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Hupé M, Streichenberger A, Wils P, Arab N, Serrero M, Amiot A, Bozon A, Vuitton L, Fumery M, Altwegg R, Nachury M, Hébuterne X, Yzet C, Coban D, Dodel M, Bazoge M, Pereira B, Buisson A. Infliximab is an effective option in patients with ulcerative colitis previously exposed to full subcutaneous anti-TNF agent: Results from a real-world multicenter study. Dig Liver Dis 2024:S1590-8658(24)00200-7. [PMID: 38281870 DOI: 10.1016/j.dld.2024.01.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Data on infliximab efficacy in bio-exposed patients with ulcerative colitis (UC) are limited. AIMS To evaluate infliximab effectiveness and its predictors in UC patients with prior exposure to subcutaneous (SC) anti-TNF agent. METHODS In this multicenter retrospective study (8 centers), we included all consecutive UC patients with prior exposure to subcutaneous anti-TNF, starting infliximab for symptomatic UC, excluding acute severe colitis. Corticosteroid-free clinical remission (CFREM) was assessed at week 14 (W14) and W52 while endoscopic improvement (CFREM + endoscopic Mayo score≤1) was evaluated at W14. RESULTS Overall, 104 patients were included (pancolitis=54.8%, primary failure to subcutaneous anti-TNF=57.4%, concomitant immunosuppressant=53.8%, median partial Mayo score at baseline=7[5-8]). The rate of CFREM was 33.6% (35/104) at W14 and 40.4% (42/104) at W52. At W14, endoscopic improvement was achieved in 29.8%(31/104). In multivariable analysis, concomitant immunosuppressant was associated with higher rate of CFREM at W14(OR=2.83[1.06-7.54], p = 0.037) and W52(OR=2.68[1.16-6.22];p = 0.021), while primary failure to a previous subcutaneous anti-TNF agent led to lower rate of CFREM at W14 (OR=0.37[0.14-0.98], p = 0.046). After a median follow-up of 20.9 months[11.7-33.7]), 50.0%(52/104) patients had discontinued infliximab. CONCLUSION Infliximab is an effective option in UC patients previously exposed to prior subcutaneous anti-TNF agent and should be used with concomitant immunosuppressant.
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Affiliation(s)
- M Hupé
- Univ. Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France
| | - A Streichenberger
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - P Wils
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - N Arab
- Gastro-entérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France
| | - M Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - A Amiot
- EC2M3-EA7375, Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, Assistance Publique-Hôpitaux de Paris, University of Paris Est Créteil, Créteil, France
| | - A Bozon
- Department of Hepatogastroenterology, CHU St Eloi Montpellier, Montpellier, France
| | - L Vuitton
- Gastroenterology department, CHU Besançon and UMR 1098, University Bourgogne-Franche-Comté, Besançon, France
| | - M Fumery
- Gastroenterology department, CHU Amiens, Université de Picardie Jules Verne, Unité Peritox, France; Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - R Altwegg
- Department of Hepatogastroenterology, CHU St Eloi Montpellier, Montpellier, France
| | - M Nachury
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - X Hébuterne
- Gastro-entérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France
| | - C Yzet
- Gastroenterology department, CHU Amiens, Université de Picardie Jules Verne, Unité Peritox, France
| | - D Coban
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - M Dodel
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - M Bazoge
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - B Pereira
- CHU Amiens, Université de Picardie Jules Verne, Unité Peritox, France
| | - A Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France.
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Poullenot F, Amiot A, Nachury M, Viennot S, Altwegg R, Bouhnik Y, Abitbol V, Nancey S, Vuitton L, Peyrin-Biroulet L, Biron A, Fumery M, Picon L, Vidon M, Reenaers C, Serrero M, Savoye G, Beaugerie L, Rivière P, Laharie D. Comparative Risk of Incident Cancer in Patients with Inflammatory Bowel Disease with Prior Non-digestive Malignancy According to Immunomodulator: a Multicentre Cohort Study. J Crohns Colitis 2022; 16:1523-1530. [PMID: 35512337 DOI: 10.1093/ecco-jcc/jjac061] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/27/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Knowledge about the cancer risk when initiating a biologic in inflammatory bowel disease [IBD] patients with prior malignancy remains scarce, especially for vedolizumab. Our aim was to evaluate the rate of incident cancer in a cohort of IBD patients with prior non-digestive malignancy, according to the subsequent treatment given. METHODS A multicentre retrospective study included consecutive IBD patients with prior non-digestive malignancy. Inclusion date corresponded to the diagnosis of index malignancy. Patients were categorized into different cohorts according to the first treatment [none, conventional immunosuppressant, anti-TNF, or vedolizumab] to which they were exposed after inclusion and before incident cancer [recurrent or new cancer]. RESULTS Among the 538 patients {58% female; mean (standard deviation [SD]) age inclusion: 52 [15] years} analyzed, the most frequent malignancy was breast cancer [25%]. The first immunomodulator given after inclusion was a conventional immunosuppressant in 27% of patients, anti-TNF in 21%, or vedolizumab in 9%. With a median (interquartile range [IQR]) follow-up duration of 55 [23-100] months, 100 incident cancers were observed. Crude cancer incidence rates per 1000 person-years were 47.0 for patients receiving no immunomodulator, 36.6 in the anti-TNF cohort, and 33.6 in the vedolizumab cohort [p = 0.23]. Incident-cancer free survival rates were not different between patients receiving anti-TNF and those receiving vedolizumab [p = 0.56]. After adjustment, incidence rates were not different between patients receiving no immunomodulator, anti-TNF, or vedolizumab. CONCLUSIONS In this large multicentre cohort study, there was no difference of cancer incidence in those IBD patients with prior non-digestive malignancy, treated with vedolizumab or anti-TNF.
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Affiliation(s)
- F Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - A Amiot
- Département de Gastroentérologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
| | - M Nachury
- Univ. Lille, Institute for Translational Research in Inflammation, France
| | - S Viennot
- Hepato-gastroenterology Department, CHU Caen, Caen, France
| | - R Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier, France
| | - Y Bouhnik
- Gastroenterology and Nutrition Support Department, Department of Gastroenterology, Beaujon Hospital, Clichy, France
| | - V Abitbol
- Hôpital Cochin AP-HP Gastro-entérologie, and Université de Paris, Paris, France
| | - S Nancey
- Department of Gastroenterology, CHU, Lyon, France
| | - L Vuitton
- Department of Gastroenterology, CHRU, Besançon, France
| | - L Peyrin-Biroulet
- Gastroenterology Department, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - A Biron
- CHU Reims, Hôpital Robert Debré. Service Hépato-gastroentérologie et cancérologie digestive, Reims, France
| | - M Fumery
- Department of Gastroenterology, CHU, Amiens, France
| | - L Picon
- Hepato-gastroenterology Department, CHRU Tours-TROUSSEAU Hospital, Tours, France
| | - M Vidon
- Departement of Gastroenterology, Hôpital Intercommunal de Créteil, Créteil, France
| | - C Reenaers
- Hepato-gastroenterology Department, CHU Sart Tilman, Liège University, Liège, Belgium
| | - M Serrero
- Hepato-gastroenterology Department, APHM Hôpital Nord, Marseille, France
| | - G Savoye
- Department of Gastroenterology, Normandie University, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - L Beaugerie
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - P Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
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Cottron C, Treton X, Altwegg R, Reenaers C, Amiot A, Fumery M, Vuitton L, Peyrin-Biroulet L, Bouguen G, Dewit O, Nancey S, Caillo L, Roblin X, Beylot-Barry M, Rivière P, Laharie D. How to Manage Inflammatory Bowel Disease Patients When They Withdraw Anti-Tumour Necrosis Factor [Anti-TNF] Due to Severe Anti-TNF-Induced Skin Lesions? A Multicentre Cohort Study. J Crohns Colitis 2022; 16:1202-1210. [PMID: 35218189 DOI: 10.1093/ecco-jcc/jjac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Optimal management of patients with inflammatory bowel disease [IBD] after anti-tumour necrosis factor [TNF] discontinuation due to severe induced skin lesions is unclear. Our study aimed to describe dermatological and IBD evolution after anti-TNF discontinuation for this side effect. METHODS We conducted a multicentre retrospective study including consecutive IBD patients who discontinued anti-TNF due to severe induced skin lesions. Our objectives were to determine factors associated with dermatological remission [complete disappearance of skin lesions] and with IBD relapse in patients with inactive disease at inclusion, notably the impact of an early switch to another biological agent within 3 months of anti-TNF discontinuation. RESULTS Among the 181 patients [134 women, 160 Crohn's disease] included in the 13 participating centres, dermatological remission occurred in 110 [62%] patients with a median [interquartile range, IQR] interval of 8.0 [6.8-11.0] months. Scalp location was independently associated with less remission of skin lesions (hazard ratio [HR] = 0.64 [95% CI 0.43-0.94], p = 0.02) while early switch was independently associated with a higher probability of remission of skin lesions (HR = 1.64 [95% CI 1.1-2.5], p = 0.02). Among the 148 patients with inactive IBD at inclusion, disease relapse occurred in 75 [51%] patients with a median [IQR] interval of 26.0 [23.0-39.1] months. Survival rates without IBD relapse at 1 year were 85.8% [95% CI 77.5-94.9] in the early switch group and 59.3% [95% CI 48.9-71.9] in the other group [p < 0.01]. CONCLUSIONS Early switch to a new biological is associated with a higher probability of healing of anti-TNF-induced skin lesions and significantly reduces the risk of IBD relapse.
