Real-World Effectiveness and Safety of SDZ-ADL (Adalimumab Biosimilar) in Patients with Psoriasis from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR)
Abstract
:1. Introduction
2. Results
2.1. Safety Set: The Conventional Systemics Cohort Compared with the SDZ-ADL Cohort
2.2. Effectiveness Set: The Biologic-Naïve and Biologic-Switch Cohorts
3. Discussion
4. Materials and Methods
4.1. Recruitment and Baseline Data Collection
4.2. Safety Set and Effectiveness Set Analyses
4.3. Analysis of Serious Adverse Events in the Safety Set
4.4. Effectiveness Analysis: The Biologic-Naïve Versus Biologic-Switch Cohort
4.5. Data Collection at the 3-Year Follow-Up
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Christophers, E. Psoriasis—Epidemiology and clinical spectrum. Clin. Exp. Dermatol. 2001, 26, 314–320. [Google Scholar] [CrossRef]
- Boehncke, W.H.; Schon, M.P. Psoriasis. Lancet 2015, 386, 983–994. [Google Scholar] [CrossRef]
- Horreau, C.; Pouplard, C.; Brenaut, E.; Barnetche, T.; Misery, L.; Cribier, B.; Jullien, D.; Aractingi, S.; Aubin, F.; Joly, P.; et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: A systematic literature review. J. Eur. Acad. Dermatol. Venereol. 2013, 27, 12–29. [Google Scholar] [CrossRef] [PubMed]
- Huerta, C.; Rivero, E.; Rodriguez, L.A. Incidence and risk factors for psoriasis in the general population. Arch. Dermatol. 2007, 143, 1559–1565. [Google Scholar] [CrossRef] [PubMed]
- Ni, C.; Chiu, M.W. Psoriasis and comorbidities: Links and risks. Clin. Cosmet. Investig. Dermatol. 2014, 7, 119–132. [Google Scholar] [PubMed]
- European Medicines Agency. Hyrimoz: EU Summary of Product Characteristics. 2018. Available online: http://www.ema.europa.eu (accessed on 6 July 2022).
- Heo, Y.A. GP2017, An Adalimumab Biosimilar. BioDrugs 2018, 32, 635–638. [Google Scholar] [CrossRef] [PubMed]
- Kronthaler, U.; Fritsch, C.; Hainzl, O.; Seidl, A.; da Silva, A. Comparative functional and pharmacological characterization of Sandoz proposed biosimilar adalimumab (GP2017): Rationale for extrapolation across indications. Expert Opin. Biol. Ther. 2018, 18, 921–930. [Google Scholar] [CrossRef] [PubMed]
- Blauvelt, A.; Leonardi, C.L.; Gaylis, N.; Jauch-Lembach, J.; Balfour, A.; Lemke, L.; Hachaichi, S.; Brueckmann, I.; Festini, T.; Wiland, P. Treatment with SDZ-ADL, an Adalimumab Biosimilar, in Patients with Rheumatoid Arthritis, Psoriasis, or Psoriatic Arthritis: Results of Patient-Reported Outcome Measures from Two Phase III Studies (ADMYRA and ADACCESS). BioDrugs 2021, 35, 229–238. [Google Scholar] [CrossRef] [PubMed]
- Blauvelt, A.; Lacour, J.-P.; Fowler, J.F.; Weinberg, J.; Gospodinov, D.; Schuck, E.; Jauch-Lembach, J.; Balfour, A.; Leonardi, C. Phase III randomized study of the proposed adalimumab biosimilar GP2017 in psoriasis: Impact of multiple switches. Br. J. Dermatol. 2018, 179, 623–631. [Google Scholar] [CrossRef] [PubMed]
- Burden, A.D.; Warren, R.B.; Kleyn, C.E.; McElhone, K.; Smith, C.H.; Reynolds, N.J.; Ormerod, A.D.; Griffiths, C.E.M.; on behalf of the BADBIR Study Group. The British Association of Dermatologists’ Biologic Interventions Register (BADBIR): Design, methodology and objectives. Br. J. Dermatol. 2012, 166, 545–554. [Google Scholar] [CrossRef] [PubMed]
- Gerdes, S.; Körber, A.; Biermann, M.; Karnthaler, C.; Reinhardt, M. Absolute and relative psoriasis area and severity index (PASI) treatment goals and their association with health-related quality of life. J. Dermatol. Treat. 2020, 31, 470–475. [Google Scholar] [CrossRef] [PubMed]
