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Gibbons CH, Levine T, Adler C, Bellaire B, Wang N, Stohl J, Agarwal P, Aldridge GM, Barboi A, Evidente VGH, Galasko D, Geschwind MD, Gonzalez-Duarte A, Gil R, Gudesblatt M, Isaacson SH, Kaufmann H, Khemani P, Kumar R, Lamotte G, Liu AJ, McFarland NR, Miglis M, Reynolds A, Sahagian GA, Saint-Hillaire MH, Schwartzbard JB, Singer W, Soileau MJ, Vernino S, Yerstein O, Freeman R. Skin Biopsy Detection of Phosphorylated α-Synuclein in Patients With Synucleinopathies. JAMA 2024; 331:1298-1306. [PMID: 38506839 PMCID: PMC10955354 DOI: 10.1001/jama.2024.0792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 03/21/2024]
Abstract
Importance Finding a reliable diagnostic biomarker for the disorders collectively known as synucleinopathies (Parkinson disease [PD], dementia with Lewy bodies [DLB], multiple system atrophy [MSA], and pure autonomic failure [PAF]) is an urgent unmet need. Immunohistochemical detection of cutaneous phosphorylated α-synuclein may be a sensitive and specific clinical test for the diagnosis of synucleinopathies. Objective To evaluate the positivity rate of cutaneous α-synuclein deposition in patients with PD, DLB, MSA, and PAF. Design, Setting, and Participants This blinded, 30-site, cross-sectional study of academic and community-based neurology practices conducted from February 2021 through March 2023 included patients aged 40 to 99 years with a clinical diagnosis of PD, DLB, MSA, or PAF based on clinical consensus criteria and confirmed by an expert review panel and control participants aged 40 to 99 years with no history of examination findings or symptoms suggestive of a synucleinopathy or neurodegenerative disease. All participants completed detailed neurologic examinations and disease-specific questionnaires and underwent skin biopsy for detection of phosphorylated α-synuclein. An expert review panel blinded to pathologic data determined the final participant diagnosis. Exposure Skin biopsy for detection of phosphorylated α-synuclein. Main Outcomes Rates of detection of cutaneous α-synuclein in patients with PD, MSA, DLB, and PAF and controls without synucleinopathy. Results Of 428 enrolled participants, 343 were included in the primary analysis (mean [SD] age, 69.5 [9.1] years; 175 [51.0%] male); 223 met the consensus criteria for a synucleinopathy and 120 met criteria as controls after expert panel review. The proportions of individuals with cutaneous phosphorylated α-synuclein detected by skin biopsy were 92.7% (89 of 96) with PD, 98.2% (54 of 55) with MSA, 96.0% (48 of 50) with DLB, and 100% (22 of 22) with PAF; 3.3% (4 of 120) of controls had cutaneous phosphorylated α-synuclein detected. Conclusions and Relevance In this cross-sectional study, a high proportion of individuals meeting clinical consensus criteria for PD, DLB, MSA, and PAF had phosphorylated α-synuclein detected by skin biopsy. Further research is needed in unselected clinical populations to externally validate the findings and fully characterize the potential role of skin biopsy detection of phosphorylated α-synuclein in clinical care.
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Affiliation(s)
- Christopher H. Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Todd Levine
- HonorHealth Neurology, Scottsdale, Arizona
- CND Life Sciences, Scottsdale, Arizona
| | - Charles Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona
| | | | - Ningshan Wang
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Georgina M. Aldridge
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
| | - Alexandru Barboi
- Department of Neurology, Northshore University Health System, Glenview, Illinois
| | | | - Douglas Galasko
- Department of Neurology, University of California, San Diego
| | | | | | - Ramon Gil
- Parkinson’s Disease Treatment Center of Southwest Florida, Port Charlotte
| | - Mark Gudesblatt
- Department of Neurology, New York University Grossman Long Island School of Medicine, New York
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, Florida
| | - Horacio Kaufmann
- Department of Neurology, New York University Grossman School of Medicine, New York
| | - Pravin Khemani
- Department of Neurology, Swedish Medical Center, Seattle, Washington
| | - Rajeev Kumar
- Rocky Mountain Movement Disorders Center, Englewood, Colorado
| | | | - Andy J. Liu
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | | | - Mitchell Miglis
- Department of Neurology, Stanford University Medical Center, Palo Alto, California
| | | | | | | | | | - Wolfgang Singer
- Department of Neurology, Mayo Clinic Rochester, Rochester, New York
| | | | - Steven Vernino
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas
| | - Oleg Yerstein
- Department of Neurology, Lahey Clinic, Burlington, Massachusetts
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Marder G, Quach T, Chadha P, Nandkumar P, Tsang J, Levine T, Schiopu E, Furie R, Davidson A, Narain S. Belimumab treatment of adult idiopathic inflammatory myopathy. Rheumatology (Oxford) 2024; 63:742-750. [PMID: 37326854 PMCID: PMC10907809 DOI: 10.1093/rheumatology/kead281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To evaluate belimumab addition to the standard of care in patents with refractory idiopathic inflammatory myopathy (IIM). METHODS We conducted a 40-week multicentre, randomized, double-blind, placebo-controlled trial with 1:1 IV belimumab 10 mg/kg or placebo randomization and a 24-week open-label extension. Clinical responses were measured by the definition of improvement (DOI) and total improvement score (TIS). Flow cytometry analyses were performed on available samples before randomization, at 24 and 60-64 weeks. Descriptive statistics, t-test, Fisher's exact test and analysis of variance tests were used. RESULTS A total of 17 patients were randomized, 15 received five or more doses of belimumab or placebo and were included in the intention-to-treat analysis. More belimumab patients vs placebo attained a TIS ≥40 [55.5% vs 33.3%; P = non-significant (NS)] and achieved the DOI (33.3% vs 16.7%; P = NS) at weeks 40 and 64; the mean TIS was similar among groups. Two patients achieved major responses (TIS = 72.5) after week 40 in the belimumab arm and none in the placebo arm. No improvement in the placebo arm after switching to the open-label phase was observed. There was no steroid-sparing effect. No new safety signals were detected. Although total B cells were not reduced, belimumab induced naïve B cell depletion while enhancing the number and frequency memory B cells. CONCLUSION The study did not meet the primary endpoint and no statistically significant differences were observed in clinical responses between arms. More patients achieved sustained TIS ≥40 and reached the DOI. Most patients who received belimumab for >40 weeks had clinical improvement. Phenotypic changes in B cell populations were not associated with clinical responses. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov (https://clinicaltrials.gov/), NCT02347891.
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Affiliation(s)
- Galina Marder
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Tam Quach
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Priyal Chadha
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Preeya Nandkumar
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Jimmy Tsang
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Todd Levine
- Phoenix Neurological Associates, Phoenix, AZ, USA
| | - Elena Schiopu
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Richard Furie
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Anne Davidson
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Sonali Narain
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
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3
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Aggarwal R, Schessl J, Charles-Schoeman C, Bata-Csörgő Z, Dimachkie MM, Griger Z, Moiseev S, Oddis CV, Schiopu E, Vencovský J, Beckmann I, Clodi E, Levine T. Safety and tolerability of intravenous immunoglobulin in patients with active dermatomyositis: results from the randomised, placebo-controlled ProDERM study. Arthritis Res Ther 2024; 26:27. [PMID: 38233885 PMCID: PMC10792872 DOI: 10.1186/s13075-023-03232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Dermatomyositis is an idiopathic inflammatory myopathy characterised by rashes and progressive muscle weakness. The recent ProDERM (Progress in DERMatomyositis) study is the first large randomised, placebo-controlled trial to establish the efficacy and safety of intravenous immunoglobulin (IVIg) in adult patients with dermatomyositis. Objectives of this analysis were to closely examine the safety and tolerability of IVIg in patients from the ProDERM study. METHODS ProDERM was a double-blind, randomised, placebo-controlled, multicentre, phase 3 study. In the first period (weeks 0-16), adults with active dermatomyositis received 2.0 g/kg IVIg (Octagam 10%; Octapharma AG) or placebo every 4 weeks. In the open-label extension period (weeks 16-40), all patients received IVIg for 6 additional cycles; dose reduction (1.0 g/kg) was permitted if patients were stable. Treatment-emergent adverse events (TEAEs) were documented. RESULTS The 95 patients enrolled were randomised to receive IVIg (N = 47) or placebo (N = 48) in the first period, with 5 switching from placebo to IVIg. Overall, 664 IVIg infusion cycles were administered. During the first period, 113 TEAEs were possibly/probably related to treatment in 30/52 patients (57.7%) receiving IVIg and 38 in 11 patients (22.9%) on placebo. Eight patients discontinued therapy due to IVIg-related TEAEs. Eight thromboembolic events (TEEs) occurred in six patients on IVIg; six in five patients were deemed possibly/probably related to IVIg. Patients with TEEs exhibited more baseline TEE risk factors than those without TEEs (2.4-15.2-fold higher). Lowering infusion rate reduced the rate of TEEs, and none occurred at the lower IVIg dose. No haemolytic transfusion reactions or deaths occurred. CONCLUSIONS Results from this study demonstrate that IVIg has a favourable safety profile for treatment of adult dermatomyositis patients and provides evidence that will help to inform treatment choice for these patients. Dermatomyositis patients receiving high-dose IVIg should be monitored for TEEs, and a low rate of infusion should be used to minimise TEE risk, particularly in those with pre-existing risk factors. TRIAL REGISTRATION ProDERM study (NCT02728752).
