Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study.
Identifieur interne : 000976 ( Main/Corpus ); précédent : 000975; suivant : 000977Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study.
Auteurs : Sofia Ramiro ; Rémy L M. Mostard ; César Magro-Checa ; Christel M P. Van Dongen ; Tom Dormans ; Jacqueline Buijs ; Michiel Gronenschild ; Martijn D. De Kruif ; Eric H J. Van Haren ; Tom Van Kraaij ; Mathie P G. Leers ; Ralph Peeters ; Dennis R. Wong ; Robert B M. LandewéSource :
- Annals of the rheumatic diseases [ 1468-2060 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Antibodies, Monoclonal, Humanized (administration & dosage), Betacoronavirus (MeSH), C-Reactive Protein (analysis), Coronavirus Infections (blood), Coronavirus Infections (complications), Coronavirus Infections (drug therapy), Coronavirus Infections (virology), Cytokine Release Syndrome (blood), Cytokine Release Syndrome (drug therapy), Cytokine Release Syndrome (virology), Cytokines (blood), Drug Therapy, Combination (MeSH), Female (MeSH), Ferritins (blood), Fibrin Fibrinogen Degradation Products (analysis), Glucocorticoids (administration & dosage), Historically Controlled Study (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (blood), Pneumonia, Viral (complications), Pneumonia, Viral (drug therapy), Pneumonia, Viral (virology), Prospective Studies (MeSH), Standard of Care (MeSH), Treatment Outcome (MeSH).
- MESH :
- chemical , administration & dosage : Antibodies, Monoclonal, Humanized, Glucocorticoids.
- chemical , analysis : C-Reactive Protein, Fibrin Fibrinogen Degradation Products.
- blood : Coronavirus Infections, Cytokine Release Syndrome, Cytokines, Ferritins, Pneumonia, Viral.
- complications : Coronavirus Infections, Pneumonia, Viral.
- drug therapy : Coronavirus Infections, Cytokine Release Syndrome, Pneumonia, Viral.
- virology : Coronavirus Infections, Cytokine Release Syndrome, Pneumonia, Viral.
- Aged, Betacoronavirus, Drug Therapy, Combination, Female, Historically Controlled Study, Humans, Male, Middle Aged, Pandemics, Prospective Studies, Standard of Care, Treatment Outcome.
Abstract
OBJECTIVES
To prospectively investigate in patients with severe COVID-19-associated cytokine storm syndrome (CSS) whether an intensive course of glucocorticoids with or without tocilizumab accelerates clinical improvement, reduces mortality and prevents invasive mechanical ventilation, in comparison with a historic control group of patients who received supportive care only.
METHODS
From 1 April 2020, patients with COVID-19-associated CSS, defined as rapid respiratory deterioration plus at least two out of three biomarkers with important elevations (C-reactive protein >100 mg/L; ferritin >900 µg/L; D-dimer >1500 µg/L), received high-dose intravenous methylprednisolone for 5 consecutive days (250 mg on day 1 followed by 80 mg on days 2-5). If the respiratory condition had not improved sufficiently (in 43%), the interleukin-6 receptor blocker tocilizumab (8 mg/kg body weight, single infusion) was added on or after day 2. Control patients with COVID-19-associated CSS (same definition) were retrospectively sampled from the pool of patients (n=350) admitted between 7 March and 31 March, and matched one to one to treated patients on sex and age. The primary outcome was ≥2 stages of improvement on a 7-item WHO-endorsed scale for trials in patients with severe influenza pneumonia, or discharge from the hospital. Secondary outcomes were hospital mortality and mechanical ventilation.
RESULTS
At baseline all patients with COVID-19 in the treatment group (n=86) and control group (n=86) had symptoms of CSS and faced acute respiratory failure. Treated patients had 79% higher likelihood on reaching the primary outcome (HR: 1.8; 95% CI 1.2 to 2.7) (7 days earlier), 65% less mortality (HR: 0.35; 95% CI 0.19 to 0.65) and 71% less invasive mechanical ventilation (HR: 0.29; 95% CI 0.14 to 0.65). Treatment effects remained constant in confounding and sensitivity analyses.