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Affiliation(s)
- C Cottron
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - X Treton
- Department of Gastroenterology, IBD and Nutrition, Beaujon Hospital, APHP, Paris, France
| | - R Altwegg
- Department of Hepatogastroenterology, Saint Eloi Hospital, CHU de Montpellier, Montpellier, France
| | - C Reenaers
- Department of Gastroenterology, CHU Sart Tilman, Liège, Belgium
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - M Fumery
- Department of Gastroenterology, CHU de Amiens, and Peritox, UMR I-01, France
| | - L Vuitton
- Department of Hepatogastroenterology, CHRU de Besançon, Besançon, France
| | - L Peyrin-Biroulet
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - G Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
| | - O Dewit
- Department of Gastroenterology, Université Catholique de Louvain Saint Luc, Brussels, Belgium
| | - S Nancey
- Department of Gastroenterology, CHU de Lyon, Lyon Sud Hospital, University Claude Bernard Lyon 1, INSERM U1111, Lyon, France
| | - L Caillo
- Department of Hepatogastroenterology, CHU de Nîmes, Nîmes, France
| | - X Roblin
- Department of Hepatogastroenterology, CHU de Saint-Etienne, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France
| | - M Beylot-Barry
- Department of Dermatology, Saint-André Hospital, CHU de Bordeaux, France
| | - P Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
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Buisson A, Filippi J, Amiot A, Cadiot G, Allez M, Marteau P, Bouhnik Y, Pineton de Chambrun G, Pelletier AL, Nancey S, Moussata D, Attar A, Blain A, Vuitton L, Vernier-Massouille G, Seksik P, Nachury M, Dupas JL, Laharie D, Peyrin-Biroulet L, Louis E, Mary JY. Defining and Assessing the Reproducibility of Crohn's Disease Endoscopic Lesions: A Delphi-like Method from the GETAID. J Crohns Colitis 2021; 15:1000-1008. [PMID: 33313808 DOI: 10.1093/ecco-jcc/jjaa250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Defining and assessing the reproducibility of Crohn's disease [CD] endoscopic lesions is essential in assessing endoscopic healing. METHODS Twelve endoscopic CD experts from the GETAID defined aphthoid erosions [AE], superficial ulcerations [SU], deep ulcerations [DU], stenosis, and fistulas according to a Delphi-like method. Thirty different GETAID physicians declared if they found acceptable each definition. Intra- and inter-observer agreements were investigated using 100 videos with one tagged specific lesion [AE, SU, DU, or sham lesion] read by 15 independent endoscopists at baseline and 1 month later in a randomised order. Video quality was determined by an external reader. According to kappa estimate [κ ±standard error], intra or inter-observer agreement was qualified as 'moderate' [0.4-0.6], 'substantial' [0.6-0.8], or 'almost perfect' [0.8-1.0]. RESULTS Among 30 different experts, 83% to 97% found acceptable the definitions retrieved from the Delphi-like method. Intra-observer κ was 0.717 [±0.019] for SU, 0.681 [±0.027] for AE, 0.856 [±0.014] for DU, showing 'substantial' agreement. It was 0.801 [±0.016] for any ulceration [DU or SU]. There was a high variability across readers from 'moderate' to 'almost perfect' agreement. Inter-observer κ was 0.548 [±0.042] for SU, 0.554 [±0.028] for AE 0.694 [±0.041] for DU, and 0.705 [±0.042] for any ulceration. Inter-observer agreement increased when reading the 53 high-quality videos: 0.787 [±0.064] [p = 0.001], 0.607 [±0.043] [p = 0.001], and 0.782 [±0.064][p = 0.001] for DU, AE, and any ulceration, respectively. CONCLUSIONS Despite variable intra-agreement level across readers, the GETAID definitions for CD endoscopic lesions provided 'substantial' inter-observer agreements, especially in case of high-quality videos.
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Affiliation(s)
- A Buisson
- Université Clermont Auvergne, Inserm, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, Inserm U1071, Clermont-Ferrand, France
| | - J Filippi
- Archet 2 University Hospital, Department of Gastroenterology, Nice, France
| | - A Amiot
- Hospital Henri-Mondor, Department of Gastroenterology, Creteil, France
| | - G Cadiot
- University Hospital of Reims, Gastroenterology, Reims, France
| | - M Allez
- APHP, Hopital Saint Louis, Department of Gastroenterology, Paris, France
| | - P Marteau
- Hopital Lariboisiere, Gastroenterologie, Paris, France
| | - Y Bouhnik
- Beaujon Hospital, Department of Gastroenterology, Clichy la Garenne, France
| | | | - A L Pelletier
- APHP, Bichat Hospital, Gastroenterology Department, Paris, France
| | - S Nancey
- Hospices Civils de Lyon, Lyon-Sud Hospital, Gastroenterology, Pierre Benite, France
| | - D Moussata
- Hospices Civils de Lyon, Lyon-Sud Hospital, Gastroenterology, Pierre Benite, France
| | - A Attar
- Beaujon Hospital, Department of Gastroenterology, Clichy la Garenne, France
| | - A Blain
- APHP-IMM, Gastroenterology Department, Paris, France
| | - L Vuitton
- University Hospital of Besançon, Gastroenterology, Besançon, France
| | | | - P Seksik
- University Hospital of Saint Antoine, APHP, Gastroenterology, Paris, France
| | - M Nachury
- University Hospital of Lille, Gastroenterology, Lille, France
| | - J L Dupas
- Amiens University Hospital, Gastroenterology, Amiens, France
| | - D Laharie
- University Hospital Haut Levesque, Gastroenterology, Pessac, France
| | - L Peyrin-Biroulet
- Nancy University Hospital, Inserm NGERE U1256, Department of Gastroenterology, Vandoeuvre les Nancy, France
| | - E Louis
- Liège University Hospital, Department of Gastroenterology, Liege, Belgium
| | - J Y Mary
- Centre de Recherche Epidémiologie et Statistiques, Equipe ECSTRRA, Université de Paris, Hôpital Saint-Louis, Paris, France
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Bataille P, Layese R, Amiot A, Claudepierre P, Sbidian E. Incidence des réactions paradoxales chez les patients débutant un biomédicament : étude de cohorte de 9303 patients. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bataille P, Amiot A, Claudepierre P, Paris N, Neuraz A, Lerner I, Garcelon N, Rance B, Grisel O, Moreau T, Bernaux M, Audureau E, Sbidian E. Infection à SARS-CoV-2 et biomédicaments : une étude multicentrique française de 7808 patients. Revue du Rhumatisme 2020. [PMCID: PMC7700096 DOI: 10.1016/j.rhum.