1
|
Toorop AA, van Lierop ZY, Gelissen LM, Hoitsma E, Zeinstra EM, van Rooij LC, van Munster CE, Vennegoor A, Mostert JP, Wokke BH, Kalkers NF, Hoogervorst EL, van Eijk JJ, Roosendaal CM, Kragt JJ, Eurelings M, van Genugten J, Nielsen J, Sinnige L, Kloosterziel ME, Arnoldus EP, van Dijk GW, Bouvy WH, Wessels MH, Boonkamp L, Strijbis EM, van Oosten BW, De Jong BA, Lissenberg-Witte BI, Barkhof F, Moraal B, Teunissen CE, Rispens T, Uitdehaag BM, Killestein J, van Kempen ZLE. Prospective trial of natalizumab personalised extended interval dosing by therapeutic drug monitoring in relapsing-remitting multiple sclerosis (NEXT-MS). J Neurol Neurosurg Psychiatry 2024; 95:392-400. [PMID: 37963723 DOI: 10.1136/jnnp-2023-332119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Extended interval dosing (EID) of natalizumab is a promising strategy to optimise treatment in multiple sclerosis (MS). Personalised EID by therapeutic drug monitoring can enable further extension of treatment intervals. METHODS The NEXT-MS trial is an investigator-initiated prospective phase IV non-randomised study. Adults with a diagnosis of relapsing-remitting MS who received ≥6 natalizumab infusions were included in three groups: personalised EID with a target drug trough concentration of 10 µg/mL (EID10), an exploratory group of personalised EID with a target of 5 µg/mL (EID5) and standard interval dosing (SID) of 4 weeks. The primary outcome is radiological disease activity (new/newly enlarged T2 lesions) comparing the EID10 group to a historical cohort of SID (HSID). RESULTS Results of the first phase of the NEXT-MS trial are reported here (n=376) as the study will continue with an amended protocol. In the EID10 group (n=251), incidence rate of radiological activity was 10.0 per 1000 person-years, which was non-inferior to the HSID cohort (24.7 per 1000 person-years (n=87), incidence rate difference 14.7, 90% CI -4.5 to 34.0). Incidence rate of radiological activity was 10.0 per 1000 person-years in the EID5 group (n=65), and 47.0 per 1000 person-years in the SID group (n=60). Serum neurofilament light levels did not increase over time within the EID groups. There were no cases of progressive multifocal leukoencephalopathy. CONCLUSIONS MS disease activity is adequately controlled with personalised natalizumab EID. Interval extension to a drug trough concentration of 5 µg/mL is likely a safe target to extend natalizumab treatment intervals >6 weeks. TRIAL REGISTRATION NUMBER NCT04225312.
Collapse
Affiliation(s)
- Alyssa A Toorop
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Zoë Ygj van Lierop
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Liza My Gelissen
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Elske Hoitsma
- Department of Neurology, MS Center, Alrijne Hospital, Leiden, The Netherlands
| | | | - Luuk C van Rooij
- Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Anke Vennegoor
- Department of Neurology, Flevoziekenhuis, Almere, The Netherlands
| | - Jop P Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Beatrijs Ha Wokke
- Department of Neurology, ErasMS, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nynke F Kalkers
- Department of Neurology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Jeroen Jj van Eijk
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Jolijn J Kragt
- Department of Neurology, Reinier de Graaf Hospital, Delft, The Netherlands
| | | | | | - Jessica Nielsen
- Department of Neurology, Ommelander Hospital Groningen, Scheemda, The Netherlands
| | - Lgf Sinnige
- Department of Neurology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Edo Pj Arnoldus
- Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Gert W van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Willem H Bouvy
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Mark Hj Wessels
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lynn Boonkamp
- Neurochemistry Laboratory, Department of Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Eva Mm Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Bob W van Oosten
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Brigit A De Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Queen Square MS Centre, Department of Neuroinflammation, Faculty of Brain Sciences, University College London Hospitals and National Institute for Health Research, London, UK
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Theo Rispens
- Diagnostic Services and Immunopathology, Sanquin Research, Amsterdam, The Netherlands
- Department of Immunopathology, Landsteiner Laboratory, University of Amsterdam, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Toorop AA, Noteboom S, Steenwijk MD, Gravendeel JW, Jasperse B, Barkhof F, Strijbis EMM, Rispens T, Schoonheim MM, van Kempen ZLE, Killestein J. Exploring the effects of extended interval dosing of natalizumab and drug concentrations on brain atrophy in multiple sclerosis. Mult Scler 2024; 30:266-271. [PMID: 38235514 PMCID: PMC10851624 DOI: 10.1177/13524585231225855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Extended interval dosing (EID) of natalizumab treatment is increasingly used in multiple sclerosis. Besides the clear anti-inflammatory effect, natalizumab is considered to have neuroprotective properties as well. OBJECTIVES This study aimed to study the longitudinal effects of EID compared to standard interval dosing (SID) and natalizumab drug concentrations on brain atrophy. METHODS Patients receiving EID or SID of natalizumab with a minimum radiological follow-up of 2 years were included. Changes in brain atrophy measures over time were derived from clinical routine 3D-Fluid Attenuated Inversion Recovery (FLAIR)-weighted magnetic resonance imaging (MRI) scans using SynthSeg. RESULTS We found no differences between EID (n = 32) and SID (n = 50) for whole brain (-0.21% vs -0.16%, p = 0.42), ventricular (1.84% vs 1.13%, p = 0.24), and thalamic (-0.32% vs -0.32%, p = 0.97) annualized volume change over a median follow-up of 3.2 years. No associations between natalizumab drug concentration and brain atrophy rate were found. CONCLUSION We found no clear evidence that EID compared to SID or lower natalizumab drug concentrations have a negative impact on the development of brain atrophy over time.
