1
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van Dam KPJ, Volkers AG, Wieske L, Stalman EW, Kummer LYL, van Kempen ZLE, Killestein J, Tas SW, Boekel L, Wolbink GJ, van der Kooi AJ, Raaphorst J, Takkenberg RB, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Sanchez AP, van Els CACM, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart RCF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, van der Pol WL, Goedee HS, Steenhuis M, Keijzer S, Keijser JBD, Cristianawati O, Ten Brinke A, Verstegen NJM, van Ham SM, Rispens T, Kuijpers TW, Löwenberg M, Eftimov F. Primary SARS-CoV-2 infection in patients with immune-mediated inflammatory diseases: long-term humoral immune responses and effects on disease activity. BMC Infect Dis 2023; 23:332. [PMID: 37198536 DOI: 10.1186/s12879-023-08298-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/29/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressants (ISPs) may have impaired long-term humoral immune responses and increased disease activity after SARS-CoV-2 infection. We aimed to investigate long-term humoral immune responses against SARS-CoV-2 and increased disease activity after a primary SARS-CoV-2 infection in unvaccinated IMID patients on ISPs. METHODS IMID patients on active treatment with ISPs and controls (i.e. IMID patients not on ISP and healthy controls) with a confirmed SARS-CoV-2 infection before first vaccination were included from an ongoing prospective cohort study (T2B! study). Clinical data on infections and increased disease activity were registered using electronic surveys and health records. A serum sample was collected before first vaccination to measure SARS-CoV-2 anti-receptor-binding domain (RBD) antibodies. RESULTS In total, 193 IMID patients on ISP and 113 controls were included. Serum samples from 185 participants were available, with a median time of 173 days between infection and sample collection. The rate of seropositive IMID patients on ISPs was 78% compared to 100% in controls (p < 0.001). Seropositivity rates were lowest in patients on anti-CD20 (40.0%) and anti-tumor necrosis factor (TNF) agents (60.5%), as compared to other ISPs (p < 0.001 and p < 0.001, respectively). Increased disease activity after infection was reported by 68 of 260 patients (26.2%; 95% CI 21.2-31.8%), leading to ISP intensification in 6 out of these 68 patients (8.8%). CONCLUSION IMID patients using ISPs showed reduced long-term humoral immune responses after primary SARS-CoV-2 infection, which was mainly attributed to treatment with anti-CD20 and anti-TNF agents. Increased disease activity after SARS-CoV-2 infection was reported commonly, but was mostly mild. TRIAL REGISTRATION NL74974.018.20, Trial ID: NL8900. Registered on 9 September 2020.
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Affiliation(s)
- Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Gerrit J Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Agner Parra Sanchez
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Faculty of Veterinary Medicine, Utrecht University Utrecht, Utrecht, The Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée C F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology section, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, the Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, the Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jim B D Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Niels J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Location Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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2
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van Dam KP, Wieske L, Stalman EW, Kummer LY, Roosen J, van Kempen ZL, Killestein J, Volkers AG, Boekel L, Wolbink GJ, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GR, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Sanchez AP, van Els CA, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJ, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart RC, Teng YO, van Paassen P, Busch MH, Jallah PB, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CR, van der Pol W, Goedee HS, Steenhuis M, Keijzer S, Keijser JB, Cristianawati O, Rispens T, Brinke AT, Verstegen NJ, Marieke van Ham S, Tas SW, Kuijpers TW, Eftimov F. Disease activity in patients with immune-mediated inflammatory diseases after SARS-CoV-2 vaccinations. J Autoimmun 2023; 135:102984. [PMID: 36621174 PMCID: PMC9805902 DOI: 10.1016/j.jaut.2022.102984] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023]
Abstract
For patients with immune-mediated inflammatory diseases (IMIDs), concerns exist about increased disease activity after vaccination. We aimed to assess changes in disease activity after SARS-CoV-2 vaccination in patients with IMIDs, and determine risk factors for increased disease activity. In this substudy of a prospective observational cohort study (Target-to-B!), we included patients with IMIDs who received a SARS-CoV-2 vaccine. Patients reported changes in disease activity on a five-point Likert scale every 60 days for up to twelve months after first vaccination. In case of self-reported increased activity, hospital records were screened whether the treating physician reported increased activity, and for potential intensification of immunosuppressive (ISP) treatment. Mixed models were used to study determinants for self-reported increased disease activity. In total, 2111 patients were included for analysis after primary immunization (mean age 49.7 years [SD 13.7], 1329/2111 (63.0%) female), from which 1266 patients for analysis after first additional vaccination. Increased disease activity at 60 days after start of primary immunization was reported by 223/2111 (10.6%). In 96/223 (43.0%) the increase was confirmed by the treating physician and in 36/223 (16.1%) ISP treatment was intensified. Increased disease activity at seven to 60 days after additional vaccination, was reported by 139/1266 (11.0%). Vaccinations were not temporally associated with self-reported increased disease activity. Conversely, increased disease activity before first vaccination, neuromuscular disease, and multiple sclerosis were associated. Altogether, self-reported increased disease activity after vaccination against SARS-CoV-2 was recorded in a minority of patients and was generally mild. Moreover, multivariate analyses suggest that disease related factors, but not vaccinations are the major determinants for self-reported increased disease activity.