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Les formes sévères d’infection à COVID-19 sont liées à une importante réponse inflammatoire. Certains biomédicaments (BM) sont en cours d’évaluation dans des essais thérapeutiques avec pour rationnel cet orage cytokinique. À l’inverse, nous pouvons nous interroger sur le risque d’infections à COVID-19 chez les patients sous BM au long cours. L’objectif principal de notre étude était de déterminer l’impact de la prise d’un BM sur le taux d’hospitalisation, de passage en réanimation (ICU) et de décès chez les patients sous BM atteints d’une infection à COVID-19. Matériels et méthodes Étude de cohorte rétrospective multicentrique à partir des données médico-administratives de l’Entrepôt de Données de Santé (EDS) de l’APHP. L’ensemble des patients recevant un BM (anti-TNF, anti-IL-12/23, anti-IL-17 ou anti-intégrine) étaient inclus. Les événements d’intérêt étaient la survenue d’une hospitalisation, d’un séjour en ICU ou d’un décès dans le cadre d’une infection à COVID-19 (confirmée par RT-PCR ou TDM thoracique) entre le 01/02 et le 22/04/20. Le risque d’hospitalisation/ICU/décès était évalué selon la méthodologie du Ratio de Morbidité/Mortalité Standardisé (SMR) en calculant le rapport entre le nombre observé et le nombre attendu. Le nombre attendu d’hospitalisation/ICU/décès était calculé en appliquant le taux d’hospitalisation/ICU/décès à COVID-19 de la population d’Ile-de-France (par tranche d’âge de 20 ans et par sexe) au nombre de personnes sous BM dans la sous-classe correspondante de la même source de données (données EDS de l’APHP). Résultats Un total de7808 patients (âge médian 45 ans, 51 % de femmes) étaient inclus ; dont 48 avec un diagnostic d’infection à COVID-19 : 19 (40 %) hospitalisés, 4 (8 %) en ICU et 1 décès. En comparaison avec la population d’Ile-de-France, les taux d’hospitalisation et d’ICU étaient significativement élevés chez les patients sous BM avec SMR 2,19, IC95 % 1,32-3,42, p < 0,001 et SMR 6,04, IC95 % 1,62-15,45, p < 0,001 respectivement, significativement observés chez les [20-40[. Cependant, une analyse post-hoc suggérait que les SMR d’hospitalisation et d’ICU étaient surestimés, un retour aux compte-rendus mettant en évidence une poussée de la pathologie sous-jacente comme principal motif d’hospitalisation chez les [20-40[et non une infection à COVID-19 nécessitant une hospitalisation ou un passage en ICU. Aucun sur-risque de mortalité était mis en évidence. Discussion À partir d’une large base de données, notre étude a permis de confirmer que les taux d’hospitalisation, de passage en réanimation et de mortalité n’étaient pas augmentés chez les patients sous BM. Nos résultats sont concordants avec les différentes études publiées dans la littérature (Haberman et al., Favalli et al. ou Sanchez-Piedra et al.). Conclusion Ces résultats plaident pour un maintien des BM en période d’épidémie du virus COVID-19 pour éviter la rechute des pathologies inflammatoires de fond.
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Bataille P, Amiot A, Claudepierre P, Paris N, Neuraz A, Lerner I, Garcelon N, Rance B, Grisel O, Moreau T, Berneaux M, Audureau E, Sbidian E. Infection à SARS-CoV-2 et biomédicaments : étude multicentrique française de 7808 patients. Ann Dermatol Venereol 2020. [PMCID: PMC7688288 DOI: 10.1016/j.annder.2020.09.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Severyns T, Kirchgesner J, Lambert J, Thieblemont C, Amiot A, Abitbol V, Treton X, Cazals-Hatem D, Malamut G, Coppo P, Galicier L, Walter-Petrich A, Deau-Fischer B, Besson C, Aparicio T, Beaugerie L, Allez M, Gornet JM. Prognosis of Lymphoma in Patients With Known Inflammatory Bowel Disease: A French Multicentre Cohort Study. J Crohns Colitis 2020; 14:1222-1230. [PMID: 32161943 DOI: 10.1093/ecco-jcc/jjaa048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The prognosis of lymphoma that occurs in patients with inflammatory bowel disease [IBD] is poorly known. METHODS A multicentre retrospective cohort analysis was done in seven French tertiary centres from 1999 to 2019. Only lymphoma occurring in patients with previous established diagnosis of IBD were analysed. The primary outcome was progression-free survival at 3 years. RESULTS A total of 52 patients [male 65%, Crohn's disease 79%, median age 48.3 years, median duration of IBD 10.1 years] were included, of whom 37 had been previously exposed to immunosuppressants and/or biologics for at least 3 months and 20 had primary intestinal lymphomas. The lymphoma histological types were: diffuse large B cell lymphomas [N = 17], Hodgkin lymphomas [N = 17], indolent B cell lymphomas [N = 12], and others including T cell lymphomas, mantle cell lymphomas, and unclassifiable B cell lymphoma [N = 6]. The median follow-up after lymphoma was 5.1 years (interquartile range [IQR] 4-7.8). Progression-free survival at 3 years was 85% in the overall population (95% confidence interval [CI] 75%-96%) with no significant difference between the exposed and unexposed group, 79% for patients exposed to immunosuppressants and/or biologics [95% CI 67%-94%], and 83% for patients diagnosed with primary intestinal lymphoma [95% CI 67%-100%]. No relapse of IBD has been observed during chemotherapy. The IBD relapse rate at the end of the last chemotherapy cycle was 23% at 3 years [95% CI 11%-39%] in the overall population. CONCLUSIONS In this large cohort, the prognosis for lymphomas occurring in IBD appears to be good and similar to what is expected, irrespective of the exposure to biologics and/or immunosuppressants.
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Affiliation(s)
- T Severyns
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - J Kirchgesner
- Service de Gastroentérologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - J Lambert
- Service de Biostatistiques et Information Médicale, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - C Thieblemont
- Service d'Hémato-oncologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - A Amiot
- Service de Gastroentérologie, Hôpital Henri Mondor, UPEC, Créteil, France
| | - V Abitbol
- Service de Gastroentérologie, Hôpital Cochin, Université de Paris, Paris, France
| | - X Treton
- Service de Gastroentérologie, Hôpital Beaujon, Université de Paris, Clichy La Garenne, France
| | - D Cazals-Hatem
- Département de Pathologie, Hôpital Beaujon, Université de Paris, Clichy La Garenne. France
| | - G Malamut
- Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - P Coppo
- Service d'Hématologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - L Galicier
- Service d'Immunohématologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - A Walter-Petrich
- Service de Biostatistiques et Information Médicale, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - B Deau-Fischer
- Service d'Hématologie, Hôpital Cochin, Université de Paris, Paris, France
| | - C Besson
- Service d'Hématologie-Oncologie, Centre Hospitalier de Versailles, Université Versailles Saint Quentin en Yvelines, Université de Paris-Saclay, Le Chesnay, France
| | - T Aparicio
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - L Beaugerie
- Service de Gastroentérologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - M Allez
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - J M Gornet
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
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Briot C, Faure P, Parmentier AL, Nachury M, Trang C, Viennot S, Altwegg R, Bulois P, Thomassin L, Serrero M, Ah-Soune P, Gilletta C, Plastaras L, Simon M, Dray X, Caillo L, Del Tedesco E, Abitbol V, Zallot C, Degand T, Rossi V, Bonnaud G, Colin D, Morel B, Winkfield B, Danset JB, Filippi J, Amiot A, Attar A, Levy J, Peyrin-Biroulet L, Vuitton L. Efficacy, Tolerability, and Safety of Low-Volume Bowel Preparations for Patients with Inflammatory Bowel Diseases: The French Multicentre CLEAN Study. J Crohns Colitis 2019; 13:1121-1130. [PMID: 30785181 DOI: 10.1093/ecco-jcc/jjz040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.
