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Lassalle R, Lignot-Maleyran S, Micon S, Lorrain S, Jové J, Larrey D, Meunier L, Pageaux GP, Droz-Perroteau C, Moore N. Exposition médicamenteuse et risque d’insuffisance hépatique aiguë conduisant à l’inscription sur liste de transplantation (IHAT) : résultats de l’étude SALT-III chez des adultes en France. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.018] [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: 11/17/2022] Open
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Pol S, Haour G, Fontaine H, Dorival C, Petrov-Sanchez V, Bourliere M, Capeau J, Carrieri P, Larrey D, Larsen C, Marcellin P, Pawlostky JM, Nahon P, Zoulim F, Cacoub P, de Ledinghen V, Mathurin P, Negro F, Pageaux GP, Yazdanpanah Y, Wittkop L, Zarski JP, Carrat F. The negative impact of HBV/HCV coinfection on cirrhosis and its consequences. Aliment Pharmacol Ther 2017; 46:1054-1060. [PMID: 28994127 DOI: 10.1111/apt.14352] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 05/16/2017] [Revised: 06/09/2017] [Accepted: 09/10/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV)/hepatitis C virus (HCV) confection has been rarely studied in nonasian series. AIM To compare the characteristics of HBV/HCV coinfected patients to those of HBV- or HCV-monoinfected patients in the ANRS CO22 HEPATHER cohort study. PATIENTS AND METHODS Of the 20 936 included patients, 95 had HBV/HCV coinfection (hepatitis B surface antigen, anti-HCV antibody and HCV RNA positive) and were matched with 375 HBV- and 380 HCV-monoinfected patients on age, gender and time since HBV or HCV diagnosis. RESULTS F3-F4 fibrosis was more frequent in coinfected patients (58%) than in HBV- (32%, P < .0001), but similar in HCV-monoinfected patients (52%, P = .3142). Decompensated cirrhosis was more frequent in coinfected patients (11%) than in HBV- (2%, P = .0002) or HCV- (4%, P = .0275) monoinfected patients. Past excessive alcohol use was more frequent in coinfected patients (26%) than in HBV (12%, P = .0011), but similar in HCV monoinfected patients (32%, P = .2868). Coinfected patients had a higher proportion with arterial hypertension (42%) than HBV- (26%) or HCV-monoinfected patients (25%) (P < .003). Multivariable analysis confirmed the association between F3-F4 fibrosis and HCV infection in HBV-infected patients (OR = 3.84, 95% CI 1.99-7.43) and the association between decompensated cirrhosis and coinfection in HBV infected (OR = 5.58, 95% CI 1.42-22.0) or HCV infected patients (OR = 3.02, 95% CI 1.22-7.44). CONCLUSIONS HCV coinfection harmfully affects liver fibrosis in HBV patients, while decompensated cirrhosis is increased in coinfected patients compared with HBV- or HCV-monoinfected patients. HCV treatment is as safe and effective in coinfected as monoinfected patients and should be considered following the same rules as HCV monoinfected patients.
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Affiliation(s)
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- Bondy, France.,Saint-Denis, France
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Bousquet J, Bourret R, Camuzat T, Augé P, Bringer J, Noguès M, Jonquet O, de la Coussaye JE, Ankri J, Cesari M, Guérin O, Vellas B, Blain H, Arnavielhe S, Avignon A, Combe B, Canovas G, Daien C, Dray G, Dupeyron A, Jeandel C, Laffont I, Laune D, Marion C, Pastor E, Pélissier JY, Galan B, Reynes J, Reuzeau JC, Bedbrook A, Granier S, Adnet PA, Amouyal M, Alomène B, Bernard PL, Berr C, Caimmi D, Claret PG, Costa DJ, Cristol JP, Fesler P, Hève D, Millot-Keurinck J, Morquin D, Ninot G, Picot MC, Raffort N, Roubille F, Sultan A, Touchon J, Attalin V, Azevedo C, Badin M, Bakhti K, Bardy B, Battesti MP, Bobia X, Boegner C, Boichot S, Bonnin HY, Bouly S, Boubakri C, Bourrain JL, Bourrel G, Bouix V, Bruguière V, Cade S, Camu W, Carre V, Cavalli G, Cayla G, Chiron R, Coignard P, Coroian F, Costa P, Cottalorda J, Coulet B, Coupet AL, Courrouy-Michel MC, Courtet P, Cros V, Cuisinier F, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dujols P, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fouletier M, Fraisse P, Gabrion P, Gellerat-Rogier M, Gelis A, Genis C, Giraudeau N, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hayot M, Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Kouyoudjian P, Lamoureux R, Landreau L, Lapierre M, Larrey D, Laurent C, Léglise MS, Lemaitre JM, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert CM, Makinson A, Mandrick K, Mares P, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G, Messner P, Meunier C, Mondain M, Morales R, Morel J, Mottet D, Nérin P, Nicolas P, Nouvel F, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Portejoie F, Pujol JLE, Quantin X, Quéré I, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Robine JM, Rolland C, Royère E, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Stephan Y, Strubel D, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Tribout V, Uziel A, Van de Perre P, Venail F, Vergne-Richard C, Vergotte G, Vian L, Vialla F, Viart F, Villain M, Viollet E, Ychou M, Mercier J. MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing. J Frailty Aging 2017; 5:233-241. [PMID: 27883170 DOI: 10.14283/jfa.2016.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.
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Affiliation(s)
- J Bousquet
- Professor Jean Bousquet, CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France, Tel +33 611 42 88 47,
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Ratziu V, Harrison SA, Francque S, Bedossa P, Lehert P, Serfaty L, Romero-Gomez M, Boursier J, Abdelmalek M, Caldwell S, Drenth J, Anstee QM, Hum D, Hanf R, Roudot A, Megnien S, Staels B, Sanyal A, Gournay J, Nguyen-Khac E, De Ledinghen V, Larrey D, Tran A, Bourliere M, Maynard-Muet M, Asselah T, Henrion J, Nevens F, Cassiman D, Geerts A, Moreno C, Beuers U, Galle P, Spengler U, Bugianesi E, Craxi A, Angelico M, Fargion S, Voiculescu M, Gheorghe L, Preotescu L, Caballeria J, Andrade R, Crespo J, Callera J, Ala A, Aithal G, Abouda G, Luketic V, Huang M, Gordon S, Pockros P, Poordad F, Shores N, Moehlen M, Bambha K, Clark V, Satapathy S, Parekh S, Reddy R, Sheikh M, Szabo G, Vierling J, Foster T, Umpierrez G, Chang C, Box T, Gallegos-Orozco J. Elafibranor, an Agonist of the Peroxisome Proliferator-Activated Receptor-α and -δ, Induces Resolution of Nonalcoholic Steatohepatitis Without Fibrosis Worsening. Gastroenterology 2016; 150:1147-1159.e5. [PMID: 26874076 DOI: 10.1053/j.gastro.2016.01.038] [Citation(s) in RCA: 708] [Impact Index Per Article: 88.5] [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: 10/19/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Elafibranor is an agonist of the peroxisome proliferator-activated receptor-α and peroxisome proliferator-activated receptor-δ. Elafibranor improves insulin sensitivity, glucose homeostasis, and lipid metabolism and reduces inflammation. We assessed the safety and efficacy of elafibranor in an international, randomized, double-blind placebo-controlled trial of patients with nonalcoholic steatohepatitis (NASH). METHODS Patients with NASH without cirrhosis were randomly assigned to groups given elafibranor 80 mg (n = 93), elafibranor 120 mg (n = 91), or placebo (n = 92) each day for 52 weeks at sites in Europe and the United States. Clinical and laboratory evaluations were performed every 2 months during this 1-year period. Liver biopsies were then collected and patients were assessed 3 months later. The primary outcome was resolution of NASH without fibrosis worsening, using protocol-defined and modified definitions. Data from the groups given the different doses of elafibranor were compared with those from the placebo group using step-down logistic regression, adjusting for baseline nonalcoholic fatty liver disease activity score. RESULTS In intention-to-treat analysis, there was no significant difference between the elafibranor and placebo groups in the protocol-defined primary outcome. However, NASH resolved without fibrosis worsening in a higher proportion of patients in the 120-mg elafibranor group vs the placebo group (19% vs 12%; odds ratio = 2.31; 95% confidence interval: 1.02-5.24; P = .045), based on a post-hoc analysis for the modified definition. In post-hoc analyses of patients with nonalcoholic fatty liver disease activity score ≥4 (n = 234), elafibranor 120 mg resolved NASH in larger proportions of patients than placebo based on the protocol definition (20% vs 11%; odds ratio = 3.16; 95% confidence interval: 1.22-8.13; P = .018) and the modified definitions (19% vs 9%; odds ratio = 3.52; 95% confidence interval: 1.32-9.40; P = .013). Patients with NASH resolution after receiving elafibranor 120 mg had reduced liver fibrosis stages compared with those without NASH resolution (mean reduction of 0.65 ± 0.61 in responders for the primary outcome vs an increase of 0.10 ± 0.98 in nonresponders; P < .001). Liver enzymes, lipids, glucose profiles, and markers of systemic inflammation were significantly reduced in the elafibranor 120-mg group vs the placebo group. Elafibranor was well tolerated and did not cause weight gain or cardiac events, but did produce a mild, reversible increase in serum creatinine (effect size vs placebo: increase of 4.31 ± 1.19 μmol/L; P < .001). CONCLUSIONS A post-hoc analysis of data from trial of patients with NASH showed that elafibranor (120 mg/d for 1 year) resolved NASH without fibrosis worsening, based on a modified definition, in the intention-to-treat analysis and in patients with moderate or severe NASH. However, the predefined end point was not met in the intention to treat population. Elafibranor was well tolerated and improved patients' cardiometabolic risk profile. ClinicalTrials.gov number: NCT01694849.
