1
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Golebski K, van der Lans RJL, van Egmond D, de Groot E, Spits H, der Zee AHMV, van Drunen CM, Fokkens WJ, Reitsma S. Inflammatory innate lymphoid cells predict response speed to dupilumab in chronic rhinosinusitis with nasal polyps. Allergy 2023; 78:3265-3268. [PMID: 37705461 DOI: 10.1111/all.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Korneliusz Golebski
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Danielle van Egmond
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther de Groot
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hergen Spits
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cornelis Maria van Drunen
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wytske Johanna Fokkens
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sietze Reitsma
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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2
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van Dijk YE, Rutjes NW, Golebski K, Şahin H, Hashimoto S, Maitland-van der Zee AH, Vijverberg SJH. Developments in the Management of Severe Asthma in Children and Adolescents: Focus on Dupilumab and Tezepelumab. Paediatr Drugs 2023; 25:677-693. [PMID: 37658954 PMCID: PMC10600295 DOI: 10.1007/s40272-023-00589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Abstract
Severe asthma in children and adolescents exerts a substantial health, financial, and societal burden. Severe asthma is a heterogeneous condition with multiple clinical phenotypes and underlying inflammatory patterns that might be different in individual patients. Various add-on treatments have been developed to treat severe asthma, including monoclonal antibodies (biologics) targeting inflammatory mediators. Biologics that are currently approved to treat children (≥ 6 years of age) or adolescents (≥ 12 years of age) with severe asthma include: anti-immunoglobulin E (omalizumab), anti-interleukin (IL)-5 (mepolizumab), anti-IL5 receptor (benralizumab), anti-IL4/IL13 receptor (dupilumab), and antithymic stromal lymphopoietin (TSLP) (tezepelumab). However, access to these targeted treatments varies across countries and relies on few and crude indicators. There is a need for better treatment stratification to guide which children might benefit from these treatments. In this narrative review we will assess the most recent developments in the treatment of severe pediatric asthma, as well as potential biomarkers to assess treatment efficacy for this patient population.
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Affiliation(s)
- Yoni E van Dijk
- Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Pediatric Pulmonology, Emma's Childrens Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels W Rutjes
- Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Pediatric Pulmonology, Emma's Childrens Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Korneliusz Golebski
- Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Havva Şahin
- Pediatric Pulmonology, Emma's Childrens Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Hashimoto
- Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Pediatric Pulmonology, Emma's Childrens Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Pediatric Pulmonology, Emma's Childrens Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Pulmonary Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Pediatric Pulmonology, Emma's Childrens Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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3
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Yasinska V, Gómez C, Kolmert J, Ericsson M, Pohanka A, James A, Andersson LI, Sparreman-Mikus M, Sousa AR, Riley JH, Bates S, Bakke PS, Zounemat Kermani N, Caruso M, Chanez P, Fowler SJ, Geiser T, Howarth PH, Horváth I, Krug N, Montuschi P, Sanak M, Behndig A, Shaw DE, Knowles RG, Dahlén B, Maitland-van der Zee AH, Sterk PJ, Djukanovic R, Adcock IM, Chung KF, Wheelock CE, Dahlén SE, Wikström Jonsson E. Low levels of endogenous anabolic androgenic steroids in females with severe asthma taking corticosteroids. ERJ Open Res 2023; 9:00269-2023. [PMID: 37868143 PMCID: PMC10588792 DOI: 10.1183/23120541.00269-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/21/2023] [Indexed: 10/24/2023] Open
Abstract
Rationale Patients with severe asthma are dependent upon treatment with high doses of inhaled corticosteroids (ICS) and often also oral corticosteroids (OCS). The extent of endogenous androgenic anabolic steroid (EAAS) suppression in asthma has not previously been described in detail. The objective of the present study was to measure urinary concentrations of EAAS in relation to exogenous corticosteroid exposure. Methods Urine collected at baseline in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease outcomes) study of severe adult asthmatics (SA, n=408) was analysed by quantitative mass spectrometry. Data were compared to that of mild-to-moderate asthmatics (MMA, n=70) and healthy subjects (HC, n=98) from the same study. Measurements and main results The concentrations of urinary endogenous steroid metabolites were substantially lower in SA than in MMA or HC. These differences were more pronounced in SA patients with detectable urinary OCS metabolites. Their dehydroepiandrosterone sulfate (DHEA-S) concentrations were <5% of those in HC, and cortisol concentrations were below the detection limit in 75% of females and 82% of males. The concentrations of EAAS in OCS-positive patients, as well as patients on high-dose ICS only, were more suppressed in females than males (p<0.05). Low levels of DHEA were associated with features of more severe disease and were more prevalent in females (p<0.05). The association between low EAAS and corticosteroid treatment was replicated in 289 of the SA patients at follow-up after 12-18 months. Conclusion The pronounced suppression of endogenous anabolic androgens in females might contribute to sex differences regarding the prevalence of severe asthma.
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Affiliation(s)
- Valentyna Yasinska
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Cristina Gómez
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Kolmert
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Ericsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
- Laboratoire AntiDopage Français, Université Paris-Saclay, Châtenay-Malabry, France
| | - Anton Pohanka
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna James
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars I. Andersson
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Maria Sparreman-Mikus
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Ana R. Sousa
- Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, UK
| | - John H. Riley
- Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, UK
| | - Stewart Bates
- Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, UK
| | - Per S. Bakke
- Institute of Clinical Science, University of Bergen, Bergen, Norway
| | - Nazanin Zounemat Kermani
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
| | - Massimo Caruso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Pascal Chanez
- Assistance Publique des Hôpitaux de Marseille, Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Marseille, France
| | - Stephen J. Fowler
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital, University of Bern, Bern, Switzerland
| | - Peter H. Howarth
- Faculty of Medicine, Southampton University, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, UK
| | - Ildikó Horváth
- Department of Public Health, Semmelweis University, Budapest, Hungary
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Paolo Montuschi
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Annelie Behndig
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dominick E. Shaw
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | | | - Barbro Dahlén
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Peter J. Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ratko Djukanovic
- Faculty of Medicine, Southampton University, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, UK
| | - Ian M. Adcock
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute and Data Science Institute, Imperial College London, London, UK
| | - Craig E. Wheelock
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Erik Dahlén
- Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Wikström Jonsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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4
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Bendien SA, Kroes JA, van Hal LHG, Braunstahl GJ, Broeders MEAC, Oud KTM, Patberg KW, Smeenk FWJM, van Veen IHPAA, Weersink EJM, Fieten KB, Hashimoto S, van Veen A, Sont JK, van Huisstede A, van de Ven MJT, Langeveld B, Maitland-van der Zee AH, Ten Brinke A. Real-World Effectiveness of IL-5/5Ra Targeted Biologics in Severe Eosinophilic Asthma With Comorbid Bronchiectasis. J Allergy Clin Immunol Pract 2023; 11:2724-2731.e2. [PMID: 37295671 DOI: 10.1016/j.jaip.2023.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Bronchiectasis is a common comorbidity in patients with asthma and is associated with increased disease severity. In patients with severe eosinophilic asthma, biologics targeting IL-5/5Ra have beneficial effects on oral corticosteroid (OCS) use and exacerbation frequency. However, how coexisting bronchiectasis affects the response to such treatments is unknown. OBJECTIVE To evaluate the real-world effectiveness of anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma and comorbid bronchiectasis on exacerbation frequency and daily maintenance and cumulative OCS dose. METHODS This real-world study evaluated data from 97 adults with severe eosinophilic asthma and computed tomography-confirmed bronchiectasis from the Dutch Severe Asthma Registry, who initiated anti-IL5/5Ra biologics (mepolizumab, reslizumab, and benralizumab) and had follow-up data for 12 months or greater. The analysis was performed for the total population and subgroups with or without maintenance OCS use. RESULTS Anti-IL-5/5Ra therapy significantly reduced exacerbation frequency in patients with maintenance OCS use as well as in those without it. In the year before biologic initiation, 74.5% of all patients had two or more exacerbations, which decreased to 22.1% in the follow-up year (P < .001). The proportion of patients on maintenance OCS decreased from 47% to 30% (P < .001), and in the OCS-dependent patients (n = 45) maintenance OCS dose decreased from median (interquartile range) of 10.0 mg/d (5-15 mg/d) to 2.5 mg/d (0-5 mg/d) after 1 year (P < .001). CONCLUSIONS This real-world study shows that anti-IL-5/5Ra therapy reduces exacerbation frequency and daily maintenance as well as the cumulative OCS dose in patients with severe eosinophilic asthma and comorbid bronchiectasis. Although it is an exclusion criterion in phase 3 trials, comorbid bronchiectasis should not preclude anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma.
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Affiliation(s)
- Sarah A Bendien
- Department of Pulmonology, Haga Teaching Hospital, The Hague, the Netherlands.
| | - Johannes A Kroes
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Lotte H G van Hal
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Respiratory Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Marielle E A C Broeders
- Department of Respiratory Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Karen T M Oud
- Department of Respiratory Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands
| | | | - Frank W J M Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Els J M Weersink
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Karin B Fieten
- Dutch Asthma Center Davos (NAD), Davos, Switzerland, Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos Wolfgang, Switzerland
| | - Simone Hashimoto
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Anneke van Veen
- Department of Respiratory Medicine, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Jaap K Sont
- Department of Biomedical Data Sciences, Medical Decision Making Section, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Bas Langeveld
- Department of Pulmonology, Deventer Ziekenhuis, Deventer, the Netherlands
| | | | - Anneke Ten Brinke
- Department of Pulmonology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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5
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Stolz D, Matera MG, Rogliani P, van den Berge M, Papakonstantinou E, Gosens R, Singh D, Hanania N, Cazzola M, Maitland-van der Zee AH, Fregonese L, Mathioudakis AG, Vestbo J, Rukhadze M, Page CP. Current and future developments in the pharmacology of asthma and COPD: ERS seminar, Naples 2022. Breathe (Sheff) 2023; 19:220267. [PMID: 37377851 PMCID: PMC10292790 DOI: 10.1183/20734735.0267-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/13/2022] [Accepted: 04/28/2023] [Indexed: 06/29/2023] Open
Abstract
Pharmacological management of airway obstructive diseases is a fast-evolving field. Several advances in unravelling disease mechanisms as well as intracellular and molecular pathways of drug action have been accomplished. While the clinical translation and implementation of in vitro results to the bedside remains challenging, advances in comprehending the mechanisms of respiratory medication are expected to assist clinicians and scientists in identifying meaningful read-outs and designing clinical studies. This European Respiratory Society Research Seminar, held in Naples, Italy, 5-6 May 2022, focused on current and future developments of the drugs used to treat asthma and COPD; on mechanisms of drug action, steroid resistance, comorbidities and drug interactions; on prognostic and therapeutic biomarkers; on developing novel drug targets based on tissue remodelling and regeneration; and on pharmacogenomics and emerging biosimilars. Related European Medicines Agency regulations are also discussed, as well as the seminar's position on the above aspects.
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Affiliation(s)
- Daiana Stolz
- Clinic of Pulmonary Medicine, Department of Internal Medicine, Medical Center University of Freiburg, Freiburg, Germany
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel, Basel, Switzerland
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Maarten van den Berge
- Groningen Research Institute for Asthma and COPD, and Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eleni Papakonstantinou
- Clinic of Pulmonary Medicine, Department of Internal Medicine, Medical Center University of Freiburg, Freiburg, Germany
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel, Basel, Switzerland
| | - Reinoud Gosens
- Groningen Research Institute for Asthma and COPD, and Department of Molecular Pharmacology, Groningen Research Institute of Pharmacy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicola Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | | | | | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Maia Rukhadze
- Center of Allergy and Immunology, Teaching University Geomedi LLC, Tbilisi, Georgia
| | - Clive P. Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
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6
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de Jong FJM, Wingelaar TT, Brinkman P, van Ooij PJAM, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Pulmonary Oxygen Toxicity Through Exhaled Breath Markers After Hyperbaric Oxygen Treatment Table 6. Front Physiol 2022; 13:899568. [PMID: 35620607 PMCID: PMC9127798 DOI: 10.3389/fphys.2022.899568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: The hyperbaric oxygen treatment table 6 (TT6) is widely used to manage dysbaric illnesses in divers and iatrogenic gas emboli in patients after surgery and other interventional procedures. These treatment tables can have adverse effects, such as pulmonary oxygen toxicity (POT). It is caused by reactive oxygen species’ damaging effect in lung tissue and is often experienced after multiple days of therapy. The subclinical pulmonary effects have not been determined. The primary aim of this study was to measure volatile organic compounds (VOCs) in breath, indicative of subclinical POT after a TT6. Since the exposure would be limited, the secondary aim of this study was to determine whether these VOCs decreased to baseline levels within a few hours.Methods: Fourteen healthy, non-smoking volunteers from the Royal Netherlands Navy underwent a TT6 at the Amsterdam University Medical Center—location AMC. Breath samples for GC-MS analysis were collected before the TT6 and 30 min, 2 and 4 h after finishing. The concentrations of ions before and after exposure were compared by Wilcoxon signed-rank tests. The VOCs were identified by comparing the chromatograms with the NIST library. Compound intensities over time were tested using Friedman tests, with Wilcoxon signed-rank tests and Bonferroni corrections used for post hoc analyses.Results: Univariate analyses identified 11 compounds. Five compounds, isoprene, decane, nonane, nonanal and dodecane, showed significant changes after the Friedman test. Isoprene demonstrated a significant increase at 30 min after exposure and a subsequent decrease at 2 h. Other compounds remained constant, but declined significantly 4 h after exposure.Discussion and Conclusion: The identified VOCs consisted mainly of (methyl) alkanes, which may be generated by peroxidation of cell membranes. Other compounds may be linked to inflammatory processes, oxidative stress responses or cellular metabolism. The hypothesis, that exhaled VOCs would increase after hyperbaric exposure as an indicator of subclinical POT, was not fulfilled, except for isoprene. Hence, no evident signs of POT or subclinical pulmonary damage were detected after a TT6. Further studies on individuals recently exposed to pulmonary irritants, such as divers and individuals exposed to other hyperbaric treatment regimens, are needed.
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Affiliation(s)
- Feiko J. M. de Jong
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
- *Correspondence: Feiko J. M. de Jong,
| | - Thijs T. Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Pieter-Jan A. M. van Ooij
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | | | - Marcus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
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7
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Slob EMA, Longo C, Vijverberg SJH, Beijsterveldt TCEMV, Bartels M, Hottenga JJ, Pijnenburg MW, Koppelman GH, Maitland-van der Zee AH, Dolan CV, Boomsma DI. Persistence of parental-reported asthma at early ages: A longitudinal twin study. Pediatr Allergy Immunol 2022; 33:e13762. [PMID: 35338742 PMCID: PMC9314674 DOI: 10.1111/pai.13762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Currently, we cannot predict whether a pre-school child with asthma-like symptoms will have asthma at school age. Whether genetic information can help in this prediction depends on the role of genetic factors in persistence of pre-school to school-age asthma. We examined to what extent genetic and environmental factors contribute to persistence of asthma-like symptoms at ages 3 to asthma at age 7 using a bivariate genetic model for longitudinal twin data. METHODS We performed a cohort study in monozygotic and dizygotic twins from the Netherlands Twin Register (NTR, n = 21,541 twin pairs). Bivariate genetic models were fitted to longitudinal data on asthma-like symptoms reported by parents at age 3 and 7 years to estimate the contribution of genetic and environmental factors. RESULTS Bivariate genetic modeling showed a correlation on the liability scale between asthma-like symptoms at age 3 and asthma at age 7 of 0.746 and the contribution of genetics was estimated to be 0.917. The genetic analyses indicated a substantial influence of genetic factors on asthma-like symptoms at ages 3 and 7 (heritability 80% and 90%, respectively); hence, contribution of environmental factors was low. Persistence was explained by a high (rg = 0.807) genetic correlation. CONCLUSION Parental-reported asthma-like symptoms at age 3 and asthma at age 7 are highly heritably. The phenotype of asthma-like symptoms at age 3 and 7 was highly correlated and mainly due to heritable factors, indicating high persistence of asthma development over ages 3 and 7.
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Affiliation(s)
- Elise Margaretha Adriana Slob
- Department of Respiratory Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatric Pulmonology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Cristina Longo
- Department of Respiratory Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatric Pulmonology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Toos C E M van Beijsterveldt
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Meike Bartels
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jouke Jan Hottenga
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mariëlle W Pijnenburg
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, ErasmusMC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Gerard H Koppelman
- Department of Paediatric Pulmonology & Paediatric Allergology, University Medical Centre Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma & COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatric Pulmonology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Conor V Dolan
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorret I Boomsma
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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8
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Rutjes N, Van den Bongaardt I, Hashimoto S, Sterk P, Van Aalderen W, Terheggen-Lagro S, Brinkman P, Maitland-van der Zee AH, Van der Schee M, Haarman E. Prediction of asthma in early preschool wheezing by electronic nose analysis. Pediatr Allergy Immunol 2022; 33:e13612. [PMID: 34407242 DOI: 10.1111/pai.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Niels Rutjes
- Department of Paediatric Pulmonology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Ivo Van den Bongaardt
- Department of Paediatric Pulmonology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Simone Hashimoto
- Respiratory Disease, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Peter Sterk
- Respiratory Disease, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Wim Van Aalderen
- Department of Paediatric Pulmonology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Suzanne Terheggen-Lagro
- Department of Paediatric Pulmonology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Marc Van der Schee
- Department of Paediatric Pulmonology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Eric Haarman
- Department of Paediatric Pulmonology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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9
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Golebski K, Dankelman LHM, Björkander S, Bønnelykke K, Brinkman P, Deschildre A, van Dijk YE, Fleming L, Grigg J, Hamelmann E, Hashimoto S, Kabesch M, Klevebro S, Maitland-van der Zee AH, Merid SK, Nieto A, Niggel J, Nilsson C, Potočnik U, Roberts G, Rusconi F, Saglani S, Valente E, van Drunen C, Wang G, Melén E, Vijverberg SJH. Expert meeting report: towards a joint European roadmap to address the unmet needs and priorities of paediatric asthma patients on biologic therapy. ERJ Open Res 2021; 7:00381-2021. [PMID: 34729368 PMCID: PMC8558470 DOI: 10.1183/23120541.00381-2021] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/28/2021] [Indexed: 02/05/2023] Open
Abstract
A digital multidisciplinary European expert meeting took place on the 9 July 2020 to identify the unmet needs of paediatric severe asthma patients, and set the priorities for clinical and research activities ahead https://bit.ly/3CeLBHB.
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Affiliation(s)
- Korneliusz Golebski
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lente H M Dankelman
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sofia Björkander
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Paul Brinkman
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoine Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Yoni E van Dijk
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Louise Fleming
- Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK
| | - Eckard Hamelmann
- Klinik für Kinder and Jugendmedizin Kinderzentrum, Bethel Evangelisches Krankenhaus, Allergy Center, Ruhr University Bochum, Bielefeld, Germany
| | - Simone Hashimoto
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michael Kabesch
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John and the University Hospital, University of Regensburg, Regensburg, Germany
| | - Susanna Klevebro
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anke-Hilse Maitland-van der Zee
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Simon K Merid
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Nieto
- Children's Hospital La Fe, Pediatric Pulmonology and Allergy Unit, Instituto de Investigacion Sanitaria La Fe, Valencia, Spain
| | - Jakob Niggel
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John and the University Hospital, University of Regensburg, Regensburg, Germany
| | - Caroline Nilsson
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Uroš Potočnik
- Center for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Graham Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - Franca Rusconi
- Epidemiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Sejal Saglani
- Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Elisangela Valente
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John and the University Hospital, University of Regensburg, Regensburg, Germany
| | - Cornelis van Drunen
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gang Wang
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Erik Melén
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,These authors contributed equally
| | - Susanne J H Vijverberg
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,These authors contributed equally
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10
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Vonk SEM, van der Meer-Vos M, Bos LDJ, Neerincx AH, Majoor CJ, Maitland-van der Zee AH, Mathôt RAA, Kemper EM. Quantitative Method for the Analysis of Ivacaftor, Hydroxymethyl Ivacaftor, Ivacaftor Carboxylate, Lumacaftor, and Tezacaftor in Plasma and Sputum Using Liquid Chromatography With Tandem Mass Spectrometry and Its Clinical Applicability. Ther Drug Monit 2021; 43:555-563. [PMID: 33165217 PMCID: PMC8277188 DOI: 10.1097/ftd.0000000000000829] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The novel cystic fibrosis transmembrane conductance regulator (CFTR) modulators, ivacaftor, lumacaftor, and tezacaftor, are the first drugs directly targeting the underlying pathophysiological mechanism in cystic fibrosis (CF); however, independent studies describing their pharmacokinetics are lacking. The aim of this study was to develop a quantification method for ivacaftor and its 2 main metabolites, lumacaftor and tezacaftor, in plasma and sputum using liquid chromatography with tandem mass spectrometry. METHODS The developed method used a small sample volume (20 µL) and simple pretreatment method; protein precipitation solution and internal standard were added in one step to each sample. Liquid chromatography with tandem mass spectrometry was performed for a total run time of 6 minutes. The method was validated by assessing selectivity, carryover, linearity, accuracy and precision, dilution, matrix effects, and stability. RESULTS The selectivity was good as no interference from matrices was observed. In the concentration range from 0.01 to 10.0 mg/L, calibration curves were linear with a correlation coefficient >0.9997 for all compounds. The within-run and between-run accuracy were between 99.7% and 116% at the lower limit of quantitation (LLOQ) and between 95.8% and 112.9% for all concentrations above LLOQ for all analytes in plasma and sputum. Within-run and between-run precisions were <12.7% for LLOQ and <6.7% for the higher limit of quantitation. Samples were stable, with no significant degradation at examined temperatures and time points. Clinical applicability was revealed by analyzing samples from 2 patients with CF. CONCLUSIONS The presented method enables simultaneous quantification of ivacaftor, lumacaftor, and tezacaftor in plasma and sputum and is an improvement over previous methods because it uses smaller sample volumes, a simple pretreatment protocol, and includes tezacaftor. In future studies, it can be applied for examining pharmacokinetics characteristics of new CF transmembrane conductance regulator modulators.
