1
|
Astouati Q, Machet T, Houssais C, Noury JB, Allenbach Y, Gallay L, Quere B, Assan F, Benveniste O, Broner J, Duffau P, Espitia A, Grasland A, Hayem G, Guern VL, Martis N, Mariampillai K, Nocturne G, Mariette X, Meyer A, Mulleman D, Devauchelle-Pensec V, Collet A, Launay D, Hachulla E, Cornec D, Guellec D, Sanges S. Inclusion-body myositis associated with Sjögren's disease: clinical characteristics and comparison with other Sjögren-associated myositis. Rheumatology (Oxford) 2024:keae129. [PMID: 38430004 DOI: 10.1093/rheumatology/keae129] [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] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES To describe the characteristics of patients with Sjögren's disease (SjD) and inclusion-body myositis (IBM), and how they compare to SjD patients with other inflammatory myopathies (IM). METHODS Patients were retrospectively recruited from 13 French centers and included if they met the ACR/EULAR criteria for SjD and for IM. They were categorized as SjD-IBM if sub-criteria for IBM were met, or as SjD-other IM if not. RESULTS SjD-IBM patients (n = 22) were mostly females (86%), with a median [Q1; Q3] age of 54 [38.5; 64] years at SjD diagnosis, and 62 [46.5; 70] years at first IBM symptoms. Although most patients displayed glandular and immunological abnormalities, additional extra-glandular manifestations were uncommon, resulting in moderate disease activity at SjD diagnosis (ESSDAI 5.5 [1; 7.8]). Classic IBM features were frequent, such as progressive symptom onset (59%), asymmetrical (27%) and distal (32%) involvements, dysphagia (41%), low CPK (386.5 [221.8; 670.5] UI/l) and CRP (3.0 [3; 8.5] mg/l) levels. Immunosuppressants were reported as efficient in 55% of cases.Compared with SjD-IBM patients, SjD patients with other IM (n = 50) were significantly younger, displayed more frequent additional extra-glandular disease, higher ESSDAI score (11 [3; 30]), shorter delay between SjD diagnosis and myositis onset (0 [-0.5; 26]), more frequent CPK values over 1000 UI/l (36%), and less frequent classic IBM features. CONCLUSION IBM can occur in SjD patients, with muscle features reminiscent of classic sporadic IBM characteristics, but mostly affecting women. In SjD patients with muscle involvement, extra-glandular manifestations, high ESSDAI score, elevated CPK values, and shorter delay after SjD diagnosis plead against IBM.
Collapse
Affiliation(s)
- Quentin Astouati
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - Thomas Machet
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - Camille Houssais
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
| | - Jean-Baptiste Noury
- Reference Centre for Neuromuscular Diseases AOC, University of Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, APHP, Centre de Référence Maladies Neuro-Musculaires, Sorbonne University, France, Centre de Recherche en Myologie INSERM-Association Institut de Myologie, UMRS 974, Paris, France
| | - Laure Gallay
- Department of Internal Medicine and Clinical Immunology, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Claude Bernard, Lyon, France
| | - Baptiste Quere
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Florence Assan
- Laboratory of Genetic Skin Diseases, Institut Imagine, INSERM UMR 1163, Paris
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, APHP, Centre de Référence Maladies Neuro-Musculaires, Sorbonne University, France, Centre de Recherche en Myologie INSERM-Association Institut de Myologie, UMRS 974, Paris, France
| | - Jonathan Broner
- Department of Internal Medicine, University Hospital of Nîmes, France
| | - Pierre Duffau
- Internal Medicine Department, Bordeaux University Hospital, FHU ACRONIM, Bordeaux, France. CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University, Bordeaux, France
| | | | - Anne Grasland
- Department of Internal Medicine, Hôpital Louis Mourier, Université Paris Cité, AP-HP, Colombes, France
| | - Gilles Hayem
- Rheumatology Department, Paris Saint-Joseph Hospital, Paris, France
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, Paris, France
| | - Nihal Martis
- Department of Internal Medicine, CHU Nice, France. Côte d'Azur University. Mediterranean Centre for Molecular Medicine, Control of gene expression (COdEX), INSERM U1065
| | - Kuberaka Mariampillai
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, APHP, Centre de Référence Maladies Neuro-Musculaires, Sorbonne University, France, Centre de Recherche en Myologie INSERM-Association Institut de Myologie, UMRS 974, Paris, France
| | - Gaëtane Nocturne
- Department of Rheumatology, Université Paris-Saclay, AP-HP, Hôpitaux Universitaires Paris-Saclay, Centre for Immunology of Viral Infections and Autoimmune Diseases, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, AP-HP, Hôpitaux Universitaires Paris-Saclay, Centre for Immunology of Viral Infections and Autoimmune Diseases, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Alain Meyer
- Department of Rheumatology, Strasbourg University Hospital, Centre de Référence des Maladies Auto-immunes Rares, Strasbourg, France
| | - Denis Mulleman
- University of Tours, EA6295 NMNS, Tours, France Department of Rheumatology, CHRU de Tours, Tours, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Aurore Collet
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
- INSERM, Lille, F-59000, France
- CHU Lille, Institut d'Immunologie, Pôle de Biologie Pathologie Génétique, Lille, F-59000, France
| | - David Launay
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
- INSERM, Lille, F-59000, France
| | - Eric Hachulla
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - Divi Cornec
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Dewi Guellec
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Sébastien Sanges
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
- INSERM, Lille, F-59000, France
| |
Collapse
|
2
|
de Valence B, Delaune M, Nguyen Y, Jachiet V, Heiblig M, Jean A, Riescher Tuczkiewicz S, Henneton P, Guilpain P, Schleinitz N, Le Guenno G, Lobbes H, Lacombe V, Ardois S, Lazaro E, Langlois V, Outh R, Vinit J, Martellosio JP, Decker P, Moulinet T, Dieudonné Y, Bigot A, Terriou L, Vlakos A, de Maleprade B, Denis G, Broner J, Kostine M, Humbert S, Lifermann F, Samson M, Pechuzal S, Aouba A, Kosmider O, Dion J, Grosleron S, Bourguiba R, Terrier B, Georgin-Lavialle S, Fain O, Mekinian A, Morgand M, Comont T, Hadjadj J. Serious infections in patients with VEXAS syndrome: data from the French VEXAS registry. Ann Rheum Dis 2024; 83:372-381. [PMID: 38071510 DOI: 10.1136/ard-2023-224819] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an acquired autoinflammatory monogenic disease with a poor prognosis whose determinants are not well understood. We aimed to describe serious infectious complications and their potential risk factors. METHODS Retrospective multicentre study including patients with VEXAS syndrome from the French VEXAS Registry. Episodes of serious infections were described, and their risk factors were analysed using multivariable Cox proportional hazards models. RESULTS Seventy-four patients with 133 serious infections were included. The most common sites of infection were lung (59%), skin (10%) and urinary tract (9%). Microbiological confirmation was obtained in 76%: 52% bacterial, 30% viral, 15% fungal and 3% mycobacterial. Among the pulmonary infections, the main pathogens were SARS-CoV-2 (28%), Legionella pneumophila (21%) and Pneumocystis jirovecii (19%). Sixteen per cent of severe infections occurred without any immunosuppressive treatment and with a daily glucocorticoid dose ≤10 mg. In multivariate analysis, age >75 years (HR (95% CI) 1.81 (1.02 to 3.24)), p.Met41Val mutation (2.29 (1.10 to 5.10)) and arthralgia (2.14 (1.18 to 3.52)) were associated with the risk of serious infections. JAK inhibitors were most associated with serious infections (3.84 (1.89 to 7.81)) compared with biologics and azacitidine. After a median follow-up of 4.4 (2.5-7.7) years, 27 (36%) patients died, including 15 (56%) due to serious infections. CONCLUSION VEXAS syndrome is associated with a high incidence of serious infections, especially in older patients carrying the p.Met41Val mutation and treated with JAK inhibitors. The high frequency of atypical infections, especially in patients without treatment, may indicate an intrinsic immunodeficiency.
