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Hadjadj J, Nguyen Y, Mouloudj D, Bourguiba R, Heiblig M, Aloui H, McAvoy C, Lacombe V, Ardois S, Campochiaro C, Maria A, Coustal C, Comont T, Lazaro E, Lifermann F, Le Guenno G, Lobbes H, Grobost V, Outh R, Campagne J, Dor-Etienne A, Garnier A, Jamilloux Y, Dossier A, Samson M, Audia S, Nicolas B, Mathian A, de Maleprade B, De Sainte-Marie B, Faucher B, Bouaziz JD, Broner J, Dumain C, Antoine C, Carpentier B, Castel B, Lartigau-Roussin C, Crickx E, Volle G, Fayard D, Decker P, Moulinet T, Dumont A, Nguyen A, Aouba A, Martellosio JP, Levavasseur M, Puigrenier S, Antoine P, Giraud JT, Hermine O, Lacout C, Martis N, Karam JD, Chasset F, Arnaud L, Marianetti P, Deligny C, Chazal T, Woaye-Hune P, Roux-Sauvat M, Meyer A, Sujobert P, Hirsch P, Abisror N, Fenaux P, Kosmider O, Jachiet V, Fain O, Terrier B, Mekinian A, Georgin-Lavialle S. Efficacy and safety of targeted therapies in VEXAS syndrome: retrospective study from the FRENVEX. Ann Rheum Dis 2024:ard-2024-225640. [PMID: 38777378 DOI: 10.1136/ard-2024-225640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease associated with somatic ubiquitin-like modifier-activating enzyme 1 (UBA1) mutations. We aimed to evaluate the efficacy and safety of targeted therapies. METHODS Multicentre retrospective study including patients with genetically proven VEXAS syndrome who had received at least one targeted therapy. Complete response (CR) was defined by a clinical remission, C-reactive protein (CRP) ≤10 mg/L and a ≤10 mg/day of prednisone-equivalent therapy, and partial response (PR) was defined by a clinical remission and a 50% reduction in CRP levels and glucocorticoid dose. RESULTS 110 patients (median age 71 (68-79) years) who received 194 targeted therapies were included: 78 (40%) received Janus kinase (JAK) inhibitors (JAKi), 51 (26%) interleukin (IL)-6 inhibitors, 33 (17%) IL-1 inhibitors, 20 (10%) tumour necrosis factor (TNFα) blockers and 12 (6%) other targeted therapies. At 3 months, the overall response (CR and PR) rate was 24% with JAKi, 32% with IL-6 inhibitors, 9% with anti-IL-1 and 0% with TNFα blockers or other targeted therapies. At 6 months, the overall response rate was 30% with JAKi and 26% with IL-6 inhibitors. Survival without treatment discontinuation was significantly longer with JAKi than with the other targeted therapies. Among patients who discontinued treatment, causes were primary failure, secondary failure, serious adverse event or death in 43%, 14%, 19% and 19%, respectively, with JAKi and 46%, 11%, 31% and 9%, respectively, with IL-6 inhibitors. CONCLUSIONS This study shows the benefit of JAKi and IL-6 inhibitors, whereas other therapies have lower efficacy. These results need to be confirmed in prospective trials.
