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Combemale L, Bohelay G, Sitbon IY, Ahouach B, Alexandre M, Martin A, Pascal F, Soued I, Doan S, Morin F, Grootenboer-Mignot S, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Lichen planus pemphigoides with predominant mucous membrane involvement: a series of 12 patients and a literature review. Front Immunol 2024; 15:1243566. [PMID: 38686381 PMCID: PMC11057232 DOI: 10.3389/fimmu.2024.1243566] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lichen planus pemphigoides (LPP), an association between lichen planus and bullous pemphigoid lesions, is a rare subepithelial autoimmune bullous disease. Mucous membrane involvement has been reported previously; however, it has never been specifically studied. Methods We report on 12 cases of LPP with predominant or exclusive mucous membrane involvement. The diagnosis of LPP was based on the presence of lichenoid infiltrates in histology and immune deposits in the basement membrane zone in direct immunofluorescence and/or immunoelectron microscopy. Our systematic review of the literature, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, highlights the clinical and immunological characteristics of LPP, with or without mucous membrane involvement. Results Corticosteroids are the most frequently used treatment, with better outcomes in LPP with skin involvement alone than in that with mucous membrane involvement. Our results suggest that immunomodulators represent an alternative first-line treatment for patients with predominant mucous membrane involvement.
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Affiliation(s)
- Loraine Combemale
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Dermatology Department, Saint Pierre-Brugmann and Queen Fabiola Children’s University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Gérôme Bohelay
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Ishaï-Yaacov Sitbon
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Btisseme Ahouach
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Marina Alexandre
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Antoine Martin
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Francis Pascal
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Isaac Soued
- Ear, Nose and Throat (ENT) Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Serge Doan
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Florence Morin
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Saint-Louis Hospital, Paris University, Paris, France
| | - Sabine Grootenboer-Mignot
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Frédéric Caux
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Histology Department, Sorbonne Paris Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
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Tedbirt B, Maho-Vaillant M, Houivet E, Mignard C, Golinski ML, Calbo S, Prost-Squarcioni C, Labeille B, Picard-Dahan C, Chaby G, Richard MA, Tancrede-Bohin E, Duvert-Lehembre S, Delaporte E, Bernard P, Caux F, Alexandre M, Musette P, Ingen-Housz-Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D’Incan M, Bédane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Benichou J, Joly P, Hébert V. Sustained Remission Without Corticosteroids Among Patients With Pemphigus Who Had Rituximab as First-Line Therapy: Follow-Up of the Ritux 3 Trial. JAMA Dermatol 2024; 160:290-296. [PMID: 38265821 PMCID: PMC10809134 DOI: 10.1001/jamadermatol.2023.5679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
Importance The Ritux 3 trial demonstrated the short-term efficacy and safety of first-line treatment with rituximab compared with a standard corticosteroid regimen in pemphigus. No data on the long-term follow-up of patients who received rituximab as first line are available. Objective To assess the long-term efficacy and safety of the Ritux 3 treatment regimen. Design, Setting, and Participants This 7-year follow-up study of the Ritux 3 trial included patients with pemphigus from 25 dermatology departments in France from January 1, 2010, to December 31, 2015. Exposure Patients were initially randomized in the rituximab plus prednisone group or prednisone-alone group. Main outcomes and measures The primary outcome was the 5- and 7-year disease-free survival (DFS) without corticosteroids, assessed by Kaplan-Meier curves. Secondary outcomes were occurrence of relapse, occurrence of severe adverse events (SAEs), and evolution of antidesmoglein (Dsg) antibody enzyme-linked immunosorbent assay values to predict long-term relapse. Results Of the 90 patients in the Ritux 3 trial, 83 were evaluated at the end of follow-up study visit (44 in the rituximab plus prednisone group; 39 in the prednisone-alone group) with a median (IQR) follow-up of 87.3 (79.1-97.5) months. Forty-three patients (93%) from the rituximab plus prednisone and 17 patients (39%) from the prednisone-alone group had achieved complete remission without corticosteroids at any time during the follow-up. Patients from the rituximab group had much longer 5- and 7-year DFS without corticosteroids than patients from the prednisone-alone group (76.7% and 72.1% vs 35.3% and 35.3%, respectively; P < .001), and had about half the relapses (42.2% vs 83.7%; P < .001). Patients who received rituximab as second-line treatment had shorter DFS than patients treated as first line (P = .007). Fewer SAEs were reported in the rituximab plus prednisone group compared with the prednisone-alone group, 31 vs 58 respectively, corresponding to 0.67 and 1.32 SAEs per patient, respectively (P = .003). The combination of anti-Dsg1 values of 20 or more IU/mL and/or anti-Dsg3 values of 48 or more IU/mL yielded 0.83 positive predictive value and 0.94 negative predictive value to predict long-term relapse. Conclusions and Relevance In this secondary analysis of the Ritux 3 trail, first-line treatment of patients with pemphigus with the Ritux 3 regimen was associated with long-term sustained complete remission without corticosteroid therapy without any additional maintenance infusion of rituximab.
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Affiliation(s)
- Billal Tedbirt
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Maud Maho-Vaillant
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics and Clinical Research, CHU Rouen, Rouen, France
| | - Claire Mignard
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Marie-Laure Golinski
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Sébastien Calbo
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint-Étienne, Saint-Étienne, France
| | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Centre in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitaire Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, 13385, Marseille, France
| | | | | | | | | | - Frédéric Caux
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Philippe Musette
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Univ Paris Est Créteil EpiDermE, Créteil, France
| | - Pierre Vabres
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Gaëlle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sébastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Michel D’Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, APHP and University of Paris cité, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Jacques Benichou
- Department of Biostatistics and Clinical Research, CHU Rouen and Inserm U1018, Université Paris-Saclay and Université de Rouen, Rouen, France
| | - Pascal Joly
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Vivien Hébert
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
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Chebani R, Lombart F, Chaby G, Dadban A, Debarbieux S, Viguier MA, Ingen-Housz-Oro S, Pham-Ledard A, Bedane CR, Picard-Dahan C, Berthin C, Dereure O, Konstantinou MP, Castel M, Jouen F, Joly P, Seta V, Duvert-Lehembre S, Le Roux C, Quereux G, Sassolas B, Brenaut E, Sin C, Richard MA, Bérard F, Giusti D, Belmondo T, Gille T, Caux F, Prost-Squarcioni C, Grootenboer-Mignot S, Alexandre M. Omalizumab in the treatment of bullous pemphigoid resistant to first-line therapy: a French national multicentre retrospective study of 100 patients. Br J Dermatol 2024; 190:258-265. [PMID: 37792727 DOI: 10.1093/bjd/ljad369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/17/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Interest in the use of omalizumab to treat bullous pemphigoid (BP) in the event of resistance or contraindication to conventional therapies is currently based on limited evidence. OBJECTIVES To assess the effectiveness and safety of omalizumab in BP and to identify predictive factors in response to treatment. METHODS We conducted a French national multicentre retrospective study including patients with a confirmed diagnosis of BP treated with omalizumab after failure of one or several treatment lines. We excluded patients with clinically atypical BP, as per Vaillant's criteria. The criteria for clinical response to omalizumab were defined according to the 2012 international consensus conference. Anti-BP180-NC16A IgE enzyme-linked immunosorbent assay was performed on sera collected before initiating omalizumab, when available. RESULTS Between 2014 and 2021, 100 patients treated in 18 expert departments were included. Median age at diagnosis was 77 years (range 20-98). Complete remission (CR) was achieved in 77% of patients, and partial remission in an additional 9%. CR was maintained 'off therapy' in 11.7%, 'on minimal therapy' in 57.1%, and 'on non-minimal therapy' in 31.2%. Median time to CR was 3 months (range 2.2-24.5). Relapse rate was 14%, with a median follow-up time of 12 months (range 6-73). Adverse events occurred in four patients. CR was more frequently observed in patients with an increased serum baseline level of anti-BP180-NC16A IgE (75% vs. 41%; P = 0.011). Conversely, urticarial lesions, blood total IgE concentration or eosinophil count were not predictive of CR. Patients with an omalizumab dosage > 300 mg every 4 weeks showed a similar final outcome to those with a dosage ≤ 300 mg every 4 weeks, but control of disease activity [median 10 days (range 5-30) vs. 15 days (range 10-60); P < 0.001] and CR [median 2.4 months (range 2.2-8.2) vs. 3.9 months (range 2.3-24.5); P < 0.001] were achieved significantly faster. CONCLUSIONS We report the largest series to date of BP treated by omalizumab and confirm its effectiveness and safety in this indication. Serum baseline level of anti-BP180-NC16A IgE may predict response to treatment.