Collapse
Affiliation(s)
| | - Marion Delaune
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Yann Nguyen
- Médecine interne, Université Paris Cité, Hôpital Beaujon, Clichy, France
| | - Vincent Jachiet
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Mael Heiblig
- Hématologie clinique, Université Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Alexis Jean
- Médecine interne, CHU de Bordeaux, Bordeaux, France
| | | | - Pierrick Henneton
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Philippe Guilpain
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Nicolas Schleinitz
- Médecine interne, Aix-Marseille Universite, Hôpital de la Timone, Marseille, France
| | | | - Hervé Lobbes
- Médecine interne, CHU Estaing, Clermont-Ferrand, France
| | - Valentin Lacombe
- Médecine interne et immunologique clinique, CHU Angers, Angers, France
| | | | | | - Vincent Langlois
- Médecine interne et infectieuse, Hospital Group Le Havre, Le Havre, France
| | - Roderau Outh
- Service de médecine interne et générale, CH Perpignan, Perpignan, France
| | - Julien Vinit
- Médecine interne, Hospital Centre Chalon-sur-Saon, Chalon-sur-Saone, France
| | | | - Paul Decker
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Thomas Moulinet
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Yannick Dieudonné
- Immunologie Clinique et Médecine Interne, CHU de Strasbourg, Strasbourg, France
| | | | - Louis Terriou
- Médecine interne - hématologie, CHU Lille, Lille, France
| | - Alexandre Vlakos
- Médecine interne, Haute-Saône Hospital Group Vesoul Site, Vesoul, France
| | | | - Guillaume Denis
- Médecine interne et hématologie, Centre Hospitalier de Rochefort, Rochefort, France
| | | | - Marie Kostine
- Rhumatologie, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Sebastien Humbert
- Hématologie, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | | | - Susann Pechuzal
- Médecine interne-polyvalente, Hôpitaux Drôme Nord, Romans, France
| | | | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, France
| | - Jeremie Dion
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | | | - Rim Bourguiba
- Médecine interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
| | - Benjamin Terrier
- Médecine interne, Université Paris Cité, Hospital Cochin, Paris, France
| | | | - Olivier Fain
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Arsène Mekinian
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Marjolaine Morgand
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Thibault Comont
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Jerome Hadjadj
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| |
Collapse
|
3
|
Rubenstein E, Henneton P, Rivière S, Casanova ML, Broner J, Arnaud E, Oziol E, Quintrec ML, Moranne O, Jorgensen C, Combe B, Bourdin A, Fontaine C, Schiffmann A, Fraison JB, Hallé O, Fraisse T, Veysseyre F, Taieb G, Aerts C, Crampette L, Alovisetti C, Guis L, Mehlal S, Papinaud L, Le Quellec A, Guilpain P, Mahr A. Prevalence of anti-neutrophil cytoplasmic antibody-associated vasculitis in the south of France, using the capture-recapture method. Rheumatology (Oxford) 2023:kead557. [PMID: 37819770 DOI: 10.1093/rheumatology/kead557] [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] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of ANCA-associated vasculitis (AAV), ie granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), in Southern France in 2018, and evaluate differences among Europeans and non-Europeans. METHODS This population-based, cross-sectional study used four sources (hospitals, community-based physicians, laboratories, National Health Insurance) to identify adults ≥ 15 years diagnosed with GPA, MPA or EGPA, living in Hérault and Gard in 2018. Cases were defined using the ACR/EULAR classification criteria, and if necessary, the European Medicines Agency algorithm. Prevalence estimates were standardised to the world population and capture-recapture analysis was used to assess the comprehensiveness of the estimation. The influence of geographical origin was evaluated. RESULTS 202 patients were selected, with 86 cases of GPA (42.6%), 85 cases of MPA (42.1%), and 31 cases of EGPA (15.3%). The standardised prevalence estimates per million inhabitants for 2018 were: 103 (95%CI 84 - 125) for AAV, 48 (95%CI 35 - 64) for GPA, 39 (95%CI 28 - 53) for MPA and 16 (95%CI 9 - 26) for EGPA, 36 (95%CI 25 - 50) for anti-PR3 positive AAV, 46 (95%CI 34 - 61) for anti-MPO positive AAV, and 16 (95%CI 9 - 26) for ANCA-negative AAV. The global estimation of comprehensiveness by capture-recapture analysis was 80.5%. The number of AAV cases was higher for non-European residents (P=0.001), particularly for MPA (P<0.0001). CONCLUSION We provide a new estimate of AAV prevalence in France and show a higher prevalence of MPA in non-European patients.
Collapse
Affiliation(s)
- Emma Rubenstein
- Department of infectious diseases, Saint-Louis Hospital, Paris, France
| | - Pierrick Henneton
- Department of vascular medicine, Saint-Eloi University Hospital, University of Montpellier, Montpellier, France
| | - Sophie Rivière
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
| | | | - Jonathan Broner
- Department of internal medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Erik Arnaud
- Department of internal medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Eric Oziol
- Department of internal medicine, Béziers Hospital, Béziers, France
| | - Moglie Le Quintrec
- Department of nephrology-transplant, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Olivier Moranne
- Department of nephrology-dialysis-apheresis, Carémeau University Hospital, IDESP, University of Montpellier, Nîmes, France
| | | | | | - Arnaud Bourdin
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | | | - Aurélie Schiffmann
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
- Department of internal medicine, Saint Jean Clinic, Montpellier, France
| | | | - Olivier Hallé
- Department of internal medicine 2, Alès Hospital, Alès, France
| | | | - Frederic Veysseyre
- Department of internal medicine, Saint Jean Clinic, Saint Jean de Vedas, France
| | - Guillaume Taieb
- Department of neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Cécile Aerts
- Department of neurology, Beau Soleil Clinic, Montpellier, France
| | - Louis Crampette
- Department of otorhinolaryngology, Gui de Chauliac University Hospital, Montpellier, France
| | - Caroline Alovisetti
- Department of otorhinolaryngology, Carémeau University Hospital, Nîmes, France
| | - Laurence Guis
- Laboratoire Eurofins Biomnis, Auto-immunité, Ivry sur Seine, France
| | - Souad Mehlal
- Laboratoire Cerba, Biochimie spécialisée, immunologie et pharmacotoxicologie, Saint-Ouen, France
| | | | - Alain Le Quellec
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
| | - Philippe Guilpain
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
- IHU IMMUN4CURE, Saint Eloi University Hospital, Montpellier cedex, France
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy (IRMB), Saint-Eloi University Hospital, Montpellier, France
| | - Alfred Mahr
- ECSTRRA Research Unit, Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France
| |
Collapse
|
4
|
Mekinian A, Biard L, Lorenzo D, Novikov PI, Salvarani C, Espitia O, Sciascia S, Michaud M, Lambert M, Hernández-Rodríguez J, Schleinitz N, Awisat A, Puechal X, Aouba A, Munoz Pons H, Smitienko I, Gaultier JB, Edwige LM, Benhamou Y, Perlat A, Jego P, Goulenok T, Sacre K, Lioger B, Hassold N, Broner J, Dufrost V, Sené T, Seguier J, Maurier F, Berthier S, Belot A, Frikha F, Denis G, Audemard-Verger A, Koné-Paut I, Humbert S, Woaye-Hune P, Tomelleri A, Baldissera EM, Kuwana M, Logullo A, Mukuchyan V, Dellal A, Gaches F, Zeminsky P, Galli E, Alvarado M, Boiardi L, Francesco M, Vautier M, Corrado C, Moiseev S, Vieira M, Cacoub P, Fain O, Saadoun D. Intravenous versus subcutaneous tocilizumab in Takayasu arteritis: multicentre retrospective study. RMD Open 2023; 9:e002830. [PMID: 37321669 DOI: 10.1136/rmdopen-2022-002830] [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] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/02/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES In this large multicentre study, we compared the effectiveness and safety of tocilizumab intravenous versus subcutaneous (SC) in 109 Takayasu arteritis (TAK) patients. METHODS We conducted a retrospective multicentre study in referral centres from France, Italy, Spain, Armenia, Israel, Japan, Tunisia and Russia regarding biological-targeted therapies in TAK, since January 2017 to September 2019. RESULTS A total of 109 TAK patients received at least 3 months tocilizumab therapy and were included in this study. Among them, 91 and 18 patients received intravenous and SC tocilizumab, respectively. A complete response (NIH <2 with less than 7.5 mg/day of prednisone) at 6 months was evidenced in 69% of TAK patients, of whom 57 (70%) and 11 (69%) patients were on intravenous and SC tocilizumab, respectively (p=0.95). The factors associated with complete response to tocilizumab at 6 months in multivariate analysis, only age <30 years (OR 2.85, 95% CI 1.14 to 7.12; p=0.027) and time between TAK diagnosis and tocilizumab initiation (OR 1.18, 95% CI 1.02 to 1.36; p=0.034). During the median follow-up of 30.1 months (0.4; 105.8) and 10.8 (0.1; 46.4) (p<0.0001) in patients who received tocilizumab in intravenous and SC forms, respectively, the risk of relapse was significantly higher in TAK patients on SC tocilizumab (HR=2.55, 95% CI 1.08 to 6.02; p=0.033). The overall cumulative incidence of relapse at 12 months in TAK patients was at 13.7% (95% CI 7.6% to 21.5%), with 10.3% (95% CI 4.8% to 18.4%) for those on intravenous tocilizumab vs 30.9% (95% CI 10.5% to 54.2%) for patients receiving SC tocilizumab. Adverse events occurred in 14 (15%) patients on intravenous route and in 2 (11%) on SC tocilizumab. CONCLUSION In this study, we confirm that tocilizumab is effective in TAK, with complete remission being achieving by 70% of disease-modifying antirheumatic drugs-refractory TAK patients at 6 months.
