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1. Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement

Author

Hellings, P. W., Pugin, B., Mariën, G., Bachert, C., Breynaert, C., Bullens, D. M., Ceuppens, J. L., Clement, G., Cox, T., Ebo, D., Gevaert, P., Halewyck, S., Hox, V., Ladha, K., Jacobs, R., Rombaux, P., Schrijvers, R., Speleman, K., Van der Brempt, X., Van Gerven, L., Vanderveken, O., Verhaeghe, B., Vierstraete, K., Vlaminck, S., Watelet, J. -B., Bousquet, J., and Seys, S. F.

Published
2019
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4. Towards inclusive service delivery through social investment in the Netherlands. An analysis of five sectors, with particular focus on housing service

Author

Haffner, M., Elsinga, M., Mariën, G., Perini, A., Murphy, M., Ünver, Ö., and Meskoub, M.

Subjects
capabilities, social investment, human rights, housing services, social policy
Abstract

The Dutch recessions of 2009, 2012 and 2013 kicked off a series of spending cuts, which were, among others, achieved by reforms of the social security system, as well as the long-term health care system. The Nether­lands placed an increasing emphasis on incentives for people to find employment, whilst access to care facilities was made more difficult, in part by making access require­ments more stringent or making access more expensive. As a result, both the number of social assistance benefit recipients and the numbers of citizens having difficulties with making ends meet rose. This RE-InVEST Work Package 6 country report analyses existing market regulations in the Netherlands reflecting social (dis)investment in relation to human rights and capabilities in five basic service sectors using two approaches. The first ‑ a macro ‑ approach articulates how the recent reforms in four service sector (early childhood education and care, health care, financial services and drinking water services) impacted on the Dutch population. The analyses are mostly based on a literature study, which was kicked off by our RE-InVEST sector experts and completed by the authors of this report. The approach involved analysing the experiences of seven of Rotterdam's residents, most of whom found themselves in a financially vulnerable position at the start of this project in the fourth quarter of 2015. For this report, they shared their experiences in the spring of 2017 in two group sessions. In the second group session employees from social landlords and the municipality, as well as members of a political party joined in the discussion. As framework of analysis, this participative study draws on the concept of capabilities which refer to the opportunities or freedom of persons to opt for certain beings or doings defining a person’s well-being (Sen, 1999). The latter will be influenced by available resources and skills and prevailing norms and institutions, including human rights, which embody the universal values for well-being and a good life. In terms of take up, affordability, and quality of services, this study shows that the Netherlands scores relatively well on average for the four service sectors (early childhood education and care, health care, financial services and drinking water services). However, averages imply that some citizens are worse off: lower-income households are often relatively worse off than higher-income households. Of the service sectors discussed here, perhaps only in the case of a basic transaction banking account, this statement may not be valid. Furthermore, a number of services, such as debt management and special early childhood education are targeted on house­holds in financial problems or with children with a language disadvantage, respectively. Others, such as affordable health and childcare services offer special provisions for households with a lower income, while again others, such as access to drinking water are not facilitated for households with a lower income. As underlyer to any public services, the Netherlands operates an income support safety net system, which represents a strong traditional welfare principle. Nevertheless, in practice the safety net may not suffice for certain households. They may then be excluded from society (for example, when households are discon­nected from water services). Major reforms and cuts in a number of service sectors in the last decade have aggravated differences between income groups and/or have initiated or strengthened social economic inequalities in the access to services, such as in the cases of ECEC and health care. These reforms, which in line with a ‘modern’ neoliberal ideology involved privatisation and (regulated) competition between suppliers, as well as austerity aiming for improving efficiency by controlling costs, will hardly have produced any social investment. In RE-InVEST terms social investment initiates the sustainable enhancement of capabilities. Furthermore, social investment is a policy that the Netherlands has not made explicit, despite the move towards a participation society. For example, the austerity measures in long-term health care and ECEC are speculated to create a need for more informal care, while the female’s position on the labour market is already at a disadvantage. Making explicit what social investment is to be about in the Netherlands, what the participation society is to achieve, and how the interrelations are formulated between classic welfare intervention and these con­cepts, is more than welcome. Such a policy formulation is needed to shed light on the policy aims in terms of when universal and/or selective basic or social rights are at stake in relation to how the capabilities of individuals are affected. Such a formulation will also need to provide extra protection for those vulnerable households that are ‘surviving’ rather than able to pursue their well-being. As with the other four types of service, investment in the home (housing services) can be considered a social investment, because of its social role in delivering benefits to society (health and social inclusion, etc.). An extension of an individual’s capability set aiming to secure a roof over one’s head may be instrumental in freeing energy to be spent on other areas of well-being and in creating freedom of choice in these areas. The question for this report then was whether recent housing policies reflect any social disinvestment in relation to enhancing ‘housing’ capabilities. Deprivation was analysed as a multi-dimensional phenomenon in terms of three anthropological roles: the judge, the receiver and the doer. As the participants in this project, who had difficulties making ends meet, mostly lived in a social rental dwelling with a right to housing allowances, they generally expressed that as a receiver of assistance they worried about the future. They worried about the impact of the total of all austerity measures, also outside the field of housing, while income had been stagnating as a result of austerity measures, limiting their free­dom of choice. In housing, the accompanying trend, which was observed to have started before the crisis, was a move towards marketisation (more market-conforming rent, sale of affordable housing) and more targeting of aid. When the economy picked up, the effects of gentrification were impacting the housing choices of the lower- and middle-income households in Rotterdam, the participants observed: housing policies had shifted towards a weakening of the traditional universal implementation of the right to housing, thereby impeding their freedom to choose. One of the participants stated it as follows: ‘Housing has become a luxury, hasn’t it, particularly to live in the city’. The extent to which the value judgements of the participants as judge were taken into account in local policies was much more of grey area than the ability to voice an opinion. The realisation of a true participative society can therefore still be considered weak. As a doer the participants generated many ideas on how to compensate for some loss in freedom to choose: how to access affordable housing and how to lower housing costs. However, for many of the ideas, acting together, the participants considered key for success: either voluntarily with like-minded individuals/ households in formal stings like a tenant client board, or informal settings, such as in a poverty network, or in more dependent relations with social organisations (social landlords) or local government assistance. (Local) Government as well as social landlords would also still be able to contribute to increasing the capa­bility set of households in need, was a conclusion that all participants supported: co-operate with the tenant to strengthen their capability for voice was one of the appeals made. Developments on the Dutch housing market have left relatively untouched the position of sitting tenants and owner-occupiers. They are (still) relatively protected by long-term rental and mortgage contracts, as well as financial aid in terms of housing allowances and subsidies for owner occupation, respectively, on the one hand. On the other hand, outsiders increasingly can no longer move into central urban areas because of a lack of affordable and adequate housing. In this study, the gap has been shown to be re-enforced by the shift in Dutch ‘housing’ society from cohesion to anonymity. Those with any type of success in alternatives (doing, receiving evaluating) stand stronger than those without. The question whether the social right to decent housing will continue to be adequately served in the longer term welcomes an affirmative answer.

Published
2017

8. De positie van flexwerkers en ZZP-ers op de woningmarkt

Author

Dol, C.P. (author), Boumeester, H.J.F.M. (author), Mariën, G. (author), Dol, C.P. (author), Boumeester, H.J.F.M. (author), and Mariën, G. (author)

Abstract

OTB, Architecture and The Built Environment

Published
2014

9. Antinuclear antibodies directed against proliferating cell nuclear antigen are not specifically associated with systemic lupus erythematosus.