Collapse
Affiliation(s)
- Alyssa A Toorop
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Samantha Noteboom
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martijn D Steenwijk
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Job W Gravendeel
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bas Jasperse
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Eva MM Strijbis
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory and Department of Immunopathology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Toorop AA, Steenhuis M, Loeff FC, Weijers SS, Killestein J, Rispens T, van Kempen ZLE. Fingerprick blood samples to measure serum natalizumab concentrations. Mult Scler 2023; 29:457-460. [PMID: 36448735 PMCID: PMC9972227 DOI: 10.1177/13524585221136448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Natalizumab via subcutaneous administration was recently approved for patients with multiple sclerosis. OBJECTIVE In light of personalized extended dosing, in which treatment intervals are prolonged to a concentration cut-off, it would be preferable to measure natalizumab drug concentrations in capillary blood. METHODS In this cross-sectional study in patients treated with intravenous (IV) natalizumab, capillary blood samples by fingerprick and venous blood samples were collected in 30 participants prior to IV administration of natalizumab. RESULTS Natalizumab concentrations were similar with a mean bias of -0.36 μg/mL (95% CI: 1.3 to -2 μg/mL). CONCLUSIONS This study shows that physicians can monitor natalizumab drug concentrations by a fingerprick, which could be used for personalized extended dosing.
Collapse
Affiliation(s)
- Alyssa A Toorop
- AA Toorop Neurology Outpatient Clinic,
Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1118,
1081 HV Amsterdam, The Netherlands.
| | | | - Floris C Loeff
- Biologics Laboratory, Sanquin Diagnostic
Services, Amsterdam, The Netherlands
| | - Suzanne S Weijers
- Central Diagnostic Laboratory, Amsterdam UMC
location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joep Killestein
- Neurology Outpatient Clinic, Amsterdam UMC
location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory, Sanquin Diagnostic
Services, Amsterdam, The Netherlands Department of Immunopathology, Sanquin
Research, Amsterdam, The Netherlands Landsteiner Laboratory, Academic
Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- Neurology Outpatient Clinic, Amsterdam UMC
location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Toorop AA, Hogenboom L, Bloem K, Kocyigit M, Commandeur NWM, Wijnants A, Lissenberg-Witte BI, Strijbis EMM, Uitdehaag BMJ, Rispens T, Killestein J, van Kempen ZLE. Ocrelizumab concentration and antidrug antibodies are associated with B-cell count in multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:487-493. [PMID: 36693720 DOI: 10.1136/jnnp-2022-330793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND The majority of patients with multiple sclerosis on ocrelizumab have B-cell depletion after standard interval dosing of 26 weeks. With B-cell-guided dosing patients receive their next dose when B-cell repopulation occurs. Prediction of B-cell repopulation using ocrelizumab concentrations could aid in personalising treatment regimes. The objectives of this study were to evaluate the association between ocrelizumab drug concentration, antidrug antibodies (ADAs) and CD19 B-cell count, and to define a cut-off ocrelizumab concentration for start of B-cell repopulation (defined by ≥10 CD19+ B cells/µL). METHODS In this investigator-initiated prospective study, blood samples at various time points during ocrelizumab treatment were collected from a biobank. Serum ocrelizumab concentrations and ADAs were measured with two different assays developed for this study. Data were analysed using linear mixed effect models. An receiver operating characteristic (ROC) curve was used to determine a cut-off ocrelizumab concentration for start of B-cell repopulation (defined by ≥10 cells/µL). RESULTS A total of 452 blood samples from 72 patients were analysed. Ocrelizumab concentrations were detectable up until 53.3 weeks after last infusion and ranged between <0.0025 and 204 µg/mL after 1-67 weeks. Ocrelizumab concentration was negatively associated with B-cell count, with body mass index identified as effect modifier. We found a cut-off value of 0.06 µg/mL for start of B-cell repopulation of ≥10 cells/µL. Ocrelizumab ADAs were detectable in four patients (5.7%) with corresponding low ocrelizumab concentrations and start of B-cell repopulation. CONCLUSIONS Serum ocrelizumab concentration was strongly associated with B-cell count. Measurement of ocrelizumab drug concentrations and ADAs could play an important role to further personalise treatment and predict the start of B-cell repopulation.