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Affiliation(s)
- Réda Chebani
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | - Florian Lombart
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | - Guillaume Chaby
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | - Ali Dadban
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Christelle Le Roux
- Department of Dermatology and Referral Centre for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | | | | | | | | | | | | | | | | | | | - Frédéric Caux
- Department of Dermatology and Referral Centre for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology and Referral Centre for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Marina Alexandre
- Department of Dermatology and Referral Centre for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
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4
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Tzoumpa S, Brun S, Amsler E, Izri A, Akhoundi M, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Bullous presentation of demodicosis in a young immunocompetent patient. Int J Dermatol 2024; 63:e6-e8. [PMID: 37990591 DOI: 10.1111/ijd.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/23/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Sofia Tzoumpa
- Department of Dermatology, Reference Center for Auto-immune Bullous Diseases, Avicenne University Hospital, AP-HP, Sorbonne-Paris-Nord University, Bobigny, France
| | - Sophie Brun
- Parasitology-Mycology Department, Avicenne University Hospital, AP-HP, Sorbonne-Paris-Nord University, Bobigny, France
| | - Emmanuelle Amsler
- Department of Dermatology, Allergology and Vascular Medicine, Tenon University Hospital, AP-HP, Sorbonne University, Paris, France
| | - Arezki Izri
- Parasitology-Mycology Department, Avicenne University Hospital, AP-HP, Sorbonne-Paris-Nord University, Bobigny, France
- Unité des Virus Émergents, Aix Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection, Marseille, France
| | - Mohammad Akhoundi
- Parasitology-Mycology Department, Avicenne University Hospital, AP-HP, Sorbonne-Paris-Nord University, Bobigny, France
- Unité des Virus Émergents, Aix Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection, Marseille, France
| | - Frédéric Caux
- Department of Dermatology, Reference Center for Auto-immune Bullous Diseases, Avicenne University Hospital, AP-HP, Sorbonne-Paris-Nord University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Reference Center for Auto-immune Bullous Diseases, Avicenne University Hospital, AP-HP, Sorbonne-Paris-Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Department of Dermatology, Reference Center for Auto-immune Bullous Diseases, Avicenne University Hospital, AP-HP, Sorbonne-Paris-Nord University, Bobigny, France
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Rousset L, Bohelay G, Gille T, Le Roux-Villet C, Kambouchner M, Levy A, Brauner M, Tandjaoui H, Aucouturier F, Mignot S, Caux F, Prost-Squarcioni C, Alexandre M. Bronchial involvement in mucous membrane pemphigoid: 2 cases and a literature review. Ann Dermatol Venereol 2023; 150:64-70. [PMID: 36435654 DOI: 10.1016/j.annder.2022.08.009] [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: 01/10/2022] [Revised: 05/05/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- L Rousset
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - G Bohelay
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - T Gille
- Department of Physiology and Functional Explorations, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Inserm U1272 "Hypoxia and the Lung", UFR SMBH Léonard de Vinci, Paris 13 University, France
| | - C Le Roux-Villet
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - M Kambouchner
- Department of Pathology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - A Levy
- Department of Pathology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - M Brauner
- Department of Radiology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - H Tandjaoui
- Department of Pulmonology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - F Aucouturier
- Department of Immunology, Saint-Louis Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 7 University, 75010 Paris, France
| | - S Mignot
- Department of Immunology, Bichat Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 7 University, 75018 Paris, France
| | - F Caux
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - C Prost-Squarcioni
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France; Histology Laboratory, UFR SMBH Léonard de Vinci, Paris 13 University, Bobigny, France
| | - M Alexandre
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France.
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6
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Bohelay G, Alexandre M, Le Roux-Villet C, Sitbon I, Doan S, Soued I, Shourick J, Rousset L, Mellottee B, Heller M, Lièvre N, Zumelzu C, Morin F, Grootenboer-Mignot S, Gabison E, Caux F, Prost-Squarcioni C, Musette P. Rituximab Therapy for Mucous Membrane Pemphigoid: A Retrospective Monocentric Study With Long-Term Follow-Up in 109 Patients. Front Immunol 2022; 13:915205. [PMID: 35844526 PMCID: PMC9281543 DOI: 10.3389/fimmu.2022.915205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is a heterogeneous group of rare, chronic, subepithelial autoimmune blistering diseases (AIBDs) with predominant involvement of mucous membranes that can be sight-threatening and life-threatening. Rituximab (RTX) has demonstrated its efficacy in severe MMP refractory to conventional immunosuppressants in small series that differed in RTX scheme, concomitant therapies, and outcome definitions. In a meta-analysis involving 112 patients with MMP treated with RTX, complete remission (CR) was reported in 70.5% of cases. Herein, we report the largest retrospective monocentric study on RTX efficacy in a series of 109 severe and/or refractory patients with MMP treated with RTX with a median follow-up period of 51.4 months. RTX was administered in association with immunomodulatory drugs (dapsone, salazopyrine) without any other systemic immunosuppressant in 104 patients. The RTX schedule comprised two injections (1 g, 2 weeks apart), repeated every 6 months until CR or failure, with a unique consolidation injection (1 g) after CR. The median survival times to disease control and to CR were 7.1 months and 12.2 months, respectively. The median number of RTX cycles required to achieve CR in 85.3% of patients was two. The larynx was the lesional site that took the longest time to achieve disease control. One year after RTX weaning, CR off RTX was obtained in 68.7% of cases. CR off RTX with only minimum doses of immunomodulatory drugs was achieved in 22.0% of patients. Further, 10.1% of patients were partial responders and 4.6% were non-responders to RTX. Relapse occurred in 38.7% of cases, of whom 91.7% had achieved CR again at the last follow-up. In MMP, CR was achieved in a longer time and after more rituximab cycles than in pemphigus, especially for patients with MMP with anti-type VII collagen reactivity. RTX with concomitant immunomodulatory drugs was not responsible for an unusual proportion of adverse events. This large study confirms that RTX is an effective therapy in patients with severe and/or refractory MMP, corroborating previous findings regarding the effects of RTX on AIBDs such as pemphigus.