- Mrowietz, U.; Kragballe, K.; Reich, K.; Spuls, P.; Griffiths, C.E.M.; Nast, A.; Franke, J.; Antoniou, C.; Arenberger, P.; Balieva, F.; et al. Definition of treatment goals for moderate to severe psoriasis: A European consensus. Arch. Dermatol. Res. 2011, 303, 1–10. [Google Scholar] [CrossRef] [PubMed]
- Burmester, G.R.; Gordon, K.B.; Rosenbaum, J.T.; Arikan, D.; Lau, W.L.; Li, P.; Faccin, F.; Panaccione, R. Long-Term Safety of Adalimumab in 29,967 Adult Patients From Global Clinical Trials Across Multiple Indications: An Updated Analysis. Adv. Ther. 2020, 37, 364–380. [Google Scholar] [CrossRef] [PubMed]
- Galloway, J.B.; Hyrich, K.L.; Mercer, L.K.; Dixon, W.G.; Fu, B.; Ustianowski, A.P.; Watson, K.D.; Lunt, M.; Symmons, D.P.M.; BSRBR Control Centre Consortium; et al. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: Updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology 2011, 50, 124–131. [Google Scholar]
- Egeberg, A.; Rosenø, N.A.L.; Aagaard, D.; Lørup, E.H.; Nielsen, M.-L.; Nymand, L.; Kristensen, L.E.; Thyssen, J.P.; Thomsen, S.F.; Cordtz, R.L.; et al. Drug survival of biologics and novel immunomodulators for rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, and psoriasis—A nationwide cohort study from the DANBIO and DERMBIO registries. Semin. Arthritis Rheum. 2022, 53, 151979. [Google Scholar] [CrossRef]
- Bellinato, F.; Gisondi, P.; Mason, E.; Ricci, P.; Maurelli, M.; Girolomoni, G. Real-Life Effectiveness of Adalimumab Biosimilars in Patients with Chronic Plaque Psoriasis. Dermatol. Ther. 2022, 12, 1303–1311. [Google Scholar] [CrossRef]
- Loft, N.; Egeberg, A.; Rasmussen, M.K.; Bryld, L.E.; Nissen, C.V.; Dam, T.N.; Ajgeiy, K.K.; Iversen, L.; Skov, L. Outcomes Following a Mandatory Nonmedical Switch From Adalimumab Originator to Adalimumab Biosimilars in Patients With Psoriasis. JAMA Dermatol. 2021, 157, 676–683. [Google Scholar] [CrossRef]
- Nabi, H.; Georgiadis, S.; Loft, A.G.; Hendricks, O.; Andersen, M.; Chrysidis, S.; Colic, A.; Danebod, K.; Hussein, M.R.; Kalisz, M.H.; et al. Comparative effectiveness of two adalimumab biosimilars in 1318 real-world patients with inflammatory rheumatic disease mandated to switch from originator adalimumab: Nationwide observational study emulating a randomised clinical trial. Ann. Rheum. Dis. 2021, 80, 1400–1409. [Google Scholar] [CrossRef]
- Di Giuseppe, D.; Lindstrom, U.; Bower, H.; Delcoigne, B.; Frisell, T.; Chatzidionysiou, K.; Sjöwall, C.; Lindqvist, E.; Askling, J. Comparison of treatment retention of originator vs biosimilar products in clinical rheumatology practice in Sweden. Rheumatology 2022, 61, 3596–3605. [Google Scholar] [CrossRef]
- Mason, K.J.; Barker, J.; Smith, C.H.; Hampton, P.J.; Lunt, M.; McElhone, K.; Warren, R.B.; Yiu, Z.Z.N.; Griffiths, C.E.M.; Burden, A.D.; et al. Comparison of Drug Discontinuation, Effectiveness, and Safety Between Clinical Trial Eligible and Ineligible Patients in BADBIR. JAMA Dermatol. 2018, 154, 581–588. [Google Scholar] [CrossRef]
- Coates, L.C.; FitzGerald, O.; Helliwell, P.S.; Paul, C. Psoriasis, psoriatic arthritis, and rheumatoid arthritis: Is all inflammation the same? Semin. Arthritis Rheum. 2016, 46, 291–304. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bray, F.; Znaor, A.; Cueva, P.; Korir, A.; Swaminathan, R.; Ullrich, A.; Wang, S.A.; Parkin, D.M. Planning and Developing Population-Based Cancer Registration in Low- or Middle-Income Settings; IARC Technical Publication: Lyon, France, 2014. [Google Scholar]
- The British Association of Dermatologists Biologics and Immunomodulators Register. Available online: http://www.badbir.org/ (accessed on 27 July 2022).