Collapse
Affiliation(s)
- Alyssa A Toorop
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Laura Hogenboom
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Karien Bloem
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Merve Kocyigit
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | | | - Anne Wijnants
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva M M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Landsteiner Laboratory, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Toorop AA, van Kempen ZLE, Steenhuis M, Nielsen J, Sinnige LGF, van Dijk G, Roosendaal CM, Arnoldus EPJ, Hoitsma E, Lissenberg-Witte BI, de Jong BA, Oosten BWV, Strijbis EMM, Uitdehaag BMJ, Rispens T, Killestein J. Decrease of natalizumab drug levels after switching from intravenous to subcutaneous administration in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:482-486. [PMID: 36639226 DOI: 10.1136/jnnp-2022-330467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Natalizumab is effective in the treatment of multiple sclerosis (MS). In 2021, the European Medicines Agency approved the subcutaneous (SC) variant of natalizumab which can be used instead of intravenous administration. However, the course of drug levels varies between administration routes, and the Food and Drug Administration rejected the request for approval of natalizumab SC for reasons that were not disclosed. Our objective was to evaluate the course of natalizumab trough drug levels in patients who switched from natalizumab intravenous to SC on various treatment intervals. METHODS The NEXT-MS trial (N=382) investigates personalised treatment of natalizumab, in which infusion intervals are prolonged based on individual natalizumab trough drug levels. In 2021, an amendment was approved allowing participants to switch from intravenous to SC administration with frequent measurements of natalizumab drug levels and antidrug antibodies (ADAs). Results were compared with linear mixed model analyses. RESULTS Until December 2022, 15 participants switched to SC natalizumab. Natalizumab drug levels with SC administration were on average 55% lower compared with intravenous administration (Exp (estimate) 0.45, 95% CI 0.39 to 0.53, p<0.001), leading to very low trough drug levels in three patients on extended treatment intervals. No natalizumab ADAs were detected during intravenous or SC treatment. None of the participants on natalizumab SC showed evidence of MS disease activity. CONCLUSIONS Natalizumab trough drug levels can decrease after switching from natalizumab intravenous to SC administration. We advise to monitor trough drug levels in patients with low natalizumab drug levels during intravenous treatment, patients with higher body mass index or patients on extended treatment intervals who switch to SC administration of natalizumab.
Collapse
Affiliation(s)
- Alyssa A Toorop
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Biologics Laboratory, Department of Immunopathology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Jessica Nielsen
- Department of Neurology, Ommelander Hospital Groningen, Scheemda, The Netherlands
| | - L G F Sinnige
- Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Gert van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Edo P J Arnoldus
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Elske Hoitsma
- Department of Neurology, Alrijne Hospital, Leiden, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brigit A de Jong
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Bob W van Oosten
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Eva M M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory, Department of Immunopathology, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Landsteiner Laboratory, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | | |
Collapse
|
6
|
van Kempen ZLE, Hogenboom L, Toorop AA, Steenhuis M, Stalman EW, Kummer LYL, van Dam KPJ, Bloem K, ten Brinke A, van Ham SM, Kuijpers TW, Wolbink GJ, Loeff FC, Wieske L, Eftimov F, Rispens T, Strijbis EMM, Killestein J. Ocrelizumab Concentration Is a Good Predictor of SARS-CoV-2 Vaccination Response in Patients with Multiple Sclerosis. Ann Neurol 2023; 93:103-108. [PMID: 36250739 PMCID: PMC9874752 DOI: 10.1002/ana.26534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 02/05/2023]
Abstract
Ocrelizumab, an anti-CD20 monoclonal antibody, counteracts induction of humoral immune responses after severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccinations in patients with multiple sclerosis (MS). We aimed to assess if serum ocrelizumab concentration measured at the time of vaccination could predict the humoral response after SARS-CoV-2 vaccination. In 52 patients with MS, we found ocrelizumab concentration at the time of vaccination to be a good predictor for SARS-CoV-2 IgG anti-RBD titers after vaccination (comparable to B-cell count). As the course of ocrelizumab concentration may be predicted using pharmacokinetic models, this may be a superior biomarker to guide optimal timing for vaccinations in B-cell depleted patients with MS. ANN NEUROL 2023;93:103-108.