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Affiliation(s)
- Koos P.J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Y.L. Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jesse Roosen
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Zoé L.E. van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Adriaan G. Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Laura Boekel
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Gerrit J. Wolbink
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Amsterdam, the Netherlands
| | - Anneke J. van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R. Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Geert R.A.M. D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I. Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel W. Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annelie H. Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicoline F. Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Angela L. Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc L. Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederike J. Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexandre E. Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, the Netherlands,Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Cécile A.C.M. van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands,Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
| | | | - Annabel M. Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée C.F. Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Y.K. Onno Teng
- Centre of Expertise for Lupus, Vasculitis- and Complement-mediated Systemic Diseases, Department of Internal Medicine – Nephrology Section, Leiden University Medical Centre, Leiden, the Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthias H. Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Papay B.P. Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Pieter A. van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adája E. Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Corine R.G. Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W.Ludo van der Pol
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, the Netherlands
| | - H. Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, the Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jim B.D. Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - Niels J.M. Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, the Netherlands,Swammerdam Institute for Life Sciences, University of Amsterdam, the Netherlands
| | - Sander W. Tas
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
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3
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Wieske L, Stalman EW, van Dam PJK, Kummer LY, Steenhuis M, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink G, Van der Kooi A, Raaphorst J, Löwenberg M, Takkenberg B, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl A, Broens B, Parra Sanchez A, van Els CACM, Wit JD, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen D, Schreurs CRG, Van der Pol WL, Goedee HS, Keijzer S, Keijser J, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Rispens T, Eftimov F. Persistence of seroconversion at 6 months following primary immunisation in patients with immune-mediated inflammatory diseases. Ann Rheum Dis 2023; 82:883-885. [PMID: 36720583 DOI: 10.1136/ard-2022-223464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - P J Koos van Dam
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Laura Y Kummer
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Zoe L E van Kempen
- Department of Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Department of Rheumatology, Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Anneke Van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Public Health and Epidemiology; Immunity and Infections, location Academic Medical Center, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Frederique J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Agner Parra Sanchez
- Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands.,Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jelle De Wit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,Center for Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Abraham Rutgers
- Rheumatology and Clinical Immunology, University Medical Center, Groningen, The Netherlands
| | - Karina de Leeuw
- Rheumatology and Clinical Immunology, University Medical Center, Groningen, The Netherlands
| | - Barbara Horváth
- Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Cornelia F Allaart
- Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Y K Onno Teng
- Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine/Devision of Clinical & Experimental Immunology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Rheumatology, Maastricht UMC+, Maastricht, The Netherlands.,Department of Nephrology and Clinical Immunology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | | | - Dirkjan Hijnen
- Department of Dermatology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - W Ludo Van der Pol
- Department of Neurology and Neurosurgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - Sofie Keijzer
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Jim Keijser
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Olvi Cristianawati
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Niels J M Verstegen
