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Alsoud D, Moes DJAR, Wang Z, Soenen R, Layegh Z, Barclay M, Mizuno T, Minichmayr IK, Keizer RJ, Wicha SG, Wolbink G, Lambert J, Vermeire S, de Vries A, Papamichael K, Padullés-Zamora N, Dreesen E. Best Practice for Therapeutic Drug Monitoring of Infliximab: Position Statement from the International Association of Therapeutic Drug Monitoring and Clinical Toxicology. Ther Drug Monit 2024; 46:291-308. [PMID: 38648666 DOI: 10.1097/ftd.0000000000001204] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/21/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Infliximab, an anti-tumor necrosis factor monoclonal antibody, has revolutionized the pharmacological management of immune-mediated inflammatory diseases (IMIDs). This position statement critically reviews and examines existing data on therapeutic drug monitoring (TDM) of infliximab in patients with IMIDs. It provides a practical guide on implementing TDM in current clinical practices and outlines priority areas for future research. METHODS The endorsing TDM of Biologics and Pharmacometrics Committees of the International Association of TDM and Clinical Toxicology collaborated to create this position statement. RESULTS Accumulating data support the evidence for TDM of infliximab in the treatment of inflammatory bowel diseases, with limited investigation in other IMIDs. A universal approach to TDM may not fully realize the benefits of improving therapeutic outcomes. Patients at risk for increased infliximab clearance, particularly with a proactive strategy, stand to gain the most from TDM. Personalized exposure targets based on therapeutic goals, patient phenotype, and infliximab administration route are recommended. Rapid assays and home sampling strategies offer flexibility for point-of-care TDM. Ongoing studies on model-informed precision dosing in inflammatory bowel disease will help assess the additional value of precision dosing software tools. Patient education and empowerment, and electronic health record-integrated TDM solutions will facilitate routine TDM implementation. Although optimization of therapeutic effectiveness is a primary focus, the cost-reducing potential of TDM also merits consideration. CONCLUSIONS Successful implementation of TDM for infliximab necessitates interdisciplinary collaboration among clinicians, hospital pharmacists, and (quantitative) clinical pharmacologists to ensure an efficient research trajectory.
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Affiliation(s)
- Dahham Alsoud
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dirk Jan A R Moes
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Zhigang Wang
- Clinical Pharmacology and Pharmacotherapy Unit, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Rani Soenen
- Dermatology Research Unit, Ghent University, Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Zohra Layegh
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Murray Barclay
- Departments of Gastroenterology and Clinical Pharmacology, Christchurch Hospital, Te Whatu Ora Waitaha and University of Otago, Christchurch, New Zealand
| | - Tomoyuki Mizuno
- Division of Translational and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Iris K Minichmayr
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | | | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center Location Reade, Amsterdam, Netherlands
- Sanquin Research and Landsteiner Laboratory, Department of Immunopathology, Amsterdam UMC, Amsterdam, Netherlands
| | - Jo Lambert
- Dermatology Research Unit, Ghent University, Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Séverine Vermeire
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Annick de Vries
- Sanquin Diagnostic Services, Pharma & Biotech Services, Amsterdam, the Netherlands
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Núria Padullés-Zamora
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; and
- School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Erwin Dreesen
- Clinical Pharmacology and Pharmacotherapy Unit, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Hooijberg F, Layegh Z, Leeuw M, Boekel L, van den Berg SPH, Ruwaard J, Bastida C, Huitema ADR, Pel S, Elkayam O, de Vries A, Nurmohamed M, Rispens T, Dorlo TPC, Wolbink G. Tocilizumab Dose Tapering Based on a Model-Based Algorithm is Feasible in Clinical Practice: A Short Communication. Ther Drug Monit 2024; 46:410-414. [PMID: 38287880 DOI: 10.1097/ftd.0000000000001168] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/13/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Tocilizumab in the treatment of rheumatoid arthritis (RA) is a potential candidate for concentration-guided tapering because the standard dose of tocilizumab results in a wide range of serum concentrations, usually above the presumed therapeutic window, and an exposure-response relationship has been described. However, no clinical trials have been published to date on this subject. Therefore, the objective of this study was to assess the feasibility of the tapering of intravenous (iv) tocilizumab with the use of a pharmacokinetic model-based algorithm in RA patients. METHODS A randomized controlled trial with a double-blind design and follow-up of 24 weeks was conducted. RA patients who received the standard of tocilizumab for at least the past 24 weeks, which is 8 mg/kg every 4 weeks, were included. Patients with a tocilizumab serum concentration above 5 mg/L at trough were randomized between concentration-guided dose tapering, referred to as therapeutic drug monitoring (TDM), or the standard 8 mg/kg dose. In the TDM group, the tocilizumab dose was tapered with a recently published model-based algorithm to achieve a target concentration of 4-6 mg/L after 20 weeks of dose tapering. RESULTS Twelve RA patients were included and 10 were randomized between the TDM and standard dose group. The study was feasible regarding the predefined feasibility criteria and patients had a positive attitude toward therapeutic drug monitoring. In the TDM group, the tocilizumab trough concentration within patients decreased on average by 24.5 ± 18.3 mg/L compared with a decrease of 2.8 ± 12 mg/L in the standard dose group. None of the patients in the TDM group reached the drug range of 4-6 mg/L. Instead, tocilizumab concentrations of 1.6 and 1.5 mg/L were found for the 2 patients who completed follow-up on the tapered dose. No differences in RA disease activity were observed between the 2 study groups. CONCLUSIONS This study was the first to show that it is feasible to apply a dose-reduction algorithm based on a pharmacokinetic model in clinical practice. However, the current algorithm needs to be optimized before it can be applied on a larger scale.
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Affiliation(s)
- Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Zohra Layegh
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
| | - Stefan P H van den Berg
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | - Jill Ruwaard
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
| | - Carla Bastida
- Department of Pharmacy, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Pharmacology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sara Pel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel; and
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel; and
| | - Annick de Vries
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | - Mike Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | | | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, the Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
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3
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Besten YR, Boekel L, Steenhuis M, Hooijberg F, Atiqi S, Leeuw M, Vogelzang EH, Keijser J, Keijzer S, Loeff FC, Gerritsen M, Tas SW, Nurmohamed MT, Rispens T, Wolbink G. Patient-perspective and feasibility of home finger-prick testing to complement and facilitate large-scale research in rheumatology. RMD Open 2024; 10:e003933. [PMID: 38642927 PMCID: PMC11033664 DOI: 10.1136/rmdopen-2023-003933] [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: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, we developed a digital research platform to longitudinally investigate COVID-19-related outcomes in patients with rheumatic diseases and healthy controls. We used home finger-prick testing in order to collect serum samples remotely and increase the overall efficiency of the platform. The aim of the present study was to evaluate the success rate of the finger prick and patients' perspective towards the finger prick. METHODS Serum samples were collected up to five times during follow-up, either via a venepuncture at the research institute or a finger prick from participants' home. Participants were asked to complete a digital evaluation questionnaire of the finger prick after their attempts. RESULTS A total of 2135 patients and 899 controls performed at least one finger prick and were included in this study. The first finger prick was successfully done by 92% (95% CI: 90% to 93%) of patients, 94% (95% CI: 92% to 95%) of controls, 93% (95% CI: 92% to 94%) of all participants aged ≤70 years and 89% (95% CI: 86% to 92%) of all participants aged >70 years. Sex did not impact these success rates. Repeated failure occurred in 11/439 (0.8%) patients and 4/712 (0.6%) controls. Both patients and controls were less willing to perform a finger prick for individual healthcare compared with scientific research. CONCLUSION The vast majority of participants, among which elderly and patients with rheumatic diseases, were able to successfully draw the required amount of blood for serological analyses. This shows that finger-prick testing is suitable for a high-throughput implementation to monitor patients remotely.
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Affiliation(s)
- Yaëlle R Besten
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Laura Boekel
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Immunopathology, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Femke Hooijberg
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Sadaf Atiqi
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Maureen Leeuw
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Erik H Vogelzang
- Medical Microbiology and Infection Control, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Jim Keijser
- Immunopathology, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Sofie Keijzer
- Immunopathology, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Floris C Loeff
- Immunopathology, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Martijn Gerritsen
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, VU University medical center, Amsterdam, Netherlands
| | - Theo Rispens
- Immunopathology, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Immunopathology, Sanquin Diagnostic Services, Amsterdam, Netherlands
- Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, VU University medical center, Amsterdam, Netherlands
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4
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Pier M, Wolbink G, Boekel L. Time to talk to adults with rheumatic diseases about herpes zoster vaccination. Lancet Rheumatol 2024; 6:e247-e251. [PMID: 38373432 DOI: 10.1016/s2665-9913(24)00019-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
The 2019 European Alliance of Associations for Rheumatology (EULAR) recommendations on herpes zoster vaccination for adult patients with rheumatic immune-mediated inflammatory diseases stated that these patients are at increased risk of herpes zoster compared with the general population. However, these recommendations lack clarity and specificity and are cautiously phrased, which might cause physicians to underestimate the importance of herpes zoster vaccination for these patients, potentially resulting in suboptimal protection. Since the formulation of the 2019 EULAR guidelines, new data on herpes zoster in patients with immune-mediated inflammatory diseases have been published. Moreover, a recombinant herpes zoster vaccine (Shingrix) has become available that can be given to these patients in a more accessible manner than the original live-attenuated vaccine (Zostavax). Here, we evaluate existing evidence on risk factors for herpes zoster and the safety and efficacy of the recombinant vaccine in patients with rheumatic immune-mediated inflammatory diseases and discuss the necessity of herpes zoster vaccination for these patients.
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Affiliation(s)
- Mischa Pier
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands.
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5
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Hooijberg F, Wolbink G. Therapeutic drug monitoring countering the effect of anti-infliximab antibodies. Lancet Rheumatol 2024; 6:e193-e194. [PMID: 38402892 DOI: 10.1016/s2665-9913(24)00040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Femke Hooijberg
- Amsterdam Rheumatology and immunology Center, Location Reade, Department of Rheumatology, Amsterdam, Netherlands; Amsterdam UMC, Location AMC, Department of Rheumatology, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and immunology Center, Location Reade, Department of Rheumatology, Amsterdam, Netherlands; Amsterdam UMC, Location AMC, Department of Rheumatology, Amsterdam, Netherlands; Sanquin Research and Landsteiner Laboratory Academic Medical Center, Department of Immunopathology, Amsterdam, Netherlands.
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6
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Butink M, Boekel L, Boonen A, deRijk A, Wolbink G, Webers C. Work participation and the COVID-19 pandemic: an observational study in people with inflammatory rheumatic diseases and population controls. Rheumatol Adv Pract 2024; 8:rkae026. [PMID: 38566834 PMCID: PMC10987210 DOI: 10.1093/rap/rkae026] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/09/2024] [Indexed: 04/04/2024] Open
Abstract
Objective During the coronavirus disease 2019 (COVID-19) crisis, people with inflammatory rheumatic diseases (iRDs) might have been more vulnerable for adverse work outcomes (AWOs) and restrictions in work ability and work performance. Our objectives were to compare AWOs during the pandemic and current work ability between iRD patients and controls, understand which patients are most vulnerable for these outcomes and (3) explore the role of work characteristics on work performance while working remotely. Methods Patients and population controls in a Dutch COVID-19 cohort study provided information in March 2022 on work participation in March 2020 (pre-pandemic, retrospective) and March 2022 (current). AWOs comprised withdrawal from paid work, working hours reduction or long-term sick leave. Multivariable logistic/linear regression analyses compared outcomes (AWOs/work ability) between groups (patients/controls) and within patients. Results Of the pre-pandemic working participants, 227/977 (23%) patients and 79/430 (18%) controls experienced AWOs following pandemic onset. A minority of AWOs (15%) were attributed to COVID-19. Patients were more likely to experience any-cause AWOs (odds ratio range 1.63-3.34) but not COVID-related AWOs, with female patients and patients with comorbidities or physically demanding jobs being most vulnerable. Current work ability was lower in female patients compared with controls [β = -0.66 (95% CI -0.92 to -0.40)]. In both groups, when working remotely, care for children and absence of colleagues had varying effects on work performance (positive 19% and 24%, negative 34% and 57%, respectively), while employer support and reduced commuting had mainly positive effects (83% and 86%, respectively). Conclusion During the pandemic, people with iRDs remained at increased risk of AWOs. COVID-related AWOs, however, were infrequent.
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Affiliation(s)
- Maarten Butink
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Angelique deRijk
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, The Netherlands
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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7
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Hageman I, Mol F, Atiqi S, Joustra V, Sengul H, Henneman P, Visman I, Hakvoort T, Nurmohamed M, Wolbink G, Levin E, Li Yim AY, D’Haens G, de Jonge WJ. Novel DNA methylome biomarkers associated with adalimumab response in rheumatoid arthritis patients. Front Immunol 2023; 14:1303231. [PMID: 38187379 PMCID: PMC10771853 DOI: 10.3389/fimmu.2023.1303231] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background and aims Rheumatoid arthritis (RA) patients are currently treated with biological agents mostly aimed at cytokine blockade, such as tumor necrosis factor-alpha (TNFα). Currently, there are no biomarkers to predict therapy response to these agents. Here, we aimed to predict response to adalimumab (ADA) treatment in RA patients using DNA methylation in peripheral blood (PBL). Methods DNA methylation profiling on whole peripheral blood from 92 RA patients before the start of ADA treatment was determined using Illumina HumanMethylationEPIC BeadChip array. After 6 months, treatment response was assessed according to the European Alliance of Associations for Rheumatology (EULAR) criteria for disease activity. Patients were classified as responders (Disease Activity Score in 28 Joints (DAS28) < 3.2 or decrease of 1.2 points) or as non-responders (DAS28 > 5.1 or decrease of less than 0.6 points). Machine learning models were built through stability-selected gradient boosting to predict response prior to ADA treatment with predictor DNA methylation markers. Results Of the 94 RA patients, we classified 49 and 43 patients as responders and non-responders, respectively. We were capable of differentiating responders from non-responders with a high performance (area under the curve (AUC) 0.76) using a panel of 27 CpGs. These classifier CpGs are annotated to genes involved in immunological and pathophysiological pathways related to RA such as T-cell signaling, B-cell pathology, and angiogenesis. Conclusion Our findings indicate that the DNA methylome of PBL provides discriminative capabilities in discerning responders and non-responders to ADA treatment and may therefore serve as a tool for therapy prediction.