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Affiliation(s)
- C Briot
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - P Faure
- Department of Gastroenterology, Clinique Pasteur, Toulouse, France
| | - A L Parmentier
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - M Nachury
- Gastroenterology Department, University Hospital of Lille, Lille, France
| | - C Trang
- Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France
| | - S Viennot
- Gastroenterology Department, University Hospital of Caen, Caen, France
| | - R Altwegg
- Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France
| | - P Bulois
- Department of Gastroenterology, Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille, France
| | - L Thomassin
- Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France
| | - M Serrero
- Department of Gastroenterology, APHM, Hopital Nord, Marseille, France
| | - P Ah-Soune
- Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France
| | - C Gilletta
- Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France
| | - L Plastaras
- Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | - X Dray
- Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France
| | - L Caillo
- Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France
| | - E Del Tedesco
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - V Abitbol
- Department of Gastroenterology, University Hospital Cochin, Paris, France
| | - C Zallot
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - T Degand
- Department of Gastroenterology, University Hospital Le Bocage, Dijon, France
| | - V Rossi
- Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France
| | - G Bonnaud
- Clinique Ambroise Paré, Toulouse, France
| | - D Colin
- Department of Gastroenterology, Clinique de la Miotte, Belfort, France
| | - B Morel
- Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France
| | - B Winkfield
- Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France
| | - J B Danset
- Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France
| | - J Filippi
- Department of Gastroenterology, University Hospital L'Archet, Nice, France
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - A Attar
- Gastroenterology Department, Beaujon University Hospital, Clichy, France
| | - J Levy
- Department of Gastroenterology, Clinique des Cèdres, Cornebarrieu, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - L Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
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Gendreau S, Amiot A, Le Baleur Y, Charpy C, Wolkenstein P, Chosidow O, Mekontso Dessap A, Ingen‐Housz‐Oro S, Prost N. Gastrointestinal involvement in Stevens–Johnson syndrome and toxic epidermal necrolysis: a retrospective case series. Br J Dermatol 2019; 180:1234-1235. [DOI: 10.1111/bjd.17428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- S. Gendreau
- Service de Réanimation Médicale Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - A. Amiot
- Service de Gastro‐entérologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - Y. Le Baleur
- Service de Gastro‐entérologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - C. Charpy
- Département de pathologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - P. Wolkenstein
- Service de Dermatologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) Créteil France
- Reference Center for Toxic Bullous Diseases Créteil France
| | - O. Chosidow
- Service de Dermatologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) Créteil France
- Reference Center for Toxic Bullous Diseases Créteil France
| | - A. Mekontso Dessap
- Service de Réanimation Médicale Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
- Groupe de Recherche Clinique CARMAS Université Paris Est‐Créteil Créteil France
| | - S. Ingen‐Housz‐Oro
- Service de Dermatologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) Créteil France
- Reference Center for Toxic Bullous Diseases Créteil France
| | - N. Prost
- Service de Réanimation Médicale Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
- Reference Center for Toxic Bullous Diseases Créteil France
- Groupe de Recherche Clinique CARMAS Université Paris Est‐Créteil Créteil France
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Gendreau S, Amiot A, Wolkenstein P, Chosidow O, Mekontso Dessap A, Oro S, de Prost N. Atteinte digestive au cours des nécrolyses épidermiques. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wils P, Bouhnik Y, Michetti P, Flourie B, Brixi H, Bourrier A, Allez M, Duclos B, Serrero M, Buisson A, Amiot A, Fumery M, Roblin X, Peyrin-Biroulet L, Filippi J, Bouguen G, Abitbol V, Coffin B, Simon M, Laharie D, Pariente B. Long-term efficacy and safety of ustekinumab in 122 refractory Crohn's disease patients: a multicentre experience. Aliment Pharmacol Ther 2018; 47:588-595. [PMID: 29315694 DOI: 10.1111/apt.14487] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/19/2017] [Accepted: 12/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term outcome of ustekinumab in Crohn's disease (CD) has not been evaluated. AIM To evaluate the long-term efficacy and safety of ustekinumab and identify the predictive factors of ustekinumab failure-free persistence in a cohort of anti-TNF refractory CD patients. METHODS We performed a retrospective multicentre cohort study including all consecutive CD patients who began subcutaneous ustekinumab and presented a clinical response (defined as a significant improvement of CD-related clinical symptoms assessed by the patient's physician leading to continued ustekinumab) during the first year of treatment. Primary outcome was treatment failure defined as withdrawal of treatment due to loss of response, intolerance or need for surgery. RESULTS Eighty-eight of the 122 (72%) CD patients beginning ustekinumab from March 2011 to December 2014, responded to ustekinumab and were followed up until November 2016. Median time on ustekinumab was 26.6 (13.4-34.4) months. Forty-seven patients (54%) continued ustekinumab with a clinical response and 38 (43%) stopped treatment (32 for failure, five for remission and one for pregnancy). Endoscopic response was observed in 82% of patients with endoscopic evaluation and mucosal healing in 39%. Ustekinumab failure-free persistence rates were 78% at 12 months, 66% at 24 months and 55% at 36 months. No predictive factor of ustekinumab failure-free persistence was identified. One severe adverse event was observed (anal adenocarcinoma). CONCLUSION In this cohort of refractory CD patients receiving long-term ustekinumab therapy, more than 50% of patients continued ustekinumab treatment with no loss of response, intolerance or surgery and with a good safety profile.
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Laharie D, Bourreille A, Branche J, Allez M, Bouhnik Y, Filippi J, Zerbib F, Savoye G, Vuitton L, Moreau J, Amiot A, Cosnes J, Ricart E, Dewit O, Lopez-Sanroman A, Fumery M, Carbonnel F, Bommelaer G, Coffin B, Roblin X, van Assche G, Esteve M, Farkkila M, Gisbert JP, Marteau P, Nahon S, de Vos M, Lambert J, Mary JY, Louis E. Long-term outcome of patients with steroid-refractory acute severe UC treated with ciclosporin or infliximab. Gut 2018; 67:237-243. [PMID: 28053054 DOI: 10.1136/gutjnl-2016-313060] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/09/2016] [Accepted: 12/11/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Ciclosporin and infliximab have demonstrated short-term similar efficacy as second-line therapies in patients with acute severe UC (ASUC) refractory to intravenous steroids. The aim of this study was to assess long-term outcome of patients included in a randomised trial comparing ciclosporin and infliximab. DESIGN Between 2007 and 2010, 115 patients with steroid-refractory ASUC were randomised in 29 European centres to receive ciclosporin or infliximab in association with azathioprine. Patients were followed until death or last news up to January 2015. Colectomy-free survival rates at 1 and 5 years and changes in therapy were estimated through Kaplan-Meier method and compared between initial treatment groups through log-rank test. RESULTS After a median follow-up of 5.4 years, colectomy-free survival rates (95% CI) at 1 and 5 years were, respectively, 70.9% (59.2% to 82.6%) and 61.5% (48.7% to 74.2%) in patients who received ciclosporin and 69.1% (56.9% to 81.3%) and 65.1% (52.4% to 77.8%) in those who received infliximab (p=0.97). Cumulative incidence of first infliximab use at 1 and 5 years in patients initially treated with ciclosporin was, respectively, 45.7% (32.6% to 57.9%) and 57.1% (43.0% to 69.0%). Only four patients from the infliximab group were subsequently switched to ciclosporin. Three patients died during the follow-up, none directly related to UC or its treatment. CONCLUSIONS In this cohort of patients with steroid-refractory ASUC initially treated by ciclosporin or infliximab, long-term colectomy-free survival was independent from initial treatment. These long-term results further confirm a similar efficacy and good safety profiles of both drugs and do not favour one drug over the other. TRIAL REGISTRATION NUMBER EudraCT: 2006-005299-42; ClinicalTrials.gouv number: NCT00542152; post-results.
