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\begin{document}

\title{Financial conflicts of interest among clinical practice guideline
authors for rheumatoid arthritis in Japan}



\author[1]{Anju Murayama}%
\affil[1]{Tohoku University School of Medicine}%


\vspace{-1em}



  
  \date{June 14, 2024}


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\par\null

\textbf{Authors:} Anju Murayama\textsuperscript{1,2*}

\textbf{Affiliations:}

\textsuperscript{1} Tohoku University School of Medicine, Sendai,
Miyagi, Japan

\textsuperscript{2} Icahn School of Medicine at Mount Sinai, New York
City, NY, USA

\par\null

* Corresponding authors

\textbf{Correspondence}

Anju Murayama

School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba ward,
Sendai City, Miyagi, 980-0872, Japan

Telephone: 81-22-717-8006

Email
address:~\emph{\href{mailto:ange21tera@gmail.com}{\nolinkurl{ange21tera@gmail.com}}}

\par\null

\textbf{Conflicts of interest:}

The author declares that there were no conflicts of interest for this
study.

\textbf{Funding sources:}

The author declares that there were no funding sources for this study.

\textbf{Keywords:}

Conflicts of interest, pharmaceutical companies, Open Payment, clinical
practice guideline, physician payment,

\textbf{Abstract}

\textbf{Objective:}

To assess the financial relationships between pharmaceutical companies
and authors of the 2020 Japan College of Rheumatology Clinical Practice
Guideline for the Management of Rheumatoid Arthritis and to evaluate the
quality of evidence supporting the guideline recommendations.

\textbf{Methods:}

This cross-sectional study evaluated financial relationships between all
27 authors of the CPG and pharmaceutical companies in Japan. Personal
payments from pharmaceutical companies to these authors between 2016 and
2020 were extracted from publicly disclosed database and each
pharmaceutical company. The quality of evidence supporting the CPG
recommendations was also assessed.

\textbf{Results} :

All 27 authors received personal payments from pharmaceutical companies,
totaling \$3,683,048 over five years. The median and mean payments per
author were \$101,624 and \$136,409, respectively. Speaking
compensations accounted for more than 80\% of all personal payments.
More than 77.8\% (21 authors), 66.7\% (18 authors), and 51.9\% (14
authors) received more than \$10,000, \$50,000, and \$100,000 in total
payments over the five years, respectively. Nevertheless, these
financial relationships between the CPG authors and pharmaceutical
companies were not disclosed. More than 81.8\% of the CPG
recommendations were supported by low or very low-quality evidence. Of
strong recommendations, 66.7\% were supported by low or very low-quality
evidence.

\textbf{Conclusion} :

Despite that all CPG authors received substantial amounts of personal
payments from pharmaceutical companies, these COIs were not disclosed in
the CPG. These findings underscore the urgent need for policy
interventions to enhance transparency, integrity, and reliability in the
development of clinical practice guidelines in Japan.



\textbf{Introduction}

Clinical practice guidelines (CPGs) are instrumental in standardizing
evidence-based diagnostic and treatment protocols in rheumatology
{[}1{]}. However, the integrity of these guidelines can be compromised
by conflicts of interest (COIs), both financial and non-financial
{[}2-4{]}. Indeed, over the last two decades, several violations of
patient-centered care by clinical practice guidelines, as well as
harmful effects on patients {[}4,5{]}, have resulted in the
establishment of more stringent COI management policies through global
collaborations {[}1,6,7{]}. Given the increasing influence of CPGs on
patients, healthcare professionals, and other stakeholders, rigorous COI
management---including full disclosure of COIs, efforts to minimize COIs
among CPG authors and organizations, and balanced recommendations by
multiple experts---is essential for establishing trustworthy CPGs and
promoting patient-centered care {[}6-12{]}.