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Affiliation(s)
- Vlad Ratziu
- Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France; Institute of Cardiometabolism and Nutrition, INSERM, UMRS 938, Paris, France.
| | - Stephen A Harrison
- Department of Medicine, Gastroenterology and Hepatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Pierre Bedossa
- Department of Pathology, Hôpital Beaujon, University Paris-Denis Diderot, Paris, France
| | - Philippe Lehert
- Department of Psychiatry, the University of Melbourne, Melbourne, Australia; Faculty of Economics, University of Louvain UCL, Belgique, Belgium
| | - Lawrence Serfaty
- Université Pierre et Marie Curie, Hôpital Saint-Antoine, Paris, France
| | - Manuel Romero-Gomez
- Unit for the Clinical Management of Digestive Diseases and CIBERehd, Hospital Universitario de Valme, Sevilla
| | - Jérôme Boursier
- Hepatology Department, University Hospital and LUNAM University, Angers, France
| | | | - Steve Caldwell
- Gastroenterology and Hepatology Division, University of Virginia, Charlottesville, Virginia
| | - Joost Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | | | - Bart Staels
- University of Lille, INSERM UMR1011, Institut Pasteur de Lille, European Genomic Institute for Diabetes, Lille, France
| | - Arun Sanyal
- Virginia Commonwealth University, Richmond, Virginia
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Boursier J, Ducancelle A, Vergniol J, Veillon P, Moal V, Dufour C, Bronowicki JP, Larrey D, Hézode C, Zoulim F, Fontaine H, Canva V, Poynard T, Allam S, De Lédinghen V. The CUPIC algorithm: an accurate model for the prediction of sustained viral response under telaprevir or boceprevir triple therapy in cirrhotic patients. J Viral Hepat 2015. [PMID: 26216230 DOI: 10.1111/jvh.12433] [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] [Indexed: 12/09/2022]
Abstract
Triple therapy using boceprevir or telaprevir remains the reference treatment for genotype 1 chronic hepatitis C in countries where new interferon-free regimens have not yet become available. Antiviral treatment is highly required in cirrhotic patients, but they represent a difficult-to-treat population. We aimed to develop a simple algorithm for the prediction of sustained viral response (SVR) in cirrhotic patients treated with triple therapy. A total of 484 cirrhotic patients from the ANRS CO20 CUPIC cohort treated with triple therapy were randomly distributed into derivation and validation sets. A total of 52.1% of patients achieved SVR. In the derivation set, a D0 score for the prediction of SVR before treatment initiation included the following independent predictors collected at day 0: prior treatment response, gamma-GT, platelets, telaprevir treatment, viral load. To refine the prediction at the early phase of the treatment, a W4 score included as additional parameter the viral load collected at week 4. The D0 and W4 scores were combined in the CUPIC algorithm defining three subgroups: 'no treatment initiation or early stop at week 4', 'undetermined' and 'SVR highly probable'. In the validation set, the rates of SVR in these three subgroups were, respectively, 11.1%, 50.0% and 82.2% (P < 0.001). By replacing the variable 'prior treatment response' with 'IL28B genotype', another algorithm was derived for treatment-naïve patients with similar results. The CUPIC algorithm is an easy-to-use tool that helps physicians weigh their decision between immediately treating cirrhotic patients using boceprevir/telaprevir triple therapy or waiting for new drugs to become available in their country.
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Affiliation(s)
- J Boursier
- Department of Hepatology and Gastroenterology, CHU d'Angers, Angers, France.,HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France
| | - A Ducancelle
- HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.,Virology Department, CHU d'Angers, Angers, France
| | - J Vergniol
- Department of Hepatology and Gastroenterology, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - P Veillon
- Department of Hepatology and Gastroenterology, CHU d'Angers, Angers, France.,HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.,Virology Department, CHU d'Angers, Angers, France
| | - V Moal
- HIFIH, UPRES 3859, SFR 4208, Université LUNAM, Angers, France.,Biochemistry Department, CHU d'Angers, Angers, France
| | - C Dufour
- Inserm UMR-S1136, Université Pierre-et-Marie-Curie Paris 6, Paris, France
| | - J-P Bronowicki
- Department of Hepatology and Gastroenterology, CHU de Nancy, Université de Lorraine, Inserm U954, Vandoeuvre-lès-Nancy, France
| | - D Larrey
- Liver Unit-IRB-INSERM1040, Hôpital Saint Eloi, CHU de Montpellier, Montpellier, France
| | - C Hézode
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - F Zoulim
- Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, INSERM U1052, Lyon, France
| | - H Fontaine
- Department of Hepatology, Hôpital Cochin, AP-HP, Université Paris-René Descartes, Inserm U1016, Paris, France
| | - V Canva
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional et Universitaire Claude Huriez, Lille, France
| | - T Poynard
- Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière AP-HP, Université Pierre et Marie Curie Paris 6, INSERM UMR-S938, Paris, France
| | - S Allam
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - V De Lédinghen
- Department of Hepatology and Gastroenterology, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France.,INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
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Bousquet J, Bourret R, Camuzat T, Augé P, Domy P, Bringer J, Best N, Jonquet O, de la Coussaye JE, Noguès M, Robine JM, Avignon A, Blain H, Combe B, Dray G, Dufour V, Fouletier M, Giraudeau N, Hève D, Jeandel C, Laffont I, Larrey D, Laune D, Laurent C, Mares P, Marion C, Pastor E, Pélissier JY, Radier-Pontal F, Reynes J, Royère E, Ychou M, Bedbrook A, Granier S, Abecassis F, Albert S, Adnet PA, Alomène B, Amouyal M, Arnavielhe S, Asteriou T, Attalin V, Aubas P, Azevedo C, Badin M, Bakhti, Baptista G, Bardy B, Battesti MP, Bénézet O, Bernard PL, Berr C, Berthe J, Bobia X, Bockaert J, Boegner C, Boichot S, Bonnin HY, Boulet P, Bouly S, Boubakri C, Bourdin A, Bourrain JL, Bourrel G, Bouix V, Breuker C, Bruguière V, Burille J, Cade S, Caimmi D, Calmels MV, Camu W, Canovas G, Carre V, Cavalli G, Cayla G, Chiron R, Claret PG, Coignard P, Coroian F, Costa DJ, Costa P, Cottalorda, Coulet B, Coupet AL, Courrouy-Michel MC, Courtet P, Cristol JP, Cros V, Cuisinier F, Daien C, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dhivert-Donnadieu H, Dujols P, Dupeyron A, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fesler P, Fraisse P, Froger J, Gabrion P, Galano E, Gellerat-Rogier M, Gellis A, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hantkié H, Hayot M, Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Journot L, Kaczorek M, Kouyoudjian P, Labauge P, Landreau L, Lapierre M, Leblond C, Léglise MS, Lemaitre JM, Le Moing V, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert JM, Makinson A, Mandrick K, Marmelat V, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G, Messner P, Meunier C, Mondain M, Morales R, Morel J, Morquin D, Mottet D, Nérin P, Nicolas P, Ninot G, Nouvel F, Ortiz JP, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Picot MC, Pin JP, Pinto N, Porte E, Portejoie F, Pujol JL, Quantin X, Quéré I, Raffort N, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Rolland C, Roubille F, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Soua B, Stephan Y, Strubel D, Sultan A, Taddei-Ologeanu, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Touchon J, Tribout V, Uziel A, Van de Perre P, Vasquez X, Verdier JM, Vergne-Richard C, Vergotte G, Vian L, Viarouge-Reunier C, Vialla F, Viart F, Villain M, Villiet M, Viollet E, Wojtusciszyn A, Aoustin M, Bourquin C, Mercier J. Introduction. Presse Med 2015; 44 Suppl 1:S1-5. [DOI: 10.1016/j.lpm.2015.07.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Carenco C, Assenat E, Faure S, Duny Y, Danan G, Bismuth M, Herrero A, Jung B, Ursic-Bedoya J, Jaber S, Larrey D, Navarro F, Pageaux GP. Tacrolimus and the risk of solid cancers after liver transplant: a dose effect relationship. Am J Transplant 2015; 15:678-86. [PMID: 25648361 DOI: 10.1111/ajt.13018] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 01/25/2023]
Abstract
Although increased rates of solid organ cancers have been reported following liver transplantation (LT), the impact of quantitative exposure to calcineurin inhibitors (CNI) remains unclear. We have therefore probed the relationship between the development of solid organ cancers following LT and the level of CNI exposure. This prospective single-center study was conducted between 1995 and 2008 and is based on 247 tacrolimus-treated liver transplant recipients who survived at least 1 year following surgery. The incidence of cancer was recorded, and the mean blood concentration of tacrolimus (TC) was determined at 1 and 3 years following LT. The study results indicate that 43 (17.4%) patients developed de novo solid cancers. Mean TC during the first year after LT was significantly higher in patients who developed solid organ tumors (10.3 ± 2.1 vs. 7.9 ± 1.9 ng/mL, p < 0.0001). Independent risks factors in multivariate analysis were tobacco consumption before LT (OR = 5.42; 95% CI [1.93-15.2], p = 0.0014) and mean annual TC during the first year after LT (p < 0.0001; OR = 2.01; 95% CI [1.57-2.59], p < 0.0001). Similar effects were observed in 216 patients who received tacrolimus continuously for ≥3 years. It appears therefore that CNI should be used with caution after LT, and that new immunosuppressive therapies could deliver significant clinical benefits in this regard.