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Affiliation(s)
- D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive-Université de Bordeaux, Bordeaux, France
| | - A Bourreille
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - J Branche
- CHRU de Lille, Hôpital Claude Huriez, Service des maladies de l'appareil digestif-Endoscopie digestive, Lille, France
| | - M Allez
- Hôpital Saint-Louis, service d'Hépato-Gastroentérologie, APHP-Université Paris VII, Paris, France
| | - Y Bouhnik
- Hôpital Beaujon, Gastroentérologie, MICI et Assistance Nutritive, APHP-Université Paris VII, Clichy, France
| | - J Filippi
- CHU de Nice, Hôpital de l'Archet 2, Service de Gastroentérologie et Nutrition Clinique, Nice, France
| | - F Zerbib
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive-Université de Bordeaux, Bordeaux, France
| | - G Savoye
- CHU de Rouen, Hôpital Charles Nicolle, service de Gastroentérologie, UMR 1073″, Normandie Université-Rouen, Rouen, France
| | - L Vuitton
- CHU de Besançon, Hôpital Jean Minjoz, Service de Gastroentérologie, Besançon, France
| | - J Moreau
- CHU de Toulouse, Hôpital Rangueil, Service de Gastro-entérologie et Nutrition, Toulouse, France
| | - A Amiot
- Hôpital Henri Mondor, Service d'Hépato-gastroentérologie, APHP-Université Créteil, Créteil, France
| | - J Cosnes
- Hôpital St-Antoine, service de Gastroentérologie, Paris, France
| | - E Ricart
- Gastroenterology Department, Hospital. Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - O Dewit
- UCL Saint Luc, Service d'Hépato-Gastroentérologie, Brussels, Belgium
| | - A Lopez-Sanroman
- Hospital Ramon y Cajal, Unidad de EII/IBD Unit, Servicio de Gastroenterología y Hepatología, Madrid, Spain
| | - M Fumery
- CHU Amiens, Hôpital Nord, service d'Hépato-Gastroentérologie, Amiens, France
| | - F Carbonnel
- Hôpital Bicêtre, service d'Hépato-Gastroentérologie, APHP-Université Paris Sud 11,Le Kremlin Bicêtre, France
| | - G Bommelaer
- CHU Clermont-Ferrand, Service Hépatologie-Gastro-entérologie, Clermont-Ferrand, France
| | - B Coffin
- Hôpital Louis Mourier, service d'Hépato-Gastroentérologie, Pôle Maladie Appareil Digestif, APHP-Université Paris VII, Colombes, France
| | - X Roblin
- CHU de Saint-Etienne, Hôpital Nord, Service de Gastro-entérologie et Hépatologie, Saint-Etienne, France
| | - G van Assche
- Division of Gastroenterology, University Hospital of Leuven, Leuven, Belgium
| | - M Esteve
- Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, University of Barcelona, Terrassa. CIBEREHD, Catalonia, Spain
| | - M Farkkila
- Helsinki University, and Helsinki University Central Hospital, Clinic of Gastroenterology, HUS, Finland
| | - J P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - P Marteau
- Hôpital St-Antoine, service de Gastroentérologie, Paris, France
| | - S Nahon
- CHI Le Raincy Montfermeil, Service d'Hépato-gastroentérologie, Montfermeil, France
| | - M de Vos
- Ghent University Hospital, Gent, Belgium
| | - J Lambert
- UMR-S- 1153 Inserm, Equipe ECSTRA, Denis Diderot-Paris 7 University, Hôpital Saint-Louis, Paris, France
| | - J Y Mary
- UMR-S- 1153 Inserm, Equipe ECSTRA, Denis Diderot-Paris 7 University, Hôpital Saint-Louis, Paris, France
| | - E Louis
- Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium
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Tadbiri S, Peyrin-Biroulet L, Serrero M, Filippi J, Pariente B, Roblin X, Buisson A, Stefanescu C, Trang-Poisson C, Altwegg R, Marteau P, Vaysse T, Bourrier A, Nancey S, Laharie D, Allez M, Savoye G, Gilletta C, Gagniere C, Vuitton L, Viennot S, Aubourg A, Pelletier AL, Bouguen G, Abitbol V, Fumery M, Claudepierre P, Bouhnik Y, Amiot A. Impact of vedolizumab therapy on extra-intestinal manifestations in patients with inflammatory bowel disease: a multicentre cohort study nested in the OBSERV-IBD cohort. Aliment Pharmacol Ther 2018; 47:485-493. [PMID: 29250803 DOI: 10.1111/apt.14419] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/26/2017] [Accepted: 10/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effectiveness of vedolizumab as a treatment for extraintestinal manifestations (EIM) is questionable due to its gut-specificity. AIM To assess effectiveness of vedolizumab for EIM in patients with inflammatory bowel disease (IBD) in a large real-life experience cohort. METHODS Between June and December 2014, 173 patients with Crohn's disease and 121 with ulcerative colitis were treated with vedolizumab. Patients were followed until week 54. EIM activity was assessed at weeks 0, 6, 14, 22, 30 and 54 by using a 3-step scale: complete remission, partial response and no response. RESULTS At baseline, 49 (16.7%) patients had EIMs of which 47 had inflammatory arthralgia/arthritis, four had cutaneous lesions and two had both rheumatologic and skin EIM. At week 54, 21 (44.7%) patients had complete remission for inflammatory arthralgia/arthritis and three (75%) for cutaneous EIM. In multivariate analysis, complete remission of inflammatory arthralgia/arthritis was associated with clinical remission of IBD (OR = 1.89, IC95% [1.05-3.41], P = .03) and recent onset of inflammatory arthralgia/arthritis (OR = 1.99, IC95% [1.12-3.52], P = .02). During the follow-up period, 34 (13.8%) patients without any EIM at baseline, developed incident cases of inflammatory arthralgia/arthritis consisting mostly of peripheral arthralgia without evidence of arthritis and 14 (4.8%) incident cases of paradoxical skin manifestation. CONCLUSION Vedolizumab therapy is commonly associated with improvement in EIM. This was associated with quiescent IBD and recent EIM. However, paradoxical skin manifestation and inflammatory arthralgia/arthritis may occur upon vedolizumab therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - P Marteau
- Lariboisière hospital, Paris, France
| | | | | | | | | | - M Allez
- Saint Louis hospital, Paris, France
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Martineau C, Flourié B, Wils P, Vaysse T, Altwegg R, Buisson A, Amiot A, Pineton de Chambrun G, Abitbol V, Fumery M, Hébuterne X, Viennot S, Laharie D, Beaugerie L, Nancey S, Sokol H. Efficacy and safety of golimumab in Crohn's disease: a French national retrospective study. Aliment Pharmacol Ther 2017; 46:1077-1084. [PMID: 29027693 DOI: 10.1111/apt.14371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/04/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anti-tumour necrosis factor (TNF) agents have improved the care of Crohn's disease (CD). After the first anti-TNF discontinuation, it is possible to switch to another anti-TNF. Three anti-TNF agents are available for ulcerative colitis (infliximab, adalimumab and golimumab), but only the first 2 have been approved for CD because golimumab has not been studied for this indication. AIM To report the efficacy and safety of golimumab in CD. METHODS Crohn's disease patients who received golimumab were identified in 12 French tertiary centres and were retrospectively analysed. The primary endpoint was the duration of golimumab treatment before escalation or discontinuation. The clinical response was defined as a decrease of more than 3 points in the Harvey-Bradshaw index or by global physician assessment. RESULTS One hundred and fifteen patients were included. The golimumab treatment duration was 9.8 months (0.55-44), and 48.7% of the patients were still under treatment at the end of follow-up. Clinical response was observed in 55.8% of the patients after a mean duration of 3.8 months. The probability of remaining under treatment without escalation at 6, 12 and 24 months was 54.6%, 34.9% and 19.3% respectively. In multivariate analysis, discontinuation of the first anti-TNF agent due to intolerance (odds ratio, OR = 2.16; 95% CI, confidence interval [1.25-3.86]; P = .005) and co-immunosuppression for more than 6 months (OR = 3.98; 95% CI [2.3-7.1]; P < .0001) were predictive factors of efficacy. Six per cent of the patients discontinued treatment due to intolerance. CONCLUSION After failure of infliximab or adalimumab for Crohn's disease, golimumab was safe and seemed beneficial in half of the patients.