CONCLUSIONS
A strategy involving a course of high-dose methylprednisolone, followed by tocilizumab if needed, may accelerate respiratory recovery, lower hospital mortality and reduce the likelihood of invasive mechanical ventilation in COVID-19-associated CSS.
DOI: 10.1136/annrheumdis-2020-218479
PubMed: 32719045
PubMed Central: PMC7456552
Links to Exploration step
pubmed:32719045Le document en format XML
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<author><name sortKey="Van Dongen, Christel M P" sort="Van Dongen, Christel M P" uniqKey="Van Dongen C" first="Christel M P" last="Van Dongen">Christel M P. Van Dongen</name>
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<author><name sortKey="Dormans, Tom" sort="Dormans, Tom" uniqKey="Dormans T" first="Tom" last="Dormans">Tom Dormans</name>
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<author><name sortKey="De Kruif, Martijn D" sort="De Kruif, Martijn D" uniqKey="De Kruif M" first="Martijn D" last="De Kruif">Martijn D. De Kruif</name>
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<author><name sortKey="Van Haren, Eric H J" sort="Van Haren, Eric H J" uniqKey="Van Haren E" first="Eric H J" last="Van Haren">Eric H J. Van Haren</name>
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</affiliation>
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<author><name sortKey="Van Kraaij, Tom" sort="Van Kraaij, Tom" uniqKey="Van Kraaij T" first="Tom" last="Van Kraaij">Tom Van Kraaij</name>
<affiliation><nlm:affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Leers, Mathie P G" sort="Leers, Mathie P G" uniqKey="Leers M" first="Mathie P G" last="Leers">Mathie P G. Leers</name>
<affiliation><nlm:affiliation>Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Peeters, Ralph" sort="Peeters, Ralph" uniqKey="Peeters R" first="Ralph" last="Peeters">Ralph Peeters</name>
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<author><name sortKey="Wong, Dennis R" sort="Wong, Dennis R" uniqKey="Wong D" first="Dennis R" last="Wong">Dennis R. Wong</name>
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</affiliation>
</author>
<author><name sortKey="Landewe, Robert B M" sort="Landewe, Robert B M" uniqKey="Landewe R" first="Robert B M" last="Landewé">Robert B M. Landewé</name>
<affiliation><nlm:affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
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<affiliation><nlm:affiliation>Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.</nlm:affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study.</title>
<author><name sortKey="Ramiro, Sofia" sort="Ramiro, Sofia" uniqKey="Ramiro S" first="Sofia" last="Ramiro">Sofia Ramiro</name>
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</affiliation>
<affiliation><nlm:affiliation>Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Mostard, Remy L M" sort="Mostard, Remy L M" uniqKey="Mostard R" first="Rémy L M" last="Mostard">Rémy L M. Mostard</name>
<affiliation><nlm:affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Magro Checa, Cesar" sort="Magro Checa, Cesar" uniqKey="Magro Checa C" first="César" last="Magro-Checa">César Magro-Checa</name>
<affiliation><nlm:affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van Dongen, Christel M P" sort="Van Dongen, Christel M P" uniqKey="Van Dongen C" first="Christel M P" last="Van Dongen">Christel M P. Van Dongen</name>
<affiliation><nlm:affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Dormans, Tom" sort="Dormans, Tom" uniqKey="Dormans T" first="Tom" last="Dormans">Tom Dormans</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Buijs, Jacqueline" sort="Buijs, Jacqueline" uniqKey="Buijs J" first="Jacqueline" last="Buijs">Jacqueline Buijs</name>
<affiliation><nlm:affiliation>Department of Internal Medicine, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Gronenschild, Michiel" sort="Gronenschild, Michiel" uniqKey="Gronenschild M" first="Michiel" last="Gronenschild">Michiel Gronenschild</name>
<affiliation><nlm:affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="De Kruif, Martijn D" sort="De Kruif, Martijn D" uniqKey="De Kruif M" first="Martijn D" last="De Kruif">Martijn D. De Kruif</name>
<affiliation><nlm:affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van Haren, Eric H J" sort="Van Haren, Eric H J" uniqKey="Van Haren E" first="Eric H J" last="Van Haren">Eric H J. Van Haren</name>
