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Coronavirus disease 2019 (COVID-19) in a patient with ankylosing spondylitis treated with secukinumab: a case-based review Severe acute respiratory syndrome coranovirus-2 (SARS-CoV-2) infection has become an important health-care issue worldwide Safety of secukinumab treatment in COVID-19 affected psoriatic patients Dermatol Ther. 2021 Jan;34(1):e14710. doi: 10.1111/dth.14710. Epub 2021 Jan 3. Authors Cristina Mugheddu 1 , Silvia Sanna 1 , Laura Atzori 1 , Franco Rongioletti 1 Affiliation 1 Dermatology Clinic, Department of. Among biologics, secukinumab is a fully human monoclonal antibody that selectively neutralizes interleukin (IL)‐17A, a key cytokine involved in psoriasis and psoriatic arthritis. Preliminary reports on COVID‐19 patients who were under secukinumab treatment suggest a favorable course,4, 5,

There are a number of articles reporting the clinical course of COVID-19 among patients on secukinumab therapy (Table (Table2)2) [ 11, 24 - 26 ]. Favalli et al. reported that one patient receiving secukinumab for PsA was managed at home with no any respiratory complication related to COVID-19 [ 11 ] The majority of patients classified as having moderate to severe psoriasis were treated with methotrexate, adalimumab (Humira, AbbVie), apremilast (Otezla, Amgen), secukinumab (Cosentyx, Novartis) and ustekinumab (Stelara, Janssen Pharmaceuticals). The aIRRs showed that 33% more patients with psoriasis had COVID-19 compared to controls Hence, it is important they get sufficient protection by a COVID-19 vaccine. However, these patients may also be at risk for a less robust vaccine response. There is an urgent need to assess the humoral and cellular immune response to COVID-19 vaccines in these patient groups Both secukinumab and ixekizumab are approved for psoriasis, psoriatic arthritis and ankylosing spondylitis; brodalumab is approved for the treatment of psoriasis alone. These three drugs are..

COVID-19 Vaccines for People with Autoimmune Rheumatic Diseases Updated: June 16, 2021 5 o Leflunomide o Oral cyclophosphamide o Prednisone less than 20mg/day (or equivalent) o Sarilumab o Secukinumab o Sulfasalazine o Tacrolimus o Tocilizumab o Ustekinumab For patients on rituximab or ocrelizumab, the COVID-19 immunization should ideally be timed four to five months afte Management of rheumatology patients during the coronavirus pandemic Table 3: Escalation matrix Prevalence of COVID-19 infection and associated available hospital resources Low (equivalent to winter pressures) Medium (ITU beds start to be in short supply, still reasonable number of hospital beds) High (no ITU beds, theatre pod Those taking IL-17 inhibitors such as secukinumab (Cosentyx) or ixekizumab (Taltz) are at risk for fungal infections such as Candida, and those taking Janus Kinase (JAK) inhibitors such as tofacitinib (Xeljanz), baracitinib (Olumiant) or upadacitinib (Rinvoq) are at risk for herpes zoster (shingles) infection - a long-term complication of the chickenpox (varicella) virus Secukinumab is an IgG1/κ monoclonal antibody that selectively inhibits IL-17A. Live vaccines should not be given with secukinumab, while inactivated or non-live vaccines, such as flu vaccines, can be used Patients with mild and severe coronavirus disease 2019 (COVID 19) will be randomized 3:1:1:3 into four groups: colchicine, ruxolitinib, secukinumab, and control groups. Patients will get investigated therapy for 10 days. Patients will be follow-up during 45 days after randomization

Most experts agree to maintain psoriasis treatment with biologics, although dismission should be considered when COVID‐19 symptoms occur. 1 The long secukinumab half‐life covered the whole period of illness in our patients, one with conclamant pneumonia and mild symptoms in the other. Current knowledge supports the role of several cytokines release in COVID‐19, including IL17, especially. Community funds. Novartis committed to donating up to USD 40 million to support communities around the world impacted by the pandemic. This includes the Novartis COVID-19 Response Fund and a US COVID- 19 Community Response Fund, established by Novartis and the Novartis US Foundation, that will provide cash and in-kind donations for immediate. Use in patients taking immunosuppressive medicines. Public Health England's Immunisation Against Infectious Disease (The Green book) states that immunosuppressed patients, due to disease or treatment are clinically extremely vulnerable and should be vaccinated against COVID-19. Adult household contacts of people with immunosuppression are also considered to be an at risk group eligible for. Secukinumab is an immunosuppressant that is used to treat moderate to severe plaque psoriasis, active psoriatic arthritis, or active ankylosing spondylitis. Secukinumab is also used in adults to treat axial spondyloarthritis. Secukinumab may also be used for purposes not listed in this medication guide

