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Kennis M, Dewitte M, T'Sjoen G, Stinkens K, Sack AT, Duecker F. The behavioral component of sexual inhibition and its relation with testosterone levels: An fMRI study in transgender and cisgender individuals. Psychoneuroendocrinology 2024; 163:106963. [PMID: 38342056 DOI: 10.1016/j.psyneuen.2024.106963] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/13/2024]
Abstract
Many transgender individuals report having difficulties with initiating and seeking sexual contacts. Relatively to cisgender individuals, transgender individuals are more likely to avoid sexual activity, indicating that the groups might differ in the neural underpinnings of the behavioral component of sexual inhibition. In this fMRI study, transgender (n = 33) and cisgender (n = 34) participants performed an Approach Avoidance Task (AAT) assessing sexual inhibition. We found that over the entire sample, the task elicited brain activation commonly associated with general and sexual inhibition, for instance in the bilateral insula, right inferior parietal lobule, and right inferior and middle frontal gyri. Upon investigating group differences between transgender and cisgender participants, we mainly found similarities in neural activation during the task. However, there were group differences in regions involved in decision making processes (left middle temporal gyrus) and sexual response inhibition (right anterior cingulate cortex and left inferior parietal lobule). In order to investigate whether these group differences were modulated by testosterone levels, we performed ROI-analyses assessing the relationship between testosterone and neural activation during the AAT (controlling for sex assigned at birth), but no correlations were found. On the whole brain level, however, we found that testosterone correlated positively with cerebral activation in the right claustrum (a region associated with sexual arousal) during the approach of sexual stimuli in the transgender group. Overall, these findings indicate that transgender and cisgender individuals mostly show similarities in their neural response to a sexual Approach-Avoidance task, and that testosterone levels are unlikely to play an important role.
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Affiliation(s)
- M Kennis
- Maastricht University, Department of Cognitive Neuroscience, Maastricht, The Netherlands; Maastricht Brain Imaging Center, Maastricht, The Netherlands; Maastricht University, Department of Clinical Psychological Science, Maastricht, The Netherlands.
| | - M Dewitte
- Maastricht University, Department of Clinical Psychological Science, Maastricht, The Netherlands
| | - G T'Sjoen
- Ghent University Hospital, Department of Endocrinology, Ghent, Belgium; Ghent University Hospital, Center for Sexology and Gender, Ghent, Belgium
| | - K Stinkens
- Hospital Oost-Limburg, Department of Endocrinology, Genk, Belgium; Hospital Oost-Limburg, Gender Center, Genk, Belgium
| | - A T Sack
- Maastricht University, Department of Cognitive Neuroscience, Maastricht, The Netherlands; Maastricht Brain Imaging Center, Maastricht, The Netherlands; Maastricht University, Center for Integrative Neuroscience, Maastricht, The Netherlands
| | - F Duecker
- Maastricht University, Department of Cognitive Neuroscience, Maastricht, The Netherlands; Maastricht Brain Imaging Center, Maastricht, The Netherlands
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2
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Quénéhervé L, Trang-Poisson C, Fantou A, Flamant M, Durand T, Bouguen G, Bregeon J, Oullier T, Amil M, Dewitte M, Bardot S, Blandin S, Braudeau C, Vibet MA, Josien R, Neunlist M, Bourreille A. Confocal laser endomicroscopy as predictive biomarker of clinical and endoscopic efficacy of vedolizumab in ulcerative colitis: The DETECT study. PLoS One 2024; 19:e0298313. [PMID: 38564601 PMCID: PMC10986992 DOI: 10.1371/journal.pone.0298313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS In patients with ulcerative colitis (UC), no biomarker is available to help the physician to choose the most suitable biotherapy. The primary objective of this pilot study was to assess the feasibility of identification of α4β7- and TNF-expressing cells, to predict the response to vedolizumab using confocal laser endoscopy (CLE). METHODS Patients with moderate-to-severe UC, naïve of biotherapy, received vedolizumab. Clinical evaluation was performed at each infusion. Endoscopic evaluation was performed before inclusion and at week 22. Fresh colonic biopsies were stained using FITC-labelled vedolizumab and Alexa fluor-labelled adalimumab and ex vivo dual-band CLE images were acquired. Blood samples were collected