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Lieberman JA, Chu DK, Ahmed T, Dribin TE, Abrams EM, Anagnostou A, Blumenthal KG, Boguniewicz M, Chase NM, Golden DBK, Hartog NL, Heimall JR, Ho T, Lawrence MG, Khan DA, Minniear TD, Mustafa SS, Oppenheimer JJ, Phillips EJ, Ramsey A, Rider NL, Schneider L, Shaker MS, Spergel JM, Stone CA, Stukus DR, Wang J, Greenhawt MJ. A systematic review and expert Delphi Consensus recommendation on the use of vaccines in patients receiving dupilumab: A position paper of the American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 2024; 133:286-294. [PMID: 38848870 DOI: 10.1016/j.anai.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Dupilumab is a monoclonal antibody that targets the interleukin (IL)-4 receptor alpha subunit, thus blocking the effects of IL-4 and IL-13, and has shown efficacy in treating various conditions including asthma, atopic dermatitis, eosinophilic esophagitis, and others. Because of its immune modulatory effects, clinical trials that studied dupilumab did not allow patients to receive live vaccines during the clinical trials because of an abundance of caution, and thus package inserts recommend that patients who are being treated with dupilumab should avoid live vaccines. Because dupilumab is now approved for use in patients from 6 months of age for the treatment of atopic dermatitis, this reported contraindication is now posing a clinical dilemma for patients and clinicians. OBJECTIVE To perform a systematic review of literature on the safety and efficacy of vaccinations in patients who are receiving dupilumab and to provide expert guidance on the use of vaccines in patients who are receiving dupilumab. METHODS A systematic review of the literature was performed, and an expert Delphi Panel was assembled. RESULTS The available literature on patients who received vaccinations while using dupilumab overall suggests that live vaccines are safe and that the vaccine efficacy, in general, is not affected by dupilumab. The expert Delphi panel agreed that the use of vaccines in patients receiving dupilumab was likely safe and effective. CONCLUSION Vaccines (including live vaccines) can be administered to patients receiving dupilumab in a shared decision-making capacity.
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Affiliation(s)
- Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee.
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Tasnuva Ahmed
- Department of Health Research Methods, Evidence, and Impact, Evidence in Allergy Group, McMaster University, Hamilton, Canada
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Aikaterini Anagnostou
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colorado
| | - Nicole M Chase
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas L Hartog
- Department of Allergy and Immunology, Corewell Health Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tina Ho
- Dermatology Section, Division of Immunology, Boston Children's Hospital and Harvard Medical school, Boston, Massachusetts
| | - Monica G Lawrence
- Departments of Medicine and Pediatrics, University of Virginia, Charlottesville, Virginia
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Timothy Dean Minniear
- Division of Pediatric Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health and the University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allison Ramsey
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health and the University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nicholas L Rider
- Section of Allergy & Immunology, Department of Health Systems & Implementation Science, The Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David R Stukus
- Division of Allergy/Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Division of Allergy & Immunology, Department of Pediatrics, Icahn School of Medicine, Mount Sinai, New York
| | - Matthew J Greenhawt
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Mari D, White K. Live vaccine administration in patients treated with biologics for allergic disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00669-X. [PMID: 38936660 DOI: 10.1016/j.jaip.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Affiliation(s)
- David Mari
- Lackland Air Force Base, Wilford Hall Ambulatory Surgical Center, Division of Allergy and Immunology, San Antonio, Tex.