<affiliation><nlm:affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van Kraaij, Tom" sort="Van Kraaij, Tom" uniqKey="Van Kraaij T" first="Tom" last="Van Kraaij">Tom Van Kraaij</name>
<affiliation><nlm:affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Leers, Mathie P G" sort="Leers, Mathie P G" uniqKey="Leers M" first="Mathie P G" last="Leers">Mathie P G. Leers</name>
<affiliation><nlm:affiliation>Department of Clinical Chemistry and Hematology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Peeters, Ralph" sort="Peeters, Ralph" uniqKey="Peeters R" first="Ralph" last="Peeters">Ralph Peeters</name>
<affiliation><nlm:affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Wong, Dennis R" sort="Wong, Dennis R" uniqKey="Wong D" first="Dennis R" last="Wong">Dennis R. Wong</name>
<affiliation><nlm:affiliation>Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Landewe, Robert B M" sort="Landewe, Robert B M" uniqKey="Landewe R" first="Robert B M" last="Landewé">Robert B M. Landewé</name>
<affiliation><nlm:affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.</nlm:affiliation>
</affiliation>
</author>
</analytic>
<series><title level="j">Annals of the rheumatic diseases</title>
<idno type="eISSN">1468-2060</idno>
<imprint><date when="2020" type="published">2020</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term>
<term>Antibodies, Monoclonal, Humanized (administration & dosage)</term>
<term>Betacoronavirus (MeSH)</term>
<term>C-Reactive Protein (analysis)</term>
<term>Coronavirus Infections (blood)</term>
<term>Coronavirus Infections (complications)</term>
<term>Coronavirus Infections (drug therapy)</term>
<term>Coronavirus Infections (virology)</term>
<term>Cytokine Release Syndrome (blood)</term>
<term>Cytokine Release Syndrome (drug therapy)</term>
<term>Cytokine Release Syndrome (virology)</term>
<term>Cytokines (blood)</term>
<term>Drug Therapy, Combination (MeSH)</term>
<term>Female (MeSH)</term>
<term>Ferritins (blood)</term>
<term>Fibrin Fibrinogen Degradation Products (analysis)</term>
<term>Glucocorticoids (administration & dosage)</term>
<term>Historically Controlled Study (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (blood)</term>
<term>Pneumonia, Viral (complications)</term>
<term>Pneumonia, Viral (drug therapy)</term>
<term>Pneumonia, Viral (virology)</term>
<term>Prospective Studies (MeSH)</term>
<term>Standard of Care (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antibodies, Monoclonal, Humanized</term>
<term>Glucocorticoids</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="analysis" xml:lang="en"><term>C-Reactive Protein</term>
<term>Fibrin Fibrinogen Degradation Products</term>
</keywords>
<keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Coronavirus Infections</term>
<term>Cytokine Release Syndrome</term>
<term>Cytokines</term>
<term>Ferritins</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term>
<term>Cytokine Release Syndrome</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Cytokine Release Syndrome</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Betacoronavirus</term>
<term>Drug Therapy, Combination</term>
<term>Female</term>
<term>Historically Controlled Study</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pandemics</term>
<term>Prospective Studies</term>
<term>Standard of Care</term>
<term>Treatment Outcome</term>
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<front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b>
</p>
<p>To prospectively investigate in patients with severe COVID-19-associated cytokine storm syndrome (CSS) whether an intensive course of glucocorticoids with or without tocilizumab accelerates clinical improvement, reduces mortality and prevents invasive mechanical ventilation, in comparison with a historic control group of patients who received supportive care only.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>From 1 April 2020, patients with COVID-19-associated CSS, defined as rapid respiratory deterioration plus at least two out of three biomarkers with important elevations (C-reactive protein >100 mg/L; ferritin >900 µg/L; D-dimer >1500 µg/L), received high-dose intravenous methylprednisolone for 5 consecutive days (250 mg on day 1 followed by 80 mg on days 2-5). If the respiratory condition had not improved sufficiently (in 43%), the interleukin-6 receptor blocker tocilizumab (8 mg/kg body weight, single infusion) was added on or after day 2. Control patients with COVID-19-associated CSS (same definition) were retrospectively sampled from the pool of patients (n=350) admitted between 7 March and 31 March, and matched one to one to treated patients on sex and age. The primary outcome was ≥2 stages of improvement on a 7-item WHO-endorsed scale for trials in patients with severe influenza pneumonia, or discharge from the hospital. Secondary outcomes were hospital mortality and mechanical ventilation.