Over the past 30 years since the first introduction of methotrexate for
rheumatoid arthritis treatment, there has been remarkable development in
systematic treatment strategies for rheumatoid arthritis {[}13{]}. In
addition, the success of the first biologic therapy, namely tumor
necrosis factor (TNF) inhibitors, has provided further impetus for the
development of other biologics targeting different pathways such as IL-1
inhibitors, IL-6 inhibitors, IL-17 inhibitors, cytotoxic T
lymphocyte-associated antigen-4 (CTLA-4) blockers, and Janus Kinase
(JAK) inhibitors {[}14{]}. Due to fierce competition among
pharmaceutical companies, the global market for rheumatoid arthritis was
expected to be worth approximately US\$26 billion in 2019 and the
pharmaceutical companies have increasingly marketed their products to
physicians involved in treating and managing patients with rheumatoid
arthritis {[}15-17{]}. Given these contexts, authors of rheumatoid
arthritis CPG should properly manage their COI with pharmaceutical
companies. This study aimed to assess the financial relationships
between pharmaceutical companies and CPG authors using publicly
disclosed payment data in Japan.

\textbf{Methods}

\emph{Study setting \& participants}

All authors of the 2020 Japan College of Rheumatology Clinical Practice
Guideline for the Management of Rheumatoid Arthritis (2020 JCR CPG) were
considered for this study. The Japan College of Rheumatology (JCR) is
the sole and most prestigious medical professional society in the field
of rheumatology in Japan, boasting 9,860 society members as of March
2021 and established in 1957. CPGs published by the JCR wield
significant influence in Japan.

\emph{Data collection \& payment source}

The JCR CPG for rheumatoid arthritis and associated official
institutional webpages provided data on author names, gender,
affiliations, and positions. Additionally, individual author COI
statements and recommendations were extracted from the CPG. As
previously described {[}18-21{]}, all pharmaceutical companies
affiliated with the Japan Pharmaceutical Manufacturers Association
disclose their payment data concerning speaking, writing, and consulting
on their company webpages. However, these companies update this payment
data annually and remove data from previous years. Therefore, payment
data for the CPG authors between 2016 and 2019 were extracted from a
publicly accessible payment database maintained by the Medical
Governance Research Institute {[}22{]}. Payments to the CPG authors in
2020 were collected directly from each pharmaceutical company's webpage.
When necessary, the author contacted the JCR's development committee and
professional offices responsible for publishing these guidelines for
further information on the development process and COI statements and
policies.

\emph{Analysis}

This study conducted a descriptive analysis of the demographic and
payment data. Additionally, the study evaluated payment concentrations
using the Gini index, as previously described {[}21,23{]}. Payment
values were converted from Japanese yen to U.S. dollars using the 2020
average monthly exchange rates of 106.8 yen per \$1. Quality of evidence
of recommendations in the CPG was initially presented on a four-point
scale. As all data used in this study were publicly available and met
the definition of non-human subjects research, no institutional review
board approval was required.

\textbf{Results}

Demographic characteristics of the CPG authors are described in Table 1.
Among the 27 CPG authors of the JCR CPG for rheumatoid arthritis, 19
(70.4\%) were male, 22 (81.5\%) were affiliated with universities or
university teaching hospitals, 9 (33.3\%) were university professors,
and 18 (66.7\%) specialized in rheumatology and immunology. Only one
author represented a rheumatoid arthritis patient organization. The
median h-index and the number of academic publications were 21
(interquartile range {[}IQR{]}: 10.5--31.0) and 95 (IQR: 35--161),
respectively.

Table 2 shows the personal payments from pharmaceutical companies to the
CPG authors. All 27 authors received at least one personal payment from
pharmaceutical companies between 2016 and 2020. A total of 3,951
payments, amounting to \$3,683,048, were made to the CPG authors by 52
pharmaceutical companies over the five years. Speaking compensation
accounted for 83.9\% of the personal payments (\$3,089,971), while
consulting payments made up 10.3\% (\$380,217) of the total. The median
and mean payments per author were \$101,624 (IQR: \$16,221--\$184,160)
and \$136,409 (standard deviation {[}SD{]}: \$156,736), respectively.
The median and mean annual personal payments per author were \$21,085
(IQR: \$5,402--\$37,968) and \$29,000 (SD: \$32,035), respectively. Gini
index for per-author personal payments was 0.55. One author received
\$686,024 in personal payments over the five years. More than 77.8\% (21
authors), 66.7\% (18 authors), and 51.9\% (14 authors) received more
than \$10,000, \$50,000, and \$100,000 in total payments over the five
years, respectively. Although the CPG stated that all authors had
self-declared their financial COI status to the JCR and that a COI
management committee of the JCR had confirmed all authors with financial
COIs as eligible for CPG development, this self-declared COI information
was not disclosed in the main text of the CPG nor on the JCR's website.
Therefore, we could not evaluate the accuracy of the authors'
self-declared COI status.