| | - Kevin White
- Lackland Air Force Base, Wilford Hall Ambulatory Surgical Center, Division of Allergy and Immunology, San Antonio, Tex
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Weins AB, Kerzel S, Schnopp C. Schwere atopische Dermatitis im frühen Kindesalter: Besonderheiten, Herausforderungen und neue Perspektiven in der Versorgung. J Dtsch Dermatol Ges 2024; 22:350-356. [PMID: 38451004 DOI: 10.1111/ddg.15344_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungDie atopische Dermatitis ist die häufigste chronische Hauterkrankung im Kindesalter mit einer Prävalenz von 10% bei Kleinkindern unter 2 Jahren, wovon etwa 15% einen hohen Schweregrad aufweisen. „Kinder sind keine kleinen Erwachsenen“, dies trifft für die schwere frühkindliche atopische Dermatitis in besonderem Maße zu. Innerhalb dieser sensiblen Lebensphase zeigen sich alterstypische Facetten der Erkrankung (psychosozial, neurokognitiv, klinisch‐morphologisch), die Unterschiede im Management mit sich bringen.Besondere Bedeutung hat die Identifikation von Säuglingen und Kleinkindern mit früh‐persistierendem, schwerem Verlauf mit Blick auf eine erstmals für diese Altersgruppe zugelassene Systemtherapie: sowohl für die unmittelbare Versorgung der Hauterkrankung als auch unter dem Aspekt einer möglichen Prävention von Begleiterkrankungen. Da der „atopische Phänotyp“ klinische Überlappungen zum Spektrum der Immundefekte aufweist, ist die korrekte Einordnung des Hautbefundes bei therapierefraktärem Ekzem essenziell. In dieser Arbeit beschreiben wir eine alltagstaugliche Strategie, um anhand anamnestischer Warnhinweise, dermatologischer Leitbefunde und Labordiagnostik eine Abgrenzung von ekzematösen Hauterscheinungen bei primären Immundefekten vorzunehmen. Dazu geben wir aktuelle Empfehlungen zum Management des schweren frühkindlichen atopischen Ekzems, auch in Bezug auf die Indikation zur Systemtherapie.
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Affiliation(s)
- Andreas Benedikt Weins
- Klinik für Kinder- und Jugendmedizin, Universitätsklinik Augsburg
- KIDZ SKIN | Praxis für Kinder- und Jugenddermatologie, Ulm
| | - Sebastian Kerzel
- Krankenhaus Barmherzige Brüder, Klinik und Poliklinik für Kinder- und Jugendmedizin, Abteilung für Pädiatrische Pneumologie und Allergologie, Regensburg
| | - Christina Schnopp
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
- Praxis Burgstraße, München
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Weins AB, Kerzel S, Schnopp C. Severe atopic dermatitis in early infancy: characteristics, challenges and new perspectives in clinical practice. J Dtsch Dermatol Ges 2024; 22:350-355. [PMID: 38450908 DOI: 10.1111/ddg.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
Atopic dermatitis (AD) is the most common skin disease in infants and children with a prevalence of 10% in the first two years of life. In this age group up to 15% are severely affected. "Children are not little adults" - this applies in particular to infants with severe atopic dermatitis. Age-specific clinical aspects (psychosocial, neurocognitive, morphological) of the disease require an adjusted disease management. Considering recent approval of systemic treatment options, early identification of infants and children with severe and early persistent disease is of particular importance also in view of possible prevention of atopic comorbidity. As several inborn errors of immunity (IEI) share features of the atopic phenotype, it is essential for clinicians to distinguish signs of immunodeficiency from severe AD. Here, we describe a practical approach on the basis of clinical history and key dermatological and laboratory findings. Furthermore, this paper is aimed at providing an update on general management of severe AD in early infancy, including recommendations for systemic treatment.