Coronavirus disease 2019 (COVID-19) in a patient with

The NIST COVID19-DATA repository is being made available to aid in meeting the White House Call to Action for the Nation's artificial intelligence experts to develop new text and data mining techniques that can help the science community answer high-priority scientific questions related to COVID-19 COVID-19 Vaccination FAQs For Rheumatology patients Updated 05.07.2021 including: Information regarding vaccination in Antiphospholipid syndrome, pregnancy and breastfeeding o Ixekizumab, Secukinumab o Ustekinumab o Anakinra o Belimumab o Rituxima Secukinumab can make you more likely to get infections or may worsen any current infections. Therefore, wash your hands well to prevent the spread of infection. Avoid contact with people who have.. COSENTYX contains the active substance secukinumab. This ingredient is a fully-human monoclonal antibody and belongs to a group of medicines called interleukin (IL) inhibitors. Monoclonal.. Some side effects of secukinumab may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects

Secukinumab (Cosentyx®) for the treatment of active non-radiographic axial spondyloarthritis with objective signs of inflammation as indicated by elevated C-reactive protein and/or magnetic resonance imaging evidence in adults who have responded inadequately to non-steroidal anti-inflammatory drugs (January 2021 Secukinumab (Cosentyx) Home page / Providers / Pharmacy Prior Authorization Criteria / Secukinumab (Cosentyx) Secukinumab (Cosentyx®) OFFICE / HOME HEALTH / SELF ADMINISTRATION. Indications for Prior Authorization: Ankylosing Spondylitis; For the latest on Coronavirus (COVID-19),. Clinical use: Secukinumab is approved by the US FDA for the treatment of plaque psoriasis.Secukinumab also met its clinical endpoints in Phase III clinical trial for ankylosing spondylitis (NCT01649375) [PMID:26699169], and was FDA approved for this indication and psoriatic arthritis [PMID:26422723][PMID:26135703] in January 2016.The antibody. - Bimekizumab demonstrated superiority to Cosentyx® (secukinumab) for PASI 100 at week 16 and PASI 100 at week 48, with no new safety signals observed for bimekizumab UCB Response to COVID-19. Secukinumab, Novartis. Drug: Secukinumab. Company: Novartis. Phase: Filed. Class: Anti-interleukin-17 (IL-17) Mab. 2020 sales: $1.03 billion. Net present value: $2.7 billion. The pharma giant.

Safety of secukinumab treatment in COVID-19 affected

Jan 14 · PIII MEASURE 3 study to generate 16-week efficacy data for secukinumab 150mg and 300mg, as well as up to 3-year efficacy, safety and tolerability data in 226 adults with active AS despite current or previous NSAID, DMARD and/or anti-TNF therapy starts (NCT02008916). Patients will be recruited in countries such as the US, EU & UK

Background: Patients with severe COVID-19 seem to have a compromised antiviral response and hyperinflammation. Neutrophils are critical players in COVID-19 pathogenesis. IL-17A plays a major role in protection against extracellular pathogens and neutrophil attraction and activation. We hypothesized that secukinumab, an anti-IL17A monoclonal antibody, could mitigate the deleterious. Of note, none of the patients treated with secukinumab contracted Covid-19. Conclusion: Selective up- and down-regulation of neutrophil transcription was observed in PsA neutrophils compared to healthy controls, and in PSA neutrophils post treatment with secukinumab. However, while these changes may alter the pro-inflammatory function of. COVID-19: Advice, updates and vaccine options COVID-19: Advice, updates and vaccine options Appropriate studies have not been performed on the relationship of age to the effects of secukinumab injection in children younger than 6 years of age with plaque psoriasis and in children with psoriatic arthritis, active ankylosing spondylitis, or. Objective To provide guidance to rheumatology providers on the use of coronavirus disease 2019 (COVID-19) vaccines for patients with rheumatic and musculoskeletal diseases (RMDs). Methods A task f.. Serious hypersensitivity reaction to secukinumab or to any of the excipients. (4) -----WARNINGS AND PRECAUTIONS-----­ • Infections: Serious infections have occurred. Caution should be exercised when considering the use of COSENTYX in patients with a chronic infection or a history of recurrent infection