Collapse
Affiliation(s)
- Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France, French Armenian research center, Erevan, Armenia
| | - Lucie Biard
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Dagna Lorenzo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pavel I Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Carlo Salvarani
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Olivier Espitia
- Department of internal and vascular medicine, Nantes Université, CHU Nantes, F-44000 Nantes, France
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Martin Michaud
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Marc Lambert
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, Lille, France
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Abid Awisat
- Rheumatology Unit, Bnei Zion Hospital, Haifa, Israel
| | - Xavier Puechal
- Université Paris Descartes, Paris, France ; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, 27 rue du Faubourg Saint-Jacques, Paris, France
| | - Achille Aouba
- Département de médecine interne, CHU Caen, Caen, France
| | - Helene Munoz Pons
- Département de médecine interne, CHU Saint Etienne, Saint-Etienne, France
| | - Ilya Smitienko
- Rheumatology Department, Medical Center K-31, Moscow, Russian Federation
| | - Jean Baptiste Gaultier
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier universitaire de St Etienne, Saint Etienne, France
| | - Le Mouel Edwige
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Ygal Benhamou
- Service de médecine interne, Université Rouen, CHU de Rouen, Rouen, France
| | - Antoinette Perlat
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Patrick Jego
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France
| | | | - Nolan Hassold
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay, Paris, France
| | | | - Virginie Dufrost
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Nancy, France
| | - Thomas Sené
- Service de médecine interne, Rothschild, Paris, France
| | - Julie Seguier
- Département de médecine interne, CHU de La Timone, Marseille, France
| | - Francois Maurier
- Service de Médecine Interne et Immunologie Clinique Groupe Hospitalier UNEOS, Vantoux, France
| | - Sabine Berthier
- Service de médecine interne et immunologie clinique, Université Dijon, Hôpital Dijon, Dijon, France
| | - Alexandre Belot
- Service de pédiatrie et immunologie clinique, Université Lyon, Hôpital Lyon, Lyon, France
| | - Faten Frikha
- Service de Médecine interne CHU Hédi Chaker, Route El Ain 3029 Sfax -Faculté de Médecine de Sfax, Sfax, Tunisia
| | - Guillaume Denis
- Service de médecine et d'hématologie, Hopital Rochefort, Rochefort, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, University of Tours, Tours, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay, Paris, France
| | - Sebastien Humbert
- Service de médecine interne et immunologie clinique, Hôpital Besancon, Besancon, France
| | | | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Marina Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Alberto Logullo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Ospedale Piemonte, Messina, Italy
| | - Vahan Mukuchyan
- Department of Internal Medicine and Rheumatology, Nairi hospital, Erevan, Armenia
| | - Azeddine Dellal
- Service de rhumatologie, Hôpital Montfermeil, GHI Le Raincy Montfermeil, Montfermeil, France
| | - Francis Gaches
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Pierre Zeminsky
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Nancy, France
| | - Elena Galli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Moya Alvarado
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Boiardi
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Muratore Francesco
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Mathieu Vautier
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Campochiaro Corrado
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Matheus Vieira
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
| | - Patrice Cacoub
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France, French Armenian research center, Erevan, Armenia
| | - David Saadoun
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
| |
Collapse
|
5
|
Bouvet J, Broner J, Arnaud E, Dumain C, Holubar J, Costa D, Fesler P, Fages M, Goulabchand R. [Easing the patients' trajectories from private practice to hospital: One-year experiment of the RAPIDO project]. Rev Med Interne 2023:S0248-8663(23)00128-5. [PMID: 37150638 DOI: 10.1016/j.revmed.2023.04.006] [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] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Internal medicine departments manage patients referred by emergency departments or private practitioners. Considering the overcrowding of emergency departments and lack of beds for inpatients, this specialty must be part of an "ambulatory shift", particularly by strengthening the links between community and hospital medicine. Our objective was to evaluate a new care pathway in internal medicine at Nîmes university hospital. METHODS Our department has developed the RAPIDO project (Réseau d'Aide à la PrIse en Charge Diagnostique et d'Orientation). The referring general practitioner contacts a senior internist on a dedicated phone line. After careful evaluation, he may offer a consultation within 15 days. A summary report is then given to the patient. RESULTS Between November 2020 and November 2021, 254 patients were seen via RAPIDO. The average call-consultation time period was 6.4 (±4.5) days, for symptoms lasting for 2 weeks to 3 months in 43% (n=109) of cases. The reason for the call was a suspicion of systemic disease in 28% of cases (n=84), or a dysfunction of an organ in 16%. A diagnosis was made in 89% of cases. The budget of the whole procedure was balanced. CONCLUSION A quick internal medicine consultation pathway for general practitioners seems to be a relevant, feasible and economically viable healthcare trajectory, which can be transposed to any type of healthcare institution, as soon as sufficient human resources are dedicated.
Collapse
Affiliation(s)
- Julie Bouvet
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France.
| | - Jonathan Broner
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Erik Arnaud
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Cyril Dumain
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Jan Holubar
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - David Costa
- Département universitaire de médecine générale, université de Montpellier-Nîmes, Nîmes, France
| | - Pierre Fesler
- Département de médecine interne et hypertension artérielle, CHU de Montpellier, université de Montpellier, Montpellier, France
| | - Marion Fages
- Département d'information médicale, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Radjiv Goulabchand
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| |
Collapse
|
6
|
Teisseyre M, Beyze A, Perrochia H, Szwarc I, Bourgeois A, Champion C, Chenine L, Serre JE, Broner J, Aglae C, Pernin V, Le Quintrec M. C5b-9 Glomerular Deposits Are Associated With Poor Renal Survival in Membranous Nephropathy. Kidney Int Rep 2022; 8:103-114. [PMID: 36644365 PMCID: PMC9831938 DOI: 10.1016/j.ekir.2022.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Membranous nephropathy (MN) is the first cause of nephrotic syndrome in patients without diabetes. Its prognosis is variable, and treatment remains controversial because of potential toxicity. Currently, there is no reliable prognostic marker common to all etiologies of MN and routinely available to predict the disease course and guide therapeutic management. Despite the major role of complement in the glomerular damage of MN, its prognostic impact has never been studied. We investigated the frequency and prognostic impact of glomerular deposition of C5b-9 in MN. Methods We retrospectively selected adults diagnosed with MN (primary or secondary) at Montpellier University Hospital between December 2004 and December 2015. To be included, all patients were required to have complete medical data and a kidney tissue sample for further immunohistochemistry. We performed PLA2R1, C4d, and C5b-9 staining by immunohistochemistry. Results Sixty-four adults were included: 45 with primary MN and 19 with secondary MN. C4d was positive in the glomeruli of 61 adults (95.3%). Twenty-nine adults (45.3%) had glomerular deposition of C5b-9. Patients with glomerular deposition of C5b-9 had more severe nephrotic syndrome on diagnosis and lower remission and renal survival rates than adults without. Conclusion C5b-9 glomerular staining is a powerful and easily accessible tool for stratifying adults according to their renal prognosis. The efficacy of complement inhibitors should be tested in adults with glomerular deposition of C5b-9.
Collapse
Affiliation(s)
- Maxime Teisseyre
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Anaïs Beyze
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Hélène Perrochia
- Department of Pathology, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Ilan Szwarc
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Alexis Bourgeois
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Coralie Champion
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Leila Chenine
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Jean-Emmanuel Serre
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Jonathan Broner
- Department of Internal Medicine, Caremeau Hospital, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Cédric Aglae
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Vincent Pernin
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology, Dialysis and Transplantation, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France,Institute for Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale, Montpellier University Hospital, University of Montpellier, Montpellier, France,Correspondence: Moglie Le Quintrec, Department of Nephrology, Dialysis and Transplantation, University of Montpellier, Institute of Regenerative Medicine and Biotherapy, Institut National de la Santé Et de la Recherche Médicale U1183, Centre Hospitalier Universitaire de Montpellier–Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
| |
Collapse
|
7
|
Robin C, Broner J, Holubar J, Bergeret B, Roger P, Arnaud E, Goulabchand R. Efficacité du Belimumab sur une atteinte cutanée sévère de connectivite mixte. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.038] [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: 10/18/2022]
|
8
|
Fantone M, Broner J, Dumain C, Fesler P, Arnaud E, Gaujoux-Viala C, Jeanjean L, Goulabchand R. Étude des évènements cortico-induits chez des patients atteints d’Uvéite Chronique Non Infectieuse. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.299] [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: 10/18/2022]
|
9
|
Dumain C, Broner J, Arnaud E, Dewavrin E, Holubar J, Fantone M, De Wazieres B, Fesler P, Guilpain P, Roubille C, Goulabchand R. Tocilizumab, corticothérapie et risque iatrogène chez des patients atteints d’une artérite à cellules géantes : comment identifier les patients à risque en « vraie-vie » ? Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.272] [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: 11/29/2022]
|
10
|
Holubar J, Broner J, Arnaud E, Hallé O, Mura T, Chambert B, Sotto A, Roubille C, Gaujoux-Viala C, Goulabchand R. Diagnostic performance of 18 F-FDG-PET/CT in inflammation of unknown origin: A clinical series of 317 patients. J Intern Med 2022; 291:856-863. [PMID: 35018669 DOI: 10.1111/joim.13452] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/27/2022]
Abstract
BACKGROUND Inflammation of unknown origin (IUO) is a challenging situation in internal medicine. OBJECTIVES To describe the final diagnoses in IUO and assess the helpfulness of 18 F-fluorodesoxyglucose positron emission tomography with computerized tomography (18 F-FDG-PET/CT) in the diagnosis strategy. RESULTS A total of 317 IUO patients with 18 F-FDG-PET/CT were enrolled. A diagnosis was reached in 228 patients: noninfectious inflammatory diseases (NIID) (37.5%), infectious diseases (18.6%), malignancies (7.9%), and non-systemic-inflammatory miscellaneous diseases (7.9%). The two leading causes of NIID were polymyalgia rheumatica and giant cell arteritis. 18 F-FDG-PET/CT results were classified as true positive in 49.8% of patients and contributory in 75.1% of overall IUO patients (after the complete investigation set and a prolonged follow-up). In multivariate analysis, only C-reactive protein minimum level (≥50 mg/L) was associated with the contributory status of 18 F-FDG-PET/CT. CONCLUSION Within the wide spectrum of IUO underlying diseases, 18 F-FDG-PET/CT is helpful to make a diagnosis and to eliminate inflammatory diseases. Obese patients constitute a specific group needing further studies.
Collapse
Affiliation(s)
- Jan Holubar
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Jonathan Broner
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Erik Arnaud
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Olivier Hallé
- Internal Medicine Department 2, CH Ales-Cevennes, Ales, France
| | - Thibault Mura
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Benjamin Chambert
- Department of Nuclear Medicine, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Albert Sotto
- Department of Infectious and Tropical Diseases, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Camille Roubille
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Cecile Gaujoux-Viala
- Department of Rheumatology, CHU Nîmes, Nîmes, France.,University of Montpellier, INSERM UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Radjiv Goulabchand
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France.,IRMB, University of Montpellier, INSERM, Montpellier, France
| |
Collapse
|
11
|
Dumain C, Broner J, Arnaud E, Dewavrin E, Holubar J, Fantone M, de Wazières B, Parreau S, Fesler P, Guilpain P, Roubille C, Goulabchand R. Patients' Baseline Characteristics, but Not Tocilizumab Exposure, Affect Severe Outcomes Onset in Giant Cell Arteritis: A Real-World Study. J Clin Med 2022; 11:jcm11113115. [PMID: 35683507 PMCID: PMC9181652 DOI: 10.3390/jcm11113115] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives: Giant cell arteritis (GCA) is associated with severe outcomes such as infections and cardiovascular diseases. We describe here the impact of GCA patients’ characteristics and treatment exposure on the occurrence of severe outcomes. Methods: Data were collected retrospectively from real-world GCA patients with a minimum of six-months follow-up. We recorded severe outcomes and treatment exposure. In the survival analysis, we studied the predictive factors of severe outcomes occurrence, including treatment exposure (major glucocorticoids (GCs) exposure (>10 g of the cumulative dose) and tocilizumab (TCZ) exposure), as time-dependent covariates. Results: Among the 77 included patients, 26% were overweight (BMI ≥ 25 kg/m2). The mean cumulative dose of GCs was 7977 ± 4585 mg, 18 patients (23%) had a major GCs exposure, and 40 (52%) received TCZ. Over the 48-month mean follow-up period, 114 severe outcomes occurred in 77% of the patients: infections—29%, cardiovascular diseases—18%, hypertension—15%, fractural osteoporosis—8%, and deaths—6%. Baseline diabetes and overweight were predictive factors of severe outcomes onset (HR, 2.41 [1.05−5.55], p = 0.039; HR, 2.08 [1.14−3.81], p = 0.018, respectively) independently of age, sex, hypertension, and treatment exposure. Conclusion: Diabetic and overweight GCA patients constitute an at-risk group requiring tailored treatment, including vaccination. The effect of TCZ exposure on the reduction of severe outcomes was not proved here.
