60e3322c494d4c6ed2f8da23945b5df7 321339.pdf 7d43bbf9ab58a55e9f34ed2aac9436800a05e062 321339.pdf d3903ed50ce80d49ee9342ce30ef6a6d89c638ed0f3300e65f9a4a4b7035fced 321339.pdf Title: Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline Subject: Park HS, Dı́az del Campo P, Plana MN, Polo y La Borda J, Guerra-Rodrı́guez M, Moreno M and Cañete JD (2025) Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline. Front. Med. 12:1621313. doi: 10.3389/fmed.2025.1621313 Keywords: tapering; discontinuation; withdrawal; suspension; antirheumatic agents; disease modifying antirheumatic drugs; spondyloarthritis Author: Hye Sang Park Creator: LaTeX with hyperref package + hypdvips Producer: pikepdf 9.10.2 CreationDate: Sat Sep 6 16:42:14 2025 CEST ModDate: Sat Sep 6 17:24:57 2025 CEST Custom Metadata: yes Metadata Stream: yes Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.26 x 842.116 pts (A4) Page rot: 0 File size: 1037864 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- BGPMOD+MuseoSans-700 Type 1C Custom yes yes yes 33 0 BGPMOE+MuseoSans-300 Type 1C Custom yes yes yes 36 0 BGPNFC+MuseoSans-300Italic Type 1C Custom yes yes yes 39 0 BGPNFD+MinionPro-Regular Type 1C Custom yes yes yes 42 0 BGPNGE+MuseoSans-500 Type 1C Custom yes yes yes 45 0 BGPNLD+RMTMI Type 1C Custom yes yes yes 48 0 BGPNPD+MTSY Type 1C Custom yes yes yes 461 0 BGPOIA+MuseoSans-500Italic Type 1C Custom yes yes yes 465 0 BGPOOP+MinionPro-It Type 1C Custom yes yes yes 462 0 BGPPCO+MTGU Type 1C Custom yes yes yes 471 0 BGPPDP+RMTMIB Type 1C Custom yes yes yes 468 0 BGPPMM+MTEX Type 1C Custom yes yes no 477 0 BGPPMN+CMSY7 Type 1C Custom yes yes yes 474 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-02-03 04:16:00 CET RepresentationInformation: 321339.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-02-02 10:48:16 CET Size: 1037864 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 0 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseOutlines Language: en Outlines: Item: Title: Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline Destination: ariclecounter.1 Children: Item: Title: 1 Introduction Destination: section*.2 Item: Title: 2 Methods Destination: section*.3 Children: Item: Title: 2.1 Inclusion criteria Destination: section*.4 Item: Title: 2.2 Search strategy Destination: section*.5 Item: Title: 2.3 Study selection and data extraction Destination: section*.6 Item: Title: 2.4 Critical appraisal Destination: section*.7 Item: Title: 2.5 Statistical analysis Destination: section*.8 Item: Title: 3 Results Destination: section*.9 Children: Item: Title: 3.1 Study selection Destination: section*.10 Item: Title: 3.2 Characteristics of the RCTs Destination: section*.11 Item: Title: 3.3 Efficacy of treatment withdrawal Destination: section*.12 Children: Item: Title: 3.3.1 Patients with sustained remission (at least 6 months) Destination: section*.13 Item: Title: 3.3.2 Patients with short term remission (<6 months) Destination: section*.14 Item: Title: 3.4 Efficacy of treatment tapering Destination: section*.15 Children: Item: Title: 3.4.1 Patients with sustained remission (at least 6 months) Destination: section*.16 Item: Title: 3.4.2 Patients with short-term remission (<6 months) Destination: section*.17 Item: Title: 3.4.3 Patients in remission at inclusion (duration not specified) Destination: section*.18 Item: Title: 4 Discussion Destination: section*.19 Item: Title: Data availability statement Destination: section*.20 Item: Title: Author contributions Destination: section*.21 Item: Title: Funding Destination: section*.22 Item: Title: Conflict of interest Destination: section*.23 Item: Title: Generative AI statement Destination: section*.24 Item: Title: Publisher's note Destination: section*.25 Item: Title: References Destination: section*.26 Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 2008 ImageHeight: 2409 BitsPerSample: 8 BitsPerSampleUnit: integer Intent: RelativeColorimetric Interpolate: true Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1389 ImageHeight: 2480 BitsPerSample: 8 BitsPerSampleUnit: integer Intent: RelativeColorimetric Interpolate: true Fonts: Type1: Font: BaseFont: BGPMOD+MuseoSans-700 FontSubset: true FirstChar: 2 LastChar: 148 FontDescriptor: FontName: BGPMOD+MuseoSans-700 Flags: Symbolic, ForceBold FontBBox: -125, -210, 1126, 902 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPMOE+MuseoSans-300 FontSubset: true FirstChar: 2 LastChar: 243 FontDescriptor: FontName: BGPMOE+MuseoSans-300 Flags: Symbolic FontBBox: -118, -210, 1088, 883 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPNFC+MuseoSans-300Italic FontSubset: true FirstChar: 46 LastChar: 116 FontDescriptor: FontName: BGPNFC+MuseoSans-300Italic Flags: Symbolic, Italic, ForceBold FontBBox: -245, -210, 1030, 883 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPNFD+MinionPro-Regular FontSubset: true FirstChar: 2 LastChar: 243 FontDescriptor: FontName: BGPNFD+MinionPro-Regular Flags: Serif, Symbolic FontBBox: -289, -360, 1684, 917 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPNGE+MuseoSans-500 FontSubset: true FirstChar: 2 LastChar: 237 FontDescriptor: FontName: BGPNGE+MuseoSans-500 Flags: Symbolic FontBBox: -121, -210, 1088, 892 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPNPD+MTSY FontSubset: true FirstChar: 2 LastChar: 138 FontDescriptor: FontName: BGPNPD+MTSY Flags: Symbolic FontBBox: 0, -954, 1043, 796 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPOOP+MinionPro-It FontSubset: true FirstChar: 40 LastChar: 237 FontDescriptor: FontName: BGPOOP+MinionPro-It Flags: Serif, Symbolic, Italic FontBBox: -201, -360, 1684, 919 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPNLD+RMTMI FontSubset: true FirstChar: 60 LastChar: 62 FontDescriptor: FontName: BGPNLD+RMTMI Flags: Symbolic, Italic FontBBox: 0, -213, 987, 680 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPOIA+MuseoSans-500Italic FontSubset: true FirstChar: 78 LastChar: 110 FontDescriptor: FontName: BGPOIA+MuseoSans-500Italic Flags: Symbolic, Italic, ForceBold FontBBox: -249, -210, 1047, 892 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPPDP+RMTMIB FontSubset: true FirstChar: 60 LastChar: 60 FontDescriptor: FontName: BGPPDP+RMTMIB Flags: Symbolic, Italic, ForceBold FontBBox: 0, -250, 994, 706 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPPCO+MTGU FontSubset: true FirstChar: 2 LastChar: 2 FontDescriptor: FontName: BGPPCO+MTGU Flags: Symbolic FontBBox: 24, -213, 839, 683 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPPMN+CMSY7 FontSubset: true FirstChar: 129 LastChar: 129 FontDescriptor: FontName: BGPPMN+CMSY7 Flags: Symbolic, Italic FontBBox: -15, -951, 1251, 782 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: BGPPMM+MTEX FontSubset: true FirstChar: 2 LastChar: 2 FontDescriptor: FontName: BGPPMM+MTEX Flags: Symbolic FontBBox: 55, -1000, 1056, 0 FontFile3: true EncodingDictionary: Differences: true XMP: application/pdf Park HS, Dı́az del Campo P, Plana MN, Polo y La Borda J, Guerra-Rodrı́guez M, Moreno M and Cañete JD (2025) Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline. Front. Med. 12:1621313. doi: 10.3389/fmed.2025.1621313 Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline Hye Sang Park Petra Dı́az del Campo Maria Nieves Plana Jessica Polo y La Borda Mercedes Guerra-Rodrı́guez Mireia Moreno Juan D. Cañete Copyright © 2025 Park, D'iaz del Campo, Planas, Polo y Laborda, Guerra-Rodriguez, Moreno and Cañete. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. tapering discontinuation withdrawal suspension antirheumatic agents disease modifying antirheumatic drugs spondyloarthritis pikepdf 9.10.2 tapering; discontinuation; withdrawal; suspension; antirheumatic agents; disease modifying antirheumatic drugs; spondyloarthritis LaTeX with hyperref package + hypdvips 2025-09-06T20:54:57+05:30 2025-09-06T19:42:14+05:00 2025-09-06T20:54:57+05:30 uuid:c9541200-a67d-479b-809d-2de429f3859f uuid:ff392611-9267-4717-aa67-41b25d920e48 True https://www.frontiersin.org/legal/copyright-statement Copyright © 2025 Park, D'iaz del Campo, Planas, Polo y Laborda, Guerra-Rodriguez, Moreno and Cañete. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Pages: Page: Label: 1 Annotations: Annotation: Subtype: Link Rect: 48, 789, 218, 806 Annotation: Subtype: Link Rect: 456, 800, 517, 808 Annotation: Subtype: Link Rect: 473, 791, 483, 799 Annotation: Subtype: Link Rect: 483, 791, 519, 799 Annotation: Subtype: Link Rect: 519, 791, 537, 799 Annotation: Subtype: Link Rect: 453, 782, 547, 790 Annotation: Subtype: Link Rect: 48, 711, 124, 728 Annotation: Subtype: Link Rect: 57, 553, 122, 562 Annotation: Subtype: Link Rect: 57, 536, 113, 544 Annotation: Subtype: Link Rect: 62, 375, 156, 382 Annotation: Subtype: Link Rect: 157, 325, 186, 332 Annotation: Subtype: Link Rect: 48, 316, 84, 323 Annotation: Subtype: Link Rect: 84, 316, 120, 323 Annotation: Subtype: Link Rect: 119, 316, 145, 323 Annotation: Subtype: Link Rect: 145, 316, 172, 323 Annotation: Subtype: Link Rect: 220, 557, 546, 728 Annotation: Subtype: Link Rect: 295, 529, 305, 539 Annotation: Subtype: Link Rect: 429, 529, 439, 539 Annotation: Subtype: Link Rect: 317, 514, 327, 524 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 2 Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 280, 489, 286, 501 Destination: 233 Annotation: Subtype: Link Rect: 112, 453, 119, 465 Destination: 233 Annotation: Subtype: Link Rect: 51, 417, 58, 429 Destination: 233 Annotation: Subtype: Link Rect: 60, 417, 67, 429 Destination: 233 Annotation: Subtype: Link Rect: 243, 345, 249, 357 Destination: 233 Annotation: Subtype: Link Rect: 94, 88, 100, 100 Destination: 233 Annotation: Subtype: Link Rect: 48, 33, 117, 40 Annotation: Subtype: Link Rect: 498, 32, 546, 40 Page: Label: 3 Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 262, 215, 269, 227 Destination: 233 Annotation: Subtype: Link Rect: 125, 179, 131, 191 Destination: 233 Annotation: Subtype: Link Rect: 363, 294, 395, 304 Destination: 223 Annotation: Subtype: Link Rect: 359, 190, 369, 202 Destination: 233 Annotation: Subtype: Link Rect: 372, 190, 382, 202 Destination: 233 Annotation: Subtype: Link Rect: 517, 190, 528, 202 Destination: 233 Annotation: Subtype: Link Rect: 530, 190, 541, 202 Destination: 233 Annotation: Subtype: Link Rect: 303, 178, 331, 187 Destination: 224 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 4 Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 105, 79, 114, 88 Destination: 233 Annotation: Subtype: Link Rect: 165, 79, 174, 88 Destination: 233 Annotation: Subtype: Link Rect: 217, 79, 226, 88 Destination: 233 Annotation: Subtype: Link Rect: 295, 79, 304, 88 Destination: 233 Annotation: Subtype: Link Rect: 382, 79, 391, 88 Destination: 233 Annotation: Subtype: Link Rect: 470, 95, 479, 104 Destination: 233 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Rotate: 