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands.,Department of Pediatric Immunology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Immunopathology, Sanquin Research an Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands
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4
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Broens B, Duitman JW, Zwezerijnen GJC, Nossent EJ, van der Laken CJ, Voskuyl AE. Novel tracers for molecular imaging of interstitial lung disease: A state of the art review. Autoimmun Rev 2022; 21:103202. [PMID: 36150433 DOI: 10.1016/j.autrev.2022.103202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
Interstitial lung disease is an overarching term for a wide range of disorders characterized by inflammation and/or fibrosis in the lungs. Most prevalent forms, among others, include idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated interstitial lung disease (CTD-ILD). Currently, only disease modifying treatment options are available for IPF and progressive fibrotic CTD-ILD, leading to reduction or stabilization in the rate of lung function decline at best. Management of these patients would greatly advance if we identify new strategies to improve (1) early detection of ILD, (2) predicting ILD progression, (3) predicting response to therapy and (4) understanding pathophysiology. Over the last years, positron emission tomography (PET) and single photon emission computed tomography (SPECT) have emerged as promising molecular imaging techniques to improve ILD management. Both are non-invasive diagnostic tools to assess molecular characteristics of an individual patient with the potential to apply personalized treatment. In this review, we encompass the currently available pre-clinical and clinical studies on molecular imaging with PET and SPECT in IPF and CTD-ILD. We provide recommendations for potential future clinical applications of these tracers and directions for future research.
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Affiliation(s)
- Bo Broens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
| | - Jan-Willem Duitman
- Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Experimental Immunology (EXIM), Meibergdreef 9, Amsterdam, the Netherlands.
| | - Gerben J C Zwezerijnen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Esther J Nossent
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands..
| | - Conny J van der Laken
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
| | - Alexandre E Voskuyl
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
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5
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Stalman EW, Wieske L, van Dam KPJ, Kummer LY, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink GJ, Van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D’Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Parra Sanchez A, van Els CACM, Wit JD, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng OYK, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, Van der Pol WL, Goedee HS, Steenhuis M, Keijzer S, Keijser JBD, Boogaard A, Cristianawati O, ten Brinke A, Verstegen NJM, Zwinderman KAH, Rispens T, van Ham SM, Kuijpers TW, Eftimov F. Breakthrough infections with the SARS-CoV-2 omicron (B.1.1.529) variant in patients with immune-mediated inflammatory diseases. Ann Rheum Dis 2022; 81:1757-1766. [DOI: 10.1136/ard-2022-222904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022]
Abstract
ObjectivesTo compare the cumulative incidence and disease severity of reported SARS-CoV-2 omicron breakthrough infections between patients with immune-mediated inflammatory diseases (IMID) on immunosuppressants and controls, and to investigate determinants for breakthrough infections.MethodsData were used from an ongoing national prospective multicentre cohort study on SARS-CoV-2 vaccination responses in patients with IMID in the Netherlands (Target-to-B! (T2B!) study). Patients wih IMID on immunosuppressants and controls (patients with IMID not on immunosuppressants and healthy controls) who completed primary immunisation were included. The observation period was between 1 January 2022 and 1 April 2022, during which the SARS-CoV-2 omicron (BA.1 and BA.2 subvariant) was dominant. A SARS-CoV-2 breakthrough infection was defined as a reported positive PCR and/or antigen test at least 14 days after primary immunisation. A multivariate logistic regression model was used to investigate determinants.Results1593 patients with IMID on immunosuppressants and 579 controls were included. The cumulative incidence of breakthrough infections was 472/1593 (29.6%; 95% CI 27% to 32%) in patients with IMID on immunosuppressants and 181/579 (31.3%; 95% CI 28% to 35%) in controls (p=0.42). Three (0.5%) participants had severe disease. Seroconversion after primary immunisation (relative risk, RR 0.71; 95% CI 0.52 to 0.96), additional vaccinations (RR 0.61; 95% CI 0.49 to 0.76) and a prior SARS-CoV-2 infection (RR 0.60; 95% CI 0.48 to 0.75) were associated with decreased risk of breakthrough infection.ConclusionsThe cumulative incidence of reported SARS-CoV-2 omicron breakthrough infections was high, but similar between patients with IMID on immunosuppressants and controls, and disease severity was mostly mild. Additional vaccinations and prior SARS-CoV-2 infections may reduce the incidence of breakthrough infections.