Impact of COVID-19 pandemic — The coronavirus disease 2019 (COVID-19) pandemic has led organizations, including the AAD, Secukinumab — Secukinumab, an anti-IL-17A monoclonal antibody, is an effective treatment for moderate to severe plaque psoriasis . Standard dosing for plaque psoriasis is 300 mg given subcutaneously once weekly at. Cosentyx ® is the first fully-human IL-17A inhibitor indicated for patients in Europe with non-radiographic axial spondyloarthritis (nr-axSpA), which forms part of the axial spondyloarthritis (axSpA) disease spectrum; There are approximately 1.7 million patients with nr-axSpA in the top five EU countries and US 1; Cosentyx is also approved for the treatment of moderate-to-severe plaque. Secukinumab belongs to a class of drugs known as monoclonal antibodies. It works by blocking a certain natural protein in your body (interleukin-17A) that may cause inflammation and swelling Basel, June 2, 2021 — Novartis, a leader in rheumatology and immuno-dermatology, today announced 2-year positive results from the Phase III JUNIPERA study, demonstrating that Cosentyx® (secukinumab) significantly delayed time to flare vs placebo (P<.001) in pediatric patients with juvenile psoriatic arthritis (JPsA) and enthesitis-related arthritis (ERA) - two subtypes of juvenile.

The German Institute for Quality and Efficiency in Health Care (IQWiG) assessments found that secukinumab and ixekizumab offer considerable added benefit for patients... Stay informed! Visit the SA Department of Health's website for COVID-19 updates: sacoronavirus.co.z The proportion of patients who met the criterion for PASI 75 at week 12 was higher with each secukinumab dose than with placebo or etanercept: in the ERASURE study, the rates were 81.6% with 300. MSK is offering COVID-19 vaccines to all patients age 12 and over. To schedule or learn more, read this. For Adult Patients / Cancer Care / Patient & Caregiver Education; Secukinumab Adult Medication. Share. Print Limited Coverage Drugs - Secukinumab. For the treatment of moderate to severe Plaque Psoriasis, according to established criteria described in Special Authority request form 5380. Coverage of secukinumab for the treatment of Plaque Psoriasis is only available when prescribed by a dermatologist. For the treatment of Ankylosing Spondylitis. Secukinumab is an immunosuppressant that is used to treat moderate to severe plaque psoriasis, active psoriatic arthritis, or active ankylosing spondylitis. Secukinumab is also used in adults to treat axial spondyloarthritis. Secukinumab may also be used for purposes not listed in this medication guide

Safety of secukinumab treatment in COVID‐19 affected

Cosentyx Full Prescribing Information, Dosage & Side

  1. The relevant corresponding RCT was the CLEAR (A 52-week, Multicenter, Randomized, Double-blind Study of Subcutaneous Secukinumab to Demonstrate Efficacy as Assessed by Psoriasis Area and Severity Index at 16 Weeks of Treatment Compared to Ustekinumab and to Assess Long-term Safety, Tolerability and Efficacy in Subjects With Moderate to Severe.
  2. Substance record SID 124490635 for Secukinumab (USAN/INN) submitted by KEGG
  3. New drug is gamechanger in psoriasis treatment. A novel drug almost entirely cleared moderate to severe psoriasis in over 60% of the patients who took part in two phase three clinical trials of a.
  4. Secukinumab is a recombinant fully human monoclonal antibody selective for interleukin-17A. Secukinumab is of the IgG1/κ-class produced in Chinese Hamster Ovary (CHO) cells. 3 Pharmaceutical Form. Powder for injection. Each vial of powder for injection contains 150 mg of secukinumab as a lyophilised cake in glass vials. Solution for injection
  5. istration (FDA) has approved Cosentyx ® (secukinumab) for the treatment of moderate to severe plaque psoriasis in pediatric patients six years and older who are candidates for systemic therapy or phototherapy 1
  6. Coronavirus (COVID-19): Information for Patient Families. Learn more about the symptoms of Coronavirus (COVID-19), how you can protect your family, and how Nationwide Children's Hospital is preparing