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Affiliation(s)
- Gérôme Bohelay
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), Bobigny, France
| | - Marina Alexandre
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Christelle Le Roux-Villet
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Ishaï Sitbon
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Serge Doan
- Department of Ophthalmology, Bichat University Hospital, AP-HP, Université de Paris, Paris, France
| | - Isaac Soued
- Department of ENT and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Jason Shourick
- Department of Epidemiology, Clinical Epidemiology and Public Health, UMR 1027 INSERM-University of Toulouse III, Toulouse University Hospital (CHU), Toulouse, France
| | - Laurie Rousset
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Benoît Mellottee
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Michel Heller
- Department of Histology, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), Bobigny, France
| | - Nicole Lièvre
- Department of Histology, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), Bobigny, France
| | - Coralie Zumelzu
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Florence Morin
- Department of Immunology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Saint Louis University Hospital, AP-HP, Université de Paris, Paris, France
| | - Sabine Grootenboer-Mignot
- Department of Immunology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Bichat University Hospital, AP-HP, Université de Paris, Paris, France
| | - Eric Gabison
- Department of Ophthalmology, Bichat University Hospital, AP-HP, Université de Paris, Paris, France
| | - Frédéric Caux
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), Bobigny, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Department of Histology, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), Bobigny, France
- Department of Pathology, Avicenne University Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), AP-HP, Université Sorbonne Paris Nord (USPN), Bobigny, France
| | - Philippe Musette
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), Bobigny, France
- *Correspondence: Philippe Musette,
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7
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Alexandre M, Bohelay G, Gille T, Le Roux-Villet C, Soued I, Morin F, Caux F, Grootenboer-Mignot S, Prost-Squarcioni C. Rapid Disease Control in First-Line Therapy-Resistant Mucous Membrane Pemphigoid and Bullous Pemphigoid with Omalizumab as Add-On Therapy: A Case Series Of 13 Patients. Front Immunol 2022; 13:874108. [PMID: 35514989 PMCID: PMC9065717 DOI: 10.3389/fimmu.2022.874108] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
The role of IgE autoantibodies has been demonstrated in the pathogenesis of bullous pemphigoid for many years. Recently, omalizumab (OMZ), a humanized monoclonal anti-IgE antibody that depletes total serum IgE, has been used off-label in a few case series of bullous pemphigoids demonstrating a rapid efficacy and allowing significant improvements or complete remission as add-on therapy in first-line treatment-resistant patients. Herein, we report the largest retrospective study to evaluate OMZ effectiveness in patients with subepidermal autoimmune blistering diseases. Our series included 13 patients from a single center with bullous pemphigoid or mucous membrane pemphigoid, of whom 7 had mucous membrane involvement. OMZ was added to the unchanged immunosuppressive therapies. Detailed clinical and immunological data during the first year were collected, notably for specific anti-BP180-NC16A IgE and IgG, and the median total follow-up was 30 months (range: 3-81). Our series demonstrated that OMZ induced a significant improvement in pruritus, urticarial score, and daily blister count on day 15, allowing disease control to be achieved in a 1-month median time and complete remission (CR) in a 3-month median time in 85% of these patients previously in therapeutic impasse. At the end of the follow-up, 31% of patients achieved CR on minimal therapy after OMZ weaning without relapses, and 54% achieved CR on OMZ continuation with a minimal dose of concomitant treatment. Two patients experienced therapeutic failure (15%). At baseline, clinical variables reflecting activity were significantly positively correlated with eosinophil blood count, total IgE serum level, specific anti-BP180 IgE and IgG. While baseline anti-BP180 IgG and specific anti-BP180 IgE were significantly positively correlated, only the two patients who experienced a therapeutic failure with OMZ did not fit with this correlation, demonstrating elevated levels of anti-BP180 IgG with no measurable BP180-specific IgE. Follow-up of immunological variables demonstrated a rapid decrease of eosinophilia towards normalization, whereas a slower decline towards negativation was observed over 1 year for anti-BP180 IgG and anti BP180 IgE in patients who responded to OMZ. This case series demonstrated that OMZ is a rapidly effective biologic therapy for refractory bullous pemphigoid and mucous membrane pemphigoid, permitting rapid disease control and reduction of concomitant therapeutics.
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Affiliation(s)
- Marina Alexandre
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Gérôme Bohelay
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France.,Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Thomas Gille
- Department of Physiology & Functional Explorations, Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France.,Inserm UMR 1272 "Hypoxia & the Lung", UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Christelle Le Roux-Villet
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Isaac Soued
- Department of ENT and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Florence Morin
- Department of Immunology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Saint Louis Hospital, AP-HP, Université de Paris, Paris, France
| | - Frédéric Caux
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France.,Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Sabine Grootenboer-Mignot
- Department of Immunology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Bichat Hospital, AP-HP, Université de Paris, Paris, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France.,Department of Pathology, Avicenne Hospital, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Université Sorbonne Paris Nord, Bobigny, France.,Department of Histology, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
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8
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Holtsche MM, van Beek N, Hashimoto T, Di Zenzo G, Zillikens D, Prost-Squarcioni C, Titeux M, Hovnanian A, Schmidt E, Goletz S. Diagnosis of Epidermolysis Bullosa Acquisita: Multicentre Comparison of Different Assays for Serum Anti-type VII Collagen Reactivity. Acta Derm Venereol 2021; 101:adv00420. [PMID: 33686442 PMCID: PMC9366678 DOI: 10.2340/00015555-3774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Epidermolysis bullosa acquisita is a pemphigoid disease characterized by autoantibodies against type VII collagen. This study compared the sensitivity and specificity of 6 diagnostic assays: type VII collagen non-collagenous domains enzyme-linked immunoassay (NC1/2 ELISA) (MBL, Nagoya, Japan); type VII collagen NC1 ELISA (Euroimmun, Lübeck, Germany); indirect immunofluorescence (IF) microscopy test based on the expression of recombinant NC1 in a human cell line (NC1 BIOCHIP®; Euroimmun); full-length recombinant type VII collagen ELISA; immunoblotting with full-length type VII collagen in the extract of human dermis; and immunoblotting with recombinant NC1. Immunoblotting with recombinant NC1 showed a sensitivity of 93.1% and specificity of 100%, followed by NC1 BIOCHIP® (sensitivity, 89.1%; specificity, 100%), immunoblotting with human dermis (sensitivity, 87.1%; specificity 100%), NC1-ELISA (sensitivity 82.2%; specificity 98.6%), NC1/NC2 ELISA (sensitivity 88.1%; specificity 93.3%), and full-length type VII collagen ELISA (sensitivity 80.2%; specificity 93.8%).