Collapse
Affiliation(s)
- Zoé L. E. van Kempen
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Laura Hogenboom
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Alyssa A. Toorop
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Maurice Steenhuis
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Laura Y. L. Kummer
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands,Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Koos P. J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Karien Bloem
- Sanquin Diagnostic ServicesSanquin LaboratoryAmsterdamThe Netherlands
| | - Anja ten Brinke
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands
| | - S. Marieke van Ham
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands,Swammerdam Institute for Life SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious DiseaseAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Gerrit J. Wolbink
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands,Department of RheumatologyAmsterdam Rheumatology and Immunology CenterAmsterdamThe Netherlands
| | - Floris C. Loeff
- Sanquin Diagnostic ServicesSanquin LaboratoryAmsterdamThe Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands,Department of Clinical NeurophysiologySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam NeuroscienceAmsterdam UMC, location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Theo Rispens
- Department of ImmunopathologySanquin Research and Landsteiner Laboratory, Amsterdam UMCAmsterdamThe Netherlands
| | - Eva M. M. Strijbis
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | - Joep Killestein
- Department of NeurologyAmsterdam UMC, Vrije UniversiteitAmsterdamThe Netherlands
| | | |
Collapse
|
7
|
van Lierop ZY, Noteboom S, Steenwijk MD, van Dam M, Toorop AA, van Kempen ZLE, Moraal B, Barkhof F, Uitdehaag BM, Schoonheim MM, Teunissen CE, Killestein J. Neurofilament-light and contactin-1 association with long-term brain atrophy in natalizumab-treated relapsing-remitting multiple sclerosis. Mult Scler 2022; 28:2231-2242. [PMID: 36062492 DOI: 10.1177/13524585221118676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite highly effective treatment strategies for patients with relapsing-remitting multiple sclerosis (RRMS), long-term neurodegeneration and disease progression are often considerable. Accurate blood-based biomarkers that predict long-term neurodegeneration are lacking. OBJECTIVE To assess the predictive value of serum neurofilament-light (sNfL) and serum contactin-1 (sCNTN1) for long-term magnetic resonance imaging (MRI)-derived neurodegeneration in natalizumab-treated patients with RRMS. METHODS sNfL and sCNTN1 were measured in an observational cohort of natalizumab-treated patients with RRMS at baseline (first dose) and at 3 months, Year 1, Year 2, and last follow-up (median = 5.2 years) of treatment. Disability progression was quantified using "EDSS-plus" criteria. Neurodegeneration was measured by calculating annualized percentage brain, ventricular, and thalamic volume change (PBVC, VVC, and TVC, respectively). Linear regression analysis was performed to identify longitudinal predictors of neurodegeneration. RESULTS In total, 88 patients (age = 37 ± 9 years, 75% female) were included, of whom 48% progressed. Year 1 sNfL level (not baseline or 3 months) was associated with PBVC (standardized (std.) β = -0.26, p = 0.013), VVC (standardized β = 0.36, p < 0.001), and TVC (standardized β = -0.24, p = 0.02). For sCNTN1, only 3-month level was associated with VVC (standardized β = -0.31, p = 0.002). CONCLUSION Year 1 (but not baseline) sNfL level was predictive for long-term brain atrophy in patients treated with natalizumab. sCNTN1 level did not show a clear predictive value.
Collapse
Affiliation(s)
- Zoë Ygj van Lierop
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Samantha Noteboom
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Martijn D Steenwijk
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Maureen van Dam
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Alyssa A Toorop
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Zoé LE van Kempen
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands/Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| |
Collapse
|
8
|
Abstract
Over the past two decades, treatment options for patients with multiple sclerosis (MS) have increased exponentially. In the current therapeutic landscape, "no evidence of MS disease activity" is within reach in many of our patients. Minimizing risks of complications, improving treatment convenience, and decreasing health care costs are goals that are yet to be reached. One way to optimize MS therapy is to implement personalized or extended interval dosing. Monoclonal antibodies are suitable candidates for personalized dosing (by therapeutic drug monitoring) or extended interval dosing. An increasing number of studies are performed and underway reporting on altered dosing intervals of anti-α4β1-integrin treatment (natalizumab) and anti-CD20 treatment (ocrelizumab, rituximab, and ofatumumab) in MS. In this review, current available evidence regarding personalized and extended interval dosing of monoclonal antibodies in MS is discussed with recommendations for future research and clinical practice.