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Affiliation(s)
- Ishtu Hageman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Femke Mol
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit (VU) University Medical Center, Amsterdam, Netherlands
| | - Vincent Joustra
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Hilal Sengul
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Peter Henneman
- Genome Diagnostics Laboratory, Department of Human Genetics, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Ingrid Visman
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit (VU) University Medical Center, Amsterdam, Netherlands
| | - Theodorus Hakvoort
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Mike Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit (VU) University Medical Center, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit (VU) University Medical Center, Amsterdam, Netherlands
| | - Evgeni Levin
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Horaizon BV, Delft, Netherlands
| | - Andrew Y.F. Li Yim
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
- Genome Diagnostics Laboratory, Department of Human Genetics, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Geert D’Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Wouter J. de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
- Department of Surgery, University of Bonn, Bonn, Germany
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8
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Boekel L, Atiqi S, Leeuw M, Hooijberg F, Besten YR, Wartena R, Steenhuis M, Vogelzang E, Webers C, Boonen A, Gerritsen M, Lems WF, Tas SW, van Vollenhoven RF, Voskuyl AE, van der Horst-Bruinsma I, Nurmohamed M, Rispens T, Wolbink G. Post-COVID condition in patients with inflammatory rheumatic diseases: a prospective cohort study in the Netherlands. The Lancet Rheumatology 2023; 5:e375-e385. [PMCID: PMC10292827 DOI: 10.1016/s2665-9913(23)00127-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
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9
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Oskam N, Ooijevaar-De Heer P, Kos D, Jeremiasse J, van Boheemen L, Verstappen GM, Kroese FGM, van Schaardenburg D, Wolbink G, Rispens T. Rheumatoid factor autoantibody repertoire profiling reveals distinct binding epitopes in health and autoimmunity. Ann Rheum Dis 2023:ard-2023-223901. [PMID: 37055152 DOI: 10.1136/ard-2023-223901] [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: 01/17/2023] [Accepted: 04/02/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Rheumatoid factors (RF) are one of the hallmark autoantibodies characteristic of rheumatoid arthritis (RA), and are frequently observed in other diseases and in healthy individuals. RFs comprise multiple subtypes with different specificities towards the constant region of human IgG. Studies indicate that these patterns differ between naturally occurring RFs and RFs associated with disease. However, individual specificities characteristic of either have not been clearly defined. METHODS In this study, we developed an extended set of engineered IgG-fragment crystallisable (Fc) targets with preferential RF binding to specific (conformational) epitopes, which was subsequently used for profiling of RF binding patterns in a compiled exploration cohort, consisting of sera from healthy donors with measurable RF and patients with RA, primary Sjögren's syndrome (pSS) and seropositive arthralgia. RESULTS We identified an epitope that is strongly associated with RA, which was targeted by both IgM-RF and IgA-RF. We also identified an epitope that is preferentially targeted by healthy donor (IgM) RFs. IgM-RFs derived from healthy donors and patients with RA and pSS all target distinct regions on the IgG-Fc, whereas overall, the IgA-RF repertoire is largely restricted to pathology-associated specificities. Using monoclonal RFs with different specificities, we furthermore demonstrate that the capacity to activate complement or even inhibit IgG-mediated complement activation varies according to the epitopes to which RFs bind. CONCLUSIONS Our results demonstrate both the need and feasibility to redefine 'RF' into pathological and physiological autoantibody subtypes.
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Affiliation(s)
- Nienke Oskam
- Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | | | - Dorien Kos
- Sanquin Reagents, Amsterdam, The Netherlands
| | - Jorn Jeremiasse
- Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | | | - Gwenny M Verstappen
- Rheumatology & Clinical Immunology, University of Groningen, Groningen, The Netherlands
| | - Frans G M Kroese
- Rheumatology & Clinical Immunology, University of Groningen, Groningen, The Netherlands
| | | | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Theo Rispens
- Immunopathology, Sanquin Research, Amsterdam, The Netherlands
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10
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Wieske L, Stalman EW, van Dam PJK, Kummer LY, Steenhuis M, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink G, Van der Kooi A, Raaphorst J, Löwenberg M, Takkenberg B, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl A, Broens B, Parra Sanchez A, van Els CACM, Wit JD, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen D, Schreurs CRG, Van der Pol WL, Goedee HS, Keijzer S, Keijser J, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Rispens T, Eftimov F. Persistence of seroconversion at 6 months following primary immunisation in patients with immune-mediated inflammatory diseases. Ann Rheum Dis 2023; 82:883-885. [PMID: 36720583 DOI: 10.1136/ard-2022-223464] [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] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - P J Koos van Dam
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Laura Y Kummer
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Zoe L E van Kempen
- Department of Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Department of Rheumatology, Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Anneke Van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Public Health and Epidemiology; Immunity and Infections, location Academic Medical Center, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Frederique J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Agner Parra Sanchez
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands.,Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jelle De Wit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,Center for Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Abraham Rutgers
- Rheumatology and Clinical Immunology, University Medical Center, Groningen, The Netherlands
| | - Karina de Leeuw
- Rheumatology and Clinical Immunology, University Medical Center, Groningen, The Netherlands
| | - Barbara Horváth
- Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Cornelia F Allaart
- Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Y K Onno Teng
- Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine/Devision of Clinical & Experimental Immunology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Rheumatology, Maastricht UMC+, Maastricht, The Netherlands.,Department of Nephrology and Clinical Immunology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | | | - Dirkjan Hijnen
- Department of Dermatology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - W Ludo Van der Pol
- Department of Neurology and Neurosurgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - Sofie Keijzer
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Jim Keijser
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Olvi Cristianawati
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Niels J M Verstegen
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Department of Pediatric Immunology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands
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11
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de Vries F, Smit AAJ, Wolbink G, de Vries A, Loeff FC, Franssen EJF. Case report: Pharmacokinetics of pembrolizumab in a patient with stage IV non-small cell lung cancer after a single 200 mg administration. Front Oncol 2023; 12:960116. [PMID: 36713570 PMCID: PMC9875126 DOI: 10.3389/fonc.2022.960116] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background Pembrolizumab is a well-tolerated biologic agent with a potentially stable and durable anti-tumor response. Unfortunately, discontinuation of therapy can occur as a consequence of immune-related adverse effects (irAEs). These irAEs appear independent of dose and exposure. However, such irAEs might also result from pembrolizumab's highly specific mechanism of action and current dosing regimens. However, the currently available pharmacokinetic (PK) and pharmacodynamic (PD) data to reassess dosing strategies are insufficient.To highlight the importance of additional PK/PD studies, we present a case describing the complexity of pembrolizumab's PK/PD after a single 200 mg pembrolizumab dose in a treatment-naive patient with non-small cell lung cancer (NSCLC). Case description A 72-year-old man with stage IV NSCLC presented hepatotoxic symptoms 19 days after receiving the first 200 mg pembrolizumab dose. Hence, pembrolizumab therapy was paused, and prednisolone therapy was initiated, which successfully inhibited the toxic effect of pembrolizumab. However, repeated flare-ups due to prednisolone tapering suggest that the toxic effect of pembrolizumab outlasts the presence of pembrolizumab in the bloodstream. This further suggests that the T-cell-mediated immune response outlasts the programmed cell death protein 1 (PD-1) receptor occupancy by pembrolizumab, which challenges the need for the current fixed-interval strategies and their stop criteria.Furthermore, a validated ELISA quantified pembrolizumab levels in 15 samples within 123 days after administration. A shift in the pembrolizumab clearance rate was evident ensuing day 77 (0.6 µg/mL) after administration. Pembrolizumab levels up to day 77 (9.1-0.6 µg/mL) strongly exhibited a linear, first-order clearance (R2 = 0.991), whereas after day 77, an accelerated non-linear clearance was observed. This transition from a linear to non-linear clearance was most likely a result of full target receptor saturation to non-full target receptor saturation, in which the added effect of target-mediated drug disposition occurs. This suggests that pembrolizumab's targets were fully saturated at levels above 0.6 µg/mL, which is 43 to 61 times lower than the steady-state trough levels (Ctrough,ss) of the currently registered fixed-dosing regimens (3-5).
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Affiliation(s)
- Fenna de Vries
- Department of Pharmacy, OLVG Hospital, Amsterdam, Netherlands,*Correspondence: Fenna de Vries,
| | | | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam, Netherlands
| | - Annick de Vries
- Diagnostic Services, Sanquin Health Solutions, Amsterdam, Netherlands
| | - Floris C. Loeff
- Diagnostic Services, Sanquin Health Solutions, Amsterdam, Netherlands
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12
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Krieckaert CL, van Tubergen A, Gehin JE, Hernández-Breijo B, Le Mélédo G, Balsa A, Böhm P, Cucnik S, Elkayam O, Goll GL, Hooijberg F, Jani M, Kiely PD, McCarthy N, Mulleman D, Navarro-Compán V, Payne K, Perry ME, Plasencia-Rodriguez C, Stones SR, Syversen SW, de Vries A, Ward KM, Wolbink G, Isaacs JD. EULAR points to consider for therapeutic drug monitoring of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis 2023; 82:65-73. [PMID: 35551063 DOI: 10.1136/annrheumdis-2022-222155] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 01/24/2022] [Accepted: 04/06/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To develop EULAR points-to-consider for therapeutic drug monitoring (TDM) of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases (RMDs). METHODS The points-to-consider were developed in accordance with EULAR standardised operation procedures by a multidisciplinary task force from eight European countries, based on a systematic literature review and expert consensus. Level of evidence and strength of the points-to-consider were determined, and mean levels of agreement among the task force were calculated using a 10-point rating scale. RESULTS Six overarching principles and 13 points-to-consider were formulated. The level of agreement among the task force for the overarching principles and points-to-consider ranged from 8.4 to 9.9.The overarching principles define TDM and its subtypes, and reinforce the underlying pharmacokinetic/pharmacodynamic principles, which are relevant to all biopharmaceutical classes. The points-to-consider highlight the clinical utility of the measurement and interpretation of biopharmaceutical blood concentrations and antidrug antibodies in specific clinical scenarios, including factors that influence these parameters. In general, proactive use of TDM is not recommended but reactive TDM could be considered in certain clinical situations. An important factor limiting wider adoption of TDM is the lack of both high quality trials addressing effectiveness and safety of TDM and robust economic evaluation in patients with RMDs. Future research should focus on providing this evidence, as well as on further understanding of pharmacokinetic and pharmacodynamic characteristics of biopharmaceuticals. CONCLUSION These points-to-consider are evidence-based and consensus-based statements for the use of TDM of biopharmaceuticals in inflammatory RMDs, addressing the clinical utility of TDM.
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Affiliation(s)
- Charlotte Lm Krieckaert
- Reumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Astrid van Tubergen
- Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Johanna Elin Gehin
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Alejandro Balsa
- Immuno-Rheumatology Research Group, La Paz University Hospital, Madrid, Spain.,Rheumatology, La Paz University Hospital, Madrid, Spain
| | - Peter Böhm
- Forschungspartner, Deutsche Rheuma-Liga Bundesverband, Bonn, Germany
| | - Sasa Cucnik
- Rheumatology, Ljubljanski Univerzitetni klinicni center, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Ori Elkayam
- Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Guro L Goll
- Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Femke Hooijberg
- Rheumatology, Reade Hoofdlocatie Dr Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Meghna Jani
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Patrick Dw Kiely
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute of Medical and Biochemical Education, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Neil McCarthy
- Patient Representative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Manchester, UK
| | - Denis Mulleman
- Rheumatology, Regional University Hospital Centre Tours, Tours, France
| | | | - Katherine Payne
- Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin E Perry
- Centre for Rheumatic Diseases, Royal Alexandra Hospital, Paisley, UK
| | | | - Simon R Stones
- EULAR Patient Research partner, Collaboro Consulting, Manchester, UK
| | | | | | - Katherine M Ward
- Department of Rheumatology, Diakonhjemmet Hospital Department of Rheumatology, Oslo, Norway
| | - Gertjan Wolbink
- Reumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.,Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK .,Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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13
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Ishigaki K, Sakaue S, Terao C, Luo Y, Sonehara K, Yamaguchi K, Amariuta T, Too CL, Laufer VA, Scott IC, Viatte S, Takahashi M, Ohmura K, Murasawa A, Hashimoto M, Ito H, Hammoudeh M, Emadi SA, Masri BK, Halabi H, Badsha H, Uthman IW, Wu X, Lin L, Li T, Plant D, Barton A, Orozco G, Verstappen SMM, Bowes J, MacGregor AJ, Honda S, Koido M, Tomizuka K, Kamatani Y, Tanaka H, Tanaka E, Suzuki A, Maeda Y, Yamamoto K, Miyawaki S, Xie G, Zhang J, Amos CI, Keystone E, Wolbink G, van der Horst-Bruinsma I, Cui J, Liao KP, Carroll RJ, Lee HS, Bang SY, Siminovitch KA, de Vries N, Alfredsson L, Rantapää-Dahlqvist S, Karlson EW, Bae SC, Kimberly RP, Edberg JC, Mariette X, Huizinga T, Dieudé P, Schneider M, Kerick M, Denny JC, Matsuda K, Matsuo K, Mimori T, Matsuda F, Fujio K, Tanaka Y, Kumanogoh A, Traylor M, Lewis CM, Eyre S, Xu H, Saxena R, Arayssi T, Kochi Y, Ikari K, Harigai M, Gregersen PK, Yamamoto K, Louis Bridges S, Padyukov L, Martin J, Klareskog L, Okada Y, Raychaudhuri S. Multi-ancestry genome-wide association analyses identify novel genetic mechanisms in rheumatoid arthritis. Nat Genet 2022; 54:1640-1651. [PMID: 36333501 PMCID: PMC10165422 DOI: 10.1038/s41588-022-01213-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [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: 12/01/2021] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Rheumatoid arthritis (RA) is a highly heritable complex disease with unknown etiology. Multi-ancestry genetic research of RA promises to improve power to detect genetic signals, fine-mapping resolution and performances of polygenic risk scores (PRS). Here, we present a large-scale genome-wide association study (GWAS) of RA, which includes 276,020 samples from five ancestral groups. We conducted a multi-ancestry meta-analysis and identified 124 loci (P < 5 × 10-8), of which 34 are novel. Candidate genes at the novel loci suggest essential roles of the immune system (for example, TNIP2 and TNFRSF11A) and joint tissues (for example, WISP1) in RA etiology. Multi-ancestry fine-mapping identified putatively causal variants with biological insights (for example, LEF1). Moreover, PRS based on multi-ancestry GWAS outperformed PRS based on single-ancestry GWAS and had comparable performance between populations of European and East Asian ancestries. Our study provides several insights into the etiology of RA and improves the genetic predictability of RA.
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Affiliation(s)
- Kazuyoshi Ishigaki
- Center for Data Sciences, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Laboratory for Human Immunogenetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Saori Sakaue
- Center for Data Sciences, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan
- The Department of Applied Genetics, The School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yang Luo
- Center for Data Sciences, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Kyuto Sonehara
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
| | - Kensuke Yamaguchi
- Department of Genomic Function and Diversity, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Tiffany Amariuta
- Center for Data Sciences, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Halıcıoğlu Data Science Institute, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Chun Lai Too
- Immunogenetics Unit, Allergy and Immunology Research Center, Institute for Medical Research, National Institutes of Health Complex, Ministry of Health, Kuala Lumpur, Malaysia
- Department of Medicine, Division of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Vincent A Laufer
- Department of Clinical Immunology and Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- Department of Pathology, Michigan Medicine, Ann Arbor, MI, USA
| | - Ian C Scott
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Burslem, UK
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sebastien Viatte
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK
| | - Meiko Takahashi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Clinical Immunology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiromu Ito
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Mohammed Hammoudeh
- Rheumatology Division, Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Samar Al Emadi
- Rheumatology Division, Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Basel K Masri
- Department of Internal Medicine, Jordan Hospital, Amman, Jordan
| | - Hussein Halabi
- Section of Rheumatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Humeira Badsha
- Dr. Humeira Badsha Medical Center, Emirates Hospital, Dubai, United Arab Emirates
| | - Imad W Uthman
- Department of Rheumatology, American University of Beirut, Beirut, Lebanon
| | - Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzeng Hospital, The Second Military Medical University, Shanghai, China
| | - Li Lin
- Department of Rheumatology and Immunology, Shanghai Changzeng Hospital, The Second Military Medical University, Shanghai, China
| | - Ting Li
- Department of Rheumatology and Immunology, Shanghai Changzeng Hospital, The Second Military Medical University, Shanghai, China
| | - Darren Plant
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK
| | - Gisela Orozco
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK
| | - Suzanne M M Verstappen
- NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK
| | | | - Suguru Honda
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masaru Koido
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Kohei Tomizuka
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Eiichi Tanaka
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Akari Suzuki
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yuichi Maeda
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Immunopathology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
| | - Kenichi Yamamoto
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Gang Xie
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Jinyi Zhang
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center (ARC), Reade, Amsterdam, the Netherlands
| | - Irene van der Horst-Bruinsma
- Department of Rheumatology & Clinical Immunology/ARC, Amsterdam Institute for Infection and Immunity, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands
| | - Jing Cui
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Katherine P Liao
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| | - Robert J Carroll
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hye-Soon Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - So-Young Bang
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Katherine A Siminovitch
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Departments of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Niek de Vries
- Department of Rheumatology & Clinical Immunology/ARC, Amsterdam Institute for Infection and Immunity, Amsterdam UMC location AMC/University of Amsterdam, Amsterdam, the Netherlands
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Elizabeth W Karlson
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Robert P Kimberly
- Center for Clinical and Translational Science, Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey C Edberg
- Center for Clinical and Translational Science, Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, Assistance Pubique - Hôpitaux de Paris, Hôpital Bicêtre, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Tom Huizinga
- Leiden University Medical Center, Leiden, the Netherlands
| | - Philippe Dieudé
- University of Paris Cité, Inserm, PHERE, F-75018, Paris, France
- Department of Rheumatology, Hôpital Bichat, APHP, Paris, France
| | - Matthias Schneider
- Department of Rheumatology & Hiller Research Unit Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Martin Kerick
- Institute of Parasitology and Biomedicine Lopez-Neyra, CSIC, Granada, Spain
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- All of Us Research Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Koichi Matsuda
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Laboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
- Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Atsushi Kumanogoh
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Immunopathology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
| | - Matthew Traylor
- Department of Medical & Molecular Genetics, King's College London, London, UK
- Department of Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK
- Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Cathryn M Lewis
- Department of Medical & Molecular Genetics, King's College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Stephen Eyre
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzeng Hospital, The Second Military Medical University, Shanghai, China
- School of Clinical Medicine Tsinghua University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, China
| | - Richa Saxena
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Thurayya Arayssi
- Department of Internal Medicine, Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
| | - Yuta Kochi
- Department of Genomic Function and Diversity, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Peter K Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kazuhiko Yamamoto
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - S Louis Bridges
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Weill Cornell Medicine, New York, NY, USA
| | - Leonid Padyukov
- Department of Medicine, Division of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Javier Martin
- Institute of Parasitology and Biomedicine Lopez-Neyra, CSIC, Granada, Spain
| | - Lars Klareskog
- Department of Medicine, Division of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan.