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Affiliation(s)
- Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Joachim Schessl
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | | | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Zoltan Griger
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elena Schiopu
- Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jiri Vencovský
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Irene Beckmann
- Octapharma Pharmazeutika Produktionsges. m.b.H., Vienna, Austria
| | - Elisabeth Clodi
- Octapharma Pharmazeutika Produktionsges. m.b.H., Vienna, Austria
| | - Todd Levine
- Phoenix Neurological Associates, Ltd, Phoenix, AZ, USA
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Nowak RJ, Breiner A, Bril V, Allen JA, Khan S, Levine T, Jacobs DH, Sahagian G, Siddiqi ZA, Xu J, Macias WL, Benatar M. Subcutaneous batoclimab in generalized myasthenia gravis: Results from a Phase 2a trial with an open-label extension. Ann Clin Transl Neurol 2024; 11:194-206. [PMID: 38062618 PMCID: PMC10791011 DOI: 10.1002/acn3.51946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/29/2023] [Accepted: 10/26/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES To assess the safety, tolerability, and key pharmacodynamic effects of subcutaneous batoclimab, a fully human anti-neonatal Fc receptor monoclonal antibody, in patients with generalized myasthenia gravis and anti-acetylcholine receptor antibodies. METHODS A Phase 2a, proof-of-concept, randomized, double-blind, placebo-controlled trial is described. Eligible patients were randomized (1:1:1) to receive once-weekly subcutaneous injections of batoclimab 340 mg, batoclimab 680 mg, or matching placebo for 6 weeks. Subsequently, all patients could enter an open-label extension study where they received batoclimab 340 mg once every 2 weeks for 6 weeks. Primary endpoints were safety, tolerability, and change from baseline in total immunoglobulin G, immunoglobulin G subclasses, and anti-acetylcholine receptor antibodies at 6 weeks post-baseline. Secondary endpoints included changes from baseline to 6 weeks post-baseline for Myasthenia Gravis Activities of Daily Living, Quantitative Myasthenia Gravis, Myasthenia Gravis Composite, and revised 15-item Myasthenia Gravis Quality of Life scores. RESULTS Seventeen patients were randomized to batoclimab 680 mg (n = 6), batoclimab 340 mg (n = 5), or placebo (n = 6). Batoclimab was associated with significantly greater reductions in total immunoglobulin G and anti-acetylcholine receptor antibodies from baseline to 6 weeks post-baseline than placebo. Reductions in immunoglobulin G subclasses were generally consistent with total immunoglobulin G. While clinical measures showed directionally favorable improvements over time, the study was not powered to draw conclusions about therapeutic efficacy. No safety issues were identified. INTERPRETATION The safety profile, pharmacodynamics, and preliminary clinical benefits observed in this study support further investigation of subcutaneous batoclimab injections as a potential patient-administered therapy for seropositive generalized myasthenia gravis.
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Affiliation(s)
- Richard J. Nowak
- Department of NeurologyYale University School of MedicineNew HavenConnecticutUSA
| | - Ari Breiner
- Division of Neurology, Department of MedicineThe Ottawa Hospital and Ottawa Research Institute, University of OttawaOttawaOntarioCanada
| | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular DiseasesUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Jeffrey A. Allen
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Shaida Khan
- Department of NeurologyUT Southwestern Medical CenterDallasTexasUSA
| | - Todd Levine
- HonorHealth Neurology dba Phoenix Neurological AssociatesPhoenixArizonaUSA
| | - Daniel H. Jacobs
- College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Gregory Sahagian
- The Neurology Center of Southern CaliforniaCarlsbadCaliforniaUSA
| | - Zaeem A. Siddiqi
- Division of Neurology, Department of MedicineUniversity of Alberta HospitalEdmontonAlbertaCanada
| | - Jing Xu
- Immunovant Inc.New YorkNew YorkUSA
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Werth VP, Aggarwal R, Charles-Schoeman C, Schessl J, Levine T, Kopasz N, Worm M, Bata-Csörgő Z. Efficacy of intravenous immunoglobulins (IVIg) in improving skin symptoms in patients with dermatomyositis: a post-hoc analysis of the ProDERM study. EClinicalMedicine 2023; 64:102234. [PMID: 37799613 PMCID: PMC10550512 DOI: 10.1016/j.eclinm.2023.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Background Dermatomyositis (DM) is a rare autoimmune disease characterized by skin involvement, with or without proximal muscle weakness. Recently, following the ProDERM study, intravenous immunoglobulin (IVIg) was approved for treatment of DM. Until ProDERM evidence from large, placebo-controlled studies supporting its use for dermatological symptoms, was lacking. Here we present efficacy data from ProDERM of IVIg versus placebo for treatment of the cutaneous aspect of DM. Methods ProDERM was a double-blind, randomized, multicenter, Phase 3 study. In the First Period (Weeks 0-16), adults with active DM received 2.0 g/kg IVIg (Octagam 10%; Octapharma AG) or placebo every 4 weeks. In the open-label Extension Period (Weeks 16-40), all patients received IVIg for 6 additional cycles. Cutaneous disease was assessed using measures including modified cutaneous DM disease area and severity index activity (CDASI-A) and damage (CDASI-D) scores, and myositis disease activity assessment tool (MDAAT) including visual analogue scale (VAS). This trial is registered with ClinicalTrials.gov, NCT02728752. Findings The study took place from February 2017 to November 2019. 95 patients received IVIg (N = 47) or placebo (N = 48) in the First Period. Together, 664 IVIg infusion cycles were administered (median dose, 2.0 g/kg). At Week 16, mean CDASI-A change from baseline was -9.36 (95% CI: -12.52, -6.19) in the IVIg group versus -1.16 (-3.32, 0.99) in placebo group (p < 0.0001). At the end of the Extension Period, mean changes from baseline were -10.44 (95% CI: -13.94, -6.94) and -10.03 (-13.12, -6.94), respectively. Similar changes were seen for CDASI-D and VAS of MDAAT. These observations were seen regardless of baseline disease severity. Interpretation ProDERM is the first large prospective, randomized trial to demonstrate the efficacy of IVIg to improve the cutaneous manifestations of DM. IVIg treatment significantly improved dermatological symptoms in patients with DM, regardless of disease severity before treatment, suggesting that IVIg is effective for even the most severe cutaneous DM. Funding This study was sponsored by Octapharma Pharmazeutika Produktionsges m.b.H.
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Affiliation(s)
- Victoria P. Werth
- Corporal Michael J. Crescenz VAMC and the University of Pennsylvania, Philadelphia, PA, USA
| | - Rohit Aggarwal
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Joachim Schessl
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | | | - Margitta Worm
- Clinic of Dermatology, Venerology and Allergology, Charité, Berlin, Germany
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Bril V, Hadden RDM, Brannagan TH, Bar M, Chroni E, Rejdak K, Rivero A, Andersen H, Latov N, Levine T, Pasnoor M, Sacconi S, Souayah N, Anderson-Smits C, Duff K, Greco E, Hasan S, Li Z, Yel L, Ay H. Hyaluronidase-facilitated subcutaneous immunoglobulin 10% as maintenance therapy for chronic inflammatory demyelinating polyradiculoneuropathy: The ADVANCE-CIDP 1 randomized controlled trial. J Peripher Nerv Syst 2023; 28:436-449. [PMID: 37314318 DOI: 10.1111/jns.12573] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS ADVANCE-CIDP 1 evaluated facilitated subcutaneous immunoglobulin (fSCIG; human immunoglobulin G 10% with recombinant human hyaluronidase) efficacy and safety in preventing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) relapse. METHODS ADVANCE-CIDP 1 was a phase 3, double-blind, placebo-controlled trial conducted at 54 sites in 21 countries. Eligible adults had definite or probable CIDP and adjusted Inflammatory Neuropathy Cause and Treatment (INCAT) disability scores of 0-7 (inclusive), and received stable intravenous immunoglobulin (IVIG) for ≥12 weeks before screening. After stopping IVIG, patients were randomized 1:1 to fSCIG 10% or placebo for 6 months or until relapse/discontinuation. fSCIG 10% was administered at the same dose (or matching placebo volume) and interval as pre-randomization IVIG. The primary outcome was patient proportion experiencing CIDP relapse (≥1-point increase in adjusted INCAT score from pre-subcutaneous treatment baseline) in the modified intention-to-treat population. Secondary outcomes included time to relapse and safety endpoints. RESULTS Overall, 132 patients (mean age 54.4 years, 56.1% male) received fSCIG 10% (n = 62) or placebo (n = 70). CIDP relapse was reduced with fSCIG 10% versus placebo (n = 6 [9.7%; 95% confidence interval 4.5%, 19.6%] vs n = 22 [31.4%; 21.8%, 43.0%], respectively; absolute difference: -21.8% [-34.5%, -7.9%], p = .0045). Relapse probability was higher with placebo versus fSCIG 10% over time (p = .002). Adverse events (AEs) were more frequent with fSCIG 10% (79.0% of patients) than placebo (57.1%), but severe (1.6% vs 8.6%) and serious AEs (3.2% vs 7.1%) were less common. INTERPRETATION fSCIG 10% more effectively prevented CIDP relapse than placebo, supporting its potential use as maintenance CIDP treatment.
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Affiliation(s)
- Vera Bril
- The Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Thomas H Brannagan
- Neurological Institute, Columbia University, New York City, New York, USA
| | - Michal Bar
- University Hospital and Faculty of Medicine, Ostrava, Czechia
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Alberto Rivero
- Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | | | - Norman Latov
- Weill Cornell Medicine, New York City, New York, USA
| | | | - Mamatha Pasnoor
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Nizar Souayah
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Kim Duff
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Erin Greco
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Shabbir Hasan
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Zhaoyang Li
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Leman Yel
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Hakan Ay
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
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Hatch J, Barkhaus P, Barnes B, Beauchamp M, Benatar M, Bertorini T, Bowser R, Bromberg M, Brown A, Mascias Cadavid J, Carter GT, Cole N, Crayle J, Dimachkie M, Ennist D, Feldman E, Fullam T, Heiman-Patterson T, Jhooty S, Levine T, Li X, Lund I, Mallon E, Maragakis N, McDermott C, Pattee G, Pierce K, Ratner D, Staats K, Wicks P, Wiedau M, Bedlack R. ALSUntangled #70: caffeine. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-5. [PMID: 37288776 DOI: 10.1080/21678421.2023.2220742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ALSUntangled reviews alternative and off-label treatments for people living with amyotrophic lateral sclerosis (PALS). Here, we review caffeine which has plausible mechanisms for slowing ALS progression. However, pre-clinical studies are contradictory, and a large case series showed no relationship between caffeine intake and ALS progression rate. While low doses of caffeine are safe and inexpensive, higher doses can cause serious side effects. At this time, we cannot endorse caffeine as a treatment to slow ALS progression.