to measure trough concentrations of vedolizumab and to determine absolute counts of T and B cells subpopulations, NK cells and monocytes. RESULTS Nineteen patients were enrolled in the study and received at least one dose of vedolizumab. Clinical remission and endoscopic improvement were observed in 58% of whom 5 patients (45%) had an endoscopic subscore of 0. In terms of clinical response and remission, endoscopic improvement and histologic response, FITC-conjugated vedolizumab staining tended to be higher in responder patients compared to non-responders at week 22. A threshold value of 6 positive FITC-vedolizumab staining areas detected by CLE seemed informative to discriminate the responders and non-responders. The results were similar in terms of clinical remission and endoscopic improvement with a sensitivity of 78% and a specificity of 85% (p = 0.05). Trough concentrations and blood immune cells were not associated with responses to vedolizumab. CONCLUSION This pilot study demonstrate that dual-band CLE is feasible to detect α4β7- and TNF-expressing cells. Positive α4β7 staining seems to be associated with clinical and endoscopic remission in UC patients treated by anti-α4β7-integrin, subject to validation by larger-scale studies. Clinical-trial.gov: NCT02878083.
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Affiliation(s)
- Lucille Quénéhervé
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Caroline Trang-Poisson
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Aurélie Fantou
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Mathurin Flamant
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Tony Durand
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Guillaume Bouguen
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Jérémy Bregeon
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Thibauld Oullier
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Morgane Amil
- CHD La Roche-Sur-Yon, Hepato-gastroentérologie, La Roche-Sur-Yon, France
| | - Marie Dewitte
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Stéphanie Bardot
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Stéphanie Blandin
- Nantes Université, UMS BioCore, Inserm US16—UAR CNRS 3556, Nantes, France
| | - Cécile Braudeau
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Marie-Anne Vibet
- CHU Nantes, Methodology and Biostatistics Department, Direction de la Recherche Clinique et de l’Innovation, Nantes, France
| | - Régis Josien
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Michel Neunlist
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Arnaud Bourreille
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
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3
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Rayer C, Nachury M, Bourreille A, Roblin X, Peyrin-Biroulet L, Viennot S, Flamant M, Laharie D, Caron B, Dewitte M, Siproudhis L, Fumery M, Bouguen G. Correction: Efficacy of ustekinumab, vedolizumab, or a second anti-TNF agent after the failure of a first anti-TNF agent in patients with Crohn's disease: a multicentre retrospective study. BMC Gastroenterol 2023; 23:31. [PMID: 36732693 PMCID: PMC9896746 DOI: 10.1186/s12876-022-02636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Cassandra Rayer
- grid.410368.80000 0001 2191 9284CHU Rennes, University Rennes, 35000 Rennes, France
| | - Maria Nachury
- grid.503422.20000 0001 2242 6780CHU Lille, University of Lille, Lille, France
| | | | - Xavier Roblin
- grid.412954.f0000 0004 1765 1491CHU Saint-Etienne, Saint- Étienne, France
| | - Laurent Peyrin-Biroulet
- grid.410527.50000 0004 1765 1301Inserm U954 Deparment of Hepato-Gastroenterology, Department of Gastroenterology, Nancy University Hospital, Vandœuvre-Lès-Nancy, France
| | | | | | - David Laharie
- grid.412041.20000 0001 2106 639XCHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-Gastroentérologie Et Oncologie Digestive, Université de Bordeaux, 33000 Bordeaux, France
| | - Bénédicte Caron
- grid.410527.50000 0004 1765 1301Inserm U954 Deparment of Hepato-Gastroenterology, Department of Gastroenterology, Nancy University Hospital, Vandœuvre-Lès-Nancy, France
| | - Marie Dewitte
- grid.410368.80000 0001 2191 9284CHU Rennes, University Rennes, 35000 Rennes, France
| | - Laurent Siproudhis
- grid.411154.40000 0001 2175 0984CHU Rennes, University Rennes, INSERM, CIC1414, Institute NUMECAN (Nutrition Metabolism and Cancer), 35000 Rennes, France
| | - Mathurin Fumery
- grid.11162.350000 0001 0789 1385Service d’Hépato-Gastroentérologie Et Oncologie Digestive, CHU Amiens Et PeriTox, UMR I0-I, Université de Picardie, Amiens, France
| | - Guillaume Bouguen