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Affiliation(s)
- Maike M Holtsche
- Department of Dermatology, University of Lubeck, DE-23522 Lubeck, Germany
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9
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Mignard C, Maho-Vaillant M, Golinski ML, Balayé P, Prost-Squarcioni C, Houivet E, Calbo SB, Labeille B, Picard-Dahan C, Konstantinou MP, Chaby G, Richard MA, Bouaziz JD, Duvert-Lehembre S, Delaporte E, Bernard P, Caux F, Alexandre M, Ingen-Housz-Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D'Incan M, Bédane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Benichou J, Joly P, Hébert V. Factors Associated With Short-term Relapse in Patients With Pemphigus Who Receive Rituximab as First-line Therapy: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Dermatol 2020; 156:545-552. [PMID: 32186656 DOI: 10.1001/jamadermatol.2020.0290] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Rituximab and short-term corticosteroid therapy are the criterion standard treatments for patients with newly diagnosed moderate to severe pemphigus. Objective To examine factors associated with short-term relapse in patients with pemphigus treated with rituximab. Design, Setting, and Participants This post hoc analysis of a randomized clinical trial (Comparison Between Rituximab Treatment and Oral Corticosteroid Treatment in Patients With Pemphigus [RITUX 3]) conducted from January 1, 2010, to December 31, 2015, included patients from 20 dermatology departments of tertiary care centers in France from the RITUX 3 trial and 3 newly diagnosed patients treated according to the trial protocol. Data analysis was performed from February 1 to June 30, 2019. Exposure Patients randomly assigned to the rituximab group in the RITUX 3 trial and the 3 additional patients were treated with 1000 mg of intravenous rituximab on days 0 and 14 and 500 mg at months 12 and 18 combined with a short-term prednisone regimen. Main Outcomes and Measures Baseline (pretreatment) clinical and biological characteristics (Pemphigus Disease Area Index [PDAI] score, ranging from 0-250 points, with higher values indicating more severe disease) and changes in anti-desmoglein (DSG) 1 and anti-DSG3 values as measured by enzyme-linked immunosorbent assay during the 3 months after rituximab treatment were compared between patients with disease relapse and those who maintained clinical remission during the first 12 months after treatment. The positive and negative predictive values of these factors were calculated. Results Among 47 patients (mean [SD] age, 54.3 [17.0] years; 17 [36%] male and 30 [64%] female) included in the study, the mean (SD) baseline PDAI score for patients with relapsing disease was higher than that of the patients with nonrelapsing disease (54 [33] vs 28 [24]; P = .03). At month 3, 7 of 11 patients with relapsing disease (64%) vs 7 of 36 patients with nonrelapsing disease (19%) had persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher (P = .01). A PDAI score of 45 or higher defining severe pemphigus and/or persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher at month 3 provided a positive predictive value of 50% (95% CI, 27%-73%) and a negative predictive value of 94% (95% CI, 73%-100%) for the occurrence of relapse after rituximab. Conclusions and Relevance The findings suggest that initial PDAI score and changes in anti-DSG antibody values after the initial cycle of rituximab might help differentiate a subgroup of patients with high risk of relapse who might benefit from maintenance rituximab infusion at month 6 from a subgroup of patients with low risk of relapse who do not need early maintenance therapy. Trial Registration NCT00784589.
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Affiliation(s)
- Claire Mignard
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Maud Maho-Vaillant
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Marie-Laure Golinski
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Pierre Balayé
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Catherine Prost-Squarcioni
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Estelle Houivet
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Sé Bastien Calbo
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint Etienne, Saint Etienne, France
| | | | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Marie-Aleth Richard
- Assistance Publique des Hôpitaux de Marseille, Department of Dermatology, Aix Marseille University, UMR 911, INSERM CRO2, Marseille, France
| | - Jean-David Bouaziz
- Department of Dermatology, St Louis Hospital, Paris 7 Sorbonne Paris Cité University, Paris, France
| | | | | | | | - Frédéric Caux
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Marina Alexandre
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Pierre Vabres
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Gaëlle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sébastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Michel D'Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, University of Paris V, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Jacques Benichou
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Pascal Joly
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Vivien Hébert
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
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Huard E, Gillibert A, Ferries L, Alexandre M, Duvert-Lehembre S, Corbaux C, Prost-Squarcioni C, Caux F, Delaporte E, Litrowski N, Boulard C, Joly P, Hebert V. Comparaison de l’évolution de la qualité de vie sous traitement des patients atteints de pemphigoïde bulleuse, pemphigoïde cicatricielle ou pemphigus. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Combemale L, Alexandre M, Sitbon I, Pascal F, Soued I, Doan S, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Lichen plan pemphigoïde avec atteinte muqueuse : étude de 12 cas. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Font G, Staumont-Salle D, Oro S, Seta V, Dupin N, Richard M, Jeudy G, Mallet S, Alexandre M, Le Roux-Villet C, Joly P, Prost-Squarcioni C, Duvert-Lehembre S. Efficacité du rituximab dans les maladies à IgA linéaire : une cohorte rétrospective. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.010] [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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13
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Masmoudi W, Vaillant M, Vassileva S, Patsatsi A, Quereux G, Moltrasio C, Abasq C, Prost-Squarcioni C, Kottler D, Kiritsi D, Litrowski N, Plantin P, Friedrichsen L, Zebrowska A, Duvert-Lehembre S, Hofmann S, Ferranti V, Jouen F, Joly P, Hebert V. International validation of the Bullous Pemphigoid Disease Area Index severity score and calculation of cut-off values for defining mild, moderate and severe types of bullous pemphigoid. Br J Dermatol 2020; 184:1106-1112. [PMID: 33067805 DOI: 10.1111/bjd.19611] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Bullous Pemphigoid Disease Area Index (BPDAI) score has been proposed to provide an objective measure of bullous pemphigoid (BP) activity. OBJECTIVES The objective of this study was to calculate BPDAI cut-off values defining mild, moderate and severe BP. We also aimed to assess the interrater reliability and correlation with the number of daily new blisters, and anti-BP180 and anti-BP230 antibodies. METHODS Severity scores were recorded by two blinded investigators. Anti-BP180 and anti-BP230 antibodies were measured using an enzyme-linked immunosorbent assay (ELISA). Cut-off values defining mild, moderate and severe subgroups were calculated based on the 25th and 75th percentiles of the BPDAI score. RESULTS In total, 285 patients with BP were enrolled from 50 dermatology departments in Europe. Median BPDAI activity was 37·5 points (range 0-164). Cut-off values corresponding to the first and third quartiles of the BPDAI score were 20 and 57, respectively; thus, these values were used to define mild (≤ 19), moderate (≥ 20 and ≤ 56) and severe (≥ 57) BP. The median BPDAI score for patients with ≤ 10 daily new blisters was 26 [interquartile range (IQR) 17-45], and for patients with > 10 daily new blisters the median score was 55 (IQR 39-82). The BPDAI intraclass correlation coefficient measured at baseline was 0·97 and remained higher than 0·90 up to month 6. The improvement in the BPDAI score was correlated with the absolute decrease in anti-BP180 ELISA value (Spearman's rank r = 0·34, P < 0·004), but not with anti-BP230 antibodies (r = 0·17, P = 0·15). CONCLUSIONS This study suggests cut-off values of 20-57 for BPDAI to distinguish mild, moderate and severe BP, and confirms that it is a robust tool to assess BP severity precisely.
