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Aggarwal R, Charles-Schoeman C, Schessl J, Bata-Csörgő Z, Dimachkie MM, Griger Z, Moiseev S, Oddis C, Schiopu E, Vencovský J, Beckmann I, Clodi E, Bugrova O, Dankó K, Ernste F, Goyal NA, Heuer M, Hudson M, Hussain YM, Karam C, Magnolo N, Nelson R, Pozur N, Prystupa L, Sárdy M, Valenzuela G, van der Kooi AJ, Vu T, Worm M, Levine T. Trial of Intravenous Immune Globulin in Dermatomyositis. N Engl J Med 2022; 387:1264-1278. [PMID: 36198179 DOI: 10.1056/nejmoa2117912] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intravenous immune globulin (IVIG) for the treatment of dermatomyositis has not been extensively evaluated. METHODS We conducted a randomized, placebo-controlled trial involving patients with active dermatomyositis. The patients were assigned in a 1:1 ratio to receive IVIG at a dose of 2.0 g per kilogram of body weight or placebo every 4 weeks for 16 weeks. The patients who received placebo and those without confirmed clinical deterioration while receiving IVIG could enter an open-label extension phase for another 24 weeks. The primary end point was a response, defined as a Total Improvement Score (TIS) of at least 20 (indicating at least minimal improvement) at week 16 and no confirmed deterioration up to week 16. The TIS is a weighted composite score reflecting the change in a core set of six measures of myositis activity over time; scores range from 0 to 100, with higher scores indicating greater improvement. Key secondary end points included at least moderate improvement (TIS ≥40) and major improvement (TIS ≥60), and change in score on the Cutaneous Dermatomyositis Disease Area and Severity Index. RESULTS A total of 95 patients underwent randomization: 47 patients were assigned to the IVIG group, and 48 to the placebo group. At 16 weeks, 79% of the patients in the IVIG group (37 of 47) and 44% of those in the placebo group (21 of 48) had a TIS of at least 20 (difference, 35 percentage points; 95% confidence interval, 17 to 53; P<0.001). The results with respect to the secondary end points, including at least moderate improvement and major improvement, were generally in the same direction as the results of the primary end-point analysis, except for the change in creatine kinase level (an individual core measure of the TIS), which did not differ meaningfully between the two groups. Over 40 weeks, 282 treatment-related adverse events occurred in the IVIG group, including headache (in 42% of patients), pyrexia (in 19%), and nausea (in 16%). A total of 9 serious adverse events that were considered to be related to IVIG occurred, including 6 thromboembolic events. CONCLUSIONS In this 16-week trial involving adults with dermatomyositis, the percentage of patients with a response of at least minimal improvement based on a composite score of disease activity was significantly greater among those who received IVIG than among those who received placebo. IVIG was associated with adverse events, including thromboembolism. (Funded by Octapharma Pharmazeutika; ProDERM ClinicalTrials.gov number, NCT02728752.).
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Affiliation(s)
- Rohit Aggarwal
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Christina Charles-Schoeman
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Joachim Schessl
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Zsuzsanna Bata-Csörgő
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Mazen M Dimachkie
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Zoltan Griger
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Sergey Moiseev
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Chester Oddis
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Elena Schiopu
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Jiri Vencovský
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Irene Beckmann
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Elisabeth Clodi
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Olga Bugrova
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Katalin Dankó
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Floranne Ernste
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Namita A Goyal
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Marvin Heuer
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Marie Hudson
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Yessar M Hussain
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Chafic Karam
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Nina Magnolo
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Ronald Nelson
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Nataliia Pozur
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Liudmyla Prystupa
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Miklós Sárdy
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Guillermo Valenzuela
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Anneke J van der Kooi
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Tuan Vu
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Margitta Worm
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Todd Levine
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
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Budding K, Johansen LE, Van de Walle I, Dijkxhoorn K, de Zeeuw E, Bloemenkamp LM, Bos JW, Jansen MD, Curial CAD, Silence K, de Haard H, Blanchetot C, Van de Ven L, Leusen JHW, Pasterkamp RJ, van den Berg LH, Hack CE, Boross P, van der Pol WL. Anti-C2 Antibody ARGX-117 Inhibits Complement in a Disease Model for Multifocal Motor Neuropathy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 9:9/1/e1107. [PMID: 34759020 PMCID: PMC8587732 DOI: 10.1212/nxi.0000000000001107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 09/10/2021] [Indexed: 11/22/2022]
Abstract
Background and Objectives To determine the role of complement in the disease pathology of multifocal motor neuropathy (MMN), we investigated complement activation, and inhibition, on binding of MMN patient-derived immunoglobulin M (IgM) antibodies in an induced pluripotent stem cell (iPSC)-derived motor neuron (MN) model for MMN. Methods iPSC-derived MNs were characterized for the expression of complement receptors and membrane-bound regulators, for the binding of circulating IgM anti-GM1 from patients with MMN, and for subsequent fixation of C4 and C3 on incubation with fresh serum. The potency of ARGX-117, a novel inhibitory monoclonal antibody targeting C2, to inhibit fixation of complement was assessed. Results iPSC-derived MNs moderately express the complement regulatory proteins CD46 and CD55 and strongly expressed CD59. Furthermore, MNs express C3aR, C5aR, and complement receptor 1. IgM anti-GM1 antibodies in serum from patients with MMN bind to MNs and induce C3 and C4 fixation on incubation with fresh serum. ARGX-117 inhibits complement activation downstream of C4 induced by patient-derived anti-GM1 antibodies bound to MNs. Discussion Binding of IgM antibodies from patients with MMN to iPSC-derived MNs induces complement activation. By expressing complement regulatory proteins, particularly CD59, MNs are protected against complement-mediated lysis. Yet, because of expressing C3aR, the function of these cells may be affected by complement activation upstream of membrane attack complex formation. ARGX-117 inhibits complement activation upstream of C3 in this disease model for MMN and therefore represents an intervention strategy to prevent harmful effects of complement in MMN.
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Affiliation(s)
- Kevin Budding
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Lill Eva Johansen
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Inge Van de Walle
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Kim Dijkxhoorn
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Elisabeth de Zeeuw
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Lauri M Bloemenkamp
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Jeroen W Bos
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Marc D Jansen
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Chantall A D Curial
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Karen Silence
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Hans de Haard
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Christophe Blanchetot
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Liesbeth Van de Ven
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Jeanette H W Leusen
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - R Jeroen Pasterkamp
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Leonard H van den Berg
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - C Erik Hack
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - Peter Boross
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands
| | - W Ludo van der Pol
- From the Center for Translational Immunology (K.B., K.D., E.Z., L.M.B., J.H.W.L., C.E.H., P.B.), University Medical Center Utrecht; Department of Neurology and Neurosurgery (L.E.J., L.M.B., J.W.B., M.D.J., C.A.D.C., L.H.B., W.L.P.), University Medical Center Utrecht Brain Center; Department of Translational Neuroscience (L.E.J., L.M.B., R.J.P.), University Medical Center Utrecht Brain Center, Utrecht University; Argenx BVBA, Industriepark-Zwijnaarde 7 (I.W., K.S., H.H., C.B., L.V.), Zwijnaarde, Belgium; and Prothix (C.E.H., P.B.), Leiden, the Netherlands.
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