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan.
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan.
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Japan.
- Department of Genome Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Soumya Raychaudhuri
- Center for Data Sciences, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
- Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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14
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Boekel L, Besten YR, Hooijberg F, Wartena R, Steenhuis M, Vogelzang E, Leeuw M, Atiqi S, Tas SW, Lems WF, van Ham SM, Eftimov F, Stalman EW, Wieske L, Kuijpers TW, Voskuyl AE, van Vollenhoven RF, Gerritsen M, Krieckaert C, Rispens T, Boers M, Nurmohamed MT, Wolbink G. SARS-CoV-2 breakthrough infections in patients with immune-mediated inflammatory diseases during the omicron dominant period. The Lancet Rheumatology 2022; 4:e747-e750. [PMID: 36034738 PMCID: PMC9398211 DOI: 10.1016/s2665-9913(22)00221-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Rosa Wartena
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Erik Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Willem F Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - S Marieke van Ham
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Charlotte Krieckaert
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
| | - Theo Rispens
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, 1056 AB, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
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15
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Verstegen NJM, Hagen RR, van den Dijssel J, Kuijper LH, Kreher C, Ashhurst T, Kummer LYL, Steenhuis M, Duurland M, de Jongh R, de Jong N, van der Schoot CE, Bos AV, Mul E, Kedzierska K, van Dam KPJ, Stalman EW, Boekel L, Wolbink G, Tas SW, Killestein J, van Kempen ZLE, Wieske L, Kuijpers TW, Eftimov F, Rispens T, van Ham SM, ten Brinke A, van de Sandt CE. Immune dynamics in SARS-CoV-2 experienced immunosuppressed rheumatoid arthritis or multiple sclerosis patients vaccinated with mRNA-1273. eLife 2022; 11:e77969. [PMID: 35838348 PMCID: PMC9337853 DOI: 10.7554/elife.77969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/17/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients affected by different types of autoimmune diseases, including common conditions such as multiple sclerosis (MS) and rheumatoid arthritis (RA), are often treated with immunosuppressants to suppress disease activity. It is not fully understood how the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral and cellular immunity induced by infection and/or upon vaccination is affected by immunosuppressants. Methods The dynamics of cellular immune reactivation upon vaccination of SARS-CoV-2 experienced MS patients treated with the humanized anti-CD20 monoclonal antibody ocrelizumab (OCR) and RA patients treated with methotrexate (MTX) monotherapy were analyzed at great depth via high-dimensional flow cytometry of whole blood samples upon vaccination with the SARS-CoV-2 mRNA-1273 (Moderna) vaccine. Longitudinal B and T cell immune responses were compared to SARS-CoV-2 experienced healthy controls (HCs) before and 7 days after the first and second vaccination. Results OCR-treated MS patients exhibit a preserved recall response of CD8+ T central memory cells following first vaccination compared to HCs and a similar CD4+ circulating T follicular helper 1 and T helper 1 dynamics, whereas humoral and B cell responses were strongly impaired resulting in absence of SARS-CoV-2-specific humoral immunity. MTX treatment significantly delayed antibody levels and B reactivation following the first vaccination, including sustained inhibition of overall reactivation marker dynamics of the responding CD4+ and CD8+ T cells. Conclusions Together, these findings indicate that SARS-CoV-2 experienced MS-OCR patients may still benefit from vaccination by inducing a broad CD8+ T cell response which has been associated with milder disease outcome. The delayed vaccine-induced IgG kinetics in RA-MTX patients indicate an increased risk after the first vaccination, which might require additional shielding or alternative strategies such as treatment interruptions in vulnerable patients. Funding This research project was supported by ZonMw (The Netherlands Organization for Health Research and Development, #10430072010007), the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement (#792532 and #860003), the European Commission (SUPPORT-E, #101015756) and by PPOC (#20_21 L2506), the NHMRC Leadership Investigator Grant (#1173871).
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Affiliation(s)
- Niels JM Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Ruth R Hagen
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Jet van den Dijssel
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Lisan H Kuijper
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Christine Kreher
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Thomas Ashhurst
- Sydney Cytometry Core Research Facility, Charles Perkins Centre, Centenary Institute, and The University of SydneySydneyAustralia
- School of Medical Sciences, Faculty of Medicine and Health, The University of SydneySydneyAustralia
| | - Laura YL Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Mariel Duurland
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Rivka de Jongh
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Nina de Jong
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Amélie V Bos
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Erik Mul
- Department of Research Facilities, Sanquin ResearchAmsterdamNetherlands
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido UniversitySapporoJapan
| | - Koos PJ van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and immunology CenterAmsterdamNetherlands
| | - Gertjan Wolbink
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Rheumatology, Amsterdam Rheumatology and immunology CenterAmsterdamNetherlands
| | - Sander W Tas
- Amsterdam Rheumatology and immunology Center, Department of Rheumatology and Clinical Immunology, University of AmsterdamAmsterdamNetherlands
| | - Joep Killestein
- Amsterdam UMC, Vrije Universiteit, Department of NeurologyAmsterdamNetherlands
| | - Zoé LE van Kempen
- Amsterdam UMC, Vrije Universiteit, Department of NeurologyAmsterdamNetherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
- Department of Clinical Neurophysiology, St Antonius HospitalNieuwegeinNetherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, University of AmsterdamAmsterdamNetherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Swammerdam Institute for Life Sciences, University of AmsterdamAmsterdamNetherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Carolien E van de Sandt
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
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16
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Palomares Cabeza V, Kummer LYL, Wieske L, Hagen RR, Duurland M, Konijn VAL, van Dam KPJ, Stalman EW, van de Sandt CE, Boekel L, Verstegen NJM, Steenhuis M, Rispens T, Tas SW, Wolbink G, Killestein J, Kuijpers TW, van Ham SM, Eftimov F, Brinke AT, van Kempen ZLE. Longitudinal T-Cell Responses After a Third SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis on Ocrelizumab or Fingolimod. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/4/e1178. [PMID: 35523569 PMCID: PMC9082763 DOI: 10.1212/nxi.0000000000001178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate whether a third vaccination shows an added effect on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) T-cell responses in patients with multiple sclerosis treated with ocrelizumab or fingolimod. METHODS This is a substudy of a prospective multicenter study on SARS-CoV-2 vaccination in patients with immune-mediated diseases. Patients with MS treated with ocrelizumab, fingolimod, and no disease-modifying therapies and healthy controls were included. The number of interferon (IFN)-γ secreting SARS-CoV-2-specific T cells at multiple time points before and after 3 SARS-CoV-2 vaccinations were evaluated. RESULTS In ocrelizumab-treated patients (N = 24), IFN-γ-producing SARS-CoV-2-specific T-cell responses were induced after 2 vaccinations with median levels comparable to healthy controls (N = 12) and patients with MS without disease-modifying therapies (N = 10). A third vaccination in ocrelizumab-treated patients (N = 8) boosted T-cell responses that had declined after the second vaccination, but did not lead to higher overall T-cell responses as compared to immediately after a second vaccination. In fingolimod-treated patients, no SARS-CoV-2-specific T cells were detected after second (N = 12) and third (N = 9) vaccinations. DISCUSSION In ocrelizumab-treated patients with MS, a third SARS-CoV-2 vaccination had no additive effect on the maximal T-cell response but did induce a boost response. In fingolimod-treated patients, no T-cell responses could be detected following both a second and third SARS-CoV-2 vaccination.
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Affiliation(s)
- Virginia Palomares Cabeza
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Laura Y L Kummer
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands.
| | - Luuk Wieske
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Ruth R Hagen
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Mariel Duurland
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Veronique A L Konijn
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Koos P J van Dam
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Eileen W Stalman
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Carolien E van de Sandt
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Laura Boekel
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Niels J M Verstegen
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Maurice Steenhuis
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Theo Rispens
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Sander W Tas
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Gertjan Wolbink
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Joep Killestein
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Taco W Kuijpers
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - S Marieke van Ham
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Filip Eftimov
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Anja Ten Brinke
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
| | - Zoé L E van Kempen
- From the Department of Immunopathology (V.P.C., L.Y.L.K., M.D., V.A.L.K., N.J.M.V., M.S., T.R., G.W., S.M.v.H., A.t.B.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Neurology and Neurophysiology (L.K., L.W., K.P.J.v.D., E.W.S., F.E.), Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam; Department of Hematopoiesis (R.R.H., C.E.v.d.S.), Sanquin Research and Landsteiner Laboratory, Amsterdam UMC; Department of Experimental Immunohematology (R.R.H.), Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands; Department of Microbiology and Immunology (C.E.v.d.S.), University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Amsterdam Rheumatology and Immunology Center (L.B., G.W.), location Reade, Department of Rheumatology; Amsterdam Rheumatology and Immunology Center (S.W.T.), Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam; Department of Neurology (J.K., Z.L.E.v.K.), Amsterdam UMC, Vrije Universiteit; Department 32 of Pediatric Immunology (T.W.K.), Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam; and Swammerdam Institute for Life Sciences (S.M.v.H.), University of Amsterdam, the Netherlands
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Kummer L, Wieske L, Stalman E, Van Dam K, Boekel L, Wolbink G, Volkers A, Steenhuis M, Verstegen N, Rispens T, Ten Brinke A, Van Kempen Z, Tas S, Van Ham M, Kuijpers T, Eftimov F. POS1256 RISK FACTORS FOR SHORT-TERM ADVERSE EVENT IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3736] [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: 11/04/2022]
Abstract
BackgroundMany countries are promoting booster SARS-CoV-2 vaccination campaigns as the COVID-19 pandemic continues. Incremental short-term adverse events after two SARS-CoV-2 vaccinations have been reported in healthy individuals.1,2 However, data on incremental short-term adverse events in patients with various immune-mediated inflammatory diseases (IMIDs) after repeated SARS-CoV-2 vaccination is scarce.ObjectivesWe report risk factors for short-term adverse events in IMID patients after SARS-CoV-2 vaccination.MethodsSelf-reported daily questionnaires on adverse events in the first seven days after SARS-CoV-2 vaccination were obtained from individuals participating in an ongoing prospective multi-arm multicenter cohort study on SARS-CoV-2 vaccination in patients with various IMIDs in the Netherlands (T2B! immunity after SARS-CoV-2). Clinically relevant adverse events were defined as systemic adverse advents lasting longer than two days or hindering daily activities. Adjusted relative risks for developing clinically relevant adverse events were calculated using a logistic mixed-effects model.ResultsData of 2081 patients and 178 healthy controls were obtained. Inflammatory bowel disease (N:480), Multiple sclerosis (N:343) and Rheumatoid arthritis (N:266) were the largest disease groups. Adjusted relative risks for relevant adverse events are presented in Figure 1. Third vaccination was not associated with increased risk on adverse events when compared to a second vaccination (aRR: 0.93 95% CI: 0.84-1.02). Patients with IMIDs were at increased risk for developing adverse events after vaccination when compared to controls (aRR: 1.16 95% CI: 1.01-1.34). Female sex (aRR 1.43 95% CI: 1.32-1.56), age below 50 (aRR 1.14 95% CI: 1.06-1.23) and a preceding SARS-CoV-2 infection (aRR: 1.14 95% CI: 1.01-1.29) were also associated with increased risk of adverse events following vaccination. Allergic reactions and hospital admission were uncommon (0.67% and 0.19% respectively); 7.4% and 6.8% of patients reported adverse events impacting daily life on day seven after second and third vaccination, respectively. Data on increase in disease activity of the IMID following vaccination are currently being investigated.Figure 1.Risk factors for adverse events after SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseaseConclusionA third SARS-CoV-2 vaccination was not associated with an increased risk on short-term clinically relevant adverse events when compared to a second vaccination. Although patients with IMIDs may be slightly more at risk to develop adverse events after SARS-CoV-2 vaccination, most adverse events were transient and disappeared within seven days. This message should reassure IMID patients who are hesitant on booster vaccination. Data on potential IMID flare-ups after vaccination will follow.References[1]Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577[2]Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403-416. doi:10.1056/NEJMoa2035389AcknowledgementsWe would like to thank ZonMw (The Netherlands Organization for Health Research and Development, grant 10430072010007) for the funding of the study and the T2B partners, including the patient groups and Health Holland for the support in this study. Also, we would like to thank E.P. Moll van Charante, J.A Bogaards and R.A. Scholten for their guidance in the data safety monitoring board.Disclosure of InterestsLaura Kummer: None declared, Luuk Wieske: None declared, Eileen Stalman: None declared, Koos van Dam: None declared, Laura Boekel: None declared, Gertjan Wolbink Grant/research support from: GW reported a grant from ZonMW (Netherlands Organization for Healthcare research and Innovation) for COVID research in patients with auto-immune diseases., Adriaan Volkers: None declared, Maurice Steenhuis: None declared, Niels Verstegen: None declared, Theo Rispens: None declared, Anja ten Brinke: None declared, Zoé van Kempen: None declared, Sander Tas: None declared, Marieke van Ham: None declared, Taco Kuijpers Grant/research support from: TW reported a grant from ZonMW (Netherlands Organization for Healthcare research and Innovation) for COVID research in patients with auto-immune diseases., Filip Eftimov Grant/research support from: FE reported a grant from ZonMW (Netherlands Organization for Healthcare research and Innovation) for COVID research in patients with auto-immune diseases.