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Affiliation(s)
- Jessica Hatch
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Paul Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Benjamin Barnes
- Department of Neurology, Medical College of Georgia, Augusta, GA, USA
| | | | - Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Tulio Bertorini
- Neurology Department, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Bowser
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Mark Bromberg
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Andrew Brown
- Department of Neurology, University of Miami, Miami, FL, USA
| | | | - Gregory T Carter
- Department of Rehabilitation, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Jesse Crayle
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Mazen Dimachkie
- Department of Neurology, University of Kansas, Kansas City, KS, USA
| | | | - Eva Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Timothy Fullam
- Department of Neurology, University of Texas, San Antonio, TX, USA
| | | | - Sartaj Jhooty
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd Levine
- Bob Bove Neuroscience Institute, Scottsdale, AZ, USA
| | - Xiaoyan Li
- Department of Neurology, Duke University, Durham, NC, USA
| | | | | | | | | | - Gary Pattee
- Department of Neurology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kaitlyn Pierce
- Department of Neuroscience, University of North Carolina, Chapel Hill, NC, USA
| | | | - Kim Staats
- Staats Life Consulting, Los Angeles, CA, USA
| | - Paul Wicks
- Independent Consultant, Lichfield, UK, and
| | - Martina Wiedau
- Department of Neurology, University of California, Los Angeles, CA, USA
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Pasnoor M, Bril V, Levine T, Trivedi J, Silvestri NJ, Phadnis M, Katzberg HD, Saperstein DS, Wolfe GI, Herbelin L, Higgs K, Heim AJ, Statland JM, Barohn RJ, Dimachkie MM. Phase 2 trial in acetylcholine receptor antibody-positive myasthenia gravis of transition from intravenous to subcutaneous immunoglobulin: The MGSCIg study. Eur J Neurol 2023; 30:1417-1424. [PMID: 36779862 DOI: 10.1111/ene.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE Data on maintenance therapy with subcutaneous immunoglobulin (SCIg) in myasthenia gravis (MG) are limited. We report on transitioning acetylcholine receptor (AChR) antibody-positive (Ab+) MG patients on stable intravenous immunoglobulin (IVIg) regimens as part of routine clinical care to SCIg 1:1.2. METHODS This multicenter North American open-label prospective investigator-initiated study had two components: the IVIg Stabilization Period (ISP) enrolling patients already on IVIg as part of routine clinical care (Weeks -10 to -1), followed by transition of stable MG subjects to SCIg in the Experimental Treatment Period (ETP; Weeks 0 to 12). We hypothesized that >65% of patients entering the ETP would have a stable Quantitative Myasthenia Gravis (QMG) score from Week 0 to Week 12. Secondary outcome measures included other efficacy measures, safety, tolerability, IgG levels, and treatment satisfaction. RESULTS We recruited 23 patients in the ISP, and 22 entered the ETP. A total of 12 subjects (54.5%) were female, and 18 (81.8%) were White, with mean age 51.4 ± 17 years. We obtained Week 12 ETP QMG data on 19 of 22; one subject withdrew from ETP owing to clinical deterioration, and two subjects withdrew due to dislike of needles. On primary analysis, 19 of 22 participants (86.4%, 95% confidence interval = 0.72-1.00) were treatment successes using last observation carried forward (p = 0.018). Secondary efficacy measures supported MG stability. SCIg was safe and well tolerated, and IgG levels were stable. Treatment satisfaction was comparable between ISP and ETP. CONCLUSIONS MG patients on IVIg as part of their routine clinical care remained stable on monthly IVIg dosage, and most maintained similar disease stability on SCIg.
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Affiliation(s)
- Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Vera Bril
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Todd Levine
- HonorHealth Neurology, Phoenix, Arizona, USA
| | - Jaya Trivedi
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Milind Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hans D Katzberg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Gil I Wolfe
- Department of Neurology, University at Buffalo, Buffalo, New York, USA
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiley Higgs
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew J Heim
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Khemani P, Elliott M, Levine T. An atypical clinical course of a 71-year-old man with right arm weakness and ataxia. Parkinsonism Relat Disord 2022; 105:154-156. [PMID: 35504790 DOI: 10.1016/j.parkreldis.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/05/2022] [Accepted: 02/15/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Pravin Khemani
- Swedish Neuroscience Institute, 500 17th Ave, Suite 540, Seattle, WA, 98122, USA.
| | - Michael Elliott
- Swedish Neuroscience Institute, 500 17th Ave, Suite 540, Seattle, WA, 98122, USA.
| | - Todd Levine
- CND Lifesciences, 5070 North 40th Street, Suite 220, Phoenix, AZ, 85018, USA.
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10
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Aggarwal R, Charles-Schoeman C, Schessl J, Bata-Csörgő Z, Dimachkie MM, Griger Z, Moiseev S, Oddis C, Schiopu E, Vencovský J, Beckmann I, Clodi E, Bugrova O, Dankó K, Ernste F, Goyal NA, Heuer M, Hudson M, Hussain YM, Karam C, Magnolo N, Nelson R, Pozur N, Prystupa L, Sárdy M, Valenzuela G, van der Kooi AJ, Vu T, Worm M, Levine T. Trial of Intravenous Immune Globulin in Dermatomyositis. N Engl J Med 2022; 387:1264-1278. [PMID: 36198179 DOI: 10.1056/nejmoa2117912] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intravenous immune globulin (IVIG) for the treatment of dermatomyositis has not been extensively evaluated. METHODS We conducted a randomized, placebo-controlled trial involving patients with active dermatomyositis. The patients were assigned in a 1:1 ratio to receive IVIG at a dose of 2.0 g per kilogram of body weight or placebo every 4 weeks for 16 weeks. The patients who received placebo and those without confirmed clinical deterioration while receiving IVIG could enter an open-label extension phase for another 24 weeks. The primary end point was a response, defined as a Total Improvement Score (TIS) of at least 20 (indicating at least minimal improvement) at week 16 and no confirmed deterioration up to week 16. The TIS is a weighted composite score reflecting the change in a core set of six measures of myositis activity over time; scores range from 0 to 100, with higher scores indicating greater improvement. Key secondary end points included at least moderate improvement (TIS ≥40) and major improvement (TIS ≥60), and change in score on the Cutaneous Dermatomyositis Disease Area and Severity Index. RESULTS A total of 95 patients underwent randomization: 47 patients were assigned to the IVIG group, and 48 to the placebo group. At 16 weeks, 79% of the patients in the IVIG group (37 of 47) and 44% of those in the placebo group (21 of 48) had a TIS of at least 20 (difference, 35 percentage points; 95% confidence interval, 17 to 53; P<0.001). The results with respect to the secondary end points, including at least moderate improvement and major improvement, were generally in the same direction as the results of the primary end-point analysis, except for the change in creatine kinase level (an individual core measure of the TIS), which did not differ meaningfully between the two groups. Over 40 weeks, 282 treatment-related adverse events occurred in the IVIG group, including headache (in 42% of patients), pyrexia (in 19%), and nausea (in 16%). A total of 9 serious adverse events that were considered to be related to IVIG occurred, including 6 thromboembolic events. CONCLUSIONS In this 16-week trial involving adults with dermatomyositis, the percentage of patients with a response of at least minimal improvement based on a composite score of disease activity was significantly greater among those who received IVIG than among those who received placebo. IVIG was associated with adverse events, including thromboembolism. (Funded by Octapharma Pharmazeutika; ProDERM ClinicalTrials.gov number, NCT02728752.).
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Affiliation(s)
- Rohit Aggarwal
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Christina Charles-Schoeman
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Joachim Schessl
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Zsuzsanna Bata-Csörgő
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Mazen M Dimachkie
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Zoltan Griger
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Sergey Moiseev
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Chester Oddis
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Elena Schiopu
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Jiri Vencovský
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Irene Beckmann
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Elisabeth Clodi
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Olga Bugrova
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Katalin Dankó
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Floranne Ernste
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Namita A Goyal
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Marvin Heuer
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Marie Hudson
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Yessar M Hussain
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Chafic Karam
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Nina Magnolo
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Ronald Nelson
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Nataliia Pozur
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Liudmyla Prystupa
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Miklós Sárdy
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Guillermo Valenzuela
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Anneke J van der Kooi
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Tuan Vu
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Margitta Worm
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Todd Levine
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
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Gibbons CH, Freeman R, Bellaire B, Adler CH, Moore D, Levine T. Synuclein-One study: skin biopsy detection of phosphorylated α-synuclein for diagnosis of synucleinopathies. Biomark Med 2022; 16:499-509. [PMID: 35272481 PMCID: PMC9169016 DOI: 10.2217/bmm-2021-0646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
Finding an easily accessible and reliable tool to diagnose the diseases collectively defined as 'synucleinopathies' is an urgent, unmet priority. The synucleinopathies include Parkinson's disease, multiple system atrophy, pure autonomic failure and dementia with Lewy bodies. There are millions of people who have a diagnosis of a synucleinopathy, with more diagnosed every year. With accessibility, ease of implementation, consistently high sensitivity (>80%) and specificity approaching 100%, skin biopsy has great potential as the clinical test of choice for the diagnosis of synucleinopathies. The large, multi-center Synuclein-One study will determine the sensitivity, specificity, accuracy and precision of α-synuclein detection within punch skin biopsies in patients with clinically established synucleinopathies using standardized, robust methods suitable for large-scale analysis. Clinical Trial Registration: NCT04700722 (ClinicalTrials.gov).
