). CMAJ. 2005;173(12):1447.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Bangs ME, Tauscher-Wisniewski S, Polzer J, Zhang S, Acharya N, Desaiah D, et al. Meta-analysis of suicide-related behavior events in patients treated with atomoxetine. J Am Acad Child Adolesc Psychiatry. 2008;47(2):209–18. doi: 10.1097/chi.0b013e31815d88b2.CrossRefPubMedGoogle Scholar
  70. 70.
    Kooij JJ, Burger H, Boonstra AM, Van der Linden PD, Kalma LE, Buitelaar JK. Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial. Psychol Med. 2004;34(6):973–82. doi: 10.1017/S0033291703001776.CrossRefPubMedGoogle Scholar
  71. 71.
    Spencer TJ, Adler LA, McGough JJ, Muniz R, Jiang H, Pestreich L. Efficacy and safety of dexmethylphenidate extended-release capsules in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2007;61(12):1380–7. doi: 10.1016/j.biopsych.2006.07.032.CrossRefPubMedGoogle Scholar
  72. 72.
    Weisler RH, Biederman J, Spencer TJ, Wilens TE, Faraone SV, Chrisman AK, et al. Mixed amphetamine salts extended-release in the treatment of adult ADHD: a randomized, controlled trial. CNS Spectr. 2006;11(8):625–39.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2009

Authors and Affiliations

  • Willemijn M. Meijer
    • 1
    Email author
  • Adrianne Faber
    • 2
  • Els van den Ban
    • 3
  • Hilde Tobi
    • 4
  1. 1.PHARMO InstituteUtrechtThe Netherlands
  2. 2.SIR Institute for Pharmacy Practice and PolicyLeidenThe Netherlands
  3. 3.Altrecht, Division Child, Youth and FamilyUtrechtThe Netherlands
  4. 4.Research MethodologyWageningen University and Research CentreWageningenThe Netherlands

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