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Krieckaert C, Hernández-Breijo B, Gehin JE, le Mélédo G, Balsa A, Jani M, Mulleman D, Navarro-Compan V, Wolbink G, Isaac J, van Tubergen A. Therapeutic drug monitoring of biopharmaceuticals in inflammatory rheumatic and musculoskeletal disease: a systematic literature review informing EULAR points to consider. RMD Open 2022; 8:e002216. [PMID: 35980738 PMCID: PMC9171282 DOI: 10.1136/rmdopen-2022-002216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/26/2022] [Accepted: 05/18/2022] [Indexed: 01/08/2023] Open
Abstract
The objectives of this review were to collect and summarise evidence on therapeutic drug monitoring (TDM) of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases and to inform the EULAR Task Force for the formulation of evidence-based points to consider. A systematic literature review (SLR) was performed, covering technical aspects and (clinical) utility of TDM, to answer 13 research questions. MEDLINE, Embase and Cochrane were searched until July 2020. American College of Rheumatology and EULAR abstracts were also considered for inclusion. Data were extracted in evidence tables and risk of bias assessment was performed. For the search on technical aspects, 678 records were identified, of which 22 papers were selected. For the clinical utility search, 3846 records were identified, of which 108 papers were included. Patient-related factors associated with biopharmaceutical blood concentrations included body weight, methotrexate comedication and disease activity. The identification of a target range was hampered by study variability, mainly disease activity measures and study type. Evidence was inconsistent for multiple clinical situations in which TDM is currently applied. However, for some particular scenarios, including prediction of future treatment response, non-response to treatment, tapering and hypersensitivity reactions, robust evidence was found. There is currently no evidence for routine use of proactive TDM, in part because published cost-effectiveness analyses do not incorporate the current landscape of biopharmaceutical costs and usage. This SLR yields evidence in favour of TDM of biopharmaceuticals in some clinical scenarios, but evidence is insufficient to support implementation of routine use of TDM.
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Affiliation(s)
- Charlotte Krieckaert
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Johanna Elin Gehin
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | | | - Meghna Jani
- Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
- department of Rheumatology, Salford Royal Hospitals NHS Trust, Salford, UK
| | | | | | - Gertjan Wolbink
- Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - John Isaac
- Translational and Clinical Research Institute, Newcastle University and Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Astrid van Tubergen
- department of Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Boekel L, Stalman EW, Wieske L, Hooijberg F, van Dam KPJ, Besten YR, Kummer LYL, Steenhuis M, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Parra Sanchez A, van Els CACM, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, van der Pol WL, Goedee HS, Vogelzang EH, Leeuw M, Atiqi S, van Vollenhoven R, Gerritsen M, van der Horst-Bruinsma IE, Lems WF, Nurmohamed MT, Boers M, Keijzer S, Keijser J, van de Sandt C, Boogaard A, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Rispens T, Kuijpers TW, Wolbink G, Eftimov F. Breakthrough SARS-CoV-2 infections with the delta (B.1.617.2) variant in vaccinated patients with immune-mediated inflammatory diseases using immunosuppressants: a substudy of two prospective cohort studies. The Lancet Rheumatology 2022; 4:e417-e429. [PMID: 35527808 PMCID: PMC9054068 DOI: 10.1016/s2665-9913(22)00102-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Concerns have been raised regarding the risks of SARS-CoV-2 breakthrough infections in vaccinated patients with immune-mediated inflammatory diseases treated with immunosuppressants, but clinical data on breakthrough infections are still scarce. The primary objective of this study was to compare the incidence and severity of SARS-CoV-2 breakthrough infections between patients with immune-mediated inflammatory diseases using immunosuppressants, and controls (patients with immune-mediated inflammatory diseases not taking immunosuppressants and healthy controls) who had received full COVID-19 vaccinations. The secondary objective was to explore determinants of breakthrough infections of the delta (B.1.617.2) variant of SARS-CoV-2, including humoral immune responses after vaccination. Methods In this substudy, we pooled data collected in two large ongoing prospective multicentre cohort studies conducted in the Netherlands (Target to-B! [T2B!] study and Amsterdam Rheumatology Center COVID [ARC-COVID] study). Both studies recruited adult patients (age ≥18 years) with immune-mediated inflammatory diseases and healthy controls. We sourced clinical data from standardised electronic case record forms, digital questionnaires, and medical files. We only included individuals who were vaccinated against SARS-CoV-2. For T2B!, participants were recruited between Feb 2 and Aug 1, 2021, and for ARC-COVID, participants were recruited between April 26, 2020, and March 1, 2021. In this study we assessed data on breakthrough infections collected between July 1 and Dec 15, 2021, a period in which the delta SARS-CoV-2 variant was the dominant variant in the Netherlands. We defined a SARS-CoV-2 breakthrough infection as a PCR-confirmed or antigen test-confirmed SARS-CoV-2 infection that occurred at least 14 days after vaccination. All breakthrough infections during this period were assumed to be due to the delta variant due to its dominance during the study period. We analysed post-vaccination serum samples for anti-receptor binding domain (RBD) antibodies to assess the humoral vaccination response (T2B! study only) and anti-nucleocapsid antibodies to identify asymptomatic breakthrough infections (ARC-COVID study only). We used multivariable logistic regression analyses to explore potential clinical and humoral determinants associated with the odds of breakthrough infections. The T2B! study is registered with the Dutch Trial Register, Trial ID NL8900, and the ARC-COVID study is registered with Dutch Trial Register, trial ID NL8513. Findings We included 3207 patients with immune-mediated inflammatory diseases who receive immunosuppressants, and 1807 controls (985 patients with immune-mediated inflammatory disease not on immunosuppressants and 822 healthy controls). Among patients receiving immunosuppressants, mean age was 53 years (SD 14), 2042 (64%) of 3207 were female and 1165 (36%) were male; among patients not receiving immunosuppressants, mean age was 54 years (SD 14), 598 (61%) of 985 were female and 387 (39%) were male; and among healthy controls, mean age was 57 years (SD 13), 549 (67%) of 822 were female and 273 (33%) were male. The cumulative incidence of PCR-test or antigen-test confirmed SARS-CoV-2 breakthrough infections was similar in patients on immunosuppressants (148 of 3207; 4·6% [95% CI 3·9–5·4]), patients not on immunosuppressants (52 of 985; 5·3% [95% CI 4·0–6·9]), and healthy controls (33 of 822; 4·0% [95% CI 2·8–5·6]). There was no difference in the odds of breakthrough infection for patients with immune-mediate inflammatory disease on immunosuppressants versus combined controls (ie, patients not on immunosuppressants and healthy controls; adjusted odds ratio 0·88 [95% CI 0·66–1·18]). Seroconversion after vaccination (odds ratio 0·58 [95% CI 0·34–0·98]; T2B! cohort only) and SARS-CoV-2 infection before vaccination (0·34 [0·18–0·56]) were associated with a lower odds of breakthrough infections. Interpretation The incidence and severity of SARS-CoV-2 breakthrough infections in patients with immune-mediated inflammatory diseases on immunosuppressants was similar to that in controls. However, caution might still be warranted for those on anti-CD20 therapy and those with traditional risk factors. Funding ZonMw (the Netherlands Organization for Health Research and Development) and Reade foundation.
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Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Zoé L E van Kempen
- Department of Neurology Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Annelie H Musters
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Nicoline F Post
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Angela L Bosma
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Groningen, Groningen, Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Groningen, Groningen, Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology section, Leiden University Medical Center, Leiden, Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - W Ludo van der Pol
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands
| | - H Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | | | - Willem F Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
| | - Sofie Keijzer
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Jim Keijser
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Carolien van de Sandt
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Arend Boogaard
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Olvi Cristianawati
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Anja Ten Brinke
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels J M Verstegen
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | | | - S Marieke van Ham
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
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Boekel L, Hooijberg F, Besten YR, Vogelzang EH, Steenhuis M, Leeuw M, Atiqi S, van Vollenhoven R, Lems WF, Bos WH, Wijbrandts CA, Gerritsen M, Krieckaert C, Voskuyl AE, van der Horst-Bruinsma IE, Tas SW, Boers M, Rispens T, Nurmohamed MT, Wolbink G. COVID-19 vaccine acceptance over time in patients with immune-mediated inflammatory rheumatic diseases. The Lancet Rheumatology 2022; 4:e310-e313. [PMID: 35156061 PMCID: PMC8824534 DOI: 10.1016/s2665-9913(22)00009-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Femke Hooijberg
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Yaëlle R Besten
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
| | - Maureen Leeuw
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Sadaf Atiqi
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
| | - Willem F Lems
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Wouter H Bos
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Carla A Wijbrandts
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Martijn Gerritsen
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
| | - Charlotte Krieckaert
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Vrije Universiteit, Amsterdam UMC, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam UMC, Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam 1056 AB, Netherlands
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
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Boekel L, Hooijberg F, Vogelzang EH, Besten YR, Leeuw M, Atiqi S, van Vollenhoven RF, Wijbrandts CA, Gerritsen M, Krieckaert C, Dijkshoorn B, Bakhlakh S, Crooijmans JJ, Voskuyl A, van der Horst-Bruinsma IE, Lems W, Kuijpers TW, van Ham SM, Wieske L, Eftimov F, Kummer LY, van Dam PK, Stalman EW, Steenhuis M, Keijzer S, Cristianawati O, Keijser J, Loeff FC, Tas SW, Nurmohamed MT, Boers M, Rispens T, Wolbink G. Antibody development and disease severity of COVID-19 in non-immunised patients with rheumatic immune-mediated inflammatory diseases: data from a prospective cohort study. RMD Open 2022; 8:rmdopen-2021-002035. [PMID: 35383121 PMCID: PMC8983412 DOI: 10.1136/rmdopen-2021-002035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/10/2022] [Indexed: 02/07/2023] Open
Abstract
Background Research on the disease severity of COVID-19 in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) has been inconclusive, and long-term prospective data on the development of SARS-CoV-2 antibodies in these patients are lacking. Methods Adult patients with rheumatic IMIDs from the Amsterdam Rheumatology and Immunology Center, Amsterdam were invited to participate. All patients were asked to recruit their own sex-matched and age-matched control subject. Clinical data were collected via online questionnaires (at baseline, and after 1–4 and 5–9 months of follow-up). Serum samples were collected twice and analysed for the presence of SARS-CoV-2-specific antibodies. Subsequently, IgG titres were quantified in samples with a positive test result. Findings In total, 3080 consecutive patients and 1102 controls with comparable age and sex distribution were included for analyses. Patients were more frequently hospitalised compared with controls when infected with SARS-CoV-2; 7% vs 0.7% (adjusted OR: 7.33, 95% CI: 0.96 to 55.77). Only treatment with B-cell targeting therapy was independently associated with an increased risk of COVID-19-related hospitalisation (adjusted OR: 14.62, 95% CI: 2.31 to 92.39). IgG antibody titres were higher in hospitalised compared with non-hospitalised patients, and slowly declined with time in similar patterns for patients in all treatment subgroups and controls. Interpretation We observed that patients with rheumatic IMIDs, especially those treated with B-cell targeting therapy, were more likely to be hospitalised when infected with SARS-CoV-2. Treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs other than B-cell targeting agents is unlikely to have negative effects on the development of long-lasting humoral immunity against SARS-CoV-2.
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Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Ronald F van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Carla A Wijbrandts
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - C Krieckaert
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Bas Dijkshoorn
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Siham Bakhlakh
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Juliette J Crooijmans
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Willem Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Laura Y Kummer
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Pj Koos van Dam
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Jim Keijser
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Floris C Loeff
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University medical center, Amsterdam, The Netherlands.,Department of Epidemiology & Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
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22
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Wieske L, Kummer LYL, van Dam KPJ, Stalman EW, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, Volkers AG, D'Haens GRAM, Tas SW, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Killestein J, van Kempen ZLE, Voskuyl AE, Broens B, Sanchez AP, Wolbink G, Boekel L, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah BP, Brusse E, van Doorn PA, Baars AE, Hijnen D, Schreurs CRG, van der Pol WL, Goedee HS, Steenhuis M, Rispens T, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Eftimov F. Risk factors associated with short-term adverse events after SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseases. BMC Med 2022; 20:100. [PMID: 35236350 PMCID: PMC8889379 DOI: 10.1186/s12916-022-02310-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have suggested incremental short-term adverse events (AE) after repeated vaccination. In this report, we assessed occurrence and risk factors for short-term AEs following repeated SARS-CoV-2 vaccination in patients with various immune-mediated inflammatory diseases (IMIDs). METHODS Self-reported daily questionnaires on AEs during the first 7 days after vaccination were obtained of 2259 individuals (2081 patients and 178 controls) participating in an ongoing prospective multicenter cohort study on SARS-CoV-2 vaccination in patients with various IMIDs in the Netherlands (T2B-COVID). Relative risks were calculated for potential risk factors associated with clinically relevant AE (rAE), defined as AE lasting longer than 2 days or impacting daily life. RESULTS In total, 5454 vaccinations were recorded (1737 first, 1992 second and 1478 third vaccinations). Multiple sclerosis, Crohn's disease and rheumatoid arthritis were the largest disease groups. rAEs were reported by 57.3% (95% CI 54.8-59.8) of patients after the first vaccination, 61.5% (95% CI 59.2-63.7) after the second vaccination and 58% (95% CI 55.3-60.6) after the third vaccination. At day 7 after the first, second and third vaccination, respectively, 7.6% (95% CI 6.3-9.1), 7.4% (95% CI 6.2-8.7) and 6.8% (95% CI 5.4-8.3) of patients still reported AEs impacting daily life. Hospital admissions and allergic reactions were uncommon (<0.7%). Female sex (aRR 1.43, 95% CI 1.32-1.56), age below 50 (aRR 1.14, 95% CI 1.06-1.23), a preceding SARS-CoV-2 infection (aRR 1.14, 95% CI 1.01-1.29) and having an IMID (aRR 1.16, 95% CI 1.01-1.34) were associated with increased risk of rAEs following a vaccination. Compared to the second vaccination, the first vaccination was associated with a lower risk of rAEs (aRR 0.92, 95% CI 0.84-0.99) while a third vaccination was not associated with increased risk on rAEs (aRR 0.93, 95% CI 0.84-1.02). BNT162b2 vaccines were associated with lower risk on rAEs compared to CX-024414 (aRR 0.86, 95% CI 0.80-0.93). CONCLUSIONS A third SARS-CoV-2 vaccination was not associated with increased risk of rAEs in IMID patients compared to the second vaccination. Patients with an IMID have a modestly increased risk of rAEs after vaccination when compared to controls. Most AEs are resolved within 7 days; hospital admissions and allergic reactions were uncommon. TRIAL REGISTRATION NL74974.018.20 , Trial ID: NL8900. Registered on 9 September 2020.
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Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Public Health/Infection and Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology Section, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B Papay Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dirkjan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Niels J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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23
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Oomen I, Nassar-Sheikh Rashid A, Bouts AH, Gouw SC, Kuijpers TW, Rispens T, de Vries A, Wolbink G, van den Berg JM, Schonenberg-Meinema D. Anti-rituximab antibodies affect pharmacokinetics and pharmacodynamics of rituximab in children with immune-mediated diseases. Clin Exp Rheumatol 2022; 40:183-190. [DOI: 10.55563/clinexprheumatol/ftira8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/07/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Ilja Oomen
- Department of Paediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands.
| | - Amara Nassar-Sheikh Rashid
- Department of Paediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Antonia H.M. Bouts
- Department of Paediatric Nephrology, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Samantha C. Gouw
- Department of Paediatric Haematology, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Taco W. Kuijpers
- Department of Paediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Annick de Vries
- Department of Biologics Laboratory, Bioanalysis, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, and Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - J. Merlijn van den Berg
- Department of Paediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Paediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands
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24
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van der Vossen AH, van der Woude HJ, Hindori VG, Wolbink G, van den Bekerom MPJ, van Deurzen DFP. [Swelling at the sternoclavicular joint]. Ned Tijdschr Geneeskd 2021; 165:D5665. [PMID: 34854595] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A visible mass around the sternoclavicular (SC) joint may be explained by a wide variety of diagnoses, each with its own diagnostic pathway and treatment options. Here we report three cases: a 56-year-old male with an anterior luxation of the right SC joint, a 59-year-old male with osteomyelitis of the left SC joint and a 78-year-old male with a painless swelling to the right medial clavicle, interpreted as sterno-costo-clavicular hyperostosis (SCCH) as part of his SAPHO syndrome. An atraumatic swelling of the SC joint is most often caused by osteoarthritis, characterized by a slowly progressing solid swelling. Acute swelling with concurrent redness and fever justifies an intra-articular- or bone aspiration, possibly CT guided, in combination with laboratory blood tests to differentiate between an infectious or rheumatologic cause. Since there are also multiple rare diseases that present specifically around the SC joint, a multidisciplinary review often proves helpful.