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6
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Broens B, van der Laken CJ, Zwezerijnen GJ, Nossent EJ, Meijboom LJ, Spierings J, de Vries-Bouwstra JK, van Laar JM, Voskuyl AE. Positron Emission Tomography to Improve Assessment of Interstitial Lung Disease in Patients With Systemic Sclerosis Eligible for Autologous Stem Cell Transplantation. Front Immunol 2022; 13:923869. [PMID: 35865521 PMCID: PMC9294594 DOI: 10.3389/fimmu.2022.923869] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Positron emission tomography (PET) is a promising technique to improve the assessment of systemic sclerosis associated interstitial lung disease (SSc-ILD). This technique could be of particular value in patients with severe diffuse cutaneous SSc (dcSSc) that are possibly eligible for autologous hematopoietic stem cell transplantation (aHSCT). aHSCT is a potentially effective therapy for patients with severe dcSSc and ILD, leading to stabilization or improvement of lung function. However, there is a high need to improve patient selection, which includes (1) the selection of patients with rapidly progressive ILD for early rather than last-resort aHSCT (2) the prediction of treatment response on ILD and (3) the understanding of the mechanism(s) of action of aHSCT in the lungs. As previous studies with 18F-FDG PET in SSc-ILD and other forms of ILD have demonstrated its potential value in predicting disease progression and reactivity to anti-inflammatory treatment, we discuss the potential benefit of using this technique in patients with early severe dcSSc and ILD in the context of aHSCT. In addition, we discuss the potential value of other PET tracers in the assessment of ILD and understanding the mechanisms of action of aHSCT in the lung. Finally, we provide several suggestions for future research.
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Affiliation(s)
- Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
| | - Conny J. van der Laken
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Esther J. Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Lilian J. Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Jacob M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Alexandre E. Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
- *Correspondence: Alexandre E. Voskuyl,
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7
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Boekel L, Stalman EW, Wieske L, Hooijberg F, van Dam KPJ, Besten YR, Kummer LYL, Steenhuis M, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Parra Sanchez A, van Els CACM, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, van der Pol WL, Goedee HS, Vogelzang EH, Leeuw M, Atiqi S, van Vollenhoven R, Gerritsen M, van der Horst-Bruinsma IE, Lems WF, Nurmohamed MT, Boers M, Keijzer S, Keijser J, van de Sandt C, Boogaard A, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Rispens T, Kuijpers TW, Wolbink G, Eftimov F. Breakthrough SARS-CoV-2 infections with the delta (B.1.617.2) variant in vaccinated patients with immune-mediated inflammatory diseases using immunosuppressants: a substudy of two prospective cohort studies. The Lancet Rheumatology 2022; 4:e417-e429. [PMID: 35527808 PMCID: PMC9054068 DOI: 10.1016/s2665-9913(22)00102-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Concerns have been raised regarding the risks of SARS-CoV-2 breakthrough infections in vaccinated patients with immune-mediated inflammatory diseases treated with immunosuppressants, but clinical data on breakthrough infections are still scarce. The primary objective of this study was to compare the incidence and severity of SARS-CoV-2 breakthrough infections between patients with immune-mediated inflammatory diseases using immunosuppressants, and controls (patients with immune-mediated