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Affiliation(s)
- Christopher H Gibbons
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446, USA
| | | | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Dan Moore
- Calico Computing, Livermore, CA 94550, USA
| | - Todd Levine
- Department of Neurology, Honorhealth, Phoenix, AZ 85251, USA
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Mantegazza R, Levine T, Oreja-Guevara C, Carrillo-Infante C, Laudon-Meyer E, Shang S, Pittock S, Howard J. Safety of eculizumab in NMOSD and MG: Analysis of the phase 3 studies prevent and regain, and their extensions. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aggarwal R, Charles-Schoeman C, Schessl J, Bata-Csorgo Z, Dimachkie M, Griger Z, Moiseev S, Oddis CV, Schiopu E, Vencovský J, Beckmann I, Levine T, Clodi E, Proderm Investigators AT. OP0008 A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE III TRIAL OF IVIG 10% IN PATIENTS WITH DERMATOMYOSITIS. THE PRODERM STUDY: RESULTS ON EFFICACY AND SAFETY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Dermatomyositis (DM) is a rare chronic systemic autoimmune disease with characteristic skin rash and progressive proximal muscle weakness. Current therapies encompass corticosteroids and other immunosuppressants and intravenous immunoglobulins (IVIg), however, none of these therapies are proven by randomized controlled phase 3 studies. There have been no large randomized clinical trials supporting the efficacy and safety of IVIg in DM.Objectives:The ProDERM study aimed to evaluate the efficacy and safety/tolerability of IVIg in DM patients in a double-blind, randomized, placebo-controlled, international multi-center, phase III clinical trial.Methods:The trial consisted of a double-blind, placebo-controlled First Period (16 weeks), in which adult patients with definite or probable DM (according to Bohan and Peter criteria) were randomized 1:1 to either high dose IVIg (2g/kg every 4 weeks) or placebo. Patients on placebo and patients without clinical worsening while on IVIg treatment entered the open label Extension Period (24 weeks) and received 2g/kg IVIg infusions every 4 weeks. To be included, subjects must have active disease with a manual muscle testing-8 (MMT-8) score < 142/150. Patients who showed clinical worsening (defined according to Oddis et al, 2013 - with slight adaptation) at 2 consecutive visits between week 8 and week 16 were switched to the alternate treatment arm.Primary endpoint was the proportion of responders in the IVIg vs. placebo arm at week 16, where response was defined per 2016 ACR/EULAR Myositis response criteria of at least minimal improvement [Total Improvement Score (TIS) ≥ 20 points)] and without clinical worsening at 2 consecutive visits up to week 16.Results:A total of 95 adult DM patients (mean age: 53 years; 75% females; 92% Caucasian) were enrolled, with 47 and 48 randomized to IVIg and placebo, respectively. Baseline clinical characteristics (including medical history and prior DM medication) were balanced between the 2 arms.The study met the primary endpoint at week 16, with the proportion of responders being significantly higher in the IVIg group (37/47; 78.7%) as compared to the placebo group (21/48; 43.8%; p-value 0.0008; Table 1).Table 1.Total Improvement Score – Analysis of Proportion of Responders at Week 16 (Full Analysis Set, N=95)TIS Responseoctagam 10%N=47PlaceboN=48Difference octagam 10% – placeboNumber (%) of responders37 (78.72%)21 (43.75%)Difference in response rates34.97[95% CI] p-valuea[16.70, 53.24] 0.0008aCochran-Mantel-Haenszel TestCI=confidence interval; N=number of patients; TIS=total improvement scoreIn the analysis of responders per improvement category at Week 16, a 45.2% higher response rate for at least moderate improvement (TIS ≥n40 points; p < 0.0001) and a 23.6% higher response rate for at least major improvement (TIS ≥060 points; p < 0.0062) was observed in the IVIG group as compared to the placebo group.The mean (SD) TIS was significantly higher in IVIg group [48.4 (24.4)] than in placebo arm [21.6 (20.2)] at week 16 (Fig 1).Figure 1.After switching to IVIG in the Extension Period the placebo group attained a similar response rate at Week 40 as did the IVIg treated patients at Week 16, i.e approx. 70% for minimal improvement.In line with the overall primary endpoint, secondary end points including all of the sub-components of TIS except muscle enzyme (MMT-8, MD global, Extramuscular global, patient global, HAQ,) as well as CDASI (Cutaneous Dermatomyositis Disease Area and Severity Index), also showed statistically significant improvement under IVIg treatment compared to placebo treatment.The safety and tolerability profile of IVIg was consistent with previously reported safety outcomes for IVIg administration.Conclusion:This is the first large international phase III randomized, placebo-controlled trial demonstrating the efficacy and safety of IVIg as a treatment for patients with DM.References:[1]Oddis, C. V. et al. Arthritis Rheum (2013), 65, 314–324Acknowledgements:Acknowledgments to all participating investigators, centers and patients and their familiesDisclosure of Interests:Rohit Aggarwal Consultant of: Q32, Alexion, Argenx, AstraZeneca, BMS, Boehringer Ingelheim, Corbus, Csl Behring, EMD Serono, Janssen, Kezar, Mallinckrodt, Kyverna, Octapharma, Orphazyme, Pfizer., Grant/research support from: BMS, Mallinckrodt, Pfizer, EMD Serono, Christina Charles-Schoeman Consultant of: Pfizer, Abbvie, Octapharma, Gilead, Regeneron-Sanofi, Grant/research support from: Bristol Myers Squibb, Pfizer, Abbvie, Octapharma, Joachim Schessl Speakers bureau: Octapharma, Grifols, CSL Behring, Consultant of: Octapharma, Zsuzsanna Bata-Csorgo Speakers bureau: Novartis, Sanofi-Genzyme, Ewopharma, Consultant of: Sanofi-Genzyme, Novartis, Ewopharma, Mazen Dimachkie Consultant of: ArgenX, Catalyst, Cello, CSL-Behring, EcoR1, Kezar, Momenta, NuFactor, Octapharma, RaPharma/UCB, RMS Medical, Sanofi Genzyme, Shire Takeda, Spark Therapeutics and UCB Biopharma., Grant/research support from: Alexion, Alnylam Pharmaceuticals, Amicus, Biomarin, Bristol-Myers Squibb, Catalyst, Corbus, CSL-Behring, GlaxoSmithKline, Genentech, Grifols, Kezar, Mitsubishi Tanabe Pharma, Novartis, Octapharma, Orphazyme, Ra Pharma/UCB, Sanofi Genzyme, Sarepta Therapeutics, Shire Takeda, Spark Therapeutics, UCB Biopharma, Viromed/Healixmith., Zoltán Griger Speakers bureau: Abbvie, CSL-Behring, Eli-Lilly, Roche, Boehringer Ingelheim, Consultant of: Octapharma, Sergey Moiseev: None declared, Chester V Oddis Consultant of: EMD Serono; Alexion Pharmaceuticals, Inc, Grant/research support from: Genentech (Clinical trial support); Bristol Myers Squibb (Clinical trial support), Elena Schiopu Consultant of: Octapharma, Grant/research support from: Octapharma, Janssen (Johnson & Johnson), BMS, Pfizer, Abbvie, Jirˇí Vencovský Speakers bureau: Abbvie, Biogen, MSD, Pfizer, Roche, Sanofi, UCB, Consultant of: Abbvie, Boehringer, Eli Lilly, Octapharma, Gilead, Irene Beckmann Employee of: Octapharma, Todd Levine Shareholder of: Corinthian Reference Labs, CND Life Sciences, Consultant of: Grifols, Octapharma, Alexion, Elisabeth Clodi Employee of: Octapharma PPG, Vienna Austria, and the ProDERM Investigators: None declared
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Allen JA, Butler L, Levine T, Haudrich A. Correction to: A Global Survey of Disease Burden in Patients Who Carry a Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. Adv Ther 2021; 38:1364-1367. [PMID: 33439475 PMCID: PMC7889557 DOI: 10.1007/s12325-020-01586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jeffrey A Allen
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
| | - Lisa Butler
- GBS/CIDP Foundation International, Conshohocken, PA, USA
| | - Todd Levine
- Phoenix Neurological Associates, Phoenix, AZ, USA
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Aggarwal R, Charles-Schoeman C, Schessl J, Dimachkie MM, Beckmann I, Levine T. Prospective, double-blind, randomized, placebo-controlled phase III study evaluating efficacy and safety of octagam 10% in patients with dermatomyositis ("ProDERM Study"). Medicine (Baltimore) 2021; 100:e23677. [PMID: 33429735 PMCID: PMC7793357 DOI: 10.1097/md.0000000000023677] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Dermatomyositis (DM) is an inflammatory myopathy characterized by distinct skin manifestations and muscle weakness. Intravenous immunoglobulin (IVIg) has been used off-label as adjuvant therapy in DM, but is not indicated for DM, due to lack of proven efficacy in a large randomized controlled trial. The objective of the ProDERM (Progress in DERMatomyositis) study was to evaluate the efficacy, safety and long-term tolerability of IVIg (Octagam 10%) in patients with DM in a randomized, placebo-controlled, double-blind, Phase III study. METHODS Adult patients with active DM who were continuing standard therapy at a stable dose were eligible for this study. Patients were randomized 1:1 to receive either 2 g/kg of IVIg or placebo, administered every 4 weeks until week 16 (First Period). Patients were switched to the alternate treatment if they showed clinical deterioration in the First Period. After response assessment at week 16, all patients on placebo and those without deterioration on IVIg entered the open-label Extension Period, receiving 2 g/kg IVIg every 4 weeks for 24 weeks. RESULTS The primary efficacy endpoint was the proportion of responders in the IVIg vs placebo arm at week 16, where response was defined per 2016 ACR/EULAR Myositis Response Criteria of at least minimal improvement [Total Improvement Score (TIS) ≥20] and without deterioration at 2 consecutive visits up to week 16. TIS consists of composite response criteria, combining weighted improvement in 6 core set measures (CSMs), Global Disease Activity (Physician and Patient), manual muscle testing-8 (MMT-8), Health Assessment Questionnaire, extra-muscular disease activity, and muscle enzymes. Secondary endpoints included the mean change in individual CSMs, time to improvement in TIS, time to confirmed deterioration in the First Period, and the overall proportion of patients with deteriorations. Adverse events, including infusion reactions and thromboembolic events, were recorded. CONCLUSIONS The ProDERM study was the first to assess the long-term efficacy and safety of IVIg (Octagam 10%) in a placebo-controlled, blinded, randomized trial in DM. The study aimed to inform on the use of IVIg in the treatment of DM, and results are expected in Q3 2020. CLINICALTRIALSGOV IDENTIFIER NCT02728752.