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25
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Ghalandari N, Kemper E, Crijns IH, Wolbink G, Rispens T, Smeele HT, Dolhain RJ. Analysing cord blood levels of TNF inhibitors to validate the EULAR points to consider for TNF inhibitor use during pregnancy. Ann Rheum Dis 2021; 81:402-405. [PMID: 34493490 PMCID: PMC8862049 DOI: 10.1136/annrheumdis-2021-221036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND To minimise placental transfer of tumour necrosis factor inhibitors (TNFi), the European League Against Rheumatism (EULAR) created points to consider (PtC) for the use of TNFi during pregnancy. We are the first to validate the EULAR-PtC by analysing TNFi concentrations in cord blood. METHODS Patients were derived from the Preconceptional Counselling in Active Rheumatoid Arthritis Study. TNFi was stopped at the time points recommended by the EULAR. Maternal blood and cord blood were collected and analysed for the concentration of TNFi. RESULTS 111 patients were eligible for the analysis. Median stop time points were gestational age (GA) 37.0 weeks for certolizumab pegol, GA 25.0 weeks for etanercept, GA 19.0 weeks for adalimumab and GA 18.4 weeks for infliximab. Certolizumab pegol (n=68) was detectable in 5.9% of cord blood samples, with a median concentration of 0.3 µg/mL (IQR: 0.2-1.3) and a median cord/maternal concentration ratio of 0.010. Etanercept (n=30) was not detected in any cord blood samples. Adalimumab (n=25) was detectable in 48.0% of cord blood samples, with a median concentration of 0.5 µg/mL (IQR: 0.2-0.7) and a median concentration ratio of 0.062 (IQR: 0.018-0.15). Infliximab (n=14) was detectable in 57.1% of cord blood samples, with a median concentration of 0.4 µg/mL (IQR: 0.1-1.2) and a median concentration ratio of 0.012 (IQR: 0.006-0.081). CONCLUSION Compliance with the EULAR-PtC results in absence or low levels of TNFi in cord blood.
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Affiliation(s)
- Nafise Ghalandari
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands .,FT1/GMB, Medicines Evaluation Board, Utrecht, The Netherlands
| | - Erik Kemper
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.,FT1/GMB, Medicines Evaluation Board, Utrecht, The Netherlands
| | | | - Gertjan Wolbink
- Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands.,Rheumatology, Jan van Breemen Research Institute
- Reade, Amsterdam, Netherlands
| | - Theo Rispens
- Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
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26
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Boekel L, Steenhuis M, Hooijberg F, Besten YR, van Kempen ZLE, Kummer LY, van Dam KPJ, Stalman EW, Vogelzang EH, Cristianawati O, Keijzer S, Vidarsson G, Voskuyl AE, Wieske L, Eftimov F, van Vollenhoven R, Kuijpers TW, van Ham SM, Tas SW, Killestein J, Boers M, Nurmohamed MT, Rispens T, Wolbink G. Antibody development after COVID-19 vaccination in patients with autoimmune diseases in the Netherlands: a substudy of data from two prospective cohort studies. Lancet Rheumatol 2021; 3:e778-e788. [PMID: 34396154 PMCID: PMC8346242 DOI: 10.1016/s2665-9913(21)00222-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Data are scarce on immunogenicity of COVID-19 vaccines in patients with autoimmune diseases, who are often treated with immunosuppressive drugs. We aimed to investigate the effect of different immunosuppressive drugs on antibody development after COVID-19 vaccination in patients with autoimmune diseases. Methods In this study, we used serum samples collected from patients with autoimmune diseases and healthy controls who were included in two ongoing prospective cohort studies in the Netherlands. Participants were eligible for inclusion in this substudy if they had been vaccinated with any COVID-19 vaccine via the Dutch national vaccine programme, which at the time was prioritising vaccination of older individuals. Samples were collected after the first or second COVID-19 vaccination. No serial samples were collected. Seroconversion rates and IgG antibody titres against the receptor-binding domain of the SARS-CoV-2 spike protein were measured. Logistic and linear regression analyses were used to investigate the association between medication use at the time of vaccination and at least until sampling, seroconversion rates, and IgG antibody titres. The studies from which data were collected are registered on the Netherlands Trial Register, Trial ID NL8513, and ClinicalTrials.org, NCT04498286. Findings Between April 26, 2020, and March 1, 2021, 3682 patients with rheumatic diseases, 546 patients with multiple sclerosis, and 1147 healthy controls were recruited to participate in the two prospective cohort studies. Samples were collected from patients with autoimmune diseases (n=632) and healthy controls (n=289) after their first (507 patients and 239 controls) or second (125 patients and 50 controls) COVID-19 vaccination. The mean age of both patients and controls was 63 years (SD 11), and 423 (67%) of 632 patients with autoimmune diseases and 195 (67%) of 289 controls were female. Among participants without previous SARS-CoV-2 infection, seroconversion after first vaccination were significantly lower in patients than in controls (210 [49%] of 432 patients vs 154 [73%] of 210 controls; adjusted odds ratio 0·33 [95% CI 0·23–0·48]; p<0·0001), mainly due to lower seroconversion in patients treated with methotrexate or anti-CD20 therapies. After the second vaccination, seroconversion exceeded 80% in all patient treatment subgroups, except among those treated with anti-CD20 therapies (three [43%] of seven patients). We observed no difference in seroconversion and IgG antibody titres between patients with a previous SARS-CoV-2 infection who had received a single vaccine dose (72 [96%] of 75 patients, median IgG titre 127 AU/mL [IQR 27–300]) and patients without a previous SARS-CoV-2 infection who had received two vaccine doses (97 [92%] of 106 patients, median IgG titre 49 AU/mL [17–134]). Interpretation Our data suggest that seroconversion after a first COVID-19 vaccination is delayed in older patients on specific immunosuppressive drugs, but that second or repeated exposure to SARS-CoV-2, either via infection or vaccination, improves humoral immunity in patients treated with immunosuppressive drugs. Therefore, delayed second dosing of COVID-19 vaccines should be avoided in patients receiving immunosuppressive drugs. Future studies that include younger patients need to be done to confirm the generalisability of our results. Funding ZonMw, Reade Foundation, and MS Center Amsterdam.
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Affiliation(s)
- Laura Boekel
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
| | | | - Femke Hooijberg
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
| | - Yaëlle R Besten
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
| | | | - Laura Y Kummer
- Department of Immunopathology, Amsterdam, Netherlands
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, University of Amsterdam, Amsterdam, Netherlands
| | | | - Sofie Keijzer
- Department of Immunopathology, Amsterdam, Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | | | - Maarten Boers
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Amsterdam, Netherlands
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, location Reade, Department of Rheumatology, Amsterdam, Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands
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Jacobse J, ten Voorde W, Tandon A, Romeijn SG, Grievink HW, van der Maaden K, van Esdonk MJ, Moes DJA, Loeff F, Bloem K, de Vries A, Rispens T, Wolbink G, de Kam M, Ziagkos D, Moerland M, Jiskoot W, Bouwstra J, Burggraaf J, Schrier L, Rissmann R, ten Cate R. Comprehensive evaluation of microneedle-based intradermal adalimumab delivery vs. subcutaneous administration: results of a randomized controlled clinical trial. Br J Clin Pharmacol 2021; 87:3162-3176. [PMID: 33403697 PMCID: PMC8359405 DOI: 10.1111/bcp.14729] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS To evaluate feasibility of intradermal (i.d.) adalimumab administration using hollow microneedles, and to compare a single i.d. dose of adalimumab using a hollow microneedle with a single subcutaneous (s.c.) dose using a conventional needle. METHODS In this single-centre double-blind, placebo-controlled, double-dummy clinical trial in 24 healthy adults we compared 40 mg adalimumab (0.4 mL) administered i.d. using a hollow microneedle with a s.c. dose using a conventional needle. Primary parameters were pain, acceptability and local tolerability; secondary parameters safety, pharmacokinetics and immunogenicity. We explored usability of optical coherence tomography, clinical photography, thermal imaging, and laser speckle contrast imaging to evaluate skin reaction after i.d. injections. In vitro protein analysis was performed to assess compatibility of adalimumab with the hollow microneedle device. RESULTS While feasible and safe, injection pain of i.d. adalimumab was higher compared to s.c. adalimumab (35.4 vs. 7.9 on a 100-point visual analogue scale). Initial absorption rate and relative bioavailability were higher after i.d. adalimumab (time to maximum plasma concentration = 95 h [47-120]; Frel = 129% [6.46%]) compared to s.c. adalimumab (time to maximum plasma concentration = 120 h [96-221]). Anti-adalimumab antibodies were detected in 50% and 83% of the subjects after i.d. and s.c. adalimumab, respectively. We observed statistically significantly more erythema and skin perfusion after i.d. adalimumab, compared to s.c. adalimumab and placebo injections (P < .0001). Cytokine secretion after whole blood lipopolysaccharide challenge was comparable between administration routes. CONCLUSIONS Intradermal injection of adalimumab using hollowing microneedles was perceived as more painful and less accepted than s.c. administration, but yields a higher relative bioavailability with similar safety and pharmacodynamic effects.
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Affiliation(s)
- Justin Jacobse
- Department of Pediatric Rheumatology Willem‐Alexander Children's HospitalLeiden University Medical CenterLeidenthe Netherlands
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
- Currently also affiliated with department of PathologyMicrobiology and Immunology at Vanderbilt UniversityNashvilleTennesseeUSA
| | - Wouter ten Voorde
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | | | - Stefan G. Romeijn
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | | | - Koen van der Maaden
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | | | - Dirk Jan A.R. Moes
- Department of Clinical Pharmacy & ToxicologyLeiden University Medical CenterLeidenthe Netherlands
| | - Floris Loeff
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Karien Bloem
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Theo Rispens
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Gertjan Wolbink
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | | | | | | | - Wim Jiskoot
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | - Joke Bouwstra
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | - Lenneke Schrier
- Department of Pediatric Rheumatology Willem‐Alexander Children's HospitalLeiden University Medical CenterLeidenthe Netherlands
- Currently at Princess Maxima Centre for Pediatric OncologyUtrechtthe Netherlands
| | - Robert Rissmann
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
- Department of Clinical Pharmacy & ToxicologyLeiden University Medical CenterLeidenthe Netherlands
| | - Rebecca ten Cate
- Department of Pediatric Rheumatology Willem‐Alexander Children's HospitalLeiden University Medical CenterLeidenthe Netherlands
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28
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Boekel L, Kummer LY, van Dam KPJ, Hooijberg F, van Kempen Z, Vogelzang EH, Wieske L, Eftimov F, van Vollenhoven R, Kuijpers TW, van Ham SM, Tas SW, Killestein J, Boers M, Nurmohamed MT, Rispens T, Wolbink G. Adverse events after first COVID-19 vaccination in patients with autoimmune diseases. Lancet Rheumatol 2021; 3:e542-e545. [PMID: 34179831 PMCID: PMC8213359 DOI: 10.1016/s2665-9913(21)00181-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands
| | - Laura Y Kummer
- Department of Neurology and Neurophysiology, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands
| | - Zoé van Kempen
- Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, 1056 AB Amsterdam, Netherlands.,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
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29
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Hoepel W, Chen HJ, Geyer CE, Allahverdiyeva S, Manz XD, de Taeye SW, Aman J, Mes L, Steenhuis M, Griffith GR, Bonta PI, Brouwer PJM, Caniels TG, van der Straten K, Golebski K, Jonkers RE, Larsen MD, Linty F, Nouta J, van Roomen CPAA, van Baarle FEHP, van Drunen CM, Wolbink G, Vlaar APJ, de Bree GJ, Sanders RW, Willemsen L, Neele AE, van de Beek D, Rispens T, Wuhrer M, Bogaard HJ, van Gils MJ, Vidarsson G, de Winther M, den Dunnen J. High titers and low fucosylation of early human anti-SARS-CoV-2 IgG promote inflammation by alveolar macrophages. Sci Transl Med 2021; 13:eabf8654. [PMID: 33979301 PMCID: PMC8158960 DOI: 10.1126/scitranslmed.abf8654] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/05/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
Patients diagnosed with coronavirus disease 2019 (COVID-19) become critically ill primarily around the time of activation of the adaptive immune response. Here, we provide evidence that antibodies play a role in the worsening of disease at the time of seroconversion. We show that early-phase severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) spike protein-specific immunoglobulin G (IgG) in serum of critically ill COVID-19 patients induces excessive inflammatory responses by human alveolar macrophages. We identified that this excessive inflammatory response is dependent on two antibody features that are specific for patients with severe COVID-19. First, inflammation is driven by high titers of anti-spike IgG, a hallmark of severe disease. Second, we found that anti-spike IgG from patients with severe COVID-19 is intrinsically more proinflammatory because of different glycosylation, particularly low fucosylation, of the antibody Fc tail. Low fucosylation of anti-spike IgG was normalized in a few weeks after initial infection with SARS-CoV-2, indicating that the increased antibody-dependent inflammation mainly occurs at the time of seroconversion. We identified Fcγ receptor (FcγR) IIa and FcγRIII as the two primary IgG receptors that are responsible for the induction of key COVID-19-associated cytokines such as interleukin-6 and tumor necrosis factor. In addition, we show that anti-spike IgG-activated human macrophages can subsequently break pulmonary endothelial barrier integrity and induce microvascular thrombosis in vitro. Last, we demonstrate that the inflammatory response induced by anti-spike IgG can be specifically counteracted by fostamatinib, an FDA- and EMA-approved therapeutic small-molecule inhibitor of Syk kinase.
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Affiliation(s)
- Willianne Hoepel
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Hung-Jen Chen
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Chiara E Geyer
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Sona Allahverdiyeva
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Xue D Manz
- Department of Pulmonary Medicine, Amsterdam UMC, location VUMC, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Steven W de Taeye
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
| | - Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam UMC, location VUMC, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Lynn Mes
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
| | - Guillermo R Griffith
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Peter I Bonta
- Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Philip J M Brouwer
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Tom G Caniels
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Karlijn van der Straten
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Korneliusz Golebski
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - René E Jonkers
- Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Mads D Larsen
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
| | - Federica Linty
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
| | - Jan Nouta
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, 2333 AZ Leiden, Netherlands
| | - Cindy P A A van Roomen
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Frank E H P van Baarle
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Cornelis M van Drunen
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Admiraal Helfrichstraat 1, 1056 AA Amsterdam, Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Godelieve J de Bree
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Rogier W Sanders
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA
| | - Lisa Willemsen
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Annette E Neele
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Diederik van de Beek
- Departments of Neurology and Neuroscience, University of Amsterdam, Meibergdreef, Amsterdam UMC, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, 2333 AZ Leiden, Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, location VUMC, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Marit J van Gils
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, Netherlands
| | - Menno de Winther
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - Jeroen den Dunnen
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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Nassar-Sheikh Rashid A, Schonenberg-Meinema D, Bergkamp SC, Bakhlakh S, de Vries A, Rispens T, Kuijpers TW, Wolbink G, van den Berg JM. Therapeutic drug monitoring of anti-TNF drugs: an overview of applicability in daily clinical practice in the era of treatment with biologics in juvenile idiopathic arthritis (JIA). Pediatr Rheumatol Online J 2021; 19:59. [PMID: 33926495 PMCID: PMC8082819 DOI: 10.1186/s12969-021-00545-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/26/2021] [Accepted: 04/14/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Anti-tumor necrosis factor (TNF) drugs have improved the prognosis for juvenile idiopathic arthritis (JIA) significantly. However, evidence for individual treatment decisions based on serum anti-TNF drug levels and the presence of anti-drug antibodies (ADAbs) in children is scarce. We aimed to assess if anti-TNF drug levels and/or ADAbs influenced physician's treatment decisions in children with JIA. METHODS Patients' records in our center were retrospectively screened for measurements of anti-TNF drug levels and ADAbs in children with JIA using etanercept, adalimumab or infliximab. Clinical characteristics and disease activity were retrieved from patient charts. RESULTS We analyzed 142 measurements of anti-TNF drug levels in 65 children with JIA. Of these, ninety-seven (68.3%) were trough concentrations. N = 14/97 (14.4%) of these showed trough concentrations within the therapeutic drug range known for adults with RA and IBD. ADAbs against adalimumab were detected in seven patients and against infliximab in one patient. Seven (87,5%) of these ADAb-positive patients had non-detectable drug levels. A flowchart was made on decisions including rational dose escalation, stopping treatment in the presence of ADAbs and undetectable drug levels, showing that 45% of measurements influenced treatment decisions, which concerned 65% of patients (n = 42/65). CONCLUSIONS In the majority of patients, measurement of anti-TNF drug levels led to changes in treatment. A wide variation of anti-TNF drug levels was found possibly due to differences in drug clearance in different age groups. There is need for determination of therapeutic drug ranges and pharmacokinetic curves for anti-TNF and other biologics in children with JIA.