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Affiliation(s)
- C Carenco
- Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier I, Montpellier, France
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Bousquet J, Bourquin C, Augé P, Domy P, Bringer J, Aoustin M, Camuzat T, Bourret R, Best N, Jonquet O, de la Coussaye J, Robine J, Avignon A, Blain H, Giraudeau N, Hève D, Jeandel C, Laffont I, Larrey D, Laurent C, Noguès M, Pélissier J, Radier-Pontal F, Royère E, Bedbrook A, Granier S, Abecassis F, Albert S, Adnet P, Alomène B, Amouyal M, Arnavieilhe S, Attalin V, Aubas P, Badin M, Baptista G, Bardy B, Battesti M, Bénézet O, Bernard P, Berr C, Berthe J, Bockaert J, Boubakri C, Bourdin A, Bourrain J, Bourrel G, Bouix V, Burille J, Cade S, Caimmi D, Calmels M, Camu W, Cavalli G, Cayla G, Chiron R, Combe B, Costa D, Costa P, Courrouy-Michel M, Courtet P, Cristol J, Cuisinier F, Daien C, Danko M, Dauenhauer P, Dauzat M, David M, Davy J, Delignières D, Demoly P, Dhivert-Donnadieu H, Dray G, Dujols P, Dupeyron A, Dupeyron G, Engberink O, Fesler P, Gellerat-Rogier M, Gouzi F, Gressard F, Hoa D, Jacquemin S, Gris J, Guillot B, Handweiler V, Hayot M, Jaber S, Jakovenko D, Jorgensen C, Journot L, Kaczorek M, Lapierre M, Laune D, Léglise M, Le Quellec A, Leclerc F, Lehmann S, Lognos B, Lussert J, Mandrick K, Marmelat V, Martin-Gousset P, Matheron A, Mathieu G, Mercier G, Messner P, Meunier C, Mondain M, Morel J, Morquin D, Nérin P, Ninot G, Nouvel F, Ortiz J, Pandraud G, Pasdelou M, Pasquié J, Pastor E, Perrey S, Pers Y, Picot M, Pin J, Pinto N, Portejoie F, Pujol J, Quantin X, Quéré I, Raffort N, Ramdani S, Reynes J, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Rolland C, Roubille F, Roux E, Salvat A, Savy J, Stephan Y, Strubel D, Sultan A, Tallon G, Tassery H, Torre K, Uziel A, Van de Perre P, Vasquez X, Verdier J, Vergotte G, Vian L, Viarouge-Reunier C, Vialla F, Viart F, Villain M, Viollet E, Ankri J, Berrut G, Crooks G, Joël M, Michel J, Samolinski B, Strandberg T, Vellas B, Mercier J. MACVIA-LR, Reference site of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) in Languedoc Roussillon. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Moore N, Ezgi Gulmez S, Larrey D, Pageaux GP, Lignot S, Lassalle R, Jové J, Pariente A, Blin P, Bénichou J, Bégaud B. Choix du dénominateur pour les études cas-population : taux d’insuffisance hépatique aiguë ayant conduit à l’inscription sur la liste de transplantation hépatique chez des patients exposés à des anti-inflammatoires non stéroïdiens en France et inclus dans l’étude SALT. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2013.11.008] [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: 11/15/2022] Open
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Lerisson M, Pageaux GP, Larrey D, Guillot B. Hépatite toxique sous rétinoïdes topiques au cours d’une maladie de Darier. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.338] [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: 10/26/2022]
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Gulmez E, Larrey D, Pageaux GP, Jové J, Lassalle R, Lignot S, Blin P, Moore N. PP031—Drug-associated acute liver failure leading to registration for transplantation in france from the study of acute liver transplant (SALT). Clin Ther 2013. [DOI: 10.1016/j.clinthera.2013.07.065] [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: 11/27/2022]
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Dore G, Lawitz E, H'ezode C, Shafran S, Ramji A, Tatum H, Taliani G, Tran A, Brunetto M, Zaltron S, Strasser S, Weis N, Ghesquiere W, Lee S, Larrey D, Pol S, Harley H, George J, Fung S, de L'edinghen V, Hagens P, Cohen D, Cooney E, Noviello S, Hughes E. 1418 DACLATASVIR COMBINED WITH PEGINTERFERON ALFA-2A AND RIBAVIRIN FOR 12 OR 16 WEEKS IN PATIENTS WITH HCV GENOTYPE 2 OR 3 INFECTION: COMMAND GT2/3 STUDY. J Hepatol 2013. [DOI: 10.1016/s0168-8278(13)61417-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
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Ezgi Gulmez S, Lignot-Maleyran S, deVries C, Sturkenboom M, Perez-Gutthann S, Bénichou J, Bissoli F, Larrey D, Pageaux GP, Horsmans Y, Bernuau J, Stricker B, Thorburn D, Blin P, Moore N. SALT-I (Study of Acute Liver Transplant) : étude de l’insuffisance hépatique aiguë liée aux AINS dans des centres de transplantation hépatique européens. Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.08.019] [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: 11/30/2022] Open
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Basset D, Ramos J, Goldman-Lévy G, Caillo L, Gala A, Larrey D. [Anicteric cholestasis revealing schistosomiasis at a distance from the infection site]. Med Trop (Mars) 2010; 70:428. [PMID: 21520640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- D Basset
- Service de Parasitologie, CHU Lapeyronie, Montpellier France.
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Pascussi JM, Gerbal-Chaloin S, Drocourt L, Assénat E, Larrey D, Pichard-Garcia L, Vilarem MJ, Maurel P. Cross-talk between xenobiotic detoxication and other signalling pathways: clinical and toxicological consequences. Xenobiotica 2008; 34:633-64. [PMID: 15672753 DOI: 10.1080/00498250412331285454] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
1. Recent investigations on nuclear receptors and other transcription factors involved in the regulation of genes encoding xenobiotic metabolizing and transport systems reveal that xenobiotic-dependent signalling pathways are embedded in, and establish functional interactions with, a tangle of regulatory networks involving the glucocorticoid and oestrogen receptors, the hypoxia-inducible factor, the vitamin D receptor and other transcription factors/nuclear receptors controlling cholesterol/bile salt homeostasis and liver differentiation. 2. Such functional interferences provide new insight, first for understanding how xenobiotics might exert adverse effects, and second how physiopathological stimuli affect xenobiotic metabolism.
