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Pascart T, Robinet P, Ottaviani S, Leroy R, Segaud N, Pacaud A, Grandjean A, Luraschi H, Rabin T, Deplanque X, Maciejasz P, Visade F, Mackowiak A, Baclet N, Maréchaux S, Lefebvre A, Budzik JF, Bardin T, Richette P, Norberciak L, Ducoulombier V, Houvenagel E. Evaluating the safety and short-term equivalence of colchicine versus prednisone in older patients with acute calcium pyrophosphate crystal arthritis (COLCHICORT): an open-label, multicentre, randomised trial. Lancet Rheumatol 2023; 5:e523-e531. [PMID: 38251496 DOI: 10.1016/s2665-9913(23)00165-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Acute calcium pyrophosphate crystal arthritis causes intense joint pain mainly affecting older people. Because guidance and evidence remain scarce, management of this disease relies on expert opinion. We therefore aimed to compare the safety and short-term equivalence of low-dose colchicine with oral prednisone in older patients with acute calcium pyrophosphate crystal arthritis. METHODS We did an open-label, multicentre, randomised, trial (COLCHICORT) at six hospitals in Paris and northern France. We enrolled patients who were admitted to hospital who were 65 years or older and who presented with acute calcium pyrophosphate crystal arthritis with a symptom duration of less than 36 h. Diagnosis of calcium pyrophosphate crystal arthritis was made by the identification of calcium pyrophosphate crystals on synovial fluid analysis or typical clinical presentation (onset of joint pain and swelling). Key exclusion criteria included absence of calcium pyrophosphate crystals on synovial fluid analysis or a history of gout. Participants were randomly allocated (1:1), using a centralised electronic treatment group allocation module, to receive either colchicine 1·5 mg on day 1 and 1 mg on day 2 (ie, the colchicine group) or oral prednisone 30 mg on days 1 and 2 (ie, the prednisone group). The primary outcome was change in joint pain (measured by visual analogue scale [VAS] from 0 mm to 100 mm) at 24 h. Equivalence was determined whether the 95% CI of the between-group difference at 24 h was within the -13 mm to +13 mm margin in the per-protocol analysis. Adverse events were recorded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0). This trial is completed and is registered with ClinicalTrials.gov, NCT03128905. FINDINGS Between Feb 5, 2018, and May 7, 2022, 111 patients who were admitted to hospital were randomly assigned (57 [51%] to the colchicine group and 54 [49%] to the prednisone group). 95 (86%) of 111 patients were included in the per-protocol analysis (49 [52%] in the colchicine group and 46 [48%] in the prednisone group). The median age was 88·0 years (IQR 82·0-91·0) and 69 (73%) of 95 participants were women and 26 (27%) were men. Acute calcium pyrophosphate crystal arthritis affected mainly the knee in 46 (48%) of 95 participants, the wrist in 19 (20%), and the ankle in 12 (13%). Pain VAS at baseline was 68 mm (SD 17). At 24 h, change in pain VAS was -36 mm (SD 32) in the colchicine group and -38 mm (SD 23) in the prednisone group. The between-group difference in change in pain VAS at 24 h was -1 mm (95% CI -12 to 10), showing equivalence between the two drugs. In the colchicine group, 12 (22%) of 55 patients had diarrhoea, one (2%) had hypertension, and none had hyperglycaemia. In the prednisone group, three (6%) of 54 had diarrhoea, six (11%) had hypertension, and three (6%) had hyperglycaemia. No deaths occurred in the colchicine group; two deaths occurred in the prednisone group, which were deemed unrelated to prednisone (one due to infectious valvular endocarditis leading to heart failure, and one due to a stroke). INTERPRETATION Colchicine and prednisone exhibit equivalent short-term efficacy for the treatment of acute calcium pyrophosphate crystal arthritis, with different safety profiles in the older population. FUNDING French Inter-regional Hospital Program of Clinical Research.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France.