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Affiliation(s)
| | | | - Lieuwe D J Bos
- Respiratory Medicine, and
- Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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11
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Aman J, Duijvelaar E, Botros L, Kianzad A, Schippers JR, Smeele PJ, Azhang S, Bartelink IH, Bayoumy AA, Bet PM, Boersma W, Bonta PI, Boomars KAT, Bos LDJ, van Bragt JJMH, Braunstahl GJ, Celant LR, Eger KAB, Geelhoed JJM, van Glabbeek YLE, Grotjohan HP, Hagens LA, Happe CM, Hazes BD, Heunks LMA, van den Heuvel M, Hoefsloot W, Hoek RJA, Hoekstra R, Hofstee HMA, Juffermans NP, Kemper EM, Kos R, Kunst PWA, Lammers A, van der Lee I, van der Lee EL, Maitland-van der Zee AH, Mau Asam PFM, Mieras A, Muller M, Neefjes L, Nossent EJ, Oswald LMA, Overbeek MJ, Pamplona C, Paternotte N, Pronk N, de Raaf MA, van Raaij BFM, Reijrink M, Schultz MJ, Serpa Neto A, Slob EM, Smeenk FWJM, Smit MR, Smits AJ, Stalenhoef JE, Tuinman PR, Vanhove ALEM, Wessels JN, van Wezenbeek JCC, Vonk Noordegraaf A, de Man FS, Bogaard HJ. Imatinib in patients with severe COVID-19: a randomised, double-blind, placebo-controlled, clinical trial. Lancet Respir Med 2021; 9:957-968. [PMID: 34147142 PMCID: PMC8232929 DOI: 10.1016/s2213-2600(21)00237-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The major complication of COVID-19 is hypoxaemic respiratory failure from capillary leak and alveolar oedema. Experimental and early clinical data suggest that the tyrosine-kinase inhibitor imatinib reverses pulmonary capillary leak. METHODS This randomised, double-blind, placebo-controlled, clinical trial was done at 13 academic and non-academic teaching hospitals in the Netherlands. Hospitalised patients (aged ≥18 years) with COVID-19, as confirmed by an RT-PCR test for SARS-CoV-2, requiring supplemental oxygen to maintain a peripheral oxygen saturation of greater than 94% were eligible. Patients were excluded if they had severe pre-existing pulmonary disease, had pre-existing heart failure, had undergone active treatment of a haematological or non-haematological malignancy in the previous 12 months, had cytopenia, or were receiving concomitant treatment with medication known to strongly interact with imatinib. Patients were randomly assigned (1:1) to receive either oral imatinib, given as a loading dose of 800 mg on day 0 followed by 400 mg daily on days 1-9, or placebo. Randomisation was done with a computer-based clinical data management platform with variable block sizes (containing two, four, or six patients), stratified by study site. The primary outcome was time to discontinuation of mechanical ventilation and supplemental oxygen for more than 48 consecutive hours, while being alive during a 28-day period. Secondary outcomes included safety, mortality at 28 days, and the need for invasive mechanical ventilation. All efficacy and safety analyses were done in all randomised patients who had received at least one dose of study medication (modified intention-to-treat population). This study is registered with the EU Clinical Trials Register (EudraCT 2020-001236-10). FINDINGS Between March 31, 2020, and Jan 4, 2021, 805 patients were screened, of whom 400 were eligible and randomly assigned to the imatinib group (n=204) or the placebo group (n=196). A total of 385 (96%) patients (median age 64 years [IQR 56-73]) received at least one dose of study medication and were included in the modified intention-to-treat population. Time to discontinuation of ventilation and supplemental oxygen for more than 48 h was not significantly different between the two groups (unadjusted hazard ratio [HR] 0·95 [95% CI 0·76-1·20]). At day 28, 15 (8%) of 197 patients had died in the imatinib group compared with 27 (14%) of 188 patients in the placebo group (unadjusted HR 0·51 [0·27-0·95]). After adjusting for baseline imbalances between the two groups (sex, obesity, diabetes, and cardiovascular disease) the HR for mortality was 0·52 (95% CI 0·26-1·05). The HR for mechanical ventilation in the imatinib group compared with the placebo group was 1·07 (0·63-1·80; p=0·81). The median duration of invasive mechanical ventilation was 7 days (IQR 3-13) in the imatinib group compared with 12 days (6-20) in the placebo group (p=0·0080). 91 (46%) of 197 patients in the imatinib group and 82 (44%) of 188 patients in the placebo group had at least one grade 3 or higher adverse event. The safety evaluation revealed no imatinib-associated adverse events. INTERPRETATION The study failed to meet its primary outcome, as imatinib did not reduce the time to discontinuation of ventilation and supplemental oxygen for more than 48 consecutive hours in patients with COVID-19 requiring supplemental oxygen. The observed effects on survival (although attenuated after adjustment for baseline imbalances) and duration of mechanical ventilation suggest that imatinib might confer clinical benefit in hospitalised patients with COVID-19, but further studies are required to validate these findings. FUNDING Amsterdam Medical Center Foundation, Nederlandse Organisatie voor Wetenschappelijk Onderzoek/ZonMW, and the European Union Innovative Medicines Initiative 2.
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Affiliation(s)
- Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Erik Duijvelaar
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Liza Botros
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Azar Kianzad
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Job R Schippers
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Patrick J Smeele
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sara Azhang
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Pulmonology, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Imke H Bartelink
- Department of Pharmacy, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Ahmed A Bayoumy
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Pulmonology, Chest Unit, Suez Canal University, Suez, Egypt
| | - Pierre M Bet
- Department of Pharmacy, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Wim Boersma
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karin A T Boomars
- Department of Pulmonology, Erasmus Medisch Centrum, Rotterdam, Netherlands
| | - Lieuwe D J Bos
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - Job J M H van Bragt
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Sint Franciscus Ziekenhuis, Rotterdam, Netherlands
| | - Lucas R Celant
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katrien A B Eger
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Yurika L E van Glabbeek
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hans P Grotjohan
- Department of Pulmonology, Isala Ziekenhuizen, Zwolle, Netherlands
| | - Laura A Hagens
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - Chris M Happe
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Boaz D Hazes
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leo M A Heunks
- Department of Intensive Care, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | | | | | - Rianne J A Hoek
- Department of Pharmacy, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Romke Hoekstra
- Department of Pulmonology, Antonius Ziekenhuis, Sneek, Netherlands
| | - Herman M A Hofstee
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands; Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | | | - Renate Kos
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter W A Kunst
- Department of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Ariana Lammers
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ivo van der Lee
- Department of Pulmonology, Spaarne Gasthuis, Haarlem, Netherlands
| | - E Laurien van der Lee
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Pearl F M Mau Asam
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adinda Mieras
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mirte Muller
- Department of Pulmonology, Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Liesbeth Neefjes
- Department of Pulmonology, Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Laurien M A Oswald
- Department of Pulmonology, Sint Franciscus Ziekenhuis, Rotterdam, Netherlands
| | - Maria J Overbeek
- Department of Pulmonology, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Carolina Pamplona
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nienke Paternotte
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | - Niels Pronk
- Department of Pulmonology, Gelre Ziekenhuis, Apeldoorn, Netherlands
| | - Michiel A de Raaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bas F M van Raaij
- Department of Pulmonology Leiden University Medical Center, Leiden, Netherlands
| | - Merlijn Reijrink
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - Ary Serpa Neto
- Department of Critical Care Medicine and Institute of Education and Research, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Elise M Slob
- Department of Respiratory Medicine, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Marry R Smit
- Department of Intensive Care, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - A Josien Smits
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Janneke E Stalenhoef
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care, Amsterdam UMC, VUMC, Amsterdam, Netherlands
| | - Arthur L E M Vanhove
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jessie N Wessels
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jessie C C van Wezenbeek
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harm J Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
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12
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Moor CC, Oppenheimer JC, Nakshbandi G, Aerts JGJV, Brinkman P, Maitland-van der Zee AH, Wijsenbeek MS. Exhaled breath analysis by use of eNose technology: a novel diagnostic tool for interstitial lung disease. Eur Respir J 2021; 57:13993003.02042-2020. [PMID: 32732331 DOI: 10.1183/13993003.02042-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Early and accurate diagnosis of interstitial lung diseases (ILDs) remains a major challenge. Better noninvasive diagnostic tools are much needed. We aimed to assess the accuracy of exhaled breath analysis using eNose technology to discriminate between ILD patients and healthy controls, and to distinguish ILD subgroups. METHODS In this cross-sectional study, exhaled breath of consecutive ILD patients and healthy controls was analysed using eNose technology (SpiroNose). Statistical analyses were done using partial least square discriminant analysis and receiver operating characteristic analysis. Independent training and validation sets (2:1) were used in larger subgroups. RESULTS A total of 322 ILD patients and 48 healthy controls were included: sarcoidosis (n=141), idiopathic pulmonary fibrosis (IPF) (n=85), connective tissue disease-associated ILD (n=33), chronic hypersensitivity pneumonitis (n=25), idiopathic nonspecific interstitial pneumonia (n=10), interstitial pneumonia with autoimmune features (n=11) and other ILDs (n=17). eNose sensors discriminated between ILD and healthy controls, with an area under the curve (AUC) of 1.00 in the training and validation sets. Comparison of patients with IPF and patients with other ILDs yielded an AUC of 0.91 (95% CI 0.85-0.96) in the training set and an AUC of 0.87 (95% CI 0.77-0.96) in the validation set. The eNose reliably distinguished between individual diseases, with AUC values ranging from 0.85 to 0.99. CONCLUSIONS eNose technology can completely distinguish ILD patients from healthy controls and can accurately discriminate between different ILD subgroups. Hence, exhaled breath analysis using eNose technology could be a novel biomarker in ILD, enabling timely diagnosis in the future.
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Affiliation(s)
- Catharina C Moor
- Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,These authors share first authorship
| | - Judith C Oppenheimer
- Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,These authors share first authorship
| | - Gizal Nakshbandi
- Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joachim G J V Aerts
- Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul Brinkman
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Rotterdam, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Rotterdam, The Netherlands.,These authors share senior authorship
| | - Marlies S Wijsenbeek
- Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,These authors share senior authorship
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13
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Bendien SA, van Loon-Kooij S, Kramer G, Huijgen W, Altenburg J, Ten Brinke A, Maitland-van der Zee AH. Bronchiectasis in Severe Asthma: Does It Make a Difference? Respiration 2020; 99:1-9. [PMID: 33321494 DOI: 10.1159/000511459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma and bronchiectasis are 2 heterogeneous diseases that frequently coexist, particularly in severe asthma. Recognition of this co-diagnosis may importantly affect treatment decisions and outcome. Previous studies in asthma with bronchiectasis show inconsistent outcomes, probably due to the heterogeneity of the included asthma cohorts. OBJECTIVES We hypothesized that bronchiectasis contributes to asthma severity and that patients with severe asthma and bronchiectasis present with distinct characteristics resulting in different treatable traits. In addition, we explored whether bronchiectasis in severe asthma is more common in a specific phenotype. METHODS This is a single-center study consecutively including patients with severe asthma from a tertiary referral center. Severe asthma was diagnosed according to the ATS/ERS guidelines. Asthma and infectious exacerbations were defined by the attending specialist as respiratory symptoms requiring treatment with systemic steroids or antibiotics, respectively. Two independent blinded radiologists evaluated each CT. RESULTS 19% of patients with severe asthma showed bronchiectasis on CT. Patients with bronchiectasis had a lower FEV1% predicted (p = 0.02) and FEV1/FVC (p = 0.004) and more infectious exacerbations (p = 0.003) compared to patients without bronchiectasis. Bronchiectasis is more common in patients with a longer duration of asthma, sensitization to A. fumigatus or a positive sputum culture. Sputum cultures of patients with severe asthma and bronchiectasis revealed more P. aeruginosa, S. maltophilia, H. parainfluenzae, and A. fumigates compared to the non-bronchiectasis group. The adult-onset, eosinophilic asthma phenotype showed the highest prevalence of bronchiectasis (29.4%). CONCLUSIONS Patients with severe asthma and coexisting bronchiectasis were found to represent a distinct group, in terms of disease severity, microbiology, and asthma phenotype. Performing (HR)CT and sputum cultures can help to identify these patients. These results can possibly contribute to early recognition and targeted treatment of this patient group.
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Affiliation(s)
- Sarah Alice Bendien
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands,
| | | | - Gerdien Kramer
- Department of Radiology, Martini Hospital, Groningen, The Netherlands
| | - Willemijn Huijgen
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Josje Altenburg
- Department of Respiratory Medicine, Amsterdam University Medical Center (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Ten Brinke
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Center (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
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14
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Nicoletti P, Devarbhavi H, Goel A, Venkatesan R, Eapen CE, Grove JI, Zafer S, Bjornsson E, Lucena MI, Andrade RJ, Pirmohamed M, Wadelius M, Larrey D, Maitland-van der Zee AH, Ibanez L, Watkins PB, Daly AK, Aithal GP. Genetic Risk Factors in Drug-Induced Liver Injury Due to Isoniazid-Containing Antituberculosis Drug Regimens. Clin Pharmacol Ther 2020; 109:1125-1135. [PMID: 33135175 DOI: 10.1002/cpt.2100] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
Drug-induced liver injury (DILI) is a complication of treatment with antituberculosis (TB) drugs, especially in isoniazid (INH)-containing regimens. To investigate genetic risk factors, we performed a genomewide association study (GWAS) involving anti-TB DILI cases (55 Indian and 70 European) and controls (1,199 Indian and 10,397 European). Most cases were treated with a standard anti-TB drug regimen; all received INH. We imputed single nucleotide polymorphism and HLA genotypes and performed trans-ethnic meta-analysis on GWAS and candidate gene genotypes. GWAS found one significant association (rs117491755) in Europeans only. For HLA, HLA-B*52:01 was significant (meta-analysis odds ratio (OR) 2.67, 95% confidence interval (CI) 1.63-4.37, P = 9.4 × 10-5 ). For N-acetyltransferase 2 (NAT2), NAT2*5 frequency was lower in cases (OR 0.69, 95% CI 0.57-0.83, P = 0.01). NAT2*6 and NAT2*7 were more common, with homozygotes for NAT2*6 and/or NAT2*7 enriched among cases (OR 1.89, 95% CI 0.84-4.22, P = 0.004). We conclude HLA genotype makes a small contribution to TB drug-related DILI and that the NAT2 contribution is complex, but consistent with previous reports when differences in the metabolic effect of NAT2*5 compared with those of NAT2*6 and NAT2*7 are considered.
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Affiliation(s)
- Paola Nicoletti
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harshad Devarbhavi
- Department of Gastroenterology, St John's Medical College Hospital, Bangalore, India
| | | | - Radha Venkatesan
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | | | - Jane I Grove
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Samreen Zafer
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Einar Bjornsson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - M Isabel Lucena
- UGC Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Raul J Andrade
- UGC Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, Liverpool University Hospitals and Liverpool Health Partners, University of Liverpool, Liverpool, UK
| | - Mia Wadelius
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Anke-Hilse Maitland-van der Zee
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Luisa Ibanez
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paul B Watkins
- Eshelman School of Pharmacy, University of North Carolina Institute for Drug Safety Sciences, Chapel Hill, North Carolina, USA
| | - Ann K Daly
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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15
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Zazuli Z, Kos R, Veltman JD, Uyterlinde W, Longo C, Baas P, Masereeuw R, Vijverberg SJH, Maitland-van der Zee AH. Comparison of Myelotoxicity and Nephrotoxicity Between Daily Low-Dose Cisplatin With Concurrent Radiation and Cyclic High-Dose Cisplatin in Non-Small Cell Lung Cancer Patients. Front Pharmacol 2020; 11:975. [PMID: 32670072 PMCID: PMC7332698 DOI: 10.3389/fphar.2020.00975] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
Aim Antineoplastic effect of cisplatin, the first line treatment in non-small cell lung cancer (NSCLC), is hindered by its nephrotoxicity and myelotoxicity. Both low-dose and high-dose regimens are used in the management of NSCLC. The aim of this study is to assess the risk on myelotoxicity and nephrotoxicity from the daily low-dose cisplatin (DLD) treatment as compared to cyclic high-dose cisplatin (CHD). Methods A retrospective cohort study was conducted. NSCLC patients treated with cisplatin between 2011 and 2018 in the Amsterdam UMC or Antoni van Leeuwenhoek cancer hospital were studied. Myelotoxicity and nephrotoxicity were defined based on common terminology criteria (CTCAE v4.03) and categorized as ≥grade 1 and ≥grade 2. Modified Poisson regression and Cox proportional hazards model were used to estimate relative risks and cumulative hazard respectively. Results Of the 115 NSCLC patients receiving DLD (N=62) and CHD (N=53), 60% had ≥grade 1 anemia, 33.9% leukopenia, 31.3% neutropenia, 27.8% thrombocytopenia, 32.2% acute nephrotoxicity with combined definition (Cr-electrolyte nephrotoxicity), and 58.3% chronic nephrotoxicity. The DLD group was older, had an earlier cancer stage, had more comorbidities, and had higher baseline albumin levels. In the DLD group less ≥grade 2 toxicities were reported compared to the CHD group except for Cr-electrolyte nephrotoxicity. However, there was a stronger association in the DLD group with ≥grade 1 leukopenia, thrombocytopenia, and Cr-electrolyte nephrotoxicity. The DLD group developed significantly more ≥grade 1 leukopenia [adjusted relative risk (adjRR)=1.83, 95% CI 1.02-3.27], thrombocytopenia (adjRR=3.43, 95% CI 1.64-7.15), and ≥grade 2 Cr-electrolyte nephrotoxicity (adjRR=3.02, 95% CI 1.20-7.56). The DLD group had a lower adjusted cumulative hazard for developing ≥grade 2 myelotoxicity and chronic nephrotoxicity but not for Cr-electrolyte nephrotoxicity [adjusted hazard ratio (adjHR)=3.90, 95% CI 1.35-11.23]. In contrast, DLD showed protective effect to ≥grade 2 nephrotoxicity when definition was restricted to the traditional creatinine-based definition (adjRR=0.07, 95% CI 0.01-0.86; adjHR=0.05, 95% CI 0.01-0.56). Conclusions Overall, the DLD regimen was safer than the CHD regimen when assessing the risk of ≥grade 2 myelotoxicity and nephrotoxicity. However, this might not be the case in patients with a higher risk of electrolyte abnormalities.
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Affiliation(s)
- Zulfan Zazuli
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Pharmacology-Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia
| | - Renate Kos
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joris D Veltman
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Wilma Uyterlinde
- Department of Thoracic Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Cristina Longo
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Rosalinde Masereeuw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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16
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Richards LB, van Bragt JJMH, Aarab R, Longo C, Neerincx AH, Sont JK, Weersink EJM, Braunstahl GJ, Brinke AT, Bel EHD, Maitland-van der Zee AH. Treatment Eligibility of Real-Life Mepolizumab-Treated Severe Asthma Patients. J Allergy Clin Immunol Pract 2020; 8:2999-3008.e1. [PMID: 32344189 DOI: 10.1016/j.jaip.2020.04.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with severe asthma not meeting the strict trial eligibility criteria for mepolizumab are now routinely treated with this biological in clinical practice, but it remains unclear whether these ineligible patients respond differently to mepolizumab treatment. OBJECTIVE This study investigated the extent and reasons for trial ineligibility of real-life, mepolizumab-treated patients with severe asthma and compared the characteristics of these patients with trial populations. Subsequently, therapeutic response in ineligible patients was assessed on the basis of oral corticosteroid (OCS) reduction. METHODS Trial eligibility, population differences, and therapeutic response were assessed using the baseline characteristics of mepolizumab-receiving patients with severe asthma treated in the Amsterdam University Medical Centres and OCS dose at 6 months for OCS-dependent patients extracted from patients' electronic health records. Eligibility criteria and population characteristics from trials investigating mepolizumab were extracted from their original publications. RESULTS A total of 82.4% of 119 mepolizumab-receiving, real-life patients with severe asthma were ineligible for trial inclusion, wherein 42.9% and 39.5% were excluded on the basis of inclusion and exclusion criteria, respectively. The clinical care population was older, more often male and demonstrating a better lung function under lower OCS maintenance dosages in comparison with trial populations. A total of 50% of 66 ineligible, OCS-dependent mepolizumab-treated patients were able to reduce their maintenance OCS dosage to ≤5 mg prednisone/day. CONCLUSIONS A large proportion of the real-life, mepolizumab-treated population with severe asthma would be excluded from trial participation, and significant differences in population characteristics exist. Regardless, a large fraction of ineligible patients in clinical care can reduce maintenance OCS dosage under mepolizumab therapy.