A new review shows secukinumab continued to have a strong safety profile after 6 years on the market. Self-management for Inflammatory Arthritis Seems Effective but Needs More Research, Study Says. Attachment: Extract from the Clinical Evaluation Report: Secukinumab (docx, 10 MB) Active Ingredient. Secukinumab. Product Name. Cosentyx / Zafrez. Sponsor. Novartis Pharmaceutical Australia Pty Ltd. Submission Number. PM-2013-04153-1-4 SECUKINUMAB (sek ue KIN ue mab) is used to treat psoriasis. It is also used to treat psoriatic arthritis and ankylosing spondylitis. This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions. COMMON BRAND NAME (S): Cosentyx. Cleveland Clinic is a non-profit academic medical center However, he said, in a prespecified sensitivity analysis using nonresponder imputation, ACR20 responses were seen in 66.9% of patients in the secukinumab group compared with 59.5% of those in the. Secukinumab is a solution for injection that comes in a pre-filled syringe or pen. Each pre-filled pen contains 150mg of secukinumab. In psoriatic arthritis and ankylosing spondylitis, the usual dose of secukinumab is 150mg (the contents of one pre-filled pen) injected each week for the first 4 weeks of treatment, then once a month after that

Facing Adversity? Just Keep Swimming - Ankylosing

Researchers Study Connection Between Psoriasis and COVID-1

Australian Public Assessment Report for Secukinumab. How to access a pdf or Word document *Large file warning: Attempting to open large files over the Internet within the browser window may cause problems. It is strongly recommended you download this document to your own computer and open from there The response to secukinumab was significantly greater than the response to placebo and etanercept whether assessed by the PASI or the investigator . There was a 100% reduction in the PASI score in 24.1% of the secukinumab 300 mg group and 14.4% of the 150 mg group, compared with 4.3% of the etanercept group and none of the placebo group. Schedule affected by COVID-19. Topic update: this appraisal has not been defined as therapeutically critical. The appraisal will therefore be paused. At this stage, we are unable to provide alternative timelines as to when the appraisal may be re-started but we will provide an update when this information is available Tocilizumab, sold under the brand name Actemra among others, is an immunosuppressive drug, used for the treatment of rheumatoid arthritis and systemic juvenile idiopathic arthritis, a severe form of arthritis in children.It is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is. Secukinumab is the latest adult plaque psoriasis treatment to be bested by a newcomer, the interleukin 17A and 17F blocker bimekizumab.. Rates of complete clearance were substantially higher with.

Vaccine Response to COVID-19 Vaccines in Patients Using

  1. Secukinumab is the first and only fully human biologic that directly inhibits interleukin-17A, which is involved in the inflammation and development of moderate to severe plaque psoriasis, according to the press release. It is also the only biologic with proven efficacy in all 6 key manifestations of psoriatic arthritis
  2. ation can rattle off Griffiths' classification of pityriasis rubra pilaris (PRP) — Type I (Classical Adult), Type II (Atypical Adult), Type III (Classic Juvenile), Type IV (Circumscribed Juvenile), and Type V (Atypical Juvenile)
  3. 1. Bimekizumab treatment was shown to be noninferior and superior for greater skin clearance of plaque psoriasis compared to secukinumab treatment. 2. Bimekizumab treatment was shown to have a higher risk for oral candidiasis infection compared to secukinumab treatment. Evidence Rating Level: 1 (Excellent) Study Rundown: The pathology of psoriasis involves the overexpression of interleukin-17
  4. Secukinumab is a medicine that may be offered to people with AS who do not respond to NSAIDs or anti-TNF medicine. Secukinumab works by blocking the effects of a protein involved in triggering inflammation. Secukinumab is not routinely available on the NHS for people with AS so you may have to pay for it
  5. A message from. Novartis on COVID-19. Thank you for your expertise in treating autoimmune/autoinflammatory diseases. The arrival of COVID-19 has increased the complexity of your calling, and we want to acknowledge you for the deep commitment you have to your patients
  6. istration