Conventional Systemics Cohort (n = 5919) | SDZ-ADL Cohort (n = 136) * | ||
---|---|---|---|
Conventional Systemics | Biologics-Naïve | Biologic-Switch # | |
Cumulative number of registrations from 27 September 2007 | 5919 | 46 | 90 |
Cumulative number by gender | |||
Male | 3333 | 29 | 52 |
Female | 2586 | 17 | 38 |
Cumulative number by age at registration | |||
<16 | 39 | 0 | 0 |
16–18 | 101 | 0 | 1 |
19–34 | 1697 | 7 | 21 |
35–44 | 1405 | 14 | 29 |
45–54 | 1355 | 11 | 22 |
55–64 | 820 | 7 | 9 |
65–74 | 402 | 7 | 7 |
75+ | 100 | 0 | 1 |
SDZ-ADL Cohort | Conventional Systemics Cohort | ||||||
---|---|---|---|---|---|---|---|
Sex | N | Mean | SD | N | Mean | SD | |
Age (years) | Male | 81 | 45.6 | 13.9 | 3333 | 44.1 | 14 |
Female | 55 | 43.8 | 12.5 | 2586 | 43 | 15.1 | |
Total | 136 | 44.9 | 13.3 | 5919 | 43.6 | 14.5 | |
Disease duration (years) | Male | 81 | 20.5 | 14.8 | 3321 | 17.2 | 12.4 |
Female | 55 | 21.5 | 13.3 | 2580 | 19.5 | 14.3 | |
Total | 136 | 20.9 | 14.2 | 5901 | 18.2 | 13.3 | |
No. of comorbidities N (%) | 0 | 46 (33.8) | 2142 (36.2) | ||||
0–2 | 84 (61.8) | 3280 (55.4) | |||||
3–4 | 4 (2.9) | 381 (6.4) | |||||
5+ | 2 (1.5) | 116 (2.0) | |||||
Total | 136 | 5919 |
Conventional Systemics (n = 5919) | SDZ-ADL (n = 136) * | |||
---|---|---|---|---|
Event | No. of Events | IR/1000 (95% CI) | No. of Events | IR/1000 (95% CI) |
Total serious event | 565 | 29.1 (26.8, 31.6) | 4 | 31.5 (8.6, 80.7) |
Pneumonia | 151 | 7.8 (6.6, 9.1) | 1 | 7.9 (0.2, 43.9) |
Septicaemia | 43 | 2.2 (1.6, 3.0) | 0 | 0.0 (0.0, 29.0) |
Opportunistic infection | 7 | 0.4 (0.1, 0.7) | 0 | 0.0 (0.0, 29.0) |
Soft tissue and skin infection | 100 | 5.2 (4.2, 6.3) | 1 | 7.9 (0.2, 43.9) |
Cellulitis | 58 | 3.0 (2.3, 3.9) | 1 | 7.9 (0.2, 43.9) |
Other | 42 | 2.2 (1.6, 2.9) | 0 | 0.0 (0.0, 29.0) |
Other serious infection | 252 | 13.0 (11.4, 14.7) | 2 | 15.7 (1.9, 56.9) |
Tuberculosis | 0 | 0.0 (0.0, 0.2) | 0 | 0.0 (0.0, 29.0) |
Cardiac SAE | 164 | 8.5 (7.2, 9.9) | 1 | 7.9 (0.2, 43.9) |
Congestive heart failure (new or worsening) | 17 | 0.9 (0.5, 1.4) | 0 | 0.0 (0.0, 29.0) |
Myocardial infarction | 48 | 2.5 (1.8, 3.3) | 1 | 7.9 (0.2, 43.9) |
Central demyelination | 0 | 0.0 (0.0, 0.2) | 0 | 0.0 (0.0, 29.0) |
Peripheral neuropathy | 3 | 0.2 (0.0, 0.5) | 0 | 0.0 (0.0, 29.0) |