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>At baseline all patients with COVID-19 in the treatment group (n=86) and control group (n=86) had symptoms of CSS and faced acute respiratory failure. Treated patients had 79% higher likelihood on reaching the primary outcome (HR: 1.8; 95% CI 1.2 to 2.7) (7 days earlier), 65% less mortality (HR: 0.35; 95% CI 0.19 to 0.65) and 71% less invasive mechanical ventilation (HR: 0.29; 95% CI 0.14 to 0.65). Treatment effects remained constant in confounding and sensitivity analyses.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>A strategy involving a course of high-dose methylprednisolone, followed by tocilizumab if needed, may accelerate respiratory recovery, lower hospital mortality and reduce the likelihood of invasive mechanical ventilation in COVID-19-associated CSS.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32719045</PMID>
<DateCompleted><Year>2020</Year>
<Month>09</Month>
<Day>08</Day>
</DateCompleted>
<DateRevised><Year>2020</Year>
<Month>10</Month>
<Day>13</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1468-2060</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>79</Volume>
<Issue>9</Issue>
<PubDate><Year>2020</Year>
<Month>09</Month>
</PubDate>
</JournalIssue>
<Title>Annals of the rheumatic diseases</Title>
<ISOAbbreviation>Ann Rheum Dis</ISOAbbreviation>
</Journal>
<ArticleTitle>Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study.</ArticleTitle>
<Pagination><MedlinePgn>1143-1151</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1136/annrheumdis-2020-218479</ELocationID>
<Abstract><AbstractText Label="OBJECTIVES">To prospectively investigate in patients with severe COVID-19-associated cytokine storm syndrome (CSS) whether an intensive course of glucocorticoids with or without tocilizumab accelerates clinical improvement, reduces mortality and prevents invasive mechanical ventilation, in comparison with a historic control group of patients who received supportive care only.</AbstractText>
<AbstractText Label="METHODS">From 1 April 2020, patients with COVID-19-associated CSS, defined as rapid respiratory deterioration plus at least two out of three biomarkers with important elevations (C-reactive protein >100 mg/L; ferritin >900 µg/L; D-dimer >1500 µg/L), received high-dose intravenous methylprednisolone for 5 consecutive days (250 mg on day 1 followed by 80 mg on days 2-5). If the respiratory condition had not improved sufficiently (in 43%), the interleukin-6 receptor blocker tocilizumab (8 mg/kg body weight, single infusion) was added on or after day 2. Control patients with COVID-19-associated CSS (same definition) were retrospectively sampled from the pool of patients (n=350) admitted between 7 March and 31 March, and matched one to one to treated patients on sex and age. The primary outcome was ≥2 stages of improvement on a 7-item WHO-endorsed scale for trials in patients with severe influenza pneumonia, or discharge from the hospital. Secondary outcomes were hospital mortality and mechanical ventilation.</AbstractText>
<AbstractText Label="RESULTS">At baseline all patients with COVID-19 in the treatment group (n=86) and control group (n=86) had symptoms of CSS and faced acute respiratory failure. Treated patients had 79% higher likelihood on reaching the primary outcome (HR: 1.8; 95% CI 1.2 to 2.7) (7 days earlier), 65% less mortality (HR: 0.35; 95% CI 0.19 to 0.65) and 71% less invasive mechanical ventilation (HR: 0.29; 95% CI 0.14 to 0.65). Treatment effects remained constant in confounding and sensitivity analyses.</AbstractText>
<AbstractText Label="CONCLUSIONS">A strategy involving a course of high-dose methylprednisolone, followed by tocilizumab if needed, may accelerate respiratory recovery, lower hospital mortality and reduce the likelihood of invasive mechanical ventilation in COVID-19-associated CSS.</AbstractText>