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Affiliation(s)
- Jerome Hadjadj
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Yann Nguyen
- Service de médecine interne, Hôpital Beaujon, AP-HP.Nord, Université Paris Cité, Clichy, France
| | - Dalila Mouloudj
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Rim Bourguiba
- Médecine Interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
- Université Tunis el Manar, Faculté de médecine de Tunis, Tunis, Tunisia
| | - Mael Heiblig
- Hématologie, Hôpital Lyon Sud - HCL, Pierre-Bénite, France
| | - Hassina Aloui
- Médecine Interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
| | - Chloe McAvoy
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Valentin Lacombe
- Department of Internal Medicine, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | | | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy ad Rre Disesaes. IRCCS San Raffaele Hospital. Vita-Salute Vita-Salute San Raffaele University, Milan, Italy
| | - Alexandre Maria
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, Montpellier, France
| | - Cyrille Coustal
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, Montpellier, France
| | - Thibault Comont
- Service de médecine interne IUCT-Oncopole, CHU Toulouse, Université Paul Sabatier, Toulouse, France
| | - Estibaliz Lazaro
- Internal Medicine, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
| | - Francois Lifermann
- Service de médecine interne, Centre Hospitalier Dax, Dax, Nouvelle-Aquitaine, France
| | - Guillaume Le Guenno
- Médecine Interne, CHU Estaing, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Hervé Lobbes
- Médecine Interne, CHU Estaing, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Vincent Grobost
- Médecine Interne, CHU Estaing, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Roderau Outh
- Service de médecine interne et générale, Perpignan University, Perpignan, France
| | | | | | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Antoine Dossier
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
| | - Maxime Samson
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Maladies Auto-immunes et Auto-inflammatoires Rares de l'adulte, CHU Dijon-Bourgogne, Dijon,France; Université de Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Sylvain Audia
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Maladies Auto-immunes et Auto-inflammatoires Rares de l'adulte, CHU Dijon-Bourgogne, Dijon,France; Université de Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Barbara Nicolas
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Maladies Auto-immunes et Auto-inflammatoires Rares de l'adulte, CHU Dijon-Bourgogne, Dijon,France; Université de Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Alexis Mathian
- French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | | | - Benjamin De Sainte-Marie
- Department of Internal Medicine, Centre Hospitalier Universitaire de La Timone, Marseille, France
| | - Benoit Faucher
- Department of Internal Medicine, Centre Hospitalier Universitaire de La Timone, Marseille, France
| | | | - Jonathan Broner
- Internal Medicine Department, University Hospital Centre Nimes, Nimes, France
| | - Cyril Dumain
- Internal Medicine Department, University Hospital Centre Nimes, Nimes, France
| | - Carole Antoine
- Internal Medicine, Sainte-Anne Military Teaching Hospital, Toulon, Provence-Alpes-Côte d'Azu, France
| | - Benjamin Carpentier
- Hématologie clinique, Universite Catholique de Lille Hopital Saint-Vincent de Paul, Lille, Hauts-de-France, France
| | - Brice Castel
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalier de Lourdes, Lourdes, France
| | | | - Etienne Crickx
- Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Geoffroy Volle
- Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Damien Fayard
- University Hospital Centre Gabriel Montpied, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Paul Decker
- Médecine interne et immunologie clinique, CHU de Nancy, UMR 7365, IMoPA, Université de Lorraine, CNRS, Nancy, France
| | - Thomas Moulinet
- Médecine interne et immunologie clinique, CHU de Nancy, UMR 7365, IMoPA, Université de Lorraine, CNRS, Nancy, France
| | - Anael Dumont
- Department of Internal Medicine, University Hospital Centre Caen, Caen, Basse-Normandie, France
| | - Alexandre Nguyen
- Department of Internal Medicine, University Hospital Centre Caen, Caen, Basse-Normandie, France
| | - Achille Aouba
- Department of Internal Medicine, University Hospital Centre Caen, Caen, Basse-Normandie, France
| | | | | | - Sebastien Puigrenier
- Department of Internal Medicine, Centre hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Pascale Antoine
- Department of Internal Medicine, Centre hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | | | | | - Carole Lacout
- Department of Internal Medicine, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Nihal Martis
- Internal Medicine Department, University Hospital of Nice, Archet 1 Hospital, Nice, France
| | - Jean-Denis Karam
- Department of Internal Medicine Amiens University Hospital, Amiens, France
| | - Francois Chasset
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et Allergologie, Paris, France
| | - Laurent Arnaud
- Department of Rheumatology. National reference Center for rare diseases (RESO). Hôpitaux Universitaires de Strasbourg et INSERM UMR-S 1109, Strasbourg, France
| | - Paola Marianetti
- Service de médecine interne, maladies infectieuses, immunologie clinique, Reims Champagne-Ardenne University, Reims, France
| | - Christophe Deligny
- Service de Médecine Interne, University Hospital of Martinique, Fort-de-France, Martinique
| | - Thibaud Chazal
- Internal Medicine, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | | | - Murielle Roux-Sauvat
- Service de médecine interne, Pierre Oudot Hospital of Bourgoin-Jallieu, Bourgoin-Jallieu, France
| | - Aurore Meyer
- Service d'immunologie clinique et médecine interne, Hopitaux universitaires de Strasbourg, Strasbourg, Alsace, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'hématologie biologique, Pierre Bénite, France
| | - Pierre Hirsch
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, SIRIC8 CURAMUS, Hôpital Saint-Antoine, Service d'Hématologie Biologique, Paris, France
| | - Noemie Abisror
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Pierre Fenaux
- Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, France
| | - Vincent Jachiet
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Olivier Fain
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Benjamin Terrier
- Médecine interne, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
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