inflammatory diseases not taking immunosuppressants and healthy controls) who had received full COVID-19 vaccinations. The secondary objective was to explore determinants of breakthrough infections of the delta (B.1.617.2) variant of SARS-CoV-2, including humoral immune responses after vaccination. Methods In this substudy, we pooled data collected in two large ongoing prospective multicentre cohort studies conducted in the Netherlands (Target to-B! [T2B!] study and Amsterdam Rheumatology Center COVID [ARC-COVID] study). Both studies recruited adult patients (age ≥18 years) with immune-mediated inflammatory diseases and healthy controls. We sourced clinical data from standardised electronic case record forms, digital questionnaires, and medical files. We only included individuals who were vaccinated against SARS-CoV-2. For T2B!, participants were recruited between Feb 2 and Aug 1, 2021, and for ARC-COVID, participants were recruited between April 26, 2020, and March 1, 2021. In this study we assessed data on breakthrough infections collected between July 1 and Dec 15, 2021, a period in which the delta SARS-CoV-2 variant was the dominant variant in the Netherlands. We defined a SARS-CoV-2 breakthrough infection as a PCR-confirmed or antigen test-confirmed SARS-CoV-2 infection that occurred at least 14 days after vaccination. All breakthrough infections during this period were assumed to be due to the delta variant due to its dominance during the study period. We analysed post-vaccination serum samples for anti-receptor binding domain (RBD) antibodies to assess the humoral vaccination response (T2B! study only) and anti-nucleocapsid antibodies to identify asymptomatic breakthrough infections (ARC-COVID study only). We used multivariable logistic regression analyses to explore potential clinical and humoral determinants associated with the odds of breakthrough infections. The T2B! study is registered with the Dutch Trial Register, Trial ID NL8900, and the ARC-COVID study is registered with Dutch Trial Register, trial ID NL8513. Findings We included 3207 patients with immune-mediated inflammatory diseases who receive immunosuppressants, and 1807 controls (985 patients with immune-mediated inflammatory disease not on immunosuppressants and 822 healthy controls). Among patients receiving immunosuppressants, mean age was 53 years (SD 14), 2042 (64%) of 3207 were female and 1165 (36%) were male; among patients not receiving immunosuppressants, mean age was 54 years (SD 14), 598 (61%) of 985 were female and 387 (39%) were male; and among healthy controls, mean age was 57 years (SD 13), 549 (67%) of 822 were female and 273 (33%) were male. The cumulative incidence of PCR-test or antigen-test confirmed SARS-CoV-2 breakthrough infections was similar in patients on immunosuppressants (148 of 3207; 4·6% [95% CI 3·9–5·4]), patients not on immunosuppressants (52 of 985; 5·3% [95% CI 4·0–6·9]), and healthy controls (33 of 822; 4·0% [95% CI 2·8–5·6]). There was no difference in the odds of breakthrough infection for patients with immune-mediate inflammatory disease on immunosuppressants versus combined controls (ie, patients not on immunosuppressants and healthy controls; adjusted odds ratio 0·88 [95% CI 0·66–1·18]). Seroconversion after vaccination (odds ratio 0·58 [95% CI 0·34–0·98]; T2B! cohort only) and SARS-CoV-2 infection before vaccination (0·34 [0·18–0·56]) were associated with a lower odds of breakthrough infections. Interpretation The incidence and severity of SARS-CoV-2 breakthrough infections in patients with immune-mediated inflammatory diseases on immunosuppressants was similar to that in controls. However, caution might still be warranted for those on anti-CD20 therapy and those with traditional risk factors. Funding ZonMw (the Netherlands Organization for Health Research and Development) and Reade foundation.