- grid.411154.40000 0001 2175 0984CHU Rennes, University Rennes, INSERM, CIC1414, Institute NUMECAN (Nutrition Metabolism and Cancer), 35000 Rennes, France ,Service Des Maladies de L’Appareil Digestif, 2 Rue Henri Le Guillou, 35033 Rennes Cedex, France
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4
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Laland M, François M, D'Amico F, Zallot C, Brochard C, Dewitte M, Siproudhis L, Peyrin-Biroulet L, Bouguen G. Identification of the optimal medical and surgical management for patients with perianal fistulising Crohn's disease. Colorectal Dis 2023; 25:75-82. [PMID: 36016511 DOI: 10.1111/codi.16314] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/28/2022] [Accepted: 08/08/2022] [Indexed: 02/02/2023]
Abstract
AIM The aim of our study was to assess the best medical and surgical approaches for perianal Crohn's disease (PCD) in order to identify an optimal combined medical and surgical treatment. METHODS Medical records of all patients with PCD treated with TNFα antagonists in two referral centres between 1998 and 2018 were reviewed. Predictors of long-term outcomes were identified using a Cox proportional hazard model. RESULTS A total of 200 patients were included. Fifty-three patients (26.5%) were treated with adalimumab and 147 (73.5%) with infliximab. A combination of TNFα antagonist with an immunosuppressant and the presence of proctitis were independently associated with fistula closure. Seton was placed in 127 patients (63.5%) before starting biological therapy. Eighty patients (40%) underwent additional perineal surgery. Prior PCD surgery, seton positioning, additional perineal surgery, and additional surgery within 52 weeks of anti-TNFα treatment were associated with an increased rate of fistula closure. Finally, medical combination therapy (anti-TNFα plus immunosuppressant) along with seton placement and additional surgery within 1 year was the best management for PCD patients (p = 0.02). CONCLUSION Combined medical and surgical management is required for the treatment of PCD patients. Medical combination therapy associated with seton placement and additional surgery within 1 year is the best management for PCD patients.
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Affiliation(s)
| | | | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Camille Zallot
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Charlène Brochard
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Marie Dewitte
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Rennes, France
| | - Laurent Siproudhis
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
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Landemaine A, Petitcollin A, Brochard C, Miard C, Dewitte M, Le Balc'h E, Grainville T, Bellissant E, Siproudhis L, Bouguen G. Cumulative Exposure to Infliximab, But Not Trough Concentrations, Correlates With Rate of Infection. Clin Gastroenterol Hepatol 2021; 19:288-295.e4. [PMID: 32200087 DOI: 10.1016/j.cgh.2020.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/13/2020] [Accepted: 03/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Infliximab increases the risk of infection in patients with inflammatory bowel diseases (IBD), but there is controversy over the relationship between drug concentration and infections. We aimed to assess factors associated with infection in infliximab-treated patients, including pharmacokinetic features. METHODS We collected data from 209 patients with IBD (102 men; mean age, 39 y; 159 with Crohn's disease; 54 received combination therapy) who received an infliximab maintenance regimen from November 2016 through April 2017 in France. Data were collected from each infusion visit (total of 640 infusions). Infliximab exposure was estimated based on the area under the curve (AUC) of drug concentration in pharmacokinetic models; individual exposures over the 6-month period were estimated based on the sum of the AUC (ΣAUC). RESULTS The mean infliximab trough level was 5.46 mg/L, and the mean ΣAUC was 3938 ± 1427 mg.d/L. A total of 215 infections were collected from the 640 infusion visits; 123 patients (59%) had at least 1 infection. Factors independently associated with infection after multivariate analysis were smoking (odds ratio [OR], 2.05; P = .046), IBD flare (OR, 2.71; P = .006), and a high ΣAUC of infliximab (above 3234 mg x d/L) (OR, 2.02; P = .02). The ΣAUC was higher in patients with an occurrence of infection (P = .04) and correlated with the number of infections (P = .04). Trough concentration of infliximab alone was not associated with infection. CONCLUSIONS Almost two-thirds of patients treated with infliximab developed an infection; risk was individually correlated with cumulative increase in drug exposure, but not infliximab trough level.