<CopyrightInformation>© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ramiro</LastName>
<ForeName>Sofia</ForeName>
<Initials>S</Initials>
<Identifier Source="ORCID">0000-0002-8899-9087</Identifier>
<AffiliationInfo><Affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands sofiaramiro@gmail.com.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Mostard</LastName>
<ForeName>Rémy L M</ForeName>
<Initials>RLM</Initials>
<AffiliationInfo><Affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Magro-Checa</LastName>
<ForeName>César</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>van Dongen</LastName>
<ForeName>Christel M P</ForeName>
<Initials>CMP</Initials>
<AffiliationInfo><Affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Dormans</LastName>
<ForeName>Tom</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Buijs</LastName>
<ForeName>Jacqueline</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Department of Internal Medicine, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gronenschild</LastName>
<ForeName>Michiel</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>de Kruif</LastName>
<ForeName>Martijn D</ForeName>
<Initials>MD</Initials>
<AffiliationInfo><Affiliation>Department of Pulmonology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>van Haren</LastName>
<ForeName>Eric H J</ForeName>
<Initials>EHJ</Initials>
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<Initials>T</Initials>
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<ForeName>Mathie P G</ForeName>
<Initials>MPG</Initials>
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</AffiliationInfo>
</Author>
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<ForeName>Dennis R</ForeName>
<Initials>DR</Initials>
<AffiliationInfo><Affiliation>Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
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<AffiliationInfo><Affiliation>Rheumatology, Zuyderland Medical Center, Heerlen, Limburg, The Netherlands.</Affiliation>
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<AffiliationInfo><Affiliation>Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.</Affiliation>
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<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>07</Month>
<Day>20</Day>
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<MedlineJournalInfo><Country>England</Country>
<MedlineTA>Ann Rheum Dis</MedlineTA>
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<CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Ann Rheum Dis. 2020 Sep;79(9):1129-1131</RefSource>
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<QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName>
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<CoiStatement>Competing interests: SR reports personal fees from AbbVie, personal fees from Eli Lilly, grants and personal fees from MSD, personal fees from Novartis, personal fees from UCB, personal fees from Sanofi, outside the submitted work. RLMM reports personal fees from Boehringer Ingelheim, personal fees from Roche, personal fees from Galapagos, outside the submitted work. CMC is a clinical trial investigator for a study sponsored by Lilly and was a subinvestigator for a study sponsored by GSK. CvD reports personal fees from Novartis, personal fees from Roche, outside the submitted work. TD reports grants from Adrenomed, grants from Inotrem, grants from Roche, grants from Shionogi and Co, other from CASTOR, outside the submitted work. MG reports personal fees from Roche, personal fees from MSD, outside the submitted work. MdK reports personal fees from ALK, personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Sanofi Genzyme, outside the submitted work. ML reports grants from AstraZeneca, grants from Pfizer, personal fees from Roche, outside the submitted work. RP reports grants and personal fees from Pfizer, grants and personal fees from AbbVie, outside the submitted work. RL reports personal fees from AbbVie, personal fees from BMS, personal fees from Galapagos, personal fees from Gilead, personal fees from Jansen, personal fees from Novartis, personal fees from Pfizer, personal fees from Roche, personal fees from UCB, outside the submitted work; and owner and director of Rheumatology Consultancy, a company that provides consultancy and read services for clinical trials.</CoiStatement>
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