Cerebrovascular accident | 52 | 2.7 (2.0, 3.5) | 0 | 0.0 (0.0, 29.0) |
Skin (non-cancer) | 207 | 10.7 (9.3, 12.2) | 0 | 0.0 (0.0, 29.0) |
Total haematologic events | 15 | 0.8 (0.4, 1.3) | 0 | 0.0 (0.0, 29.0) |
Aplastic anaemia | 3 | 0.2 (0.0, 0.5) | 0 | 0.0 (0.0, 29.0) |
Total malignant events | 308 | 7.3 (6.5, 8.2) | 0 | 0.0 (0.0, 13.4) |
Lymphoproliferative | 17 | 0.4 (0.2, 0.6) | 0 | 0.0 (0.0, 13.4) |
Lymphoma | 11 | 0.3 (0.1, 0.5) | 0 | 0.0 (0.0, 13.4) |
Myeloma | 2 | 0.0 (0.0, 0.2) | 0 | 0.0 (0.0, 13.4) |
Leukaemia | 4 | 0.1 (0.0, 0.2) | 0 | 0.0 (0.0, 13.4) |
Skin cancer | 127 | 3.0 (2.5, 3.6) | 0 | 0.0 (0.0, 13.4) |
Non-melanoma skin-cancer | 118 | 2.8 (2.3, 3.4) | 0 | 0.0 (0.0, 13.4) |
Melanoma | 9 | 0.2 (0.1, 0.4) | 0 | 0.0 (0.0, 13.4) |
Other skin cancer | 0 | 0.0 (0.0, 0.1) | 0 | 0.0 (0.0, 13.4) |
Solid tumours | 162 | 3.8 (3.3, 4.5) | 0 | 0.0 (0.0, 13.4) |
Brain neoplasms | 2 | 0.0 (0.0, 0.2) | 0 | 0.0 (0.0, 13.4) |
Glioblastoma | 1 | 0.0 (0.0, 0.1) | 0 | 0.0 (0.0, 13.4) |
Other brain neoplasm | 1 | 0.0 (0.0, 0.1) | 0 | 0.0 (0.0, 13.4) |
Pregnancy | 126 | 14.6 (12.1, 17.3) | 0 | 0.0 (0.0, 77.4) |
Death | 183 | 4.3 (3.7, 5.0) | 0 | 0.0 (0.0, 24.2) |
Conventional Systemics (n = 5919) | SDZ-ADL (n = 136) | HR | ||||
---|---|---|---|---|---|---|
SAEs | N | IR/1000 (95% CI) | N | IR/1000 (95% CI) | Unadjusted HR (95% CI) | Adjusted HR (95% CI) |
Total serious infection | 380 | 9.5 (8.6, 10.5) | 3 | 6.3 (2.03, 19.5) | 0.53 (0.17, 1.64) | 0.60 (0.19, 1.86) |
Pneumonia | 114 | 2.7 (2.3, 3.3) | 1 | 2.1 (0.3, 14.8) | 0.58 (0.08, 4.18) | 0.64 (0.09, 4.58) |
Septicaemia | 38 | 0.9 (0.7, 1.2) | 0 | - | - | - |
Opportunistic infection | 7 | 0.2 (0.1, 0.3) | 0 | - | - | - |
Soft tissue and skin infection | 91 | 2.2 (1.8, 2.7) | 1 | 2.1 (0.3, 14.8) | 0.74 (0.10, 5.34) | 0.86 (0.12, 6.26) |
Cellulitis | 60 | 1.4 (1.1, 1.9) | 1 | 2.1 (0.3, 14.8) | 1.15 (0.16, 8.29) | 1.28 (0.18, 9.39) |
Other soft tissue and skin infection | 39 | 0.9 (0.7, 1.3) | 0 | - | - | - |
Other serious infection | 210 | 5.1 (4.5, 5.9) | 2 | 4.2 (1.05, 16.7) | 0.66 (0.16, 2.67) | 0.74 (0.18, 2.97) |
Tuberculosis | 0 | - | 0 | - | - | - |
Respiratory (non-infection) | 50 | 1.2 (0.9, 1.6) | 0 | - | - | - |
Cardiac SAE | 132 | 3.2 (2.7, 3.8) | 1 | 2.1 (0.3, 14.8) | 0.55 (0.08, 3.92) | 0.56 (0.08, 3.99) |