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Affiliation(s)
| | | | - Charlène Brochard
- CHU Rennes, University of Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Céline Miard
- CHU Rennes, University of Rennes, Rennes, France
| | | | | | | | | | - Laurent Siproudhis
- CHU Rennes, University of Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Guillaume Bouguen
- CHU Rennes, University of Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France.
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6
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Herissay A, Siproudhis L, Le Balc'h E, Merlini L'Heritier A, Dewitte M, Wallenhorst T, Bouguen G, Brochard C. Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors. Colorectal Dis 2021; 23:159-168. [PMID: 32640112 DOI: 10.1111/codi.15241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/21/2020] [Indexed: 12/13/2022]
Abstract
AIM The medico-surgical strategy for the treatment of perianal fistulizing Crohn's disease (CD) following surgical drainage remains challenging and debated. Our aims were to describe the failure rate of therapeutic interventions after drainage of the fistula tract and determine the factors associated with failure to optimize medico-surgical strategies. METHOD All consecutive patients with perianal fistulizing CD who underwent surgical drainage with at least a 12-week follow-up were included. Failure was defined as the occurrence of at least one of the following items: abscess recurrence, purulent discharge from the tract, visible external opening and further drainage procedure(s). RESULTS One hundred and sixty-nine patients were included. The median follow-up was 4.0 years. The cumulative failure rates were 20%, 30% and 36% at 1, 3 and 5 years, respectively. The cumulative failure rates in patients who had sphincter-sparing surgeries or seton removal were significantly higher than in those who had a fistulotomy. Anterior fistula [hazard ratio (HR) = 2.52 (1.13-5.61), P = 0.024], supralevator extension [HR = 20.78 (3.38-127.80), P = 0.001] and the absence or discontinuation of immunosuppressants after anal drainage [HR = 3.74 (1.11-12.5), P = 0.032] were significantly associated with failure in the multivariate analysis model. CONCLUSION Combined strategies for perianal fistulizing CD lead to a failure rate of 36% at 5 years. Where advisable, fistulotomy may be preferred because it has a lower rate of recurrence. The benefits of immunosuppressants require a dedicated prospective randomized trial.
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Affiliation(s)
- A Herissay
- CHU Rennes, Universitaire Rennes, Rennes, France
| | - L Siproudhis
- INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, Universitaire Rennes, Rennes, France
| | - E Le Balc'h
- CHU Rennes, Universitaire Rennes, Rennes, France
| | | | - M Dewitte
- CHU Rennes, Universitaire Rennes, Rennes, France
| | | | - G Bouguen
- INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, Universitaire Rennes, Rennes, France
| | - C Brochard
- INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, Universitaire Rennes, Rennes, France
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7
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Le Berre C, Flamant M, Bouguen G, Siproudhis L, Dewitte M, Dib N, Cesbron-Metivier E, Goronflot T, Hanf M, Gourraud PA, Kerdreux E, Poinas A, Bourreille A, Trang-Poisson C. VALIDation of the IBD-Disk Instrument for Assessing Disability in Inflammatory Bowel Diseases in a French Cohort: The VALIDate Study. J Crohns Colitis 2020; 14:1512-1523. [PMID: 32417910 DOI: 10.1093/ecco-jcc/jjaa100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases [IBD] are disabling disorders. The IBD-Disability Index [IBD-DI] was developed for quantifying disability in IBD patients but is difficult to use. The IBD-Disk is a visual adaptation of the IBD-DI. It has not been validated yet. The main objectives were to validate the IBD-Disk and to assess the clinical factors associated with a change in the score and its variability over time. METHODS From May 2018 to July 2019, IBD patients from three university-affiliated hospitals responded twice to both IBD-Disk and IBD-DI at 3-12 month intervals. Validation included concurrent validity, reproducibility, and internal consistency. Mean IBD-Disk scores were compared according to clinical factors. Variability was assessed by comparing scores between baseline and follow-up visits. RESULTS A total of 447 patients [71% Crohn's disease, 28% ulcerative colitis] were included in the analysis at baseline and 265 at follow-up. There was a good correlation between IBD-Disk and IBD-DI [r = 0.75, p <0.001]. Reproducibility was excellent [intra-class correlation coefficient = 0.90], as well as internal consistency [Cronbach's α = 0.89]. The IBD-Disk was not influenced by IBD type but was associated with female gender and physician global assessment. Extra-intestinal manifestations, history of resection, elevated C-reactive protein and faecal calprotectin also tended to be associated with higher disability. The IBD-Disk score decreased in patients becoming inactive over time. CONCLUSIONS This study validated the IBD-Disk in a large cohort of IBD patients, demonstrating that it is a valid and reliable tool for quantifying disability for both CD and UC.