Author

UCL - MD/MINT - Département de médecine interne, UCL - (SLuc) Service de rhumatologie, Vermeersch, P., De Beeck, K Op, Lauwerys, Bernard, Van den Bergh, K, Develter, M, Mariën, G, Houssiau, Frédéric, Bossuyt, X, UCL - MD/MINT - Département de médecine interne, UCL - (SLuc) Service de rhumatologie, Vermeersch, P., De Beeck, K Op, Lauwerys, Bernard, Van den Bergh, K, Develter, M, Mariën, G, Houssiau, Frédéric, and Bossuyt, X

Published
2009

14. Clinical spectrum associated with positive ANCA titres in 94 consecutive patients: is there a relation with PR-3 negative c-ANCA and hypergammaglobulinaemia?

Author

Blockmans, D., Stevens, E., Marien, G., Bobbaers, H., and Mariën, G

Subjects
CYTOPLASM, NEUTROPHILS, IMMUNOGLOBULINS
Abstract

Objective: To calculate the positive predictive value (ppv) of cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCAs) and anti-proteinase 3 (PR 3) antibodies for Wegener's granulomatosis (WG) and to evaluate their association with other diseases.Methods: The clinical files of all 94 patients who had a positive c- or perinuclear (p)-ANCA test, or both, in the laboratory of the University Hospital, Leuven between April 1995 and March 1996 and who attended the Internal Medicine Department of the hospital were retrospectively studied.Results: Of the 94 patients with ANCAs (fluorescence titre > or = 1/40), 57 were c-ANCA positive and 45 p-ANCA positive (eight were simultaneously c- and p-ANCA positive). Of the 57 c-ANCA positive patients, 23 had WG. The ppv for WG thus was 40%. This value did not increase by defining a higher threshold for a positive ANCA. There was not a good relation between ANCA titres and disease activity in the WG patients, nor was there a relation between anti-PR 3 antibody levels and WG disease activity. The ppv of anti-PR 3 antibodies for WG however was very high (85%). There was a positive correlation between the level of (hyper) gammaglobulinaemia and c-ANCA titres in those patients with final diagnoses not known to be associated with c-ANCA. Forty five patients had positive p-ANCAs. The largest group were those with inflammatory bowel disease (n = 20, of whom the majority had colitis ulcerosa or primary sclerosing cholangitis, or both); the great majority of these patients had no anti-myeloperoxidase antibodies. Vasculitis was present in eight patients, of whom two had WG (both were also c-ANCA positive).Conclusion: There is a low ppv of c-ANCAs for WG, caused by a high percentage of PR 3 negative, positive c-ANCA determinations, possibly related to hypergammaglobulinaemia. Anti-PR 3 antibodies have a high ppv for WG. However, neither c-ANCA titre, nor the level of anti-PR 3 antibodies correlated with the activity of the disease. [ABSTRACT FROM AUTHOR]

Published
1998
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16. Towards inclusive service delivery through social investment in the Netherlands. An analysis of five sectors, with particular focus on housing service

Author

Haffner, M., Elsinga, M., Mariën, G., Perini, A., Murphy, M., Ünver, Ö., and Meskoub, M.

Subjects
8. Economic growth, 1. No poverty, capabilities, social investment, 10. No inequality, human rights, housing services, social policy
Abstract

The Dutch recessions of 2009, 2012 and 2013 kicked off a series of spending cuts, which were, among others, achieved by reforms of the social security system, as well as the long-term health care system. The Nether­lands placed an increasing emphasis on incentives for people to find employment, whilst access to care facilities was made more difficult, in part by making access require­ments more stringent or making access more expensive. As a result, both the number of social assistance benefit recipients and the numbers of citizens having difficulties with making ends meet rose. This RE-InVEST Work Package6 country report analyses existing market regulations in the Netherlands reflecting social (dis)investment in relation to human rights and capabilities in five basic service sectors using two approaches. The first ‑a macro‑ approach articulates how the recent reforms in four service sector (early childhood education and care, health care, financial services and drinking water services) impacted on the Dutch population. The analyses are mostly based on a literature study, which was kicked off by our RE-InVEST sector experts and completed by the authors of this report. The approach involved analysing the experiences of seven of Rotterdam's residents, most of whom found themselves in a financially vulnerable position at the start of this project in the fourth quarter of 2015. For this report, they shared their experiences in the spring of 2017 in two group sessions. In the second group session employees from social landlords and the municipality, as well as members of a political party joined in the discussion. As framework of analysis, this participative study draws on the concept of capabilities which refer to the opportunities or freedom of persons to opt for certain beings or doings defining a person’s well-being (Sen, 1999). The latter will be influenced by available resources and skills and prevailing norms and institutions, including human rights, which embody the universal values for well-being and a good life. In terms of take up, affordability, and quality of services, this study shows that the Netherlands scores relatively well on average for the four service sectors (early childhood education and care, health care, financial services and drinking water services). However, averages imply that some citizens are worse off: lower-income households are often relatively worse off than higher-income households. Of the service sectors discussed here, perhaps only in the case of a basic transaction banking account, this statement may not be valid. Furthermore, a number of services, such as debt management and special early childhood education are targeted on house­holds in financial problems or with children with a language disadvantage, respectively. Others, such as affordable health and childcare services offer special provisions for households with a lower income, while again others, such as access to drinking water are not facilitated for households with a lower income. As underlyer to any public services, the Netherlands operates an income support safety net system, which represents a strong traditional welfare principle. Nevertheless, in practice the safety net may not suffice for certain households. They may then be excluded from society (for example, when households are discon­nected from water services). Major reforms and cuts in a number of service sectors in the last decade have aggravated differences between income groups and/or have initiated or strengthened social economic inequalities in the access to services, such as in the cases of ECEC and health care. These reforms, which in line with a ‘modern’ neoliberal ideology involved privatisation and (regulated) competition between suppliers, as well as austerity aiming for improving efficiency by controlling costs, will hardly have produced any social investment. In RE-InVEST terms social investment initiates the sustainable enhancement of capabilities. Furthermore, social investment is a policy that the Netherlands has not made explicit, despite the move towards a participation society. For example, the austerity measures in long-term health care and ECEC are speculated to create a need for more informal care, while the female’s position on the labour market is already at a disadvantage. Making explicit what social investment is to be about in the Netherlands, what the participation society is to achieve, and how the interrelations are formulated between classic welfare intervention and these con­cepts, is more than welcome. Such a policy formulation is needed to shed light on the policy aims in terms of when universal and/or selective basic or social rights are at stake in relation to how the capabilities of individuals are affected. Such a formulation will also need to provide extra protection for those vulnerable households that are ‘surviving’ rather than able to pursue their well-being. As with the other four types of service, investment in the home (housing services) can be considered a social investment, because of its social role in delivering benefits to society (health and social inclusion, etc.). An extension of an individual’s capability set aiming to secure a roof over one’s head may be instrumental in freeing energy to be spent on other areas of well-being and in creating freedom of choice in these areas. The question for this report then was whether recent housing policies reflect any social disinvestment in relation to enhancing ‘housing’ capabilities. Deprivation was analysed as a multi-dimensional phenomenon in terms of three anthropological roles: the judge, the receiver and the doer. As the participants in this project, who had difficulties making ends meet, mostly lived in a social rental dwelling with a right to housing allowances, they generally expressed that as a receiver of assistance they worried about the future. They worried about the impact of the total of all austerity measures, also outside the field of housing, while income had been stagnating as a result of austerity measures, limiting their free­dom of choice. In housing, the accompanying trend, which was observed to have started before the crisis, was a move towards marketisation (more market-conforming rent, sale of affordable housing) and more targeting of aid. When the economy picked up, the effects of gentrification were impacting the housing choices of the lower- and middle-income households in Rotterdam, the participants observed: housing policies had shifted towards a weakening of the traditional universal implementation of the right to housing, thereby impeding their freedom to choose. One of the participants stated it as follows: ‘Housing has become a luxury, hasn’t it, particularly to live in the city’. The extent to which the value judgements of the participants as judge were taken into account in local policies was much more of grey area than the ability to voice an opinion. The realisation of a true participative society can therefore still be considered weak. As a doer the participants generated many ideas on how to compensate for some loss in freedom to choose: how to access affordable housing and how to lower housing costs. However, for many of the ideas, acting together, the participants considered key for success: either voluntarily with like-minded individuals/ households in formal stings like a tenant client board, or informal settings, such as in a poverty network, or in more dependent relations with social organisations (social landlords) or local government assistance. (Local) Government as well as social landlords would also still be able to contribute to increasing the capa­bility set of households in need, was a conclusion that all participants supported: co-operate with the tenant to strengthen their capability for voice was one of the appeals made. Developments on the Dutch housing market have left relatively untouched the position of sitting tenants and owner-occupiers. They are (still) relatively protected by long-term rental and mortgage contracts, as well as financial aid in terms of housing allowances and subsidies for owner occupation, respectively, on the one hand. On the other hand, outsiders increasingly can no longer move into central urban areas because of a lack of affordable and adequate housing. In this study, the gap has been shown to be re-enforced by the shift in Dutch ‘housing’ society from cohesion to anonymity. Those with any type of success in alternatives (doing, receiving evaluating) stand stronger than those without. The question whether the social right to decent housing will continue to be adequately served in the longer term welcomes an affirmative answer.