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Affiliation(s)
- W Masmoudi
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes
| | - M Vaillant
- Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
| | - S Vassileva
- Department of Dermatology, Medical University of Sofia, Sofia, Bulgaria
| | - A Patsatsi
- 2nd Department of Dermatology and Venerology, Papageorgiou General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece
| | - G Quereux
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | - C Moltrasio
- Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Abasq
- Department of Dermatology, Brest University Hospital, Brest, France
| | - C Prost-Squarcioni
- Department of Dermatology, Avicenne Hospital, University Paris 13, Bobigny, France
| | - D Kottler
- Department of Dermatology, Bichat Hospital, AP-HP, Paris, France
| | - D Kiritsi
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - N Litrowski
- Department of Dermatology, Monod General Hospital, Le Havre, France
| | - P Plantin
- Department of Dermatology, Centre Hospitalier de Cornouaille, Quimper, France
| | - L Friedrichsen
- Department of Dermatology, University of Lubeck, Lubeck, Germany
| | - A Zebrowska
- Department of Dermatology and Venerology, Medical University of Lodz, Lodz, Poland
| | | | - S Hofmann
- Department of Dermatology, HELIOS University of Wuppertal, Wuppertal, Germany
| | - V Ferranti
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes
| | - F Jouen
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes.,Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
| | - P Joly
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes.,Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
| | - V Hebert
- Department of Dermatology, Centre de Référence des Maladies Bulleuses Autoimmunes.,Department of Immunology, INSERM U1234, Rouen University Hospital, Rouen, France
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Bastos S, Hebert V, Vassileva S, Patsatsi A, Meijer J, Quéreux G, Bedane C, Prost-Squarcioni C, Debardieux S, Oro S, Chaby G, D’Incan M, Litrowski N, Boulard C, Lunardon L, Kiritsi D, Jedlickova H, Feliciani C, Roussel A, Kottler D, Plantin P, Richard MA, Friedrichsen L, Abasq C, Duvert Lehembre S, Gottlieb J, Zebrowska A, Hofmann S, Joly P. Efficacité et tolérance de la prednisone à 0,5 mg/kg/j en traitement initial de la pemphigoïde bulleuse. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Mignard C, Maho-Vaillant M, Prost-Squarcioni C, Calbo S, Golinski ML, Labeille B, Picard-Dahan C, Konstantinou M, Richard MA, Bouaziz J, Duvert-Lehembre S, Bernard P, Caux F, Alexandre M, Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Martin L, D’Incan M, Bedane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Hébert V, Joly P. Facteurs pronostiques de rechute à long terme chez les patients atteints de pemphigus traités par rituximab en première ligne. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.099] [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]
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Pinard C, Duvert-Lehembre S, Prost-Squarcioni C, Alsubaiei F, Houivet E, Le Henaff Y, Heas S, Picard-Dahan C, Bernard P, Doutre M, Beylot-Barry M, Richard MA, Delaporte E, Fleuret C, Oro S, D’Incan M, Alexandre M, Caux F, Maillard H, Bénéton N, Hebert V, Joly P. Évaluation d’un questionnaire de sévérité au cours du pemphigus. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.101] [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]
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Yatim A, Bohelay G, Grootenboer-Mignot S, Prost-Squarcioni C, Alexandre M, Le Roux-Villet C, Martin A, Maubec E, Caux F. Paraneoplastic Pemphigus Revealed by Anti-programmed Death-1 Pembrolizumab Therapy for Cutaneous Squamous Cell Carcinoma Complicating Hidradenitis Suppurativa. Front Med (Lausanne) 2019; 6:249. [PMID: 31750309 PMCID: PMC6848154 DOI: 10.3389/fmed.2019.00249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/10/2019] [Accepted: 10/16/2019] [Indexed: 11/17/2022] Open
Abstract
A 64-year-old patient developed a widespread autoimmune mucocutaneous blistering disease 3 weeks after the initiation of the anti-programmed death-1 (anti-PD-1) pembrolizumab therapy administered for a locally advanced cutaneous squamous cell carcinoma (SCC) of the buttocks arising from hidradenitis suppurativa. A diagnosis of paraneoplastic pemphigus (PNP) was made based on the presence of a suprabasal acantholysis associated with intercellular deposits of immunoglobulin G and C3 on basement membrane zone. Analysis of the patient's sera was positive on monkey bladder and detected circulating antibodies against desmoglein 3 and desmoplakin I prior to the initiation of pembrolizumab. At that time, the patient had few localized blisters limited to the peri-tumoral skin of the buttocks with acantholysis but without in vivo immune deposits. Pembrolizumab therapy was discontinued and a complete remission of PNP was obtained using oral steroids. Reintroduction of pembrolizumab resulted in flare of PNP. Given the close temporal relation between pembrolizumab initiation and the subsequent clinical expression of a widespread PNP, the patient was diagnosed with pre-existing subclinical PNP exacerbated by PD-1 inhibitor. The extreme rarity of PNP in the setting of cutaneous SCC and the effects of challenge, dechallenge, and rechallenge of pembrolizumab argue in favor of a checkpoint inhibitor related adverse effect. Our case is the first PNP associated with anti-PD-1 therapy and serological follow-up suggest that one infusion of pembrolizumab is sufficient to allow clinical expression of underlying pemphigus auto-immunity.
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Affiliation(s)
- Ahmad Yatim
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Gérôme Bohelay
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Sabine Grootenboer-Mignot
- Laboratory of Immunology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Bichat Hospital, AP-HP, Paris, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France.,Department of Pathology, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Christelle Le Roux-Villet
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Antoine Martin
- Department of Pathology, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Eve Maubec
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Frédéric Caux
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
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Rousseau A, Prost-Squarcioni C, Doan S, Leroux-Villet C, Caux F, Hoang-Xuan T, Cochereau I, Gabison E. Ocular involvement in epidermolysis bullosa acquisita with long-term follow-up. Br J Ophthalmol 2019; 104:235-240. [DOI: 10.1136/bjophthalmol-2019-313960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/25/2019] [Accepted: 04/20/2019] [Indexed: 11/03/2022]
Abstract
Background/aimsTo describe the ocular manifestations associated with epidermolysis bullosa acquisita (EBA).MethodsThis retrospective study was conducted at a tertiary bullous disease clinic. Consecutive patients were enrolled with biopsy proven diagnosis of EBA, with ocular involvement and a follow-up of at least 36 months. A multidisciplinary team of dermatologists, ENT specialists and ophthalmologists evaluated all patients. Immunological workup included direct (including immune-electron microscopy) and indirect immunofluorescence. Ophthalmological examination included best-corrected visual acuity (BCVA) and slit-lamp examination with grading of conjunctival fibrosis using the Tauber classification.ResultsNine patients (five females, four males) were included. The mean age at diagnosis was 32 years (range 1–52 years). Follow-up ranged from 3 to 18 years (mean 10.7 years). Conjunctival fibrosis was present in all affected eyes and was stage III or greater in 60% of patients. Eight patients (14 eyes) had corneal involvement most frequently associated with trichiasis-associated mechanical irritation or extensive cicatrising conjunctivitis. Corneal lesions developed on three eyes of three patients without eyelid disease or severe fibrosis or any identifiable triggering factor. Eyelids were affected in six patients, with trichiasis being the most common feature (affecting three patients, four eyes). Corneal-related blindness occurred in at least one eye in 44% of the patients.ConclusionEBA may be associated with devastating ocular manifestations. Most patients develop severe cicatrising conjunctivitis. A subset of patients may present with isolated corneal lesions. Further studies are warranted to assess the effects of systemic treatments on the evolution of ocular manifestations.