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Affiliation(s)
- Catherine Le Berre
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Mathurin Flamant
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.,Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - Guillaume Bouguen
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - Laurent Siproudhis
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - Marie Dewitte
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - Nina Dib
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | | | - Thomas Goronflot
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- Clinique des Données, Nantes University Hospital, Nantes, France
| | | | - Elise Kerdreux
- Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - Alexandra Poinas
- Direction de la Recherche Clinique, Nantes University Hospital, Nantes, France
| | - Arnaud Bourreille
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.,Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - Caroline Trang-Poisson
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.,Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
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8
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Le Berre C, Bourreille A, Flamant M, Bouguen G, Siproudhis L, Dewitte M, Dib N, Cesbron-Metivier E, Goronflot T, Hanf M, Gourraud PA, Kerdreux E, Poinas A, Trang-Poisson C. Protocol of a multicentric prospective cohort study for the VALIDation of the IBD-disk instrument for assessing disability in inflammatory bowel diseases: the VALIDate study. BMC Gastroenterol 2020; 20:110. [PMID: 32299390 PMCID: PMC7164208 DOI: 10.1186/s12876-020-01246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Inflammatory Bowel Diseases (IBD) affect psychological, family, social and professional dimensions of patients’ life, leading to disability which is essential to quantify as part of Patient-Reported Outcomes (PROs) newly included in the targets to reach in IBD patients. Up to now, the IBD-Disability Index (IBD-DI) was the only validated tool to assess disability, but it is not appropriate for use in clinical practice. The IBD Disk was developed, a shortened and self-administered tool, adapted from the IBD-DI, in order to give immediate representation of patient-reported disability. However, the IBD Disk has not been validated yet in clinical practice. The aims of the VALIDate study are to validate this tool in a large population of IBD patients and to compare it to the already validated IBD-DI. Methods The VALIDate study is an ongoing multicentric prospective cohort study launched in April 2018 in 3 French University Hospitals (Nantes, Rennes, Angers), with an objective to reach a sample of 400 patients over a period inclusion of 6 months. Each patient will fill in the two questionnaires IBD Disk and IBD-DI at baseline, then between 3 and 12 months later, during a follow-up visit. Clinical and socio-demographic data will also be collected. During these two consultations, gastroenterologists and patients will evaluate disease activity thanks to a semi-quantitative 4-grade scale, named respectively PGA (Physician Global Assessment) and PtGA (Patient Global Assessment). This cohort will allow to evaluate the validity of the IBD Disk with respect to the IBD-DI in order to generalize its use for clinical practice. Other psychometric criteria of the IBD Disk will also be analysed as its reliability or its discriminant capacity. Close attention will nonetheless be needed to minimize the number of lost to follow-up patients between baseline and follow-up. Discussion The VALIDate study is the study designed to validate the IBD Disk, a visual tool easily useable in daily practice to assess disability in IBD patients. The results of this trial should enable the diffusion of this tool. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT03590639. First posted: July 18, 2018.