17. Towards inclusive service delivery through social investment in the Netherlands. An analysis of five sectors, with particular focus on housing service

Author

Haffner, M., Elsinga, M., Mariën, G., Perini, A., Murphy, M., Ünver, Ö., and Meskoub, M.

Subjects
8. Economic growth, 1. No poverty, capabilities, social investment, 10. No inequality, human rights, housing services, social policy
Abstract

The Dutch recessions of 2009, 2012 and 2013 kicked off a series of spending cuts, which were, among others, achieved by reforms of the social security system, as well as the long-term health care system. The Nether­lands placed an increasing emphasis on incentives for people to find employment, whilst access to care facilities was made more difficult, in part by making access require­ments more stringent or making access more expensive. As a result, both the number of social assistance benefit recipients and the numbers of citizens having difficulties with making ends meet rose. This RE-InVEST Work Package 6 country report analyses existing market regulations in the Netherlands reflecting social (dis)investment in relation to human rights and capabilities in five basic service sectors using two approaches. The first ‑ a macro ‑ approach articulates how the recent reforms in four service sector (early childhood education and care, health care, financial services and drinking water services) impacted on the Dutch population. The analyses are mostly based on a literature study, which was kicked off by our RE-InVEST sector experts and completed by the authors of this report. The approach involved analysing the experiences of seven of Rotterdam's residents, most of whom found themselves in a financially vulnerable position at the start of this project in the fourth quarter of 2015. For this report, they shared their experiences in the spring of 2017 in two group sessions. In the second group session employees from social landlords and the municipality, as well as members of a political party joined in the discussion. As framework of analysis, this participative study draws on the concept of capabilities which refer to the opportunities or freedom of persons to opt for certain beings or doings defining a person’s well-being (Sen, 1999). The latter will be influenced by available resources and skills and prevailing norms and institutions, including human rights, which embody the universal values for well-being and a good life. In terms of take up, affordability, and quality of services, this study shows that the Netherlands scores relatively well on average for the four service sectors (early childhood education and care, health care, financial services and drinking water services). However, averages imply that some citizens are worse off: lower-income households are often relatively worse off than higher-income households. Of the service sectors discussed here, perhaps only in the case of a basic transaction banking account, this statement may not be valid. Furthermore, a number of services, such as debt management and special early childhood education are targeted on house­holds in financial problems or with children with a language disadvantage, respectively. Others, such as affordable health and childcare services offer special provisions for households with a lower income, while again others, such as access to drinking water are not facilitated for households with a lower income. As underlyer to any public services, the Netherlands operates an income support safety net system, which represents a strong traditional welfare principle. Nevertheless, in practice the safety net may not suffice for certain households. They may then be excluded from society (for example, when households are discon­nected from water services). Major reforms and cuts in a number of service sectors in the last decade have aggravated differences between income groups and/or have initiated or strengthened social economic inequalities in the access to services, such as in the cases of ECEC and health care. These reforms, which in line with a ‘modern’ neoliberal ideology involved privatisation and (regulated) competition between suppliers, as well as austerity aiming for improving efficiency by controlling costs, will hardly have produced any social investment. In RE-InVEST terms social investment initiates the sustainable enhancement of capabilities. Furthermore, social investment is a policy that the Netherlands has not made explicit, despite the move towards a participation society. For example, the austerity measures in long-term health care and ECEC are speculated to create a need for more informal care, while the female’s position on the labour market is already at a disadvantage. Making explicit what social investment is to be about in the Netherlands, what the participation society is to achieve, and how the interrelations are formulated between classic welfare intervention and these con­cepts, is more than welcome. Such a policy formulation is needed to shed light on the policy aims in terms of when universal and/or selective basic or social rights are at stake in relation to how the capabilities of individuals are affected. Such a formulation will also need to provide extra protection for those vulnerable households that are ‘surviving’ rather than able to pursue their well-being. As with the other four types of service, investment in the home (housing services) can be considered a social investment, because of its social role in delivering benefits to society (health and social inclusion, etc.). An extension of an individual’s capability set aiming to secure a roof over one’s head may be instrumental in freeing energy to be spent on other areas of well-being and in creating freedom of choice in these areas. The question for this report then was whether recent housing policies reflect any social disinvestment in relation to enhancing ‘housing’ capabilities. Deprivation was analysed as a multi-dimensional phenomenon in terms of three anthropological roles: the judge, the receiver and the doer. As the participants in this project, who had difficulties making ends meet, mostly lived in a social rental dwelling with a right to housing allowances, they generally expressed that as a receiver of assistance they worried about the future. They worried about the impact of the total of all austerity measures, also outside the field of housing, while income had been stagnating as a result of austerity measures, limiting their free­dom of choice. In housing, the accompanying trend, which was observed to have started before the crisis, was a move towards marketisation (more market-conforming rent, sale of affordable housing) and more targeting of aid. When the economy picked up, the effects of gentrification were impacting the housing choices of the lower- and middle-income households in Rotterdam, the participants observed: housing policies had shifted towards a weakening of the traditional universal implementation of the right to housing, thereby impeding their freedom to choose. One of the participants stated it as follows: ‘Housing has become a luxury, hasn’t it, particularly to live in the city’. The extent to which the value judgements of the participants as judge were taken into account in local policies was much more of grey area than the ability to voice an opinion. The realisation of a true participative society can therefore still be considered weak. As a doer the participants generated many ideas on how to compensate for some loss in freedom to choose: how to access affordable housing and how to lower housing costs. However, for many of the ideas, acting together, the participants considered key for success: either voluntarily with like-minded individuals/ households in formal stings like a tenant client board, or informal settings, such as in a poverty network, or in more dependent relations with social organisations (social landlords) or local government assistance. (Local) Government as well as social landlords would also still be able to contribute to increasing the capa­bility set of households in need, was a conclusion that all participants supported: co-operate with the tenant to strengthen their capability for voice was one of the appeals made. Developments on the Dutch housing market have left relatively untouched the position of sitting tenants and owner-occupiers. They are (still) relatively protected by long-term rental and mortgage contracts, as well as financial aid in terms of housing allowances and subsidies for owner occupation, respectively, on the one hand. On the other hand, outsiders increasingly can no longer move into central urban areas because of a lack of affordable and adequate housing. In this study, the gap has been shown to be re-enforced by the shift in Dutch ‘housing’ society from cohesion to anonymity. Those with any type of success in alternatives (doing, receiving evaluating) stand stronger than those without. The question whether the social right to decent housing will continue to be adequately served in the longer term welcomes an affirmative answer.