Status of a real-life cohort of patients with moderate-to-severe plaque psoriasis treated with secukinumab and considerations on the use of biological agents in the Covid-19 era Article Jun 202 Fifty adults hospitalized Covid-19 patients, confirmed by a positive SARS-CoV-2 RT-PCR, were randomized 1:1 to receive 300mg of secukinumab subcutaneously at day-0 (group A) plus standard of care. Secukinumab and ixekizumab are immunomodulators that block IL-17A and could be beneficial in therapy of severe COVID-19. Brodalumab is directed against interleukin-17 receptor A (IL-17RA), another potential target molecule in therapy of severe COVID-19

COVID-19: a case for inhibiting IL-17? Nature Reviews

Lilly's Mirikizumab Superior to Cosentyx® (secukinumab) in a Phase 3 Study for Patients with Moderate to Severe Plaque Psoriasis After pausing enrollment due to the COVID-19 pandemic, these. COVID-19 Information. Important information regarding COVID-19 (coronavirus) for people who are living with psoriasis and psoriatic arthritis, including those taking immunosuppressive medicines. In response to the COVID-19 pandemic, we have put together this information for people who are living with psoriasis and/or psoriatic arthritis

Scotland currently has a system of local COVID protection levels (tiers) in place. There are 5 different levels, from 0 to 4. The lowest level is 0 and the highest level is 4. If you are on the shielding list, you should follow the general advice for your local protection level. Find your area's current COVID protection level and guidelines.

COVID-19 and Spondyloarthritis: Your Questions, Answere

Secukinumab 300 mg and 150 mg provided sustained improvement in the signs and symptoms of psoriatic arthritis, with consistent safety over 5 years. This study supports the clinical benefit and safety of long-term treatment with secukinumab in patients with psoriatic arthritis Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus , that was first recognized in Wuhan, China, in December 2019. Genetic sequencing of the virus suggests that it is a betacoronavirus closely linked to the SARS virus (1) Positive New Data for Johnson & Johnson Single-Shot COVID-19 Vaccine on Delta Variant. Learn More (secukinumab) * in treating adults with moderate to severe plaque psoriasis for the primary endpoint assessed at week 48. Data from the multi-center, randomized, double-blind head-to-head Phase 3 study demonstrated that 84.5 percent of patients. An ambitious vaccination program is now underway in the U.S., ever since the U.S. Food and Drug Administration (FDA) issued emergency use authorization for Pfizer and BioNTech's COVID-19 vaccine on December 11th and Moderna's vaccine one week later. SAA hosted a Facebook Live discussion on COVID-19 vaccines and SpA on December 9th to address the questions that many in the spondyloarthritis. Skip to Conten

Safety and Efficacy of Vaccines during COVID-19 Pandemic

  1. Cosentyx (secukinumab) is a prescription drug used to treat plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. The drug is given as an injection. Learn about cost, side effects.
  2. It also demonstrated non-inferiority to secukinumab in key secondary endpoints at week 16 and demonstrated superiority in key secondary endpoints at week 52. The most common adverse event in mirikizumab-treated patients was nasopharyngitis, occurring in at least 5% of patients up to week 16
  3. AbbVie (NYSE: ABBV), a research-based global biopharmaceutical company, today announced new late-breaking Phase 3b head-to-head data showing superior rates of skin clearance for SKYRIZI.
  4. Secukinumab (anti-IL-17A) (Cosentyx, AIN457) is a human IgG1κ monoclonal antibody that binds to the protein interleukin (IL)-17A, and is applied for the treatment of psoriasis, ankylosing spondylitis, and psoriatic arthritis. MW=147.9 kDa. In vitro. Healthy donors show both significantly less frequent T cell responses and lower numbers of pre.
  5. OASIS-2 is a multicenter randomized, double-blind, placebo-controlled study comparing the efficacy and safety of mirikizumab to placebo and Cosentyx (secukinumab) in patients with moderate to.
  6. ed how PsA patients respond to secukinumab
  7. Secukinumab is a fully human IgG1/κ monoclonal antibody that selectively binds to and neutralises the proinflammatory cytokine interleukin-17A (IL-17A). Secukinumab works by targeting IL-17A and inhibiting its interaction with the IL-17 receptor, which is expressed on various cell types including keratinocytes