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Affiliation(s)
- J M Pascussi
- INSERM U632, Hepatic Physiopathology, Montpellier F-34293, France
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Aufort S, Molina E, Assenat E, Rigole H, Bauret P, Calvet C, Navarro F, Fabre JM, Blanc P, Taourel P, Larrey D, Bruel JM, Pageaux GP, Gallix BP. [Value of MRCP for diagnosis of biliary complications after liver transplantation]. ACTA ACUST UNITED AC 2008; 89:221-7. [PMID: 18354352 DOI: 10.1016/s0221-0363(08)70397-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the value of MRCP in the detection of biliary complications after orthotopic liver transplantation. MATERIALS AND METHODS 27 transplanted patients with suspected biliary complication underwent a total of 34 MR and direct cholangiography procedures. MRCP were reviewed by 2 independent reviewers blinded to clinical and laboratory findings. The biliary tract was divided into 7 segments, and all lesions were evaluated using this segmental anatomy. Each segment was evaluated for the presence of dilatation, stenosis and intra-ductal debris. MRCP results were compared to results frpm direct cholangiography. RESULTS 216 (98%) of 221 biliary segments could be evaluated on MRCP, with good to excellent visualization in 179 (80%) cases. Segmental analysis showed sensitivity, specificity and accuracy values of 85%, 81% and 83% for the detection of biliary stenosis, 82%, 81% and 81% for the detection of biliary dilatation, and 60%, 88% and 80% for the detection of inyraductal debris. CONCLUSION MRCP is accurate for the detection of biliary stenosis and dilatation in patients after liver transplantation and provides an alternative to direct cholangiography.
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Affiliation(s)
- S Aufort
- Service d'Imagerie Médicale, CHU Montpellier, Hôpital Saint-Eloi, 80, rue Augustin Fliche, 34295 Montpellier Cedex 5
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Rigole H, Perney P, Van Der Meulen-Reboul S, Turrière C, Cristol JP, Larrey D, Blanc F. Étiologies, pronostic et traitement des ascites chyleuses du cirrhotique. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.305] [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: 11/24/2022]
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Larrey D. Thérapeutique - Utilisation du paracétamol en cas d’hépatopathie: davantage de prudence. Presse Med 2006. [DOI: 10.1016/s0755-4982(06)74813-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Bonny C, Fontaine H, Poynard T, Hézode C, Larrey D, Marcellin P, Bourlière M, Bronowicki JP, Merle P, Zarski JP, Sapey T, Guillemard C, Ughetto S, Henquell C, Nicolas C, Roche C, Randl K, Bommelaer G, Abergel A. Effectiveness of interferon plus ribavirin combination in the treatment of naive patients with hepatitis C virus type 5. A French multicentre retrospective study. Aliment Pharmacol Ther 2006; 24:593-600. [PMID: 16907892 DOI: 10.1111/j.1365-2036.2006.03018.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM To assess the rate of sustained virological response in naïve hepatitis C virus-type 5 patients treated by standard interferon or pegylated-interferon [corrected] (peg-interferon) and ribavirin combination for 48 weeks. PATIENTS AND METHODS A total of 87 hepatitis C virus patients were included from 12 centres in France; 28 patients received interferon plus ribavirin and 59 were treated with peg-interferon plus ribavirin. RESULTS Baseline characteristics were: mean age 58 +/- 11 years, sex ratio 1, 66% had metavir fibrosis score >or=F2, 21% were cirrhotics and 53% had pretherapeutic viral load >or=800,000 IU/mL. Sustained virological response was achieved in 64% and 58% of hepatitis C virus-5 patients treated with interferon and peg-interferon, respectively (NS). In adherent patients, sustained virological response was obtained in 75% of patients. Sustained virological response in hepatitis C virus-5 patients (60%) was significantly higher than sustained virological response in hepatitis C virus-1 patients (37%) (P = 0.0499) and not significantly different from sustained virological response in hepatitis C virus-2-3 patients (63%) (P = 0.8098). CONCLUSIONS Combination therapy is effective in 60% of hepatitis C virus-5-infected patients. Sustained virological response seems better in hepatitis C virus-5 patients than in hepatitis C virus-1 patients, and is similar to that of hepatitis C virus-2-3 patients. More studies are needed to determine optimal duration of treatment in hepatitis C virus-5 patients.
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Affiliation(s)
- C Bonny
- Service d'Hépato-Gastroentérologie, Hôtel-Dieu, Clermont-Ferrand, France.
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Duboc H, Hyrailles V, Izopet J, Yousfi D, Ducos J, Pageaux G, Larrey D. CA 61-Épidémie d’hépatites aiguës C dans un centre d’hémodialyse. Aspects épidémiologiques, virologiques, thérapeutiques et évolution à 4,5 ans. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0399-8320(06)73471-6] [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: 11/30/2022]
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Rolain JM, Gouriet F, Brouqui P, Larrey D, Janbon F, Vene S, Jarnestrom V, Raoult D. Concomitant or consecutive infection with Coxiella burnetii and tickborne diseases. Clin Infect Dis 2004; 40:82-8. [PMID: 15614696 DOI: 10.1086/426440] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Accepted: 09/01/2004] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Q fever is a worldwide zoonosis caused by Coxiella burnetii, which can be isolated from ticks. Reports of people with both Q fever and other tickborne diseases are rare. In this study, we describe 6 patients with Q fever who were infected with 1 of the following tickborne pathogens: Rickettsia conorii (2 patients), Rickettsia slovaca (2), Rickettsia africae (1), and Francisella tularensis (1). METHODS Diagnoses were made on the basis of results of microimmunofluorescence assays for detection of C. burnetii, R. conorii, R. slovaca, R. africae, and F. tularensis antigens. Cross-adsorption studies and Western blots were used to confirm dual infections. RESULTS Among the 6 cases presented, 3 were probably due to a concomitant infection after a tick bite, whereas the remaining 3 were more likely consecutive infections. CONCLUSIONS Because acute Q fever is often asymptomatic, we recommend that patients infected with the tickborne pathogens mentioned above also undergo routine testing for concurrent infections with C. burnetii.
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Affiliation(s)
- J M Rolain
- Unité des Rickettsies, Faculté de Medecine, Université de la Mediterranée, Marseille, France
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Acharki M, Ponssoda P, Veyrac M, Kanouni N, Bessis D, Amrani N, Larrey D. Ictère fébrile révélant un DRESS syndrome avec réactivation virale à herpès simplex 1 et 2. ACTA ACUST UNITED AC 2004. [DOI: 10.1007/bf03004262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Poynard T, Marcellin P, Bissery A, Myers RP, Moussalli J, Degos F, Dhumeaux D, Riachi G, Bronowicki JP, Brissot P, Buffet C, Serfaty L, Naveau S, Sogni P, Beaugrand M, Gayno S, Larrey D, Samuel D, Eugene C, Pol S, Bedossa P, Daurat V, Chaumet-Riffaud P. Reinforced interferon alpha-2b and ribavirin is more effective than standard combination therapy in the retreatment of chronic hepatitis C previously nonresponsive to interferon: a randomized trial. J Viral Hepat 2003; 10:197-204. [PMID: 12753338 DOI: 10.1046/j.1365-2893.2003.00427.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Interferon-alpha (IFN) monotherapy results in sustained virological clearance in a minority of patients with chronic hepatitis C. The aim of this study was to assess the effect of a reinforced regimen combining ribavirin and high-dose IFN for 48 weeks compared with a nonreinforced regimen combining a standard IFN regimen and ribavirin for 24 weeks in nonresponders with chronic hepatitis C. A total of 231 patients with chronic hepatitis C and previous nonresponse to IFN monotherapy were randomized. The reinforced group (n = 114) received IFN-2b 6 million units (MU) thrice weekly (TIW) and ribavirin for 48 weeks, and the nonreinforced group (n = 117) received IFN-2b 3 MU TIW and ribavirin for 24 weeks. The main outcome measure was a sustained virological response, defined as negative serum hepatitis C virus (HCV)-RNA 24 weeks following the end of treatment. This endpoint was determined in 98 patients of the reinforced group and 105 patients of the nonreinforced group. At the end of follow-up, a sustained virological response was observed in 29 of the 98 patients (29.6%) in the reinforced group vs 16 of the 105 patients (15.2%) in the nonreinforced group (P = 0.014). In multivariate analysis, factors associated with a sustained virological response were treated with a reinforced regimen [odds ratio (OR) 2.9; P = 0.06] and genotype 2 or 3 (OR 8.8; P < 0.0002). A total of 160 patients had paired biopsies before and after treatment. Histological activity improvement was observed in 32 of 80 patients (40%) and fibrosis worsening in 26 of 80 patients (33%) in the reinforced group vs 13 of 80 (16%) and 19 of 80 (24%) in the nonreinforced group (P = 0.30 and 0.20, respectively). Hence in nonresponders, a high-dose 48-week regimen of IFN and ribavirin combination was more effective than a regimen with interferon at lower dose and ribavirin for 24 weeks only.