18. Real-world effectiveness of dupilumab in a European cohort of CRSwNP (CHRINOSOR).

Author

Seys SF, Schneider S, de Kinderen J, Reitsma S, Cavaliere C, Tomazic PV, Morgenstern C, Mortuaire G, Wagenmann M, Bettio G, Ciofalo A, Diamant Z, Eckl-Dorna J, Fokkens WJ, Holzmeister C, Mariën G, Masieri S, Otten J, Scheckenbach K, Tu A, and Bachert C

Abstract

Background: Pivotal studies with dupilumab demonstrated clinically relevant improvements in nasal polyp score (NPS), symptom and quality of life scores in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)., Objective: We evaluated the effectiveness of dupilumab in a large-scale CRSwNP cohort from 6 European tertiary care centres., Methodology: NPS, SinoNasal Outcome Test (SNOT)-22 score, visual analogue scale (VAS) for total sinus symptoms, loss of smell (LoS) and nasal blockage (NB), and Asthma Control Test (ACT) score were collected from hospital records and assessed at baseline, 24 and 52 weeks of treatment of dupilumab in CRSwNP patients. Treatment effectiveness was evaluated in relation to demographic and lifestyle factors, sinus surgery history, presence of comorbidities and blood eosinophil counts (BEC). Treatment response was evaluated according to EUFOREA 2021 criteria., Results: All patient outcomes improved at 24 and 52 weeks of treatment compared to baseline. Dupilumab showed effectiveness independent of age, sex, body mass index, smoking status, prior sinus surgery, presence of asthma, NSAID exacerbated respiratory disease (NERD), allergy or baseline BEC. 92.5% and 94.4% showed an improvement in at least 1 EUFOREA criterion at 24 and 52 weeks respectively. 54.4% and 68.2% reached all 4 of the more stringent EUFOREA criteria at 24 and 52 weeks respectively., Conclusions: Real-world evaluation of dupilumab effectiveness demonstrates a robust and sustained response in at least two thirds of patients at 52 weeks of treatment. Favourable treatment response was independent of the number of sinus surgery procedures, major comorbidities or baseline systemic levels of type 2 inflammation., (Copyright © 2024. Published by Elsevier Inc.)

Published
2024
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19. Chronic Rhinosinusitis Outcome Registry (CHRINOSOR): Establishment of an International Outcome Registry Driven by mHealth Technology.

Author

Seys SF, Hellings PW, Alobid I, Backer V, Bequignon E, von Buchwald C, Cavaliere C, Coste A, Deneyer L, Diamant Z, Eckl-Dorna J, Fokkens WJ, Gane S, Gevaert P, Holbaek-Haase C, Holzmeister C, Hopkins C, Hox V, Huart C, Jankowski R, Jorissen M, Kjeldsen A, Knipps L, Lange B, van der Lans R, Laulajainen-Hongisto A, Larsen K, Liu DT, Lund V, Mariën G, Masieri S, Mortuaire G, Mullol J, Reitsma S, Rombaux P, Schneider S, Steinsvik A, Tomazic PV, Toppila-Salmi SK, Van Gerven L, Van Zele T, Virkkula P, Wagenmann M, and Bachert C

Subjects
Adult, Humans, Adrenal Cortex Hormones therapeutic use, Chronic Disease, Nasal Polyps drug therapy, Rhinitis therapy, Rhinitis drug therapy, Sinusitis therapy, Sinusitis drug therapy
Abstract

Background: Real-world evidence (RWE) is a valuable instrument to better understand the patient journey and effectiveness of therapies. RWE on the prevalence of uncontrolled chronic rhinosinusitis (CRS) and CRS natural course of disease across Europe is scarce. In addition, there is limited RWE that enables comparison of the effectiveness of marketed therapies including topical or systemic corticosteroids, sinus surgery, or biologics., Objective: To establish an international CHRonic rhINOSinusitis Outcome Registry (CHRINOSOR) based on real-world data collection enabled by mobile health technology., Methodology: A digital platform, Galenus Health, supporting patients and physicians in the management of chronic respiratory diseases, is used to collect data on patient profile, disease history, patient outcomes, and a set of relevant clinical outcomes. Adult patients with a diagnosis of CRS are eligible for inclusion., Results: A collaborative scientific network of 17 university ear-nose-throat (ENT) clinics from 10 European countries has been established with the aim to collect real-world data in a longitudinal and standardized manner. The Galenus Health digital platform is currently being implemented in these ENT clinics taking into account legal, privacy, and data security aspects. Up to 300 patients have already been included., Conclusions: CHRINOSOR is a collaborative effort that aims at improving our understanding of CRS, its comorbidities, and the effectiveness of its treatments. Ultimately, these insights will guide us as scientific community to develop future care pathways informed by RWE., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Published
2023
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20. Real-life assessment of chronic rhinosinusitis patients using mobile technology: The mySinusitisCoach project by EUFOREA.

Author

Seys SF, De Bont S, Fokkens WJ, Bachert C, Alobid I, Bernal-Sprekelsen M, Bjermer L, Callebaut I, Cardell LO, Carrie S, Castelnuovo P, Cathcart R, Constantinidis J, Cools L, Cornet M, Clement G, Cox T, Delsupehe L, Correia-de-Sousa J, Deneyer L, De Vos G, Diamant Z, Doulaptsi M, Gane S, Gevaert P, Hopkins C, Hox V, Hummel T, Hosemann W, Jacobs R, Jorissen M, Kjeldsen A, Landis BN, Lemmens W, Leunig A, Lund V, Mariën G, Mullol J, Onerci M, Palkonen S, Proano I, Prokopakis E, Ryan D, Riechelmann H, Sahlstrand-Johnson P, Salmi-Toppila S, Segboer C, Speleman K, Steinsvik A, Surda P, Tomazic PV, Vanderveken O, Van Gerven L, Van Zele T, Verfaillie J, Verhaeghe B, Vierstraete K, Vlaminck S, Wagenmann M, Pugin B, and Hellings PW

Subjects
Chronic Disease, Cross-Sectional Studies, Humans, Quality of Life, Nasal Polyps epidemiology, Rhinitis diagnosis, Rhinitis epidemiology, Sinusitis diagnosis, Sinusitis epidemiology
Abstract

Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS., Methods: This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria., Results: The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell., Conclusion: Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine., (© 2020 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Published
2020
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21. EUFOREA consensus on biologics for CRSwNP with or without asthma.