Regarding the CPG recommendations, a total of 55 unique recommendations
were listed. Of these, 15 (27.3\%) were strong recommendations, and 40
(72.7\%) were conditional recommendations. More than 81.8\% (45 out of
55 recommendations) were supported by low or very low-quality evidence.
Of the 15 strong recommendations, 66.7\% (10 out of 15) were supported
by low or very low-quality evidence, while 87.5\% of conditional
recommendations were based on low or very low-quality evidence.

\textbf{Discussion}

The present study aimed to investigate the financial conflicts of
interest among authors of the 2020 Japan College of Rheumatology
Clinical Practice Guideline for the Management of Rheumatoid Arthritis.
To the best of our knowledge, this study is the first to evaluate the
prevalence and magnitude of financial relationships between CPG authors
and pharmaceutical companies in Japan in the field of rheumatology.
Remarkably, all 27 authors received personal payments from
pharmaceutical companies between 2016 and 2020, totaling \$3,683,048.
The median and mean payments per author were substantial, and one author
received as much as \$686,024 over the five years. These findings raise
ethical concerns, especially considering that the COI information was
not publicly disclosed in the CPG or on the JCR's website. Additionally,
more than 80\% of recommendations were supported by low or very
low-quality evidence, including single observational studies, case
reports, and the opinions of the CPG authors.

The high prevalence of financial COIs among the authors in our study
aligns with previous research, albeit with a higher percentage. This
could indicate a field-specific vulnerability to financial COIs,
particularly in the realm of rheumatology in Japan. For example, we
previously reported that the prevalence of CPG authors receiving
personal payments from pharmaceutical companies was 87.0\% in infectious
diseases {[}24{]}, 88\% in nephrology {[}11{]}, 88.2\% in
gastroenterology {[}23{]}, 88.6\% in urology {[}25{]}, 90.6\% in
dermatology {[}18{]}, 91.3\% in psoriatic arthritis {[}10{]}, 94.6\% in
hematology {[}26{]}, 96.3\% in otolaryngology {[}12{]}, and 100\% in
hepatology {[}27{]} and esophageal cancer {[}28{]}. Additionally, the
mean annual payment of \$29,000 was larger than those to CPG authors in
most previously reported specialties {[}8,18,23-25,28{]}. We also
previously found that the mean annual personal payments to general
rheumatologists were \$4,882--\$5,673 {[}16{]}. These findings support
our hypothesis that pharmaceutical companies concentrate their payments
significantly on rheumatology CPG authors in Japan, even compared to
other specialties.

Our study also evaluated the strength and quality of the CPG
recommendations. A significant majority (81.8\%) of the recommendations
were supported by low or very low-quality evidence. This is particularly
concerning given that the majority of strong recommendations were
supported by low-quality evidence, such as case reports and opinions of
experts with insufficient COI management, as seen in previous studies
{[}3,11,29{]}. The incongruence between the strength of recommendations
and the quality of evidence underscores the need for more rigorous
evidence-based approaches in guideline development in Japan.

Nevertheless, these financial relationships between the CPG authors and
the pharmaceutical companies were managed within the JCR and not
publicly disclosed to the CPG readers. Although almost all CPGs
published by US and European medical societies have publicly disclosed
their authors' COI information and emphasized the importance of
transparency in financial relationships {[}2,6,7,30{]}, non-disclosure
of financial COI among CPG authors is commonly reported in Japan
{[}11,12,18,24,25,28{]}. In some cases, significant amounts of payments
and a large number of CPG authors under-declared their COI status to the
public in Japan {[}10,23,28{]}. This study highlights an urgent need for
transparency and reform in the development of clinical practice
guidelines in Japan, particularly in the field of rheumatology. The
undisclosed financial COIs and the low quality of evidence supporting
the recommendations have far-reaching ethical and clinical implications.
They not only compromise the integrity of the guidelines but also risk
skewing treatment paradigms towards less evidence-based treatments. This
is particularly relevant in a field like rheumatology, where treatment
decisions have long-term consequences for patients.