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Affiliation(s)
- Rohit Aggarwal
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Joachim Schessl
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | - Irene Beckmann
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
| | - Todd Levine
- Department of Neurology, Phoenix Neurological Associates, Ltd., Phoenix, AZ
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Allen JA, Butler L, Levine T, Haudrich A. A Global Survey of Disease Burden in Patients Who Carry a Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. Adv Ther 2021; 38:316-328. [PMID: 33113101 PMCID: PMC7854453 DOI: 10.1007/s12325-020-01540-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/15/2020] [Indexed: 01/24/2023]
Abstract
Introduction The extent to which work productivity, emotional well-being, social interactions, and family life are impacted in patients who self-identify as having chronic inflammatory demyelinating polyneuropathy (CIDP) is not well characterized. Methods Data from an online survey of 595 individuals with self-reported CIDP, recruited by the Guillain–Barré syndrome (GBS)/CIDP Foundation, were used to assess disease and treatment burden. A total of 37% of patients were classified as “likely”, 34% as “somewhat likely”, and 28% as “unlikely” CIDP. Results Of ten symptoms that patients with CIDP may experience, each symptom was experienced by 77–94% of “likely”, 79–96% of “somewhat likely”, and 66–91% of “unlikely” patients. In “likely” CIDP patients 44% stopped working because of their symptoms and 24% moved to a new home. The most common treatments were intravenous immunoglobulin (IVIg) infusion and corticosteroids. IVIg was associated with venous access issues and work/school absenteeism. Conclusions CIDP diagnostic confirmation was not performed in any of the survey respondents. Our results do not add any knowledge on the diagnosis or treatment of CIDP. Our findings do provide insight into the symptoms that patients that think they have CIDP or have been told they have CIDP experience, explores how patients that are labeled as having CIDP view treatment expectations, and highlights how these symptoms affect home and work life. We hope that the findings are constructively used to get patients the services they need to improve quality of life, maintain employment, and ensure a safe home environment regardless of diagnostic accuracy.
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Freeman R, Gewandter JS, Faber CG, Gibbons C, Haroutounian S, Lauria G, Levine T, Malik RA, Singleton JR, Smith AG, Bell J, Dworkin RH, Feldman E, Herrmann DN, Hoke A, Kolb N, Mansikka H, Oaklander AL, Peltier A, Polydefkis M, Ritt E, Russell JW, Sainati S, Steiner D, Treister R, Üçeyler N. Idiopathic distal sensory polyneuropathy: ACTTION diagnostic criteria. Neurology 2020; 95:1005-1014. [PMID: 33055271 DOI: 10.1212/wnl.0000000000010988] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/21/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To present standardized diagnostic criteria for idiopathic distal sensory polyneuropathy (iDSP) and its subtypes: idiopathic mixed fiber sensory neuropathy (iMFN), idiopathic small fiber sensory neuropathy (iSFN), and idiopathic large fiber sensory neuropathy (iLFN) for use in research. METHODS The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities and Networks (ACTTION) public-private partnership with the Food and Drug Administration convened a meeting to develop consensus diagnostic criteria for iMFN, iSFN, and iLFN. After background presentations, a collaborative, iterative approach was used to develop expert consensus for new criteria. RESULTS An iDSP diagnosis requires at least 1 small fiber (SF) or large fiber (LF) symptom, at least 1 SF or LF sign, abnormalities in sensory nerve conduction studies (NCS) or distal intraepidermal nerve fiber density (IENFD), and exclusion of known etiologies. An iMFN diagnosis requires that at least 1 of the above clinical features is SF and 1 clinical feature is LF with abnormalities in sensory NCS or IENFD. Diagnostic criteria for iSFN require at least 1 SF symptom and at least 1 SF sign with abnormal IENFD, normal sensory NCS, and the absence of LF symptoms and signs. Diagnostic criteria for iLFN require at least 1 LF symptom and at least 1 LF sign with normal IENFD, abnormal sensory NCS, and absence of SF symptoms and signs. CONCLUSION Adoption of these standardized diagnostic criteria will advance research and clinical trials and spur development of novel therapies for iDSPs.
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Affiliation(s)
- Roy Freeman
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany.
| | - Jennifer S Gewandter
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Catharina G Faber
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Christopher Gibbons
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Simon Haroutounian
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Giuseppe Lauria
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Todd Levine
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Rayaz A Malik
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - J Robinson Singleton
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - A Gordon Smith
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Josh Bell
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Robert H Dworkin
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Eva Feldman
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - David N Herrmann
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Ahmet Hoke
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Noah Kolb
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Heikki Mansikka
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Anne Louise Oaklander
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Amanda Peltier
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Michael Polydefkis
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Elissa Ritt
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - James W Russell
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Stephen Sainati
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Deborah Steiner
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Roi Treister
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
| | - Nurcan Üçeyler
- From the Beth Israel Deaconess Medical Center (R.F., C.G.), Harvard Medical School, MA; University of Rochester Medical Center (J.S.G., R.H.D., D.N.H.), Rochester, NY; Department of Neurology (C.G.F.), School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Anesthesiology (S.H.), Washington University in St. Louis School of Medicine, St. Louis, MO; Neuroalgology Unit (G.L.), Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco" (G.L.), University of Milan,Milan, Italy; Phoenix Neurological Associates (T.L.), Phoenix, AZ; Weill Cornell Medicine-Qatar (R.A.M.), Qatar Foundation, Education City, Doha, Qatar; University of Utah (J.R.S.), Salt Lake City, UT; Virginia Commonwealth University (A.G.S.), Richmond, VA; Biogen (J.B.), Cambridge, MA; University of Michigan (E.F.), Ann Arbor, MI; Johns Hopkins School of Medicine (A.H., M.P.), Baltimore, MD; University of Vermont (N.K.), Burlington, VT; Chromocell Corp (H.M.), North Brunswick, NJ; Harvard Medical School (A.L.O.), Boston, MA; Departments of Neurology and Medicine (A.P.), and Vanderbilt Heart and Vascular Institute, Nashville, TN; NuFactor Specialty Pharmacy (E.R.), Temecula, CA; University of Maryland (J.W.R.), Baltimore, MD; Aptinyx (S.S.), INC., Evanston. IL; Amgen (D.S.), Cambridge, MA; University of Haifa (R.T.), Haifa, Israel; and University of Würzburg (N.Ü.), Würzburg, Germany
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Aggarwal R, Charles-Schoeman C, Schessl J, Bata-Csorgo Z, Dimachkie M, Griger Z, Moiseev S, Oddis C, Schiopu E, Vencovsky J, Beckmann I, Clodi E, Levine T, Investigators P. AUTOIMMUNE MYOPATHIES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pasnoor M, Bril V, Levine T, Trivedi J, Silvestri N, Phadnis M, Saperstein D, Nations S, Katzberg H, Wolfe G, Herbelin L, Higgs K, Heim A, Statland J, Barohn R, Dimachkie M. O.33Subcutaneous immunoglobulin in myasthenia gravis: results of a North American open label study. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Machado P, Barohn R, McDermott M, Blaetter T, Lloyd T, Shaibani A, Freimer M, Amato A, Ciafaloni E, Burns T, Mozaffar T, Gibson S, Wicklund M, Saperstein D, Levine T, Sundgreen C, Aaes-Jørgensen A, Liu T, Herbelin L, Hanna M, Dimachkie M. P.02Phase 2/3 study of Arimoclomol in sporadic inclusion body myositis: study design. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kishnani P, Tarnopolsky M, Roberts M, Sivakumar K, Dasouki M, Dimachkie MM, Finanger E, Goker-Alpan O, Guter KA, Mozaffar T, Pervaiz MA, Laforet P, Levine T, Adera M, Lazauskas R, Sitaraman S, Khanna R, Benjamin E, Feng J, Flanagan JJ, Barth J, Barlow C, Lockhart DJ, Valenzano KJ, Boudes P, Johnson FK, Byrne B. Duvoglustat HCl Increases Systemic and Tissue Exposure of Active Acid α-Glucosidase in Pompe Patients Co-administered with Alglucosidase α. Mol Ther 2017; 25:1199-1208. [PMID: 28341561 PMCID: PMC5417791 DOI: 10.1016/j.ymthe.2017.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/03/2017] [Accepted: 02/25/2017] [Indexed: 11/26/2022] Open
Abstract
Duvoglustat HCl (AT2220, 1-deoxynojirimycin) is an investigational pharmacological chaperone for the treatment of acid α-glucosidase (GAA) deficiency, which leads to the lysosomal storage disorder Pompe disease, which is characterized by progressive accumulation of lysosomal glycogen primarily in heart and skeletal muscles. The current standard of care is enzyme replacement therapy with recombinant human GAA (alglucosidase alfa [AA], Genzyme). Based on preclinical data, oral co-administration of duvoglustat HCl with AA increases exposure of active levels in plasma and skeletal muscles, leading to greater substrate reduction in muscle. This phase 2a study consisted of an open-label, fixed-treatment sequence that evaluated the effect of single oral doses of 50 mg, 100 mg, 250 mg, or 600 mg duvoglustat HCl on the pharmacokinetics and tissue levels of intravenously infused AA (20 mg/kg) in Pompe patients. AA alone resulted in increases in total GAA activity and protein in plasma compared to baseline. Following co-administration with duvoglustat HCl, total GAA activity and protein in plasma were further increased 1.2- to 2.8-fold compared to AA alone in all 25 Pompe patients; importantly, muscle GAA activity was increased for all co-administration treatments from day 3 biopsy specimens. No duvoglustat-related adverse events or drug-related tolerability issues were identified.