Collapse
Affiliation(s)
- Zoé LE van Kempen
- MS Center Amsterdam, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Alyssa A Toorop
- MS Center Amsterdam Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Joep Killestein
- MS Center Amsterdam Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Toorop AA, Rispens T, Strijbis EM, van Oosten BW, de Jong BA, Uitdehaag BM, Killestein J, van Kempen ZLE. Natalizumab concentrations during pregnancy in three patients with multiple sclerosis. Mult Scler 2021; 28:323-326. [PMID: 34931887 PMCID: PMC8795211 DOI: 10.1177/13524585211052168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In women with very active multiple sclerosis (MS), natalizumab can be continued during pregnancy to prevent rebound disease activity. Our aim was to evaluate changes in serum natalizumab trough concentrations during pregnancy. Blood samples of 3 patients were collected before, during, and after pregnancy. Natalizumab trough concentrations gradually decreased during pregnancy. The patient with the lowest trough concentrations during the third trimester was treated with extended interval dosing (EID). After delivery, natalizumab concentrations increased to similar levels as before pregnancy. All patients remained clinically and radiologically stable. MS neurologists should be aware of decreasing natalizumab concentrations during pregnancy, especially in patients with low initial trough concentrations and patients with EID.
Collapse
Affiliation(s)
- Alyssa A Toorop
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Eva Mm Strijbis
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Bob W van Oosten
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Brigit A de Jong
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
10
|
van Kempen ZLE, Wieske L, Stalman EW, Kummer LYL, van Dam PJ, Volkers AG, Boekel L, Toorop AA, Strijbis EMM, Tas SW, Wolbink GJ, Löwenberg M, van Sandt C, Ten Brinke A, Verstegen NJM, Steenhuis M, Kuijpers TW, van Ham SM, Rispens T, Eftimov F, Killestein J. Longitudinal humoral response after SARS-CoV-2 vaccination in ocrelizumab treated MS patients: To wait and repopulate? Mult Scler Relat Disord 2021; 57:103416. [PMID: 34847379 PMCID: PMC8608662 DOI: 10.1016/j.msard.2021.103416] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to measure humoral responses after SARS-CoV-2 vaccination in MS patients treated with ocrelizumab (OCR) compared to MS patients without disease modifying therapies (DMTs) in relation to timing of vaccination and B-cell count. METHODS OCR treated patients were divided into an early and a late group (cut-off time 12 weeks between infusion and first vaccination). Patients were vaccinated with mRNA-1273 (Moderna). B-cells were measured at baseline (time of first vaccination) and SARS-CoV-2 antibodies were measured at baseline, day 28, 42, 52 and 70. RESULTS 87 patients were included (62 OCR patients, 29 patients without DMTs). At day 70, seroconversion occurred in 39.3% of OCR patients compared to 100% of MS patients without DMTs. In OCR patients, seroconversion varied between 26% (early group) to 50% (late group) and between 27% (low B-cells) to 56% (at least 1 detectable B-cell/µL). CONCLUSIONS Low B-cell counts prior to vaccination and shorter time between OCR infusion and vaccination may negatively influence humoral response but does not preclude seroconversion. We advise OCR treated patients to get their first vaccination as soon as possible. In case of an additional booster vaccination, timing of vaccination based on B-cell count and time after last infusion may be considered.
Collapse
Affiliation(s)
- Z L E van Kempen
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland.
| | - L Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - E W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - L Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland; Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - A G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - L Boekel
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, the Netherland
| | - A A Toorop
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland
| | - E M M Strijbis
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland
| | - S W Tas
- Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - G J Wolbink
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, the Netherland
| | - M Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - C van Sandt
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland; Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth, Melbourne, VIC 3000, USA
| | - A Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - N J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - M Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - T W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - S M van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland; Swammerdam Institute for Life Sciences, University of Amsterdam, the Netherland
| | - T Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Plesmanlaan 125, 1066 CX Amsterdam, the Netherland
| | - F Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherland
| | - J Killestein
- Department of Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, the Netherland
| |
Collapse
|
11
|
van Lierop ZY, Toorop AA, van Ballegoij WJ, Olde Dubbelink TB, Strijbis EM, de Jong BA, van Oosten BW, Moraal B, Teunissen CE, Uitdehaag BM, Killestein J, Kempen ZLEV. Personalized B-cell tailored dosing of ocrelizumab in patients with multiple sclerosis during the COVID-19 pandemic. Mult Scler 2021; 28:1121-1125. [PMID: 34240631 PMCID: PMC9131403 DOI: 10.1177/13524585211028833] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this observational study, 159 patients with multiple sclerosis received personalized dosing of ocrelizumab incentivized by the COVID-19 pandemic. Re-dosing was scheduled when CD19 B-cell count was ⩾10 cells/µL (starting 24 weeks after the previous dose, repeated 4-weekly). Median interval until re-dosing or last B-cell count was 34 [30-38] weeks. No clinical relapses were reported and a minority of patients showed Expanded Disability Status Scale (EDSS) progression. Monthly serum neurofilament light levels remained stable during extended intervals. Two (1.9%) of 107 patients with a follow-up magnetic resonance imaging (MRI) scan showed radiological disease activity. Personalized dosing of ocrelizumab could significantly extend intervals with low short-term disease activity incidence, encouraging future research on long-term safety and efficacy.