| | - Pierre Robinet
- Department of Geriatrics, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | | | - Rémi Leroy
- Department of Rheumatology, Centre Hospitalier de Dunkerque, Dunkirk, France
| | - Nicolas Segaud
- Department of Internal Medicine, Centre Hospitalier d'Armentières, Armentières, France
| | - Aurore Pacaud
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Agathe Grandjean
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Hélène Luraschi
- Department of Rheumatology, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Thibault Rabin
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Xavier Deplanque
- Department of Geriatrics, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Pierre Maciejasz
- Department of Geriatrics, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Fabien Visade
- Department of Geriatrics, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Alexandre Mackowiak
- Department of Neurology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Nicolas Baclet
- Department of Internal Medicine, Hôpital Saint-Vincent-de-Paul, Université Catholique de Lille, Lille, France
| | - Sylvestre Maréchaux
- Department of Cardiology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Antoine Lefebvre
- Department of Pharmacy, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Jean-François Budzik
- Department of Radiology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière APHP Paris Nord, INSERM, UMR 1132, Bioscar, Paris, France
| | - Pascal Richette
- Department of Rheumatology, Hôpital Lariboisière APHP Paris Nord, INSERM, UMR 1132, Bioscar, Paris, France
| | - Laurène Norberciak
- Research Department-Biostatistics and Methodology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
| | - Eric Houvenagel
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lomme, France
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Letarouilly JG, Flachaire B, Labadie C, Kyheng M, Cohen N, Sellam J, Richette P, Dieude P, Claudepierre P, Fautrel B, Houvenagel E, Nguyen CD, Guyot MH, Segaud N, Marguerie L, Deprez X, Salmon JH, Baudens G, Miceli-Richard C, Gervais E, Chary-Valckenaere I, Lafforgue P, Philippe P, Loeuille D, Richez C, Tubach F, Pham T, Flipo RM. Secukinumab and ustekinumab treatment in psoriatic arthritis: results of a direct comparison. Rheumatology (Oxford) 2021; 60:2773-2782. [PMID: 33232465 DOI: 10.1093/rheumatology/keaa710] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/19/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate the characteristics of patients (pts) with PsA treated by ustekinumab (UST) or secukinumab (SEK) and to compare real-world persistence of UST and SEK in PsA. METHODS In this retrospective, national, multicentre cohort study, pts with PsA (CASPAR criteria or diagnosis confirmed by the rheumatologist) initiating UST or SEK with a follow-up ≥6 months were included from January 2011 to April 2019. The persistence between SEK and UST was assessed after considering the potential confounding factors by using pre-specified propensity-score methods. Causes of discontinuation and tolerance were also collected. RESULTS A total of 406 pts were included: 245 with UST and 161 with SEK. The persistence rate was lower in the UST group compared with the SEK group [median persistence 9.4 vs 14.7 months; 26.4% vs 38.0% at 2 years; weighted hazard ratio (HR) = 1.42; 95% CI: 1.07, 1.92; P =0.015]. In subgroup analysis, the persistence rate of SEK associated with MTX was significantly higher than that of UST associated with MTX: HR = 2.20; 95% CI: 1.30, 3.51; P =0.001, in contrast to SEK vs UST monotherapy: HR = 1.06; 95% CI: 0.74, 1.53; P =0.75. Discontinuation due to inefficacy was reported in 91.7% (SEK) and 82.4% (UST) of pts. Discontinuation due to an adverse event was reported in 12.2% (SEK) and 7.7% (UST) of pts. CONCLUSION In this first study comparing UST and SEK, the persistence of SEK was higher than that of UST in PsA. In subgroup analysis, this difference was only found in association with MTX.