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Affiliation(s)
| | - Mark Tarnopolsky
- McMaster University Medical Center, Hamilton, ON L8N 3Z5, Canada
| | - Mark Roberts
- Salford Royal Hope HNS Trust Hope Hospital, Salford M6 8HD, UK
| | | | - Majed Dasouki
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| | | | - Erika Finanger
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Ozlem Goker-Alpan
- LSD Research and Treatment Unit, O&O Alpan, LLC, Fairfax, VA 22030, USA
| | | | | | | | - Pascal Laforet
- Hopital la Salpetriere Institut de Myologie, 75013 Paris, France
| | - Todd Levine
- Phoenix Neurological Associates, Phoenix, AZ 85018, USA
| | | | | | | | | | | | - Jessie Feng
- Amicus Therapeutics, Cranbury, NJ 08512, USA
| | | | - Jay Barth
- Amicus Therapeutics, Cranbury, NJ 08512, USA
| | - Carrolee Barlow
- The Parkinson's Institute and Clinical Center, Sunnyvale, CA 94085, USA
| | | | | | - Pol Boudes
- Cymabay Therapeutics, Newark, CA 94560, USA
| | | | - Barry Byrne
- University of Florida, Gainesville, FL 32611, USA
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Boylan K, Levine T, Lomen-Hoerth C, Lyon M, Maginnis K, Callas P, Gaspari C, Tandan R. Prospective study of cost of care at multidisciplinary ALS centers adhering to American Academy of Neurology (AAN) ALS practice parameters. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:119-27. [DOI: 10.3109/21678421.2015.1091478] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Levine T, White D, Francisco L, Rice G. Comparison of Schindler-Patalas Traps and Wisconsin Nets for Monitoring Zooplankton in a Large, Shallow Reservoir. ACTA ACUST UNITED AC 2013. [DOI: 10.3101/1098-7096-74.1.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Todd Levine
- Hancock Biological Station, Murray State University, Murray, Kentucky 42071
| | - David White
- Hancock Biological Station, Murray State University, Murray, Kentucky 42071
| | - Laura Francisco
- Hancock Biological Station, Murray State University, Murray, Kentucky 42071
| | - Gary Rice
- Hancock Biological Station, Murray State University, Murray, Kentucky 42071
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Fournier C, Bedlack B, Hardiman O, Heiman-Patterson T, Gutmann L, Bromberg M, Ostrow L, Carter G, Kabashi E, Bertorini T, Mozaffar T, Andersen P, Dietz J, Gamez J, Dimachkie M, Wang Y, Wicks P, Heywood J, Novella S, Rowland LP, Pioro E, Kinsley L, Mitchell K, Glass J, Sathornsumetee S, Kwiecinski H, Baker J, Atassi N, Forshew D, Ravits J, Conwit R, Jackson C, Sherman A, Dalton K, Tindall K, Gonzalez G, Robertson J, Phillips L, Benatar M, Sorenson E, Shoesmith C, Nash S, Maragakis N, Moore D, Caress J, Boylan K, Armon C, Grosso M, Gerecke B, Wymer J, Oskarsson B, Bowser R, Drory V, Shefner J, Lechtzin N, Leitner M, Miller R, Mitsumoto H, Levine T, Russell J, Sharma K, Saperstein D, McClusky L, MacGowan D, Licht J, Verma A, Strong M, Lomen-Hoerth C, Tandan R, Rivner M, Kolb S, Polak M, Rudnicki S, Kittrell P, Quereshi M, Sachs G, Pattee G, Weiss M, Kissel J, Goldstein J, Rothstein J, Pastula D, Gleb L, Ogino M, Rosenfeld J, Carmi E, Oster C, Barkhaus P, Valor E. ALS Untangled No. 20: the Deanna protocol. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:319-23. [PMID: 23638638 DOI: 10.3109/21678421.2013.788405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Kishnani P, Tarnopolsky M, Sivakumar K, Byrne B, Goker-Alpan O, Guter K, Pervaiz M, Dasouki M, Levine T, Roberts M, Johnson F, Sitaraman S, Khanna R, Flanagan J, Sjoberg E, Valenzano K, Lockhart D, Boudes P. T.P.45 An ongoing phase 2a study to investigate drug–drug interactions between escalating doses of AT2220 (duvoglustat hydrochloride) and acid alpha glucosidase in subjects with Pompe disease – Preliminary results. Neuromuscul Disord 2012. [DOI: 10.1016/j.nmd.2012.06.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kishnani P, Tarnopolsky M, Sivakumar K, Byrne B, Goker-Alpan O, Guter K, Pervaiz M, Dasouki M, Levine T, Roberts M, Johnson F, Valenzano K, Lockhart D, Boudes P. T.P.46 A novel phase 2a study design to investigate drug-drug interactions between escalating doses of AT2220 (duvoglustat hydrochloride) and acid alpha-glucosidase in subjects with Pompe disease. Neuromuscul Disord 2012. [DOI: 10.1016/j.nmd.2012.06.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Effective and tolerable treatment options for patients with dermatomyositis and polymyositis are limited. This retrospective case review describes treatment with adrenocorticotropic hormone (ACTH) gel in five patients who experienced a disease exacerbation and either failed or were unable to tolerate the side effects of previous therapy with steroids, intravenous immunoglobulins, and steroid-sparing drugs. METHODS Patients received ACTH gel subcutaneous injections of 80 U (1 mL) twice weekly (four patients) or once weekly (one patient) over the course of 12 weeks for short-term treatment of symptom exacerbations. Manual muscle testing using the Medical Research Council scale was assessed at baseline and at 3 months. RESULTS Improvement was seen in all patients, including improved muscle strength, decreased pain, and resolution of skin involvement. All patients tolerated the treatment well, and no significant side effects occurred. CONCLUSION The treatment of dermatomyositis and polymyositis is an approved use for ACTH gel, and these anecdotal reports would suggest consideration of ACTH gel as a therapeutic option. Further investigation is warranted.
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Affiliation(s)
- Todd Levine
- Phoenix Neurological Associates, Phoenix, AZ, USA
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Saperstein D, Levine T. Substitution of SCIg for IVIg in Immune-Mediated Neuropathy Patients Unable To Tolerate IVIg (P06.132). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Levine T, Hank N, Saperstein D, Bradley W, Cox P. A Pilot Trial of Zinc in Patients with ALS (P04.153). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bland R, Clarke K, Levine T. In-Office Intravenous Treatment for Intractable Headaches (P03.234). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ahmed A, Syed Z, Levine T, Gilhooley M. An audit of parotidectomy cases from 2008 to 2010 at NWLH trust. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Walter K, Kung H, Levine T, Tesmer J, Kodali P, Wood B, Rej D, Nastasi M, Koskinen J, Hirvonen JP. Characterization and Performance of Carbon Films Deposited by Plasma and Ion Beam Based Techniques. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-354-87] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractPlasma and ion beam based techniques have been used to deposit carbon-based films. The ion beam based method, a cathodic arc process, used a magnetically mass analyzed beam and is inherently a line-of-sight process. Two hydrocarbon plasma-based, non-line-of-sight techniques were also used and have the advantage of being capable of coating complicated geometries. The self-bias technique can produce hard carbon films, but is dependent on rf power and the surface area of the target. The pulsed-bias technique can also produce hard carbon films but has the additional advantage of being independent of rf power and target surface area. Tribological results indicated the coefficient of friction is nearly the same for carbon films from each deposition process, but the wear rate of the cathodic arc film was five times less than for the self-bias or pulsed-bias films. Although the cathodic arc film was the hardest, contained the highest fraction of sp3 bonds and exhibited the lowest wear rate, the cathodic arc film also produced the highest wear on the 440C stainless steel counterface during tribological testing. Thus, for tribological applications requiring low wear rates for both counterfaces, coating one surface with a very hard, wear resistant film may detrimentally affect the tribological behavior of the counterface.
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Patel HS, Silver AR, Levine T, Williams G, Northover JM. Human papillomavirus infection and anal dysplasia in renal transplant recipients. Br J Surg 2010; 97:1716-21. [PMID: 20730855 DOI: 10.1002/bjs.7218] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Immunosuppression is a known risk factor for anal human papillomavirus (HPV) disease, including anal squamous cell carcinoma. Additional risk factors for HPV-related disease have not been studied in the renal transplant population. The demographics of anal HPV and associated risk factors were investigated in this population. METHODS Anal cytology and polymerase chain reaction were used to assess anal HPV disease in a cohort of transplant recipients at the Royal London Hospital. Risk factors associated with increased immunosuppression and HPV exposure were collated to determine any association with anal disease. RESULTS Anal dysplasia was associated with anal oncogenic HPV infection (P < 0.001), duration of immunosuppression (P = 0.050), previous genital warts (P = 0.018) and receptive anal intercourse (P = 0.013). CONCLUSION Anal dysplasia was related to immunosuppression and patient factors in this cohort.
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Affiliation(s)
- H S Patel
- Colorectal Cancer Genetics Group, Institute for Cell and Molecular Sciences, Barts and the London School of Medicine and Dentistry, London, UK
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Gordon PH, Cheung YK, Levin B, Andrews H, Doorish C, Macarthur RB, Montes J, Bednarz K, Florence J, Rowin J, Boylan K, Mozaffar T, Tandan R, Mitsumoto H, Kelvin EA, Chapin J, Bedlack R, Rivner M, McCluskey LF, Pestronk A, Graves M, Sorenson EJ, Barohn RJ, Belsh JM, Lou JS, Levine T, Saperstein D, Miller RG, Scelsa SN. A novel, efficient, randomized selection trial comparing combinations of drug therapy for ALS. ACTA ACUST UNITED AC 2008; 9:212-22. [PMID: 18608093 DOI: 10.1080/17482960802195632] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Combining agents with different mechanisms of action may be necessary for meaningful results in treating ALS. The combinations of minocycline-creatine and celecoxib-creatine have additive effects in the murine model. New trial designs are needed to efficiently screen the growing number of potential neuroprotective agents. Our objective was to assess two drug combinations in ALS using a novel phase II trial design. We conducted a randomized, double-blind selection trial in sequential pools of 60 patients. Participants received minocycline (100 mg)-creatine (10 g) twice daily or celecoxib (400 mg)-creatine (10 g) twice daily for six months. The primary objective was treatment selection based on which combination best slowed deterioration in the ALS Functional Rating Scale-Revised (ALSFRS-R); the trial could be stopped after one pool if the difference between the two arms was adequately large. At trial conclusion, each arm was compared to a historical control group in a futility analysis. Safety measures were also examined. After the first patient pool, the mean six-month decline in ALSFRS-R was 5.27 (SD=5.54) in the celecoxib-creatine group and 6.47 (SD=9.14) in the minocycline-creatine group. The corresponding decline was 5.82 (SD=6.77) in the historical controls. The difference between the two sample means exceeded the stopping criterion. The null hypothesis of superiority was not rejected in the futility analysis. Skin rash occurred more frequently in the celecoxib-creatine group. In conclusion, the celecoxib-creatine combination was selected as preferable to the minocycline-creatine combination for further evaluation. This phase II design was efficient, leading to treatment selection after just 60 patients, and can be used in other phase II trials to assess different agents.