Collapse
Affiliation(s)
- Cyril Dumain
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Jonathan Broner
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Erik Arnaud
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Emmanuel Dewavrin
- Intensive Care Medicine Department, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France;
| | - Jan Holubar
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Myriam Fantone
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Benoit de Wazières
- Department of Internal Medicine and Geriatrics, CHU Nîmes, University of Montpellier, 30029 Nîmes, France;
| | - Simon Parreau
- Department of Internal Medicine, Limoges University Hospital Center, 87042 Limoges, France;
| | - Pierre Fesler
- Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France; (P.F.); (C.R.)
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine and Multi-Organic Diseases, St. Eloi Hospital, CHU Montpellier, 34295 Montpellier, France;
- Institute for Regenerative Medicine & Biotherapy, St. Eloi Hospital, University of Montpellier, INSERM, 34295 Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France; (P.F.); (C.R.)
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
| | - Radjiv Goulabchand
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
- Institute for Regenerative Medicine & Biotherapy, St. Eloi Hospital, University of Montpellier, INSERM, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-(0)4-66683241
| |
Collapse
|
12
|
Mahr A, Hachulla E, de Boysson H, Guerroui N, Héron E, Vinzio S, Broner J, Lapébie FX, Michaud M, Sailler L, Zenone T, Djerad M, Jouvray M, Shipley E, Tieulie N, Armengol G, Bouldoires B, Viallard JF, Idier I, Paccalin M, Devauchelle-Pensec V. Presentation and Real-World Management of Giant Cell Arteritis (Artemis Study). Front Med (Lausanne) 2021; 8:732934. [PMID: 34859001 PMCID: PMC8631900 DOI: 10.3389/fmed.2021.732934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Few studies of daily practice for patients with giant cell arteritis (GCA) are available. This French study aimed to describe the characteristics and management of GCA in a real-life setting. Methods: Cross-sectional, non-interventional, multicenter study of patients ≥50 years old who consulted hospital-based specialists for GCA and were under treatment. Patient characteristics and journey, diagnostic methods and treatments were collected. Descriptive analyses were performed. Results: In total, 306 patients (67% females, mean age 74 ± 8 years old) were recruited by 69 physicians (internists: 85%, rheumatologists: 15%); 13% of patients had newly diagnosed GCA (diagnosis-to-visit interval <6 weeks). Overall median disease duration was 13 months (interquartile range 5–26). Most patients were referred by general practitioners (56%), then ophthalmologists (10%) and neurologists (7%). Most common comorbidities were hypertension (46%), psychiatric disorders (10%), dyslipidemia (12%), diabetes (9%), and osteoporosis (6%). Initial GCA presentations included cranial symptoms (89%), constitutional symptoms (74%), polymyalgia rheumatica (48%), and/or other extra-cranial manifestations (35%). Overall, 85, 31, 26, and 30% of patients underwent temporal artery biopsy, high-resolution temporal artery Doppler ultrasonography, 18FDG-PET, and aortic angio-CT, respectively. All patients received glucocorticoids, which were ongoing for 89%; 29% also received adjunct medication(s) (methotrexate: 19%, tocilizumab: 15%). A total of 40% had relapse(s); the median time to the first relapse was 10 months. Also, 37% had comorbidity(ies) related to or aggravated by glucocorticoids therapy. Conclusion: This large observational study provides insight into current medical practices for GCA. More than one third of patients had comorbidities related to glucocorticoid therapy for a median disease duration of 13 months. Methotrexate and tocilizumab were the most common adjunct medications.
Collapse
Affiliation(s)
- Alfred Mahr
- Department of Internal Medicine, University Hospital Paris (AP-HP, Saint Louis), Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Nassim Guerroui
- Department of Rheumatology, European Hospital of Marseille, Marseille, France
| | - Emmanuel Héron
- Department of Internal Medicine, Hospital Quinze-Vingts, Internal Medicine, Paris, France
| | - Stéphane Vinzio
- Department of Internal Medicine, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Jonathan Broner
- Department of Internal Medicine, University Hospital Centre Nimes, Nimes, France
| | | | - Martin Michaud
- Department of Internal Medicine, Hopital Joseph Ducuing Toulouse, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, University Hospital of Toulouse, Toulouse, France
| | - Thierry Zenone
- Department of Internal Medicine, General Hospital of Valence, Valence, France
| | - Mohamed Djerad
- Department of Internal Medicine, General Hospital of Nevers, Nevers, France
| | - Mathieu Jouvray
- Department of Internal Medicine, General Hospital of Arras, Arras, France
| | - Emilie Shipley
- Department of Rheumatology, General Hospital of Dax, Dax, France
| | - Nathalie Tieulie
- Department of Rheumatology, University Hospital of Nice, Nice, France
| | - Guillaume Armengol
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Bastien Bouldoires
- Department of Internal Medicine, Civil Hospital of Colmar, Colmar, France
| | | | - Isabelle Idier
- Medical Affairs, Chugai Pharma France, Paris La Défense, Paris, France
| | - Marc Paccalin
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | | |
Collapse
|
13
|
Mekinian A, Biard L, Dagna L, Novikov P, Salvarani C, Espita O, Sciscia S, Michaud M, Lambert M, Hernández-Rodríguez J, Schleinitz N, Awisat A, Puéchal X, Aouba A, Pons HM, Smitienko I, Gaultier JB, Edwige LM, Benhamou Y, Perlat A, Jego P, Goulenok T, Sacre K, Lioger B, Nolan H, Broner J, Dufrost V, Sene T, Seguier J, Maurier F, Berthier S, Belot A, Frikha F, Denis G, Audemard-Verger A, Pault IK, Humbert S, Woaye-Hune P, Tomelleri A, Baldissera E, Kuwana M, Logullo A, Gaches F, Zeminsky P, Galli E, Alvarado M, Luigi PB, Francesco M, Vautier M, Campochiaro C, Moiseev S, Cacoub P, Fain O, Saadoun D. Efficacy and safety of TNF-α antagonists and tocilizumab in Takayasu arteritis: Multicenter retrospective study of 209 patients. Rheumatology (Oxford) 2021; 61:1376-1384. [PMID: 34363461 DOI: 10.1093/rheumatology/keab635] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 03/16/2021] [Revised: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess safety and efficacy of TNF-α antagonists and tocilizumab in patients with Takayasu arteritis (TAK). METHODS AND RESULTS Two-hundred nine patients with TAK [median age of 29 years [7-62], and 186 (89%) females] were included. They received either TNF-α antagonists [n = 132 (63%) with 172 lines; infliximab (n = 109), adalimumab (n = 45), golimumab (n = 8), certolizumab (n = 6) and etanercept (n = 5)], or tocilizumab [n = 77 (37%) with 121 lines; intravenous and subcutaneous in 95 and 26 cases, respectively]. A complete response at 6 months was evidenced in 101/152 (66%) on TNF-α antagonists and 75/107 (70%) on tocilizumab, respectively. Age ≥ 30 years [OR = 2.09 [1.09; 3.99]] was associated with complete response, whereas vascular signs [0.26 [0.1; 0.65]], baseline prednisone ≥ 20 mg/day [0.51 [0.28; 0.93]] were negatively associated with the complete response to TNF-α antagonists or tocilizumab. During a median follow-up of 36 months, 103 relapses were noted. Supra-aortic branches and thoracic aorta involvements [HR 2.44 (1.06; 5.65) and 3.66 (1.18; 11.4), respectively], and systemic signs at baseline [HR 2.01 (1.30; 3.11)] were significantly associated with relapse. The cumulative incidence of treatment discontinuation and relapse were similar in TNFα antagonists and tocilizumab. Fifty-eight (20%) adverse effects occurred on biological-targeted therapies of whom 37 (21%) and 21 (17%), (p= 0.4) on TNF-α antagonists and tocilizumab, respectively. CONCLUSION This large multicentre study shows high efficacy of biological-targeted treatments in refractory TAK. Efficacy, relapse and drug retention rate were equivalent with TNF-α antagonists and tocilizumab.