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Affiliation(s)
- C Martineau
- Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), CHU, Paris, France
| | - B Flourié
- Lyon Sud Hospital, Hospices Civils de Lyon, CHU, Lyon, France
| | - P Wils
- Hurriez Hospital, CHU, Lille, France
| | - T Vaysse
- Kremlin-Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (APHP), CHU, Le Kremlin-Bicêtre, France
| | - R Altwegg
- Saint-Eloi Hospital, CHU, Montpellier, France
| | - A Buisson
- Clermont Ferrand Hospital, CHU, Clermont-Ferrand, France
| | - A Amiot
- Henri Mondor Hospital, Assistance Publique des Hôpitaux de Paris (APHP), CHU, Créteil, France
| | | | - V Abitbol
- Cochin Hospital, Assistance Publique des Hôpitaux de Paris (APHP), CHU, Paris, France
| | - M Fumery
- Amiens Hospital, CHU, Amiens, France
| | | | | | - D Laharie
- Haut-Levèque Hospital, CHU, Pessac, France
| | - L Beaugerie
- Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), CHU, Paris, France
| | - S Nancey
- Lyon Sud Hospital, Hospices Civils de Lyon, CHU, Lyon, France
| | - H Sokol
- Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris (APHP), CHU, Paris, France
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Amiot A, Serrero M, Peyrin-Biroulet L, Filippi J, Pariente B, Roblin X, Buisson A, Stefanescu C, Trang-Poisson C, Altwegg R, Marteau P, Vaysse T, Bourrier A, Nancey S, Laharie D, Allez M, Savoye G, Moreau J, Vuitton L, Viennot S, Aubourg A, Pelletier AL, Bouguen G, Abitbol V, Gagniere C, Bouhnik Y. One-year effectiveness and safety of vedolizumab therapy for inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2017; 46:310-321. [PMID: 28593685 DOI: 10.1111/apt.14167] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/23/2017] [Accepted: 05/09/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND We recently showed that vedolizumab is effective in patients with Crohn's disease (CD) and ulcerative colitis (UC) with prior anti-TNF failure in a multicentre compassionate early-access programme before marketing authorisation was granted to vedolizumab. AIMS To assess effectiveness and safety of vedolizumab at week 54 in patients UC and CD. METHODS Between June and December 2014, 173 patients with Crohn's disease (CD) and 121 with ulcerative colitis (UC) were treated with vedolizumab induction therapy. Among those 294 patients, 272 completed the induction period and were evaluated at the week 14 visit (161 patients with CD and 111 with UC). Disease activity was assessed using the Harvey-Bradshaw Index for CD and the partial Mayo Clinic score for UC. The primary outcome was steroid-free clinical remission at week 54. RESULTS At week 54, steroid-free clinical remission rates at week 54 were 27.2% and 40.5% in patients with CD and UC respectively. In addition, the sustained steroid-free clinical remission (from week 14 to week 54) rates were 8.1% and 19.0% respectively. No deaths were observed. Severe adverse events occurred in 17 (7.2%) patients, including six (2.5%) leading to vedolizumab discontinuation. CONCLUSION Vedolizumab is able to maintain steroid-free clinical remission in up to one-third of patients with UC and CD at week 54 with a reasonable safety profile. A significant number of patients experienced loss of response during the first year of treatment, particularly in patients with CD.
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Damy T, Galat A, Rouffiac S, Guendouz S, Kharoubi M, Ayad K, De Nadai N, Plante-Bordeneuve V, Lebras F, Amiot A, Radu C, Dubois-Rande J, Bodez D. P5845Prognosis of patients with cardiac amyloidosis referred in the French cardiac amyloidosis expert center. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T. Damy
- AP-HP - University Hospital Henri Mondor, Creteil, France
| | - A. Galat
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - S. Rouffiac
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - S. Guendouz
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - M. Kharoubi
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - K. Ayad
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - N. De Nadai
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | | | - F. Lebras
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - A. Amiot
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - C. Radu
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | | | - D. Bodez
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
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Amiot A, Stefanescu C, Bouhnik Y. Editorial: what can be done when infliximab stops working in ulcerative colitis? Authors' reply. Aliment Pharmacol Ther 2016; 43:165. [PMID: 26638931 DOI: 10.1111/apt.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- A Amiot
- EA75-73-EC2M3 Laboratory, Department of Gastroenterology, Henri Mondor Hospital, APHP, Paris Est Creteil-Val de Marne University, Creteil, France
| | - C Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, APHP, Beaujon Hospital, Paris VII University, Clichy, France
| | - Y Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, APHP, Beaujon Hospital, Paris VII University, Clichy, France.
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Dumitrescu G, Amiot A, Seksik P, Baudry C, Stefanescu C, Gagniere C, Allez M, Cosnes J, Bouhnik Y. The outcome of infliximab dose doubling in 157 patients with ulcerative colitis after loss of response to infliximab. Aliment Pharmacol Ther 2015; 42:1192-9. [PMID: 26354674 DOI: 10.1111/apt.13393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 01/22/2015] [Accepted: 08/13/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Optimising infliximab therapy is recommended in inflammatory bowel disease (IBD) patients who lose response to infliximab; however, there are no data on the outcome of ulcerative colitis (UC) patients after doubling the dose. AIM To determine the efficacy and safety of infliximab dose doubling in UC patients with a loss of response to infliximab. METHODS From January 2006 to May 2013, we retrospectively reviewed the outcome of the consecutive UC patients who were treated with infliximab dose doubling (10 mg/kg) for loss of response in four French academic centres. The clinical response and remission were assessed. A composite event-free survival analysis was performed using the log-rank test and the Cox model. RESULTS One hundred and fifty-seven patients [84 males; median age 37. 6 (IQR 28.2-49.4) years] were included. The median follow-up after infliximab dose doubling was 1.8 (1.0-3.1) years. At weeks 8 and 24, 55% and 43% of the patients achieved a clinical response respectively. The probabilities of the event-free survival were 71%, 61% and 55% at 6 months, 1 year and 2 years respectively. In the multivariate analysis, the predictors of infliximab dose doubling failure were the absence of the introduction of an immunomodulator concomitantly to dose doubling, a partial Ulcerative Colitis Disease Activity Index >6, a C-reactive protein level >10 mg/L, a leucocyte count >8000/mm(3) and a haemoglobin level <12.5 g/dL. Adverse events were reported in 12 patients (8%). CONCLUSIONS Infliximab dose doubling led to short- and long-term event-free survival in UC patients, who had a loss of response to infliximab, in greater than 50% of the cases. The benefits of such a strategy were significantly improved by adding a concomitant immunomodulator.