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Jelti L, Prost-Squarcioni C, Ingen-Housz-Oro S, Caux F, Bernard P, Bedane C, Alexandre M, Dereure O, Quereux G, Le Bidre E, Plée J, Picard-Dahan C, Le Roux-Villet C, Duvert-Lehembre S, Richard MA, Delaporte E, Debarbieux S, Jullien D, D'Incan M, Konstantinou MP, Bouaziz JD, Tancrède-Bohin E, Doutre MS, Bourgault Villada I, Cordel N, Sassolas B, Viguier MA, Mellottée B, Jouen F, Hebert V, Joly P. [Update of the French recommendations for the management of pemphigus]. Ann Dermatol Venereol 2019; 146:279-286. [PMID: 30929874 DOI: 10.1016/j.annder.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/24/2018] [Accepted: 01/23/2019] [Indexed: 01/29/2023]
Affiliation(s)
- L Jelti
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France.
| | - C Prost-Squarcioni
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - F Caux
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - P Bernard
- Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France
| | - C Bedane
- Service de dermatologie, hôpital Dupuytren, 87042 Limoges, France
| | - M Alexandre
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - O Dereure
- Service de dermatologie, Inserm U1058, université de Montpellier, hôpital St-Eloi, 34295 Montpellier, France
| | - G Quereux
- Service de dermatologie, CHU Hôtel-Dieu, 44093 Nantes, France
| | - E Le Bidre
- Service de dermatologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France
| | - J Plée
- Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France
| | - C Picard-Dahan
- Service de dermatologie, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France
| | - C Le Roux-Villet
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - S Duvert-Lehembre
- Service de dermatologie, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France
| | - M-A Richard
- EA3279 : CEReSS-centre d'étude et de recherche sur les services de santé et la qualité de vie, service de dermatologie, université Aix-Marseille, hôpital de La Timone, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France
| | - E Delaporte
- Service de dermatologie, université Aix-Marseille, hôpital Nord, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France
| | - S Debarbieux
- Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - D Jullien
- Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - M D'Incan
- Service de dermatologie, CHU Estaing, 63000 Clermont-Ferrand, France
| | - M-P Konstantinou
- Service de dermatologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse, France
| | - J-D Bouaziz
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - E Tancrède-Bohin
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - M-S Doutre
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France
| | - I Bourgault Villada
- Service de dermatologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - N Cordel
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France; Unité de dermatologie-immunologie clinique, CHU de Guadeloupe, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - B Sassolas
- Service de médecine interne et pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest, France
| | - M-A Viguier
- Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France
| | - B Mellottée
- Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - F Jouen
- Inserm U1234, laboratoire d'immunologie, université de Normandie, CHU de Rouen, 76000 Rouen, France
| | - V Hebert
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France
| | - P Joly
- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France
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- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France; Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France; Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France; Service de dermatologie, hôpital Dupuytren, 87042 Limoges, France; Service de dermatologie, Inserm U1058, université de Montpellier, hôpital St-Eloi, 34295 Montpellier, France; Service de dermatologie, CHU Hôtel-Dieu, 44093 Nantes, France; Service de dermatologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France; Service de dermatologie, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Service de dermatologie, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France; EA3279 : CEReSS-centre d'étude et de recherche sur les services de santé et la qualité de vie, service de dermatologie, université Aix-Marseille, hôpital de La Timone, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, université Aix-Marseille, hôpital Nord, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Service de dermatologie, CHU Estaing, 63000 Clermont-Ferrand, France; Service de dermatologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse, France; Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France; Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France; Service de dermatologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Unité de dermatologie-immunologie clinique, CHU de Guadeloupe, 97159 Pointe-à-Pitre cedex, Guadeloupe; Service de médecine interne et pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest, France; Inserm U1234, laboratoire d'immunologie, université de Normandie, CHU de Rouen, 76000 Rouen, France
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- Service de dermatologie, Inserm U1234, université de Normandie, CHU de Rouen, 1 rue de Germont, 76000 Rouen, France; Service de dermatologie, université Paris 13, hôpital Avicenne, AP-HP, 93000 Bobigny, France; Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Service de dermatologie, hôpital Robert-Debré, CHU de Reims, 51092 Reims, France; Service de dermatologie, hôpital Dupuytren, 87042 Limoges, France; Service de dermatologie, Inserm U1058, université de Montpellier, hôpital St-Eloi, 34295 Montpellier, France; Service de dermatologie, CHU Hôtel-Dieu, 44093 Nantes, France; Service de dermatologie, hôpital Trousseau, CHRU de Tours, 37044 Tours, France; Service de dermatologie, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Service de dermatologie, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France; EA3279 : CEReSS-centre d'étude et de recherche sur les services de santé et la qualité de vie, service de dermatologie, université Aix-Marseille, hôpital de La Timone, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, université Aix-Marseille, hôpital Nord, Assistance publique-Hôpitaux de Marseille, 13385 Marseille, France; Service de dermatologie, hôpital Edouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Service de dermatologie, CHU Estaing, 63000 Clermont-Ferrand, France; Service de dermatologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse, France; Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France; Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France; Service de dermatologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Unité de dermatologie-immunologie clinique, CHU de Guadeloupe, 97159 Pointe-à-Pitre cedex, Guadeloupe; Service de médecine interne et pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest, France; Inserm U1234, laboratoire d'immunologie, université de Normandie, CHU de Rouen, 76000 Rouen, France
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20
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Koga H, Prost-Squarcioni C, Iwata H, Jonkman MF, Ludwig RJ, Bieber K. Epidermolysis Bullosa Acquisita: The 2019 Update. Front Med (Lausanne) 2019; 5:362. [PMID: 30687710 PMCID: PMC6335340 DOI: 10.3389/fmed.2018.00362] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [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: 08/15/2018] [Accepted: 12/19/2018] [Indexed: 11/13/2022] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is an orphan autoimmune disease. Patients with EBA suffer from chronic inflammation as well as blistering and scarring of the skin and mucous membranes. Current treatment options rely on non-specific immunosuppression, which in many cases, does not lead to a remission of treatment. Hence, novel treatment options are urgently needed for the care of EBA patients. During the past decade, decisive clinical observations, and frequent use of pre-clinical model systems have tremendously increased our understanding of EBA pathogenesis. Herein, we review all of the aspects of EBA, starting with a detailed description of epidemiology, clinical presentation, diagnosis, and current treatment options. Of note, pattern analysis via direct immunofluorescence microscopy of a perilesional skin lesion and novel serological test systems have significantly facilitated diagnosis of the disease. Next, a state-of the art review of the current understanding of EBA pathogenesis, emerging treatments and future perspectives is provided. Based on pre-clinical model systems, cytokines and kinases are among the most promising therapeutic targets, whereas high doses of IgG (IVIG) and the anti-CD20 antibody rituximab are among the most promising "established" EBA therapeutics. We also aim to raise awareness of EBA, as well as initiate basic and clinical research in this field, to further improve the already improved but still unsatisfactory conditions for those diagnosed with this condition.