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Affiliation(s)
- Levi B Richards
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands.
| | - Job J M H van Bragt
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Reim Aarab
- Department of Pulmonary Medicine, OLVG Hospital, Amsterdam, the Netherlands
| | - Cristina Longo
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Anne H Neerincx
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap K Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Els J M Weersink
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Anneke Ten Brinke
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Elisabeth H D Bel
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
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17
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Wingelaar TT, Brinkman P, Hoencamp R, van Ooij PJA, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Assessment of pulmonary oxygen toxicity in special operations forces divers under operational circumstances using exhaled breath analysis. Diving Hyperb Med 2020; 50:2-7. [PMID: 32187611 DOI: 10.28920/dhm50.1.2-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/12/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The Netherlands Maritime Special Operations Forces use closed circuit oxygen rebreathers (O₂-CCR), which can cause pulmonary oxygen toxicity (POT). Recent studies demonstrated that volatile organic compounds (VOCs) can be used to detect POT in laboratory conditions. It is unclear if similar VOCs can be identified outside the laboratory. This study hypothesised that similar VOCs can be identified after O₂-CCR diving in operational settings. METHODS Scenario one: 4 h O₂-CCR dive to 3 metres' seawater (msw) with rested divers. Scenario two: 3 h O₂-CCR dive to 3 msw following a 5 day physically straining operational scenario. Exhaled breath samples were collected 30 min before and 30 min and 2 h after diving under field conditions and analysed using gas chromatography-mass spectrometry (GC-MS) to reconstruct VOCs, whose levels were tested longitudinally using a Kruskal-Wallis test. RESULTS Eleven divers were included: four in scenario one and seven in scenario two. The 2 h post-dive sample could not be obtained in scenario two; therefore, 26 samples were collected. GC-MS analysis identified three relevant VOCs: cyclohexane, 2,4-dimethylhexane and 3-methylnonane. The intensities of 2,4-dimethylhexane and 3-methylnonane were significantly (P = 0.048 and P = 0.016, respectively) increased post-dive relative to baseline (range: 212-461%) in both scenarios. Cyclohexane was increased not significantly (P = 0.178) post-dive (range: 87-433%). CONCLUSIONS VOCs similar to those associated with POT in laboratory conditions were identified after operational O₂-CCR dives using GC-MS. Post-dive intensities were higher than in previous studies, and it remains to be determined if this is attributable to different dive profiles, diving equipment or other environmental factors.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands.,Corresponding author: Dr Thijs T Wingelaar, Royal Netherlands Navy Diving Medical Centre, Rijkszee en marinehaven, 1780 CA, Den Helder, the Netherlands,
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands.,Defence Healthcare Organisation, Ministry of Defence, Utrecht, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Pieter-Jan Am van Ooij
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Pulmonology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | | | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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18
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Zhang Y, Souverein PC, Gardarsdottir H, van den Ham HA, Maitland-van der Zee AH, de Boer A. Risk of major bleeding among users of direct oral anticoagulants combined with interacting drugs: A population-based nested case-control study. Br J Clin Pharmacol 2020; 86:1150-1164. [PMID: 32022295 PMCID: PMC7256117 DOI: 10.1111/bcp.14227] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Aims To assess the association between concurrent use of potential pharmacokinetic or pharmacodynamic interacting drugs and major bleeding among direct oral anticoagulant (DOAC) users. Methods We performed a case–control study nested in a cohort of new users of DOACs (dabigatran etexilate, apixaban or rivaroxaban). Data were obtained from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics (2008–2015). Cases were patients hospitalized having a primary diagnosis of major bleeding. Up to 4 controls were matched on age, sex, index date and region. Odds ratios (ORs) for the risk of major bleeding were assessed by conditional logistic regression analysis and adjusted for well‐known covariates for the risk of bleeding. Results We identified 393 patients with a major bleeding from a total of 23 492 new users of DOACs and 1494 matched controls. Most subjects were users of rivaroxaban (58.8%) on the index date. The concurrent use of pharmacodynamic interacting drugs was associated with an increased risk of major bleeding (21.6% of cases vs 13.5% of controls, adjusted odds ratio [aOR] 1.92; 95% confidence interval [CI], 1.40–2.66). For the antiplatelet drugs the aOR was 2.01 (95% CI, 1.29–3.11) and for the selective serotonin reuptake inhibitors the aOR was 1.68 (95% CI, 1.10–2.59). We found no increased risk of major bleeding for concurrent use of pharmacokinetic interacting drugs vs DOACs alone (45.0 vs 51.2%; aOR: 0.77; 95% CI: 0.53–1.10). Conclusion Among patients taking DOACs the concurrent use of antiplatelet drugs or selective serotonin reuptake inhibitors was associated with increased risk of major bleeding, while pharmacokinetic interacting drugs do not increase this risk.
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Affiliation(s)
- Yumao Zhang
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacy, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hendrika A van den Ham
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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19
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van den Heuvel JM, Farzan N, van Hoek M, Maitland-van der Zee AH, Ahmadizar F. Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands. BMJ Open Diabetes Res Care 2020; 8:8/1/e000767. [PMID: 31958296 PMCID: PMC6954782 DOI: 10.1136/bmjdrc-2019-000767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/18/2019] [Revised: 11/12/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
RATIONALE AND OBJECTIVES Different classes of glucose-lowering medications are used for patients with type 2 diabetes mellitus (T2DM) management. It is unclear how often these medications are prescribed in clinical practice. In this study, we aimed to describe treatment patterns of glucose-lowering medications in patients with T2DM in the Netherlands. METHODS We studied a cohort of 73 819 patients with T2DM, aged ≥45 years with a first prescription for oral glucose-lowering medication between 2011 and 2017. We used the NControl database with dispensing data from 800 pharmacies in the Netherlands. Prevalence of each glucose-lowering medication class during 6 years after the index date was calculated. Using SQL Server, we identified stepwise patterns of medication prescription in this population. FINDINGS During the study period, prevalence of biguanides (BIGU) decreased from 95.6% to 80.8% and use of sulfonylureas (SU) increased from 27.3% to 42.3%. 55.2% of all patients only received BIGUs, 19.1% of all patients started on BIGUs but switched to BIGU +SU. 13.5% of patients with T2DM initiated insulins, on average 532 days (almost 18 months) after the index date. CONCLUSIONS Our findings showed that in the Netherlands, medication treatment in patients with T2DM is mainly consistent with the clinical guidelines in the Netherlands during the study period.
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Affiliation(s)
| | - Niloufar Farzan
- Department of Respiratory Disease, Academic Medical Center, Amsterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus University, Rotterdam, Zuid-Holland, The Netherlands
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20
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Wingelaar TT, Brinkman P, de Vries R, van Ooij PJA, Hoencamp R, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Detecting Pulmonary Oxygen Toxicity Using eNose Technology and Associations between Electronic Nose and Gas Chromatography-Mass Spectrometry Data. Metabolites 2019; 9:metabo9120286. [PMID: 31766640 PMCID: PMC6950559 DOI: 10.3390/metabo9120286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/04/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Exposure to oxygen under increased atmospheric pressures can induce pulmonary oxygen toxicity (POT). Exhaled breath analysis using gas chromatography–mass spectrometry (GC–MS) has revealed that volatile organic compounds (VOCs) are associated with inflammation and lipoperoxidation after hyperbaric–hyperoxic exposure. Electronic nose (eNose) technology would be more suited for the detection of POT, since it is less time and resource consuming. However, it is unknown whether eNose technology can detect POT and whether eNose sensor data can be associated with VOCs of interest. In this randomized cross-over trial, the exhaled breath from divers who had made two dives of 1 h to 192.5 kPa (a depth of 9 m) with either 100% oxygen or compressed air was analyzed, at several time points, using GC–MS and eNose. We used a partial least square discriminant analysis, eNose discriminated oxygen and air dives at 30 min post dive with an area under the receiver operating characteristics curve of 79.9% (95%CI: 61.1–98.6; p = 0.003). A two-way orthogonal partial least square regression (O2PLS) model analysis revealed an R² of 0.50 between targeted VOCs obtained by GC–MS and eNose sensor data. The contribution of each sensor to the detection of targeted VOCs was also assessed using O2PLS. When all GC–MS fragments were included in the O2PLS model, this resulted in an R² of 0.08. Thus, eNose could detect POT 30 min post dive, and the correlation between targeted VOCs and eNose data could be assessed using O2PLS.
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Affiliation(s)
- Thijs T. Wingelaar
- Diving and Submarine Medical Center, Royal Netherlands Navy, Rijkszee en Marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-889-510-480
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rianne de Vries
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Breathomix, Pascalstraat 13H, 2811 EL Reeuwijk, the Netherlands
| | - Pieter-Jan A.M. van Ooij
- Diving and Submarine Medical Center, Royal Netherlands Navy, Rijkszee en Marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
- Defense Healthcare Organisation, Ministry of Defence, Herculeslaan 1, 3584 AB Utrecht, The Netherlands
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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21
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Floyd JS, Bloch KM, Brody JA, Maroteau C, Siddiqui MK, Gregory R, Carr DF, Molokhia M, Liu X, Bis JC, Ahmed A, Liu X, Hallberg P, Yue QY, Magnusson PKE, Brisson D, Wiggins KL, Morrison AC, Khoury E, McKeigue P, Stricker BH, Lapeyre-Mestre M, Heckbert SR, Gallagher AM, Chinoy H, Gibbs RA, Bondon-Guitton E, Tracy R, Boerwinkle E, Gaudet D, Conforti A, van Staa T, Sitlani CM, Rice KM, Maitland-van der Zee AH, Wadelius M, Morris AP, Pirmohamed M, Palmer CAN, Psaty BM, Alfirevic A. Pharmacogenomics of statin-related myopathy: Meta-analysis of rare variants from whole-exome sequencing. PLoS One 2019; 14:e0218115. [PMID: 31242253 PMCID: PMC6594672 DOI: 10.1371/journal.pone.0218115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/25/2019] [Indexed: 11/25/2022] Open
Abstract
AIMS Statin-related myopathy (SRM), which includes rhabdomyolysis, is an uncommon but important adverse drug reaction because the number of people prescribed statins world-wide is large. Previous association studies of common genetic variants have had limited success in identifying a genetic basis for this adverse drug reaction. We conducted a multi-site whole-exome sequencing study to investigate whether rare coding variants confer an increased risk of SRM. METHODS AND RESULTS SRM 3-5 cases (N = 505) and statin treatment-tolerant controls (N = 2047) were recruited from multiple sites in North America and Europe. SRM 3-5 was defined as symptoms consistent with muscle injury and an elevated creatine phosphokinase level >4 times upper limit of normal without another likely cause of muscle injury. Whole-exome sequencing and variant calling was coordinated from two analysis centres, and results of single-variant and gene-based burden tests were meta-analysed. No genome-wide significant associations were identified. Given the large number of cases, we had 80% power to identify a variant with minor allele frequency of 0.01 that increases the risk of SRM 6-fold at genome-wide significance. CONCLUSIONS In this large whole-exome sequencing study of severe statin-related muscle injury conducted to date, we did not find evidence that rare coding variants are responsible for this adverse drug reaction. Larger sample sizes would be required to identify rare variants with small effects, but it is unclear whether such findings would be clinically actionable.
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Affiliation(s)
- James S. Floyd
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Katarzyna M. Bloch
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Jennifer A. Brody
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Cyrielle Maroteau
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
| | - Moneeza K. Siddiqui
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
| | - Richard Gregory
- Functional and Comparative Genomics, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Daniel F. Carr
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Mariam Molokhia
- School of Population Health and Environmental Sciences, London, United Kingdom
| | - Xiaoming Liu
- Human Genetics Center, University of Texas Health Science Center, Houston, United States of America
| | - Joshua C. Bis
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Ammar Ahmed
- Medical School, University of Liverpool, Liverpool, United Kingdom
| | - Xuan Liu
- Functional and Comparative Genomics, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Pär Hallberg
- Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | | | - Patrik K. E. Magnusson
- Swedish Twin Registry, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Diane Brisson
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Quebec, Canada
| | - Kerri L. Wiggins
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Alanna C. Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Etienne Khoury
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Quebec, Canada
| | - Paul McKeigue
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, Edinburgh, Scotland, United Kingdom
| | - Bruno H. Stricker
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Maryse Lapeyre-Mestre
- Paul Sabatier University - Toulouse III, UPS Toulouse, Laboratoire de Pharmacologie Medicale et Clinique, Toulouse, France
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Arlene M. Gallagher
- Clinical Practice Research Datalink (CPRD) Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | - Hector Chinoy
- Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, United Kingdom
| | - Richard A. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, United States of America
| | - Emmanuelle Bondon-Guitton
- Centre Hospitalier Universitaire de Toulouse, CHU Toulouse, Centre de Pharmacovigilance, Toulouse, France
| | - Russell Tracy
- Departments of Pathology & Laboratory Medicine and Biochemistry, Larner College of Medicine, University of Vermont, Burlington, Vermont, United States of America
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Daniel Gaudet
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Quebec, Canada
| | - Anita Conforti
- U.O. Farmacologia, Policlinico "Gb Rossi", Verona, Italy
| | - Tjeerd van Staa
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Colleen M. Sitlani
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Kenneth M. Rice
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | | | - Mia Wadelius
- Medical School, University of Liverpool, Liverpool, United Kingdom
| | - Andrew P. Morris
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Colin A. N. Palmer
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
| | - Bruce M. Psaty
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Ana Alfirevic
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
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22
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Brinkman P, Wagener AH, Hekking PP, Bansal AT, Maitland-van der Zee AH, Wang Y, Weda H, Knobel HH, Vink TJ, Rattray NJ, D'Amico A, Pennazza G, Santonico M, Lefaudeux D, De Meulder B, Auffray C, Bakke PS, Caruso M, Chanez P, Chung KF, Corfield J, Dahlén SE, Djukanovic R, Geiser T, Horvath I, Krug N, Musial J, Sun K, Riley JH, Shaw DE, Sandström T, Sousa AR, Montuschi P, Fowler SJ, Sterk PJ. Identification and prospective stability of electronic nose (eNose)-derived inflammatory phenotypes in patients with severe asthma. J Allergy Clin Immunol 2018; 143:1811-1820.e7. [PMID: 30529449 DOI: 10.1016/j.jaci.2018.10.058] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/04/2018] [Accepted: 10/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Severe asthma is a heterogeneous condition, as shown by independent cluster analyses based on demographic, clinical, and inflammatory characteristics. A next step is to identify molecularly driven phenotypes using "omics" technologies. Molecular fingerprints of exhaled breath are associated with inflammation and can qualify as noninvasive assessment of severe asthma phenotypes. OBJECTIVES We aimed (1) to identify severe asthma phenotypes using exhaled metabolomic fingerprints obtained from a composite of electronic noses (eNoses) and (2) to assess the stability of eNose-derived phenotypes in relation to within-patient clinical and inflammatory changes. METHODS In this longitudinal multicenter study exhaled breath samples were taken from an unselected subset of adults with severe asthma from the U-BIOPRED cohort. Exhaled metabolites were analyzed centrally by using an assembly of eNoses. Unsupervised Ward clustering enhanced by similarity profile analysis together with K-means clustering was performed. For internal validation, partitioning around medoids and topological data analysis were applied. Samples at 12 to 18 months of prospective follow-up were used to assess longitudinal within-patient stability. RESULTS Data were available for 78 subjects (age, 55 years [interquartile range, 45-64 years]; 41% male). Three eNose-driven clusters (n = 26/33/19) were revealed, showing differences in circulating eosinophil (P = .045) and neutrophil (P = .017) percentages and ratios of patients using oral corticosteroids (P = .035). Longitudinal within-patient cluster stability was associated with changes in sputum eosinophil percentages (P = .045). CONCLUSIONS We have identified and followed up exhaled molecular phenotypes of severe asthma, which were associated with changing inflammatory profile and oral steroid use. This suggests that breath analysis can contribute to the management of severe asthma.
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Affiliation(s)
- Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ariane H Wagener
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter-Paul Hekking
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Aruna T Bansal
- Acclarogen, St John's Innovation Centre, Cambridge, United Kingdom
| | | | | | - Hans Weda
- Philips Research, Eindhoven, The Netherlands
| | | | | | - Nicholas J Rattray
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, Conn
| | - Arnaldo D'Amico
- Department of Electronic Engineering, University of Rome "Tor Vergata," Rome, Italy
| | - Giorgio Pennazza
- Center for Integrated Research-CIR, Unit for Electronics for Sensor Systems, Campus Bio-Medico U, Rome, Italy
| | - Marco Santonico
- Center for Integrated Research-CIR, Unit for Electronics for Sensor Systems, Campus Bio-Medico U, Rome, Italy
| | - Diane Lefaudeux
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Bertrand De Meulder
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, CIRI UMR5308, CNRS-ENS-UCBL-INSERM, Lyon, France
| | - Per S Bakke
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Massimo Caruso
- Department of Clinical and Experimental Medicine Hospital University, University of Catania, Catania, Italy
| | - Pascal Chanez
- Département des Maladies Respiratoires APHM,U1067 INSERM, Aix Marseille Université Marseille, Marseille, Italy
| | - Kian F Chung
- National Heart and Lung Institute, Imperial College, London, UK Biomedical Research Unit, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Julie Corfield
- AstraZeneca R&D, Mölndal, Sweden; Areteva R&D, Nottingham, United Kingdom
| | - Sven-Erik Dahlén
- Centre for Allergy Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Thomas Geiser
- the Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland
| | - Ildiko Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Nobert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine Hannover, Hannover, Germany
| | - Jacek Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kai Sun
- Data Science Institute, South Kensington Campus, Imperial College Londont, London, United Kingdom
| | - John H Riley
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Dominic E Shaw
- Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Department of Medicine, Respiratory Medicine Unit, Umeå University, Umeå, Sweden
| | - Ana R Sousa
- Respiratory Therapeutic Unit, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Stephen J Fowler
- Respiratory Research Group, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Healthy Science Centre, and NIHR Translational Research Faculty in Respiratory Medicine, University Hospital of South Manchester, Manchester, United Kingdom; Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Oshagbemi OA, Franssen FME, Braeken DCW, Henskens Y, Wouters EFM, Maitland-van der Zee AH, Burden AM, de Vries F. Blood eosinophilia, use of inhaled corticosteroids, and risk of COPD exacerbations and mortality. Pharmacoepidemiol Drug Saf 2018; 27:1191-1199. [PMID: 30264901 PMCID: PMC6282838 DOI: 10.1002/pds.4655] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE It remains unclear whether eosinophilia is useful for in guiding inhaled corticosteroid (ICS) therapy in chronic obstructive pulmonary disease (COPD) patients. The goal of this study is to evaluate the risk of acute exacerbations, COPD-related hospitalisations/accident and emergency visits, and all-cause mortality with various levels of eosinophil counts among COPD patients using ICS. METHODS A cohort study was conducted using the UK Clinical Practice Research Datalink. Patients were aged 40+ and had COPD (n = 32 693). Current users of ICS were stratified by relative and absolute eosinophil counts to determine the risk of outcomes with blood eosiniphilia using Cox regression analysis. RESULTS Among COPD patients, current use of ICS was not associated with a reduced risk of acute COPD exacerbations, COPD-related hospitalisations/accident and emergency visits, and all-cause mortality. Stratification of ICS use by absolute or relative eosinophil counts did not result in significant differences in risk of COPD exacerbations or hospitalisations/accident and emergency visits. However, all-cause mortality was reduced by 12% to 24% among patients with eosinophilia. CONCLUSIONS COPD-related acute exacerbations or hospitalisations/accident and emergency visits were not reduced with eosinophilia among users of ICS with COPD. However, all-cause mortality was reduced by 12% to 24%. These findings are potentially important and require further evaluation in prospective studies.
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Affiliation(s)
- Olorunfemi A Oshagbemi
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands.,CIRO, Horn, the Netherlands
| | - Frits M E Franssen
- CIRO, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Dionne C W Braeken
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands.,CIRO, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Yvonne Henskens
- Department of Clinical Chemistry, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Emiel F M Wouters
- CIRO, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands.,Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - Andrea M Burden
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, the Netherlands
| | - Frank de Vries
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
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24
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Zazuli Z, Vijverberg S, Slob E, Liu G, Carleton B, Veltman J, Baas P, Masereeuw R, Maitland-van der Zee AH. Genetic Variations and Cisplatin Nephrotoxicity: A Systematic Review. Front Pharmacol 2018; 9:1111. [PMID: 30319427 PMCID: PMC6171472 DOI: 10.3389/fphar.2018.01111] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Nephrotoxicity is a notable adverse effect in cisplatin treated patients characterized by tubular injury and/or increased serum creatinine (SCr) with incidence varying from 20 to 70%. Pharmacogenomics has been shown to identify strongly predictive genetic markers to help determine which patients are more likely to experience, for example, a serious adverse drug reaction or receive optimal benefit through enhanced efficacy. Genetic variations have been reported to influence the risk of cisplatin nephrotoxicity; however, a comprehensive overview is lacking. Methods: A systematic review was performed using Pubmed, Embase and Web of Science on clinical studies that used cisplatin-based chemotherapy as treatment, had available genotyping data, and evaluated nephrotoxicity as an outcome. The quality of reporting was assessed using the STrengthening the REporting of Genetic Association Studies (STREGA) checklist. Results: Twenty-eight eligible studies were included; all were candidate gene studies. Over 300 SNPs across 135 genes were studied; 29 SNPs in 14 genes were significantly associated with cisplatin-induced nephrotoxicity. A variation in SLC22A2 rs316019, a gene involved in platinum uptake by the kidney, was associated with different measures of nephrotoxicity in four independent studies. Further, variants of ERCC1 (rs11615 and rs3212986) and ERCC2 (rs13181), two genes involved in DNA repair, were found to be positively associated with increased risks of nephrotoxicity in two independent studies. Conclusion: Three genes consistently associated with cisplatin-induced nephrotoxicity. Further research is needed to assess the biological mechanism and the clinical value of modifying treatment based on SLCC22A2 and ERCC1/2 genotypes.