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Affiliation(s)
- A. Nassar-Sheikh Rashid
- grid.7177.60000000084992262Zaans Medical Center, Zaandam and Emma Children’s Hospital, Amsterdam UMC, Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
| | - D. Schonenberg-Meinema
- grid.7177.60000000084992262Emma Children’s Hospital, Amsterdam UMC, Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
| | - S. C. Bergkamp
- grid.7177.60000000084992262Emma Children’s Hospital, Amsterdam UMC, Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
| | - S. Bakhlakh
- grid.7177.60000000084992262Emma Children’s Hospital, Amsterdam UMC, Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
| | - A. de Vries
- grid.417732.40000 0001 2234 6887Department of Immunopathology, Sanquin Diagnostic Services Amsterdam, Amsterdam, The Netherlands
| | - T. Rispens
- grid.417732.40000 0001 2234 6887Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - T. W. Kuijpers
- grid.7177.60000000084992262Emma Children’s Hospital, Amsterdam UMC, Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Wolbink
- grid.418029.60000 0004 0624 3484Department of Immunopathology, CLB Sanquin Amsterdam and Department of Rheumatology, Jan van Breemen Institute Amsterdam, Amsterdam, The Netherlands
| | - J. M. van den Berg
- grid.7177.60000000084992262Emma Children’s Hospital, Amsterdam UMC, Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
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Alvarez DF, Wolbink G, Cronenberger C, Orazem J, Kay J. Interchangeability of Biosimilars: What Level of Clinical Evidence is Needed to Support the Interchangeability Designation in the United States? BioDrugs 2021; 34:723-732. [PMID: 32990892 PMCID: PMC7669758 DOI: 10.1007/s40259-020-00446-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A biosimilar is a biologic drug that is "highly similar to a reference (originator) product, with no clinically meaningful differences between the two products in safety, purity, and potency". Regulatory approval of a biosimilar is based on analytical, structural, and functional comparisons with the reference product, comparative nonclinical (in vivo) studies, clinical pharmacokinetics and/or pharmacodynamics, and immunogenicity. In addition, comparative clinical efficacy and safety assessments are usually conducted and, taken together, comprise the "totality of the evidence" supporting biosimilarity. For a biosimilar to meet the additional designation of interchangeability in the United States (US), the applicant must demonstrate that the biological drug can be expected to produce the "same clinical result as the reference product in any given patient" and "if the biological drug is administered more than once to an individual, the risk in terms of safety or diminished efficacy of alternating or switching between the use of the biological drug and the reference product is no greater than the risk of using the reference product without such alternation or switch". The challenges faced in conducting clinical studies to support a designation of interchangeability, as defined in the final interchangeability guidance from the US Food and Drug Administration, are considered. Potential alternative approaches to generating adequate and sufficient clinical data to support a designation of interchangeability are also presented.
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Affiliation(s)
- Daniel F Alvarez
- Inflammation and Immunology, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, 19426, USA.
| | | | | | - John Orazem
- Global Biostatistics and Data Management, Pfizer Inc, New York, NY, USA
| | - Jonathan Kay
- Departments of Medicine and of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
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Larsen MD, de Graaf EL, Sonneveld ME, Plomp HR, Nouta J, Hoepel W, Chen HJ, Linty F, Visser R, Brinkhaus M, Šuštić T, de Taeye SW, Bentlage AEH, Toivonen S, Koeleman CAM, Sainio S, Kootstra NA, Brouwer PJM, Geyer CE, Derksen NIL, Wolbink G, de Winther M, Sanders RW, van Gils MJ, de Bruin S, Vlaar APJ, Rispens T, den Dunnen J, Zaaijer HL, Wuhrer M, Ellen van der Schoot C, Vidarsson G. Afucosylated IgG characterizes enveloped viral responses and correlates with COVID-19 severity. Science 2020; 371:science.abc8378. [PMID: 33361116 PMCID: PMC7919849 DOI: 10.1126/science.abc8378] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/12/2020] [Accepted: 12/18/2020] [Indexed: 12/21/2022]
Abstract
Antibodies are divided into several classes based on their nonvariable tail (Fc) domains. These regions interact with disparate immune cell receptors and complement proteins to help instruct distinct immune responses. The Fc domain of immunoglobulin G (IgG) antibodies contains a conserved N-linked glycan at position 297. However, the particular glycan used at this position is highly variable. IgG lacking core fucosylation at this position initiates enhanced antibody-dependent cellular cytotoxicity by increased affinity to the Fc receptor FcRIIIa. Larsen et al. report that COVID-19 patients with severe symptoms have increased levels of anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG afucosylation compared with patients with mild disease. These findings suggest that treatment of COVID-19 patients with fucosylated anti–SARS-CoV-2 antibodies may circumvent pathologies associated with severe COVID-19. Science, this issue p. eabc8378 INTRODUCTION Antibody function is often considered static and mostly determined by isotype and subclass. The conserved N-linked glycan at position 297 in the Fc domain of immunoglobulin G (IgG) is essential for an antibody’s effector functions. Moreover, this glycan is highly variable and functionally relevant, especially for the core fucose moiety. IgG lacking core fucosylation (afucosylated IgG) causes increased antibody-dependent cellular cytotoxicity (ADCC) through highly increased IgG-Fc receptor IIIa (FcγRIIIa) affinity. Despite constant levels of total plasma IgG-Fc fucosylation above 90%, specific IgG responses with low core fucosylation have been sporadically reported. These are directed against alloantigens on blood cells and glycoproteins of HIV and dengue virus. In this study, we investigated the induction of afucosylated IgG to various antigens and delineated its dynamics and proinflammatory potential in COVID-19. RATIONALE Afucosylated IgG responses have only been found in various alloimmune responses against cellular blood groups and two enveloped viruses. Therefore, we tested the hypothesis that foreign surface–exposed, membrane-embedded proteins induce a specific B cell response that results in afucosylated IgG. We compared immune responses to natural infections by enveloped viruses and nonenveloped viruses, protein subunit vaccination, and live attenuated virus vaccinations. We also assessed the relation to the clinical outcome of such a response in COVID-19. RESULTS Analogous to blood cell alloantigens, the response to all enveloped viruses showed clear signatures of afucosylation of the antigen-specific IgG. By contrast, IgG against the nonenveloped virus, parvovirus B19, were highly fucosylated. The extent of afucosylated IgG responses varied, both between individuals and between antigens. The viral context was essential to induce afucosylated IgG because induction did not occur after subunit vaccination against hepatitis B virus. However, afucosylated IgG responses were found in response to attenuated viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific afucosylated IgG were also found in critically ill COVID-19 patients but not in individuals with mild symptoms. Over the 2 weeks after seroconversion, the amount of fucosylated anti–SARS-CoV-2 IgG increased markedly, in most reaching relative levels similar to those found in total IgG. Afucosylated IgG promoted interleukin-6 (IL-6) release in macrophages cultured in vitro, which is in line with an observed association of SARS-CoV-2–specific IgG afucosylation with IL-6 and C-reactive protein (CRP) in these patients. CONCLUSION This work suggests that providing foreign B cell antigens in the context of host cells may be required to trigger an afucosylated IgG immune response. The strength of this response is highly variable for different antigens and between individuals. An afucosylated IgG response is a potent immune response, honed for the destruction of target cells by FcγRIII-expressing natural killer (NK) and myeloid cells. This may sometimes be desirable—for example, against HIV—and can be achieved in vaccines by providing the target as a surface protein, as is the case with attenuated viral vaccines or mRNA vaccines. However, for SARS-CoV-2, this afucosylated IgG response may promote the exacerbation of COVID-19 under conditions with high viral loads at the time of seroconversion. Immunoglobulin G (IgG) antibodies are crucial for protection against invading pathogens. A highly conserved N-linked glycan within the IgG-Fc tail, which is essential for IgG function, shows variable composition in humans. Afucosylated IgG variants are already used in anticancer therapeutic antibodies for their increased activity through Fc receptors (FcγRIIIa). Here, we report that afucosylated IgG (approximately 6% of total IgG in humans) are specifically formed against enveloped viruses but generally not against other antigens. This mediates stronger FcγRIIIa responses but also amplifies brewing cytokine storms and immune-mediated pathologies. Critically ill COVID-19 patients, but not those with mild symptoms, had high concentrations of afucosylated IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplifying proinflammatory cytokine release and acute phase responses. Thus, antibody glycosylation plays a critical role in immune responses to enveloped viruses, including COVID-19.
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Affiliation(s)
- Mads Delbo Larsen
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Erik L de Graaf
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Myrthe E Sonneveld
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - H Rosina Plomp
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Jan Nouta
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Willianne Hoepel
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hung-Jen Chen
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Federica Linty
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Remco Visser
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maximilian Brinkhaus
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Tonći Šuštić
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Steven W de Taeye
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Arthur E H Bentlage
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Carolien A M Koeleman
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Neeltje A Kootstra
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Philip J M Brouwer
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Chiara Elisabeth Geyer
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ninotska I L Derksen
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Menno de Winther
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Rogier W Sanders
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, Netherlands.,Weill Medical College, Cornell University, New York, USA
| | - Marit J van Gils
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Sanne de Bruin
- Department of Intensive Care Medicine, Amsterdam UMC (Location AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC (Location AMC), University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jeroen den Dunnen
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin, Amsterdam, Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands. .,Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Hooijberg F, Boekel L, Vogelzang EH, Leeuw M, Boers M, van Vollenhoven R, Lems WF, Nurmohamed MT, Wolbink G. Patients with rheumatic diseases adhere to COVID-19 isolation measures more strictly than the general population. Lancet Rheumatol 2020; 2:e583-e585. [PMID: 33106791 PMCID: PMC7579459 DOI: 10.1016/s2665-9913(20)30286-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Femke Hooijberg
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, 1056 AB Amsterdam, Netherlands
| | - Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, 1056 AB Amsterdam, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology, Amsterdam University Medical Center, Vanderbilt University Medical Center, Amsterdam, Netherlands
| | - Maureen Leeuw
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, 1056 AB Amsterdam, Netherlands
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Vanderbilt University Medical Center, Amsterdam, Netherlands
| | - Ronald van Vollenhoven
- Amsterdam Rheumatology and Immunology Center, Location AMC, Department of Rheumatology, Amsterdam, Netherlands
| | - Willem F Lems
- Amsterdam Rheumatology and Immunology Center, Location VU University Medical Center, Department of Rheumatology, Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, 1056 AB Amsterdam, Netherlands.,Amsterdam Rheumatology and Immunology Center, Location VU University Medical Center, Department of Rheumatology, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, 1056 AB Amsterdam, Netherlands.,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, Netherlands
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Falkenburg WJJ, Oskam N, Koers J, van Boheemen L, Ooijevaar-de Heer P, Verstappen GM, Bootsma H, Kroese FGM, van Schaardenburg D, Wolbink G, Rispens T. Identification of Clinically and Pathophysiologically Relevant Rheumatoid Factor Epitopes by Engineered IgG Targets. Arthritis Rheumatol 2020; 72:2005-2016. [PMID: 32648642 DOI: 10.1002/art.41430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Rheumatoid factors (RFs), which are anti-IgG autoantibodies strongly associated with rheumatoid arthritis (RA), are also found in other diseases and in healthy individuals. RFs bind to various epitopes in the constant (Fc-) domain of IgG. Therefore, disease-specific reactivity patterns may exist. This study was undertaken in order to develop a new approach to dissecting RF epitope binding patterns across different diseases. METHODS We analyzed RF reactivity patterns in serum from patients with seropositive arthralgia, patients with RA, and patients with primary Sjögren's syndrome (SS) using bioengineered, natively folded IgG-Fc targets that demonstrated selective RF binding toward several distinct regions of the IgG-Fc domain. RESULTS Rheumatoid factor responses primarily bound the Fc Elbow region, with a smaller number of RFs binding the Fc Tail region, while the Fc receptor binding region was hardly targeted. A restricted reactivity against the IgG-Fc Tail region was associated with less positivity for anti-citrullinated protein antibodies (ACPAs) and less arthritis development in arthralgia, whereas combined reactivity toward IgG-Fc Tail and Elbow regions was associated with more arthritis development. Reactivity toward the IgG-Fc Tail region was observed far more frequently in RA than in primary SS. CONCLUSION Bioengineered IgG targets enable serologic characterization of RF reactivity patterns, and use of this approach appears to reveal patterns associated with ACPA detection and arthritis development in patients with arthralgia. These patterns are able to distinguish RA patients from primary SS patients. This new methodology improves the clinical value of RFs and our understanding of their pathophysiologic processes.
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Affiliation(s)
- Willem J J Falkenburg
- Amsterdam Rheumatology and Immunology Center, Reade, Sanquin Research, and Academic Medical Center, Amsterdam, The Netherlands
| | - Nienke Oskam
- Sanquin Research and Academic Medical Center, Amsterdam, The Netherlands
| | - Jana Koers
- Sanquin Research and Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Gwenny M Verstappen
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Frans G M Kroese
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, and, Academic Medical Center, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center and Reade, Amsterdam, The Netherlands
| | - Theo Rispens
- Sanquin Research and Academic Medical Center, Amsterdam, The Netherlands
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Ruwaard J, Marsman AF, Nurmohamed MT, van der Horst-Bruinsma IE, Te Velthuis H, Bloem K, de Vries A, Rispens T, Wolbink G. Antidrug antibody detection for adalimumab depends on the type of assay used: an experimental approach to help clinicians interpret diagnostic data. Clin Exp Rheumatol 2019; 37:756-761. [PMID: 30943139] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To compare different methods of antidrug antibody (ADA) against adalimumab detection in ankylosing spondylitis (AS) patients and the impact of ADA on adalimumab drug levels and mean ASDAS-CRP. METHODS We used the acid-dissociation-radioimmunoassay (ARIA), antidrug-binding-test (ABT) and a bridging Enzyme-linked Immunosorbent Assay (ELISA) to detect ADA at 4, 12 and 24 weeks of treatment. Patients were divided into groups; all assays negative (All-neg), only ARIA positive (ARIA-only-pos), ARIA and ABT positive, bridging ELISA negative (ARIA/ABT-double-pos) and all assays positive (All-pos). RESULTS Eighty-three consecutive AS patient were included. At week 4, 18% compared to 11% and 0% of the patients tested positive for ADA in the ARIA, ABT and bridging ELISA, respectively. At week 12 and 24, cumulative 52% and 69% patients tested positive in the ARIA, compared to 27% and 30% patients in the ABT and 2% patients in the bridging ELISA. Adalimumab levels between All-neg and ARIA-only-pos were 9.1 (5.5-12.5) and 8.5 (5.7-12.3). Drug levels differed between ARIA/ABT-double-pos (2.7 (1.3-4.4)) and All-neg (9.1 (5.5-12.5)). All-pos patients had undetectable drug levels. Mean ASDAS-CRP at week 24 differs between All-neg (1.9 (±1.2)), and All-pos (3.8 (±1.9)) and ARIA/ABT-double-pos (2.0 (±1.1)) and All-pos. CONCLUSIONS The majority of AS patients had detectable ADA against adalimumab in the ARIA. The ARIA detects more ADA compared to the less drug tolerant ABT and bridging ELISA. The clinical relevance depends on the impact on the bio-availability of the drug. A drug level measurement therefore helps to interpret ADA data regardless of type of assay used.