Collapse
Affiliation(s)
- Zoë Ygj van Lierop
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alyssa A Toorop
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter Jc van Ballegoij
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands/Department of Neurology, OLVG Hospital, Amsterdam, The Netherlands
| | - Tom Bg Olde Dubbelink
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands/Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Eva Mm Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brigit A de Jong
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bob W van Oosten
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bastiaan Moraal
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
12
|
van Lierop ZYGJ, Toorop AA, Coerver EME, Willemse EAJ, Strijbis EMM, Kalkers NF, Moraal B, Barkhof F, Teunissen CE, Killestein J, van Kempen ZLE. Ocrelizumab after natalizumab in JC-virus positive relapsing remitting multiple sclerosis patients. Mult Scler J Exp Transl Clin 2021; 7:20552173211013831. [PMID: 34123391 PMCID: PMC8175839 DOI: 10.1177/20552173211013831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Ocrelizumab is often used as an alternative therapy in natalizumab-treated MS patients at risk for progressive multifocal leukoencephalopathy (PML). Our objective was to assess efficacy and safety of JC-virus positive patients switching (either directly or indirectly) from natalizumab to ocrelizumab. Forty-two patients were included from an observational cohort (median follow-up 21 months). No evidence of disease activity was found in 83% of direct switchers and 50% of indirect switchers. Two direct switchers were diagnosed with carry-over PML. Our data support a direct switch for adequate disease suppression, although carry-over PML illustrates the dilemma when choosing between a direct or indirect switch.
Collapse
Affiliation(s)
- ZYGJ van Lierop
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - AA Toorop
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - EME Coerver
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - EAJ Willemse
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - EMM Strijbis
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - NF Kalkers
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - B Moraal
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - F Barkhof
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - CE Teunissen
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - J Killestein
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - ZLE van Kempen
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Toorop AA, van Lierop ZYG, Strijbis EEM, Teunissen CE, Petzold A, Wattjes MP, Barkhof F, de Jong BA, van Kempen ZLE, Killestein J. Mild progressive multifocal leukoencephalopathy after switching from natalizumab to ocrelizumab. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e904. [PMID: 33051344 PMCID: PMC7577542 DOI: 10.1212/nxi.0000000000000904] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/03/2020] [Indexed: 12/23/2022]
Abstract
Objective To describe the disease course of carryover progressive multifocal leukoencephalopathy (PML) after switching from natalizumab to ocrelizumab in 2 patients with relapsing-remitting MS. Methods Two case reports with 1 year of follow-up and retrospective longitudinal measurements of serum neurofilament light (NfL) levels and B-cells. Results PML was diagnosed 78 days (case 1) and 97 days (case 2) after discontinuation of natalizumab. Both patients developed mild immune reconstitution inflammatory syndrome (IRIS) despite B-cell depletion caused by ocrelizumab. NfL levels increased in both patients during PML-IRIS. PML-IRIS lesions stabilized after treatment with mefloquine and mirtazapine, followed by methylprednisolone, and both patients continued therapy with ocrelizumab when B-cells started to repopulate. Conclusions The clinical course of carryover PML was mild in both patients, suggesting that B-cell depletion possibly did not aggravate PML-IRIS in these 2 patients.
Collapse
Affiliation(s)
- Alyssa A Toorop
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom.
| | - Zoë Y G van Lierop
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Eva E M Strijbis
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Charlotte E Teunissen
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Axel Petzold
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Mike P Wattjes
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Frederik Barkhof
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Brigit A de Jong
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Zoé L E van Kempen
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| | - Joep Killestein
- From the Department of Neurology (A.A.T., Z.Y.G.L., E.E.M.S., B.A.J., Z.L.E.K., J.K.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam; Department of Clinical Chemistry (C.E.T.), Neurochemistry Laboratory and Biobank, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam; Department of Ophthalmology (A.P.), Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hanover Medical School, Hanover, Germany; Department of Radiology and Nuclear Medicine (M.P.W., F.B.), Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, the Netherlands; Department of Neuroinflammation (F.B.), Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (F.B.), London, United Kingdom
| |
Collapse
|
14
|
Toorop AA, van der Voorn B, Hollanders JJ, Dijkstra LR, Dolman KM, Heijboer AC, Rotteveel J, Honig A, Finken MJJ. Diurnal rhythmicity in breast-milk glucocorticoids, and infant behavior and sleep at age 3 months. Endocrine 2020; 68:660-668. [PMID: 32274700 PMCID: PMC7308244 DOI: 10.1007/s12020-020-02273-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/16/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE In previous studies, associations between breast-milk cortisol levels obtained on one occasion and infant neurodevelopment were demonstrated. However, more recent evidence indicates that breast-milk cortisol and cortisone concentrations follow the diurnal rhythm of maternal hypothalamus-pituitary-adrenal axis, peaking in the early morning and with a nadir at midnight. We studied associations between breast-milk glucocorticoid (GC) rhythmicity, and infant behavior and sleep. METHODS We included 59 mothers, and their infants, of whom 17 had consulted an expert center during pregnancy for an increased risk of psychological distress. At 1 month postpartum, breast milk was sampled (on average six times) over a 24 h period for assessment of cortisol and cortisone using LC-MS/MS, and experienced maternal distress was assessed using the Hospital Anxiety and Depression Scale questionnaire. Three months after birth, infant behavior was assessed with the Infant Behavior Questionnaire, and infant sleep pattern was quantified by questionnaire. Associations between breast-milk GC rhythm parameters (maximum, delta, and Area Under the Curve increase and ground) and infant behavior and sleep were tested with linear regression analyses. RESULTS No consistent associations between breast-milk GC rhythm parameters and infant behavior or sleep were found. CONCLUSIONS Breast-milk GC rhythmicity at 1 month postpartum was not associated with infant behavior or sleep at the age of 3 months. Findings from previous studies linking breast-milk cortisol to infant neurodevelopment might be biased by the lack of GC measurements across the full diurnal cycle, and should therefore be interpreted with caution.