Author

Fokkens WJ, Lund V, Bachert C, Mullol J, Bjermer L, Bousquet J, Canonica GW, Deneyer L, Desrosiers M, Diamant Z, Han J, Heffler E, Hopkins C, Jankowski R, Joos G, Knill A, Lee J, Lee SE, Mariën G, Pugin B, Senior B, Seys SF, and Hellings PW

Subjects
Biological Products administration & dosage, Biological Products adverse effects, Chronic Disease, Clinical Decision-Making, Comorbidity, Disease Management, Health Services Needs and Demand, Humans, Research, Treatment Outcome, Asthma complications, Biological Products therapeutic use, Nasal Polyps complications, Rhinitis complications, Rhinitis drug therapy, Sinusitis complications, Sinusitis drug therapy
Abstract

Novel therapies such as type 2 targeting biologics are emerging treatment options for patients with chronic inflammatory respiratory diseases, fulfilling the needs of severely uncontrolled patients. The majority of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and over half of patients with asthma show a type 2 inflammatory signature in sinonasal mucosa and/or lungs. Importantly, both chronic respiratory diseases are frequent comorbidities, ensuring alleviation of both upper and lower airway pathology by systemic biological therapy. Type 2-targeting biologics such as anti-IgE, anti-IL4Rα, anti-IL5, and anti-IL5Rα have entered the market for selected pheno/endotypes of asthma patients and may soon also become available for CRSwNP patients. Given the high prevalence of chronic respiratory diseases and the high cost associated with biologics, patient selection is crucial in order to implement such therapies into chronic respiratory disease care pathways. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) organized a multidisciplinary Expert Board Meeting to discuss the positioning of biologics into the care pathways for CRSwNP patients with and without comorbid asthma., (© 2019 The Authors Allergy Published by John Wiley & Sons Ltd.)

Published
2019
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22. Value-added reporting of antinuclear antibody testing by automated indirect immunofluorescence analysis.

Author

Schouwers S, Bonnet M, Verschueren P, Westhovens R, Blockmans D, Mariën G, and Bossuyt X

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Autoimmune Diseases immunology, Female, Humans, Male, Middle Aged, Young Adult, Antibodies, Antinuclear blood, Antibodies, Antinuclear immunology, Autoimmune Diseases blood, Autoimmune Diseases diagnosis, Fluorescent Antibody Technique, Indirect
Abstract

Background: Automated systems for antinuclear antibody analysis are being introduced. The aim was to evaluate whether automated quantitative reading of fluorescence intensity is clinically relevant and allows for value-added reporting of test results., Methods: Consecutive samples (n=260) were used to correlate fluorescence intensity with end-point titer. Moreover, 434 samples from controls (150 healthy blood donors, 150 chronic fatigue syndrome, and 134 diseased controls) and 252 samples (obtained at diagnosis) from patients with systemic rheumatic diseases were screened for antinuclear antibodies (1:80) on HEp-2 cells using NOVA View, and likelihood ratios were calculated for fluorescence intensity result intervals., Results: There was a significant correlation between end-point titer and fluorescence intensity. Likelihood ratios for a systemic rheumatic disease increased with increasing fluorescence intensity. The likelihood ratio for a systemic rheumatic disease was 0.06, 0.18, 0.51, 5.3, and 37.5 for a fluorescence intensity of ≤66, 67-150, 151-300, 301-1000, >1000, respectively. A range of 31%-37% of the patients with Sjögren's syndrome, systemic sclerosis or systemic lupus erythematosus had fluorescence intensities >1000., Conclusions: Estimation of fluorescence intensity by automated antinuclear antibody analysis offers clinically useful information. Likelihood ratios based on fluorescence intensity test result intervals aid with the interpretation of automated antinuclear antibody analysis and allow value-added reporting.

Published
2014
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23. Defining thresholds of antibody levels improves diagnosis of celiac disease.

Author

Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, and Bossuyt X

Subjects
Adolescent, Adult, Child, Child, Preschool, Female, Guidelines as Topic, Humans, Infant, Male, Predictive Value of Tests, Protein Glutamine gamma Glutamyltransferase 2, Celiac Disease diagnosis, GTP-Binding Proteins immunology, Immunoglobulin A blood, Transglutaminases immunology
Abstract

Background & Aims: The European Society for Pediatric Gastroenterology and Nutrition proposed guidelines for the diagnosis of celiac disease, stating that duodenal biopsy is no longer needed if patients have symptoms and levels of immunoglobulin A anti-tissue transglutaminase (IgA anti-tTG) more than 10-fold the cut-off value. We evaluated the accuracy of this guideline in a well-characterized population using different commercial assays., Methods: We analyzed levels of IgA anti-tTG in serum samples from 104 consecutive pediatric and adult patients who were not deficient in IgA and were diagnosed with celiac disease from August 1, 2000, to December 31, 2009. We also analyzed serum samples from 537 consecutive patients without celiac disease (controls), collected from May 1, 2004, to October 12, 2006, who underwent intestinal biopsy analysis. Serum levels of antibodies were quantified using assays from Bio-Rad, INOVA, Genesis, and Thermo Fisher., Results: The likelihood ratio (probability of a specific result in patients divided by the probability of the same result in controls) for celiac disease increased with levels of IgA anti-tTG in all assays. Depending on the assay, the likelihood ratio for levels greater than 10-fold the cut-off value ranged from 111 to 294. The percentage of patients with celiac disease with levels of IgA anti-tTG greater than 10-fold the cut-off value ranged from 41% to 61%, depending on the assay. For levels of anti-tTG greater than 10-fold the cut-off value, the post-test probabilities for celiac disease (probability of disease, based on pretest probability and test result) were, depending on the assay, 89%-96% and 53%-75% for pretest probabilities (probability of disease depending on symptoms) of 7% and 1%, respectively., Conclusions: To diagnose celiac disease based on serologic factors, it might be best to define thresholds for levels of IgA anti-tTG based on a predefined likelihood ratio or post-test probability, instead of a multiple of a cut-off value. Patients with a high pretest probability and levels of anti-tTG greater than 10-fold the cut-off value have a high probability for having celiac disease, aiding clinical decision making., (Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Published
2013
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24. Detection of antinuclear antibodies by automated indirect immunofluorescence analysis.

Author

Bossuyt X, Cooreman S, De Baere H, Verschueren P, Westhovens R, Blockmans D, and Mariën G

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Biomarkers blood, Case-Control Studies, Child, Child, Preschool, Fatigue Syndrome, Chronic diagnosis, Female, High-Throughput Screening Assays, Humans, Lupus Erythematosus, Systemic diagnosis, Male, Middle Aged, Probability, Reproducibility of Results, Rheumatic Diseases diagnosis, Sensitivity and Specificity, Antibodies, Antinuclear blood, Fatigue Syndrome, Chronic blood, Immunoassay standards, Lupus Erythematosus, Systemic blood, Rheumatic Diseases blood
Abstract

Background: Testing for antinuclear antibodies is useful for the diagnosis of systemic rheumatic diseases. Automated systems for image acquisition and interpretation of indirect immunofluorescence-based tests are increasingly used. The diagnostic performance of such automated approach in untreated patients has not been reported., Methods: Antinuclear antibodies were measured by automated indirect immunofluorescence using Zenit G. Sight on HEp2 and HEp2000 substrate in 268 consecutive samples submitted to the laboratory for antinuclear antibody testing, and in 231 patients with a systemic rheumatic disease at the time of diagnosis, 143 blood donors, 134 patients with chronic fatigue syndrome, and 133 diseased controls., Results: Image acquisition by G-Sight was of high quality. The accuracy of pattern assignment was limited. There was a significant correlation between automated estimation of fluorescence intensity (probability index of positivity) and end-point titer. Probability index interval specific likelihood ratios for systemic rheumatic disease increased with increasing level of positivity probability. With the HEp-2 substrate, the likelihood ratio for systemic lupus erythematosus was 0.06, 0.4, 6.8, 12.1, and 43.9 for a probability measure of positivity of ≤10, 11-≤30, 31-≤50, 51-≤85, and >85, respectively., Conclusion: Quantitative data generated by automated image acquisition facilitates standardized interpretation., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Published
2013
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25. Antinuclear antibody detection by automated multiplex immunoassay in untreated patients at the time of diagnosis.