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Affiliation(s)
- Paul H Gordon
- Department of Neurology, Columbia University, New York, USA.
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Holton T, Smith D, Terry M, Madgwick A, Levine T. The effect of lubricant contamination on ThinPrep(Cytyc) cervical cytology liquid-based preparations. Cytopathology 2008; 19:236-43. [DOI: 10.1111/j.1365-2303.2007.00525.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dunckley T, Huentelman MJ, Craig DW, Pearson JV, Szelinger S, Joshipura K, Halperin RF, Stamper C, Jensen KR, Letizia D, Hesterlee SE, Pestronk A, Levine T, Bertorini T, Graves MC, Mozaffar T, Jackson CE, Bosch P, McVey A, Dick A, Barohn R, Lomen-Hoerth C, Rosenfeld J, O'connor DT, Zhang K, Crook R, Ryberg H, Hutton M, Katz J, Simpson EP, Mitsumoto H, Bowser R, Miller RG, Appel SH, Stephan DA. Whole-genome analysis of sporadic amyotrophic lateral sclerosis. N Engl J Med 2007; 357:775-88. [PMID: 17671248 DOI: 10.1056/nejmoa070174] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Approximately 90% of persons with amyotrophic lateral sclerosis (ALS) have the sporadic form, which may be caused by the interaction of multiple environmental factors and previously unknown genes. METHODS We performed a genomewide association analysis using 766,955 single-nucleotide polymorphisms (SNPs) found in 386 white patients with sporadic ALS and 542 neurologically normal white controls (the discovery series). Associations of SNPs with sporadic ALS were confirmed in two independent replication populations: replication series 1, with 766 case patients with the disease and 750 neurologically normal controls, and replication series 2, with 135 case patients and 275 controls. RESULTS We identified 10 genetic loci that are significantly associated (P<0.05) with sporadic ALS in three independent series of case patients and controls and an additional 41 loci that had significant associations in two of the three series. The most significant association with disease in white case patients as compared with controls was found for a SNP near an uncharacterized gene known as FLJ10986 (P=3.0x10(-4); odds ratio for having the genotype in patients vs. controls, 1.35; 95% confidence interval, 1.13 to 1.62). The FLJ10986 protein was found to be expressed in the spinal cord and cerebrospinal fluid of patients and of controls. Specific SNPs seem to be associated with sex, age at onset, and site of onset of sporadic ALS. CONCLUSIONS Variants of FLJ10986 may confer susceptibility to sporadic ALS. FLJ10986 and 50 other candidate loci warrant further investigation for their potential role in conferring susceptibility to the disease.
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Affiliation(s)
- Travis Dunckley
- Translational Genomics Research Inst., Phoenix, AZ 85004, USA
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Rastogi P, Jeong J, Geyer CE, Costantino JP, Romond EH, Ewer MS, Keefe DL, Levine T, Swain SM, Wolmark N. Five year update of cardiac dysfunction on NSABP B-31, a randomized trial of sequential doxorubicin/cyclophosphamide (AC)→paclitaxel (T) vs. AC→T with trastuzumab (H). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.lba513] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA513 Background: Trastuzumab (H) has been shown to improve survival in HER2 positive, node-positive breast cancer patients when combined with paclitaxel following AC (Romond NEJM 2005:353;1673–1684). Cardiac dysfunction is the major toxicity associated with this regimen. Methods: NSABP B-31 compared doxorubicin and cyclophosphamide (AC) followed by paclitaxel with AC followed by paclitaxel plus 52 weeks of trastuzumab beginning concurrently with paclitaxel in patients with node- positive, HER2-positive breast cancer. Initiation of trastuzumab required normal post-AC left ventricular ejection fraction (LVEF) on MUGA scan. If symptoms suggestive of congestive heart failure (CHF) developed, source documents were blindly reviewed by a panel of cardiologists to determine whether criteria were met for a cardiac event (CE), defined as NYHA class III or IV CHF or possible/probable cardiac death. Among patients with normal post-AC LVEF who began post-AC treatment, 10 of 872 (1.3%) control patients subsequently had confirmed CEs (9 CHFs and 1 cardiac death) compared with 35 of 932 (3.9%) trastuzumab-treated patients (35 CHFs and no cardiac deaths). The difference in cumulative incidence at 5 years was 2.7%. Risk factors for CHF were age 50 (5.2–5.3%), requirement for hypertension medication (7.7%), and post AC-LVEF values of 50–54% (13.0%). Conclusion: Administering trastuzumab with paclitaxel after AC increases incidence of CHF. Risk factors for increased risk of cardiotoxicity should be carefully considered when discussing benefits and risks of this therapy. No significant financial relationships to disclose.
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Affiliation(s)
- P. Rastogi
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - J. Jeong
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - C. E. Geyer
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - J. P. Costantino
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - E. H. Romond
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - M. S. Ewer
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - D. L. Keefe
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - T. Levine
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - S. M. Swain
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
| | - N. Wolmark
- NSABP; University of Pittsburgh Cancer Institute and Magee Womens Hospital, Pittsburgh, PA; NSABP; Univ Pittsburgh, Biostatistical Center, Pittsburgh, PA; NSABP; Allegheny General Hospital, Pittsburgh, PA; University of Kentucky, Markey Cancer Center, Houston, TX; University of Texas, M.D. Anderson Cancer Center, Houston, TX; Novartis Pharmaceutical Corporation, East Hanover, NJ; Allegheny General Hospital, Pittsburgh, PA; Medical Oncology Branch, National Cancer Institute, Bethesda, MD
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Affiliation(s)
- T Levine
- Department of Cellular Pathology, North West London Hospitals NHS Trust, Northwick Park Hospital, Middlesex, UK.
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Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T, Ramneantu I, Waheed W, Stambuk M, Stone MJ, Choksi R. Peripheral neuropathies in Waldenström's macroglobulinaemia. J Neurol Neurosurg Psychiatry 2006; 77:224-8. [PMID: 16421127 PMCID: PMC2077569 DOI: 10.1136/jnnp.2005.071175] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We sought to determine the prevalence, clinical features, and laboratory characteristics of polyneuropathies in Waldenström's macroglobulinaemia (WM), a malignant bone marrow disorder with lymphocytes that produce monoclonal IgM. METHODS We prospectively studied 119 patients with WM and 58 controls. Medical history was taken, and neurological examinations, electrodiagnostic tests, and serum studies were performed by different examiners who were blinded to results except the diagnosis of WM. RESULTS Polyneuropathy symptoms, including discomfort and sensory loss in the legs, occurred more frequently (p<0.001) in patients with WM (47%) than in controls (9%). Patients with WM had 35% lower quantitative vibration scores, and more frequent pin loss (3.4 times) and gait disorders (5.5 times) than controls (all p<0.001). Patients with IgM binding to sulphatide (5% of WM) had sensory axon loss; those with IgM binding to myelin associated glycoprotein (MAG) (4% of WM) had sensorimotor axon loss and demyelination. Patients with WM with IgM binding to sulphatide (p<0.005) or MAG (p<0.001) had more severe sensory axon loss than other patients with WM. Demyelination occurred in 4% of patients with WM with no IgM binding to MAG. Age related reductions in vibration sense and sural SNAP amplitudes were similar ( approximately 30%) in WM and controls. CONCLUSIONS Peripheral nerve symptoms and signs occur more frequently in patients with WM than controls, involve sensory modalities, and are often associated with gait disorders. IgM binding to MAG or sulphatide is associated with a further increase in the frequency and severity of peripheral nerve involvement. Age related changes, similar to those in controls, add to the degree of reduced nerve function in patients with WM.
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Affiliation(s)
- T Levine
- Phoenix Neurological Associates, AZ, USA
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Lopate G, Pestronk A, Al-Lozi M, Lynch T, Florence J, Miller T, Levine T, Rampy T, Beson B, Ramneantu I. Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndrome. Muscle Nerve 2006; 33:672-6. [PMID: 16453296 DOI: 10.1002/mus.20514] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Peripheral neuropathy is common in patients with Sjögren's syndrome (SS), but its precise prevalence is unknown. Most prior studies were conducted at neurology or rheumatology specialty clinics and likely selected for a more severely affected population. We evaluated 22 SS patients and 10 controls for evidence of neuropathy in an outpatient setting at a regional meeting of the Sjögren's Syndrome Foundation. We performed neurological examinations and nerve conduction studies (NCSs) and measured serum antinuclear antibody (ANA) and SS-A and SS-B antibody levels. Participants filled out a questionnaire pertaining to symptoms, diagnosis, and treatment. We found that signs and symptoms related to small axons were more common in patients with SS than in controls. Complaints of painful distal paresthesias in the feet were noted in 59% of patients but in only 10% of controls, and of abnormal sweating in 41% and 0%, respectively. Examination revealed decreased pinprick sensation in 64% of patients with SS, but in only 30% of controls. Overall, 45% of the patients but none of the controls were thought to have an isolated small-fiber neuropathy. Large-fiber dysfunction (as measured by testing vibration, deep tendon reflexes, and NCSs) was similar between the two groups. We conclude that small-fiber neuropathy is common in patients with SS.