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Affiliation(s)
- G Dumitrescu
- Department of Gastroenterology, IBD and Nutrition Support, APHP, Beaujon Hospital, Paris VII University, Clichy, France.,University of Medicine and Pharmacy "Gr. T Popa", Iasi, Romania
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EA73-75-EC2M3 Laboratory, Paris Est Creteil-Val de Marne University, Creteil, France
| | - P Seksik
- Department of Gastroenterology, Saint Antoine Hospital, APHP, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - C Baudry
- Department of Gastroenterology, Saint Louis Hospital, APHP, Équipe Avenir Inserm U940, Paris VII University, Paris, France
| | - C Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, APHP, Beaujon Hospital, Paris VII University, Clichy, France
| | - C Gagniere
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EA73-75-EC2M3 Laboratory, Paris Est Creteil-Val de Marne University, Creteil, France
| | - M Allez
- Department of Gastroenterology, Saint Louis Hospital, APHP, Équipe Avenir Inserm U940, Paris VII University, Paris, France
| | - J Cosnes
- Department of Gastroenterology, Saint Antoine Hospital, APHP, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Y Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, APHP, Beaujon Hospital, Paris VII University, Clichy, France
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Gagniere C, Beaugerie L, Pariente B, Seksik P, Amiot A, Abitbol V, Allez M, Cosnes J, Sokol H. Benefit of infliximab reintroduction after successive failure of infliximab and adalimumab in Crohn's disease. J Crohns Colitis 2015; 9:349-55. [PMID: 25547977 DOI: 10.1093/ecco-jcc/jju024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Infliximab [IFX] and adalimumab [ADA] are effective in Crohn's disease [CD] for induction and maintenance therapy. However, high annual rate of discontinuation for loss of response or intolerance may lead to a switch to another anti-tumor necrosis factor agent. Patients with successive failure to IFX and ADA are becoming more frequent. The aim of this study was to assess the efficacy and the tolerance of re-treatment with IFX in CD patients who successively failed IFX and ADA. METHODS A total of 61 patients with CD who received and discontinued successively IFX and ADA, and who were re-exposed to IFX, were identified in four French tertiary centers and retrospectively analyzed. Clinical data, follow-up and outcome were abstracted from medical records. RESULTS Median treatment duration after reintroduction was 16 months, and probability of remaining under IFX was 60% and 51%, respectively, at 12 and 24 months. In all 29 patients discontinued the second IFX treatment due to intolerance [13], primary non-response [8], loss of response [7] or patient's wish [1]. Remission was achieved in 42% at week 6-8 after IFX re-induction, and was predictive of better long-term response [p = 0.006]. In multivariate analysis, receiving co-immunosuppression in both first and second IFX treatments [p = 0.04] and shorter interval between first and second IFX treatments [p = 0.017] were independently associated with longer duration of second IFX treatment. CONCLUSION For CD patients who successively failed IFX and ADA, reintroducing IFX is feasible and often clinically efficient, particularly in patients who received co-immunosuppression during both first and second IFX treatments.
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Affiliation(s)
- C Gagniere
- Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France
| | - L Beaugerie
- Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France
| | - B Pariente
- Department of Gastroenterology, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris and Paris VII University, Paris, France
| | - P Seksik
- Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris and Paris XII University, Paris, France
| | - V Abitbol
- Department of Gastroenterology, Cochin Hospital, Assistance Publique Hôpitaux de Paris and Paris V University, Paris, France
| | - M Allez
- Department of Gastroenterology, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris and Paris VII University, Paris, France
| | - J Cosnes
- Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France
| | - H Sokol
- Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France
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Seirafi M, de Vroey B, Amiot A, Seksik P, Roblin X, Allez M, Peyrin-Biroulet L, Marteau P, Cadiot G, Laharie D, Boureille A, De Vos M, Savoye G, Rahier JF, Carbonnel F, Bonaz B, Colombel JF, Bouhnik Y. Factors associated with pregnancy outcome in anti-TNF treated women with inflammatory bowel disease. Aliment Pharmacol Ther 2014; 40:363-73. [PMID: 24980270 DOI: 10.1111/apt.12833] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/11/2013] [Accepted: 05/21/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The safety of anti-tumour necrosis factor (TNF) agents during pregnancy is a major concern for child-bearing women and physicians. AIM To assess the impact of anti-TNF therapy on adverse pregnancy and foetal outcomes in women with inflammatory bowel disease (IBD). METHODS Pregnancies occurring during anti-TNF treatment or less than 3 months after its cessation in IBD patients followed in GETAID centres were recorded from January 2009 to December 2010. Ninety-nine pregnancies in women without anti-TNF treatment were identified from the CESAME registry. We compared pregnancy and neonatal outcomes by a case-control study. RESULTS In the 124 IBD patients followed, 133 pregnancies were reported. At the conception time, 23% of patients had active disease. Eighty-eight per cent (n = 117) of the 133 pregnancies followed until delivery resulted in 118 liveborns (one twin pregnancy). Complications were observed in 47 (35%) women and 24 (20%) newborns. In multivariate analysis, factors associated with pregnancy complications were: current smoking (P = 0.004), a B2 (stenotic) phenotype in CD women (P = 0.004), occurrence of a flare during pregnancy (P = 0.006) and a past history of complicated pregnancy (P = 0.007). Current smoking was the only factor associated with severe (i.e. potentially lethal) pregnancy complications (P = 0.02). Having IBD for more than 10 years prior to conception was associated with newborn complications (P = 0.007). No difference was found with the control group for any of the pregnancy and neonatal outcomes. CONCLUSION In our series, the safety profile of anti-TNF therapy during pregnancy and the neonatal period appears similar to control group of IBD women not treated with anti-TNF therapy.
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Affiliation(s)
- M Seirafi
- Beaujon University Hospital Paris VII University, Clichy, France; Geneva University Hospital, Geneva, Switzerland
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Ingen-Housz-Oro S, Amiot A, Ortonne N, Hüe S. [Dermatitis herpetiformis antibodies: What the dermatologist must know]. Ann Dermatol Venereol 2014; 141:387-91. [PMID: 24835656 DOI: 10.1016/j.annder.2014.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/26/2014] [Accepted: 03/05/2014] [Indexed: 01/16/2023]
Affiliation(s)
- S Ingen-Housz-Oro
- Service de dermatologie, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
| | - A Amiot
- Service de gastro-entérologie, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Université Paris-Est-Créteil (UPEC) Val-de-Marne, 61, avenue du Général-de-Gaulle, 94010 Créteil, France
| | - N Ortonne
- Université Paris-Est-Créteil (UPEC) Val-de-Marne, 61, avenue du Général-de-Gaulle, 94010 Créteil, France; Service d'anatomie pathologique, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - S Hüe
- Université Paris-Est-Créteil (UPEC) Val-de-Marne, 61, avenue du Général-de-Gaulle, 94010 Créteil, France; Service d'immunologie biologique, équipe 16, U955, IMRB, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
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Amiot A, Lévy M, Copie-Bergman C, Dupuis J, Szablewski V, Le Baleur Y, Baia M, Belhadj K, Sobhani I, Leroy K, Haioun C, Delchier JC. Rituximab, alkylating agents or combination therapy for gastric mucosa-associated lymphoid tissue lymphoma: a monocentric non-randomised observational study. Aliment Pharmacol Ther 2014; 39:619-28. [PMID: 24467480 DOI: 10.1111/apt.12635] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 12/14/2013] [Accepted: 01/06/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is no consensus on the standard treatment of gastric mucosa-associated lymphoid tissue (MALT) lymphoma for Helicobacter pylori-negative patients and for patients with persistent disease despite H. pylori eradication. AIM To evaluate the comparative efficacy and safety of alkylating agents and rituximab alone or in combination. METHODS In this monocentric retrospective study, which included 106 patients who had not been previously treated with anti-cancer agents, we evaluated the efficacy and safety of oral alkylating agents monotherapy (n = 48), rituximab monotherapy (n = 28) and the therapy combining both drugs (n = 30). Evaluations were performed at weeks 6 (W6), 25 (W25), and 52 (W52) and after 2 years (W104). RESULTS After a median follow-up period of 4.9 years (range 0.4-17.2 years), complete remission and overall response were significantly higher in patients in the combination therapy group at W104 (92% and 100% respectively) compared with patients treated with alkylating agents alone (66% and 68%) and rituximab alone (64% and 73%). The 5-year progression-free survival probabilities were 68%, 70% and 89% in patients treated with alkylating agents alone, rituximab alone and combination therapy respectively. Haematological adverse events were reported in 32 (30%) patients (mostly grade 1) and were more frequent in the two groups receiving alkylating agents (P = 0.05 and P < 0.001). No toxicity-related death was reported. CONCLUSIONS The use of anti-cancer systemic therapy is safe and efficient in gastric MALT lymphoma. In this retrospective study, the combination of rituximab plus chlorambucil seems more efficient than rituximab or alkylating agents alone. Rituximab has a better safety profile than regimens containing alkylating agents.