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Affiliation(s)
- C Le Berre
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France.
| | - A Bourreille
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - M Flamant
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - G Bouguen
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - L Siproudhis
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - M Dewitte
- Service des Maladies de l'Appareil Digestif, Rennes University Hospital, Rennes, France
| | - N Dib
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | - E Cesbron-Metivier
- Service de Gastroentérologie, Angers University Hospital, Angers, France
| | - T Goronflot
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - M Hanf
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - P-A Gourraud
- Clinique des Données, Nantes University Hospital, Nantes, France
| | - E Kerdreux
- Centre d'Investigation Clinique, Nantes University Hospital, Nantes, France
| | - A Poinas
- Direction de la Recherche Clinique, Nantes University Hospital, Nantes, France
| | - C Trang-Poisson
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
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9
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Ataky A, Dewitte M, Kok G, Schepers J. PS-01-013 The role of sexual desire, sexual satisfaction and relationship satisfaction in the sexual function of Arab couples living in Saudi Arabia. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Lucidarme C, Petitcollin A, Brochard C, Siproudhis L, Dewitte M, Landemaine A, Bellissant E, Bouguen G. Predictors of relapse following infliximab de-escalation in patients with inflammatory bowel disease: the value of a strategy based on therapeutic drug monitoring. Aliment Pharmacol Ther 2019; 49:147-154. [PMID: 30589970 DOI: 10.1111/apt.15046] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/11/2018] [Accepted: 10/09/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are limited data concerning infliximab drug monitoring during de-escalation of the treatment of inflammatory bowel disease (IBD). AIM To define the rate and the predictors of relapse following infliximab de-escalation in IBD patients in remission. METHODS All IBD patients at a single referral centre in clinical and biological remission and in whom the dose of infliximab had been de-escalated were included. Patients in remission with a high trough level of infliximab (>7 mg/L) were considered to be trough level-based de-escalation patients. The data were retrieved from a prospective IBD database. Actuarial analysis was performed for statistical purposes. RESULTS A total of 146 de-escalations were performed in 96 patients (Crohn's disease/ulcerative colitis: 68%/32%); 54 (37%) were based on clinical remission only, and 92 (63%) were based on clinical remission associated with a trough level above 7 mg/L. The cumulative probabilities of relapse following infliximab de-escalation were 16% and 47% at 1 and 2 years, respectively. Ulcerative colitis was associated with an increased risk of relapse (HR = 3.2, P = 0.005). Conversely, combination therapy at infliximab initiation (HR = 0.39, P = 0.0110) and trough level-based de-escalation were associated with decreased risk of relapse (HR = 0.45, P = 0.024). Trough levels before and after de-escalation were well correlated; a decrease by half was observed following a 2-week interval increase or a half-dose decrease. CONCLUSION The use of trough levels to assess the feasibility of dose de-escalation seems to be a prerequisite for decreasing the risk of relapse.