Collapse
Affiliation(s)
- Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75012, France
| | - Lucie Biard
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy.,Unit of Rheumatology, Università di Modena e Reggio Emilia, Italy
| | - Olivier Espita
- Service de Médecine Interne, CHU Hôtel-Dieu, Nantes, 44093, France
| | - Savino Sciscia
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Martin Michaud
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, 31076
| | - Marc Lambert
- Service de médecine interne, CHU Lille, Université Lille II, Lille, France
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS, University of Barcelona, Barcelona, Spain )
| | | | - Abid Awisat
- Rheumatology unit, Bnai Zion medical center, Haifa, Israel
| | - Xavier Puéchal
- Université Paris Descartes, Paris, France; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Achille Aouba
- Département de médecine interne, CHU, Caen, Caen, France
| | - Helene Munoz Pons
- Département de médecine interne, CHU, Saint Etienne, Saint Etienne, France
| | - Ilya Smitienko
- Rheumatology department, Medical Center, Moscow, K-31, Russia
| | - Jean Baptiste Gaultier
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier universitaire de St Etienne, saint Etienne cedex 2, 42055, France
| | - Le Mouel Edwige
- Département de médecine interne, CHU de Rennes, Rennes, France
| | - Ygal Benhamou
- Service de médecine interne, Université Rouen, CHU de Rouen, Rouen, France
| | | | - Patrick Jego
- Département de médecine interne, CHU de Rennes, Rennes, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, INSERM U1149, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, INSERM U1149, France
| | | | - Hassold Nolan
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay
| | | | - Virginie Dufrost
- University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, F-54000, France
| | - Thomas Sene
- Service de médecine interne, Rothschild, Paris, France
| | - Julie Seguier
- Département de médecine interne, CHU de La Timone, Marseille, France
| | - Francois Maurier
- Service de Médecine Interne et Immunologie Clinique Groupe Hospitalier UNEOS Metz-Vantoux, France
| | - Sabine Berthier
- Service de médecine interne et immunologie clinique, Université Dijon, Hôpital Dijon, Dijon, France
| | - Alexandre Belot
- Service de pédiatrie et immunologie clinique, Université Lyon, Hôpital Lyon, Lyon, France
| | - Faten Frikha
- Service de Médecine interne CHU Hédi Chaker, Route El Ain, Sfax -Faculté de Médecine de Sfax, 3029, Tunisie
| | - Guillaume Denis
- Service de médecine et d'hématologie, Hopital Rochefort, Rochefort, France
| | | | - Isabelle Kone Pault
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay
| | - Sebastien Humbert
- Service de médecine interne et immunologie clinique, Hôpital Besancon, Besancon, France
| | | | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Alberto Logullo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Ospedale Piemonte, Messina, Italy
| | - Francis Gaches
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, 31076
| | - Pierre Zeminsky
- University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, F-54000, France
| | - Elena Galli
- Unit of Rheumatology, Università di Modena e Reggio Emilia, Italy
| | - Moya Alvarado
- Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | | | | | - Mathieu Vautier
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Patrice Cacoub
- Sorbonne Université, AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75013, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75012, France
| | - David Saadoun
- Sorbonne Université, AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75013, France
| | | |
Collapse
|
14
|
Broner J, Arnaud E, Bisiou S, Artiaga A, Fantone M, Gonzalez S, Goulabchand R. A rare case of small-vessel necrotizing vasculitis of the bone marrow revealing granulomatosis with polyangiitis. Rheumatology (Oxford) 2021; 60:3956-3957. [PMID: 33331945 DOI: 10.1093/rheumatology/keaa866] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | - Samia Gonzalez
- Department of Pathological Anatomy and Cytology, CHU Nîmes, University of Montpellier, Nimes, France
| | - Radjiv Goulabchand
- Internal Medicine Department, Nimes, France.,Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 avenue Augustin Fliche, Montpellier, France
| |
Collapse
|
15
|
Comont T, Meunier M, Cherait A, Santana C, Cluzeau T, Slama B, Laribi K, Giraud JT, Dimicoli S, Berceanu A, Le Clech L, Cony-Makhoul P, Gruson B, Torregrosa J, Sanhes L, Jachiet V, Azerad MA, Al Jijakli A, Gyan E, Gaudin C, Broner J, Guerveno C, Guillaume T, Ades PL, Beyne-Rauzy O, Fenaux P. Eltrombopag for myelodysplastic syndromes or chronic myelomonocytic leukaemia with no excess blasts and thrombocytopenia: a French multicentre retrospective real-life study. Br J Haematol 2021; 194:336-343. [PMID: 34151423 DOI: 10.1111/bjh.17539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/02/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
Despite a moderate prevalence in low-risk myelodysplastic syndromes (MDS) and chronic myelomonocytic leukaemia (CMML), thrombocytopenia remains a risk of severe bleeding and therapeutic options are still limited. There are only a few studies with eltrombopag (ELT), a thrombopoietin receptor agonist, in those patients. In this retrospective multicentre study, ELT was used in 50 patients with MDS and 11 with CMML, with no excess of marrow blasts and platelet counts of <50 × 109 /l in a 'real-life' situation. Platelet response occurred in 47 (77%) patients. The median (range) duration of response was 8 (0-69) months. None of the eight still responders who discontinued ELT had relapsed, at a median (range) of 16 (6-23) months after ELT discontinuation. Although 36% of the patients were anti-coagulated or anti-aggregated only 10% of patients had Grade ≥3 bleeding events. Thrombotic events were observed in six (10%) patients, who all but one had a medical history of arterial or venous thrombosis. Progression to acute myeloid leukaemia occurred in four (7%) patients. In this first 'real-life' study, ELT was effective and generally well tolerated in patients with MDS/CMML without excess blasts.
Collapse
Affiliation(s)
- Thibault Comont
- Service de Médecine Interne, IUCT Oncopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Mathieu Meunier
- CHU Grenoble Alpes, Université Grenoble Alpes, Institute for Advanced Biosciences, INSERM U1209, CNRS, UMR 5309, Grenoble, France
| | - Amina Cherait
- Service d'Hématologie Sénior, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | | | - Thomas Cluzeau
- Service d'Hématologie Clinique, CHU de Nice, Nice, France
| | - Bohrane Slama
- Service d'onco-hématologie, Centre Hospitalier Général d'Avignon, Avignon, France
| | - Kamel Laribi
- Service d'Hématologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Jean-Thomas Giraud
- Service de Médecine Interne, Centre Hospitalier de Tarbes, Tarbes, France
| | - Sophie Dimicoli
- Service d'Hématologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Ana Berceanu
- Service d'Hématologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Lenaïg Le Clech
- Service d'Hématologie, Centre Hospitalier de Quimper, Quimper, France
| | | | - Berangere Gruson
- Service d'Hématologie, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Jose Torregrosa
- Service d'Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier de Perpignan, Perpignan, France
| | - Vincent Jachiet
- Service de Médecine Interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Marie-Agnes Azerad
- Service d'Hématologie, Centre Hospitalier Universitaire de Liège, Liège, Belgique
| | - Ahmad Al Jijakli
- Service d'Hématologie, Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - Emmanuel Gyan
- Service d'Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Clement Gaudin
- Service de Médecine Interne-Oncogériatrie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jonathan Broner
- Service de Médecine Interne, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Claire Guerveno
- Service de Médecine Interne, Centre Hospitalier d'Albi, Albi, France
| | - Thierry Guillaume
- Service d'Hématologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pr Lionel Ades
- Service d'Hématologie Sénior, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Odile Beyne-Rauzy
- Service de Médecine Interne, IUCT Oncopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Fenaux
- Service d'Hématologie Sénior, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | | |
Collapse
|
16
|
Jachiet V, Moulis G, Hadjadj J, Seguier J, Laribi K, Schleinitz N, Vey N, Sacre K, Godeau B, Beyne-Rauzy O, Bouvet R, Broner J, Brun N, Comont T, Gaudin C, Lambotte O, Le Clech L, Peterlin P, Roy-Peaud F, Salvado C, Versini M, Isnard F, Kahn JE, Gobert D, Adès L, Fenaux P, Fain O, Mekinian A. Clinical spectrum, outcome and management of immune thrombocytopenia associated with myelodysplastic syndromes and chronic myelomonocytic leukemia. Haematologica 2021; 106:1414-1422. [PMID: 33626866 PMCID: PMC8094121 DOI: 10.3324/haematol.2020.272559] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) are associated with systemic inflammatory or autoimmune diseases in 10-20 % of cases. Among them, immune thrombocytopenia (ITP) has been reported but large studies assessing this association are missing. Whether such patients have a particular phenotype and require particular management is unclear. This study analyzes the clinical spectrum, outcome and therapeutic management of patients with ITP associated with MDS or CMML, in comparison (i) to patients with primary ITP without MDS/CMML and (ii) to patients with MDS/CMML without ITP. Forty-one MDS/CMML-associated ITP patients were included, with chronic ITP in 26 (63%) patients, low-risk myelodysplasia in 30 (73%) patients and CMML in 24 (59%) patients. An associated autoimmune disease was noted in 10 (24%) patients. In comparison to primary ITP patients, MDS/CMML-associated ITP patients had a higher occurrence of severe bleeding despite similar platelet counts at diagnosis. First-line treatment consisted of glucocorticoids (98%) and intravenous immunoglobulin (IVIg) (56%). Response achievement with IVIg was more frequent in primary ITP than in MDS/CMML-associated ITP patients. Response rates to second-line therapies were not statistically different between primary ITP and MDS/CMMLassociated ITP patients. Ten percent (n=4) of patients with MDS/CMML-associated ITP had multirefractory ITP versus none in primary ITP controls. After a median follow-up of 60 months, there was no difference in overall survival between MDS/CMML-associated ITP and primary ITP patients. Leukemia-free-survival was significantly better in MDS/CMMLassociated ITP patients than in MDS/CMML without ITP MDS/CMML-associated ITP have a particular outcome with more severe bleeding and multirefractory profile than primary ITP, similar response profile to primary ITP therapy except for IVIg, and less progression toward acute myeloid leukemia than MDS/CMML without ITP.