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Affiliation(s)
| | - Benoît Flachaire
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - Céline Labadie
- Service de Rhumatologie, Université Bordeaux, CHU Bordeaux, Bordeaux, France
| | - Maéva Kyheng
- ULR 2694 - METRICS: Évaluation des Technologies de santé et Des Pratiques Médicales, Université Lille, France.,Département des Biostatistiques, CHU de Lille, Lille, France
| | - Nicolas Cohen
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - Jérémie Sellam
- Service de Rhumatologie, APHP, Hôpital Saint Antoine, Sorbonne Université, CRSA Inserm UMRS_938, Paris, France
| | - Pascal Richette
- Service de Rhumatologie, APHP, Hôpital Lariboisière, Paris, France.,Inserm, UMR-S 1132, Bioscar, Université de Paris, Paris, France
| | - Philippe Dieude
- Service de Rhumatologie, Université de Paris, INSERM UMR1152, Groupe Hospitalier Universitaire Bichat-Claude Bernard, APHP, Paris, France
| | - Pascal Claudepierre
- Ep, iDermE, EA7379, Université Paris Est Creteil, Creteil, France.,Department of Rheumatology, Hopital Henri-Mondor, AP-HP, Creteil, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié, Sorbonne Université, AP-HP, Paris, France
| | - Eric Houvenagel
- Service de Rhumatologie, Institut Catholique de Lille, Hôpital Saint Philibert, Ghicl, Lomme, France
| | | | | | - Nicolas Segaud
- Service de Médecine Interne, CH Armentières, Armentières, France
| | | | - Xavier Deprez
- Service de Rhumatologie, CH Valenciennes, Valenciennes, France
| | - Jean-Hugues Salmon
- Service de Rhumatologie, Université Reims, Champagne-Ardenne, CHU Reims, Reims, France
| | - Guy Baudens
- Cabinet, Libéral de Rhumatologie, Valenciennes, France
| | | | - Elisabeth Gervais
- Service de Rhumatologie, Université de Poitiers, CHU Poitiers, Poitiers, France
| | | | - Pierre Lafforgue
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - Peggy Philippe
- Service de Rhumatologie, Université Lille, CHU Lille, Lille, France
| | - Damien Loeuille
- Service de Rhumatologie, Université de Poitiers, CHU Poitiers, Poitiers, France
| | - Christophe Richez
- Service de Rhumatologie, Université Bordeaux, CHU Bordeaux, Bordeaux, France
| | - Florence Tubach
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Thao Pham
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - René-Marc Flipo
- Service de Rhumatologie, Université Lille, CHU Lille, Lille, France
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Letarouilly JG, Flachaire B, Labadie C, Cohen N, Kyheng M, Sellam J, Richette P, Dieudé P, Claudepierre P, Fautrel B, Houvenagel E, Nguyen CD, Guyot MH, Segaud N, Maury F, Marguerie L, Deprez X, Salmon JH, Baudens G, Miceli Richard C, Gervais E, Chary Valckenaere I, Lafforgue P, Loeuille D, Richez C, Pham T, Flipo RM. FRI0348 PERSISTENCE OF SECUKINUMAB AND USTEKINUMAB IN PSORIATIC ARTHRITIS: A REAL-WORLD MULTICENTRIC COHORT OF 409 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Real-world data are missing for Ustekinumab (UST) and secukinumab (SEK) in psoriatic arthritis (PsA).Objectives:To evaluate the characteristics of the patients (pts) with PsA treated by UST or SEK and to assess real world persistence of UST and SEK in PsA.Methods:This is a retrospective, multicenter study of pts with PsA (CASPAR criteria or diagnosis confirmed by a rheumatologist) initiating UST or SEK with a follow-up ≥ 6 months from January 2011 to April 2019. The comparison of persistence between UST and SEK was analysed using a Cox model with an inverse probability of treatment weighting propensity score including 11 confounding factors. Subgroup analyses (age>65 years, gender, Body Mass Index (BMI), Charlson score>2, psoriasis, CRP>5mg/L, number (nb) of prior biotherapies, proportion of pts on maximum dose of UST or SEK, combination with methotrexate (MTX), enthesitic and axial forms of PsA) were also performed to test the heterogeneity of UST and SEK persistence. Finally, 2 sensitivity analyses were performed, first excluding