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Affiliation(s)
- Jill Ruwaard
- Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, the Netherlands.
| | - Anneke F Marsman
- Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, the Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, location Reade and location VU Medical Center, Amsterdam, the Netherlands
| | | | - Henk Te Velthuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | - Karien Bloem
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, and Biologics Laboratory, Diagnostic Services Sanquin, Amsterdam, the Netherlands
| | - Annick de Vries
- Biologics Laboratory, Diagnostic Services Sanquin, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and immunology Center, location Reade, and Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
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Spiliopoulou A, Colombo M, Plant D, Nair N, Cui J, Coenen MJ, Ikari K, Yamanaka H, Saevarsdottir S, Padyukov L, Bridges SL, Kimberly RP, Okada Y, van Riel PLC, Wolbink G, van der Horst-Bruinsma IE, de Vries N, Tak PP, Ohmura K, Canhão H, Guchelaar HJ, Huizinga TW, Criswell LA, Raychaudhuri S, Weinblatt ME, Wilson AG, Mariette X, Isaacs JD, Morgan AW, Pitzalis C, Barton A, McKeigue P. Association of response to TNF inhibitors in rheumatoid arthritis with quantitative trait loci for CD40 and CD39. Ann Rheum Dis 2019; 78:1055-1061. [PMID: 31036624 PMCID: PMC6669378 DOI: 10.1136/annrheumdis-2018-214877] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 12/05/2018] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We sought to investigate whether genetic effects on response to TNF inhibitors (TNFi) in rheumatoid arthritis (RA) could be localised by considering known genetic susceptibility loci for relevant traits and to evaluate the usefulness of these genetic loci for stratifying drug response. METHODS We studied the relation of TNFi response, quantified by change in swollen joint counts ( Δ SJC) and erythrocyte sedimentation rate ( Δ ESR) with locus-specific scores constructed from genome-wide assocation study summary statistics in 2938 genotyped individuals: 37 scores for RA; scores for 19 immune cell traits; scores for expression or methylation of 93 genes with previously reported associations between transcript level and drug response. Multivariate associations were evaluated in penalised regression models by cross-validation. RESULTS We detected a statistically significant association between Δ SJC and the RA score at the CD40 locus (p=0.0004) and an inverse association between Δ SJC and the score for expression of CD39 on CD4 T cells (p=0.00005). A previously reported association between CD39 expression on regulatory T cells and response to methotrexate was in the opposite direction. In stratified analysis by concomitant methotrexate treatment, the inverse association was stronger in the combination therapy group and dissipated in the TNFi monotherapy group. Overall, ability to predict TNFi response from genotypic scores was limited, with models explaining less than 1% of phenotypic variance. CONCLUSIONS The association with the CD39 trait is difficult to interpret because patients with RA are often prescribed TNFi after failing to respond to methotrexate. The CD39 and CD40 pathways could be relevant for targeting drug therapy.
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Affiliation(s)
- Athina Spiliopoulou
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Marco Colombo
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Darren Plant
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nisha Nair
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jing Cui
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marieke Jh Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- The Centers of Research Excellence in Science and Technology, Japan Science and Technology Agency, Tokyo, Japan
| | - Hisashi Yamanaka
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Saedis Saevarsdottir
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - S Louis Bridges
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert P Kimberly
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
| | - Piet L Cm van Riel
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Centre, Reade, Amsterdam, The Netherlands
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology, VU University Medical Centre, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Niek de Vries
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul P Tak
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Helena Canhão
- CEDOC, EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom Wj Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lindsey A Criswell
- Rosalind Russell / Ephraim P Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, California, USA
| | - Soumya Raychaudhuri
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Data Sciences, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael E Weinblatt
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anthony G Wilson
- EULAR Centre of Excellence/UCD Centre for Arthritis Research, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Xavier Mariette
- y Université Paris-Sud, INSERM UMR1184, Hôpitaux Universitaire Paris-Sud, AP-HP, Le Kremlin Bicêtre, Paris, France
| | - John D Isaacs
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ann W Morgan
- School of Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anne Barton
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paul McKeigue
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Papamichael K, Vogelzang EH, Lambert J, Wolbink G, Cheifetz AS. Therapeutic drug monitoring with biologic agents in immune mediated inflammatory diseases. Expert Rev Clin Immunol 2019; 15:837-848. [PMID: 31180729 DOI: 10.1080/1744666x.2019.1630273] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
: Most exposure-response relationship studies show a positive correlation between biologic drug concentrations and favorable therapeutic outcomes in IMID with higher drug concentrations typically associated with more objective outcomes. Clinically, reactive TDM rationalizes the management of PNR and SLR to anti-tumor necrosis factor therapy and is emerging as the new standard of care in IBD as it is also more cost-effective than empiric dose escalation. Preliminary data suggest that proactive TDM with the goal to achieve a threshold drug concentration is associated with better therapeutic outcomes when compared to empiric drug optimization and/or reactive TDM of infliximab and adalimumab in IBD. However, more data from well-designed prospective studies are needed to prove the benefit of TDM-based algorithms in real life clinical practice in IMID.
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Affiliation(s)
- Konstantinos Papamichael
- a Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Erik H Vogelzang
- b Rheumatology and Immunology Center, Research by AMC, READE and VUMC , Amsterdam , the Netherlands
| | - Jo Lambert
- c Department of Dermatology, Ghent University , Ghent , Belgium
| | - Gertjan Wolbink
- b Rheumatology and Immunology Center, Research by AMC, READE and VUMC , Amsterdam , the Netherlands.,d Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center , Amsterdam , the Netherlands
| | - Adam S Cheifetz
- a Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
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Layegh Z, Ruwaard J, Hebing RCF, L' Ami MJ, van der Weele W, Nurmohamed MT, Krieckaert C, Wolbink G. Efficacious transition from reference infliximab to biosimilar infliximab in clinical practice. Int J Rheum Dis 2019; 22:869-873. [PMID: 30767391 DOI: 10.1111/1756-185x.13512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/21/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the transition from reference infliximab Remicade to biosimilar Remsima in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA). METHODS Patients were informed through a letter about the transition to a biosimilar and were subsequently contacted for possible additional questions and whether they agreed upon the transition. Once agreed, Remsima was administered at the same dosage and interval as previous treatment with Remicade. Data on the transition were analyzed in January 2018. The primary outcome was the percentage of patients continuing treatment with Remsima and secondary outcome was the change in disease activity measured with the Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR). In addition, the reasons for discontinuation with infliximab or restarting Remicade were recorded. RESULTS In total 47 patients were approached, 45 patients switched from Remicade to Remsima, two patients disagreed upon transition and continued Remicade. At the end of the follow-up period of 2 years, 39 patients (87%) continued with Remsima, three patients (7%) restarted Remicade due to inefficacy according to the patient (this was not objectified by the rheumatologist) 2 (4%) patients switched to another biological due to lack of effect and in one patient (2%) infliximab was stopped because of lung malignancy. Furthermore, the DAS28-ESR remained comparable before and after the switch, with a mean (SD) of 2.34 (±1.02) and 2.31 (±1.11) respectively. CONCLUSION In our population, 87% of patients continued Remsima during the follow-up period of approximately 2 years. Three patients restarted Remicade, while retaining stable DAS28-ESR.
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Affiliation(s)
- Zohra Layegh
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands
| | - Jill Ruwaard
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands
| | - Renske C F Hebing
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands.,Reade, Rheumatology, Pharmacy, Amsterdam, The Netherlands
| | - Merel J L' Ami
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands
| | - Wilfred van der Weele
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands
| | - Mike T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands
| | - Charlotte Krieckaert
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Reade, Rheumatology, Amsterdam, The Netherlands
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Ruwaard J, VAN DER Vlugt ER, Wolbink G. Differences in Palmoplantar Pustulosis and Psoriasis Vulgaris in Patients with Rheumatoid Arthritis or Ankylosing Spondylitis Treated with Biological Therapy. J Rheumatol 2018; 46:117-118. [PMID: 30323005 DOI: 10.3899/jrheum.180566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jill Ruwaard
- Amsterdam Rheumatology and Immunology Center, location Reade;
| | | | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, location Reade, and the Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, the Netherlands
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Vogelzang EH, Hebing RCF, Nurmohamed MT, van Kuijk AWR, Kruijff JWF, l'Ami MJ, Krieckaert CLM, Wolbink G. Adherence to etanercept therapy in rheumatoid arthritis patients during 3 years of follow-up. PLoS One 2018; 13:e0205125. [PMID: 30300358 PMCID: PMC6177149 DOI: 10.1371/journal.pone.0205125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/19/2018] [Indexed: 12/11/2022] Open
Abstract
Objectives To determine the percentage non-adherence to etanercept in patients with rheumatoid arthritis during three years of follow-up. Methods During study visits in this prospective cohort study, blood samples were taken to determine serum etanercept concentrations using ELISA and patients were asked if they had missed an etanercept dose, at which date and for what reason. Non-adherence was defined as serum etanercept concentration <0.1 μg/mL and no valid reason to miss the prescribed etanercept dose. Results In total, 292 consecutive patients treated with etanercept were included. Most patients had a valid reason to miss their etanercept dose (25/37). In total 12 out of 292 patients (4.1%, 95% confidence interval 2.2–7.2) were non-adherent during the 3 year period. In a small percentage of patients (3.4%, 95% confidence interval 0.8–10.4) who failed to respond to etanercept therapy, according to their rheumatologist, this was associated with inadequate exposure to etanercept and thus non-adherence. Conclusion In this study, adherence to etanercept therapy was measured using serum etanercept concentration. In most patients an absent etanercept concentration was due to a medical reason. Furthermore, the majority of patients were adherent to etanercept therapy and had adequate drug exposure. In total, only 12 out of 292 patients (4.1%) were non-adherent during 3 years of follow-up. These findings highlight that only a small minority of patients are non-adherent to etanercept treatment, especially compared to adherence rates of other drugs. However, physicians should be aware that in patients failing to respond to treatment, non-adherence is a possible cause.
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Affiliation(s)
- E H Vogelzang
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - R C F Hebing
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Pharmacy, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - A W R van Kuijk
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - J W F Kruijff
- University of Amsterdam, Faculty of Science, Amsterdam, The Netherlands
| | - M J l'Ami
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - C L M Krieckaert
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands
| | - G Wolbink
- Amsterdam Rheumatology and Immunology Center
- Reade, Rheumatology, Amsterdam, The Netherlands.,Sanquin Research and Landsteiner Laboratory, Immunopathology, Amsterdam, The Netherlands
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van Schie KA, Kruithof S, Ooijevaar-de Heer P, Derksen NIL, van de Bovenkamp FS, Saris A, Vidarsson G, Bentlage AEH, Jiskoot W, Romeijn S, Koning RI, Bos E, Stork EM, Koeleman CAM, Wuhrer M, Wolbink G, Rispens T. Restricted immune activation and internalisation of anti-idiotype complexes between drug and antidrug antibodies. Ann Rheum Dis 2018; 77:1471-1479. [DOI: 10.1136/annrheumdis-2018-213299] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 11/03/2022]
Abstract
ObjectivesTherapeutic antibodies can provoke an antidrug antibody (ADA) response, which can form soluble immune complexes with the drug in potentially high amounts. Nevertheless, ADA-associated adverse events are usually rare, although with notable exceptions including infliximab. The immune activating effects and the eventual fate of these ‘anti-idiotype’ complexes are poorly studied, hampering assessment of ADA-associated risk of adverse events. We investigated the in vitro formation and biological activities of ADA-drug anti-idiotype immune complexes using patient-derived monoclonal anti-infliximab antibodies.MethodsSize distribution and conformation of ADA-drug complexes were characterised by size-exclusion chromatography and electron microscopy. Internalisation of and immune activation by complexes of defined size was visualised with flow imaging, whole blood cell assay and C4b/c ELISA.ResultsSize and conformation of immune complexes depended on the concentrations and ratio of drug and ADA; large complexes (>6 IgGs) formed only with high ADA titres. Macrophages efficiently internalised tetrameric and bigger complexes in vitro, but not dimers. Corroborating these results, ex vivo analysis of patient sera demonstrated only dimeric complexes in circulation.No activation of immune cells by anti-idiotype complexes was observed, and only very large complexes activated complement. Unlike Fc-linked hexamers, anti-idiotype hexamers did not activate complement, demonstrating that besides size, conformation governs immune complex potential for triggering effector functions.ConclusionsAnti-idiotype ADA-drug complexes generally have restricted immune activation capacity. Large, irregularly shaped complexes only form at high concentrations of both drug and ADA, as may be achieved during intravenous infusion of infliximab, explaining the rarity of serious ADA-associated adverse events.
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Ruwaard J, l'Ami MJ, Marsman AF, Kneepkens EL, van Denderen JC, van der Horst-Bruinsma IE, Nurmohamed MT, Wolbink G. Comparison of drug survival and clinical outcome in patients with ankylosing spondylitis treated with etanercept or adalimumab. Scand J Rheumatol 2017; 47:122-126. [PMID: 28745108 DOI: 10.1080/03009742.2017.1330419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare rates of drug survival and clinical response during 2 years of follow-up in ankylosing spondylitis (AS) patients treated with etanercept or adalimumab in routine care. METHOD Biological-naïve consecutive AS patients treated with etanercept (n = 163) or adalimumab (n = 82) were followed. Treatment discontinuation was due to inefficacy, adverse events, loss to follow-up, planning a pregnancy, or uveitis. Disease activity was assessed by the Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP). Moderate disease activity was defined as an ASDAS-CRP < 2.1. RESULTS Twenty-seven patients (32.9%) treated with adalimumab and 30 (18.4%) with etanercept discontinued treatment. Cox regression analysis demonstrated a significant difference in survival rate between discontinuation of the drug in adalimumab patients compared with etanercept patients [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.3-4.5, p = 0.005; corrected for confounding factors: HR 2.5, 95% CI 1.3-4.5, p = 0.006]. There was no significant difference at 2 years of follow-up between the adalimumab- and the etanercept-treated patients in mean ± sd ASDAS-CRP (1.9 ± 1.1 and 2.0 ± 0.9, respectively, p = 0.624), and 23 out of 34 (67.6%) compared to 71 out of 117 (60.7%) reached ASDAS-CRP moderate disease activity (odds ratio 0.738, 95% CI 0.329-1.657, p = 0.530). CONCLUSION No significant difference was found between AS patients treated with etanercept and those treated with adalimumab in mean ASDAS-CRP and reaching ASDAS-CRP minimal disease activity at 2 year follow-up. Drug survival rate was higher in etanercept- compared to adalimumab-treated patients. However, this should be interpreted cautiously as the risk of allocation bias cannot be excluded.