Guselkumab showed superior long-term efficacy based on PASI 90 at week 48 when compared with secukinumab for treating moderate-to-severe psoriasis. This finding could assist health-care providers in their decision making process when selecting a biologic for treating moderate-to-severe psoriasis Secukinumab is an investigational medicine that works by stopping the action of interleukin-17A (IL-17A)[4], a protein that is central to the development of inflammatory diseases[5] NORTH CHICAGO, Ill., June 12, 2020 /PRNewswire/ -- AbbVie (NYSE: ABBV), a research-based global biopharmaceutical company, today announced new late-breaking Phase 3b head-to-head data showing superior rates of skin clearance for SKYRIZI ® (risankizumab-rzaa) to COSENTYX ® (secukinumab) at week 52. 1 Particularly, 66 percent of psoriasis patients receiving SKYRIZI achieved completely clear. Cosentyx 150mg and 300mg solution for injection in pre-filled syringe and pre-filled pen (Northern Ireland) secukinumab Novartis Pharmaceuticals UK Lt secukinumab, having considered evidence on the nature of ankylosing spondylitis (AS) and the value placed on the benefits of secukinumab by people with the condition, those who represent them, and clinical experts. It also took into account the effective use of NHS resources. Clinical effectiveness . 4.

Ixekizumab, Secukinumab, and Adalimumab: A Healthcare Cost

COLchicine Versus Ruxolitinib and Secukinumab In Open

SECUKINUMAB is used to treat psoriasis.It is also used to treat psoriatic arthritis, ankylosing spondylitis, and active non-radiographic axial spondyloarthritis. The lowest GoodRx price for the most common version of Cosentyx is around $5,651.98, 38% off the average retail price of $9,218.51 Collagenous colitis is a chronic inflammatory condition and one type of a bigger entity, microscopic colitis. Collagenous colitis is associated with autoimmune diseases, such as psoriatic arthritis, suggesting an immune mechanism involved in the pathogenesis of the disease. New onset and flares of inflammatory bowel disease have been associated with the use of secukinumab, but no cases of.

Our response to COVID-19 Novarti

Using COVID-19 vaccines in patient taking

Cosentyx (secukinumab) is a human IgG1κ monoclonal antibody that binds to the protein interleukin (IL)-17A,[1] and is manufactured by Novartis Pharma AG for the treatment of psoriasis, ankylosing spondylitis, and psoriatic arthritis. Read more about Cosentyx (secukinumab) It targets member A form of the cytokine family of interleukin 17, severely inhibiting its functioning. On January 21. OBJECTIVE: To evaluate minimal disease activity (MDA) among psoriatic arthritis (PsA) patients receiving secukinumab through 2 years in the FUTURE 2 study (NCT01752634).METHODS: Patients with active PsA were randomized to receive subcutaneous secukinumab 300, 150, or 75 mg or placebo. MDA was assessed in the overall population (anti-tumor necrosis factor [TNF]-naïve an In this industry-funded, phase III study, investigators randomized 397 adults with active psoriatic arthritis to receive placebo or a human anti-interleukin-17A monoclonal antibody (secukinumab) subcutaneously in doses of 300 mg, 150 mg, and 75 mg weekly for 4 weeks then every 4 weeks Secukinumab in children with plaque psoriasis: study unsuitable for benefit assessment The comparator group was not treated appropriately. Firstly, therapy in this group remained unchanged despite. Secukinumab for Plaque Psoriasis. PASI, global assessment, and quality-of-life measures all showed efficacy. Secukinumab is a recombinant, high-affinity, fully humanized IgG monoclonal antibody that selectively binds and neutralizes interleukin-17A (IL-17A). IL-17A is a master cytokine that mediates the pathogenesis of psoriasis, so.

COSENTYX® PsA Treatment Results | COSENTYX (secukinumab)

Secukinumab Uses, Side Effects & Warnings - Drugs

Secukinumab Improved Signs and Symptoms in Patients withMicrodose Lupron Flare - Infertility - Inspire

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