the pts treated before the marketing authorization of SEK, and then excluding the pts that underwent a molecule switch. Causes of discontinuation were also collected.Results:406 pts were included: 245 with UST and 161 with SEK. At baseline before propensity score-matching, the UST group has a higher BMI (28.9 ± 6.4 kg/m2vs. 27.4 ± 6.0 kg/m2), more peripheral forms (98% vs. 90.8%), a higher nb of active smokers (27.1% vs. 19.9%), a higher frequency of psoriasis (96.3% vs. 83.2%), less MTX users (38.9% vs. 44.2%), a higher nb of pts with CRP >5mg/L (54.3% vs. 47%), a higher nb of pts naïve to biotherapies (22% vs. 13%) and a higher nb of pts with recommended dosing (97.3% vs 50.9%). The median persistence was 9.4 months and 14.7 months for UST and SEK, respectively. The persistence rate was lower in the UST group compared to the SEK group (40.9% vs. 59.1% % at 1 year; 26.4% vs. 38.0% at 2 years; weighted HR=1.42; 95% CI 1.07 to 1.92; p=0.015) (Fig 1). In subgroup analysis, combination with MTX was associated with a higher persistence rate in the patients with SEK compared to those receiving UST: 43.6% vs. 23.2% (HR=2.20; 95% CI 1.30 to 3.51; p=0.001), whereas no difference was observed in SEK and UST monotherapy: 33.8% vs 28.4%, respectively (HR=1.06; 95% CI 0.74 to 1.53; p=0.75) (Fig 2). A similar difference was found in the sensitivity analyses, with however a difference at the limit of significance for the analysis excluding pts with a molecule switch (adjusted HR=1.35; IC95% 0.96 to 1.92; p=0.085). The causes of discontinuation were due to inefficacy in 85% of cases and an adverse event in 12% of cases (19% in the SEK group and 9% in the UST group).Conclusion:In this first real-world study comparing UST and SEK persistence in PsA, the persistence of SEK was longer than that of UST. Subgroup analysis revealed this difference of persistence was restricted to patients treated in combination with MTX.Disclosure of Interests:Jean-Guillaume Letarouilly Grant/research support from: Research grant from Pfizer, Benoît Flachaire: None declared, Céline Labadie: None declared, Nicolas Cohen Speakers bureau: Novartis, Janssen, Maeva Kyheng: None declared, Jérémie SELLAM: None declared, Pascal Richette: None declared, Philippe Dieudé: None declared, Pascal Claudepierre Speakers bureau: Janssen, Novartis, Lilly, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Eric Houvenagel Speakers bureau: Janssen, Novartis, Chi Duc Nguyen: None declared, Marie-Hélène Guyot: None declared, Nicolas Segaud: None declared, Frederic Maury: None declared, Laurent Marguerie: None declared, Xavier Deprez Speakers bureau: Novartis, Janssen, Jean-Hugues Salmon Speakers bureau: Novartis, Janssen, Guy Baudens: None declared, Corinne Miceli Richard: None declared, Elisabeth Gervais Speakers bureau: Novartis, Janssen, Roche, Pfizer, BMS, Abbvie, Isabelle CHARY VALCKENAERE: None declared, Pierre Lafforgue Speakers bureau: Novartis, Janssen, Damien LOEUILLE: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Thao Pham Speakers bureau: Novartis, Janssen, Lilly, Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly
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Segaud N, Legroux I, Hazzan M, Noel C, Cortet B. Changes in bone mineral density after kidney transplantation: 2-year assessment of a French cohort. Osteoporos Int 2018; 29:1165-1175. [PMID: 29500526 DOI: 10.1007/s00198-018-4383-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/15/2017] [Accepted: 01/04/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION In renal transplant patients, bone loss may be related to the drugs patients are taking but also to their past history of chronic kidney disease. The purpose of this study was to assess changes in BMD 2 years after an initial assessment (performed 9 months post transplantation) and the factors associated with these changes. METHODS This longitudinal study included patients who had undergone a renal transplantation between 2005 and 2011, and who