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Affiliation(s)
- Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Yaëlle R Besten
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Zoé L E van Kempen
- Department of Neurology Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Annelie H Musters
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Nicoline F Post
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Angela L Bosma
- Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Groningen, Groningen, Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Groningen, Groningen, Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology section, Leiden University Medical Center, Leiden, Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - W Ludo van der Pol
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands
| | - H Stephan Goedee
- Brain Center UMC Utrecht, Department of Neurology and Neurosurgery, Utrecht, Netherlands
| | - Erik H Vogelzang
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Maureen Leeuw
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Sadaf Atiqi
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Gerritsen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
| | | | - Willem F Lems
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
| | - Mike T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Maarten Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit, Amsterdam UMC, Amsterdam, Netherlands
| | - Sofie Keijzer
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Jim Keijser
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Carolien van de Sandt
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Arend Boogaard
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Olvi Cristianawati
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Anja Ten Brinke
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels J M Verstegen
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | | | - S Marieke van Ham
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, Netherlands
- Department of immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
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8
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Wieske L, van Dam KPJ, Steenhuis M, Stalman EW, Kummer LYL, van Kempen ZLE, Killestein J, Volkers AG, Tas SW, Boekel L, Wolbink GJ, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, D'Haens GRAM, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Voskuyl AE, Broens B, Sanchez AP, van Els CACM, de Wit J, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart RCF, Teng YKO, van Paassen P, Busch MH, Jallah PBP, Brusse E, van Doorn PA, Baars AE, Hijnen DJ, Schreurs CRG, van der Pol WL, Goedee HS, Keijzer S, Keijser JBD, Boogaard A, Cristianawati O, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Rispens T, Eftimov F. Humoral responses after second and third SARS-CoV-2 vaccination in patients with immune-mediated inflammatory disorders on immunosuppressants: a cohort study. The Lancet Rheumatology 2022; 4:e338-e350. [PMID: 35317410 PMCID: PMC8930018 DOI: 10.1016/s2665-9913(22)00034-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Disease-specific studies have reported impaired humoral responses after SARS-CoV-2 vaccination in patients with immune-mediated inflammatory disorders treated with specific immunosuppressants. Disease-overarching studies, and data on recall responses and third vaccinations are scarce. Our primary objective was to investigate the effects of immunosuppressive monotherapies on the humoral immune response after SARS-CoV-2 vaccination in patients with prevalent immune-mediated inflammatory disorders. Methods We did a cohort study in participants treated in outpatient clinics in seven university hospitals and one rheumatology treatment centre in the Netherlands as well as participants included in two national cohort studies on COVID-19-related disease severity. We included patients aged older than 18 years, diagnosed with any of the prespecified immune-mediated inflammatory disorders, who were able to understand and complete questionnaires in Dutch. Participants with immune-mediated inflammatory disorders who were not on systemic immunosuppressants and healthy participants were included as controls. Anti-receptor binding domain IgG responses and neutralisation capacity were monitored following standard vaccination regimens and a three-vaccination regimen in subgroups. Hybrid immune responses—ie, vaccination after previous SARS-CoV-2 infection—were studied as a proxy for recall responses. Findings Between Feb 2 and Aug 1, 2021, we included 3222 participants in our cohort. Sera from 2339 participants, 1869 without and 470 participants with previous SARS-CoV-2 infection were analysed (mean age 49·9 years [SD 13·7]; 1470 [62·8%] females and 869 [37·2%] males). Humoral responses did not differ between disorders. Anti-CD20 therapy, sphingosine 1-phosphate receptor (S1P) modulators, and mycophenolate mofetil combined with corticosteroids were associated with lower relative risks for reaching seroconversion following standard vaccination (0·32 [95% CI 0·19–0·49] for anti-CD20 therapy, 0·35 [0·21–0·55] for S1P modulators, and 0·61 [0·40–0·90] for mycophenolate mofetil combined with corticosteroids). A third vaccination increased seroconversion for mycophenolate mofetil combination treatments (from 52·6% after the second vaccination to 89·5% after the third) but not significantly for anti-CD20 therapies (from 36·8% to 45·6%) and S1P modulators (from 35·5% to 48·4%). Most other immunosuppressant groups showed moderately reduced antibody titres after standard vaccination that did not increase after a third vaccination, although seroconversion rates and neutralisation capacity were unaffected. In participants with previous SARS-CoV-2 infection, SARS-CoV-2 antibodies were boosted after vaccination, regardless of immunosuppressive treatment. Interpretation Humoral responses following vaccination are impaired by specific immunosuppressants. After standard vaccination regimens, patients with immune-mediated inflammatory disorders taking most immunosuppressants show similar seroconversion to controls, although antibody titres might be moderately reduced. As neutralisation capacity and recall responses are also preserved in these patients, this is not likely to translate to loss of (short-term) protection. In patients on immunosuppressants showing poor humoral responses after standard vaccination regimens, a third vaccination resulted in additional seroconversion in patients taking mycophenolate mofetil combination treatments, whereas the effect of a third vaccination in patients on anti-CD20 therapy and S1P modulators was limited. Funding ZonMw (The Netherlands Organization for Health Research and Development).