\textbf{Limitations}

Our study has some limitations. The cross-sectional design precludes
longitudinal analysis, and the focus on a single set of guidelines may
not be generalizable to other fields or countries. The payment data was
extracted from a secondary database maintained by a non-profit research
organization, which includes nearly all personal payment data collected
from each pharmaceutical company. Additionally, there are no legal
regulations requiring pharmaceutical companies to accurately disclose
their payments to physicians in Japan. Therefore, we cannot exclude the
possibility of errors in the payment data disclosed by the companies.

\textbf{Conclusions}

All the authors of CPG for rheumatoid arthritis developed by the Japan
College of Rheumatology received personal payments from the
pharmaceutical companies five years before its publication. The total
amounts of personal payments were more than \$3.6 million.
Non-disclosure of financial COIs and the low quality of evidence
supporting the majority of recommendations in the CPG raise significant
ethical and clinical concerns. These findings call for immediate policy
interventions to enhance the transparency, integrity, and reliability of
clinical practice guidelines in rheumatology in Japan.

\textbf{Acknowledgments}

The authors appreciate Ms Megumi Aizawa for her dedicated support of my
research project.

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Table 1. Demographic characteristics of clinical practice guideline
authors for rheumatologic arthritis inJapan\selectlanguage{english}
\begin{longtable}[]{@{}ll@{}}
\toprule
\begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
Variables\strut
\end{minipage} & \begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
\textbf{Number of authors, n (\%)}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Gender\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
19 (70.4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
8 (29.6)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Affiliation\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
University and university teaching hospitals\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
22 (81.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Professor\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
9 (33.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Other positions including associate professors, assistant professors,
and lecturers\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
13 (48.1)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Other general hospitals\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
4 (14.8)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Patient organization\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
1 (3.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Specialty\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Rheumatology and clinical immunology\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
18 (66.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Epidemiology, public health, and methodology\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
3 (11.1)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Orthopedic surgery\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
3 (11.1)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Pediatrics\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
1 (3.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Rehabilitation medicine\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
1 (3.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Patient\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
1 (3.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Academic performance\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Median h-index (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
21 (11-31)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Median number of publications (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
95 (35-161)\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 2. Characterization of personal payments from pharmaceutical
companies to the authors of clinical practice guideline for rheumatoid
arthritis issued by the Japan College of Rheumalogy\selectlanguage{english}
\begin{longtable}[]{@{}ll@{}}
\toprule
\begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
Variables\strut
\end{minipage} & \begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
Value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Total amount of payments, \$\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
3,683,048\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Mean per author (standard deviation), \$\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
136,409 (156,736)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Median per author (interquartile range), \$\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
101,624 (16,221-184,160)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Range, \$\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
187-686,024\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Authors with payments, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Any payments\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
27 (100)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
\textgreater{}\$10,000\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
21 (77.8)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
\textgreater{}\$50,000\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
18 (66.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
\textgreater{}\$100,000\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
14 (51.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
\textgreater{}\$250,000\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
5 (18.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
\textgreater{}\$500,000\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
1 (3.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Type of payments, \$ (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Speaking\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
3,089,971 (83.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Consulting\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
380,217 (10.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Writing/Honoraria\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
180,013 (4.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Other\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
32,848 (0.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
Gini index\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
0.55\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Japanese yen (\selectlanguage{ngerman}¥) were converted to US dollars (\$) using the 2020
average monthly exchange rate of ¥106.8 per \$1.

\par\null

Table 3. Evidence level and strength of recommendation underlying the
clinical practice guideline for rheumatoid arthritis in Japan~\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
Level of evidence & Strength of recommendation & Strength of
recommendation & Total\tabularnewline
\midrule
\endhead
& Class 1 (strong) & Class 2 (weak and conditional) &\tabularnewline
High & 3 (5.5) & 1 (1.8) & 4 (7.3)\tabularnewline
Moderate & 2 (3.6) & 4 (7.3) & 6 (10.9)\tabularnewline
Low & 4 (7.3) & 3 (5.5) & 7 (12.7)\tabularnewline
Very low & 6 (10.9) & 32 (58.2) & 38 (69.1)\tabularnewline
Total & 15 (27.3) & 40 (72.7) & 55 (100)\tabularnewline
\bottomrule
\end{longtable}

\selectlanguage{english}
\FloatBarrier
\end{document}