were followed up at the Lille Regional University Hospital. Patients were included if they had a first bone evaluation (including bone densitometry, spine X-rays and biological assessment) and at least another BMD assessment. The first assessment was performed on average 9 months post transplantation. A second assessment was performed at 2 years. RESULTS Two hundred fifty-nine out of 366 patients satisfied the inclusion criteria. The population included 96 women. Mean age at transplantation was 49.7 ± 12.1 years. Mean duration of dialysis was 3.2 ± 3.3 years. For 75 patients (29.0%), corticosteroid treatment was discontinued 7 days after transplantation without subsequent resumption during follow-up. Vertebral fractures assessed by X-rays at baseline were found in 28 patients (10.8%). According to the WHO classification, 106 patients (40.9%) patients had osteoporosis and 111 patients (42.8%) had osteopenia at the first assessment. Oral bisphosphonates were prescribed for 95 patients. The decision to prescribe bisphosphonates was taken jointly by rheumatologists and nephrologists based on BMD assessment, past history of fracture and corticosteroid management. In all patients, BMD gains at the second evaluation (2.2 ± 0.79 years) compared with baseline were significant (3.9 ± 6.6, 2.6% ± 7.6, 3.0 ± 7.2% at the lumbar spine, femoral neck and total hip respectively; p < 0.0001). The difference in gain between bisphosphonate-treated and untreated patients was significant (+ 5.0 ± 0.8% (p < 0.0001), + 2.5 ± 1.0% (p = 0.01) and + 2.7 ± 0.9% (p < 0.01) at the lumbar spine, femoral neck and total hip respectively. The patients who benefited early corticosteroid discontinuation had higher gains in BMD at the lumbar spine (+ 2.1 ± 0.9%; p = 0.02) and total hip (+ 2.0 ± 1.0%; p = 0.04) compared to those for whom corticosteroid therapy was maintained. Stepwise regression analysis (patients without bisphosphonates) showed associations between change in BMD (femoral neck) and duration of corticosteroid therapy, bone alkaline phosphatase level at baseline, and absence of vertebral fracture. No correlation was found between change in BMD and duration of dialysis or renal function. CONCLUSION Kidney transplant recipients have an increased risk of bone fragility in the year following transplantation. Bisphosphonates and early corticosteroid discontinuation can improve BMD.
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Affiliation(s)
- N Segaud
- Service de médecine interne, CH Armentières, F-59280, Armentières, France.
- Service de Rhumatologie, CHU Lille, F-59000, Lille, France.
| | - I Legroux
- Service de Rhumatologie, CHU Lille, F-59000, Lille, France
- EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, Université de Lille, F-59000, Lille, France
| | - M Hazzan
- Service de Néphrologie, CHU Lille, F-59000, Lille, France
| | - C Noel
- Service de Néphrologie, CHU Lille, F-59000, Lille, France
| | - B Cortet
- Service de Rhumatologie, CHU Lille, F-59000, Lille, France
- EA 4490 - PMOI - Physiopathologie des Maladies Osseuses Inflammatoires, Université de Lille, F-59000, Lille, France
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Leroy R, Segaud N, Migaud H, Senneville E, Cortet B, Flipo RM. SAT0499 Septic Arthritis in Rheumatology: Management and Evolution over The Past 50 Years. About 374 Cases. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Segaud N, Legroux I, Hazzan M, Noel C, Cortet B. SAT0296 Bone Mineral Density Changes After Kidney Transplantation. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2219] [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: 11/03/2022]
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Segaud N, Haffner C, Philippe P, Deprez X, Houvenagel E, Coquerel P, Cortet B, Flipo RM. SAT0242 Therapeutic Response to TOCILIZUMAB in Rheumatoid Arthritis: Does Body Weight Have an Influence? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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