Collapse
Affiliation(s)
- Alyssa A Toorop
- Emma Children's Hospital, Department of Pediatric Endocrinology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Bibian van der Voorn
- Emma Children's Hospital, Department of Pediatric Endocrinology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jonneke J Hollanders
- Emma Children's Hospital, Department of Pediatric Endocrinology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Lisette R Dijkstra
- Emma Children's Hospital, Department of Pediatric Endocrinology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Koert M Dolman
- Department of Pediatrics, OLVG Hospital, Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam University Medical Centers, location VUmc and AMC, Amsterdam, The Netherlands
| | - Joost Rotteveel
- Emma Children's Hospital, Department of Pediatric Endocrinology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Emma Children's Hospital, Department of Pediatric Endocrinology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.
| |
Collapse
|
15
|
Hollanders JJ, van der Voorn B, de Goede P, Toorop AA, Dijkstra LR, Honig A, Rotteveel J, Dolman KM, Kalsbeek A, Finken MJJ. Biphasic Glucocorticoid Rhythm in One-Month-Old Infants: Reflection of a Developing HPA-Axis? J Clin Endocrinol Metab 2020; 105:5606942. [PMID: 31650172 PMCID: PMC9216505 DOI: 10.1210/clinem/dgz089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/07/2019] [Indexed: 12/15/2022]
Abstract
CONTEXT The hypothalamus-pituitary-adrenal (HPA) axis displays a diurnal rhythm. However, little is known about its development in early life. OBJECTIVE To describe HPA-axis activity and study possible influencing factors in 1-month-old infants. DESIGN Observational. SETTING Amsterdam University Medical Center, location VU University Medical Center (VUMC), and Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam. PARTICIPANTS Fifty-five mother-infant pairs. INTERVENTIONS Collection of breast milk and infants' saliva 1 month postpartum for analysis of glucocorticoids (GCs; ie, cortisol and cortisone) using liquid chromatography- tandem mass spectrometry. MAIN OUTCOME MEASURE GC rhythm in infants' saliva and associations with vulnerability for maternal psychological distress (increased Hospital Anxiety and Depression Scale [HADS] score) or consultation at the Psychiatric Obstetric Pediatric (POP clinic), season at sampling, sex, and breast milk GC rhythmicity analyzed with SigmaPlot 14.0 software (Systat Software, San Jose, CA, USA) and regression analyses. RESULTS A significant biphasic GC rhythm was detected in infants, with mean peaks [standard error of the mean, SEM] at 6:53 am [1:01] and 18:36 pm [1:49] for cortisol, and at 8:50 am [1:11] and 19:57 pm [1:13] for cortisone. HADS score, POP consultation, season at sampling, and sex were not associated with the infants' GC rhythm. Breast milk cortisol maximum was positively associated with infants' cortisol area-under-the-curve (AUC) increase and maximum. Higher breast milk cortisone AUC increase, AUC ground, and maximum were associated with an earlier maximum in infants. Breast milk and infant GC concentrations were associated between 6:00 am and 9:00 am. CONCLUSIONS A biphasic GC rhythm, peaking in the morning and evening, was seen in 1-month-old infants at a group level. Breast milk GC parameters might be associated with the infants' GC rhythm, possibly caused by a signaling effect of breast milk GCs, or as an associative effect of increased mother-infant synchrony. These results contribute to an increased understanding of early life HPA-axis development.
