News items ZonMW subsidies for faster weaning from ventilation and the effectiveness of Rituximab in systemic sclerosis

22 November 2023

People who have difficulty weaning off ventilation in the ICU may benefit from a medication that can strengthen the respiratory muscles. Professor of Intensive Care Leo Heunks will investigate whether people can resume independent breathing more quickly with the help of this medication. In addition, rheumatologist Madelon Vonk will lead a study on the effectiveness of the drug Rituximab in systemic sclerosis. Both researchers will receive eight hundred thousand euros from ZonMW as part of the Good Use of Medicines program.

Leo Heunks – faster weaning from ventilation

While ventilation saves lives in cases of acute lung problems, it also has drawbacks. Prolonged ventilation leads to more complications, a greater risk of mortality, and more long-term health issues. Therefore, it is crucial for patients to be weaned from ventilation as quickly as possible. In addition to the benefits for patients, this also contributes to more efficient use of the busy ICUs in the Netherlands.

A challenge in weaning off ventilation is that the respiratory muscles weaken due to inactivity during ventilation combined with inflammation. Research also shows that patients can experience the feeling of shortness of breath, resulting from muscle weakness, as traumatic. Research leader Leo Heunks of Radboudumc says: ‘If we can strengthen the respiratory muscles, the feeling of shortness of breath may hopefully decrease.’


During a study conducted at Radboudumc, Heunks discovered that Levosimendan, a drug known for strengthening the heart muscle, can also strengthen respiratory muscles. ‘We measured this in patients with balloons filled with pressure sensors, which measure the strength of the respiratory muscles’, Heunks explains.

Whether the medication also enables individuals to resume independent breathing more quickly is now being investigated by Heunks in a follow-up study involving 244 people struggling to be weaned from ventilation. Half of the participants will receive the medication, while the other half will serve as the control group. In addition to Radboudumc, Erasmus MC and various hospitals from the Nijmegen and Rotterdam regions are participating in the research.

Madelon Vonk – effectiveness of Rituximab in systemic sclerosis

Systemic sclerosis is a rare autoimmune disease associated with a high disease burden and a significant risk of mortality. Treatment involves medication that suppresses the immune system. Unfortunately, this is not always effective and sometimes causes severe side effects. Rituximab is a biological drug that has been safely used for more than twenty years for various diseases, but it has not been adequately studied for systemic sclerosis.

Rheumatologist Madelon Vonk will test the effectiveness and safety of this drug in a large clinical study involving various hospitals. This will be done in both early-stage systemic sclerosis and progressive disease. Vonk and her team showed in a previous study that they can identify patients with very early disease and high risk of progression. These patients and patients with progression of the disease may be eligible for this new study.


Madelon Vonk says: ‘If the study yields positive results, a safe, effective treatment will be available for all patients with systemic sclerosis, and progression of this condition can be better prevented. This would have a tremendous positive impact on patients, their families, and ultimately on healthcare costs.’

Radboudumc is the national referral center for systemic sclerosis and the center of expertise has European Reference Network (ERN) accreditation.

More information

Annemarie Eek


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