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Affiliation(s)
- Zulfan Zazuli
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pharmacology-Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia
| | - Susanne Vijverberg
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Elise Slob
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Hospital-University Health Network and University of Toronto, Toronto, ON, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Joris Veltman
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Baas
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Rosalinde Masereeuw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
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25
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Slob EMA, Vijverberg SJH, Pijnenburg MW, Koppelman GH, Maitland-van der Zee AH. What do we need to transfer pharmacogenetics findings into the clinic? Pharmacogenomics 2018; 19:589-592. [PMID: 29701121 DOI: 10.2217/pgs-2018-0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Elise M A Slob
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22700, NL-1100 DE Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22700, NL-1100 DE Amsterdam, The Netherlands
| | - Mariëlle W Pijnenburg
- Department of Paediatrics, Paediatric Pulmonology & Allergology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gerard H Koppelman
- Department of Paediatric Pulmonology & Paediatric Allergology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.,Groningen Research Institute for Asthma & COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22700, NL-1100 DE Amsterdam, The Netherlands
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26
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Arabkhazaeli A, Ahmadizar F, Leusink M, Arets HGM, Raaijmakers JAM, Uiterwaal CSPM, van der Ent CK, Maitland-van der Zee AH, Vijverberg SJH. The association between a genetic risk score for allergy and the risk of developing allergies in childhood-Results of the WHISTLER cohort. Pediatr Allergy Immunol 2018; 29:72-77. [PMID: 29047167 DOI: 10.1111/pai.12824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several genetic variants have been associated with the susceptibility to allergic disease in adults, but it remains unclear whether these genetic variants are also associated with the onset of allergic disease early in life. The aim of this study was to develop a genetic risk score (GRS) for allergy based on findings in adults and study its predictive capacity for allergy in children. METHODS A GRS was constructed based on 10 SNPs previously associated with allergies in adults. The GRS was tested in children who participated in a population-based newborn cohort (WHISTLER) and were followed from birth to school age. Logistic regression analysis was used to study the association between the GRS and the parental-reported allergies at age 5 (based on a reported allergy to ≥1 of the following allergens: pollen, house dust mites, or pets). A Cox regression model was used to study the association between GRS and a physician-diagnosed allergy during follow-up (allergic conjunctivitis, allergic rhinitis, and eczema/dermatitis). Cohen's kappa coefficient was calculated to study the agreement between physician-diagnosed allergy and parental-reported allergy at age 5. RESULTS The GRS was significantly associated with parental-reported allergy (odds ratio: 15.9, 95% confidence interval (CI): 1.07-233.73) at age 5, as well as with a physician-diagnosed allergy during follow-up (hazard ratio: 1.89, 95% CI: 1.05-3.41). The overall agreement between physician-diagnosed and parental-reported allergies was 70.5% (kappa: 0.10, 95% CI: 0.03-0.18). CONCLUSIONS An adult-derived GRS for allergy predicts the risk of developing allergies in childhood.
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Affiliation(s)
- Ali Arabkhazaeli
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Fariba Ahmadizar
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Maarten Leusink
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hubertus G M Arets
- Department of Pediatric Pulmonology, WKZ, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan A M Raaijmakers
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology, WKZ, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Division of Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
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27
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de Vries R, Dagelet YWF, Spoor P, Snoey E, Jak PMC, Brinkman P, Dijkers E, Bootsma SK, Elskamp F, de Jongh FHC, Haarman EG, In 't Veen JCCM, Maitland-van der Zee AH, Sterk PJ. Clinical and inflammatory phenotyping by breathomics in chronic airway diseases irrespective of the diagnostic label. Eur Respir J 2018; 51:51/1/1701817. [PMID: 29326334 DOI: 10.1183/13993003.01817-2017] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/01/2017] [Indexed: 01/10/2023]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are complex and overlapping diseases that include inflammatory phenotypes. Novel anti-eosinophilic/anti-neutrophilic strategies demand rapid inflammatory phenotyping, which might be accessible from exhaled breath.Our objective was to capture clinical/inflammatory phenotypes in patients with chronic airway disease using an electronic nose (eNose) in a training and validation set.This was a multicentre cross-sectional study in which exhaled breath from asthma and COPD patients (n=435; training n=321 and validation n=114) was analysed using eNose technology. Data analysis involved signal processing and statistics based on principal component analysis followed by unsupervised cluster analysis and supervised linear regression.Clustering based on eNose resulted in five significant combined asthma and COPD clusters that differed regarding ethnicity (p=0.01), systemic eosinophilia (p=0.02) and neutrophilia (p=0.03), body mass index (p=0.04), exhaled nitric oxide fraction (p<0.01), atopy (p<0.01) and exacerbation rate (p<0.01). Significant regression models were found for the prediction of eosinophilic (R2=0.581) and neutrophilic (R2=0.409) blood counts based on eNose. Similar clusters and regression results were obtained in the validation set.Phenotyping a combined sample of asthma and COPD patients using eNose provides validated clusters that are not determined by diagnosis, but rather by clinical/inflammatory characteristics. eNose identified systemic neutrophilia and/or eosinophilia in a dose-dependent manner.
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Affiliation(s)
- Rianne de Vries
- Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Yennece W F Dagelet
- Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Pien Spoor
- Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Erik Snoey
- Dept of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Patrick M C Jak
- Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Brinkman
- Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Erica Dijkers
- Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | | | | | - Frans H C de Jongh
- Dept of Pulmonary Function, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Eric G Haarman
- Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands
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K Siddiqui M, Maroteau C, Veluchamy A, Tornio A, Tavendale R, Carr F, Abelega NU, Carr D, Bloch K, Hallberg P, Yue QY, Pearson ER, Colhoun HM, Morris AD, Dow E, George J, Pirmohamed M, Ridker PM, Doney ASF, Alfirevic A, Wadelius M, Maitland-van der Zee AH, Chasman DI, Palmer CNA. A common missense variant of LILRB5 is associated with statin intolerance and myalgia. Eur Heart J 2017; 38:3569-3575. [PMID: 29020356 PMCID: PMC5837247 DOI: 10.1093/eurheartj/ehx467] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/26/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
Abstract
Aims A genetic variant in LILRB5 (leukocyte immunoglobulin-like receptor subfamily-B) (rs12975366: T > C: Asp247Gly) has been reported to be associated with lower creatine phosphokinase (CK) and lactate dehydrogenase (LDH) levels. Both biomarkers are released from injured muscle tissue, making this variant a potential candidate for susceptibility to muscle-related symptoms. We examined the association of this variant with statin intolerance ascertained from electronic medical records in the GoDARTS study. Methods and results In the GoDARTS cohort, the LILRB5 Asp247 variant was associated with statin intolerance (SI) phenotypes; one defined as having raised CK and being non-adherent to therapy [odds ratio (OR) 1.81; 95% confidence interval (CI): 1.34-2.45] and the other as being intolerant to the lowest approved dose of a statin before being switched to two or more other statins (OR 1.36; 95% CI: 1.07-1.73). Those homozygous for Asp247 had increased odds of developing both definitions of intolerance. Importantly the second definition did not rely on CK elevations. These results were replicated in adjudicated cases of statin-induced myopathy in the PREDICTION-ADR consortium (OR1.48; 95% CI: 1.05-2.10) and for the development of myalgia in the JUPITER randomized clinical trial of rosuvastatin (OR1.35, 95% CI: 1.10-1.68). A meta-analysis across the studies showed a consistent association between Asp247Gly and outcomes associated with SI (OR1.34; 95% CI: 1.16-1.54). Conclusion This study presents a novel immunogenetic factor associated with statin intolerance, an important risk factor for cardiovascular outcomes. The results suggest that true statin-induced myalgia and non-specific myalgia are distinct, with a potential role for the immune system in their development. We identify a genetic group that is more likely to be intolerant to their statins.
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Affiliation(s)
- Moneeza K Siddiqui
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Cyrielle Maroteau
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Abirami Veluchamy
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Aleksi Tornio
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Roger Tavendale
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Fiona Carr
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Ngu-Uma Abelega
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Dan Carr
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Katyrzyna Bloch
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Par Hallberg
- Department of Medical Sciences, Clinical Pharmacology and Science of Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Qun-Ying Yue
- Medical Products Agency, Dag Hammarskjölds väg 42, 75237 Uppsala, Sweden
| | - Ewan R Pearson
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Helen M Colhoun
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
- Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Andrew D Morris
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Eleanor Dow
- Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Jacob George
- Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Munir Pirmohamed
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Paul M Ridker
- Brigham and Women's Hospital, Department of Medicine, Preventive Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alex S F Doney
- Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Ana Alfirevic
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Mia Wadelius
- Department of Medical Sciences, Clinical Pharmacology and Science of Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, 3508 TB Utrecht, The Netherlands
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Daniel I Chasman
- Brigham and Women's Hospital, Department of Medicine, Preventive Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Colin N A Palmer
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
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29
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Neerincx AH, Vijverberg SJH, Bos LDJ, Brinkman P, van der Schee MP, de Vries R, Sterk PJ, Maitland-van der Zee AH. Breathomics from exhaled volatile organic compounds in pediatric asthma. Pediatr Pulmonol 2017; 52:1616-1627. [PMID: 29082668 DOI: 10.1002/ppul.23785] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 05/18/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022]
Abstract
Asthma is the most common chronic disease in children, and is characterized by airway inflammation, bronchial hyperresponsiveness, and airflow obstruction. Asthma diagnosis, phenotyping, and monitoring are still challenging with currently available methods, such as spirometry, FE NO or sputum analysis. The analysis of volatile organic compounds (VOCs) in exhaled breath could be an interesting non-invasive approach, but has not yet reached clinical practice. This review describes the current status of breath analysis in the diagnosis and monitoring of pediatric asthma. Furthermore, features of an ideal breath test, different breath analysis techniques, and important methodological issues are discussed. Although only a (small) number of studies have been performed in pediatric asthma, of which the majority is focusing on asthma diagnosis, these studies show moderate to good prediction accuracy (80-100%, with models including 6-28 VOCs), thereby qualifying breathomics for future application. However, standardization of procedures, longitudinal studies, as well as external validation are needed in order to further develop breathomics into clinical tools. Such a non-invasive tool may be the next step toward stratified and personalized medicine in pediatric respiratory disease.
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Affiliation(s)
- Anne H Neerincx
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Marc P van der Schee
- Department of Paediatric Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Rianne de Vries
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Peter J Sterk
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
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30
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Vijverberg SJ, Pijnenburg MW, Hövels AM, Koppelman GH, Maitland-van der Zee AH. The need for precision medicine clinical trials in childhood asthma: rationale and design of the PUFFIN trial. Pharmacogenomics 2017; 18:393-401. [PMID: 28244806 DOI: 10.2217/pgs-2016-0174] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 'one-size fits all'-approach does not fit all pediatric asthma patients. Current evidence suggests that in children with persistent asthma, ADRB2 genotype-guided treatment can improve treatment outcomes, yet this evidence is mainly derived from observational and genotype-stratified studies. Implementation of precision medicine-guided asthma treatment in clinical practice will only occur if randomized clinical trials can show that this approach will improve patient outcomes and is cost effective. In this paper, we will discuss why precision medicine trials are currently needed to improve childhood asthma management and present the rationale and design of the PUFFIN trial, that has been set up to address this need.
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Affiliation(s)
- Susanne Jh Vijverberg
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëlle W Pijnenburg
- Department of Pediatrics, Pediatric Pulmonology & Allergology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Anke M Hövels
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Science, Utrecht University, Utrecht, The Netherlands
| | - Gerard H Koppelman
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology & Pediatric Allergology, Beatrix Children's Hospital, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma & COPD (GRIAC), Groningen, The Netherlands
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Yavuz ST, Koc O, Gungor A, Gok F, Hawley J, O’Brien C, Thomas M, Brodlie M, Michaelis L, Mota I, Gaspar Â, Piedade S, Sampaio G, Dias JG, Paiva M, Morais-Almeida M, Madureira C, Lopes T, Lopes S, Almeida F, Sequeira A, Carvalho F, Oliveira J, Gay-Crosier F, Nenciu IV, Nita AF, Ulmeanu A, Oraseanu D, Zapucioiu C, Machinena A, Sánchez OD, Lozano MA, Feijoo RJ, Blasco JL, Gibert MP, Muñoz MTG, da Costa MD, Martín AMP, Yilmaz EA, Cavkaytar Ö, Buyuktiryaki B, Soyer O, Sackesen C, Netting M, El-Merhibi A, Gold M, Quinn P, Penttila I, Makrides M, Giavi S, Muraro A, Lauener R, Mercenier A, Bersuch E, Montagner IM, Passioti M, Celegato N, Summermatter S, Nutten S, Bourdeau T, Vissers YM, Papadopoulos NG, van der Kleij H, Warmenhoven H, van Ree R, Pieters R, Opstelten DJ, van Schijndel H, Smit J, Fitzsimons R, Timms V, Du Toit G, Kaya G, Gulec M, Saldir M, Sener O, Hassan N, Shaaban H, El-Hariri H, Mahfouz AKIE, Gabor P, Gabor B, Csaba K, Chawes B, Bønnelykke K, Stokholm J, Heickendorff L, Brix S, Rasmussen M, Bisgaard H, Hallas HW, Arianto L, Pincus M, Keil T, Reich A, Wahn U, Lau S, Grabenhenrich L, Fagerstedt S, Hesla HM, Johansson E, Rosenlund H, Mie A, Scheynius A, Alm J, Esparza-Gordillo J, Matanovic A, Marenholz I, Bauerfeind A, Rohde K, Nemat K, Lee-Kirsch MA, Nordenskjöld M, Winge MC, Krüger R, Beyer K, Kalb B, Niggemann B, Hübner N, Cordell HJ, Bradley M, Lee YA, Gough H, Schramm D, Beschorner J, Schuster A, Bauer CP, Forster J, Zepp F, Bergmann R, Bergmann K, Garcia FB, Santos N, Pité H, Papadopoulou A, Mermiri D, Xatziagorou E, Tsanakas I, Lampidi S, Priftis K, Fuertes E, Markevych I, Bowatte G, Gruzieva O, Gehring U, Becker A, Berdel D, Brauer M, Carlsten C, Hoffmann B, Kozyrskyj A, Lodge C, Pershagen G, Wijga A, Joachim H, Zivkovic Z, Djuric-Filipovic I, Jocić-Stevanovic J, Zivanovic S, Taka S, Kokkinou D, Papakonstantinou A, Stefanopoulou P, Georgountzou A, Maggina P, Stamataki S, Papaevanggelou V, Andreakos E, Gibert MP, Spera AM, Deliu M, Belgrave D, Simpson A, Custovic A, Marques JG, Carreiro-Martins P, Belo J, Serranho S, Peralta I, Neuparth N, Leiria-Pinto P, Vazquez-Ortiz M, Pascal M, Plaza AM, Juan M, Paparo L, Nocerino R, Aitoro R, Langella I, Amoroso A, Amoroso A, Di Scala C, Berni Canani R, Maity S, Rotiroti G, Gandhi M, Jonsson K, Ljung A, Hesselmar B, Adlerbert I, Brekke H, Johansen S, Wold A, Sandberg AS, Nordlund B, Lundholm C, Ullemar V, van Hage M, Örtqvist A, Almqvist C, Selby A, Grimshaw K, Clausen M, Dubakiene R, Fiocchi A, Kowalski M, Papadopoulos N, Reche M, Sigurdardottir S, Sprikkleman A, Xepapadaki P, Mills C, Roberts G, Neto HJC, Wandalsen GF, Bianca ACD, Aranda C, Rosário NA, Solé D, Mallol J, Marcos LG, Banic I, Rijavec M, Plavec D, Korosec P, Turkalj M, Bozicevic A, De Mieri M, Hamburger M, Holley S, Morris R, Mitchell F, Knibb R, Latter S, Liossi C, Hassan MMM, Barman M, Sandin A, Posa D, Perna S, Hoffmann U, Chen KW, Resch Y, Vrtala S, Valenta R, Matricardi PM, Tsilochristou O, Rohrbach A, Cappella A, Hofmaier S, Hatzler L, D’Amelio R, Björkander S, Johansson MA, Lasaviciute G, Sverremark-Ekström E, Rüschendorf F, Strachan DP, Spycher BD, Baurecht H, Margaritte-Jeannin P, Sääf A, Kerkhof M, Ege M, Baltic S, Matheson MC, Li J, Michel S, Ang WQ, McArdle W, Arnold A, Homuth G, Demenais F, Bouzigon E, Söderhäll C, de Jongste JC, Postma DS, Braun-Fahrländer C, Horak E, Ogorodova LM, Puzyrev VP, Bragina EY, Hudson TJ, Morin C, Duffy DL, Marks GB, Robertson CF, Montgomery GW, Musk B, Thompson PJ, Martin NG, James A, Sleiman P, Toskala E, Rodriguez E, Fölster-Holst R, Franke A, Lieb W, Gieger C, Heinzmann A, Rietschel E, Cichon S, Nöthen MM, Pennell CE, Sly PD, Schmidt CO, Schneider V, Heinig M, Holt PG, Kabesch M, Weidinger S, Hakonarson H, Ferreira MAR, Laprise C, Freidin MB, Genuneit J, Koppelman GH, Melén E, Dizier MH, John Henderson A, Lee YA, González-Delgado P, Caparrós E, Clemente F, Cueva B, Moreno VM, Carretero JL, Fernández J, Swan K, Gopi M, Smith T, Ramesh E, Sadasivam A, Arêde C, Borrego LM, Pires G, Santa-Marta C, Brand S, Stein K, Heine H, Kauth M, Rolfsjord LB, Bakkeheim E, Skjerven HO, Carlsen KH, Hunderi JO, Berents TL, Mowinckel P, Lødrup Carlsen KC, Munzel U, Berger W, Valiente R, Vozmediano V, Lukas JC, Rodríguez M, Guarnaccia S, Vitale L, Pluda A, D’Agata E, Colombo D, Felici S, Gretter V, Facchetti S, Pecorelli G, Quecchia C, Guibas G, Spandou E, Megremis S, West P, Papadopoulos N, Rufo JC, Madureira J, Paciência I, Aguiar L, Padrão P, Pinto M, Delgado L, Moreira P, Teixeira JP, Fernandes EO, Moreira A, Dominguez AI, Valero A, Mullol J, Del Cuvillo A, Montoro J, Jauregui I, Bartra J, Davila I, Ferrer M, Sastre J, Martins C, Lima J, Leandro MJ, Nunes G, Branco JC, Trindade H, Borrego LM, Conkar S, Kilic M, Aygun C, Sancak R, Tagalaki E, Banos L, Vlachou A, Giannoula F, Pavlakou M, Kryoni M, Makris K, Lazova S, Petrova G, Miteva D, Perenovska P, Klyucharova A, Skorohodkina O, Koumaki D, Manousaki A, Agrapidi M, Iatridou L, Eruk O, Myridakis K, Manousakis E, Koumaki V, Dimou M, Ingemansson M, Hedlin G, Pastor N, de Boissieu D, Vanderhoof J, Moore N, Maditz K, Mehdi A, Elhassan S, Beck C, Al-Hammadi A, Maris I, O’Sullivan R, Hourihane J, Raptis G, DunnGalvin A, Greenhawt M, Venter C, O’Regan E, Cronin D, O’Reilly A, Abdelaziz F, Khelifi-Touhami D, Selim N, Khelifi-Touhami T, Merida P, Plaza AM, Castellanos JH, Lozano J, Dominguez O, Piquer M, Jimenez R, Giner MT, Kakleas K, Joishy M, Maskele W, Jenkins HR, Escarrer M, Madroñero A, Guerra MT, Julia JC, Cerda JC, Contreras J, Tauler E, Vidorreta MJ, Rojo A, Del Valle S, Flynn N, Foley G, Harmon C, Fitzsimons J, Baynova K, Del Robledo ÁM, Marina L, Cortes A, Sciaraffia A, Castillo A, Juel-Berg N, Hansen KS, Poulsen LK, Lazar A, Aguiar R, Lopes A, Paes MJ, Santos AS, Pereira-Barbosa MA, Eke Gungor H, Uytun S, Sahiner UM, Altuner Torun Y, Zivanovic M, Atanasković-Marković M, Vesel T, Nahtigal M, Obermayer-Temlin A, Križnik EŠ, Maslar M, Bizjak R, Tomšič-Matic M, Posega-Devetak S, Skerbinjek-Kavalar M, Predalič M, Avčin T, Pouessel G, Beaudouin