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Affiliation(s)
- Andreas Benedikt Weins
- Department of Pediatrics, University Hospital Augsburg, Augsburg, Germany
- KIDZ SKIN | Practice for Pediatric Dermatology, Ulm, Germany
| | - Sebastian Kerzel
- Barmherzige Brüder Hospital, Department of Pediatrics, Section for Pediatric Pneumonology and Allergology, Regensburg, Germany
| | - Christina Schnopp
- Department of Dermatology and Allergology am Biederstein, Technical University Munich, Munich, Germany
- Practice Burgstraße, Munich, Germany
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Siegfried EC, Wine Lee L, Spergel JM, Prescilla R, Uppal S, Coleman A, Bansal A, Cyr SL, Shumel B. A case series of live attenuated vaccine administration in dupilumab-treated children with atopic dermatitis. Pediatr Dermatol 2024; 41:204-209. [PMID: 38308453 DOI: 10.1111/pde.15518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/16/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Current regulatory labeling recommends avoiding live vaccine use in dupilumab-treated patients. Clinical data are not available to support more specific guidance for live or live attenuated vaccines administration in dupilumab-treated patients. METHODS Children (6 months-5 years old) with moderate-to-severe atopic dermatitis (AD) enrolled in a phase 2/3 clinical trial of dupilumab (LIBERTY AD PRESCHOOL Part A/B; NCT03346434) and subsequently participated in the LIBERTY AD PED-OLE (NCT02612454). During these studies, protocol deviations occurred in nine children who received measles, mumps, rubella (MMR) vaccine with or without varicella vaccine; five with a ≤12-week gap between dupilumab administration and vaccination and four with a >12-week gap after discontinuing dupilumab. RESULTS Nine children (1 female; 8 male) had severe AD at baseline (8-56 months old). Of the nine children, five had a ≤12-week gap ranged 1-7 weeks between dupilumab administration and vaccination who received MMR vaccine (n = 2) or MMR and varicella vaccines (n = 3); among these, one resumed dupilumab treatment as early as 2 days and four resumed treatment 18-43 days after vaccination. No treatment-emergent adverse events, including serious adverse events and infections, were reported within the 4-week post-vaccination period in any children. CONCLUSIONS In this case series of dupilumab-treated children with severe AD who received MMR vaccine with or without varicella vaccine, no adverse effects (including vaccine-related infection) were reported within 4 weeks after vaccination. Further studies are warranted to evaluate the safety, tolerability, and immune response to live attenuated vaccines in dupilumab-treated patients.
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Affiliation(s)
- Elaine C Siegfried
- Department of Dermatology and Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatric Dermatology, Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan M Spergel
- Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Sumeet Uppal
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | | | - Ashish Bansal
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Sonya L Cyr
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Brad Shumel
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
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Narbutt J, Żuber Z, Lesiak A, Bień N, Szepietowski JC. Vaccinations in Selected Immune-Related Diseases Treated with Biological Drugs and JAK Inhibitors-Literature Review and Statement of Experts from Polish Dermatological Society. Vaccines (Basel) 2024; 12:82. [PMID: 38250895 PMCID: PMC10820194 DOI: 10.3390/vaccines12010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The growing use of biological drugs in immune-mediated chronic diseases has undoubtedly revolutionized their treatment. Yet, the topic of vaccinations in this group of patients still raises many concerns and implies many therapeutic problems that require discussion and standardization of management. The aim of this literature review is to present current knowledge regarding safety and efficacy of vaccinations in dermatological and rheumatological patients treated with biological drugs and JAK inhibitors. Additionally, this article provides recommendation from experts of the Polish Dermatological Society about proper use of vaccinations during therapy with biologics. Generally, all live attenuated vaccines are contraindicated during immunosuppressive/immunomodulatory therapy. If there is need, they should be administered long enough prior to the therapy or after cessation. Yet, inactivated vaccines mostly can be safely used, but the problem in this case is the effectiveness of the vaccination. Most studies report that the immune response in patients on biologics after administration of different inactivated vaccines is similar to or even better than in the control group. Thus, the importance of vaccination among patients on biologics must be emphasized to reduce omissions and the fear of possible side effects or insufficient post-vaccination response.