congestive heart failure (new or worsening) | 12 | 0.3 (0.2, 0.5) | 0 | - | - | - |
Myocardial infarction | 47 | 1.1 (0.8, 1.5) | 1 | 2.1 (0.3, 14.8) | 1.53 (0.21, 11.13) | 1.71 (0.23, 12.53) |
Other cardiac events | 86 | 2.1 (1.7, 2.6) | 0 | - | - | - |
Nervous system SAE | 88 | 2.1 (1.7, 2.6) | 0 | - | - | - |
Central demyelination | 0 | - | 0 | - | - | - |
Peripheral neuropathy | 3 | 0.1 (0.02, 0.2) | 0 | - | - | - |
Cerebrovascular accident | 47 | 1.1 (0.8, 1.5) | 0 | - | - | - |
Total haematologic events | 13 | 0.3 (0.2, 0.5) | 0 | - | - | - |
Total malignant events | 207 | 5.1 (4.4, 5.8) | 0 | - | - | - |
Death | 183 | 4.4 (3.8, 5.1) | 0 | - | - | - |
Effectiveness Set (n = 133) ** | |||||||||
---|---|---|---|---|---|---|---|---|---|
Biologic-Naïve (n = 46; 34.6%) | Biologic-Switch (n = 87; 65.4%) | p Value * | |||||||
Characteristics | N | Mean (SD) | Median (IRQ) | Range | N | Mean (SD) | Median (IRQ) | Range | |
Follow-up (years) | 46 | 1.9 (0.6) | 2.0 | (1.8–2.4) | 87 | 1.8 (0.7) | 2.0 | (1.6–2.3) | 0.535 |
Age (years) | 46 | 45.9 (12.6) | 45.0 | (36.0–56.0) | 87 | 44.1 (13.6) | 43.0 | (36.0–52.0) | 0.571 |
Age of onset (years) | 46 | 26.7 (12.3) | 27.5 | (17.0–37.0) | 87 | 22.3 (13.6) | 20.0 | (14.0–28.0) | 0.009 |
Disease duration (years) | 46 | 19.2 (13.4) | 16.0 | (9.0–26.0) | 87 | 21.9 (14.8) | 19.0 | (10.0–30.0) | 0.578 |
Weight (kg) | 36 | 85.5 (18.7) | 83.4 | (68.6–99.5) | 81 | 88.4 (20.8) | 86.3 | (72.9–99.2) | 0.639 |
Height (kg) | 44 | 169.5 (9.7) | 170.0 | (161.0–176.0) | 87 | 169.4 (11.1) | 170.0 | (160.0–177.0) | 1.000 |
BMI (kg/m2) | 36 | 29.4 (5.3) | 28.4 | (25.9–33.0) | 81 | 30.8 (6.9) | 29.7 | (26.2–33.3) | 0.475 |
Waist circumference (cm) | 30 | 84.9 (23.2) | 90.0 | (78.0–100.0) | 78 | 102.6 (17.5) | 102.0 | (89.8–111.0) | 0.010 |
Baseline PASI # | 39 | 12.9 (5.3) | 11.5 | (10.5–12.6) | 26 | 2.1 (4.0) | 0.3 | (0.0–1.9) | 0.001 |
Baseline DLQI ## | 38 | 17.2 (5.9) | 16.0 | (13.0–22.0) | 17 | 2.9 (3.4) | 2.0 | (0.0–4.0) | 0.001 |
Psoriatic arthritis, N (%) | 46 | 11 (23.9) | 87 | 22 (25.3) | 0.861 | ||||
No. of comorbidities | 46 | 1.5 (1.9) | 0.0 | (0.0–3.0) | 87 | 1.3 (1.2) | 1.0 | (0.0–2.0) | 0.002 |
No. of skin cancers/pre-skin cancers | 46 | 0.0 (0.1) | 0.0 | 0.0–0.0 | 87 | 0 | 0 | 0 | - |
No. of biologics prior to Hyrimoz | 46 | 0 | 0 | 0 | 87 | 1.3 (0.6) | 1.0 | 1.0–1.0 | - |