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Affiliation(s)
- Glenn Lopate
- Department of Neurology Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA.
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Boxer GM, Tsiompanou E, Levine T, Watson R, Begent RHJ. Immunohistochemical expression of vascular endothelial growth factor and microvessel counting as prognostic indicators in node-negative colorectal cancer. Tumour Biol 2005; 26:1-8. [PMID: 15741766 DOI: 10.1159/000084180] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 09/07/2004] [Indexed: 02/01/2023] Open
Abstract
This manuscript reports a carefully controlled study of patients with Dukes B colorectal cancer (Dukes stage A, n=12 and Dukes stage B, n=44). Immunohistochemistry has been used to demonstrate reactivity for vascular endothelial growth factor (VEGF), and to measure levels of microvessel density (MVD) in order to assess the relationship of tumor angiogenesis with clinical outcome. Immunohistochemistry was performed using antibodies to VEGF and CD34 (for intratumoral vessel identification) and counting was performed at the invasive margin of the tumor. Results showed that for Dukes stage A patients 4/12 died of their disease, none of whose tumor was VEGF positive. In contrast, 2 patients who survived were positive for VEGF cytoplasmically, but neither showed increased tumor MVD. In Dukes B patients 10/44 died, 5 of whose tumor demonstrated VEGF reactivity, both in malignant cells and in tumor vascular endothelium. MVD ranged from 11 to 53 (median 28) for Dukes A cases and from 9 to 69 (median 32.5) for the Dukes B group. Kaplan-Meier plots and log rank test statistics for Dukes B patients demonstrated that VEGF reactivity in cells, and in tumor vascular endothelium was correlated with survival (p=0.047 and p < or = 0.06, respectively). There was a significant relationship between the presence of VEGF reactivity on vascular endothelium and outcome by Fisher's exact test (p=0.018). Similarly, by the same test VEGF positivity was significantly correlated with patient mortality (p=0.032). The presence of endothelial VEGF reactivity correlated with VEGF in malignant cells (p=0.0001) by Mann-Whitney U test and a significant inverse relationship between vessel density and patient survival was demonstrated (p = 0.019). The finding that in Dukes B patients MVD was inversely correlated with mortality supports the hypothesis that a low microvascular count is predicted close to the invasive margin, where VEGF expression is upregulated in response to hypoxia, induced by a lack of a functional vasculature. These data will be used to identify cohorts of patients who have a high risk of relapse and can be selected for adjuvant therapies such as VEGF antibody or antitumor antibody-directed therapy.
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Affiliation(s)
- G M Boxer
- Department of Academic Oncology, Hamstead Campus, Royal Free & UC Medical School, UCL, London, UK.
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Pestronk A, Florence J, Levine T, Al-Lozi MT, Lopate G, Miller T, Ramneantu I, Waheed W, Stambuk M. Sensory exam with a quantitative tuning fork: rapid, sensitive and predictive of SNAP amplitude. Neurology 2005; 62:461-4. [PMID: 14872031 DOI: 10.1212/01.wnl.0000106939.41855.36] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In the standard neurologic examination, outcome measures of sensation testing are typically qualitative and subjective. The authors compared the outcome of vibratory sense evaluation using a quantitative Rydel-Seiffer 64 Hz tuning fork with qualitative vibration testing, and two other features of the neurologic evaluation, deep tendon reflexes and sensory nerve conduction studies. METHODS The authors studied 184 subjects, including 126 with Waldenström's macroglobulinemia and 58 controls, over the course of a weekend. Standard neurologic examinations and quantitative vibratory testing were performed. Sensory nerve action potentials (SNAP) were tested as a measure of sensory nerve function. Tests were carried out by different examiners who were blinded to the results of other testing and to clinical information other than the diagnosis of Waldenström's macroglobulinemia. RESULTS Quantitative vibration measurements in all body regions correlated with sural SNAP amplitudes. Quantitative vibration outcomes were more strongly related to sural SNAP results than qualitative evaluations of vibration. Quantitative vibration testing also detected a loss of sensation with increased age in all body regions tested. CONCLUSIONS Quantitative vibratory evaluation with Rydel-Seiffer tuning fork is rapid, has high inter- and intrarater reliability, and provides measures for evaluating changes in sensory function over time. Examinations with the quantitative tuning fork are also more sensitive and specific than qualitative vibration testing for detecting changes in sensory nerve function. Use of the quantitative tuning fork takes no more time, provides more objective information, and should replace the qualitative vibratory testing method that is now commonly used in the standard neurologic examination.
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Affiliation(s)
- A Pestronk
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Gertz MA, Anagnostopoulos A, Anderson K, Branagan AR, Coleman M, Frankel SR, Giralt S, Levine T, Munshi N, Pestronk A, Rajkumar V, Treon SP. Treatment recommendations in Waldenstrom's macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom's Macroglobulinemia. Semin Oncol 2003; 30:121-6. [PMID: 12720120 DOI: 10.1053/sonc.2003.50039] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This presentation represents consensus recommendations for the treatment of patients with Waldenstrom's macroglobulinemia (WM), which were prepared in conjunction with the second International Workshop held in Athens, Greece during September 2002. The faculty adopted the following statements for the management of patients with Waldenstrom's macroglobulinemia: (1) Alkylating agents, nucleoside analogues, and rituximab are reasonable choices for first line therapy of WM. (2) Both cladribine and fludarabine are reasonable choices for the therapy of WM. (3) Combinations of alkylating agents, nucleoside analogues, or rituximab should at this time be encouraged in the context of a clinical trial. (4) In WM, rituximab can cause a sudden rise in serum IgM and viscosity levels in certain patients, which may lead to complications, therefore close monitoring of these parameters and symptoms of hyperviscosity is recommended for WM patients undergoing rituximab therapy. (5) For relapsed disease, it is reasonable to use an alternate first line agent or re-use of the same agent; however, since autologous stem cell transplantation may have a role in treating patients with relapsed disease it is recommended that for patients in whom autologous transplantation is seriously being considered, exposure to alkylator or nucleoside analogue drugs should be limited. (6) Combination chemotherapy for patients who can tolerate myelotoxic therapy, thalidomide alone or with dexamethasone, can reasonably be considered to have relapsed. (7) Autologous stem cell transplantation may be considered for patients with refractory or relapsing disease. (8) Allogeneic transplantation should only be undertaken in the context of a clinical trial. (9) Plasmapheresis should be considered as interim therapy until definitive therapy can be initiated. (10) Rituximab should be considered for patients with IgM-related neuropathies. (11) Corticosteroids may be useful in the treatment of symptomatic mixed cryoglobulinemia. (12) Splenectomy is rarely indicated but has been used to manage painful splenomegaly and hypersplenism.
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Deere H, Hore I, McDermott N, Levine T. Epithelial-myoepithelial carcinoma of the parotid gland: a case report and review of the cytological and histological features. J Laryngol Otol 2001; 115:434-6. [PMID: 11410145 DOI: 10.1258/0022215011907875] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Epithelial-myoepithelial carcinoma (EMC) is a rare biphasic tumour of the salivary glands typically arising in the parotid. Fine needle aspiration cytology is widely used in the initial investigation of salivary gland swellings and whilst the cytological features of this tumour have been described they are not well recognized. This report describes the clinicopathological features of a case of epithelial-myoepithelial carcinoma of the parotid gland and highlights the importance of awareness of this tumour in the differential diagnosis of biphasic tumours on fine needle aspiration cytology.
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Affiliation(s)
- H Deere
- Department of Cytopathology, Royal Free Hospital, London, UK
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Abstract
The roles of gender and the sexual motives of Love, Pleasure, Conformity, Recognition, Dominance, and Submission in numerous usual and unusual sexual behaviors were investigated. In a survey of 191 college undergraduates it was found that Love, Pleasure, Conformity, and Recognition motives, often in interaction with gender, were all important predictors of sexual behavior. Gender was the best predictor of initiating usual sexual behavior, whereas the Love motive was the best predictor of actually engaging in usual sexual behavior. Pleasure and Recognition in interaction with gender were the best predictors of engaging in unusual sexual behavior. None of the sexual motives predicted initiating unusual sexual behavior. Findings suggest that a variety of sexual motives may underlie sexual behavior.
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Affiliation(s)
- J R Browning
- Department of Psychology, University of Hawaii, Honolulu 96822, USA
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Levine T. Training in cervical cytology. Cytopathology 1999; 10:289-90. [PMID: 10458509 DOI: 10.1046/j.1365-2303.1999.00197.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND The effect of labor analgesia on breastfeeding success is not well defined. Some authors have hypothesized that labor analgesia may affect lactation success. The purpose of this observational study was to determine if intrapartum analgesia influenced breastfeeding success at 6 weeks postpartum in a setting that strongly supported breastfeeding. METHODS Healthy women with uncomplicated term pregnancies who planned to breastfeed consented to a telephone interview. We recorded demographic data, labor induction status, delivery mode, and analgesic medications. At between 6 and 8 weeks postpartum, patients were asked to describe breastfeeding use, problems encountered, solutions derived, sources of support and information, and satisfaction. We created a logistic regression model using intrapartum analgesia information and controlling for demographic factors previously correlated with lactation success. RESULTS We enrolled 189 women, contacted 177 women postpartum, and obtained complete data on 171 women. Of these, 59 percent received epidural analgesia, 72 percent breastfed fully, and 20 percent breastfed partially (> 50% of infant nutrition) at 6 weeks postpartum. After controlling for demographics and labor outcome, we could not demonstrate a correlation between breastfeeding success at 6 to 8 weeks and labor analgesia. CONCLUSIONS In a hospital that strongly promotes breastfeeding, epidural labor analgesia with local anesthetics and opioids does not impede breastfeeding success. We recommend that hospitals that find decreased lactation success in parturients receiving epidural analgesia reexamine their postdelivery care policies.
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Affiliation(s)
- S H Halpern
- Department of Anesthesia, University of Toronto, Women's College Hospital, Ontario, Canada
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Affiliation(s)
- S Thomas
- Department of Medicine, Imperial College School of Medicine at St Mary's, London, UK
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