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Jachiet M, Samson M, Cottin V, Kahn JE, Le Guenno G, Bonniaud P, Devilliers H, Bouillet L, Gondouin A, Makhlouf F, Meaux-Ruault N, Gil H, Bienvenu B, Coste A, Groh M, Giraud V, Dominique S, Godeau B, Puéchal X, Khouatra C, Ruivard M, Le Jeunne C, Mouthon L, Guillevin L, Terrier B. Anti-IgE Monoclonal Antibody (Omalizumab) in Refractory and Relapsing Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss): Data on Seventeen Patients. Arthritis Rheumatol 2017; 68:2274-82. [PMID: 26946346 DOI: 10.1002/art.39663] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 02/23/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the efficacy and safety of omalizumab, an anti-IgE monoclonal antibody, in patients with refractory and/or relapsing eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA). METHODS We conducted a nationwide retrospective study including EGPA patients who received omalizumab. Response was defined as the absence of asthma and/or sinonasal exacerbations with a prednisone dosage of ≤7.5 mg/day (complete response) or >7.5 mg/day (partial response). RESULTS Seventeen patients (median age 45 years) received omalizumab for severe steroid-dependent asthma (88%) and/or sinonasal involvement (18%). After a median follow-up of 22 months, 6 patients (35%) achieved a complete response, 5 patients (30%) achieved a partial response, and 6 patients (35%) had no improvement. The median Birmingham Vasculitis Activity Score decreased from 2.5 at baseline to 0.5 at 12 months. The median number of exacerbations per month decreased from 1 at baseline to 0 at 12 months, and the median forced expiratory volume in 1 second increased from 63% of the percent predicted at baseline to 85% of the percent predicted at 12 months. The median prednisone dosage decreased from 16 mg/day at baseline to 11 mg/day at 6 months and 9 mg/day at 12 months. Omalizumab was discontinued in 8 patients (47%) during follow-up, because of remission (12.5%), adverse event despite disease remission (12.5%), refractory disease (25%), or relapse (50%). Relapses included retrobulbar optic neuritis attributable to EGPA in 2 patients and severe asthma flare in 2 others. CONCLUSION The results of this study suggest that omalizumab may have a corticosteroid-sparing effect in EGPA patients with asthmatic and/or sinonasal manifestations, but reducing the corticosteroid dose may also increase the risk of severe EGPA flares, which raises the question of the safety of omalizumab in patients with EGPA.
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Affiliation(s)
- Marie Jachiet
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Maxime Samson
- Centre Hospitalier Universitaire (CHU) de Dijon, Dijon, France
| | | | - Jean-Emmanuel Kahn
- Hôpital Foch, Université Versailles Saint-Quentin en Yvelines, Suresnes, France
| | | | - Philippe Bonniaud
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | | | | | | | - Fatma Makhlouf
- CHU de Grenoble and Michallon Hospital, Grenoble, France
| | | | | | | | | | - Matthieu Groh
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | | | | | | | - Xavier Puéchal
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | | | | | - Claire Le Jeunne
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Luc Mouthon
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
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Hachicha F, Brour J, Zahaf A, Ben Abdallah M, Ouederni M, Cheour M, Kraiem A. [Progression of a rare and serious ocular manifestation of Wegener's granulomatosis: occlusive retinal vasculitis]. J Fr Ophtalmol 2014; 37:e153-5. [PMID: 25455551 DOI: 10.1016/j.jfo.2014.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/10/2014] [Accepted: 03/20/2014] [Indexed: 10/24/2022]
Affiliation(s)
- F Hachicha
- Service d'ophtalmologie, hôpital Habib Thameur, rue de Bab el falah, 2004 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie.
| | - J Brour
- Service d'ophtalmologie, hôpital Habib Thameur, rue de Bab el falah, 2004 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - A Zahaf
- Service d'ophtalmologie, hôpital Habib Thameur, rue de Bab el falah, 2004 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - M Ben Abdallah
- Service d'ophtalmologie, hôpital Habib Thameur, rue de Bab el falah, 2004 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - M Ouederni
- Service d'ophtalmologie, hôpital Habib Thameur, rue de Bab el falah, 2004 Tunis, Tunisie
| | - M Cheour
- Service d'ophtalmologie, hôpital Habib Thameur, rue de Bab el falah, 2004 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
| | - A Kraiem
- Service d'ophtalmologie, hôpital Habib Thameur, rue de Bab el falah, 2004 Tunis, Tunisie; Faculté de médecine de Tunis, université Tunis El Manar, Tunis, Tunisie
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[Ocular involvement in polyarteritis nodosa: two cases]. J Fr Ophtalmol 2012; 35:724.e1-5. [PMID: 22981522 DOI: 10.1016/j.jfo.2011.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/04/2011] [Accepted: 12/19/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Polyarteritis nodosa (PAN) is a systemic vasculitis with polymorphic manifestations. Ocular involvement is rare; we report two such cases. CASES The first case was a 56-year-old man with PAN treated with corticosteroids. A year and a half later, during a disease outbreak associated with decreased visual acuity, ocular examination objectified a localized pigment epithelial detachment in the right eye. The outcome was favorable with corticoid bolus followed by azathioprine. The second case was a 41-year-old man presenting with PAN and decreased visual acuity. Ophthalmologic examination showed inferotemporal branch vein occlusion in the right eye with serous retinal detachments in the left eye. The outcome was favorable with intravenous cyclophosphamide followed by azathioprine. DISCUSSION The incidence of ocular involvement in PAN varies from 10 to 20%. It is most often associated with vasculitis of retinal and choroidal arteries. Fluorescein angiography is the gold standard of diagnosis. Multifocal acute ischemia of the choriocapillaris is very pathognomonic. Immunosuppressant drugs are effective and should be reserved for severe forms.
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