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Affiliation(s)
| | | | - Charlène Brochard
- CHU Rennes, Univ Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
| | - Laurent Siproudhis
- CHU Rennes, Univ Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
| | | | | | | | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
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Varagnolo D, Knorn S, Chiva E, Melles R, Dewitte M. 491 Towards the individualization of vaginal dilatation exercises: A Quantitative analysis of the variability of vaginal pressure responses. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.398] [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]
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12
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Legué C, Brochard C, Bessi G, Wallenhorst T, Dewitte M, Siproudhis L, Bouguen G. Outcomes of Perianal Fistulising Crohn's Disease Following Anti-TNFα Treatment Discontinuation. Inflamm Bowel Dis 2018; 24:1107-1113. [PMID: 29733370 DOI: 10.1093/ibd/izy008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Discontinuation of antitumour necrosis factor (TNF)α therapy with perianal fistulising Crohn's disease remains controversial due to the risk of severe relapse without any clear evidence. AIM The aim of this study was to assess the rate and type of perianal and luminal relapses following anti-TNFα discontinuation. METHODS All patients treated with anti-TNFα for perianal fistulising Crohn's disease with subsequent discontinuation of therapy were retrospectively reviewed from a prospective database (1998-2016). Cumulative probabilities of relapse-free survival were estimated by actuarial analysis. RESULTS After a median follow-up of 62 months, 24 of the 45 patients experienced perianal relapse. A new surgical drainage was needed in 19 (79%) patients. The cumulative probabilities of perianal relapse at 1 and 5 years were 24% and 55%, respectively. Ileal localization (L1) at diagnosis, persistence of an external fistula opening, second line anti-TNFα use, or prior dose optimization was associated with perianal relapse, whereas continuation of immunosuppressive agents decreased this risk (HR = 0.3). Luminal relapse occurred in 42% of patients at 5 years. The cumulative probability of global relapse at 5 years was 67%. Retreatment with anti-TNFα allowed further remission in 23 of 24 (96%) patients. CONCLUSION Half of patients with perianal fistulising Crohn's disease relapse within 5 years after anti-TNFα discontinuation. Immunosuppressant continuation may decrease this risk. The high risk of relapse (perianal and luminal) may suggest a benefit in pursuing biologics over a longer period in patients with perianal fistulas.
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Affiliation(s)
- Clémence Legué
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France
| | - Charlène Brochard
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France.,Inserm 991, University of Rennes, France.,CIC1414, Université de Rennes, France
| | - Grégoire Bessi
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France
| | - Timothée Wallenhorst
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France
| | - Marie Dewitte
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France
| | - Laurent Siproudhis
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France.,Inserm 991, University of Rennes, France.,CIC1414, Université de Rennes, France
| | - Guillaume Bouguen
- Department of Hepato-Gastroenterology, University Hospital of Pontchaillou, Rennes, France.,Inserm 991, University of Rennes, France.,CIC1414, Université de Rennes, France
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13
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Coron E, Dewitte M, Aubert P, Musquer N, Neunlist M, Bruley des Varannes S. Reversibility of gastric mucosal lesions induced by sodium phosphate tablets and characterized by probe-based confocal laser endomicroscopy. Endosc Int Open 2015; 3:E69-75. [PMID: 26134776 PMCID: PMC4423282 DOI: 10.1055/s-0034-1377934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/15/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Adequate bowel preparation is key for the optimal quality of colonoscopy. The sodium phosphate laxatives used for preparation may induce gastric injuries. However, in vivo studies monitoring the effects of sodium phosphate on the gastric mucosa are currently lacking. We aimed to characterize the effects of sodium phosphate tablets (Colokit®; Mayoly Spindler, Chatou, France) on the gastric mucosa in a large-animal model. METHODS Fourteen anesthetized pigs were used for this study. Fundic mucosal sites were analyzed at 1.5, 24, and 72 hours after the endoscopically guided application of sodium phosphate tablets (NaPT) and placebo tablets (PlaT) and were compared with unexposed sites. Different mucosal parameters were assessed with white light endoscopy, probe-based confocal laser endomicroscopy (pCLE), histology, and ex vivo permeability measurements. RESULTS At 90 minutes after the application of NaPT, significant increases in epithelial irregularity and crypt pit intensity were observed with pCLE. These microscopic lesions persisted at 24 hours but were resolved at 72 hours. In addition, white light endoscopy revealed local exanthema in 57 % of the animals at 1.5 hours after NaPT application. Such lesions were observed in 22 % of the pigs at 24 hours and disappeared at 72 hours after application. After 1.5 hours, PlaT induced a slight but significant increase in epithelial irregularity, as well as architectural scores that were significantly lower than the ones induced by NaPT and that disappeared after 72 hours. CONCLUSIONS The direct and prolonged gastric application of NaPT in pigs can induce acute superficial macroscopic and microscopic injuries that are reversible within 72 hours.