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Affiliation(s)
- T Poynard
- Service d'Hepatogastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Université Paris 6, 47-83 Boulevard de l'Hôpital, CNRS ESA 8067, 75651 Paris Cedex 13, France.
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Portal I, Bourlière M, Halfon P, De Lédinghen V, Couzigou P, Bernard PH, Blanc F, Caroli-Bosc F, Arpurt JP, Vetter D, Mathieu-Chandelier C, Chazouillères O, Thiefin G, Pol S, Sogni P, Abergel A, Bailly F, Picon M, Debonne JM, Zamora C, Alleman I, Moreau X, Doll F, Eugène C, Ducloux S, Larrey D, Ouzan D, Grimaud JC, Gouvernet J, Botti G, Gérolami V, Khiri H, Gérolami A, Gauthier AP, Botta-Fridlund D. Retreatment with interferon and ribavirin vs interferon alone according to viraemia in interferon responder-relapser hepatitis C patients: a prospective multicentre randomized controlled study. J Viral Hepat 2003; 10:215-23. [PMID: 12753341 DOI: 10.1046/j.1365-2893.2003.00426.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Low pretreatment viral load has consistently been shown to be an independent predictor of sustained response (SR) in patients with chronic hepatitis C infection. We assessed the efficacy of interferon (IFN) plus ribavirin vs IFN alone in low viraemic patients (<2 millions copies/mL) who had relapsed to a previous course of IFN and the efficacy of 24 vs 48 week combination therapy in high viraemic patients. Two hundred and ninety-seven patients were randomly assigned to one of the four regimens after stratification on pretreatment viral load. All patients received IFN-alpha2b (6 million units thrice weekly for 24 weeks and 3 million units thrice weekly for 24 weeks). Patients with low viraemia received either IFN-alpha2b alone for 48 weeks (R1: 42 patients) or IFN-alpha2b plus ribavirin (600 mg/day) for 24 weeks and IFN-alpha2b alone for the next 24 weeks (R2: 48 patients). Patients with high viral load received either IFN-alpha2b plus ribavirin for 24 weeks and then IFN-alpha2b alone for the next 24 weeks (R3: 104 patients) or IFN-alpha2b plus ribavirin for 48 weeks (R4: 103 patients). In low viraemic patients the rate of SR was 37.7% in group R1 and 59.6% in group R2 (P < 0.05). In high viraemic patients, the rate of SR was 44.7% in group R3 and 51.4% in group R4 (P: NS). Thirty-one patients discontinued treatment (10.4%) without difference regarding treatment regimen. In the regimen using ribavirin we found no difference in terms of SR between patients receiving a dose of ribavirin below 10.6 mg/kg/day (55%) or over 10.6 mg/kg/day (58%). Histological improvement occurred in 70.2% of patients regardless of the regimen. Logistic regression showed that genotype 2 and 3, Knodell score <6 and alanine aminotransferase pretreatment level >3 x upper limit of normal were significantly and independently correlated with SR. In low viraemic patients who relapsed to a previous IFN treatment, combination therapy using high-dose IFN and low-dose ribavirin is better than high-dose IFN alone. In high viraemic patients there was no benefit in increasing the duration of combination therapy from 24 to 48 weeks. In this study, it was found that low dose of ribavirin can be used safely and there is no effect of ribavirin dose on SR.
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Affiliation(s)
- I Portal
- Department of Hepato-gastroenterology, Hospital La Conception, 13008 Marseille, France
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Dereure O, Raison-Peyron N, Larrey D, Blanc F, Guilhou JJ. Diffuse inflammatory lesions in patients treated with interferon alfa and ribavirin for hepatitis C: a series of 20 patients. Br J Dermatol 2002; 147:1142-6. [PMID: 12452863 DOI: 10.1046/j.1365-2133.2002.04897.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cutaneous side-effects of treatment with interferon alfa or interferon alfa plus ribavirin in patients with hepatitis C have already been reported but they are mostly local with inflammation and, much less frequently, necrosis at the injection points. By contrast, very few data are available with regard to distant skin reactions, particularly inflammatory lesions on other parts of the body. OBJECTIVES To assess the clinical and histological pattern of inflammatory skin lesions outside the injection points in patients treated with interferon alfa and ribavirin for chronic hepatitis C. METHODS Twenty patients attending a University Hospital in Southern France (secondary referral centre) were evaluated regard to clinical history, type and localization of lesions, progression and histology. Skin testing was performed in some patients and the relevance of the results was evaluated. RESULTS Eczema-like skin lesions were mainly distributed on the extremities, sometimes associated with photosensitivity. They usually occurred between 2 and 4 months of treatment. Histology was nonspecific, with a dermal, mainly perivascular, mononuclear infiltrate. Skin testing was poorly informative and was not predictive of relapse. Treatment had to be interrupted in half the patients, of whom two of three relapsed on resuming therapy. CONCLUSIONS The incidence of inflammatory skin lesions at a distance from injection sites in patients treated with interferon alfa and ribavirin for chronic hepatitis C is currently unknown, but this adverse event must be taken into consideration as it may lead to the transient or definitive interruption of treatment.
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Affiliation(s)
- O Dereure
- Department of Dermatology-Phlebology, CHRU Montpellier, Hôpital Saint-Eloi, 80 avenue Augustin Fliche, 34265 Montpellier cedex 5, France.
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Bessis D, Luong MS, Blanc P, Chapoutot C, Larrey D, Guilhou JJ, Guillot B. Straight hair associated with interferon-alfa plus ribavirin in hepatitis C infection. Br J Dermatol 2002; 147:392-3. [PMID: 12174125 DOI: 10.1046/j.1365-2133.2002.48215.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cantarell Dart M, Larrey D. [Acute bacterial hepatitis]. Acta Gastroenterol Latinoam 2002; 31:405-9. [PMID: 11873670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Christidis C, Mal F, Ramos J, Senejoux A, Callard P, Navarro R, Trinchet JC, Larrey D, Beaugrand M, Guettier C. Worsening of hepatic dysfunction as a consequence of repeated hydroxyethylstarch infusions. J Hepatol 2001; 35:726-32. [PMID: 11738099 DOI: 10.1016/s0168-8278(01)00200-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Due to its apparent safety and low cost, hydroxyethylstarch (HES) is increasingly used as a volume expander. The aim of this retrospective study was to highlight the risk of hepatic dysfunction after iterative HES infusions. METHODS Between April 1996 and April 1998, nine patients were referred for worsening of their clinical condition after repeated HES infusions. Six patients had previous chronic liver disease, cirrhosis in four cases. All patients underwent a liver biopsy. RESULTS All post-HES liver biopsies showed diffuse microvacuolization of Kupffer cells, which was associated with focal hepatocyte vacuolization in seven cases. The vacuoles contained periodic acid Schiff positive material at their margins and were lysosomal by electron microscopy. The clinical symptoms of hepatic disease, although difficult to interpret in cirrhotic patients, worsened after HES infusions. Portal hypertension was noted in three non-cirrhotic patients. Serum alkaline phosphatase and gammaglutamyl transferase activities were increased when compared with previous values. Eight patients died, six of them within 1-4 weeks of hepatic failure or septic shock. In the only living patient, symptoms improved after HES withdrawal. CONCLUSIONS Repeated administration of HES could favour severe portal hypertension, liver failure and sepsis, particularly in the setting of chronic liver disease. The basis of these adverse effects is the lysosomal storage of HES in Kupffer cells and hepatocytes.
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Affiliation(s)
- C Christidis
- Department of Hepatogastroenterology, Jean Verdier Hospital, Bondy, France
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31
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Parolini I, Blanc P, Larrey D. [Bacterial perihepatitis]. Rev Prat 2001; 51:2081-5. [PMID: 11842726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The Fitz-Hugh-Curtis syndrome is a peri-hepatitis following a genital infection. It usually occurs in young women. Chlamydia trachomatis is the most frequent causal agent. Clinical signs include acute or recurrent pain in the right hypochondria. Liver tests are not modified and the sonographic examination is normal. Diagnosis can be suspected on the basis of serology, and formally established by laparoscopy showing violin string-like adhesions. Prolonged antibiotic treatment is effective.