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Affiliation(s)
- A Amiot
- Department of Gastroenterology, Albert Chenevier-Henri Mondor Hospital, Créteil, France; Department of Pathology, Albert Chenevier-Henri Mondor Hospital, Créteil, France; Lymphoid Malignancies Unit, Albert Chenevier-Henri Mondor Hospital, Créteil, France
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Sabbagh C, Amiot A, Maggiori L, Corcos O, Joly F, Panis Y. Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases. Neurogastroenterol Motil 2013; 25:e680-6. [PMID: 23895212 DOI: 10.1111/nmo.12191] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic intestinal pseudo-obstruction (CIPO) is a recurrent disorder caused by intestinal dysmotility. Although, CIPO is not a surgically remediable condition, surgery is a common issue in CIPO patients. The aim of this study was to assess postoperative morbidity and mortality of patients operated on for CIPO and risk of re-operation. METHODS Adult patients that have undergone surgery for CIPO since 1980 were included in this retrospective study using a prospective database. Postoperative morbidity, according to Clavien-Dindo classification and CIPO-related re-operation rates were evaluated with univariate and multivariate analysis. KEY RESULTS Sixty-three patients (33 women, median age 37 [range: 15-79] years) were included. Median follow-up was 6 (0.2-28) years. Overall postoperative mortality rate was 7.9%. Overall morbidity rate was 58.2% (Clavien-Dindo ≥3 in 20.7%) leading to re-operation in 17% of cases. In multivariate analysis, major postoperative morbidity (Clavien-Dindo ≥3) was significantly increased when there was an intraoperative bowel injury (HR = 15.7 [2.4-102], P = 0.004), idiopathic CIPO (HR = 4.2 [1.5-12], P = 0.007) and emergency procedure (HR = 3 [1.3-6.8]. After the first surgery, probabilities of CIPO-related re-operation were 44%, 60%, and 66% at 1, 3, and 5 years respectively. In multivariate analysis, CIPO-related reoperation for CIPO was significantly increased when there was a major postoperative morbidity (HR = 2.1 [1.1-4.4], P = 0.040) and intraoperative bowel injury (HR = 33.1 [2-553], P = 0.015) after the first procedure. CONCLUSIONS & INFERENCES The surgical management of CIPO patients was associated with high postoperative morbidity and mortality rates and frequent re-operation. Attempts should be made to avoid surgery when possible and optimize nutritional status.
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Affiliation(s)
- C Sabbagh
- Department of Colorectal Surgery, Beaujon Hospital, APHP, Clichy, France; University Diderot Paris 7, Paris, France
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Chollet-Martin S, Nicaise-Roland P, de Chaisemartin L, Grootenboer-Mignot S, Hayem G, Pelletier AL, Amiot A, Descamps V, Bouhnik Y, Meyer O. AB0497 Simultaneous determination of anti-infliximab antibodies and residual infliximab levels to monitor anti-TNF therapy. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Amiot A, Joly F, Cazals-Hatem D, Merrouche M, Jouet P, Coffin B, Bouhnik Y. Prognostic yield of esophageal manometry in chronic intestinal pseudo-obstruction: a retrospective cohort of 116 adult patients. Neurogastroenterol Motil 2012; 24:1008-e542. [PMID: 22762287 DOI: 10.1111/j.1365-2982.2012.01973.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic intestinal pseudo-obstruction (CIPO) refers to a wide and heterogeneous group of neuromuscular disorders, which classically involve the small intestine. However, further investigation is required to determine if motility disturbances involve all parts of the gastrointestinal (GI) tract. METHODS Medical records and follow-up examinations of 116 adult CIPO patients [70F, median age 28 (0-79) years] were reviewed and performed at our institution since 1980. Manometry (esophageal, small bowel and anorectal) and gastric emptying scintigraphy reports were retrieved and analyzed. Survival, home parenteral nutrition requirement, and the inability to maintain sufficient oral feeding was analyzed using univariate and multivariate analysis. KEY RESULTS The median follow-up time was 6 (0.1-30) years. In all, 90% of patients who underwent at least one motility test, with the exception of small bowel manometry, exhibited at least one abnormal pattern. Esophageal manometry was abnormal in 73% of the cases, including 51% with severe ineffective esophageal motility. Anorectal manometry was abnormal in 59% of the cases, including only 17% with severe abnormalities. Gastric emptying was abnormal in 61% of the cases. Only esophageal motor disorders had significant predicting values for survival, home parenteral nutrition requirement, and an inability to maintain sufficient oral feeding. CONCLUSIONS & INFERENCES Our study showed that CIPO was associated with a diffuse involvement of all parts of the GI tract and was not restricted to the small intestine in 90% of the cases studied. Esophageal manometry had a significant prognostic yield and should be systematically performed in CIPO patients.
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Affiliation(s)
- A Amiot
- Department of Gastroenterology and Nutrition Support, Beaujon Hospital, APHP, Clichy, France. aurelien.amiot.aphp.fr
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Lefevre JH, Amiot A, Joly F, Bretagnol F, Panis Y. Risk of recurrence after surgery for chronic radiation enteritis. Br J Surg 2011; 98:1792-7. [DOI: 10.1002/bjs.7655] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2011] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Approximately one-third of patients with chronic radiation enteritis (CRE) require surgery, which is associated with a high morbidity rate and a high risk of reoperation. The aim of this study was to report outcome after surgery for CRE.
Methods
Patients with CRE who underwent operation with extensive small bowel resection between 1980 and 2009 were included in the study. Postoperative morbidity and mortality, reoperation for recurrent enteritis and risk factors for reoperation were analysed.
Results
Of 107 patients (94 women; 87·8 per cent) with CRE included in the study, the main indication for surgery was symptomatic stricture (82 patients; 76·6 per cent). Forty-nine ileocaecal resections (45·8 per cent) were performed. Overall and surgical morbidity rates were 74·8 per cent (80 patients) and 28·0 per cent (30) respectively. Fourteen patients (13·1 per cent) underwent reoperation for complications. Reoperation rates for CRE at 1 and 3 years of follow-up were 37 and 54 per cent respectively. Risk factors for reoperation for recurrent enteritis were: emergency surgery (odds ratio (OR) 2·72, 95 per cent confidence interval 1·57 to 4·86), anastomotic leakage (OR 2·53, 1·54 to 4·42) and male sex (OR 3·57, 1·82 to 7·29). The only protective factor for reoperation was ileocaecal resection during the first surgical procedure (OR 4·48, 2·52 to 8·31).
Conclusion
Ileocaecal resection was the only factor that protected against reoperation for recurrent CRE, demonstrating the importance of resecting all damaged tissue in these patients. These results suggest that there is little place for intestinal bypass surgery or adhesiolysis.
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Affiliation(s)
- J H Lefevre
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - A Amiot
- Department of Gastroenterology and Nutritive Assistance, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - F Joly
- Department of Gastroenterology and Nutritive Assistance, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - F Bretagnol
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
| | - Y Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital—Assistance Publique des Hôpitaux de Paris, Université Paris VII (Denis Diderot), Clichy Cedex, France
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Amiot A, Joly F, Messing B, Sokol H, Lavergne-Slove A, Delattre JY, Bouhnik Y. Pseudo-obstruction intestinale chronique et syndrome des anti-Hu : 13ans de suivi sans apparition de néoplasie. ACTA ACUST UNITED AC 2008; 32:51-5. [DOI: 10.1016/j.gcb.2007.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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