Collapse
MESH Headings
- Humans
- Leukemia, Myeloid, Acute
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Leukemia, Myelomonocytic, Chronic/therapy
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/therapy
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Thrombocytopenia
Collapse
Affiliation(s)
- Vincent Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris
| | - Guillaume Moulis
- Service de médecine interne, CHU de Toulouse, France; CIC 1436, CHU de Toulouse, France; UMR 1027 Inserm-Université de Toulouse
| | - Jérome Hadjadj
- Imagine Institute, laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, Université de Paris, F-75015, Paris ; Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, F-75014
| | - Julie Seguier
- Département de médecine interne, Hôpital de la Timone, AP-HM, Aix Marseille Université, Marseille
| | - Kamel Laribi
- Department of Hematology, Centre hospitalier Le Mans, Le Mans
| | - Nicolas Schleinitz
- Département de médecine interne, Hôpital de la Timone, AP-HM, Aix Marseille Université, Marseille
| | - Norbert Vey
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille
| | - Karim Sacre
- Departement de Médecine Interne, Hôpital Bichat, APHP, Université de Paris, INSERM U1149, Paris
| | - Bertrand Godeau
- Hôpitaux de Paris, Hôpital Henri Mondor, Médecine Interne, Centre de Référence des Cytopénies Autoimmunes de L'Adulte, Université Paris-Est Créteil, F-94010, Créteil
| | - Odile Beyne-Rauzy
- Department of internal medicine, Toulouse University Hospital, Institut universitaire du cancer de Toulouse, and University of Toulouse, F-31059, Toulouse
| | - Romain Bouvet
- Médecine interne et maladies systémiques, CHU Dijon Bourgogne, 21000 Dijon
| | - Jonathan Broner
- Internal Médicine Department, Nîmes University Hospital, University of Montpellier, Nîmes
| | - Natacha Brun
- Service de Médecine Interne, Centre Hospitalier de Rodez, Rodez
| | - Thibault Comont
- Department of internal medicine, Toulouse University Hospital, Institut universitaire du cancer de Toulouse, and University of Toulouse, F-31059, Toulouse
| | - Clément Gaudin
- Department of oncogeriatric medicine, University Hospital Purpan, Toulouse
| | - Olivier Lambotte
- Hôpitaux de Paris, Hôpital Bicêtre, Médecine Interne et Immunologie Clinique, F-94275, Le Kremlin-Bicêtre, France; INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, F-94276, Le Kremlin-Bicêtre, France; Université Paris Sud, UMR 1184, F-94276, Le Kremlin-Bicêtre, France; CEA, DSV/iMETI, IDMIT, F-92265, Fontenay-aux-Roses
| | - Lenaïg Le Clech
- Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper
| | | | - Frédérique Roy-Peaud
- Service de médecine interne, maladies infectieuses et tropicales, CHU de Poitiers, Poitiers
| | | | | | - Françoise Isnard
- Department of Clinical Hematology, Saint-Antoine Hospital, AP-HP, Paris
| | | | - Delphine Gobert
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris
| | - Lionel Adès
- Hopital Saint-Louis (APHP) and Paris University and INSERM U944, Paris
| | - Pierre Fenaux
- Hopital Saint-Louis (APHP) and Paris University and INSERM U944, Paris
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris
| | - Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), F-75012, Paris.
| |
Collapse
|
17
|
Péan de Ponfilly-Sotier M, Jachiet V, Benhamou Y, Lahuna C, De Renzis B, Kottler D, Voillat L, Dimicoli-Salazar S, Banos A, Chauveheid MP, Alexandra JF, Grignano E, Liferman F, Laborde M, Broner J, Michel M, Lambotte O, Laribi K, Venon MD, Dussol B, Martis N, Thepot S, Park S, Couret D, Roux-Sauvat M, Terriou L, Hachulla E, Bally C, Galland J, Allain JS, Parcelier A, Peterlin P, Cohen-Bittan J, Regent A, Ackermann F, Le Guen J, Algrin C, Charles P, Daguindau E, Puechal X, Dunogue B, Blanchard-Delaunay C, Beyne-Rauzy O, Grobost V, Schmidt J, Le Gallou T, Dubos-Lascu G, Sonet A, Denis G, Roy-Peaud F, Fenaux P, Adès L, Fain O, Mekinian A. Venous thromboembolism during systemic inflammatory and autoimmune diseases associated with myelodysplastic syndromes, chronic myelomonocytic leukaemia and myelodysplastic/myeloproliferative neoplasms: a French multicentre retrospective case-control study. Clin Exp Rheumatol 2021; 40:1336-1342. [DOI: 10.55563/clinexprheumatol/nbn38d] [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] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Marie Péan de Ponfilly-Sotier
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Vincent Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Ygal Benhamou
- Normandie Université, UNIROUEN, Service de Médecine Interne, INSERM U1096, Rouen, France
| | - Constance Lahuna
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Benoit De Renzis
- CHU de Clermont-Ferrand, Service d’Hématologie, Clermont-Ferrand, France
| | - Diane Kottler
- CHU Bichat APHP, Service de Dermatologie, Paris, France
| | - Laurent Voillat
- CH Chalon sur Saône, service d’Hématologie-Oncologie, Chalon sur Saône, France
| | | | - Anne Banos
- CH de la Côte Basque, Service d’Hématologie, Bayonne, France
| | | | | | | | | | | | | | - Marc Michel
- CHU Henri Mondor APHP, Service de Médecine Interne, Créteil, France
| | - Olivier Lambotte
- Paris Saclay Université, CHU Kremlin-Bicêtre, Service de Médecine Interne, Le Kremlin Bicêtre, France
| | - Kamel Laribi
- CH Le Mans, Service d’Hématologie, Le Mans, France
| | | | - Bertrand Dussol
- CHU Hôpital de la Conception APHM, Service de Néphrologie, Marseille, France
| | - Nihal Martis
- CHU de Nice Côte d’Azur, Service de Médecine Interne, Nice, France
| | | | - Sophie Park
- CHU Grenoble, Service d’Hématologie, Grenoble, France
| | - David Couret
- CH de Cornouailles Quimper Concarneau, Service de Médecine Interne-Maladies Infectieuses, Maladies du Sang, Quimper, France
| | - Marielle Roux-Sauvat
- CH Pierre-Oudot Groupe Hospitalier Nord Dauphiné, Service de Médecine Interne, Bourgoin-Jallieu, France
| | - Louis Terriou
- Université de Lille, Hôpital Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- Université de Lille, Hôpital Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Cécile Bally
- CHU Necker-Enfants Malades APHP, Service d’Hématologie Adultes, Paris, France
| | - Joris Galland
- CH Bourg-En-Bresse, Service Médecine Interne, Bourg-En-Bresse, France
| | - Jean-Sébastien Allain
- CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, CIC 1414, Rennes, France
| | - Anne Parcelier
- CHU de Nantes, Service d’Hématologie Clinique, Nantes, France
| | - Pierre Peterlin
- CHU de Nantes, Service d’Hématologie Clinique, Nantes, France
| | | | | | | | - Julien Le Guen
- CHU Hôpital Européen Georges Pompidou APHP, Service de Gériatrie, Paris, France
| | - Caroline Algrin
- Institut de Cancérologie Daniel Hollard Groupe Hospitalier Mutualiste de Grenoble, Service d’Oncologie, Grenoble, France
| | - Pierre Charles
- Institut Mutualiste Montsouris, Service de Médecine Interne, Paris, France
| | | | | | | | | | - Odile Beyne-Rauzy
- Institut Universitaire du Cancer de Toulouse, Service de Médecine Interne et Immunopathologie Clinique, Toulouse, France
| | - Vincent Grobost
- CHU Estaing de Clermont-Ferrand, Service de Médecine Interne, Clermond-Ferrand, France
| | - Jean Schmidt
- CHU Amiens Nord, Service de Médecine Interne, Amiens, France
| | - Thomas Le Gallou
- CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, CIC 1414, Rennes, France
| | | | - Anne Sonet
- CHU UCL Namur-Site Godinne, Service d’Hématologie, Yvoir, Belgium
| | - Guillaume Denis
- CH de la Rochelle, Service de Médecine Interne et Hématologie, La Rochelle, France
| | - Frédérique Roy-Peaud
- CHU de Poitiers, Service de Médecine Interne-Maladies infectieuses et Tropicales, Poitiers, France
| | - Pierre Fenaux
- CHU Saint-Louis APHP, Service d’Hématologie Clinique, Université Paris VII, Paris, France
| | - Lionel Adès
- CHU Saint-Louis APHP, Service d’Hématologie Clinique, Université Paris VII, Paris, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France.