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Affiliation(s)
- I Parolini
- Service d'hépato-gastro-entérologie Hôpital Saint-Eloi 34295 Montpellier
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32
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Aguilar-Martinez P, Esculié-Coste C, Bismuth M, Giansily-Blaizot M, Larrey D, Schved JF. Transferrin receptor-2 gene and non-C282Y homozygous patients with hemochromatosis. Blood Cells Mol Dis 2001; 27:290-3. [PMID: 11358390 DOI: 10.1006/bcmd.2001.0382] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
More than 80% of the patients affected by hereditary hemochromatosis, a common inherited iron disorder, are homozygotes for the 845G --> A (C282Y) mutation of the HFE gene. However, depending on the population, 10-20% of hereditary hemochromatosis can be linked either to other HFE genotypes, particularly the compound heterozygous state for C282Y and the 187 C --> G (H63D) mutation, or to mutations of new other genes. Recently, Camaschella et al. (Nat. Genet. 25, 14-15, 2000) identified a stop mutation (exon 6 nt 750 C --> T, Y250X) on the transferrin receptor-2 (TFR2) gene in two unrelated Sicilian families with hereditary hemochromatosis. The TFR2 gene is a transferrin receptor gene homologue that seems to be involved in iron metabolism. Moreover, one of the patients described by Camaschella et al. was a H63D homozygote. H63D homozygosity can be associated with various phenotypes from asymptomatic subjects to patients with a typical form of hereditary hemochromatosis. Thus, the Y250X mutation could be the molecular defect responsible for hereditary hemochromatosis in subjects with atypical HFE genotypes. We have searched for the Y250X mutation in 63 unrelated French subjects. Forty-three had a diagnosis of hereditary hemochromatosis based on classical criteria. This group included 12 H63D homozygotes, 3 C282Y heterozygotes, and 3 patients with none of the two most prevalent HFE mutants. These 18 patients had no other HFE sequence change and were subsequently subjected to DNA sequencing of the 15 last exons and flanking sequences of the TFR2 gene. The 25 remaining hereditary hemochromatosis patients who were tested for the Y250X mutant were compound heterozygotes for the C282Y and H63D mutations. Finally, we also tested for this TFR2 mutation 20 H63D homozygotes with milder manifestations of iron overload and no acquired cause of iron overload. None of the 63 tested subjects had the Y250X mutation. Concurrently, none of the 18 hereditary hemochromatosis patients who had their TFR2 gene sequenced had any deleterious mutation. Thus, TFR2 mutations are not responsible for hemochromatosis in non-C282Y homozygous patients of our area.
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Aguilar-Martinez P, Bismuth M, Picot MC, Thelcide C, Pageaux GP, Blanc F, Blanc P, Schved JF, Larrey D. Variable phenotypic presentation of iron overload in H63D homozygotes: are genetic modifiers the cause? Gut 2001; 48:836-42. [PMID: 11358905 PMCID: PMC1728323 DOI: 10.1136/gut.48.6.836] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND First considered as a polymorphism of the HFE gene, the H63D mutation is now widely recognised as a haemochromatosis associated allele. But few H63D homozygotes with clinical manifestations of hereditary haemochromatosis (HH) have been reported. Concurrently, an increasing number of genes have been shown to interact with HFE in iron metabolism. AIMS To describe the clinical expression of iron overload (IO) associated with H63D homozygosity, and search for potential genetic modifiers (within the HFE or other genes) that could explain the variability of the phenotypes. PATIENTS AND METHODS We retrospectively analysed the clinical phenotype of 56 H63D homozygotes referred for a personal or family history of IO. For each subject we examined intragenic HFE haplotypes and transferrin receptor (TfR) gene polymorphisms and searched for the Y250X mutation on the TFR2 gene. Additionally, we sequenced the HFE gene of H63D homozygotes with HH. RESULTS Fifty of 56 subjects had biological and/or clinical abnormalities of iron metabolism. Up to two thirds of patients (n=34) had no acquired cause of IO. Among these, 12 had a phenotypic diagnosis of HH. In the iron loaded group there was a strong prevalence of male patients. No correlation was found between the potential genetic modifiers and phenotypes. No additional mutation of HFE was identified. CONCLUSION The variable phenotypes associated with H63D homozygosity do not appear to be linked to other HFE mutations, to the TFR2 Y250X mutation, or to HFE or TfR gene intragenic polymorphisms. The exact role of H63D homozygosity in IO and HH needs to be further investigated in unselected populations.
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Affiliation(s)
- P Aguilar-Martinez
- Laboratory of Haematology, CHU of Montpellier, 34295 Montpellier, France.
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34
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Vandome A, Pageaux GP, Bismuth M, Fabre JM, Domergue J, Larrey D, Perez C, Makeieff M, Mourad G, Pageaux GP. Nocardiosis revealed by thyroid abcess in a liver-kidney transplant recipient. Transpl Int 2001. [DOI: 10.1111/j.1432-2277.2001.tb00042.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Vandĵme A, Pageaux GP, Bismuth M, Fabre JM, Domergue J, Perez C, Makeieff M, Mourad G, Larrey D. Nocardiosis revealed by thyroid abscess in a liver--kidney transplant recipient. Transpl Int 2001; 14:202-4. [PMID: 11499912 DOI: 10.1007/s001470100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nocardiosis is a life-threatening infection, particularly among immunocompromised patients, which usually affects lungs, skin and central nervous system. We report a case of disseminated nocardiosis revealed by suppurative thyroiditis in a liver-kidney transplant recipient with poor nutritional status at the time of infection. Nocardia Asteroides was isolated from fine-needle aspiration material of the thyroid abscess. Clinical manifestations resolved after surgical drainage of the thyroid abscess, prolonged antibiotherapy and diminution of immunosuppressive regimen. Clinicians should be aware of this entity, as Nocardia Asteroides may need more than 5 days of culture to be isolated.
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Affiliation(s)
- A Vandĵme
- Fédération Médicochirurgicale, Hôpital Saint Eloi, Montpellier, France
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36
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Larrey D. [Mitochondrial liver diseases]. Gastroenterol Clin Biol 2001; 25:B117-22. [PMID: 11449152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- D Larrey
- Hépato-Gastroentérologie et Transplantation Hépatique, Hôpital Saint-Eloi, 80, rue A.-Fliche, 34295 Montpellier Cedex 5
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37
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Poupon RE, Bonnand AM, Queneau PE, Trépo C, Vetter D, Raabe JJ, Thieffin G, Larrey D, Grangé JD, Capron JP, Serfaty L, Chrétien Y, St Marc Girardin MF, Mathiex-Fortunet H, Zafrani ES, Guéchot J, Beuers U, Paumgartner G, Poupon R. Randomized trial of interferon-alpha plus ursodeoxycholic acid versus interferon plus placebo in patients with chronic hepatitis C resistant to interferon. Scand J Gastroenterol 2000; 35:642-9. [PMID: 10912666 DOI: 10.1080/003655200750023624] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ursodeoxycholic acid (UDCA) could potentiate the effect of interferon (IFN) in patients with chronic hepatitis C resistant to IFN. We compared the efficacy of IFN with that of a combination of IFN and UDCA. METHODS Patients were randomized to receive UDCA (13-15 mg/kg/day) (n = 47) or placebo (n = 44) plus interferon (3 MU three times weekly) for 6 months and were then followed up for 6 additional months. RESULTS At entry 30% of patients had cirrhosis, and 70% had HCV genotype 1. Five and four patients withdrew from the combination and the monotherapy groups, respectively. At 6 months alanine aminotransferase (ALAT) and gamma-glutamyl transferase (GGT) activities were significantly lower (P < 0.001) in the combination group than in the monotherapy group; the differences were no longer significant at 1 year. At 6 months ALAT activities normalized in 10 and 8 patients in the combination and the monotherapy groups, respectively (P = 0.67). In 10 of them (5 in each group) HCV RNA levels became undetectable. At 1 year four versus one patient had a sustained normalization of ALAT, and in one patient the HCV RNA became negative. There was no difference in the histologic progression. In this setting, in contrast to chronic cholestasis, UDCA administration induced an increase in total serum bile acids and did not change primary bile acids. CONCLUSIONS An IFN plus UDCA combination is more effective than IFN alone in terms of ALAT but not in terms of the virologic response. These results favor the hypothesis that UDCA has an effect on the biochemical indices of cellular injury independent of a change in primary bile acids.