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Affiliation(s)
- Emmanuel Coron
- Hôtel Dieu, Centre Hospitalier Universitaire, Institut des Maladies de l’Appareil Digestif, Nantes, France,INSERM U 913, Nantes, France,Université de Nantes, Faculté de Médecine, Nantes, France,Corresponding author Emmanuel Coron, MD, PhD Institut des Maladies de l’Appareil Digestif – INSERM U 913CHU Hôtel Dieu44093 Nantes CedexFrance+33 (0)2 40 08 31 54
| | - Marie Dewitte
- Hôtel Dieu, Centre Hospitalier Universitaire, Institut des Maladies de l’Appareil Digestif, Nantes, France,INSERM U 913, Nantes, France,Université de Nantes, Faculté de Médecine, Nantes, France
| | - Philippe Aubert
- Hôtel Dieu, Centre Hospitalier Universitaire, Institut des Maladies de l’Appareil Digestif, Nantes, France,INSERM U 913, Nantes, France,Université de Nantes, Faculté de Médecine, Nantes, France
| | - Nicolas Musquer
- Hôtel Dieu, Centre Hospitalier Universitaire, Institut des Maladies de l’Appareil Digestif, Nantes, France
| | - Michel Neunlist
- Hôtel Dieu, Centre Hospitalier Universitaire, Institut des Maladies de l’Appareil Digestif, Nantes, France,INSERM U 913, Nantes, France,Université de Nantes, Faculté de Médecine, Nantes, France
| | - Stanislas Bruley des Varannes
- Hôtel Dieu, Centre Hospitalier Universitaire, Institut des Maladies de l’Appareil Digestif, Nantes, France,INSERM U 913, Nantes, France,Université de Nantes, Faculté de Médecine, Nantes, France
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Hulstaert F, Van Belle S, Bleiberg H, Canon JL, Dewitte M, Buyse M, De Keyser P, Westelinck KJ. Optimal combination therapy with tropisetron in 445 patients with incomplete control of chemotherapy-induced nausea and vomiting. J Clin Oncol 1994; 12:2439-46. [PMID: 7964961 DOI: 10.1200/jco.1994.12.11.2439] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE This study evaluated tropisetron (Navoban; Sandoz Pharma, Basle, Switzerland)-based combination therapy in patients who had incomplete control of chemotherapy-induced nausea or vomiting when using tropisetron as a single antiemetic agent. PATIENTS AND METHODS One thousand seventy-two patients, who were scheduled to receive at least two identical cycles of emetogenic chemotherapy, were treated with 5 mg tropisetron once daily in their first chemotherapy course. A 2 x 2 x 2 factorial design was used to evaluate three additional treatments to the recommended 5 mg once daily (intravenously [i.v.] on day 1; orally on days 2 through 6) tropisetron regimen during course 2 in those patients who had shown incomplete control of nausea and/or vomiting on any day of course 1. Four hundred forty-five patients were centrally randomized to receive, in addition, open-label dexamethasone (day 1, 0.2 mg/kg i.v.; days 2 through 6, 8 mg orally) and/or open-label alizapride (day 1, 100 mg i.v. and 4 x 50 mg orally; days 2 through 6, 4 x 50 mg orally) and/or double-blind tropisetron (ie, doubling the dose to 10 mg once daily) or corresponding placebo. RESULTS Complete response rates (no nausea and no vomiting) were 72% for day 1 and 48% for days 1 through 6 of course 1. During course 2, more complete responders were observed when dexamethasone was added, both for day 1 (76% v 66%, P = .020) and for days 1 through 6 (50% v 34%, P = .0004). A moderate increase in the complete response rate was seen with the addition of conventional-dose alizapride (day 1, 75% v 68%, P = .14; days 1 through 6: 47% v 37%, P = .041). Doubling the dose of tropisetron did not change the complete response rate. CONCLUSION The addition of dexamethasone significantly increases the complete response rate of both acute and delayed emesis in patients who have incomplete disease control with tropisetron alone.
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Affiliation(s)
- F Hulstaert
- Medical Department, Sandoz, Brussels, Belgium
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Willems J, Dewitte M, Lombaerts MP, Joniau M. Separation and characterization of intracisternal A type virus proteins from neuroblastoma C1300 tumour [proceedings]. Arch Int Physiol Biochim 1979; 87:220-2. [PMID: 92287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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