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Affiliation(s)
- Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland;
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Natalia Bień
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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Limnander A, Kaur N, Asrat S, Tasker C, Boyapati A, Ben LH, Janczy J, Pedraza P, Abreu P, Chen WC, Godin S, Daniel BJ, Chin H, DeVeaux M, Rodriguez Lorenc K, Sirulnik A, Harari O, Stahl N, Sleeman MA, Murphy AJ, Yancopoulos GD, Orengo JM. A therapeutic strategy to target distinct sources of IgE and durably reverse allergy. Sci Transl Med 2023; 15:eadf9561. [PMID: 38091405 DOI: 10.1126/scitranslmed.adf9561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/14/2023] [Indexed: 12/18/2023]
Abstract
Immunoglobulin E (IgE) is a key driver of type 1 hypersensitivity reactions and allergic disorders, which are globally increasing in number and severity. Although eliminating pathogenic IgE may be a powerful way to treat allergy, no therapeutic strategy reported to date can fully ablate IgE production. Interleukin-4 receptor α (IL-4Rα) signaling is required for IgE class switching, and IL-4Rα blockade gradually reduces, but does not eliminate, IgE. The persistence of IgE after IL-4Rα blockade may be due to long-lived IgE+ plasma cells that maintain serological memory to allergens and thus may be susceptible to plasma cell-targeted therapeutics. We demonstrate that transient administration of a B cell maturation antigen x CD3 (BCMAxCD3) bispecific antibody markedly depletes IgE, as well as other immunoglobulins, by ablating long-lived plasma cells, although IgE and other immunoglobulins rapidly rebound after treatment. Concomitant IL-4Rα blockade specifically and durably prevents the reemergence of IgE by blocking IgE class switching while allowing the restoration of other immunoglobulins. Moreover, this combination treatment prevented anaphylaxis in mice. Together with additional cynomolgus monkey and human data, our studies demonstrate that allergic memory is primarily maintained by both non-IgE+ memory B cells that require class switching and long-lived IgE+ plasma cells. Our combination approach to durably eliminate pathogenic IgE has potential to benefit allergy in humans while preserving antibody-mediated immunity.
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Affiliation(s)
| | - Navneet Kaur
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | - Carley Tasker
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Anita Boyapati
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Li-Hong Ben
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - John Janczy
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | - Pablo Abreu
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Wen-Chi Chen
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Stephen Godin
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | - Harvey Chin
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | | | | | - Olivier Harari
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Neil Stahl
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | | | | | - Jamie M Orengo
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
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Tran J, Trinh DL, Pan AY, Humphrey SR. Vaccines and use of immunosuppressive and immunomodulatory therapy in a pediatric dermatology clinic-A single institution experience. Pediatr Dermatol 2023. [PMID: 37321854 DOI: 10.1111/pde.15352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/30/2023] [Indexed: 06/17/2023]
Abstract
Vaccine type and timing are critical issues to prevent unintended infections in those on immunosuppressive therapies. We retrospectively chart reviewed patients at Children's Wisconsin Pediatric Dermatology Clinic on immunosuppressives and immunomodulators between 11/1/2012 and 6/1/2020 and found that approximately 76% of patient encounters do not have documented vaccine counseling in the medical chart before initiation of immunosuppressives and immunomodulators. As age increased, vaccine counseling was less likely to be documented (odds ratio: 0.89; 95% confidence interval: 0.84-0.95, p = .001). In addition, 13 patient encounters (4%) were not up to date with live vaccines before immunosuppressive or immunomodulating therapy. There is an opportunity to improve clinical processes to ensure documentation of vaccination status and vaccine counseling before starting immunosuppressive and immunomodulator medications in a pediatric dermatology clinic.
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Affiliation(s)
- Jacqueline Tran
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dylan L Trinh
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy Y Pan
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen R Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Liao SY, Gerber AN, Zelarney P, Make B, Wechsler ME. SARS-CoV-2 mRNA Vaccine Antibody Response in Patients with Asthma Receiving Biologic Therapy: A Real-World Analysis. Am J Respir Crit Care Med 2022; 206:644-648. [PMID: 35549647 PMCID: PMC9716899 DOI: 10.1164/rccm.202203-0599le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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