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Affiliation(s)
- R E Poupon
- INSERM, Unit 370, Faculté de Médecine Necker, Paris France
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38
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Chapoutot C, Esslimani M, Joomaye Z, Ramos J, Perney P, Laurent C, Fabbro-Peray P, Larrey D, Domergue J, Blanc F. Liver iron excess in patients with hepatocellular carcinoma developed on viral C cirrhosis. Gut 2000; 46:711-4. [PMID: 10764717 PMCID: PMC1727940 DOI: 10.1136/gut.46.5.711] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Liver iron deposits are frequent in viral C cirrhotic patients but their role is not well defined. AIMS To investigate the effect of liver iron excess on the prevalence of hepatocellular carcinoma (HCC) in patients with viral C cirrhosis. METHODS Hepatic iron was evaluated retrospectively using a semiquantitative method in liver biopsies of 104 viral C cirrhotic patients, 48 with HCC and 56 controls (HCC free). Corrected total iron score (0-60) was defined by the sum of three scores: hepatocytic iron score (0-36), sinusoidal iron score (0-12), and portal iron score (0-12), multiplied by 3/3, 2/3, or 1/3 according to the heterogeneous iron localisation in the nodules. RESULTS After adjustment for known risk factors for HCC, regression analysis showed that iron deposits (corrected total iron score >0) were more frequent in HCC patients than in controls (odds ratio 4.94; 95% confidence interval 1.59-15. 32; p=0.0056). The median of corrected total iron score was significantly higher in HCC patients than in controls (odds ratio 1. 092; 95% confidence interval 1.01-1.13; p=0.021). This liver iron overload was sinusoidal (odds ratio 5.2; 95% confidence interval 1. 82-15.11; p=0.0022). CONCLUSIONS Liver iron deposition was more frequent and more important in viral C cirrhotic patients with HCC than in HCC free controls. Liver iron overload seems to contribute to the development of HCC in patients with viral C cirrhosis.
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Affiliation(s)
- C Chapoutot
- Service de Médecine Interne E, Hôpital St Eloi, Montpellier, France
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39
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Abstract
Drug-induced liver injuries make up a persisting and challenging problem for physicians, health agencies and pharmaceutical firms. The clinical expression is polymorphous, acute hepatitis being predominant. The diagnosis is frequently difficult because of the absence of specific signs in most cases and mainly relies on the exclusion of other causes. The diagnosis should be particularly evoked in patients over 50 yr who are taking many drugs, after viral infections have been ruled out. Acute hepatocellular hepatitis is particularly severe because of the risk of fulminant hepatitis or of a more insidious course leading to cirrhosis. Cross hepatotoxicity can sometimes occur. One should avoid re-administration of not only the causative agents but also of other drugs belonging to the same family or having a related chemical structure. The prediction of the hepatotoxicity of new drugs must be improved. Investigations would be particularly useful for drugs having critical chemical structures and belonging to families with an established history of hepatotoxicity.
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Affiliation(s)
- D Larrey
- Service d'Hépatogastro-entérologie et Transplantation hépatique, Hôpital Saint-Eloi, Montpellier, France.
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40
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41
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Remy AJ, Daurès JP, Tanguy G, Khemissa F, Chevrier M, Lezotre PL, Blanc P, Larrey D. [Measurement of the quality of life in chronic hepatitis C: validation of a general index and specific index. First French results]. Gastroenterol Clin Biol 1999; 23:1296-309. [PMID: 10642618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To report the validation of 2 questionnaires of quality of life in chronic hepatitis C and the first results in 100 patients. METHODS The questionnaire included 118 items and took 30 to 45 minutes to answer. It included a general index, the Nottingham Health Profile, with 38 items in 6 themes (physical mobility, social isolation, emotional reactions, pain, sleep and energy) and a specific index, the Montpellier Specific Index, with 80 items in 7 themes: symptoms, food, alcohol and tobacco, work, relations with other people, perception of disease. RESULTS The questionnaires were self-administered to the 100 first patients with chronic hepatitis C without cirrhosis before treatment; 55 men, 45 women, average age 40 year-old, median Knodell's score 8 and median METAVIR score A2 F1. Reduction in the quality of life was frequent and was not highly correlated with biological, virological and histological parameters; it was associated with psychological disorders, reduced sexuality and apprehension of the future. CONCLUSION This study showed the feasibility, validation, sensitivity and agreement of a quality of life questionnaire, which included a general index and a specific index of chronic hepatitis C in France. These initial results must be confirmed in studies during antiviral treatment of patients.
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Affiliation(s)
- A J Remy
- Service d'Hépato-Gastroenterologie, Hôpital Saing-Eloi, Montpellier
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42
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remy AJ, Desprez D, Ducos J, Blanc P, Larrey D. [Risk of transmission of hepatitis C virus by biopsy clamps during gastrointestinal biopsy]. Gastroenterol Clin Biol 1999; 23:1260-1. [PMID: 10651538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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43
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Pageaux GP, Michel J, Coste V, Perney P, Possoz P, Perrigault PF, Navarro F, Fabre JM, Domergue J, Blanc P, Larrey D. Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism. Gut 1999; 45:421-6. [PMID: 10446113 PMCID: PMC1727657 DOI: 10.1136/gut.45.3.421] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND/AIMS Alcoholic cirrhosis remains a controversial indication for liver transplantation, mainly because of ethical considerations related to the shortage of donor livers. The aim of this study was to review experience to date, focusing on survival rates and complications, and the effect of alcohol relapse on outcome and alterations in marital and socioprofessional status. METHODS The results for 53 patients transplanted for alcoholic cirrhosis between 1989 and 1994 were compared with those for 48 patients transplanted for non-alcoholic liver disease. The following variables were analysed: survival, rejection, infection, cancer, retransplantation, employment and marital status, alcoholic recurrence. The same variables were compared between alcohol relapsers and non-relapsers. RESULTS Recovery of employment was the only significantly different variable between alcoholic (30%) and non-alcoholic patients (60%). Two factors influenced survival in the absence of alcohol recidivism: age and abstinence before transplantation. For all other variables, there were no differences between alcoholic and non-alcoholic patients, and, within the alcoholic group, between relapsers and non-relapsers. The recidivism rate was 32%. CONCLUSION The data indicate that liver transplantation is justified for alcoholic cirrhosis, even in cases of recidivism, which did no affect survival and compliance with the immunosuppressive regimen. These good results should help in educating the general population about alcoholic disease.
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Affiliation(s)
- G P Pageaux
- Fédération Médico-chirurgicale d'Hépatogastro-entérologie, Unité de Transplantation Hépatique, Hôpital Saint Eloi, Montpellier, France
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44
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Pol S, Couzigou P, Bourlière M, Abergel A, Combis JM, Larrey D, Tran A, Moussalli J, Poupon R, Berthelot P, Bréchot C. A randomized trial of ribavirin and interferon-alpha vs. interferon-alpha alone in patients with chronic hepatitis C who were non-responders to a previous treatment. Multicenter Study Group under the coordination of the Necker Hospital, Paris, France. J Hepatol 1999; 31:1-7. [PMID: 10424277 DOI: 10.1016/s0168-8278(99)80157-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIM Fifty percent of patients infected with hepatitis C virus (HCV) show no response to alpha-interferon, and no alternative therapy has thus far proven to be effective. Therapeutic combination with ribavirin and alpha-interferon has shown promising results in naive patients and in relapsers, but based on limited series, it was reported to be inefficient in non-responders. The aim of our study was therefore to explore and compare, in a randomized trial, the tolerance and potential efficacy of alpha-interferon alone with a sequential combination of ribavirin and the same alpha-interferon regimen in those patients. METHODS Sixty-four non-responder patients were randomized in the alpha2b-interferon group (a 6-month course at a dosage of 6 MU followed by a 6-month course of 3 MU three times weekly subcutaneously) and 62 in the "combination" group (sequential combination of the same alpha2b-interferon therapy preceded by a 2-month course of ribavirin which was then associated for 2 months with alpha2b-interferon at a daily dosage of 1.0 or 1.2 g). RESULTS Treatment withdrawal was necessary for six patients from the alpha-interferon and eight patients from the combination group. Normalization of aminotransferase activities was significantly more frequent after the 4-month course of ribavirin with 2 months of interferon than after 2 months of interferon alone (52.8 vs. 26.2%, p<0.01), but this difference was not maintained after ribavirin withdrawal. Disappearance of serum HCV RNA (PCR) was significantly more frequent at the end of treatment in the combination group (24.5 vs. 7.7%, p=0.02), but did not differ 6 months after the end of therapy (9.8 and 8.3%, respectively). The long-term response was not associated with liver status (cirrhosis vs. absence of cirrhosis) or genotype. Mean viremia was significantly lower in long-term responders than in non-responders or relapsers in both groups (p<0.001 for the interferon group and p<0.05 for the combination group), but the large extent of viral load precluded reliable prediction. The pre- and post-treatment hepatitis activity index did not differ between the two groups. While a crude histopathological improvement in the hepatitis activity index for a given patient was more frequently observed in the combination group (69.2 vs. 35.9%, p<0.01), improvement as defined by a decrease of at least 2 in the hepatitis activity index was significant only for lobular necrosis and degeneration. CONCLUSIONS This study demonstrates the efficacy of the combination of ribavirin/alpha-interferon in non-responders. Indeed, (i) it is fairly tolerated; (ii) it increases the rate of the initial biological response, and of the virological response by decreasing breakthrough, though this benefit is not sustained; and (iii) it induces a significant histological improvement in necrosis. A simultaneous and prolonged combination of ribavirin/alpha-interferon should be further evaluated in non-responders.