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Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Gerrit J Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, University of Amsterdam, Amsterdam, Netherlands
| | - Cécile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Faculty of Veterinary Medicine, Utrecht University Utrecht, Utrecht, Netherlands
| | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Renée C F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine, Nephrology Section, Leiden University Medical Center, Leiden, Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Papay B P Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, Netherlands
| | - Sofie Keijzer
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Jim B D Keijser
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Arend Boogaard
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Olvi Cristianawati
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam UMC and Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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9
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Wieske L, Kummer LYL, van Dam KPJ, Stalman EW, van der Kooi AJ, Raaphorst J, Löwenberg M, Takkenberg RB, Volkers AG, D'Haens GRAM, Tas SW, Spuls PI, Bekkenk MW, Musters AH, Post NF, Bosma AL, Hilhorst ML, Vegting Y, Bemelman FJ, Killestein J, van Kempen ZLE, Voskuyl AE, Broens B, Sanchez AP, Wolbink G, Boekel L, Rutgers A, de Leeuw K, Horváth B, Verschuuren JJGM, Ruiter AM, van Ouwerkerk L, van der Woude D, Allaart CF, Teng YKO, van Paassen P, Busch MH, Jallah BP, Brusse E, van Doorn PA, Baars AE, Hijnen D, Schreurs CRG, van der Pol WL, Goedee HS, Steenhuis M, Rispens T, Ten Brinke A, Verstegen NJM, Zwinderman KAH, van Ham SM, Kuijpers TW, Eftimov F. Risk factors associated with short-term adverse events after SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseases. BMC Med 2022; 20:100. [PMID: 35236350 PMCID: PMC8889379 DOI: 10.1186/s12916-022-02310-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have suggested incremental short-term adverse events (AE) after repeated vaccination. In this report, we assessed occurrence and risk factors for short-term AEs following repeated SARS-CoV-2 vaccination in patients with various immune-mediated inflammatory diseases (IMIDs). METHODS Self-reported daily questionnaires on AEs during the first 7 days after vaccination were obtained of 2259 individuals (2081 patients and 178 controls) participating in an ongoing prospective multicenter cohort study on SARS-CoV-2 vaccination in patients with various IMIDs in the Netherlands (T2B-COVID). Relative risks were calculated for potential risk factors associated with clinically relevant AE (rAE), defined as AE lasting longer than 2 days or impacting daily life. RESULTS In total, 5454 vaccinations were recorded (1737 first, 1992 second and 1478 third vaccinations). Multiple sclerosis, Crohn's disease and rheumatoid arthritis were the largest disease groups. rAEs were reported by 57.3% (95% CI 54.8-59.8) of patients after the first vaccination, 61.5% (95% CI 59.2-63.7) after the second vaccination and 58% (95% CI 55.3-60.6) after the third vaccination. At day 7 after the first, second and third vaccination, respectively, 7.6% (95% CI 6.3-9.1), 7.4% (95% CI 6.2-8.7) and 6.8% (95% CI 5.4-8.3) of patients still reported AEs impacting daily life. Hospital admissions and allergic reactions were uncommon (<0.7%). Female sex (aRR 1.43, 95% CI 1.32-1.56), age below 50 (aRR 1.14, 95% CI 1.06-1.23), a preceding SARS-CoV-2 infection (aRR 1.14, 95% CI 1.01-1.29) and having an IMID (aRR 1.16, 95% CI 1.01-1.34) were associated with increased risk of rAEs following a vaccination. Compared to the second vaccination, the first vaccination was associated with a lower risk of rAEs (aRR 0.92, 95% CI 0.84-0.99) while a third vaccination was not associated with increased risk on rAEs (aRR 0.93, 95% CI 0.84-1.02). BNT162b2 vaccines were associated with lower risk on rAEs compared to CX-024414 (aRR 0.86, 95% CI 0.80-0.93). CONCLUSIONS A third SARS-CoV-2 vaccination was not associated with increased risk of rAEs in IMID patients compared to the second vaccination. Patients with an IMID have a modestly increased risk of rAEs after vaccination when compared to controls. Most AEs are resolved within 7 days; hospital admissions and allergic reactions were uncommon. TRIAL REGISTRATION NL74974.018.20 , Trial ID: NL8900. Registered on 9 September 2020.