Collapse
Affiliation(s)
- Jonneke J Hollanders
- Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Correspondence: Jonneke J. Hollanders, MD, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pediatrics, Room ZH 9 D 36, Postbus 7057, 1007 MB Amsterdam, The Netherlands. E-mail:
| | - Bibian van der Voorn
- Department of Paediatric Endocrinology, Obesity Center Centrum voor Gezond Gewicht (CGG), Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Paul de Goede
- Laboratory of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
- Netherlands Institute for Neuroscience (NIN), Royal Dutch Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Alyssa A Toorop
- Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lisette R Dijkstra
- Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry Obstetrics and Pediatrics (POP), Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Joost Rotteveel
- Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Koert M Dolman
- Department of Psychiatry Obstetrics and Pediatrics (POP), Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Andries Kalsbeek
- Laboratory of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
- Netherlands Institute for Neuroscience (NIN), Royal Dutch Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Martijn J J Finken
- Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Hollanders J, Dijkstra LR, van der Voorn B, Kouwenhoven SM, Toorop AA, van Goudoever JB, Rotteveel J, Finken MJ. No Association between Glucocorticoid Diurnal Rhythm in Breastmilk and Infant Body Composition at 3 Months. Nutrients 2019; 11:nu11102351. [PMID: 31581748 PMCID: PMC6835896 DOI: 10.3390/nu11102351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: Glucocorticoids (GCs) in breastmilk have previously been associated with infant body growth and body composition. However, the diurnal rhythm of breastmilk GCs was not taken into account, and we therefore aimed to assess the associations between breastmilk GC rhythmicity at 1 month and growth and body composition at 3 months in infants. Methods: At 1 month postpartum, breastmilk GCs were collected over a 24-h period and analyzed by LC-MS/MS. Body composition was measured using air-displacement plethysmography at 3 months. Length and weight were collected at 1, 2, and 3 months. Results: In total, 42 healthy mother–infant pairs were included. No associations were found between breastmilk GC rhythmicity (area-under-the-curve increase and ground, maximum, and delta) and infant growth trajectories or body composition (fat and fat free mass index, fat%) at 3 months. Conclusions: This study did not find an association between breastmilk GC rhythmicity at 1 month and infant’s growth or body composition at 3 months. Therefore, this study suggests that previous observations linking breastmilk cortisol to changes in infant weight might be flawed by the lack of serial cortisol measurements and detailed information on body composition.
Collapse
Affiliation(s)
- Jonneke Hollanders
- Emma Children’s Hospital, Amsterdam UMC, Pediatric Endocrinology, Vrije Universiteit Amsterdam, 1000-1183 Amsterdam, The Netherlands; (L.R.D.); (A.A.T.); (J.R.)
- Correspondence: ; Tel.: +31-(0)20-4443137
| | - Lisette R. Dijkstra
- Emma Children’s Hospital, Amsterdam UMC, Pediatric Endocrinology, Vrije Universiteit Amsterdam, 1000-1183 Amsterdam, The Netherlands; (L.R.D.); (A.A.T.); (J.R.)
| | - Bibian van der Voorn
- Department of Paediatric Endocrinology, Obesity Center CGG, Sophia Children’s Hospital, 3000-3099 Rotterdam, The Netherlands;
| | - Stefanie M.P. Kouwenhoven
- Emma Children’s Hospital, Amsterdam UMC, Department of Pediatrics, Vrije Universiteit Amsterdam, 1000-1183 Amsterdam, The Netherlands (J.B.v.G.)
| | - Alyssa A. Toorop
- Emma Children’s Hospital, Amsterdam UMC, Pediatric Endocrinology, Vrije Universiteit Amsterdam, 1000-1183 Amsterdam, The Netherlands; (L.R.D.); (A.A.T.); (J.R.)
| | - Johannes B. van Goudoever
- Emma Children’s Hospital, Amsterdam UMC, Department of Pediatrics, Vrije Universiteit Amsterdam, 1000-1183 Amsterdam, The Netherlands (J.B.v.G.)
| | - Joost Rotteveel
- Emma Children’s Hospital, Amsterdam UMC, Pediatric Endocrinology, Vrije Universiteit Amsterdam, 1000-1183 Amsterdam, The Netherlands; (L.R.D.); (A.A.T.); (J.R.)
| | - Martijn J.J. Finken
- Emma Children’s Hospital, Amsterdam UMC, Pediatric Endocrinology, Vrije Universiteit Amsterdam, 1000-1183 Amsterdam, The Netherlands; (L.R.D.); (A.A.T.); (J.R.)
| |
Collapse
|
17
|
Finken MJJ, van der Voorn B, Hollanders JJ, Dijkstra LR, Toorop AA, Rotteveel J. Cortisol in human milk: The good, the bad, or the ugly? Obesity (Silver Spring) 2017; 25:1153. [PMID: 28556568 DOI: 10.1002/oby.21882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Martijn J J Finken
- Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
| | - Bibian van der Voorn
- Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
| | - Jonneke J Hollanders
- Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
| | - Lisette R Dijkstra
- Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
| | - Alyssa A Toorop
- Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
| | - Joost Rotteveel
- Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|