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Affiliation(s)
- S Pol
- Assistance Publique/Hôpitaux de Paris, Necker, France
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45
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Chapoutot C, Perney P, Fabre D, Taourel P, Bruel JM, Larrey D, Domergue J, Ciurana AJ, Blanc F. [Needle-tract seeding after ultrasound-guided puncture of hepatocellular carcinoma. A study of 150 patients]. Gastroenterol Clin Biol 1999; 23:552-6. [PMID: 10429862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVES To study the frequency of tumor seeding after percutaneous biopsy of hepatocellular carcinoma and to evaluate the impact on long-term survival. METHODS Records of 150 patients with cirrhosis who underwent ultrasound-guided aspiration biopsy for hepatocellular carcinoma between 1989 and 1996 were reviewed in June 1998. Liver transplantation was performed in 7 patients. One to three needle passes were performed with 18 to 20 gauge needles. Follow-up included regular clinical examinations and ultrasonography or computerized tomography. RESULTS Four cases (2.66%) of subcutaneous metastasis were noted at the needle insertion site; none in transplanted patients. All patients had viral cirrhosis, Okuda class I. Nodules were detected 4, 12, 22 and 24 months after biopsy. The second patient is alive 24 months after tumor seeding. For other patients, survival time was 4, 24 and 60 months respectively, without local tumor extension after surgical resection or radiotherapy. During a mean 11.8 months of follow-up, 127 patients died without tumor seeding. Eleven patients are still being followed and have no signs of needle tract implantation of hepatocellular carcinoma (mean follow-up 34.7 months). CONCLUSION The prevalence of tumoral seeding after percutaneous biopsy of hepatocellular carcinoma was 2.66%, which is higher than in previous studies. After liver transplantation, no evidence of needle tract seeding was identified. Survival did not seem to be influenced by local evolution.
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Affiliation(s)
- C Chapoutot
- Service de Médecine Interne E, Hôpital Saint-Eloi, CHU Montpellier
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46
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Abstract
Riluzole is a new drug representing the first active treatment for amyotrophic lateral sclerosis. We report the cases of two patients who developed acute hepatitis after taking riluzole at the recommended dose (100 mg daily) for 7 and 4 weeks, respectively. In both cases, liver histology showed hepatocellular damage with inflammatory infiltration and microvesicular steatosis without fibrosis. Liver enzymes returned to normal 4 and 8 weeks, respectively, after riluzole withdrawal. In one case, the readministration of riluzole was followed by the relapse of hepatitis. These two observations strongly suggest that riluzole can induce acute hepatitis with associated hepatocellular damage and microvesicular steatosis. They also suggest that liver enzymes should be monitored during treatment with riluzole.
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Affiliation(s)
- A J Remy
- Service d'Hépato-Gastroentérologie, Hôpital Saint-Eloi, Montpellier, France
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47
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Chapoutot C, Pageaux GP, Perrigault PF, Joomaye Z, Perney P, Jean-Pierre H, Jonquet O, Blanc P, Larrey D. Staphylococcus aureus nasal carriage in 104 cirrhotic and control patients. A prospective study. J Hepatol 1999; 30:249-53. [PMID: 10068104 DOI: 10.1016/s0168-8278(99)80070-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Bacterial infections, specially Staphylococcus aureus (S. aureus) septicemia, remain a leading cause of death following liver transplantation. It has been demonstrated that nasal carriage of S. aureus is associated with invasive infections in patients undergoing hemodialysis and could be decreased by use of antibiotic nasal ointment. However, in cirrhotic patients, the frequency of nasal carriage is unknown. The aims of this study were to determine the prevalence of S. aureus nasal carriage in cirrhotic patients and to assess nosocomial contamination. METHODS One hundred and four patients were included in a prospective study, 52 cirrhotic and 52 control (hospitalized patients without cirrhosis or disease which might increase the rate of nasal carriage of S. aureus). On admission and after a few days of hospitalization, nasal specimens from each anterior naris were obtained for culture. S. aureus was identified by the gram strain, positive catalase and coagulase reactions; antibiotic susceptibility was determined using a disk-diffusion test. RESULTS Both groups were similar with regard to age and sex. The prevalence of nasal colonization on hospital admission was 56% in cirrhotic patients and 13% in control patients (p = 0.001). After an average of 4 days, 42% of cirrhotics and 8% of control patients were colonized (p = 0.001), without any nosocomial contamination. Three strains out of 29 were oxacillin-resistant in cirrhotic patients, and none in controls (p>0.05). There was no statistical difference in carriage rate according to sex, age, cause of cirrhosis and Child-Pugh score. Previous hospitalization (OR, 6.3; 95% CI, 2.3 to 19.9; p = 0.0006) and cirrhosis (OR, 4.4; 95% CI, 1.5 to 13.4; p = 0.0048) were independent predictors of colonization. CONCLUSION Cirrhotic patients had a higher S. aureus nasal carriage rate than control subjects. Previous hospitalization and cirrhosis diagnosis were correlated to nasal colonization. Further studies are necessary to determine if nasal decontamination could reduce S. aureus infections after liver transplantation.
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Affiliation(s)
- C Chapoutot
- Department of Hepato-Gastro-Enterology, School of Medicine of Montpellier, France
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Costes V, Durand L, Pageaux GP, Ducos J, Mondain AM, Picot MC, Domergue J, Larrey D, Baldet P. Hepatitis C virus genotypes and quantification of serum hepatitis C RNA in liver transplant recipients. Relationship with histologic outcome of recurrent hepatitis C. Am J Clin Pathol 1999; 111:252-8. [PMID: 9930149 DOI: 10.1093/ajcp/111.2.252] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The reasons for wide variations in the severity of recurrent hepatitis C after liver transplantation are unclear. We studied liver transplant recipients to assess the effect of hepatitis C virus (HCV) genotype and HCV RNA quantification on histologic progression of recurrent hepatitis C after transplantation. Twenty-five patients underwent transplantation for HCV cirrhosis and were followed up with virologic and histologic assessments for a mean of 51 months. HCV genotype was determined by line probe assay. HCV RNA was quantitated in serum samples by nested polymerase chain reaction. The HCV genotype 1 was detected in 17 patients and other genotypes in 8. Acute lobular hepatitis developed in 17 patients 162 days posttransplantation on average. Long-term biopsy specimens (mean, 51 months after the date of liver transplantation; range, 24-86 months) showed chronic hepatitis in 19 patients (mild, 5; moderate, 9; and severe, 5, 2 with extensive scarring). The serum alanine aminotransferase level was correlated with hepatocyte necrosis (piecemeal and lobular) but not with portal inflammation or fibrosis. Patients infected with genotype 1 had a higher Knodell score, and the 5 patients with severe hepatitis C all were infected with genotype 1. HCV RNA levels were significantly higher in patients with genotype 1 than in patients with other genotypes, as were the severity of histologic recurrence and levels of viral replication.
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Affiliation(s)
- V Costes
- Department of Pathology, Hopital Gui de Chauliac, Montpellier, France
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Remy AJ, Heran B, Galindo G, Tapie C, Khemissa F, Larrey D. [A new drug responsible for microvesicular steatosis: ticlopidine]. Gastroenterol Clin Biol 1999; 23:151-2. [PMID: 10219621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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50
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Remy AJ, Debette M, Diaz D, Voigt JJ, Blanc P, Larrey D. [Dexchlorpheniramine-induced acute hepatitis: a case with positive rechallenge]. Gastroenterol Clin Biol 1998; 22:831-2. [PMID: 9854210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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