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Affiliation(s)
- Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
| | - Catherine Prost-Squarcioni
- Department of Dermatology, APHP, Avicenne Hospital, Referral Center for Autoimmune Bullous Diseases, Bobigny, France
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Marcel F Jonkman
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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21
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Garel B, Ingen-Housz-Oro S, Afriat D, Prost-Squarcioni C, Tétart F, Bensaid B, Bara Passot C, Beylot-Barry M, Descamps V, Duvert-Lehembre S, Grootenboer-Mignot S, Jeudy G, Soria A, Valnet-Rabier MB, Barbaud A, Caux F, Lebrun-Vignes B. Drug-induced linear immunoglobulin A bullous dermatosis: A French retrospective pharmacovigilance study of 69 cases. Br J Clin Pharmacol 2019; 85:570-579. [PMID: 30511379 DOI: 10.1111/bcp.13827] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/08/2018] [Accepted: 11/23/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Linear immunoglobin A (IgA) bullous dermatosis is a rare autoimmune dermatosis considered spontaneous or drug-induced (DILAD). We assessed all DILAD cases, determined the imputability score of drugs and highlighted suspected drugs. METHODS Data for patients with DILAD were collected retrospectively from the French Pharmacovigilance network (from 1985 to 2017) and from physicians involved in the Bullous Diseases French Study Group and the French Investigators for Skin Adverse Reactions to Drugs. Drug causality was systematically determined by the French imputability method. RESULTS Of the 69 patients, 42% had mucous membrane involvement, 20% lesions mimicking toxic epidermal necrolysis (TEN), 21% eosinophil infiltrates and 10% keratinocytes necrosis. Direct immunofluorescence, in 80%, showed isolated linear IgA deposits. Vancomycin (VCM) was suspected in 39 cases (57%), 11 had TEN-like lesions, as compared with three without VCM suspected. Among the 33 patients with a single suspected drug, 85% had an intrinsic imputability score of I4. Among them, enoxaparin, minocycline and vibramycin were previously unpublished. For all patients, the suspect drug was withdrawn; 15 did not receive any treatment. First-line therapy for 31 patients was topical steroids. Among the 60 patients with available follow-up, 52 achieved remission, 10 without treatment. Four patients experienced relapse, four died and five had positive accidental rechallenges. CONCLUSIONS There is no major clinical difference between DILAD and idiopathic linear IgA bullous dermatosis, but the former features a higher prevalence of patients mimicking TEN. VCM, suspected in more than half of the cases, might be responsible for more severe clinical presentations. We report three new putative drugs.
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Affiliation(s)
- Bethsabée Garel
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Henri-Mondor Hospital, 94010, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Henri-Mondor Hospital, 94010, Créteil, France.,EA 7379 EpiDermE, Université Paris Est Créteil Val de Marne UPEC, Créteil, France.,Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France
| | - Daniele Afriat
- Regional Center of Pharmacovigilance, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Pathology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France
| | - Florence Tétart
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Benoit Bensaid
- Drug Allergy Unit-CCR2A, Department of Allergy and Clinical Immunology, CHU Lyon-Sud, Pierre Benite, France
| | | | - Marie Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Descamps
- Department of Dermatology, APHP, Bichat Claude Bernard Hospital, Paris Diderot University
| | | | | | - Géraldine Jeudy
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Angèle Soria
- Department of Dermatology and Allergology, APHP, Tenon Hospital, Paris, France.,Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France.,Inserm, UMR 1135, Paris, France
| | | | - Annick Barbaud
- Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France.,Department of Dermatology and Allergology, APHP, Tenon Hospital, Paris, France.,Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France
| | - Frédéric Caux
- Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France
| | - Bénédicte Lebrun-Vignes
- EA 7379 EpiDermE, Université Paris Est Créteil Val de Marne UPEC, Créteil, France.,Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France.,Regional Center of Pharmacovigilance, APHP, Pitié-Salpêtrière Hospital, Paris, France
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22
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Hébert V, Boulard C, Houivet E, Duvert Lehembre S, Borradori L, Della Torre R, Feliciani C, Fania L, Zambruno G, Camaioni DB, Didona B, Marinovic B, Schmidt E, Schumacher N, Hünefeld C, Schanz S, Kern JS, Hofmann S, Bouyeure AC, Picard-Dahan C, Prost-Squarcioni C, Caux F, Alexandre M, Ingen-Housz-Oro S, Bagot M, Tancrede-Bohin E, Bouaziz JD, Franck N, Vabres P, Labeille B, Richard MA, Delaporte E, Dupuy A, D’Incan M, Quereux G, Skowro F, Paul C, Livideanu CB, Beylot-Barry M, Doutre MS, Avenel-Audran M, Bedane C, Bernard P, Machet L, Maillard H, Jullien D, Debarbieux S, Sassolas B, Misery L, Abasq C, Dereure O, Lagoutte P, Ferranti V, Werth VP, Murrell DF, Hertl M, Benichou J, Joly P. Large International Validation of ABSIS and PDAI Pemphigus Severity Scores. J Invest Dermatol 2019; 139:31-37. [DOI: 10.1016/j.jid.2018.04.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 11/29/2022]
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23
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Plaquevent M, Tétart F, Fardet L, Ingen-Housz-Oro S, Valeyrie-Allanore L, Bernard P, Hebert V, Roussel A, Avenel-Audran M, Chaby G, D'Incan M, Ferrier-Le-Bouedec MC, Duvert-Lehembre S, Picard-Dahan C, Jeudy G, Collet E, Labeille B, Morice C, Richard MA, Bourgault-Villada I, Litrowski N, Bara C, Mahe E, Prost-Squarcioni C, Alexandre M, Quereux G, Bernier C, Soria A, Thomas-Beaulieu D, Pauwels C, Dereure O, Benichou J, Joly P. Higher Frequency of Dipeptidyl Peptidase-4 Inhibitor Intake in Bullous Pemphigoid Patients than in the French General Population. J Invest Dermatol 2018; 139:835-841. [PMID: 30543900 DOI: 10.1016/j.jid.2018.10.045] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
Dipeptidyl peptidase-4 inhibitors have been suspected to induce bullous pemphigoid (BP). The objective of this study was to compare the observed frequency of gliptin intake in a large sample of 1,787 BP patients diagnosed between 2012 and 2015 in France, with the expected frequency after indirect age standardization on 225,412 individuals extracted from the database of the National Healthcare Insurance Agency. The secondary objective was to assess the clinical characteristics and the course of gliptin-associated BP, depending on whether gliptin was continued or stopped. The observed frequencies of intake of the whole gliptin class and that of vildagliptin in the BP population were higher than those in the general population after age standardization (whole gliptin class: 6.0%; 95% confidence interval = 4.9-7.1% vs. 3.6%, observed-to-expected drug intake ratio = 1.7; 95% confidence interval = 1.4-2.0; P < 0.0001; vildagliptin = 3.3%; 95% confidence interval = 2.5-4.1% vs. 0.7%, ratio = 4.4; 95% confidence interval = 3.5-5.7; P < 0.0001). The association of any gliptin+metformin was also higher than in the general population, ratio = 1.8 (95% confidence interval = 1.3-2.4; P < 0.0001). Gliptin-associated BP had no specific clinical characteristics. Gliptin was stopped in 48 (45.3%) cases. Median duration to achieve disease control, rate, and delay of relapse were not different whether gliptin was stopped or continued. This study strongly supports the association between gliptin intake, particularly vildagliptin, and the onset of BP.