Previous systemics, N (%): | 46 | 87 | |||||||
Methotrexate | 36 (78.3) | 64 (73.6) | 0.551 | ||||||
Acitretin | 13 (28.3) | 39 (44.8) | 0.063 | ||||||
Mycophenolate mofetil | 0 | 2 (2.3) | 0.300 | ||||||
Ciclosporin | 31 (67.4) | 55 (63.2) | 0.632 | ||||||
Hydroxycarbamide | 1 (2.2) | 1 (1.2) | 0.644 | ||||||
Fumaric acidEsters | 10 (21.7) | 12 (13.8) | 0.241 | ||||||
PUVA | 2 (4.4) | 2 (2.3) | 0.510 |
Time Point | PRO Achieved | Biologic-Naïve n (%) | Biologic-Switch n (%) |
---|---|---|---|
6 months | PASI ≤ 2 | 17 (77.3) | 20 (76.9) |
DLQI 0 or 1 | 9 (42.9) | 8 (80.0) | |
12 months | PASI ≤ 2 | 11 (84.6) | 10 (76.9) |
DLQI 0 or 1 | 7 (70.0) | 3 (75.0) |
Reason for Stopping Treatment | Biologic-Naïve n = 46 (34.6%) | Biologic-Switch n = 87 (65.4%) | Full Cohort n = 133 (100%) | |||
---|---|---|---|---|---|---|
n (%) | Time to Interruption * (IQR) | n (%) | Time to Interruption * (IQR) | N (%) | Time to Interruption * (IQR) | |
Did not stop | 39 (84.8) | - | 71 (81.6) | - | 110 (82.7) | - |
Adverse events | 3 (6.5) | 0.3 (0.2–0.8) | 11 (12.6) | 0.5 (0.2–0.6) | 14 (10.5) | 0.4 (0.2–0.6) |
Ineffectiveness | 1 (2.2) | 0.5 (0.5–0.5) | 3 (3.5) | 0.5 (0.2–2.4) | 4 (3.0) | 0.5 (0.3–1.5) |
Other ** | 3 (6.5) | 0.9 (0.3–1.4) | 2 (2.3) | 0.4 (0.4–0.5) | 5 (3.8) | 0.5 (0.4–0.9) |
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Puig, L.; Shams, K.; Furlan, F.; Salvati, C.; Romero, E.; Fan, J.; Iversen, L. Real-World Effectiveness and Safety of SDZ-ADL (Adalimumab Biosimilar) in Patients with Psoriasis from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR). Biologics 2022, 2, 213-225. https://doi.org/10.3390/biologics2040017
Puig L, Shams K, Furlan F, Salvati C, Romero E, Fan J, Iversen L. Real-World Effectiveness and Safety of SDZ-ADL (Adalimumab Biosimilar) in Patients with Psoriasis from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR). Biologics. 2022; 2(4):213-225. https://doi.org/10.3390/biologics2040017
Chicago/Turabian StylePuig, Lluís, Kave Shams, Fabricio Furlan, Cristofer Salvati, Elisa Romero, Jamie Fan, and Lars Iversen. 2022. "Real-World Effectiveness and Safety of SDZ-ADL (Adalimumab Biosimilar) in Patients with Psoriasis from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR)" Biologics 2, no. 4: 213-225. https://doi.org/10.3390/biologics2040017