90 Page: Label: 5 Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 117, 79, 126, 88 Destination: 233 Annotation: Subtype: Link Rect: 168, 79, 177, 88 Destination: 233 Annotation: Subtype: Link Rect: 316, 752, 343, 760 Destination: 226 Annotation: Subtype: Link Rect: 489, 644, 516, 652 Destination: 226 Annotation: Subtype: Link Rect: 453, 506, 463, 518 Destination: 233 Annotation: Subtype: Link Rect: 317, 254, 345, 263 Destination: 227 Annotation: Subtype: Link Rect: 303, 240, 335, 250 Destination: 229 Annotation: Subtype: Link Rect: 494, 178, 505, 190 Destination: 233 Annotation: Subtype: Link Rect: 511, 178, 521, 190 Destination: 233 Annotation: Subtype: Link Rect: 364, 166, 374, 178 Destination: 233 Annotation: Subtype: Link Rect: 373, 118, 384, 130 Destination: 233 Annotation: Subtype: Link Rect: 443, 118, 453, 130 Destination: 233 Annotation: Subtype: Link Rect: 532, 118, 543, 130 Destination: 233 Annotation: Subtype: Link Rect: 468, 82, 478, 94 Destination: 233 Annotation: Subtype: Link Rect: 484, 82, 494, 94 Destination: 233 Annotation: Subtype: Link Rect: 500, 82, 510, 94 Destination: 233 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 6 Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 48, 260, 76, 268 Destination: 227 Annotation: Subtype: Link Rect: 78, 257, 116, 268 Destination: 229 Annotation: Subtype: Link Rect: 128, 248, 139, 260 Destination: 233 Annotation: Subtype: Link Rect: 220, 188, 230, 200 Destination: 233 Annotation: Subtype: Link Rect: 235, 188, 245, 200 Destination: 233 Annotation: Subtype: Link Rect: 249, 188, 260, 200 Destination: 233 Annotation: Subtype: Link Rect: 118, 140, 146, 148 Destination: 227 Annotation: Subtype: Link Rect: 148, 137, 185, 147 Destination: 229 Annotation: Subtype: Link Rect: 215, 128, 225, 140 Destination: 233 Annotation: Subtype: Link Rect: 227, 128, 238, 140 Destination: 233 Annotation: Subtype: Link Rect: 48, 80, 76, 88 Destination: 227 Annotation: Subtype: Link Rect: 78, 77, 116, 88 Destination: 229 Annotation: Subtype: Link Rect: 436, 308, 447, 320 Destination: 233 Annotation: Subtype: Link Rect: 530, 175, 541, 187 Destination: 233 Annotation: Subtype: Link Rect: 377, 163, 388, 175 Destination: 233 Annotation: Subtype: Link Rect: 477, 163, 487, 175 Destination: 233 Annotation: Subtype: Link Rect: 345, 115, 355, 127 Destination: 233 Annotation: Subtype: Link Rect: 358, 115, 369, 127 Destination: 233 Annotation: Subtype: Link Rect: 434, 115, 445, 127 Destination: 233 Annotation: Subtype: Link Rect: 427, 91, 437, 103 Destination: 233 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 7 Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Rotate: 90 Page: Label: 8 Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Rotate: 90 Page: Label: 9 Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 10 Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 11 Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 51, 728, 62, 740 Destination: 233 Annotation: Subtype: Link Rect: 236, 680, 247, 692 Destination: 233 Annotation: Subtype: Link Rect: 136, 668, 146, 680 Destination: 233 Annotation: Subtype: Link Rect: 261, 608, 272, 620 Destination: 233 Annotation: Subtype: Link Rect: 275, 608, 286, 620 Destination: 233 Annotation: Subtype: Link Rect: 48, 548, 76, 556 Destination: 227 Annotation: Subtype: Link Rect: 78, 546, 116, 556 Destination: 229 Annotation: Subtype: Link Rect: 239, 478, 250, 490 Destination: 233 Annotation: Subtype: Link Rect: 256, 478, 266, 490 Destination: 233 Annotation: Subtype: Link Rect: 121, 466, 132, 478 Destination: 233 Annotation: Subtype: Link Rect: 