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Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Laura Y L Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koos P J van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Adriaan G Volkers
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepathology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Public Health/Infection and Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Annelie H Musters
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicoline F Post
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc L Hilhorst
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yosta Vegting
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine, Section of Nephrology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Agner Parra Sanchez
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Amsterdam, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University Groningen, Groningen, The Netherlands
| | | | - Annabel M Ruiter
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte van Ouwerkerk
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y K Onno Teng
- Centre of Expertise for Lupus-, Vasculitis- and Complement-Mediated Systemic Diseases, Department of Internal Medicine - Nephrology Section, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pieter van Paassen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias H Busch
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B Papay Jallah
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adája E Baars
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dirkjan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corine R G Schreurs
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Niels J M Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koos A H Zwinderman
- Clinical Research Unit, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Broens B, Zwezerijnen BGJC, van der Laken CJ, Voskuyl AE. Quantification of 68Ga-FAPI-04 in systemic sclerosis-associated interstitial lung disease. Lancet Rheumatol 2021; 3:e475. [PMID: 38279399 DOI: 10.1016/s2665-9913(21)00143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/20/2021] [Indexed: 01/28/2024]
Affiliation(s)
- Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam 1007 MB, Netherlands
| | - Ben G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam 1007 MB, Netherlands
| | - Conny J van der Laken
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam 1007 MB, Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam 1007 MB, Netherlands.
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11
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Denneman N, Hessels L, Broens B, Gjaltema J, Stapel SN, Stohlmann J, Nijsten MW, Oudemans-van Straaten HM. Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study. Eur J Clin Nutr 2020; 74:1410-1419. [DOI: 10.1038/s41430-020-0622-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 02/08/2023]
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12
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Looijaard WGPM, Denneman N, Broens B, Girbes ARJ, Weijs PJM, Oudemans-van Straaten HM. Achieving protein targets without energy overfeeding in critically ill patients: A prospective feasibility study. Clin Nutr 2018; 38:2623-2631. [PMID: 30595377 DOI: 10.1016/j.clnu.2018.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/01/2018] [Accepted: 11/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS High protein delivery during early critical illness is associated with lower mortality, while energy overfeeding is associated with higher mortality. Protein-to-energy ratios of traditional enteral formulae are sometimes too low to reach protein targets without energy overfeeding. This prospective feasibility study aimed to evaluate the ability of a new enteral formula with a high protein-to-energy ratio to achieve the desired protein target while avoiding energy overfeeding. METHODS Mechanically ventilated non-septic patients received the high protein-to-energy ratio nutrition during the first 4 days of ICU stay (n = 20). Nutritional prescription was 90% of measured energy expenditure. Primary endpoint was the percentage of patients reaching a protein target of ≥1.2 g/kg ideal body weight on day 4. Other endpoints included a comparison of nutritional intake to matched historic controls and the response of plasma amino acid concentrations. Safety endpoints were gastro-intestinal tolerance and plasma urea concentrations. RESULTS Nineteen (95%) patients reached the protein intake target of ≥1.2 g/kg ideal body weight on day 4, compared to 65% in historic controls (p = 0.024). Mean plasma concentrations of all essential amino acids increased significantly from baseline to day 4. Predefined gastro-intestinal tolerance was good, but unexplained foul smelling diarrhoea occurred in two patients. In one patient plasma urea increased unrelated to acute kidney injury. CONCLUSIONS In selected non-septic patients tolerating enteral nutrition, recommended protein targets can be achieved without energy overfeeding using a new high protein-to-energy ratio enteral nutrition.
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Affiliation(s)
- W G P M Looijaard
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Institute for Cardiovascular Research, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
| | - N Denneman
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
| | - B Broens
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
| | - A R J Girbes
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Institute for Cardiovascular Research, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
| | - P J M Weijs
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
| | - H M Oudemans-van Straaten
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Institute for Cardiovascular Research, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
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