Author

Op De Beéck K, Vermeersch P, Verschueren P, Westhovens R, Mariën G, Blockmans D, and Bossuyt X

Subjects
Fluorescent Antibody Technique, Indirect instrumentation, Fluorescent Antibody Technique, Indirect standards, Humans, Lupus Erythematosus, Systemic diagnosis, Lupus Erythematosus, Systemic immunology, Sensitivity and Specificity, Antibodies, Antinuclear immunology, Connective Tissue Diseases diagnosis, Connective Tissue Diseases immunology, Fluorescent Antibody Technique, Indirect methods
Abstract

Fully automated multiplex immunoassays are increasingly used as first line screening for antinuclear antibodies. The diagnostic performance of such multiplex assays in untreated patients at the time of diagnosis has not been reported. Antinuclear antibodies were measured by indirect immunofluorescence (IIF) (dilution 1:160) and by BioPlex 2200 ANA screen (antibodies to dsDNA, chromatin, ribosomal protein, SSA-52, SSA-60, SSB, Sm, SmRNP, RNP-A, RNP-68, Scl-70, Jo-1, and centromere B) in 236 patients with a systemic rheumatic disease at the time of diagnosis, 149 blood donors, 139 patients with chronic fatigue syndrome (CFS), and 134 diseased controls. BioPlex ANA screen and IIF were positive in, respectively, 79% and 90% of patients with systemic lupus erythematosus (SLE), 60% and 60% with cutaneous lupus, 72% and 93% with systemic sclerosis (SSc), 100% and 100% with mixed connective tissue disease (MCTD), 89% and 56% with primary Sjögren's (SS) syndrome, 36% and 36% with polymyositis/dermatomyositis, 5.4% and 6% of blood donors, 7.2% and 3.6% of patients with CFS, and 11% and 18% of diseased controls. BioPlex test result interval specific likelihood ratios increased with increasing antibody concentration. The simultaneous presence of at least three antibodies by BioPlex was found in 35% of patients with SLE, 4% with SSc, 100% with MCTD, 64% with SS, 7% with inflammatory myopathy, 0.7% of CFS and diseased controls, and none of the blood donors. In conclusion, test result specific likelihood ratios and the presence of multiple autoantibodies help with the interpretation of data generated by multiplex immunoassays., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Published
2012
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26. Serological diagnosis of celiac disease: comparative analysis of different strategies.

Author

Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, and Bossuyt X

Subjects
Adolescent, Adult, Case-Control Studies, Female, Humans, Likelihood Functions, Male, Protein Glutamine gamma Glutamyltransferase 2, Sensitivity and Specificity, Young Adult, Celiac Disease diagnosis, GTP-Binding Proteins immunology, Gliadin immunology, Serologic Tests methods, Transglutaminases immunology
Abstract

Background: Different serologic tests are available for the diagnosis of celiac disease (CD)., Aim: To evaluate the diagnostic performance of anti-tissue transglutaminase (tTG) and anti-deamidated gliadin (DGP) for the serologic diagnosis of CD., Methods: The study population consisted of 107 consecutive adult CD and 542 consecutive disease controls who underwent an intestinal biopsy. Samples were tested for total IgA, IgA anti-tTG, and IgG anti-DGP antibodies using assays from 2 manufacturers (INOVA and Thermo Fisher). Samples were also tested by a screening assay that simultaneously detects IgA and IgG antibodies to tTG and DGP (tTG/DGP screen) (INOVA)., Results: Positivity for anti-DGP or anti-tTG had a likelihood ratio for CD that varied between 20 and 115, depending on the assay. Double positivity (positive for anti-tTG and anti-DGP) had the highest likelihood ratio (≥ 215) for CD. The likelihood ratios for single positivity (positivity for one assay combined with negativity for the other) had a likelihood ratio between 0.8 and 10.1. The likelihood ratio for CD was lowest (≤ 0.12) for double negative test results. Decision tree analysis revealed that determining IgA anti-tTG and IgG anti-DGP in all patients performed better than other serologic strategies., Conclusions: The use of likelihood ratios improves the clinical interpretation of serologic testing for CD. Double positive test results had the highest likelihood ratio for CD, whereas double negative test results had the lowest likelihood ratio., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Published
2012
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28. Detection of antinuclear antibodies by indirect immunofluorescence and by solid phase assay.

Author

Op De Beeck K, Vermeersch P, Verschueren P, Westhovens R, Mariën G, Blockmans D, and Bossuyt X

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Antigens immunology, Autoimmune Diseases immunology, Connective Tissue Diseases immunology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Young Adult, Antibodies, Antinuclear blood, Autoimmune Diseases diagnosis, Connective Tissue Diseases diagnosis, Fluorescent Antibody Technique, Indirect methods, Immunoenzyme Techniques methods, Reagent Kits, Diagnostic
Abstract

Testing for antinuclear antibodies is useful for the diagnosis of systemic rheumatic diseases. Solid phase assays are increasingly replacing indirect immunofluorescence for detection of antinuclear antibodies. In the most recent generation of solid phase assays, manufacturers attempt to improve the performance of the assays by adding extra antigens. Solid phase assay (EliA CTD Screen, Phadia, in which antibodies to 17 antigens are detected) was compared to indirect immunofluorescence for the detection of antinuclear antibodies in diagnostic samples of 236 patients with autoimmune connective tissue diseases, in 149 healthy blood donors, 139 patients with chronic fatigue syndrome, and 134 diseased controls. The sensitivity of EliA CTD Screen for systemic lupus erythematosus, systemic sclerosis, primary Sjögren's syndrome, mixed connective tissue disease, and inflammatory myopathy was 74%, 72%, 89%, 100%, and 39%, respectively. The reactivity in blood donors, in patients with chronic fatigue syndrome, and in diseased controls was <4%. Likelihood ratios increased with increasing antibody concentrations. Generally, a positive test result by EliA CTD Screen had a higher likelihood ratio for systemic rheumatic disease than a positive test result by indirect immunofluorescence. A negative test result by indirect immunofluorescence, however, had a lower likelihood ratio than a negative test result by EliA CTD Screen, indicating that the negative predictive value was higher for indirect immunofluorescence than for EliA CTD screen., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Published
2011
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29. A transient IgE monoclonal protein in a child.

Author

Bossuyt X, Mariën G, and Uyttebroeck A

Subjects
Busulfan adverse effects, Busulfan therapeutic use, Child, Cyclosporine adverse effects, Cyclosporine therapeutic use, Epstein-Barr Virus Infections immunology, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Vidarabine adverse effects, Vidarabine analogs & derivatives, Vidarabine therapeutic use, Adrenoleukodystrophy surgery, Antibodies, Monoclonal blood, Epstein-Barr Virus Infections diagnosis, Hematopoietic Stem Cell Transplantation adverse effects, Herpesvirus 4, Human, Immunoglobulin E blood, Virus Activation immunology
Published
2011
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30. A 67-year-old woman with a systemic inflammatory syndrome and sicca.