E, Moneret-Vautrin AM, Deschildre A, Viñas M, Borja B, Hernández N, Castillo MJ, Izquierdo A, Ibero M, Kocabas CN, Heming C, Garrett E, Blackstock A, Chodhari R, Belohlavkova S, Kopelentova E, Visek P, Setinova I, Svarcova I, Sjölander S, Nilsson N, Berthold M, Ekoff H, Borres M, Nilsson C, González Domínguez L, Muñoz Archidona C, Moreira Jorge A, Quevedo Teruel S, Bracamonte Bermejo T, Castillo Fernández M, Pineda de la Losa F, Echeverría Zudaire LÁ, Vrani O, Mavroudi A, Fotoulaki M, Emporiadou M, Spiroglou K, Xinias I, Sadreddini HA, Warnes M, Traves D, Kostić G, Filipovic Đ, Sittisomwong S, Sittisomwong S, Podolec Z, Hartel M, Panek D, Podolec-Rubiś M, Banasik T, Abbasi E, Moghtaderi M, Sanneerappa P, Deliu A, Kutty M, Ramesh N, Sherkat R, Sabri MR, Dehghan B, Bigdelian H, Raeesi N, Afshar M, Rahimi H, Klein C, Al-Jebouri M, Svitich OA, Zubacheva DO, Potemkin DA, Gankovskaya LV, Zverev VV, OB Doyle E, Gallagher P, Dewlett S, Man K, Pocock J, Gerrardhughes A, Wasilewska J, Kaczmarski M, Lebensztejn D, Thuraisingham C, Sinniah D, Chen Y, Mei X, Ozdogan S, Karadeniz P, Ayyildiz-Emecen D, Oncul U, Sari G, Cavdar S, Farzan N, Vijverberg SJ, Palmer CJ, Tantisira KG, Maitland-van der Zee AH, Yavuzyilmaz F, Urganci N, Usta M, Hoxha M, Basho M, Wandalsen GF, Monteiro F, Lame B, Mesonjesi E, Sherri A, Ibranji A, Gjati L, Loloci G, Bardhi A, Moghtaderi B, Farjadian S, Eghtedari D, Olaya M, Del Mar Vasquez L, Ramirez LF, Serrano CD, Usta Guc B, Asilsoy S, Ozer F, Shopova S, Papochieva V, Loekmanwidjaja J, Mallozi M, Ratner P, Soteres D, Novák Z, Yáñez A, Ildikó K, Kuna P, Tortajada M, Valiente R, Feuerhahn J, Blome C, Hadler M, Karagiannis E, Langenbruch A, Augustin M, Roux M, Kakudo S, Zeldin RK, Sokolova A, Silva TM, Zivanovic SS, Cvetkovic V, Nikolic I, Zivanovic SJ, Saranac L, Nesterenko Z, Radic S, Milenkovic B, Smiljanic S, Micic-Stanijevic M, Calovic O, Hofbauer AMB, Agertoft L, Everson L, Kearney J, Coppel J, Braithwaite S, Christiansen ES, Kjaer HF, Eller E, Mørtz CG, Halken S, Román India C, Jiménez Jiménez J, Echeverría Zudaire L, O’Connor C, Kanti V, Lünnemann L, Malise G, Ludriksone L, Stroux A, Henrich W, Abu-Dakn M, Blume-Peytavi U, Garcia Bartels N, Schario M, Stanley T, Brandenbarg N, Boardman A, McGreevy G, Rodger E, Knight K, Taylor T, Scanlan G, Christoph G, van Stuivenberg M, Mosca F, Moro G, Chirico G, Braegger CP, Riedler J, Yavuz Y, Boehm G, Arasi S, Crisafulli G, Caminiti L, Porcaro F, Pajno GB, Tanaka A, Togawa Y, Oida K, Kambe N, Arkwright P, Amagai Y, Shimojo N, Sato Y, Mochizuki H, Jang H, Ishizaka S, Matsuda H, Barlianto W, Olivianto E, Chandra Kusuma HMS, Mollica M, Trinchese G, Alfano E, Amato F, Pirozzi C, Calignano A, Meli R, Rossberg S, Gerhold K, Zimmermann K, Zaino M, Geske T, Hamelmann E, Bogovic S, van den Berg J, Janssen C, Claver A, Martin-Muñoz MF, Martorell C, Belver MT, Alonso Lebrero E, Zapatero L, Fuentes V, Piqué M, Plaza A, Muñoz C, Blasco C, Villa B, Gómez C, Nevot S, García JM, Echeverria L, DeWitt B, Holloway J, Hodge D, Ludman S, Jafari-Mamaghani M, Ebling R, Fox AT, Lack G, Lovén Björkman S, Ballardini N, Basu S, Hallet J, Srinivas J, Stringer H, Jay N, Fonseca P, Vieira C, Mastrorilli C, Caffarelli C, Asero R, Tripodi S, Dondi A, Ricci G, Povesi Dascola C, Calamelli E, Cipriani F, Di Rienzo Businco A, Bianchi A, Candelotti P, Frediani T, Verga C, Korovessi P, Tiliakou S, Tavoulari E, Moraiti KM, Tee WJ, Deiratany S, Seedhoo R, McNamara R, Okafor I, Khaleva E, Novic G, Bychkova N, Abd Al-Aziz A, Fatouh A, Motawie A, Bostany EE, Ibrahim A, Andonova S, Savov A, Zoto M, Kyriakakou M, Vassilopoulou M, Balaska A, Kostaridou S, Wartna J, Bohnen AM, Elshout G, Pols DHJ, Bindels PJE, Seys SF, Dilissen E, Van der Eycken S, Schelpe AS, Marijsse G, Troosters T, Vanbelle V, Aertgeerts S, Ceuppens JL, Dupont LJ, Peers K, Bullens DM, Lokas SB, Zivkovic J, Nogalo B, Kobal IM, Oliveira G, Pike K, Melo A, Amélia T, Cidrais Rodrigues JC, Serrano C, Lopes dos Santos JM, Lopes C, Schauer U, Bergmann KC, Moral L, Toral T, Marco N, Avilés BG, Fuentes MJ, Garde J, Montahud C, Perona J, Forniés MJ, Arroabarren E, Anda M, Sanz ML, Lizaso MT, Arregui C, May S, Hartz M, Joshi A, Park MA, Posega Devetak S, Koren Jeverica A, Castro L, Gouveia C, Marques AC, Cabral AJ, Amaral L, Carolino F, Castro E, Passos M, Cernadas JR, Amaral L, Dias de Castro E, Pineda F, Gomes A, Brough H, Röhmel J, Schwarz C, Mehl A, Stock P, Staab D, Seib C, Critchlow A, Barber A, Delavalle B, Garriga T, Vilá B, Astolfi A, Di Chiara C, Neri I, Patrizi A, Neskorodova K, Kudryavtseva A, Alvarez J, Palacios M, Martinez-Merino M, Vaquero I. 4th Pediatric Allergy and Asthma Meeting (PAAM). Clin Transl Allergy 2016. [PMCID: PMC5123301 DOI: 10.1186/s13601-016-0117-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
WORKSHOP 4: Challenging clinical scenarios (CS01–CS06) CS01 Bullous lesions in two children: solitary mastocytoma S. Tolga Yavuz, Ozan Koc, Ali Gungor, Faysal Gok CS02 Multi-System Allergy (MSA) of cystic fibrosis: our institutional experience Jessica Hawley, Christopher O’Brien, Matthew Thomas, Malcolm Brodlie, Louise Michaelis CS03 Cold urticaria in pediatric age: an invisible cause for severe reactions Inês Mota, Ângela Gaspar, Susana Piedade, Graça Sampaio, José Geraldo Dias, Miguel Paiva, Mário Morais-Almeida CS04 Angioedema with C1 inhibitor deficiency in a girl: a challenge diagnosis Cristina Madureira, Tânia Lopes, Susana Lopes, Filipa Almeida, Alexandra Sequeira, Fernanda Carvalho, José Oliveira CS05 A child with unusual multiple organ allergy disease: what is the primer? Fabienne Gay-Crosier CS06 A case of uncontrolled asthma in a 6-year-old patient Ioana-Valentina Nenciu, Andreia Florina Nita, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen Zapucioiu ORAL ABSTRACT SESSION 1: Food allergy (OP01–OP06) OP01 Food protein-induced enterocolitis syndrome: oral food challenge outcomes for tolerance evaluation in a Pediatric Hospital Adrianna Machinena, Olga Domínguez Sánchez, Montserrat Alvaro Lozano, Rosa Jimenez Feijoo, Jaime Lozano Blasco, Mònica Piquer Gibert, Mª Teresa Giner Muñoz, Marcia Dias da Costa, Ana Maria Plaza Martín OP02 Characteristics of infants with food protein-induced enterocolitis syndrome and allergic proctocolitis Ebru Arik Yilmaz, Özlem Cavkaytar, Betul Buyuktiryaki, Ozge Soyer, Cansin Sackesen OP03 The clinical and immunological outcomes after consumption of baked egg by 1–5 year old egg allergic children: results of a randomised controlled trial MerrynNetting, Adaweyah El-Merhibi, Michael Gold, PatrickQuinn, IrmeliPenttila, Maria Makrides OP04 Oral immunotherapy for treatment of egg allergy using low allergenic, hydrolysed egg Stavroula Giavi, Antonella Muraro, Roger Lauener, Annick Mercenier, Eugen Bersuch, Isabella M. Montagner, Maria Passioti, Nicolò Celegato, Selina Summermatter, Sophie Nutten, Tristan Bourdeau, Yvonne M. Vissers, Nikolaos G. Papadopoulos OP05 Chemical modification of a peanut extract results in an increased safety profile while maintaining efficacy Hanneke van der Kleij, Hans Warmenhoven, Ronald van Ree, Raymond Pieters, Dirk Jan Opstelten, Hans van Schijndel, Joost Smit OP06 Administration of the yellow fever vaccine in egg allergic children Roisin Fitzsimons, Victoria Timms, George Du Toit ORAL ABSTRACT SESSION 2: Asthma (OP07–OP12) OP07 Previous exacerbation is the most important risk factor for future exacerbations in school-age children with asthma S. Tolga Yavuz, Guven Kaya, Mustafa Gulec, Mehmet Saldir, Osman Sener, Faysal Gok OP08 Comparative study of degree of severity and laboratory changes between asthmatic children using different acupuncture modalities Nagwa Hassan, Hala Shaaban, Hazem El-Hariri, Ahmed Kamel Inas E. Mahfouz OP09 The concentration of exhaled carbon monoxide in asthmatic children with different controlled stadium Papp Gabor, Biro Gabor, Kovacs Csaba OP10 Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomised clinical trial Bo Chawes, Klaus Bønnelykke, Jakob Stokholm, Lene Heickendorff, Susanne Brix, Morten Rasmussen, Hans Bisgaard OP11 Lung function development in childhood Henrik Wegener Hallas, Bo Chawes, Lambang Arianto, Hans Bisgaard OP12 Is the effect of maternal and paternal asthma different in female and male children before puberty? Maike Pincus, Thomas Keil, Andreas Reich, Ulrich Wahn, Susanne Lau, Linus Grabenhenrich ORAL ABSTRACT SESSION 3: Epidemiology—genetics (OP13–OP18) OP13 Lifestyle is associated with incidence and category of allergen sensitisation: the ALADDIN birth cohort Sara Fagerstedt, Helena Marell Hesla, Emelie Johansson, Helen Rosenlund, Axel Mie, Annika Scheynius, Johan Alm OP15 Maternal filaggrin mutations increase the risk of atopic dermatitis in children: an effect independent of mutation inheritance Jorge Esparza-Gordillo, Anja Matanovic, Ingo Marenholz, Anja Bauerfeind, Klaus Rohde, Katja Nemat, Min-Ae Lee-Kirsch, Magnus Nordenskjöld, Marten C. G. Winge, Thomas Keil, Renate Krüger, Susanne Lau, Kirsten Beyer, Birgit Kalb, Bodo Niggemann, Norbert Hübner, Heather J. Cordell, Maria Bradley, Young-Ae Lee OP16 Allergic multimorbidity of asthma, rhinitis and eczema in the first 2 decades of the German MAS birth cohort Thomas Keil, Hannah Gough, Linus Grabenhenrich, Dirk Schramm, Andreas Reich, John Beschorner, Antje Schuster, Carl-Peter Bauer, Johannes Forster, Fred Zepp, Young-Ae Lee, Renate Bergmann, Karl Bergmann, Ulrich Wahn, Susanne Lau OP17 Childhood anaphylaxis: a growing concern Filipe Benito Garcia, Inês Mota, Susana Piedade, Ângela Gaspar, Natacha Santos, Helena Pité, Mário Morais-Almeida OP18 Indoor exposure to molds and dampness in infancy and its association to persistent atopic dermatitis in school age. Results from the Greek ISAAC II study Athina Papadopoulou, Despina Mermiri, Elpida Xatziagorou, Ioannis Tsanakas, Stavroula Lampidi, Kostas Priftis ORAL ABSTRACT SESSION 4: Pediatric rhinitis—immunotherapy (OP19–OP24) OP19 Associations between residential greenness and childhood allergic rhinitis and aeroallergen sensitisation in seven birth cohorts Elaine Fuertes, Iana Markevych, Gayan Bowatte, Olena Gruzieva, Ulrike Gehring, Allan Becker, Dietrich Berdel, Michael Brauer, Chris Carlsten, Barbara Hoffmann, Anita Kozyrskyj, Caroline Lodge, Göran Pershagen, Alet Wijga, Heinrich Joachim OP20 Full symptom control in pediatric patients with allergic rhinitis and asthma: results of a 2-year sublingual allergen immunotherapy study Zorica Zivkovic, Ivana Djuric-Filipovic, Jasmina Jocić-Stevanovic, Snežana Zivanovic OP21 Nasal epithelium of different ages of atopic subjects present increased levels of oxidative stress and increased cell cytotoxicity upon rhinovirus infection Styliani Taka, Dimitra Kokkinou, Aliki Papakonstantinou, Panagiota Stefanopoulou, Anastasia Georgountzou, Paraskevi Maggina, Sofia Stamataki, Vassiliki Papaevanggelou, Evangelos Andreakos, Nikolaos G. Papadopoulos OP22 Cluster subcutaneous immunotherapy schedule: tolerability profile in children Monica Piquer Gibert, Montserrat Alvaro Lozano, Jaime Lozano Blasco, Olga Domínguez Sánchez, Rosa Jiménez Feijoo, Marcia Dias da Costa, Mª Teresa Giner Muñoz, Adriana Machinena Spera, Ana Maria Plaza Martín OP23 Rhinitis as a risk factor for asthma severity in 11-year old children: population-based cohort study Matea Deliu, Danielle Belgrave, Angela Simpson, Adnan Custovic OP24 The Global Lung Function Initiative equations in airway obstruction evaluation of asthmatic children João Gaspar Marques, Pedro Carreiro-Martins, Joana Belo, Sara Serranho, Isabel Peralta, Nuno Neuparth, Paula Leiria-Pinto POSTER DISCUSSION SESSION 1: Food allergy (PD01–PD05) PD01 Allergen-specific humoral and cellular responses in children who fail egg oral immunotherapy due to allergic reactions Marta Vazquez-Ortiz, Mariona Pascal, Ana Maria Plaza, Manel Juan PD02 FoxP3 epigenetic features in children with cow milk allergy Lorella Paparo, Rita Nocerino, Rosita Aitoro, Ilaria Langella, Antonio Amoroso, Alessia Amoroso, Carmen Di Scala, Roberto Berni Canani PD04 Combined milk and egg allergy in early childhood: let them eat cake? Santanu Maity, Giuseppina Rotiroti, Minal Gandhi PD05 Introduction of complementary foods in relation to allergy and gut microbiota in farm and non-farm children Karin Jonsson, Annika Ljung, Bill Hesselmar, Ingegerd Adlerbert, Hilde Brekke, Susanne Johansen, Agnes Wold, Ann-Sofie Sandberg POSTER DISCUSSION SESSION 2: Asthma and wheeze (PD06–PD16) PD06 The association between asthma and exhaled nitric oxide is influenced by genetics and sensitisation Björn Nordlund, Cecilia Lundholm, Villhelmina Ullemar, Marianne van Hage, Anne Örtqvist, Catarina Almqvist PD09 Prevalence patterns of infant wheeze across Europe Anna Selby, Kate Grimshaw, Thomas Keil, Linus Grabenhenrich, Michael Clausen, Ruta Dubakiene, Alessandro Fiocchi, Marek Kowalski, Nikos Papadopoulos, Marta Reche, Sigurveig Sigurdardottir, Aline Sprikkleman, Paraskevi Xepapadaki, Clare Mills, Kirsten Beyer, Graham Roberts PD10 Epidemiologic changes in recurrent wheezing infants Herberto Jose Chong Neto, Gustavo Falbo Wandalsen, Ana Carolina Dela Bianca, Carolina Aranda, Nelson Augusto Rosário, Dirceu Solé, Javier Mallol, Luis García Marcos PD13 A single nucleotide polymorphism in the GLCCI1 gene is associated with response to asthma treatment in children IvanaBanic, Matija Rijavec, Davor Plavec, Peter Korosec, Mirjana Turkalj PD14 Pollen induced asthma: Could small molecules in pollen exacerbate the protein-mediated allergic response? Alen Bozicevic, Maria De Mieri, Matthias Hamburger PD15 A qualitative study to understand how we can empower teenagers to better self-manage their asthma Simone Holley, Ruth Morris, Frances Mitchell, Rebecca Knibb, Susan Latter, Christina Liossi, Graham Roberts PD16 Polymorphism of endothelial nitric oxide synthase (eNOS) gene among Egyptian children with bronchial asthma Mostafa M. M. Hassan POSTER DISCUSSION SESSION 3: Mechanisms—Epidemiology (PD17–PD21) PD17 Pregnancy outcomes in relation to development of allergy in a Swedish birth cohort Malin Barman, Anna Sandin, Agnes Wold, Ann-Sofie Sandberg PD18 Evolution of the IgE response to house dust mite molecules in childhood Daniela Posa, Serena Perna, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, Ulrich Wahn, Thomas Keil, Susanne Lau, Kuan-Wei Chen, Yvonne Resch, Susanne Vrtala, Rudolf Valenta, Paolo Maria Matricardi PD19 Antibody recognition of nsLTP-molecules as antigens but not as allergens in the German-MAS birth cohort Olympia Tsilochristou, Alexander Rohrbach, Antonio Cappella, Stephanie Hofmaier, Laura Hatzler, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, RaffaeleD’Amelio, Ulrich Wahn, Thomas Keil, Susanne Lau, Paolo Maria Matricardi PD20 Early life colonization with Lactobacilli and Staphylococcus aureus oppositely associates with the maturation and activation of FOXP3+ CD4 T-cells Sophia Björkander, Maria A. Johansson, Gintare Lasaviciute, Eva Sverremark-Ekström PD21 Genome-wide meta-analysis identifies 7 susceptibility loci involved in the atopic march Ingo Marenholz, Jorge Esparza-Gordillo, Franz Rüschendorf, Anja Bauerfeind, David P. Strachan, Ben D. Spycher, Hansjörg Baurecht, Patricia Margaritte-Jeannin, Annika Sääf, Marjan Kerkhof, Markus Ege, Svetlana Baltic, Melanie C Matheson, Jin Li, Sven Michel, Wei Q. Ang, Wendy McArdle, Andreas Arnold, Georg Homuth, Florence Demenais, Emmanuelle Bouzigon, Cilla Söderhäll, Göran Pershagen, Johan C. de Jongste, Dirkje S Postma, Charlotte Braun-Fahrländer, Elisabeth Horak, Ludmila M. Ogorodova, Valery P. Puzyrev, Elena Yu Bragina, Thomas J Hudson, Charles Morin, David L Duffy, Guy B Marks, Colin F Robertson, Grant W Montgomery, Bill Musk, Philip J Thompson, Nicholas G. Martin, Alan James, Patrick Sleiman, Elina Toskala, Elke Rodriguez, Regina Fölster-Holst, Andre Franke, Wolfgang Lieb, Christian Gieger, Andrea Heinzmann, Ernst Rietschel, Thomas Keil, Sven Cichon, Markus M Nöthen, Craig E Pennell, Peter D Sly, Carsten O Schmidt, Anja Matanovic, Valentin Schneider, Matthias Heinig, Norbert Hübner, Patrick G. Holt, Susanne Lau, Michael Kabesch, Stefan Weidinger, Hakon Hakonarson, Manuel AR Ferreira, Catherine Laprise, Maxim B. Freidin, Jon Genuneit, Gerard H Koppelman, Erik Melén, Marie-Hélène Dizier, A. John Henderson, Young Ae Lee POSTER DISCUSSION SESSION 4: Food allergy—Anaphylaxis (PD22–PD26) PD22 Atopy patch test in food protein induced enterocolitis caused by solid food Purificacion González-Delgado, Esther Caparrós, Fernando Clemente, Begoña Cueva, Victoria M. Moreno, Jose Luis Carretero, Javier Fernández PD23 Watermelon allergy: a novel presentation Kate Swan, George Du Toit PD24 A pilot study evaluating the usefulness of a guideline template for managing milk allergy in primary care Mudiyur Gopi, Tim Smith, Edara Ramesh, Arun Sadasivam PD26 Efficacy and safety of cow’s milk oral immunotherapy protocol Inês Mota, Filipe Benito Garcia, Susana Piedade, Angela Gaspar, Graça Sampaio, Cristina Arêde, Luís Miguel Borrego, Graça Pires, Cristina Santa-Marta, Mário Morais-Almeida POSTER DISCUSSION SESSION 5: Prevention and treatment—Allergy (PD27–PD36) PD27 Allergy-protection by the lactic acid bacterium Lactococcus lactis G121: mode-of-action as revealed in a murine model of experimental allergy Stephanie Brand, Karina Stein, Holger Heine, Marion Kauth PD29 The relationship between quality of life and morning salivary cortisol after acute bronchiolitis in infancy Leif Bjarte Rolfsjord, Egil Bakkeheim, Johan Alm, Håvard Ove Skjerven, Kai-Håkon Carlsen, Jon Olav Hunderi, Teresa Løvold Berents, Petter Mowinckel, Karin C. Lødrup Carlsen PD30 Randomised trial of the efficacy of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥6 years to <12 years with allergic rhinitis Ulrich Wahn, Ullrich Munzel, William Berger PD31 10 mg of oral bilastine in 2 to 11 years old children has similar exposure to the adult therapeutic dose (20 mg) Ulrich Wahn, Román Valiente, Valvanera Vozmediano, John C. Lukas, Mónica Rodríguez PD33 Daily symptoms, nocturnal symptoms, activity limitations and reliever therapies during the three steps of IOEASMA programme: a comparison Sebastiano Guarnaccia, Luigi Vitale, Ada Pluda, Emanuele D’Agata, Denise Colombo, Stefano Felici, Valeria Gretter, Susanna Facchetti, Gaia Pecorelli, Cristina Quecchia PD34 Sensitisation to an inert aeroallergen in weaning rats and longstanding disease, in a sensitisation-tolerant and easily tolerisable rodent strain George Guibas, Evangelia Spandou, Spyridon Megremis, Peter West, Nikolaos Papadopoulos PD35 Bacterial and fungi exposure in school and allergic sensitisation in children João Cavaleiro Rufo, Joana Madureira, Inês Paciência, Lívia Aguiar, Patrícia Padrão, Mariana Pinto, Luís Delgado, Pedro Moreira, João Paulo Teixeira, Eduardo Oliveira Fernandes, André Moreira PD36 Comparative study of allergy rhinitis between two populations: children vs. adults Adriana Izquierdo Dominguez, Antonio Valero, Joaquim Mullol, Alfonso Del Cuvillo, Javier Montoro, Ignacio Jauregui, Joan Bartra, Ignacio Davila, Marta Ferrer, Joaquin Sastre POSTER VIEWING SESSION 1: Inflammation—Genetics—Immunology—Dermatology (PP01–PP09) PP01 Immune profile in late pregnancy: immunological markers in atopic asthmaticwomen as risk factors for atopy in the progeny Catarina Martins, Jorge Lima, Maria José Leandro, Glória Nunes, Jorge Cunha Branco, Hélder Trindade, Luis Miguel Borrego PP02 The impact of neonatal sepsis on development of allergic diseases Secil Conkar, Mehtap Kilic, Canan Aygun, Recep Sancak PP03 Clinical overview of selective IgE deficiency in childhood Athina Papadopoulou, Eleni Tagalaki, Lambros Banos, Anna Vlachou, Fotini Giannoula, Despina Mermiri PP04 Inverse relationship between serum 25(ΟΗ) vitamin D3 and total IgE in children and adolescence Athina Papadopoulou, Stavroula Lampidi, Marina Pavlakou, Maria Kryoni, Kostas Makris PP05 PP06 PP07 Asthma control questionnaire and specific IgE in children Snezhina Lazova, Guergana Petrova, Dimitrinka Miteva, Penka Perenovska PP08 Features of chronic urticaria of adolescents Aliya Klyucharova, Olesya Skorohodkina PP09 Cutaneous mastocytosis in children: a clinical analysis of 8 cases in Greece Dimitra Koumaki, Alkisti Manousaki, Maria Agrapidi, Lida Iatridou, Omima Eruk, Konstantinos Myridakis, Emmanouil Manousakis, Vasiliki Koumaki POSTER VIEWING SESSION 2: Food allergy—Anaphylaxis (PP10–PP47) PP10 Prognostic factors in egg allergy Maria Dimou, Maria Ingemansson, Gunilla Hedlin PP11 Evaluation of the efficacy of an amino acid-based formula in infants who are intolerant to extensively hydrolysed protein formula Nitida Pastor, Delphine de Boissieu, Jon Vanderhoof, Nancy Moore, Kaitlin Maditz PP12 Anaphylaxis and epinephrine auto-injector use: a survey of pediatric trainees Adeli Mehdi, Shaza Elhassan, Carolin Beck, Ahmed Al-Hammadi PP13 Anaphylaxis in children: acute management in the Emergency Department Ioana Maris, Ronan O’Sullivan, Jonathan Hourihane, PP14 Understanding Cumbrian schools preparedness in managing children at risk of anaphylaxis in order to provide training and support which will create healthy and safe environments for children with allergies George Raptis, Louise Michaelis PP15 A new valid and reliable parent and child questionnaire to measure the impact of food protein enterocolitis syndrome on children: the FPIES Quality of Life Questionnaire (FPIESQL), Parent and Child Short Form Audrey DunnGalvin, Matthew Greenhawt, Carina Venter, Jonathan Hourihane PP16 An in-depth case study investigation of the experiences of teenagers and young adults in growing up and living with food allergy with emphasis on coping, management and risk, support, and social and self-identity Evelyn O’Regan, Duncan Cronin, Jonathan Hourihane, Anna O’Reilly, Audrey DunnGalvin PP17 Cow’s milk protein allergy in Constantine. A retrospective study of 62 cases between 1996 and 2013 Foued Abdelaziz, Dounia