198, 394, 208, 406 Destination: 233 Annotation: Subtype: Link Rect: 212, 394, 223, 406 Destination: 233 Annotation: Subtype: Link Rect: 226, 394, 237, 406 Destination: 233 Annotation: Subtype: Link Rect: 118, 334, 146, 343 Destination: 227 Annotation: Subtype: Link Rect: 148, 332, 184, 342 Destination: 229 Annotation: Subtype: Link Rect: 185, 322, 196, 334 Destination: 233 Annotation: Subtype: Link Rect: 249, 262, 260, 274 Destination: 233 Annotation: Subtype: Link Rect: 262, 262, 273, 274 Destination: 233 Annotation: Subtype: Link Rect: 275, 262, 286, 274 Destination: 233 Annotation: Subtype: Link Rect: 118, 202, 146, 211 Destination: 227 Annotation: Subtype: Link Rect: 148, 200, 184, 210 Destination: 229 Annotation: Subtype: Link Rect: 233, 190, 243, 202 Destination: 233 Annotation: Subtype: Link Rect: 246, 190, 256, 202 Destination: 233 Annotation: Subtype: Link Rect: 48, 130, 76, 139 Destination: 227 Annotation: Subtype: Link Rect: 78, 128, 116, 138 Destination: 229 Annotation: Subtype: Link Rect: 137, 70, 148, 82 Destination: 233 Annotation: Subtype: Link Rect: 443, 728, 454, 740 Destination: 233 Annotation: Subtype: Link Rect: 306, 608, 317, 620 Destination: 233 Annotation: Subtype: Link Rect: 306, 238, 313, 250 Destination: 233 Annotation: Subtype: Link Rect: 375, 202, 381, 214 Destination: 233 Annotation: Subtype: Link Rect: 306, 130, 317, 142 Destination: 233 Annotation: Subtype: Link Rect: 319, 130, 330, 142 Destination: 233 Annotation: Subtype: Link Rect: 515, 94, 525, 106 Destination: 233 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 12 Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 169, 716, 175, 728 Destination: 233 Annotation: Subtype: Link Rect: 74, 560, 85, 572 Destination: 233 Annotation: Subtype: Link Rect: 218, 500, 229, 512 Destination: 233 Annotation: Subtype: Link Rect: 51, 332, 62, 344 Destination: 233 Annotation: Subtype: Link Rect: 306, 632, 317, 644 Destination: 233 Annotation: Subtype: Link Rect: 48, 34, 117, 41 Annotation: Subtype: Link Rect: 498, 33, 546, 41 Page: Label: 13 Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 451, 800, 546, 807 Annotation: Subtype: Link Rect: 168, 547, 221, 554 Annotation: Subtype: Link Rect: 179, 519, 252, 526 Annotation: Subtype: Link Rect: 96, 481, 184, 490 Annotation: Subtype: Link Rect: 92, 445, 175, 454 Annotation: Subtype: Link Rect: 96, 402, 186, 410 Annotation: Subtype: Link Rect: 202, 366, 287, 374 Annotation: Subtype: Link Rect: 121, 338, 170, 347 Annotation: Subtype: Link Rect: 91, 310, 144, 319 Annotation: Subtype: Link Rect: 47, 265, 292, 284 Annotation: Subtype: Link Rect: 67, 232, 128, 239 Annotation: Subtype: Link Rect: 47, 195, 292, 212 Annotation: Subtype: Link Rect: 112, 158, 203, 167 Annotation: Subtype: Link Rect: 400, 554, 493, 561 Annotation: Subtype: Link Rect: 322, 511, 424, 518 Annotation: Subtype: Link Rect: 325, 466, 419, 474 Annotation: Subtype: Link Rect: 322, 431, 424, 438 Annotation: Subtype: Link Rect: 351, 387, 453, 394 Annotation: Subtype: Link Rect: 370, 358, 459, 367 Annotation: Subtype: Link Rect: 347, 322, 438, 331 Annotation: Subtype: Link Rect: 383, 287, 465, 294 Annotation: Subtype: Link Rect: 325, 252, 378, 259 Annotation: Subtype: Link Rect: 350, 214, 435, 223 Annotation: Subtype: Link Rect: 400, 194, 484, 203 Annotation: Subtype: Link Rect: 48, 33, 117, 40 Annotation: Subtype: Link Rect: 498, 32, 546, 40 Checksum: 9df981c6 Type: CRC32 Checksum: 60e3322c494d4c6ed2f8da23945b5df7 Type: MD5 Checksum: 7d43bbf9ab58a55e9f34ed2aac9436800a05e062 Type: SHA-1 Checksum: d3903ed50ce80d49ee9342ce30ef6a6d89c638ed0f3300e65f9a4a4b7035fced Type: SHA-256