Author

Bossuyt X, Mariën G, and Vanderschueren S

Subjects
Aged, Antibodies, Antinuclear blood, False Negative Reactions, Female, Humans, Magnetic Resonance Imaging, Sjogren's Syndrome complications, Sjogren's Syndrome immunology, Systemic Inflammatory Response Syndrome complications, Systemic Inflammatory Response Syndrome immunology, Sjogren's Syndrome diagnosis, Systemic Inflammatory Response Syndrome diagnosis
Published
2010
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31. Diagnostic performance of IgG anti-deamidated gliadin peptide antibody assays is comparable to IgA anti-tTG in celiac disease.

Author

Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, and Bossuyt X

Subjects
Adolescent, Adult, Biopsy, Case-Control Studies, Celiac Disease blood, Celiac Disease immunology, Celiac Disease pathology, Child, Cohort Studies, Duodenum pathology, Female, Humans, Immunoglobulin A blood, Immunoglobulin A immunology, Immunoglobulin G blood, Linear Models, Male, Protein Glutamine gamma Glutamyltransferase 2, Sensitivity and Specificity, Amides metabolism, Celiac Disease diagnosis, GTP-Binding Proteins immunology, Gliadin immunology, Gliadin metabolism, Immunoglobulin G immunology, Serologic Tests methods, Transglutaminases immunology
Abstract

Background: Detection of IgG antibodies against deamidated gliadin peptides (DGP) is more sensitive and more specific for celiac disease than detection of IgG antibodies against native gliadin. Our aim was to evaluate the technical performance and diagnostic accuracy of four commercial IgG anti-DGP assays., Methods: Commercial IgG anti-DGP assays from Euroimmun, Inova, Phadia and The Binding Site were evaluated and their diagnostic accuracy (sensitivity and specificity) compared to other serologic assays for celiac disease (3IgA and 2IgG anti-tTG assays, 1IgA and 1IgG anti-gliadin assay, 1IgA anti-DGP assay). The study population consisted of 86 consecutive CD patients and 741 disease controls., Results: The technical performance (linearity, interference and imprecision) of the IgG anti-DGP assays was acceptable. The sensitivity of the IgG anti-DGP assays varied between 76.7% and 86.0% at the cut-off recommended by the manufacturer and between 74.4% and 86.0% at the cut-off that corresponded to a specificity of 98%. The specificity varied between 97.3% and 99.3%. The diagnostic accuracy of the IgG anti-DGP assays was comparable to the diagnostic accuracy of the IgA anti-tTG assays. The sensitivity of the IgG anti-DGP assays was significantly better than sensitivity of the IgG anti-tTG assays (p<0.05) and the specificity was significantly better than the IgA and IgG anti-gliadin assays (p<0.05)., Conclusions: The overall performance of the four IgG anti-DGP assays was acceptable and the diagnostic accuracy comparable to the three IgA anti-tTG assays., (Copyright 2010 Elsevier B.V. All rights reserved.)

Published
2010
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32. Use of likelihood ratios improves clinical interpretation of IgA anti-tTG antibody testing for celiac disease.

Author

Vermeersch P, Coenen D, Geboes K, Mariën G, Hiele M, and Bossuyt X

Subjects
Adult, Celiac Disease immunology, False Positive Reactions, Female, Humans, Likelihood Functions, Male, Sensitivity and Specificity, Celiac Disease diagnosis, Immunoglobulin A immunology, Transglutaminases immunology
Abstract

Background: We investigated whether taking into account IgA anti-tissue transglutaminase antibody concentration (IgA anti-tTG) and total IgA concentration could improve clinical interpretation of serologic testing for celiac disease (CD)., Methods: We retrospectively identified 43 consecutive newly diagnosed CD patients and 545 consecutive disease control patients who had an IgA anti-tTG request during the 42-month study period and for whom intestinal biopsy results were available., Results: Sensitivity and specificity of the IgA anti-tTG assay from Genesis was 95.3% and 92.7%, respectively, with a likelihood ratio (LR) of 12.4. The LR for CD markedly increased with increasing IgA anti-tTG concentration (from 2.0 for results between 7 and 20 U/ml up to 319 for results >100 U/ml). The LR for CD was also higher in patients with a normal IgA concentration (0.82-4.53 g/L) compared to patients with an increased IgA concentration (15.3 vs. 3.1, respectively). These observations were confirmed with a second IgA anti-tTG assay from BioRad., Conclusion: Sensitivity of IgA anti-tTG was good. Specificity, however, was reduced when IgA anti-tTG was weak positive or when the IgA concentration was increased. Taking into account IgA anti-tTG concentration and IgA concentration improves clinical interpretation of serologic testing for CD.

Published
2010
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33. Diagnostic performance of serum free light chain measurement in patients suspected of a monoclonal B-cell disorder.

Author

Vermeersch P, Van Hoovels L, Delforge M, Mariën G, and Bossuyt X

Subjects
Adult, Aged, Biomarkers blood, Biomarkers, Tumor blood, Diagnosis, Differential, Female, Humans, Immunoglobulin Light Chains urine, Male, Middle Aged, Multiple Myeloma diagnosis, Sensitivity and Specificity, Young Adult, Immunoglobulin Light Chains blood, Lymphoma, B-Cell diagnosis, Paraproteinemias diagnosis
Abstract

The present study aimed to determine the diagnostic performance of different testing strategies to diagnose malignant B-cell disorder or monoclonal gammopathy of unknown significance (MGUS). Sensitivity and specificity were determined in 833 consecutive patients investigated for a monoclonal gammopathy. Serum protein electrophoresis (PE), serum kappa/lambda free light chain (FLC) ratio, and serum and urine immunofixation electrophoresis (IFE) were performed in all patients. Twenty-eight patients were diagnosed with a malignant plasma cell disorder, 25 with B-cell non-Hodgkin lymphoma and 156 with MGUS. Serum PE (with follow-up IFE) plus FLC had a sensitivity of 82.3% and a specificity of 96.8% and missed one plasmacytoma and 23 patients with MGUS. Serum IFE plus urine IFE had a sensitivity of 92.3% and a specificity of 100% and missed two MGUS patients. Serum IFE plus FLC had a sensitivity of 93.8% and a specificity of 96.8% and missed one MGUS patient. Serum PE plus FLC had a significantly lower sensitivity than serum IFE plus FLC or serum IFE plus urine IFE for the diagnosis of MGUS. The sensitivity of serum IFE plus FLC was comparable to the sensitivity of serum IFE plus urine IFE. The specificity of serum IFE plus FLC, however, was lower than the specificity of serum IFE plus urine IFE.

Published
2008
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34. Establishment of reference values for immunoglobulins in the cryoprecipitate.

Author

Vermeersch P, Gijbels K, Knockaert D, Blockmans D, Westhovens R, Mariën G, and Bossuyt X

Subjects
Adult, Aged, Aged, 80 and over, Complement C4 analysis, Cryoglobulinemia blood, Female, Humans, Male, Middle Aged, Reference Values, Cryoglobulins analysis
Abstract

Cryoglobulins are often estimated by determining cryocrit or total protein content in the cryoprecipitate, but these are only indirect measures. Direct quantification of immunoglobulins in combination with agarose gel electrophoresis, to appreciate the presence of other proteins in the cryoprecipitate, offers a more sensitive and specific tool for confirming the diagnosis of cryoglobulinemia. Using such strategy, we established reference values for immunoglobulins in cryoprecipitate in diseased controls and applied them to 214 consecutive patients. The 97.5th percentile for IgA, IgG and IgM in diseased controls was 2, 11 and 26 mg/L serum, respectively. The distribution of the 49 positive patients (23%) was 10% type I, 33% type IIa, 16% type IIb, and 41% type III. Complement C4 was decreased in 61% and 55% of the patients classified as type II and type III compared to 16% of the patients that were negative for cryoglobulins and 9% of the diseased controls.