Khelifi-Touhami, Nihad Selim, Tahar Khelifi-Touhami PP18 PP19 Cow’s milk and egg oral immunotherapy in children older than 5 years Pablo Merida, Ana Mª Plaza, Juan Heber Castellanos, Adrianna Machinena, Montserrat Alvaro Lozano, Jaime Lozano, Olga Dominguez, Monica Piquer, Rosa Jimenez, Mª Teresa Giner PP20 Professionals’ awareness of management of Cow’s Milk Protein Allergy (CMPA) in North Wales Hospitals Konstantinos Kakleas, Manohar Joishy, Wendmu Maskele, Huw R. Jenkins PP21 PP22 Anaphylaxis: the great unknown for teachers. Presentation of a protocol for schools Mercedes Escarrer, Agustín Madroñero, Maria Teresa Guerra, Juan Carlos Julia, Juan Carlos Cerda, Javier Contreras, Eulalia Tauler, Maria Jesus Vidorreta, Ana Rojo, Silvia Del Valle PP23 Challenges facing children with food allergies and their parents in out of school activity sectors Niamh Flynn PP24 A review of food challenges at a Regional Irish Centre Gary Foley, Carol Harmon, John Fitzsimons PP25 The use of epinephrine in infants with anaphylaxis Krasimira Baynova, Ávila Maria Del Robledo, Labella Marina PP26 PP27 PP28 Mother’s psychological state predicts the expression of symptoms in food allergic children Aaron Cortes, Alicia Sciaraffia, Angela Castillo PP29 The correlation between sIgE towards tree nuts and birch pollen in a Danish Pediatric Allergy Clinic Nanna Juel-Berg, Kirsten Skamstrup Hansen, Lars Kærgaard Poulsen PP30 Food allergy in children: evaluation of parents’ use of online social media Andreia Florina Nita, Ioana Valentina Nenciu, Adina Lazar, Dumitru Oraseanu PP31 The impact of food allergy on quality of life: FAQLQ questionnaire Rita Aguiar, Anabela Lopes, Maria J. Paes, Amélia S. Santos, M. A. Pereira-Barbosa PP32 An unexpected cause of anaphylaxis: potato Hatice Eke Gungor, Salih Uytun, Umit Murat Sahiner, Yasemin Altuner Torun PP33 Is it clinical phenotype of allergic diseases determined by sensitisation to food? Mirjana Zivanovic, Marina Atanasković-Marković PP34 PP35 Prescribing adrenaline auto-injectors in children in 2014: the data from regional pediatricians Tina Vesel, Mihaela Nahtigal, Andreja Obermayer-Temlin, Eva Šoster Križnik, Mirjana Maslar, Ruben Bizjak, Marjeta Tomšič-Matic, Sonja Posega-Devetak, Maja Skerbinjek-Kavalar, Mateja Predalič, Tadej Avčin PP36 Who should have an adrenaline autoinjector? Adherence to the European and French guidelines among 121 allergists from the Allergy Vigilance Network Guillaume Pouessel, Etienne Beaudouin, Anne M. Moneret-Vautrin, Antoine Deschildre, Allergy Vigilance Network PP37 Anaphylaxis by Anacardium Occidentale Marta Viñas, Bartolomé Borja, Nora Hernández, Mª José Castillo, Adriana Izquierdo, Marcel Ibero PP38 Anaphylaxis with honey in a child S. Tolga Yavuz, Ali Gungor, Betul Buyuktiryaki, Ozan Koc, Can Naci Kocabas, Faysal Gok PP39 Evaluation of courses adopted to children on prevention, recognition and management of anaphylaxis Tina Vesel, Mihaela Nahtigal PP40 Symptomatic dust mites and shrimp allergy: three pediatric case reports Filipa Almeida, Susana Lopes, Cristina Madureira, Tânia Lopes, Fernanda Carvalho PP41 Poor identification rates of nuts by high risk individuals: a call for improved education and support for families Camille Heming, Emily Garrett, Adam Blackstock, Santanu Maity, Rahul Chodhari PP42 DAFALL: database of food allergies in the Czech Republic Simona Belohlavkova, Eliska Kopelentova, Petr Visek, Ivana Setinova, Ivana Svarcova PP43 Serological cross-reactivity between grass and wheat is not only caused by profilins and CCDs Sigrid Sjölander, Nora Nilsson, Malin Berthold, Helena Ekoff, Gunilla Hedlin, Magnus Borres, Caroline Nilsson PP44 Oil body associated proteins in children with nuts allergy. Allergens to consider in IgE-mediated nuts allergy Loreto González Domínguez, Cristina Muñoz Archidona, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire PP45 PP46 Protective effect of helicobacter pylori infection against food allergy in children Olga Vrani, Antigone Mavroudi, Maria Fotoulaki, Maria Emporiadou, Kleomenis Spiroglou, Ioannis Xinias PP47 Anaphylaxis pathway: A road tryp-tase to success? Helyeh A. Sadreddini, Mia Warnes, Donna Traves POSTER VIEWING SESSION 3: Miscellaneous (PP48–PP58) PP48 Surveillance study on safety of SLIT in pediatric population Ivana Djuric-Filipovic, Zorica Zivkovic, Snežana Zivanovic, Gordana Kostić, Đorđe Filipovic PP49 Efficacy and safety of mixed mite subcutaneous immunotherapy among allergic rhinitis patients in the Northeastern Thailand Sawapon Sittisomwong, Siripong Sittisomwong PP50 Effect of inhaled beclomethasone or placebo on brain stem activity in a patient chronically treated with steroids: preliminary report Zygmunt Podolec, Marcin Hartel, Daria Panek, Magdalena Podolec-Rubiś, Tomasz Banasik PP51 Sensitisation to aeroallergens in patients with allergic rhinitis, asthma and atopic dermatitis in Shiraz, Southwestern Iran Elham Abbasi, Mozhgan Moghtaderi PP52 Referring a child for allergy test: how appropriate are we? Phani Sanneerappa, Alina Deliu, Moosa Kutty, Nagabathula Ramesh PP53 EBV lymphoproliferative disease and cardiac lymphoma in a STK4 deficient patient Roya Sherkat, Mohammad Reza Sabri, Bahar Dehghan, Hamid Bigdelian, Nahid Raeesi, Mino Afshar, Hamid Rahimi, Christoph Klein PP54 A case study: the effect of massive honeybees attack on various body parameters atopic girl including allergy Mohemid Al-Jebouri PP55 The role of TLR9, NLRP3 and proIL-1β in activation of antiviral innate immunity Oxana A. Svitich, Daria O. Zubacheva, Dmitrii A. Potemkin, Ludmila V. Gankovskaya, Vitalii V. Zverev PP56 Overnight pulse oximetry, as a screening tool to diagnose obstructive sleep apnoea. How effective is it? Phani Sanneerappa, Elaine OB Doyle, Paul Gallagher, Nagabathula Ramesh PP57 The presentation and management of acute urticaria and allergic reactions in children in a multi-ethnic, inner city Emergency Department (ED) Sherine Dewlett, Kin Man, Minal Gandhi, James Pocock, Anna Gerrardhughes PP58 Food allergens responsible for delayed-type sensitisation in atopy patch test in children diagnosed with autism spectrum disorder Jolanta Wasilewska, Maciej Kaczmarski, Dariusz Lebensztejn POSTER VIEWING SESSION 4: Asthma—Rhinitis (PP59–PP87) PP59 Systematic review of incense as a trigger factor for asthma Chandramani Thuraisingham, Davendralingam Sinniah PP60 Increased risks of mood and anxiety disorders in children with asthma Yue Chen, Xiaomei Mei PP61 PP62 Asthma Control Test (ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) association in children Sebnem Ozdogan, Pinar Karadeniz, Durdugul Ayyildiz-Emecen, Ummuhan Oncul PP63 Seasonal and gender variations in vitamin D levels in children with asthma and its association with pulmonary function tests Sebnem Ozdogan, Gizem Sari, Sabanur Cavdar PP64 Defining treatment response in childhood asthma: rationale and design of the Pharmacogenomics in the Childhood Asthma (PiCA) consortium Niloufar Farzan, Susanne J. Vijverberg, Colin J. Palmer, Kelan G. Tantisira, Anke-Hilseon Maitland-van der Zee behalf of the PiCA consortium PP65 Prevalence of asthma and allergic disease in patients with inflammatory disease compared to celiac disease Fatma Yavuzyilmaz, Sebnem Ozdogan, Nafiye Urganci, Merve Usta PP66 A severe case with cystic fibrosis (CF) asthma Mehmet Hoxha, Maksim Basho PP67 Severe asthma exacerbation complicated with pneumothorax in a child with uncontrolled asthma due to poor treatment compliance Ioana Valentina Nenciu, Andreia Florina Nita, Adina Lazar, Alexandru Ulmeanu, Carmen Zapucioiu, Dumitru Oraseanu PP68 Evaluation of the Pediatric Quality of Life inventory (PedsQL) asthma module among low income asthmatic children and adolescents in Sao Paolo, Brazil Gustavo F. Wandalsen, Fernanda Monteiro, Dirceu Solé PP69 Early initiation of specific immunotherapy in asthma patients leads to higher benefits Blerta Lame, Eris Mesonjesi, Arjeta Sherri PP70 Treatment resistant asthma and rhinosinusitis with recurrent pulmonary infections. Is it primary ciliary dyskinesia? Alkerta Ibranji, Laert Gjati, Gjustina Loloci, Ardii Bardhi PP71 The comparison of sensitisation to animal allergens in children- and adult- onset patients with asthma Behnam Moghtaderi, Shirin Farjadian, Dorna Eghtedari PP72 Characterisation of children less than five years with wheezing episodes in Cali, Colombia Manuela Olaya, Laura Del Mar Vasquez, Luis Fernando Ramirez, Carlos Daniel Serrano PP73 Evaluation of the patients with recurrent croup Belgin Usta Guc, Suna Asilsoy, Fulya Ozer PP74 Obesity in adolescence compromising the asthma control Guergana Petrova, Sylvia Shopova, Vera Papochieva, Snezhina Lazova, Dimitrinka Miteva, Penka Perenovska PP75 Sleep behavior in children with persistent allergic rhinitis Gustavo F. Wandalsen, Jessica Loekmanwidjaja, Márcia Mallozi, Dirceu Solé PP76 Randomised trial of the safety of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥4 years to <12 years with allergic rhinitis William Berger, Ulrich Wahn, Paul Ratner, Daniel Soteres PP77 Safety and tolerability evaluation of bilastine 10 mg in children from 2 to 11 years of age with allergic rhinoconjunctivitis or urticaria Zoltán Novák, Anahí Yáñez, Kiss Ildikó, Piotr Kuna, Miguel Tortajada, Román Valiente, the Bilastine Pediatric Safety Study Group PP78 Sensitisation to Alternaria alternata: Is it a risk factor for severe rhinitis? Susana Lopes, Filipa Almeida, Tânia Lopes, Cristina Madureira, José Oliveira, Fernanda Carvalho PP79 Validation of the Patient Benefit Index (PBI) for the assessment of patient-related outcomes in allergic rhinitis in children Julia Feuerhahn, Christine Blome, Meike Hadler, Efstrathios Karagiannis, Anna Langenbruch, Matthias Augustin PP80 Efficacy of sublingual tablet of house dust mite allergen extracts in adolescents with house dust mite-associated allergic rhinitis Michel Roux, Shinji Kakudo, Efstrathios Karagiannis, Robert K. Zeldin PP81 Lung function improvement in a child treated with omalizumab for bronchial asthma Anna Sokolova, Tiago Milheiro Silva PP82 How to treat a child suffering from asthma, allergic rhinitis, allergy to peanuts and diabetes at the same time? Snezana S. Zivanovic, Vesna Cvetkovic, Ivana Nikolic, Sonja J. Zivanovic PP83 Nitric oxide in exhaled air in the relationship of the degree of sensitisation to aeroallergens Snezana S. Zivanovic, Ljiljana Saranac, Ivana Nikolic, Sonja J. Zivanovic, Zorica Zivkovic PP84 Clinical basis of diagnostic errors in pediatric asthma Zoia Nesterenko PP85 PP86 Childhood asthma control in Serbia and organised Asthma Educational Intervention (AEI) Snezana Radic, Branislava Milenkovic, Spomenka Smiljanic, Milka Micic-Stanijevic, Olivera Calovic PP87 Experience from a group of adolescents with severe allergic asthma treated with Omalizumab Anne Marie Bro Hofbauer, Lone Agertoft THEMATIC POSTER SESSION 1: Prevention and Treatment—Epidemiology (TP01–TP18) TP01 A cost effective primary school asthma education program: pilot study from inner London schools Lucy Everson, Jessica Kearney, Jonny Coppel, Simon Braithwaite, Rahul Chodhari TP02 The prevalence of allergic diseases among 14–15 years old adolescents in two Danish birth cohorts 14 years apart Elisabeth S. Christiansen, Henrik Fomsgaard Kjaer, Esben Eller, Charlotte G. Mørtz, Susanne Halken TP03 Does pattern of sensitisation to phleum pratense change with age? Is it different in children with allergic rhinitis or asthma? Cristina Román India, Ana Moreira Jorge, Loreto González Domínguez, Cristina Muñoz Archidona, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Juana Jiménez Jiménez, Luis Echeverría Zudaire TP04 Practicalities of prevention of peanut allergy: modelling a national response to LEAP Cathal O’Connor, Jonathan Hourihane TP05 Comparison of the influence of sunflower seed oil and skin care lotion on the skin barrier function of newborns: a randomised controlled trial Varvara Kanti, Lena Lünnemann, Günther Malise, Laine Ludriksone, Andrea Stroux, Wolfgang Henrich, Michael Abu-Dakn, Ulrike Blume-Peytavi, Natalie Garcia Bartels TP06 The effect of daily skin care on skin barrier properties in infants with dry skin and risk for atopic dermatitis Varvara Kanti, Lena Lünnemann, Laine Ludriksone, Marianne Schario, Andrea Stroux, Ulrike Blume-Peytavi, Natalie Garcia Bartels TP07 Change in sum total aeroallergen skin prick test wheal diameters at 6 months predicts which children will respond to subcutaneous immunotherapy by three years Thorsten Stanley, Nicolien Brandenbarg TP08 Are mobile apps regarding adrenaline auto-injectors accessed by adolescents for support and education in the community? Alia Boardman, Gary McGreevy, Emily Rodger, Katherine Knight, Victoria Timms, Trisha Taylor, Gemma Scanlan, Roisin Fitzsimons TP09 TP10 Prevention of early atopic dermatitis among low-atopy-risk infants by immunoactive prebiotics is not sustained after the first year of life Grüber Christoph, Ulrich Wahn, Margriet van Stuivenberg, Fabio Mosca, Guido Moro, Gaetano Chirico, Christian P. Braegger, Joseph Riedler, Yalcin Yavuz, Günther Boehm TP11 TP12 TP13 Treatment with Omalizumab in a 16-year-old Caucasian girl with refractory solar urticaria Stefania Arasi, Giuseppe Crisafulli, Lucia Caminiti, Federica Porcaro, Giovanni Battista Pajno TP14 Ultra-pure soft water ameliorates skin conditions of adult and child patients with atopic dermatitis Akane Tanaka, Yaei Togawa, Kumiko Oida, Naotomo Kambe, Peter Arkwright, Yosuke Amagai, Naoki Shimojo, Yasunori Sato, Hiroyuki Mochizuki, Hyosun Jang, Saori Ishizaka, Hiroshi Matsuda TP15 Potential adjuvant effect of immunomodulator to improve specific immunotherapy in asthmatic child Wisnu Barlianto, Ery Olivianto, H. M. S. Chandra Kusuma TP16 How can Component Resolved Diagnosis (CRD) influence in Specific Immunotherapy (SIT) prescription, in a Spanish children population Ana Moreira Jorge, Cristina Román India, Loreto González Domínguez, Cristina Muñoz Archidona, Juana Jiménez Jiménez, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Luis Echeverría Zudaire TP17 Mitochondrial dysfunction in food allergy: effects of L. rhamnosus GG in a mice model of peanut allergy Rosita Aitoro, Mariapia Mollica, Roberto Berni Canani, Giovanna Trinchese, Elena Alfano, Antonio Amoroso, Lorella Paparo, Francesco Amato, Claudio Pirozzi, Antonio Calignano, Rosaria Meli TP18 Prediction of atopic diseases in childhood: elevated blood eosinophils in infancy in a high risk birth cohort Siri Rossberg, Kerstin Gerhold, Kurt Zimmermann, Mohammad Zaino, Thomas Geske, Eckard Hamelmann, Susanne Lau THEMATIC POSTER SESSION 2: Food allergy—Anaphylaxis (TP19–TP38) TP19 TP20 TP21 Double-blind provocation tests in non-IgE mediated cow’s milk allergy and the occurrence of placebo reactions Sarah Bogovic, Jochem van den Berg, Chantal Janssen TP22 Gradual introduction of baked egg (BE) in egg allergic patients under 2 years old Angela Claver TP23 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy I: safety and efficacy of daily vs. weekly protocols of induction Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria TP24 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy II: a randomised controlled trial to study a safer, more effective and easy to perform maintenance (daily vs. every two days) pattern of egg SOTI Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria TP25 Determining the safety of baked egg home reintroduction for children with mild egg allergy Brenda DeWitt, Judith Holloway, Donald Hodge TP26 Demographics, investigations and patterns of sensitisation in children with oral allergy syndrome in a London Teaching Hospital Sian Ludman, Merhdad Jafari-Mamaghani, Rosemary Ebling, Adam T. Fox, Gideon Lack, George Du Toit TP27 Airborne peanut challenge in children: allergic reactions are rare Sofia Lovén Björkman, Caroline Nilsson, Natalia Ballardini TP28 The nutty question on Pediatric Wards: to be or “nut” to be? Supriyo Basu, Jenny Hallet, Jyothi Srinivas TP29 TP30 TP31 Allergy education in nursery schools Hazel Stringer, Nicola Jay TP32 Food allergy in the first year of life Tânia Lopes, Cristina Madureira, Filipa Almeida, Susana Lopes, Paula Fonseca, Clara Vieira, Fernanda Carvalho TP33 Prevalence and geographic distribution of oral allergy syndrome in Italian children: a multicenter study Carla Mastrorilli, Carlo Caffarelli, Riccardo Asero, Salvatore Tripodi, Arianna Dondi, Gianpaolo Ricci, Carlotta Povesi Dascola, Elisabetta Calamelli, Francesca Cipriani, Andrea Di Rienzo Businco, Annamaria Bianchi, Paolo Candelotti, Tullio Frediani, Carmen Verga, Paolo Maria Matricardi TP34 Are common standardised allergen extracts used in skin test enough in the diagnosis of nuts allergy? Cristina Muñoz Archidona, Loreto González Domínguez, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire TP35 Evaluation of IgE sensitisation in children with allergic proctocolitis and its relationship to atopic dermatitis Despina Mermiri, Paraskevi Korovessi, Skevi Tiliakou, Evaggelia Tavoulari, Kalliopi-Maria Moraiti, Fotini Giannoula, Athina Papadopoulou TP36 Food allergy in children: are we managing them appropriately in the Emergency Department? Wan Jean Tee, Samir Deiratany, Raymond Seedhoo, Roisin McNamara, Ike Okafor TP37 Importance of oil body associated allergenic proteins in nuts suspected allergy children Loreto González Domínguez, Ana Moreira Jorge, Cristina Muñoz Archidona, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Fernando Pineda de la Losa, Miriam Castillo Fernández, Luis Ángel Echeverría Zudaire TP38 Practical application of basophil activation test in children with food allergy Ekaterina Khaleva, Gennady Novic, Natalia Bychkova THEMATIC POSTER SESSION 3: Asthma (TP39–TP57) TP39 Effect of corticosteroid therapy upon serum magnesium level in chronic asthmatic children Amany Abd Al-Aziz, Amany Fatouh, Ayat Motawie, Eman El Bostany, Amr Ibrahim TP40 ADAM33 in Bulgarian children with asthma Guergana Petrova, Dimitrinka Miteva, Snezhina Lazova, Penka Perenovska, Sylvia Andonova, Alexey Savov TP41 TP42 The impact of vitamin D serum levels in asthma and allergic rhinitis Maria Zoto, Marialena Kyriakakou, Paraskevi Xepapadaki, Nikolaos G. Papadopoulos TP43 Life-threatening, first reported, paradoxical bronchospasm after nebulised Salbutamol in a 10 year old child Paraskevi Korovessi, Mariza Vassilopoulou, Athina Balaska, Lambros Banos, Stavroula Kostaridou, Despina Mermiri TP44 TP45 Asthma symptoms in children with treatment for allergic rhinoconjunctivitis Jorien Wartna, Arthur M. Bohnen, Gijs Elshout, David H. J. Pols, Patrick J. E. Bindels Erasmus MC, Rotterdam, The Netherlands TP46 Atopy increased the risk of developing exercise-induced bronchoconstriction in young athletes Sven F. Seys; Ellen Dilissen, Sarah Van der Eycken, An-Sofie Schelpe, Gudrun Marijsse, Thierry Troosters, Vincent Vanbelle, Sven Aertgeerts, Jan L. Ceuppens, Lieven J. Dupont, Koen Peers, Dominique M. Bullens TP47 The effect of higher BMI on risk for asthma and treatment outcome in overweight and obese children Ivana Banic, Sandra Bulat Lokas, Jelena Zivkovic, Boro Nogalo, Iva Mrkic Kobal, Davor Plavec, Mirjana Turkalj TP48 TP49 TP50 TP51 TP52 The impact of a multidisciplinary project intended to change the culture of nebulisers towards pressurised metered dose inhalers Georgeta Oliveira, Katharine Pike, Alda Melo, Tomás Amélia, José Carlos Cidrais Rodrigues, Cristina Serrano, José Manuel Lopes dos Santos, Carla Lopes TP53 TP54 TP55 TP56 Increased asthma control in patients with severe persistent allergic asthma after 12 month of nightly temperature controlled laminar airflow (TLA) Eckard Hamelmann, Uwe Schauer, Karl-Christian Bergmann TP57 THEMATIC POSTER SESSION 4: Drug allergy—Dermatology (TP58–TP77) TP58 Should we proceed directly to provocation challenges to diagnose drug allergy? Our experience says yes Luis Moral, Teresa Toral, Nuria Marco, Beléns García Avilés, Mª Jesús Fuentes, Jesús Garde, Cristina Montahud, Javier Perona, Mª José Forniés TP59 Anaphylaxis to 13-valent pneumococcal vaccine Esozia Arroabarren, Marta Anda, Maria Luisa Sanz, Maria Teresa Lizaso, Candida Arregui TP60 Intrapartum antibiotic exposure for treatment of group B streptococcus was not associated with the development of penicillin allergy in children Sara May, Martha Hartz, Avni Joshi, Miguel A. Park TP61 Evaluation of suspected drug hypersensitivity reactions in 169 children referred to the General Hospital Sonja Posega Devetak, Tina Vesel, Anja Koren Jeverica, Tadej Avčin TP62 Drug provocation testing: experience of a tertiary hospital Leonor Castro, Carolina Gouveia, Ana Carvalho Marques, Antonio Jorge Cabral TP63 Perioperative anaphylaxis: a growing concern in pediatric population Luis Amaral, Fabrícia Carolino, Eunice Castro, Madalena Passos, Josefina R. Cernadas TP64 Raising awareness of hypersensitivity to non-steroidal anti-inflammatory drugs in the pediatric age Fabrícia Carolino, Luís Amaral, Eunice Dias de Castro, Josefina R. Cernadas TP65 Perioperative anaphylaxis in young children: how to confirm the suspicion Josefina R. Cernadas, Fabrícia Carolino, Luís Amaral, Fernando Pineda, Armanda Gomes TP66 A case study of a child suspected to be penicillin allergic-digging deeper Katherine Knight, Roisin Fitzsimons, Helen Brough TP67 Prevalence, characteristics and risk factors of hypersensitivity reactions to antibiotics in patients with cystic fibrosis Jobst Röhmel, Carsten Schwarz, Anne Mehl, Philippe Stock, Doris Staab TP68 Antibiotic drug hypersensitivity in cystic fibrosis: A pilot study using cellular allergy tests for diagnostics Jobst Röhmel, Carsten Schwarz, Christine Seib, Doris Staab, Philippe Stock TP69 Oral antibiotics challenges in children Anita Critchlow, Alyson Barber, Nicola Jay TP70 Hypersensitivity reaction to vancomycin: a new successful desensitization protocol Belen Delavalle, Teresa Garriga, Blanca Vilá, Cristina Blasco TP71 TP72 Clinical phenotypes according to FLG gene loss of function mutations in children with atopic dermatitis Francesca Cipriani, Annalisa Astolfi, Costanza Di Chiara, Elisabetta Calamelli, Iria Neri, Annalisa Patrizi, Gianpaolo Ricci TP73 TP74 Urticaria in children: clinical and epidemiological features Katerina Neskorodova, Asya Kudryavtseva TP75 TP76 Acute urticaria at the Pediatrics Emergency Department: is it allergy? Esozia Arroabarren, Jorge Alvarez, Marta Anda, Miriam Palacios, Marta Martinez-Merino, Ibone Vaquero TP77