| |
Collapse
|
18
|
Broner J, Chambert B, Arnaud E, Goulabchand R. Cerebral Vertebral Artery Vasculitis Presenting as Neck Pain and Fever. Arthritis Rheumatol 2020; 72:1970. [DOI: 10.1002/art.41448] [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] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Erik Arnaud
- CHU Nimes and University of Montpellier Nimes France
| | - Radjiv Goulabchand
- CHU Nimes and University of Montpellier Nimes France
- INSERM U1183 Montpellier France
| |
Collapse
|
19
|
Roupie AL, Guedon A, Terrier B, Lahuna C, Jachiet V, Regent A, de Boysson H, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Ledoult E, Clech LL, D'Aveni M, Rossignol J, Galland J, Willems L, Chiche NJ, Peterlin P, Roux-Sauvat M, Parcelier A, Wemeau M, Lambert M, Belizna C, Puechal X, Swiader L, Cohen-Valensi R, Noc V, Dao E, Thepot S, de Frémont GM, Tanguy-Schmidt A, Koka AM, Bussone G, Philipponnet C, Konate A, Cavaille G, Guilpain P, Allain JS, Broner J, Solary E, Ruivard M, de Renzis B, Corm S, Baati N, Schleinitz N, Ponsoye M, Stamatoullas-Bastard A, Ades L, Dellal A, Tchirkov A, Aouba A, Fenaux P, Fain O, Mekinian A. Vasculitis associated with myelodysplastic syndrome and chronic myelomonocytic leukemia: French multicenter case-control study. Semin Arthritis Rheum 2020; 50:879-884. [PMID: 32896704 DOI: 10.1016/j.semarthrit.2020.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/14/2020] [Revised: 06/13/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Our objective was to evaluate characteristics, treatment and outcome of vasculitis associated with myelodysplastic syndrome (MDS) and chronic myelomonicytic leukemia (CMML) PATIENTS AND METHODS: Retrospective descriptive analysis of MDS/CMML-related vasculitis and comparison with MDS/CMML patients without dysimmune features. RESULTS Seventy patients with vasculitis and MDS/CMML were included, with median age of 71.5 [21-90] years and male/female ratio of 2.3. Vasculitis was diagnosed prior to MDS/CMML in 31 patients (44%), and after in 20 patients. In comparison with MDS/CMML without autoimmune/inflammatory features, vasculitis with MDS/MPN showed no difference in MDS/CMML subtypes distribution nor International Prognostic Scoring System and CMML-specific prognostic (IPSS/CPSS) scores. Vasculitis subtypes included Giant cell arteritis in 24 patients (34%), Behçet's-like syndrome in 11 patients (20%) and polyarteritis nodosa in 6 patients (9%). Glucocorticoids (GCs) were used as first-line therapy for MDS/CMML vasculitis in 64/70 patients (91%) and 41 (59%) received combined immunosuppressive therapies during the follow-up. After a median follow-up of 33.2 months [1-162], 31 patients (44%) achieved sustained remission. At least one relapse occurred in 43 patients (61%). Relapse rates were higher in patients treated with conventional Disease Modifying Anti-Rheumatic Drug (DMARDs) (odds ratio 4.86 [95% CI 1.38 - 17.10]), but did not differ for biologics (odds ratio 0.59 [95% CI 0.11-3.20]) and azacytidine (odds ratio 1.44 [95% CI 0.21-9.76]) than under glucocorticoids. Overall survival in MDS/CMML vasculitis was not significantly different from MDS/CMML patients without autoimmune/inflammatory features (p = 0.5), but acute leukemia progression rates were decreased (log rank <0.05). CONCLUSION This study shows no correlation of vasculitis diagnoses with subtypes and severity of MDS/CMML, and no significant impact of vasculitis on overall survival. Whereas conventional DMARDs seem to be less effective, biologics or azacytidine therapy could be considered for even low-risk MDS/CMML vasculitis.
Collapse
Affiliation(s)
- Anne Laure Roupie
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Guedon
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Constance Lahuna
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Vincent Jachiet
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Regent
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP Sorbonne Université, Hôpital Saint Antoine, 75012 Paris, France
| | - Julie Seguier
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, CHU Lille, Lille, France
| | | | | | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndromes (CEREO), Foch Hospital, Suresnes, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Rouen, France
| | - Francois Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Emmanuel Ledoult
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France
| | | | - Maud D'Aveni
- Department of Hematology, CHU Nancy, Nancy, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Joris Galland
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Lise Willems
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Noemie Jourde Chiche
- Department of Nephrology, Centre de Néphrologie et de Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital La Conception, Marseille, France
| | | | | | - Anne Parcelier
- Department of Hematology, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | | | - Marc Lambert
- Department of Internal Medicine, CHU Lille, Lille, France
| | - Cristina Belizna
- Department of Vascular Medicine, CHU d'Angers, UMR-CNRS 6015 INSERM 1083, Angers, France
| | - Xavier Puechal
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Laure Swiader
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Rolande Cohen-Valensi
- Department of Internal Medicine, CH de Martigues Hôpital des Rayettes, Martigues, France
| | - Valérie Noc
- Department of Nephrology, CH Hyères, Hyères, France
| | - Emmanuel Dao
- Department of Nephrology, CH Hyères, Hyères, France
| | | | | | | | | | - Guillaume Bussone
- Department of Internal Medicine, Hôpital Antoine Béclère, Clamart, France
| | | | - Amadou Konate
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Guilhem Cavaille
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Philippe Guilpain
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Jean-Sébastien Allain
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France; Pôle cardio vasculaire et métabolisme, CH Saint-Malo, Saint-Malo, France
| | - Jonathan Broner
- Department of Internal Medicine, CHU de Nîmes, Nîmes, France
| | - Eric Solary
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Marc Ruivard
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benoit de Renzis
- Department of Hematology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sélim Corm
- Department of Hematology, Médipôle de Savoie, Charles Les Eaux, France
| | - Nadia Baati
- Department of Hematology, CH Strasbourg, Strasbourg, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, CHU Ambroise Paré, Boulogne- Billancourt, France
| | | | - Lionel Ades
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Azeddine Dellal
- Department of Rheumatology, Montfermeil Hospital, 93370 Montfermeil, France
| | - Andrei Tchirkov
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Fenaux
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
| | | |
Collapse
|
20
|
Gris JC, Mousty É, Bouvier S, Ripart S, Cochery-Nouvellon É, Fabbro-Peray P, Broner J, Letouzey V, Pérez-Martin A. Increased incidence of cancer in the follow-up of obstetric antiphospholipid syndrome within the NOH-APS cohort. Haematologica 2020; 105:490-497. [PMID: 31101755 PMCID: PMC7012495 DOI: 10.3324/haematol.2018.213991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/16/2019] [Indexed: 12/16/2022] Open
Abstract
Malignancies can be associated with positive antiphospholipid antibodies but the incidence of cancer among women with the purely obstetric form of antiphospholipid syndrome (APS) is currently unknown. Our aim was to investigate the comparative incidence of cancers in women with a history of obstetric APS within a referral university hospital-based cohort (NOH-APS cohort). We performed a 17-year observational study of 1,592 non-thrombotic women with three consecutive spontaneous abortions before the 10th week of gestation or one fetal death at or beyond the 10th week of gestation. We compared the incidence of cancer diagnosis during follow-up among the cohort of women positive for antiphospholipid antibodies (n=517), the cohort of women carrying the F5 rs6025 or F2 rs1799963 polymorphism (n=279) and a cohort of women with negative thrombophilia screening results (n=796). The annualized rate of cancer was 0.300% (0.20%-0.44%) for women with obstetric APS and their cancer risk was substantially higher than that of women with negative thrombophilia screening [adjusted hazard ratio (aHR) 2.483; 95% confidence interval (CI) 1.27-4.85]. The computed standardized incidence ratio for women with obstetric APS was 2.89; 95% CI: 1.89-4.23. Among antiphospholipid antibodies, lupus anticoagulant was associated with incident cancers (aHR 2.608; 95% CI: 1.091-6.236). Our cohort study shows that the risk of cancer is substantially higher in women with a history of obstetric APS than in the general population, and in women with a similar initial clinical history but negative for antiphospholipid antibodies.
Collapse
Affiliation(s)
- Jean-Christophe Gris
- Department of Hematology, University Hospital of Nîmes, Nîmes, France .,Faculty of Pharmaceutical and Biological Sciences, University of Montpellier, Montpellier, France.,UPRES EA2992 "Caractéristiques Féminines des Dysfonctions des Interfaces Vasculaires", University of Montpellier, Montpellier, France.,I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Éve Mousty
- Department of Gynecology and Obstetrics, University Hospital of Nîmes, Nîmes, France
| | - Sylvie Bouvier
- Department of Hematology, University Hospital of Nîmes, Nîmes, France.,Faculty of Pharmaceutical and Biological Sciences, University of Montpellier, Montpellier, France.,UPRES EA2992 "Caractéristiques Féminines des Dysfonctions des Interfaces Vasculaires", University of Montpellier, Montpellier, France
| | - Sylvie Ripart
- Department of Gynecology and Obstetrics, University Hospital of Nîmes, Nîmes, France
| | - Éva Cochery-Nouvellon
- Department of Hematology, University Hospital of Nîmes, Nîmes, France.,UPRES EA2992 "Caractéristiques Féminines des Dysfonctions des Interfaces Vasculaires", University of Montpellier, Montpellier, France
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Epidemiology, Public Health, Innovation and Methodology, University Hospital of Nîmes, Nîmes, France
| | - Jonathan Broner
- Department of Internal Medicine, University Hospital of Nîmes, Nîmes, France
| | - Vincent Letouzey
- Department of Gynecology and Obstetrics, University Hospital of Nîmes, Nîmes, France
| | - Antonia Pérez-Martin
- UPRES EA2992 "Caractéristiques Féminines des Dysfonctions des Interfaces Vasculaires", University of Montpellier, Montpellier, France.,Department of Vascular Medicine, University Hospital of Nîmes, Nîmes, France
| |
Collapse
|
21
|
Jachiet V, Moulis G, Seguier J, Schleinitz N, Vey N, Hadjadj J, Sacré K, Godeau B, Laribi K, Lambotte O, Broner J, Frédérique R, Salvado C, Le Clech L, Peterlin P, Versini M, Ades L, Fenaux P, Fain O, Mekinian A. Caractéristiques cliniques, évolution et prise en charge des thrombopénies immunologiques associées aux syndromes myélodysplasiques et leucémies myélomonocytaires chroniques : une étude multicentrique rétrospective comparative. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.020] [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: 11/16/2022]
|
22
|
Bouvet J, Broner J, Veysseyre F, Arnaud E. Encéphalite paranéoplasique avec anticorps anti-SOX1 et anti-CV2 révélatrice d’un carcinome neuro-endocrine à petites cellules. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.315] [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]
|
23
|
Grossin D, Broner J, Arnaud E, Goulabchand R, Gris JC. [Acquired autoimmune haemophilia: Where is the place of rituximab in the treatment strategy? Reflection from a monocentric series of 8 patients and literature review]. Rev Med Interne 2019; 40:574-580. [PMID: 30904179 DOI: 10.1016/j.revmed.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2018] [Revised: 02/14/2019] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Autoimmune acquired haemophilia is a rare autoimmune disease. The purpose of immunosuppressive therapy is to stop the production of autoantibodies that inhibit clotting factors VIII or IX. A corticosteroids-cyclophosphamide combination is recommanded as first-line therapy. From our experience at the University Hospital of Nîmes, we discuss the place of rituximab in the therapeutic arsenal. METHODS We report a monocentric observational retrospective study. Our data are discussed in light of literature data, in particular cohorts EACH2 and SACHA. RESULTS Eight patients (7 with FVIII anibodies) were consecutively included from 2005. The average age was 68.5 years with a male predominance (62.5%). Bleeding manifestations were usually spontaneous and superficial. A pathology, mostly autoimmune or neoplastic, was associated in 5/8 patients. A "by-pass" haemostatic treatment was prescribed for 3/8 patients. Rituximab was prescribed for 5/8 patients, three times as first-line therapy, and always associated with corticosteroids. Three patients received a cyclophosphamid/cortisone combination, two were treated exclusively with oral corticosteroids. Remission was obtained in all patients, without subsequent relapse. The average time to obtain remission under rituximab (after the first injection) was 32.5 days (10-143). The results observed in our series of patients are consistent with the data from the literature. CONCLUSIONS Rituximab appears to be an effective and well-tolerated treatment for autoimmune acquired haemophilia. However, its place remains to be specified.