Published
2008
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35. Determination of anti-neutrophil cytoplasmic antibodies in small vessel vasculitis: Comparative analysis of different strategies.

Author

Vermeersch P, Vervaeke S, Blockmans D, van Hoovels L, Mariën G, Vanmaele H, and Bossuyt X

Subjects
Enzyme-Linked Immunosorbent Assay, Fluorescent Antibody Technique, Indirect, Humans, Myeloblastin immunology, Neutrophils enzymology, Neutrophils immunology, Peroxidase immunology, Sensitivity and Specificity, Vasculitis blood, Antibodies, Antineutrophil Cytoplasmic blood, Autoantibodies blood, Blood Vessels immunology, Vasculitis immunology
Abstract

Background: Anti-neutrophil cytoplasmic antibodies (ANCA) are associated with primary small vessel vasculitis (SVV). Proteinase-3 (PR3)-ANCA are primarily associated with Wegener granulomatosis, whereas myeloperoxidase (MPO)-ANCA are primarily associated with microscopic polyangiitis (MPA) and vasculitic Churg-Strauss syndrome. We evaluated whether a strategy that is based on screening with ELISA or fluoroenzymeimmunoassay (FEIA) is an accurate alternative to screening with indirect immunofluorescence (IIF)., Methods: C-ANCA and P-ANCA were determined by IIF and PR3-ANCA and MPO-ANCA were determined by ELISA (Inova) or FEIA (Phadia) on 326 patients (38 with newly diagnosed SVV and 288 diseased controls)., Results: Specificity and positive likelihood ratios were higher for ELISA and FEIA than for IIF. Post-test probability for SVV of a positive test result was higher for ELISA and FEIA than for IIF. Decision tree analysis in which several testing strategies were compared revealed that a testing strategy that is based on screening with ELISA or FEIA had an expected clinical utility that was comparable to screening with IIF and confirming with ELISA or FEIA. The highest expected clinical utility was found when both IIF and ELISA or FEIA were performed on all samples., Conclusions: A strategy based on screening for ANCA with ELISA or FEIA (without prior IIF) is a valuable alternative to screening with IIF and confirming with ELISA or FEIA.

Published
2008
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37. A critical appraisal of current practice in the detection, analysis, and reporting of cryoglobulins.

Author

Vermeersch P, Gijbels K, Mariën G, Lunn R, Egner W, White P, and Bossuyt X

Subjects
Humans, Reference Values, Research Design standards, Surveys and Questionnaires, Cryoglobulinemia diagnosis, Cryoglobulins analysis, Hematologic Tests standards
Abstract

To assess current practice in the detection, analysis, and reporting of cryoglobulins, a questionnaire was sent to 140 laboratories. Only 36% of laboratories used standard procedures (tube preheating, transport in container, and sedimentation and/or centrifugation at 37 degrees C) to ensure that the temperature did not drop below 37 degrees C until after serum separation. Time periods allowed for cryoprecipitation at 4 degrees C varied from 12 h to 9 days, with 30% of laboratories allowing precipitation for <3 days. After cryoprecipitation, 81% of laboratories resolubilized the cryoprecipitate at 37 degrees C, and 77% further immunotyped the cryoprecipitate. After analysis, 5% referred the sample for confirmation, 58% provided a nonquantitative report, and 37% reported the cryoglobulin concentration in the cryoprecipitate as cryocrit, total protein concentration, and/or immunoglobulin concentration. Only 3 laboratories (2%) provided cryoprecipitate-specific reference values for total protein content, and none provided reference values for immunoglobulins. We believe standardization is needed for cryoglobulin detection to avoid missed diagnoses and improve the comparability of results. Laboratories should ensure that sample temperature does not drop below 37 degrees C until after serum separation. The serum should cryoprecipitate at 4 degrees C for at least 3 (preferably 7) days. The cryoprecipitate should be washed and resolubilized at 37 degrees C for further analysis.

Published
2008
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41. Pseudoparaproteinemia related to iomeprol administration after angiocardiography: Detection in the beta fraction by capillary zone electrophoresis.

Author

Vermeersch P, Mariën G, and Bossuyt X

Subjects
Agammaglobulinemia diagnosis, Angiocardiography, Child, Preschool, Electrophoresis, Capillary, False Positive Reactions, Female, Humans, Iopamidol administration & dosage, Contrast Media administration & dosage, Iopamidol analogs & derivatives, Paraproteinemias diagnosis, Paraproteins analysis
Published
2006
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45. Determination of IgG subclasses: a need for standardization.

Author

Bossuyt X, Mariën G, Meyts I, Proesmans M, and De Boeck K

Subjects
Adolescent, Adult, Child, Female, Humans, Male, Reference Standards, Reference Values, Reproducibility of Results, Respiratory Tract Infections immunology, Enzyme-Linked Immunosorbent Assay standards, Immunoglobulin G blood, Isoantibodies blood
Published
2005
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47. Detection of anti-SSA antibodies by indirect immunofluorescence.

Author

Bossuyt X, Frans J, Hendrickx A, Godefridis G, Westhovens R, and Mariën G

Subjects
Autoantigens, Cell Line, Fluorescent Antibody Technique, Indirect, Humans, Lupus Erythematosus, Cutaneous immunology, Lupus Erythematosus, Systemic immunology, Mixed Connective Tissue Disease immunology, Sjogren's Syndrome immunology, SS-B Antigen, Antibodies, Antinuclear analysis, Antibodies, Antinuclear blood, Connective Tissue Diseases immunology, Ribonucleoproteins immunology
Abstract

Background: HEp-2 cells that overexpress the human 60-kDa SSA antigen have been used to improve sensitivity and specificity for the detection of anti-SSA antibodies by indirect immunofluorescence. We describe a survey on the detection of anti-SSA antibodies using a commercial substrate that overexpresses SSA., Methods: The evaluation was done on 18 371 consecutive samples submitted to the laboratory for detection of anti-nuclear antibodies, from which 188 anti-SSA antibody-containing and clinically documented samples were obtained. The presence of anti-SSA antibodies produced a distinct bright speckled pattern with nucleolar staining in 10-20% of interphase cells. The identity of all anti-SSA antibodies was confirmed by dot-blot analysis., Results: Samples containing anti-SSA antibodies were separated into three main groups: group I, distinctive SSA pattern and other nuclear staining (50%); group II, only the distinctive SSA pattern (29%); group III, nuclear staining but without the distinctive SSA pattern (21%). Anti-SSA antibodies with concurrent SSB antibodies were associated with group I, whereas anti-SSA antibodies with concurrent U(1)-RNP antibodies were associated with group III. Group I included mainly patients with Sjogren syndrome and systemic lupus erythematosus (SLE), whereas group III included patients with mixed connective tissue disease and SLE. Diseases not classically associated with the presence of anti-SSA antibodies were found in group II in >50% of the cases., Conclusions: SSA-positive individuals were identified in a population selected on the basis of HEp-2000 positivity. Our study highlights diseases associated with anti-SSA antibodies and associations between the presence of the distinctive SSA pattern on HEp-2000 and some clinical conditions.

Published
2004
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