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Verhoef TI, Redekop WK, Bouvy ML, Dorenbos B, Karwar Z, van Schie RMF, de Boer A, Maitland-van der Zee AH. Beliefs about medicines in Dutch acenocoumarol and phenprocoumon users. Br J Clin Pharmacol 2015; 78:422-9. [PMID: 24528215 DOI: 10.1111/bcp.12346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/04/2014] [Indexed: 11/29/2022] Open
Abstract
AIMS Adherence to the generally complex regimen of coumarin derivatives is vital in order to keep patients in the adequate International Normalized Ratio range. Patients' beliefs about medicines are associated with the level of therapy adherence. Our first aim was to assess beliefs about coumarins. Secondly, we compared the beliefs about coumarins with the beliefs about other cardiovascular drugs. METHODS The Beliefs about Medicines Questionnaire was used to assess medication beliefs. The questionnaire was completed by new users of coumarins indicated for venous thromboembolism or atrial fibrillation. A necessity score and a concerns score were calculated for all patients. The analyses were repeated for users of antihypertensive drugs or statins (not using coumarins). RESULTS Three hundred and twenty patients were included in the analysis of the beliefs about coumarins. The mean necessity score was 15.3, the concerns score 12.3 and the necessity-concerns differential 3.0. Patients with venous thromboembolism (n = 71) had higher necessity scores than patients with atrial fibrillation (n = 249; 16.8 vs. 14.9, P < 0.001). The mean necessity score in 493 users of other cardiovascular drugs was 16.1, the concerns score 13.5 and the necessity-concerns differential 2.6. The necessity score was higher in chronic cardiovascular drug users (n = 192) than in new users (n = 301; 17.9 vs. 14.9, P < 0.001). CONCLUSIONS Coumarin users score higher on the necessity scale than on the concerns scale, which is also the case in users of other cardiovascular drugs. Patients with atrial fibrillation have a less positive attitude towards these drugs than patients with venous thromboembolism, and could therefore benefit more from specific attention.
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Affiliation(s)
- Talitha I Verhoef
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Baranova EV, Verhoef TI, Asselbergs FW, de Boer A, Maitland-van der Zee AH. Genotype-guided coumarin dosing: where are we now and where do we need to go next? Expert Opin Drug Metab Toxicol 2015; 11:509-22. [DOI: 10.1517/17425255.2015.1004053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Verhoef TI, Redekop WK, Daly AK, van Schie RMF, de Boer A, Maitland-van der Zee AH. Pharmacogenetic-guided dosing of coumarin anticoagulants: algorithms for warfarin, acenocoumarol and phenprocoumon. Br J Clin Pharmacol 2014; 77:626-41. [PMID: 23919835 DOI: 10.1111/bcp.12220] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022] Open
Abstract
Coumarin derivatives, such as warfarin, acenocoumarol and phenprocoumon are frequently prescribed oral anticoagulants to treat and prevent thromboembolism. Because there is a large inter-individual and intra-individual variability in dose-response and a small therapeutic window, treatment with coumarin derivatives is challenging. Certain polymorphisms in CYP2C9 and VKORC1 are associated with lower dose requirements and a higher risk of bleeding. In this review we describe the use of different coumarin derivatives, pharmacokinetic characteristics of these drugs and differences amongst the coumarins. We also describe the current clinical challenges and the role of pharmacogenetic factors. These genetic factors are used to develop dosing algorithms and can be used to predict the right coumarin dose. The effectiveness of this new dosing strategy is currently being investigated in clinical trials.
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Affiliation(s)
- Talitha I Verhoef
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht
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Vijverberg SJH, Hilvering B, Raaijmakers JAM, Lammers JWJ, Maitland-van der Zee AH, Koenderman L. Clinical utility of asthma biomarkers: from bench to bedside. Biologics 2013; 7:199-210. [PMID: 24009412 PMCID: PMC3762671 DOI: 10.2147/btt.s29976] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 01/01/2023]
Abstract
Asthma is a chronic disease characterized by airway inflammation, bronchial hyperresponsiveness, and recurrent episodes of reversible airway obstruction. The disease is very heterogeneous in onset, course, and response to treatment, and seems to encompass a broad collection of heterogeneous disease subtypes with different underlying pathophysiological mechanisms. There is a strong need for easily interpreted clinical biomarkers to assess the nature and severity of the disease. Currently available biomarkers for clinical practice - for example markers in bronchial lavage, bronchial biopsies, sputum, or fraction of exhaled nitric oxide (FeNO) - are limited due to invasiveness or lack of specificity. The assessment of markers in peripheral blood might be a good alternative to study airway inflammation more specifically, compared to FeNO, and in a less invasive manner, compared to bronchoalveolar lavage, biopsies, or sputum induction. In addition, promising novel biomarkers are discovered in the field of breath metabolomics (eg, volatile organic compounds) and (pharmaco)genomics. Biomarker research in asthma is increasingly shifting from the assessment of the value of single biomarkers to multidimensional approaches in which the clinical value of a combination of various markers is studied. This could eventually lead to the development of a clinically applicable algorithm composed of various markers and clinical features to phenotype asthma and improve diagnosis and asthma management.
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Affiliation(s)
- Susanne JH Vijverberg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bart Hilvering
- Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan AM Raaijmakers
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Jan-Willem J Lammers
- Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Leo Koenderman
- Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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Maitland-van der Zee AH. Pharmacogenetics of statins. Clin Biochem 2013. [DOI: 10.1016/j.clinbiochem.2013.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Schie RM, Wessels JA, le Cessie S, de Boer A, Schalekamp T, van der Meer FJ, Verhoef TI, van Meegen E, Rosendaal FR, Maitland-van der Zee AH. Corrigendum to: ‘Loading and maintenance dose algorithms for phenprocoumon and acenocoumarol using patient characteristics and pharmacogenetic data’ [Eur Heart J (2011) 32 (15): 1909-1917, doi:10.1093/eurheartj/ehr116]. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van Schie RMF, Verhoef TI, Boejharat SB, Schalekamp T, Wessels JAM, le Cessie S, Rosendaal FR, van der Meer FJM, de Boer A, Maitland-van der Zee AH. Evaluation of the effect of statin use on the acenocoumarol and phenprocoumon maintenance dose. ACTA ACUST UNITED AC 2013; 27:229-34. [PMID: 23096528 DOI: 10.1515/dmdi-2012-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/31/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Statins and coumarins are prescribed in combination on a regular basis. Some case reports suggested that statins might affect the dose requirements of coumarins. The aim of the study was to investigate whether acenocoumarol and phenprocoumon maintenance doses are influenced by statin use. METHODS The Pre-EU-PACT database was used, which contains information on 471 acenocoumarol and 624 phenprocoumon users. The influence of individual statins on the acenocoumarol and phenprocoumon maintenance dose was investigated by comparing unadjusted and adjusted mean differences of the maintenance dose between statin and non-statin users. RESULTS Lower adjusted acenocoumarol dose requirements were observed for patients using atorvastatin, simvastatin, pravastatin, and rosuvastatin. These patients had a reduction in adjusted mean acenocoumarol maintenance dose of 0.11, 0.29, 0.38, and 0.69 mg/day, respectively, compared with a mean adjusted dose of 2.60 mg/day for the patients not using a statin. There was no significant effect of statin use on unadjusted and adjusted phenprocoumon maintenance dose (p=0.23 and p=0.35, respectively). CONCLUSIONS Mean acenocoumarol maintenance dosages were decreased when acenocoumarol is co-administered with the different statins. Statin use does not affect phenprocoumon maintenance doses significantly.
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Affiliation(s)
- Rianne M F van Schie
- sion of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Vijverberg SJH, Koenderman L, van Erp FC, van der Ent CK, Postma DS, Brinkman P, Sterk PJ, Raaijmakers JAM, Maitland-van der Zee AH. Inflammatory phenotypes underlying uncontrolled childhood asthma despite inhaled corticosteroid treatment: rationale and design of the PACMAN2 study. BMC Pediatr 2013; 13:94. [PMID: 23768206 PMCID: PMC3691827 DOI: 10.1186/1471-2431-13-94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/16/2012] [Accepted: 06/10/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The diagnosis of childhood asthma covers a broad spectrum of pathological mechanisms that can lead to similarly presenting clinical symptoms, but may nonetheless require different treatment approaches. Distinct underlying inflammatory patterns are thought to influence responsiveness to standard asthma medication. METHODS/DESIGN The purpose of the PACMAN2 study is to identify inflammatory phenotypes that can discriminate uncontrolled childhood asthma from controlled childhood asthma by measures in peripheral blood and exhaled air. PACMAN2 is a nested, case-control follow-up study to the ongoing pharmacy-based "Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects" (PACMAN) study. The original PACMAN cohort consists of children aged 4-12 years with reported use of asthma medication. The PACMAN2 study will be conducted within the larger PACMAN cohort, and will focus on detailed phenotyping of a subset of the PACMAN children. The selected participants will be invited to a follow-up visit in a clinical setting at least six months after their baseline visit based on their adherence to usage of inhaled corticosteroids, their asthma symptoms in the past year, and their age (≥ 8 years). During the follow-up visit, current and long-term asthma symptoms, medication use, environmental factors, medication adherence and levels of exhaled nitric oxide will be reassessed. The following measures will also be examined: pulmonary function, exhaled volatile organic compounds, as well as inflammatory markers in peripheral blood and blood plasma. Comparative analysis and cluster-analyses will be used to identify markers that differentiate children with uncontrolled asthma despite their use of inhaled corticosteroids (ICS) (cases) from children whose asthma is controlled by the use of ICS (controls). DISCUSSION Asthmatic children with distinct inflammatory phenotypes may respond differently to anti-inflammatory therapy. Therefore, by identifying inflammatory phenotypes in children with the PACMAN2 study, we may greatly impact future personalised treatment strategies, uncover new leads for therapeutic targets and improve the design of future clinical studies in the assessment of the efficacy of novel therapeutics.
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Affiliation(s)
- Susanne JH Vijverberg
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Universiteitsweg 99, Utrecht 3508 TB, the Netherlands
- Department of Respiratory Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Leo Koenderman
- Department of Respiratory Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Francine C van Erp
- Department of Paediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht 3584 EA, the Netherlands
| | - Cornelis K van der Ent
- Department of Paediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht 3584 EA, the Netherlands
| | - Dirkje S Postma
- Department of Pulmonology, Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, the Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Peter J Sterk
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Jan AM Raaijmakers
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Universiteitsweg 99, Utrecht 3508 TB, the Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Universiteitsweg 99, Utrecht 3508 TB, the Netherlands
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Verhoef TI, Redekop WK, Veenstra DL, Thariani R, Beltman PA, van Schie RMF, de Boer A, Maitland-van der Zee AH. Cost–effectiveness of pharmacogenetic-guided dosing of phenprocoumon in atrial fibrillation. Pharmacogenomics 2013; 14:869-83. [DOI: 10.2217/pgs.13.74] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: To investigate the cost–effectiveness of pharmacogenetic-guided phenprocoumon dosing versus standard anticoagulation care in Dutch patients with atrial fibrillation. Materials & methods: Using a decision-analytic Markov model, cost–effectiveness of pharmacogenetic-guided therapy versus standard care was estimated. Results: Compared with standard care, the pharmacogenetic-guided dosing strategy increased quality-adjusted life-years (QALYs) only very slightly and increased costs by €15. The incremental cost–effectiveness ratio was €2658 per QALY gained. In sensitivity analyses, the cost of genotyping had the largest influence on the cost–effectiveness ratio. In a probabilistic sensitivity analysis, the incremental costs of genotype-guided dosing were less than €20,000 per QALY gained in 75.6% of the simulations. Conclusion: Pharmacogenetic-guided dosing of phenprocoumon has the potential to increase health slightly and may be able to achieve this in a cost-effective way. Owing to the many uncertainties it is too early to conclude whether or not patients starting phenprocoumon should be genotyped. Original submitted 20 December 2012; Revision submitted 8 April 2013
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Affiliation(s)
- Talitha I Verhoef
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands.
| | - William K Redekop
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - David L Veenstra
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Rahber Thariani
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Peter A Beltman
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Rianne MF van Schie
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Anthonius de Boer
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
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Verhoef TI, Redekop WK, van Schie RM, Bayat S, Daly AK, Geitona M, Haschke-Becher E, Hughes DA, Kamali F, Levin LÅ, Manolopoulos VG, Pirmohamed M, Siebert U, Stingl JC, Wadelius M, de Boer A, Maitland-van der Zee AH. Cost-effectiveness of pharmacogenetics in anticoagulation: international differences in healthcare systems and costs. Pharmacogenomics 2013; 13:1405-17. [PMID: 22966889 DOI: 10.2217/pgs.12.124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Genotyping patients for CYP2C9 and VKORC1 polymorphisms can improve the accuracy of dosing during the initiation of anticoagulation with vitamin K antagonists (coumarin derivatives). The anticipated degree of improvement in the safety of anticoagulation with coumarins through genotyping may vary depending on the quality of patient care, which varies both with and among countries. The management and the cost of anticoagulant care can therefore influence the cost-effectiveness of genotyping within any given country. In this article, we provide an overview of the cost-effectiveness of pharmacogenetics-guided dosing of coumarin derivatives. We describe the organization of anticoagulant care in the UK, Sweden, The Netherlands, Greece, Germany and Austria, where a genotype-guided dosing algorithm is currently being investigated as part of the EU-PACT trial. We also explore the costs of anticoagulant care for the treatment of atrial fibrillation in these countries.
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Affiliation(s)
- Talitha I Verhoef
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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van Schie RMF, Wessels JAM, Verhoef TI, Schalekamp T, le Cessie S, van der Meer FJM, Rosendaal FR, Visser LE, Teichert M, Hofman A, Buhre PNM, de Boer A, Maitland-van der Zee AH. Evaluation of the effect of genetic variations in GATA-4 on the phenprocoumon and acenocoumarol maintenance dose. Pharmacogenomics 2012; 13:1917-23. [DOI: 10.2217/pgs.12.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate whether the phenprocoumon and acenocoumarol maintenance doses are influenced by genetic variations in GATA-4, a transcription factor of CYP2C9. Patients & methods: The influence of seven GATA-4 SNPs on the coumarin maintenance dose was investigated by performing an analysis of variance trend analysis, stratified for CYP2C9 genotypes. Results of the best-explaining SNP were validated in the Rotterdam Study cohort. Results: The largest dose differences were found for rs3735814 in patients using acenocoumarol and having the common allele for CYP2C9. The mean dosages decreased from 2.92 mg/day for the patients having the GATA-4 common alleles to 2.65 mg/day for the patients carrying one GATA-4 variant allele and to 2.37 mg/day for patients carrying two GATA-4 variant alleles (p = 0.004). Results could not be replicated in the validation cohort. For phenprocoumon, no significant effects were observed. Conclusion: Genetic variation in GATA-4 does not seem relevant for clinical implementation. Original submitted 31 August 2012; Revision submitted 12 October 2012
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Affiliation(s)
- Rianne MF van Schie
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Judith AM Wessels
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Talitha I Verhoef
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Tom Schalekamp
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Saskia le Cessie
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Felix JM van der Meer
- Department of Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, The Netherlands and Medial, Medical-diagnostic Laboratories, Hoofddorp, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands and Department of Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Loes E Visser
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands and Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands and Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martina Teichert
- R&D Department, Royal Dutch Pharmacists Association, The Hague, The Netherlands and Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter NM Buhre
- Star Medical Diagnostic Center, Rotterdam, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, PO Box 80 082, Utrecht University, 3508 TB Utrecht, The Netherlands
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Vijverberg SJH, Koster ES, Koenderman L, Arets HGM, van der Ent CK, Postma DS, Koppelman GH, Raaijmakers JAM, Maitland-van der Zee AH. Exhaled NO is a poor marker of asthma control in children with a reported use of asthma medication: a pharmacy-based study. Pediatr Allergy Immunol 2012; 23:529-36. [PMID: 22624949 DOI: 10.1111/j.1399-3038.2012.01279.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A high fraction of nitric oxide in exhaled breath (FeNO) has been suggested to be a marker of ongoing airway inflammation and poorly controlled disease in asthma. The usefulness of FeNO to monitor asthma control is still debated today. AIM To assess the validity of FeNO as a marker of asthma control in children with reported use of asthma medication. METHODS Fraction of nitric oxide in exhaled breath was measured in 601 children (aged 4-12 yr) with reported use of asthma medication in the past 6 months and in 63 healthy non-asthmatic children (aged 5-12). Asthma control was assessed by the Asthma Control Questionnaire (ACQ). A receiver-operator characteristics (ROC) curve was generated to assess the accuracy of FeNO as a marker for asthma control. Logistic regression analysis was used to study whether clinical, healthcare, medication, and environmental factors are associated with high FeNO levels (>25 ppb). RESULTS Fraction of nitric oxide in exhaled breath had a poor accuracy to discriminate well-controlled from not well-controlled asthma [area under the ROC curve: 0.56 (95% CI: 0.52-0.61, p = 0.008)]. In addition, high FeNO (>25 ppb) was associated with lower medication adherence rates (OR: 0.4; 95% CI 0.3-0.6), fewer antibiotic courses in the past year (OR: 0.6; 95% CI: 0.4-0.9), fewer leukotriene antagonists use in the past year (OR: 0.4; 95% CI: 0.2-0.9), and fewer visits to a (pulmonary) pediatrician (OR: 0.6; 95% CI: 0.4-0.9). Children living in a non-urban environment had more often high FeNO levels (OR: 1.7; 95% CI: 1.1-2.6). CONCLUSION High FeNO is a poor marker of asthma control in children with reported use of asthma medication. Various other factors, including medication adherence and medication use, are associated with increased FeNO levels.