Collapse
Affiliation(s)
- D Grossin
- Service de médecine interne, CHU Nîmes, 30029 Nîmes, France.
| | - J Broner
- Service de médecine interne, CHU Nîmes, 30029 Nîmes, France
| | - E Arnaud
- Service de médecine interne, CHU Nîmes, 30029 Nîmes, France
| | - R Goulabchand
- Département de médecine interne maladies multi-organiques, CHU Saint-Éloi, Montpellier, France
| | - J C Gris
- Service d'hématologie, CHU Nîmes, 30029 Nîmes, France
| |
Collapse
|
24
|
Gris JC, Mousty E, Bouvier S, Ripart S, Cochery-Nouvellon E, Mercier E, Broner J, Letouzey V, Perez-Martin A. O002: Increased incidence of cancer in the follow-up of obstetric antiphospholipid syndrome: the NOHA-K observational study. Thromb Res 2019. [DOI: 10.1016/s0049-3848(19)30082-9] [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: 11/29/2022]
|
25
|
Dumain C, Grossin D, Viala M, Broner J. Lénalidomide : Une nouvelle alternative thérapeutique dans la prise en charge des angiodysplasies digestives. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.170] [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: 11/26/2022]
|
26
|
Robilliard B, Arnaud E, Gastaud L, Broner J. A case of pembrolizumab-induced autoimmune haemolytic anaemia with polymyalgia rheumatica. Eur J Cancer 2018; 103:281-283. [PMID: 30286977 DOI: 10.1016/j.ejca.2018.07.318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/28/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | - Erik Arnaud
- Department of Internal Medicine, Nîmes University Hospital, Nîmes, France
| | - Lauris Gastaud
- Oncology Department, Anticancer Center Antoine Lacassagne, Nice, France
| | - Jonathan Broner
- Department of Internal Medicine, Nîmes University Hospital, Nîmes, France.
| |
Collapse
|
27
|
Robilliard B, Broner J, Hazebroucq J, Arnaud E. Aplasie médullaire iatrogène sous azathioprine : à propos d’un cas. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.158] [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: 11/29/2022]
|
28
|
Naciri T, Broner J, Goujon J, Arnaud E. Un cas d’amylose à chaînes légères révélée par des nodules pulmonaires. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.147] [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: 10/14/2022]
|
29
|
Affiliation(s)
- Jonathan Broner
- Department of Internal Medicine, Nîmes University Hospital, Nîmes, France.
| | - Valérie Reymann
- Department of Cytopathology, Gui de Chauliac Hospital, Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, Montpellier, France
| |
Collapse
|
30
|
Goulabchand R, Dufour S, Murez T, Broner J, Rivière S, Guilpain P, Le Quellec A. [Systemic Bacillus Calmette-Guerin sepsis manifesting as autoimmunity, 17 months after an intravesical BCG-therapy]. Med Mal Infect 2017; 47:558-561. [PMID: 28943176 DOI: 10.1016/j.medmal.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023]
Affiliation(s)
- R Goulabchand
- Département de médecine interne maladies multi-organiques, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, 2, rue de l'École-de-médecine, 34060 Montpellier cedex 2, France.
| | - S Dufour
- Département de médecine interne maladies multi-organiques, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, 2, rue de l'École-de-médecine, 34060 Montpellier cedex 2, France; Département de maladies infectieuses et tropicales, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - T Murez
- Service d'urologie et de transplantation rénale, hôpital Lapeyronie, 371, avenue du doyen Gaston-Giraud, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, 2, rue de l'École-de-médecine, 34060 Montpellier cedex 2, France
| | - J Broner
- Département de médecine interne maladies multi-organiques, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, 2, rue de l'École-de-médecine, 34060 Montpellier cedex 2, France
| | - S Rivière
- Département de médecine interne maladies multi-organiques, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - P Guilpain
- Département de médecine interne maladies multi-organiques, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, 2, rue de l'École-de-médecine, 34060 Montpellier cedex 2, France
| | - A Le Quellec
- Département de médecine interne maladies multi-organiques, hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, 2, rue de l'École-de-médecine, 34060 Montpellier cedex 2, France
| |
Collapse
|
31
|
Suzon B, Arnaud E, Galy C, Broner J. [Hands and feet lesions]. Rev Med Interne 2017; 40:56-57. [PMID: 28942058 DOI: 10.1016/j.revmed.2017.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/13/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
- B Suzon
- Service de médecine interne, CHU Carémeau Nîmes, place du Professeur-Robert-Debré, 30000 Nîmes, France.
| | - E Arnaud
- Service de médecine interne, CHU Carémeau Nîmes, place du Professeur-Robert-Debré, 30000 Nîmes, France
| | - C Galy
- Service d'oto-rhino-laryngologie, CHU Carémeau Nîmes, place du Professeur-Robert-Debré, 30000 Nîmes, France
| | - J Broner
- Service de médecine interne, CHU Carémeau Nîmes, place du Professeur-Robert-Debré, 30000 Nîmes, France
| |
Collapse
|
32
|
Mekinian A, Dervin G, Lapidus N, Kahn JE, Terriou L, Liozon E, Grignano E, Piette JC, Rauzy OB, Grobost V, Godmer P, Gillard J, Rossignol J, Launay D, Aouba A, Cardon T, Bouillet L, Broner J, Vinit J, Ades L, Carrat F, Salvado C, Toussirot E, Versini M, Costedoat-Chalumeau N, Fraison JB, Guilpain P, Fenaux P, Fain O. Biologics in myelodysplastic syndrome-related systemic inflammatory and autoimmune diseases: French multicenter retrospective study of 29 patients. Autoimmun Rev 2017; 16:903-910. [DOI: 10.1016/j.autrev.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 12/23/2022]
|
33
|
Broner J, Arnaud E. Colite ischémique révélant une thromboangéite oblitérante : à propos d’un cas. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.190] [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: 10/19/2022]
|
34
|
Parreau S, Nadalon S, Broner J, Gall E, Souweine J, Gondran G, Palat S, Ly K, Fauchais A. Troubles neuropsychiatriques au cours d’une histiocytose langerhansienne de l’adulte. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.285] [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: 10/19/2022]
|
35
|
Suzon B, Broner J, Arnaud E. Des bulles hémorragiques : association entre une hémophilie A acquise auto-immune et une pemphigoïde bulleuse. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.297] [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: 12/01/2022]
|
36
|
Broner J, Danière F, Coestier B, Menjot de Champfleur N, Le Quellec A. Mammillary bodies infiltration in Langerhans-cell histiocytosis. J Neuroradiol 2016; 43:417-419. [PMID: 27697298 DOI: 10.1016/j.neurad.2016.09.002] [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] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/05/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan Broner
- Service de Médecine interne et Maladies Multi-Organiques de l'Adulte, Hôpital Saint-Éloi, Centre Hospitalier Régional Universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - Florian Danière
- Département de Neuroradiologie, Hôpital Gui-de-Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
| | - Bérengère Coestier
- Service d'Endocrinologie-Diabétologie-Nutrition, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
| | - Nicolas Menjot de Champfleur
- Département de Neuroradiologie, Hôpital Gui-de-Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France; Département d'Imagerie Médicale, Centre Hospitalier Universitaire Caremeau, Nîmes, France; Institut d'Imagerie Fonctionnelle Humaine (I2FH), Hôpital Gui-de-Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France; Institut de Neurosciences de Montpellier, INSERM U1051, Hôpital Saint-Éloi, Montpellier, France; Laboratoire Charles-Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France
| | - Alain Le Quellec
- Service de Médecine interne et Maladies Multi-Organiques de l'Adulte, Hôpital Saint-Éloi, Centre Hospitalier Régional Universitaire de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| |
Collapse
|
37
|
Dufour S, Goulabchand R, Boclé H, Henneton P, Broner J, Rivière S, Guilpain P, Le Quellec A. Mycobactériose disséminée avec cytopénies auto-immunes après instillation vésicale de BCG : à propos d’un cas. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.194] [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: 10/21/2022]
|
38
|
Henneton P, Goulabchand R, Dufour S, Broner J, Rivière S, Lambotte O, Guilpain P, Le Quellec A. Syndrome d’activation macrophagique induit par l’EBV comportant des critères de gravité : efficacité du rituximab. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.196] [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]
|
39
|
Broner J, Cerutti D, Tchernonog E, Rousset T, Cartron G, Guilpain P, Le Quellec A. Régression d’un syndrome lymphoprolifératif induit par EBV après interruption du méthotrexate, chez un patient traité pour une périartérite noueuse. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.178] [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: 10/25/2022]
|
40
|
Blake RL, Broner J. Deficiency of a glucocorticoid inducible isoenzyme of liver tyrosine aminotransferase in the obese C57BL-6J-ob mutant mouse. Biochem Biophys Res Commun 1970; 41:1443-51. [PMID: 4395129 DOI: 10.1016/0006-291x(70)90548-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|