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Affiliation(s)
- J Ruwaard
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - M J l'Ami
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - A F Marsman
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - E L Kneepkens
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - J C van Denderen
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - I E van der Horst-Bruinsma
- b Rheumatology , Amsterdam Rheumatology and Immunology Center, Location VU Medical Center , Amsterdam , The Netherlands
| | - M T Nurmohamed
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands.,b Rheumatology , Amsterdam Rheumatology and Immunology Center, Location VU Medical Center , Amsterdam , The Netherlands
| | - G Wolbink
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands.,c Department of Immunopathology , Sanquin Research and Landsteiner Laboratory Academic Medical Centre , Amsterdam , The Netherlands
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de Jong TD, Blits M, de Ridder S, Vosslamber S, Wolbink G, Nurmohamed MT, Verweij CL. Type I interferon response gene expression in established rheumatoid arthritis is not associated with clinical parameters. Arthritis Res Ther 2016; 18:290. [PMID: 27955694 PMCID: PMC5154062 DOI: 10.1186/s13075-016-1191-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/22/2016] [Indexed: 12/22/2022] Open
Abstract
Background A peripheral blood interferon (IFN) signature (i.e., elevated type I interferon response gene [IRG] expression) has been described in a subset of patients with rheumatoid arthritis (RA). In the present study, we systematically assessed the association between this IRG expression and clinical parameters. Methods Expression of 19 IRGs was determined in peripheral blood from 182 consecutive patients with RA and averaged into an IFN score per individual. Correlation and unpaired analyses were performed on the complete patient group. The analyses were internally validated by using an algorithm to randomize the patient group 1000 times into two equally sized sets, and then analyses were performed on both sets. Results Associations were assessed between IFN score and disease duration, 28-joint Disease Activity Score and its components, the occurrence of erosions and nodules, autoantibody positivity, and immunosuppressive treatment. This analysis revealed lower IFN scores in patients using hydroxychloroquine, prednisone, and/or sulfasalazine, but it did not show significant associations between the other parameters and the IFN score. Selecting patients who were not treated with hydroxychloroquine, prednisone, and/or sulfasalazine (n = 95) did not reveal any significant associations either. Conclusions IRG expression in RA is affected by immunosuppressive treatment with prednisone, hydroxychloroquine, and/or sulfasalazine, but it is not evidently associated with other clinical parameters. Hence, the IFN signature appears to describe a subgroup of patients with RA but does not seem to reflect disease activity. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1191-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tamarah D de Jong
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, CCA 2.21, P.O. Box 7075, 1007MB, Amsterdam, The Netherlands.
| | - Marjolein Blits
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sander de Ridder
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Saskia Vosslamber
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Mike T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Cornelis L Verweij
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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Falkenburg WJJ, van Schaardenburg D, Ooijevaar-de Heer P, Tsang-A-Sjoe MWP, Bultink IEM, Voskuyl AE, Bentlage AEH, Vidarsson G, Wolbink G, Rispens T. Anti-Hinge Antibodies Recognize IgG Subclass- and Protease-Restricted Neoepitopes. J Immunol 2016; 198:82-93. [PMID: 27864476 DOI: 10.4049/jimmunol.1601096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
Anti-hinge Abs (AHAs) target neoepitopes exposed after proteolytic cleavage of IgG. In this study, we explored the diversity of protease- and IgG subclass-restricted AHAs and their potential as immunological markers in healthy donors (HDs) and patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). AHA reactivity against IgG-degrading enzyme of Streptococcus pyogenes (IdeS)- or pepsin-generated F(ab')2 fragments of all four human IgG subclasses was determined. AHA reactivity against one or more out of eight F(ab')2 targets was found in 68% (68 of 100) of HDs, 69% (68 of 99) of SLE patients, and 81% (79 of 97) of RA patients. Specific recognition of hinge epitopes was dependent on IgG subclass and protease used to create the F(ab')2 targets, as confirmed by inhibition experiments with F(ab')2 fragments and hinge peptides. Reactivity against IdeS-generated F(ab')2 targets was found most frequently, whereas reactivity against pepsin-generated F(ab')2 targets better discriminated between RA and HDs or SLE, with significantly higher AHA levels against IgG1/3/4. In contrast, AHA levels against pepsin-cleaved IgG2 were comparable. No reactivity against IdeS-generated IgG2-F(ab')2s was detected. The most discriminatory AHA reactivity in RA was against pepsin-cleaved IgG4, with a 35% prevalence, ≥5.8-fold higher than in HDs/SLE, and significantly higher levels (p < 0.0001). Cross-reactivity for F(ab')2s generated from different IgG subclasses was only observed for subclasses having homologous F(ab')2 C termini (IgG1/3/4). For IgG2, two pepsin cleavage sites were identified; anti-hinge reactivity was restricted to only one of these. In conclusion, AHAs specifically recognize IgG subclass- and protease-restricted hinge neoepitopes. Their protease-restricted specificity suggests that different AHA responses developed under distinct inflammatory or infectious conditions and may be markers of, and participants in, such processes.
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Affiliation(s)
- Willem J J Falkenburg
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, the Netherlands; .,Department of Immunopathology, Sanquin Research, 1006 AN Amsterdam, the Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, the Netherlands.,Amsterdam Rheumatology and Immunology Center, Academic Medical Center, 1100 DD Amsterdam, the Netherlands
| | - Pleuni Ooijevaar-de Heer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
| | - Michel W P Tsang-A-Sjoe
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, 1007 MB Amsterdam, the Netherlands; and
| | - Irene E M Bultink
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, 1007 MB Amsterdam, the Netherlands; and
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, 1007 MB Amsterdam, the Netherlands; and
| | - Arthur E H Bentlage
- Department of Experimental Immunohematology, Sanquin Research, 1006 AN Amsterdam, the Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research, 1006 AN Amsterdam, the Netherlands
| | - Gertjan Wolbink
- Amsterdam Rheumatology and Immunology Center, Reade, 1056 AB Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
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van Schie KA, Kruithof S, van Schouwenburg PA, Vennegoor A, Killestein J, Wolbink G, Rispens T. Neutralizing capacity of monoclonal and polyclonal anti-natalizumab antibodies: The immune response to antibody therapeutics preferentially targets the antigen-binding site. J Allergy Clin Immunol 2016; 139:1035-1037.e6. [PMID: 27717666 DOI: 10.1016/j.jaci.2016.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Karin A van Schie
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Kruithof
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Pauline A van Schouwenburg
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anke Vennegoor
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Jan van Breemen Research Institute
- Reade, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Kneepkens EL, van den Oever I, Plasencia CH, Pascual-Salcedo D, de Vries A, Hart M, Nurmohamed MT, Balsa A, Rispens T, Wolbink G. Serum tocilizumab trough concentration can be used to monitor systemic IL-6 receptor blockade in patients with rheumatoid arthritis: a prospective observational cohort study. Scand J Rheumatol 2016; 46:87-94. [PMID: 27440258 DOI: 10.1080/03009742.2016.1183039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the pharmacokinetics (PK) and dynamics of tocilizumab (TCZ) in daily practice. METHOD An observational study of 66 consecutive RA patients treated with TCZ 8 mg/kg once every 4 weeks intravenously, monitored for 24 weeks. Spearman's rank test was used to investigate the correlation between TCZ concentration and C-reactive protein (CRP). Clinical improvement was assessed at week 24 using the Disease Activity Score in 28 joints (DAS28) compared to baseline, and its relationship with TCZ concentration was investigated using linear regression analyses. TCZ trough concentrations and anti-drug antibodies were measured using an enzyme-linked immunosorbent assay (ELISA) and antigen binding test, respectively. RESULTS At baseline, 26 patients (39.4%) had a CRP level above 10 mg/L with a median (interquartile range, IQR) of 37.7 (21.9-49.7) mg/L. A TCZ concentration above 1 mg/L was sufficient to normalize CRP levels. Spearman's rank test showed a correlation coefficient of -0.460 (p < 0.0001). The TCZ concentration varied widely, with concentrations < 1 mg/L in 17-31% of patients, depending on the time point of measurement. Anti-TCZ antibodies were detected in one sample. Linear regression analyses showed a coefficient of 0.080 with a 95% confidence interval (CI) of 0.039-0.113 (p < 0.001) for the association between TCZ concentration and ΔDAS28. No confounders were identified. CONCLUSIONS The TCZ standard regimen results in a wide variety of serum TCZ trough concentrations; this is mostly due to target binding and to a lesser extent to immunogenicity. The majority of patients obtained TCZ concentrations > 1 mg/L, which is sufficient for CRP normalization. Therefore, dose taper strategies might be possible in a substantial proportion of patients.
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Affiliation(s)
- E L Kneepkens
- a Department of Rheumatology , Amsterdam Rheumatology and immunology Centre, location Reade , Amsterdam , The Netherlands
| | - Iam van den Oever
- a Department of Rheumatology , Amsterdam Rheumatology and immunology Centre, location Reade , Amsterdam , The Netherlands
| | - C H Plasencia
- b Department of Rheumatology , La Paz hospital Madrid , Spain
| | | | - A de Vries
- d Sanquin Diagnostic Services Amsterdam , The Netherlands
| | - M Hart
- e Department of Immunopathology , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre Amsterdam , The Netherlands
| | - M T Nurmohamed
- a Department of Rheumatology , Amsterdam Rheumatology and immunology Centre, location Reade , Amsterdam , The Netherlands.,f Department of Rheumatology , Amsterdam Rheumatology and immunology Centre, VU Medical Centre , Amsterdam , The Netherlands
| | - A Balsa
- b Department of Rheumatology , La Paz hospital Madrid , Spain
| | - T Rispens
- e Department of Immunopathology , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre Amsterdam , The Netherlands
| | - G Wolbink
- a Department of Rheumatology , Amsterdam Rheumatology and immunology Centre, location Reade , Amsterdam , The Netherlands.,e Department of Immunopathology , Sanquin Research and Landsteiner Laboratory, Academic Medical Centre Amsterdam , The Netherlands
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van Brummelen EMJ, Ros W, Wolbink G, Beijnen JH, Schellens JHM. Antidrug Antibody Formation in Oncology: Clinical Relevance and Challenges. Oncologist 2016; 21:1260-1268. [PMID: 27440064 DOI: 10.1634/theoncologist.2016-0061] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 01/15/2016] [Accepted: 06/09/2016] [Indexed: 12/12/2022] Open
Abstract
: In oncology, an increasing number of targeted anticancer agents and immunotherapies are of biological origin. These biological drugs may trigger immune responses that lead to the formation of antidrug antibodies (ADAs). ADAs are directed against immunogenic parts of the drug and may affect efficacy and safety. In other medical fields, such as rheumatology and hematology, the relevance of ADA formation is well established. However, the relevance of ADAs in oncology is just starting to be recognized, and literature on this topic is scarce. In an attempt to fill this gap in the literature, we provide an up-to-date status of ADA formation in oncology. In this focused review, data on ADAs was extracted from 81 clinical trials with biological anticancer agents. We found that most biological anticancer drugs in these trials are immunogenic and induce ADAs (63%). However, it is difficult to establish the clinical relevance of these ADAs. In order to determine this relevance, the possible effects of ADAs on pharmacokinetics, efficacy, and safety parameters need to be investigated. Our data show that this was done in fewer than 50% of the trials. In addition, we describe the incidence and consequences of ADAs for registered agents. We highlight the challenges in ADA detection and argue for the importance of validating, standardizing, and describing well the used assays. Finally, we discuss prevention strategies such as immunosuppression and regimen adaptations. We encourage the launch of clinical trials that explore these strategies in oncology. IMPLICATIONS FOR PRACTICE Because of the increasing use of biologicals in oncology, many patients are at risk of developing antidrug antibodies (ADAs) during therapy. Although clinical consequences are uncertain, ADAs may affect pharmacokinetics, patient safety, and treatment efficacy. ADA detection and reporting is currently highly inconsistent, which makes it difficult to evaluate the clinical consequences. Standardized reporting of ADA investigations in the context of the aforementioned parameters is critical to understanding the relevance of ADA formation for each drug. Furthermore, the development of trials that specifically aim to investigate clinical prevention strategies in oncology is needed.
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Affiliation(s)
- Emilie M J van Brummelen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Willeke Ros
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Immunopathology, Sanquin Research, Amsterdam, The Netherlands Reade Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy, The Netherlands Cancer Institute, Amsterdam, The Netherlands Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan H M Schellens
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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48
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Plasencia C, Wolbink G, Krieckaert CLM, Kneepkens EL, Turk S, Jurado T, Martínez-Feito A, Navarro-Compán V, Bonilla G, Villalba A, Peiteado D, Nuño L, Martín-Mola E, Nurmohamed MT, van der Kleij D, Rispens T, Pascual-Salcedo D, Balsa A. Comparing a tapering strategy to the standard dosing regimen of TNF inhibitors in rheumatoid arthritis patients with low disease activity. Clin Exp Rheumatol 2016; 34:655-662. [PMID: 27214767] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The aim of this study is to compare clinical outcomes, incidence of flares and administered drug reduction between rheumatoid arthritis (RA) patients under TNF inhibitors (TNFi) tapering strategy and RA patients on standard regimen. METHODS Two groups of RA patients on TNFi with DAS28<3.2 were compared: the tapering group (TG: 67 pts from Spain) and the control group with standard therapy regimen (CG: 77 pts from the Netherlands). DAS28 was measured at different time points: visit 0 (prior starting TNFi), visit 1 (prior to start tapering in TG and with DAS28<3.2 in TG and CG), visit 2 (6 months after visit 1), visit 3 (1 year after visit 1), visit 4 (the last visit available after visit 1) and visit-flare (visit with the worst flare between visit 1 and visit 4). RESULTS Despite the reduction of administered drug at visit 4 in the TG (interval elongation of 32.8% in infliximab, 52.9% in adalimumab and 52.6% in etanercept), the DAS28 remained similar between groups at the end of the study (DAS28: 2.7±0.9 in TG vs. 2.5±1 in CG, p=0.1). No differences were seen in the number of patients with flares [26/67 (38.9%) in the TG vs. 30/77 (39%) in the CG, p=0.324] and only nineteen out of 136 patients (14%) had anti-drug antibodies at the end of the study. CONCLUSIONS The tapering strategy of TNFi in RA patients result in a reduction of the drug administered, while the disease control is not worse than patients on the standard regimen.
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Affiliation(s)
- Chamaida Plasencia
- Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain.
| | - Gertjan Wolbink
- Jan van Breemen Research Institute/Reade, Amsterdam; and Department of Rheumatology, V.U. University Medical Centre, Amsterdam, The Netherlands
| | | | - Eva L Kneepkens
- Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands
| | - Samina Turk
- Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands
| | - Teresa Jurado
- Immunology Unit, La Paz University Hospital-Idipaz, Madrid, Spain
| | - Ana Martínez-Feito
- Department of Rheumatology, V.U. University Medical Centre, Amsterdam, The Netherlands
| | | | - Gema Bonilla
- Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain
| | - Alejandro Villalba
- Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain
| | - Diana Peiteado
- Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain
| | - Laura Nuño
- Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain
| | - Emilio Martín-Mola
- Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain
| | - Michael T Nurmohamed
- Jan van Breemen Research Institute/Reade, Amsterdam; and Department of Rheumatology, V.U. University Medical Centre, Amsterdam, The Netherlands
| | | | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Alejandro Balsa
- Department of Rheumatology, La Paz University Hospital-Idipaz, Madrid, Spain
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49
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Ruwaard J, l'Ami M, Marsman A, Kneepkens E, van der Horst-Bruinsma I, van Denderen C, Nurmohamed M, Wolbink G. SAT0397 Comparison of Long-Term Drug Survival Outcome with Etanercept Treatment and Adalimumab Treatment of Ankylosing Spondylitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2345] [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: 11/03/2022]
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50
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Falkenburg W, van Schaardenburg D, Ooijevaar-de Heer P, Tsang-A-Sjoe M, Bultink I, Voskuyl A, Bentlage A, Vidarsson G, Wolbink G, Rispens T. FRI0038 Anti-Hinge Antibodies Recognize IGG Subclass- and Protease-Restricted Hinge neo-Epitopes. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2373] [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: 11/04/2022]
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