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Affiliation(s)
- Susanne J H Vijverberg
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Voight BF, Peloso GM, Orho-Melander M, Frikke-Schmidt R, Barbalic M, Jensen MK, Hindy G, Hólm H, Ding EL, Johnson T, Schunkert H, Samani NJ, Clarke R, Hopewell JC, Thompson JF, Li M, Thorleifsson G, Newton-Cheh C, Musunuru K, Pirruccello JP, Saleheen D, Chen L, Stewart AFR, Schillert A, Thorsteinsdottir U, Thorgeirsson G, Anand S, Engert JC, Morgan T, Spertus J, Stoll M, Berger K, Martinelli N, Girelli D, McKeown PP, Patterson CC, Epstein SE, Devaney J, Burnett MS, Mooser V, Ripatti S, Surakka I, Nieminen MS, Sinisalo J, Lokki ML, Perola M, Havulinna A, de Faire U, Gigante B, Ingelsson E, Zeller T, Wild P, de Bakker PIW, Klungel OH, Maitland-van der Zee AH, Peters BJM, de Boer A, Grobbee DE, Kamphuisen PW, Deneer VHM, Elbers CC, Onland-Moret NC, Hofker MH, Wijmenga C, Verschuren WMM, Boer JMA, van der Schouw YT, Rasheed A, Frossard P, Demissie S, Willer C, Do R, Ordovas JM, Abecasis GR, Boehnke M, Mohlke KL, Daly MJ, Guiducci C, Burtt NP, Surti A, Gonzalez E, Purcell S, Gabriel S, Marrugat J, Peden J, Erdmann J, Diemert P, Willenborg C, König IR, Fischer M, Hengstenberg C, Ziegler A, Buysschaert I, Lambrechts D, Van de Werf F, Fox KA, El Mokhtari NE, Rubin D, Schrezenmeir J, Schreiber S, Schäfer A, Danesh J, Blankenberg S, Roberts R, McPherson R, Watkins H, Hall AS, Overvad K, Rimm E, Boerwinkle E, Tybjaerg-Hansen A, Cupples LA, Reilly MP, Melander O, Mannucci PM, Ardissino D, Siscovick D, Elosua R, Stefansson K, O'Donnell CJ, Salomaa V, Rader DJ, Peltonen L, Schwartz SM, Altshuler D, Kathiresan S. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet 2012; 380:572-80. [PMID: 22607825 PMCID: PMC3419820 DOI: 10.1016/s0140-6736(12)60312-2] [Citation(s) in RCA: 1631] [Impact Index Per Article: 135.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease processes, mendelian randomisation can be used to test the hypothesis that the association of a plasma biomarker with disease is causal. METHODS We performed two mendelian randomisation analyses. First, we used as an instrument a single nucleotide polymorphism (SNP) in the endothelial lipase gene (LIPG Asn396Ser) and tested this SNP in 20 studies (20,913 myocardial infarction cases, 95,407 controls). Second, we used as an instrument a genetic score consisting of 14 common SNPs that exclusively associate with HDL cholesterol and tested this score in up to 12,482 cases of myocardial infarction and 41,331 controls. As a positive control, we also tested a genetic score of 13 common SNPs exclusively associated with LDL cholesterol. FINDINGS Carriers of the LIPG 396Ser allele (2·6% frequency) had higher HDL cholesterol (0·14 mmol/L higher, p=8×10(-13)) but similar levels of other lipid and non-lipid risk factors for myocardial infarction compared with non-carriers. This difference in HDL cholesterol is expected to decrease risk of myocardial infarction by 13% (odds ratio [OR] 0·87, 95% CI 0·84-0·91). However, we noted that the 396Ser allele was not associated with risk of myocardial infarction (OR 0·99, 95% CI 0·88-1·11, p=0·85). From observational epidemiology, an increase of 1 SD in HDL cholesterol was associated with reduced risk of myocardial infarction (OR 0·62, 95% CI 0·58-0·66). However, a 1 SD increase in HDL cholesterol due to genetic score was not associated with risk of myocardial infarction (OR 0·93, 95% CI 0·68-1·26, p=0·63). For LDL cholesterol, the estimate from observational epidemiology (a 1 SD increase in LDL cholesterol associated with OR 1·54, 95% CI 1·45-1·63) was concordant with that from genetic score (OR 2·13, 95% CI 1·69-2·69, p=2×10(-10)). INTERPRETATION Some genetic mechanisms that raise plasma HDL cholesterol do not seem to lower risk of myocardial infarction. These data challenge the concept that raising of plasma HDL cholesterol will uniformly translate into reductions in risk of myocardial infarction. FUNDING US National Institutes of Health, The Wellcome Trust, European Union, British Heart Foundation, and the German Federal Ministry of Education and Research.
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Affiliation(s)
- Benjamin F Voight
- Department of Pharmacology and Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study of the National, Heart, Lung, and Blood Institute, Framingham, MA, USA
| | - Marju Orho-Melander
- Diabetes and Cardiovascular Disease Genetic Epidemiology, Skania University Hospital, Lund University, Malmö, Sweden
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Section for Molecular Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maja Barbalic
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Majken K Jensen
- Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - George Hindy
- Diabetes and Cardiovascular Disease Genetic Epidemiology, Skania University Hospital, Lund University, Malmö, Sweden
| | | | - Eric L Ding
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Toby Johnson
- Clinical Pharmacology and The Genome Centre, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester National Institute of Health Research Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Robert Clarke
- The Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Jemma C Hopewell
- The Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - John F Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mingyao Li
- Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Christopher Newton-Cheh
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Kiran Musunuru
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - James P Pirruccello
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Danish Saleheen
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Li Chen
- The John & Jennifer Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alexandre FR Stewart
- The John & Jennifer Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Arne Schillert
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - Unnur Thorsteinsdottir
- deCODE Genetics, Reykjavik, Iceland
- University of Iceland Faculty of Medicine, Reykjavik, Iceland
| | - Gudmundur Thorgeirsson
- University of Iceland Faculty of Medicine, Reykjavik, Iceland
- Department of Internal Medicine, Division of Cardiology, Landspitali University Hospital, Reykjavik, Iceland
| | - Sonia Anand
- Population Health Research Institute, Hamilton Health Sciences and Department of Medicine and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - James C Engert
- Department of Medicine and Department of Human Genetics, McGill University, Montréal, QC, Canada
| | - Thomas Morgan
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John Spertus
- Mid-America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Monika Stoll
- Leibniz-Institute for Arteriosclerosis Research, University of Münster, Münster, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | | | | - Pascal P McKeown
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Belfast, UK
| | - Christopher C Patterson
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Belfast, UK
| | - Stephen E Epstein
- Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC, USA
| | - Joseph Devaney
- Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC, USA
| | - Mary-Susan Burnett
- Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC, USA
| | - Vincent Mooser
- Genetics Division and Drug Discovery, GlaxoSmithKline, King of Prussia, Pennsylvania, PA, USA
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
| | - Ida Surakka
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
| | - Markku S Nieminen
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Division of Cardiology Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Sinisalo
- Division of Cardiology Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Marja-Liisa Lokki
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Markus Perola
- Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Aki Havulinna
- Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Division of Cardiovascular Epidemiology and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Ingelsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tanja Zeller
- der Johannes Gutenberg-Universität Mainz II, Medizinische Klinik und Poliklinik, Mainz, Germany
| | - Philipp Wild
- der Johannes Gutenberg-Universität Mainz II, Medizinische Klinik und Poliklinik, Mainz, Germany
| | - Paul I W de Bakker
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
| | - Bas J M Peters
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter W Kamphuisen
- Department of Vascular Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Vera H M Deneer
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, Netherlands
| | - Clara C Elbers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marten H Hofker
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, Netherlands
| | - Cisca Wijmenga
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | - WM Monique Verschuren
- Center for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jolanda MA Boer
- Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Asif Rasheed
- Center for Non-Communicable Diseases, Karachi, Pakistan
| | | | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study of the National, Heart, Lung, and Blood Institute, Framingham, MA, USA
| | - Cristen Willer
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Ron Do
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
- Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Gonçalo R Abecasis
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Michael Boehnke
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Mark J Daly
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Candace Guiducci
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Noël P Burtt
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Aarti Surti
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Elena Gonzalez
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Shaun Purcell
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Stacey Gabriel
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain
| | - John Peden
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | | | - Patrick Diemert
- Medizinische Klinik II, Universität zu Lübeck, Lübeck, Germany
| | - Christina Willenborg
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - Marcus Fischer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christian Hengstenberg
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Andreas Ziegler
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - Ian Buysschaert
- Vesalius Research Center, VIB-KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Diether Lambrechts
- Vesalius Research Center, VIB-KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Frans Van de Werf
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Keith A Fox
- Cardiovascular Research, Division of Medical and Radiological Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Diana Rubin
- Medizinische Klinik I, Universitätsklinikum Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Jürgen Schrezenmeir
- Max-Rubner-Institut, Institut für Physiologie und Biochemie der Ernährung, Kiel, Germany
| | - Stefan Schreiber
- Institut für Klinische Molekularbiologie, Christian-Albrechts Universität, Kiel, Germany
| | - Arne Schäfer
- Institut für Klinische Molekularbiologie, Christian-Albrechts Universität, Kiel, Germany
| | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stefan Blankenberg
- der Johannes Gutenberg-Universität Mainz II, Medizinische Klinik und Poliklinik, Mainz, Germany
| | - Robert Roberts
- The John & Jennifer Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ruth McPherson
- The John & Jennifer Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Hugh Watkins
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Alistair S Hall
- LIGHT and LIMM Research Institutes, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Kim Overvad
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Eric Rimm
- Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anne Tybjaerg-Hansen
- Department of Clinical Biochemistry, Section for Molecular Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The Copenhagen City Heart Study Bispebjerg University Hospital, Copenhagen, Denmark
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study of the National, Heart, Lung, and Blood Institute, Framingham, MA, USA
| | - Muredach P Reilly
- The Institute for Translational Medicine and Therapeutics and The Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Olle Melander
- Department of Clinical Sciences, Hypertension and Cardiovascular Diseases, Skania University Hospital, Lund University, Malmö, Sweden
| | - Pier M Mannucci
- Department of Internal Medicine and Medical Specialities, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - David Siscovick
- Cardiovascular Health Research Unit, Department of Medicine and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Kari Stefansson
- deCODE Genetics, Reykjavik, Iceland
- University of Iceland Faculty of Medicine, Reykjavik, Iceland
| | - Christopher J O'Donnell
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Framingham Heart Study of the National, Heart, Lung, and Blood Institute, Framingham, MA, USA
| | - Veikko Salomaa
- Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Daniel J Rader
- The Institute for Translational Medicine and Therapeutics and The Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Leena Peltonen
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Wellcome Trust Sanger Institute Cambridge, UK
| | - Stephen M Schwartz
- Cardiovascular Health Research Unit, Department of Medicine and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - David Altshuler
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Sekar Kathiresan
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Correspondence to: Dr Sekar Kathiresan, Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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van Schie RMF, el Khedr N, Verhoef TI, Teichert M, Stricker BH, Hofman A, Buhre PN, Wessels JAM, Schalekamp T, le Cessie S, van der Meer FJM, Rosendaal FR, de Boer A, Maitland-van der Zee AH, Visser LE. Validation of the acenocoumarol EU-PACT algorithms: similar performance in the Rotterdam Study cohort as in the original study. Pharmacogenomics 2012; 13:1239-45. [DOI: 10.2217/pgs.12.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: To evaluate the performance of the European Pharmacogenetics of Anticoagulant Therapy (EU-PACT) acenocoumarol dose algorithms in an independent data set. The EU-PACT trial investigates the added value of pretreatment genotyping for use of warfarin, phenprocoumon and acenocoumarol. Patients & methods: External validation was performed in the Rotterdam Study cohort using information about 707 acenocoumarol users. R2, which measures the strength of correlation between the predicted and observed acenocoumarol dose, mean absolute error and mean squared error were calculated to evaluate the performance of the original algorithm. Results: Validation resulted in a R2 of 52.7 and 12.9% compared with an R2 of 52.6 and 17.8% in the original study for the genotype-guided and nongenotype-guided dose algorithm, respectively. For the genotype-guided dose algorithm, the mean absolute error was 0.48 mg/day and the mean squared error was 0.38 (mg/day)2. For the nongenotype-guided dose algorithm, the mean absolute error was 0.62 mg/day and the mean squared error was 0.63 (mg/day)2. Conclusion: The EU-PACT acenocoumarol algorithm performs just as accurately in this study as in the original study, which implies applicability in various populations. Original submitted 4 April 2012; Revision submitted 31 May 2012
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Affiliation(s)
- Rianne MF van Schie
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Nadia el Khedr
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Talitha I Verhoef
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Martina Teichert
- R&D Department, Royal Dutch Pharmacists Association, The Hague, The Netherlands and Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands and Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands and Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands and Inspectorate of Health Care, The Hague, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter N Buhre
- Star Medical Diagnostic Center, Rotterdam, The Netherlands
| | - Judith AM Wessels
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom Schalekamp
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Saskia le Cessie
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Felix JM van der Meer
- Department of Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, The Netherlands and Medial, Medical-Diagnostic Laboratories, Hoofddorp, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands and Department of Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80 082, 3508 TB, Utrecht, The Netherlands
| | - Loes E Visser
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands and Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands and Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
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47
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Fox JC, Daly A, Cascorbi I, Alfirevic A, Linden H, Maitland-van der Zee AH. Conference Scene: 5th Anniversary Meeting of the European Research Network Pharmacogenetics/Pharmacogenomics. Pharmacogenomics 2012; 13:747-9. [DOI: 10.2217/pgs.12.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The European Research Network Pharmacogenetics/Pharmacogenomics (PGx) is a specialist group of scientists and clinicians who share a common interest in research in PGx and its implementation to improve clinical care. This 5th anniversary meeting focused on progress and future challenges for PGx in Europe. A series of expert presentations were made, and are summarized below. The meeting concluded with an open debate on the current challenges facing the field in a time of limited funding.
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Affiliation(s)
- Jayne Catherine Fox
- AstraZeneca Pharmaceuticals, Personalised Healthcare & Biomarkers, Alderley Park, Macclesfield, UK
| | - Ann Daly
- Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Ingolf Cascorbi
- Institute of Experimental & Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ana Alfirevic
- The Wolfson Centre for Personalised Medicine, Department of Pharmacology, University of Liverpool, Block A, Waterhouse Buildings, 1–5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Hans Linden
- European Federation of Pharmaceutical Sciences (EUFEPS), Stockholm, Sweden
| | - Anke-Hilse Maitland-van der Zee
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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48
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Koster ES, Raaijmakers JAM, Vijverberg SJH, Koenderman L, Postma DS, Koppelman GH, van der Ent CK, Maitland-van der Zee AH. Limited agreement between current and long-term asthma control in children: the PACMAN cohort study. Pediatr Allergy Immunol 2011; 22:776-83. [PMID: 21749459 DOI: 10.1111/j.1399-3038.2011.01188.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have shown that predictors of asthma treatment outcomes differ depending on the definition of the outcome chosen. This provides evidence that different outcomes studied may reflect distinct aspects of asthma control. To assess predictors of asthma control, we need firm outcome phenotypes. The aim of this study was to investigate the association between measurements of current and long-term asthma control. METHODS We included 527 children using inhaled corticosteroids participating in the Pharmacogenetics of Asthma medication in Children: Medication with ANti-inflammatory effects cohort. Current asthma control (previous week) was defined using the Asthma Control Questionnaire. Long-term asthma control was based on Global Initiative for Asthma guidelines. Not well-controlled asthma in a season was defined as ≥ 3 of the following items present in a season: (i) day-time or (ii) night-time symptoms, (iii) limitations in activities, and (iv) rescue medication use. Asthma control during (i) the previous season and (ii) the year preceding the pharmacy visit was used as long-term asthma control definitions. Current and long-term asthma control were compared to investigate agreement. RESULTS Long-term uncontrolled asthma rates were highest in autumn and winter (50%) and lowest in summer (32%) (p < 0.05). Overall agreement between current and long-term asthma control was limited (66% for previous season and 68% for previous year). CONCLUSION Congruence between current and long-term asthma control was limited. Furthermore, we showed significant seasonal differences. It is therefore important to calculate asthma control over a longer period of time, instead of using current asthma control as indicator.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology & Clinical Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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49
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Koster ES, Raaijmakers JAM, Vijverberg SJH, Maitland-van der Zee AH. Inhaled corticosteroid adherence in paediatric patients: the PACMAN cohort study. Pharmacoepidemiol Drug Saf 2011; 20:1064-72. [PMID: 21953846 DOI: 10.1002/pds.2228] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 06/01/2011] [Accepted: 07/18/2011] [Indexed: 11/07/2022]
Abstract
AIMS Poor adherence with inhaled corticosteroids (ICSs) has been reported frequently and may be associated with uncontrolled asthma. A better understanding of factors influencing adherence may help to achieve higher adherence rates for a larger part of the population, which will eventually lead to better asthma control. The aim of this study was to investigate factors associated with adherence in paediatric ICS users. METHODS We included 527 children using ICSs who participated in the Pharmacogenetics of Asthma Medication in Children: Medication with Anti-inflammatory Effects (PACMAN) cohort study. The outcome, a parent-reported adherence, was assessed by using the Medication Adherence Report Scale. Four categories of determinants were studied: child characteristics, family characteristics, medication use (parental beliefs towards medication; using Beliefs about Medicines Questionnaire) and environmental factors. RESULTS Good adherence was observed in 302 children (57%). Increased fractional exhaled nitric oxide values (indication for airway inflammation) were associated with a lower chance of good adherence (OR = 0.25, 95%CI = 0.15-0.41). Parental necessity beliefs about medication were associated with higher adherence (OR = 2.32, 95%CI = 1.59-3.39). Dutch origin was also associated with higher adherence rates (OR = 2.11, 95%CI = 1.09-4.07). Furthermore, younger age (< 6 years) was associated with better adherence (OR = 1.62, 95%CI = 1.02-2.59). CONCLUSIONS Increased airway inflammation was associated with lower ICS adherence, which underlines the need of good adherence to reach disease control. Our results suggest that by improving knowledge, especially in ethnic minorities, and by stimulating positive parental perception towards the nature of the disease, the characteristics of the prescribed drugs and the use of medications, better adherence and as a result better asthma control could be reached.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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50
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Koster ES, Raaijmakers JAM, Vijverberg SJH, van der Ent CK, Maitland-van der Zee AH. Asthma symptoms in pediatric patients: differences throughout the seasons. J Asthma 2011; 48:694-700. [PMID: 21806485 DOI: 10.3109/02770903.2011.601780] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Seasonal variation in asthma has been widely recognized. The aim of this study was to describe seasonal patterns of asthma symptoms and asthma medication use in a cohort of pediatric asthma medication users and to study determinants of seasonal childhood asthma. METHODS For this study, 602 children participating in the Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects) cohort were included. Parents were asked about their child's respiratory symptoms and quick-reliever medication use over the past year. Logistic regression analysis was used to study determinants of seasonality in asthma control (the level of disease control based on symptoms, limitations in activities, and rescue medication use). RESULTS There was a decline in asthma symptoms and asthma medication use during the summer period and a peak occurred from autumn to spring. The prevalence of wheeze ranged from 32% in summer to 56% in autumn. The prevalence of respiratory symptoms and medication use was significantly lower during summer (p < .0001). Oral steroids and antibiotics use and strong parental necessity beliefs were associated with uncontrolled asthma, regardless of seasonality. Allergic rhinitis was associated with an increased risk of uncontrolled asthma during spring [odds ratio (OR): 1.9; 95% confidence interval (CI): 1.3-2.8] and summer (OR: 1.9; 95% CI: 1.2-3.0). Eczema was associated with a higher risk of uncontrolled asthma during autumn (OR: 1.5; 95% CI: 1.0-2.2) and winter (OR: 1.3; 95% CI: 1.0-1.9). CONCLUSION We showed seasonal patterns in asthma symptoms and medication use. Associations were shown between allergic rhinitis and asthma control during spring/summer and eczema was associated with uncontrolled asthma during autumn/winter. Seasonality in asthma morbidity and health-care use is most likely associated with atopic constitution and viral infections, which are common during fall, winter, and spring.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology & Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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