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Affiliation(s)
- Marthe Plaquevent
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France.
| | - Florence Tétart
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France
| | - Laurence Fardet
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Laurence Valeyrie-Allanore
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | | | - Vivien Hebert
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France
| | - Aude Roussel
- Department of Dermatology, Orleans Hospital, Orléans, France
| | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Michel D'Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | - Geraldine Jeudy
- Department of Dermatology Dijon University Hospital, Dijon, France
| | - Evelyne Collet
- Department of Dermatology Dijon University Hospital, Dijon, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint Etienne, Saint Etienne, France
| | - Cécile Morice
- Department of Dermatology, University of Caen, Caen, France
| | - Marie-Aleth Richard
- Department of Dermatology, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Unité Mixte de Recherche 911, Institut National de la Santé et de la Recherche Médicale CRO2, Marseille, France
| | | | - Noémie Litrowski
- Department of Dermatology, Jacques Monod Hospital, Montivilliers, France
| | - Corina Bara
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Emmanuel Mahe
- Department of Dermatology, Argenteuil Hospital, Argenteuil, France
| | | | - Marina Alexandre
- Department of Dermatology, University of Paris XIII, Bobigny, France
| | - Gaelle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Claire Bernier
- Department of Dermatology, University of Nantes, Nantes, France
| | - Angèle Soria
- Department of Dermatology and Allergology, Tenon Hospital, Paris, France
| | | | - Christine Pauwels
- Department of Dermatology, Poissy-Saint Germain Hospital, Saint-Germain-en-Laye, France
| | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Jacques Benichou
- Department of Biostatistics, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1219, Normandie University, Rouen, France
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France
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Seta V, Le Roux-Villet C, Mellottée B, Taïeb C, Alexandre M, Caux F, Joly P, Falissard B, Prost-Squarcioni C. Construction d’un questionnaire Fardeau pour les pemphigus et les pemphigoïdes des muqueuses. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hebert V, Vermeulin T, Prost-Squarcioni C, Picard-Dahan C, Duvert-Lehembre S, Bruno L, Marie-Aleth R, Bernard P, Dupuy A, Bouaziz JD, Oro S, Dalac-Rat S, Delaporte E, Avenel-Audran M, Sassolas B, Alexandre M, Caux F, D’Incan M, Bedane C, Quereux G, Machet L, Dereure O, Skowron F, Franck N, Beylot-Barry M, Doutre MS, Debarbieux S, Jullien D, Misery L, Musette P, Paul C, Vabres P, Bénéton N, Dupin N, Houivet E, Joly P. Comparaison des coûts de santé du traitement de première ligne par rituximab par rapport à la corticothérapie standard chez les patients pemphigus nouvellement diagnostiqués. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.012] [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]
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26
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Masmoudi W, Hebert V, Quéreux G, Bedane C, Prost-Squarcioni C, Debarbieux S, Oro S, Chaby G, D’incan M, Litrowski N, Boulard C, Roussel A, Kottler D, Abasq C, Richard MA, Duvert-Lehembre S, Gottlieb J, Plantin P, Joly P. Calcul des valeurs seuils du score BPDAI (Bullous Pemphigoid Disease Area Index) définissant les formes légères, modérées et sévères de la pemphigoïde bulleuse. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Murrell DF, Caux F, Prost-Squarcioni C. Is the Oral Disease Severity Score going to be useful for dermatologists when assessing pemphigus? Br J Dermatol 2018; 179:816-817. [PMID: 30318808 DOI: 10.1111/bjd.16911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D F Murrell
- Department of Dermatology, St George Hospital, UNSW Australia, Sydney, Australia
| | - F Caux
- Department of Dermatology and Referral Centre for Autoimmune Blistering Diseases, Avicenne Hospital, Bobigny, France
| | - C Prost-Squarcioni
- Department of Dermatology and Referral Centre for Autoimmune Blistering Diseases, Avicenne Hospital, Bobigny, France.,Department of Histology, UFR Léonard de Vinci, University Paris 13, Bobigny, France
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28
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Zumelzu C, Alexandre M, Le Roux C, Weber P, Guyot A, Levy A, Aucouturier F, Mignot-Grootenboer S, Caux F, Maubec E, Prost-Squarcioni C. Mucous Membrane Pemphigoid, Bullous Pemphigoid, and Anti-programmed Death-1/ Programmed Death-Ligand 1: A Case Report of an Elderly Woman With Mucous Membrane Pemphigoid Developing After Pembrolizumab Therapy for Metastatic Melanoma and Review of the Literature. Front Med (Lausanne) 2018; 5:268. [PMID: 30320114 PMCID: PMC6170650 DOI: 10.3389/fmed.2018.00268] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 06/23/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022] Open
Abstract
An 83-year-old patient developed erosions and a blister of the gingival mucous membrane, 6 months after discontinuation of the anti-programmed death-1 (anti PD-1) pembrolizumab therapy administered for 10 months for a metastatic melanoma. A diagnosis of mild mucous membrane pemphigoid (MMP) was made. Complete remission of MMP was rapidly obtained with minimal therapy (doxycycline). MMP remained in complete remission after a 3-month follow-up since discontinuation of the doxycycline therapy and no evidence of relapse of the melanoma was observed after a 14-month follow-up since discontinuation of the pembrolizumab therapy. The widespread use of anti PD-1 and anti-programmed death-ligand-1 (PD-L1) in several malignancies reveals new adverse events. MMP describes a group of chronic, inflammatory, mucous membrane-predominant, subepithelial auto-immune blistering diseases. It is clinically distinct from bullous pemphigoid another autoimmune blistering disease but shares some immunological similarities with it. Twenty-nine cases of bullous pemphigoid associated with anti PD-1/PD-L1 have been reported in the literature and one of MMP. Here, we described the case of a MMP developed after pembrolizumab and discussed the accountability of anti PD-1/PD-L1 in our case and the previous reported bullous pemphigoid and MMP cases using the Begaud system scoring.
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Affiliation(s)
- Coralie Zumelzu
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Christelle Le Roux
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Patricia Weber
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Alexis Guyot
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Annie Levy
- Department of Pathology, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Françoise Aucouturier
- Department of Immunology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Saint-Louis Hospital, AP-HP, Paris, France
| | - Sabine Mignot-Grootenboer
- Department of Immunology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Bichat Hospital, AP-HP, Paris, France
| | - Frédéric Caux
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Eve Maubec
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases MALIBUL, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France.,Department of Pathology, Avicenne Hospital, AP-HP, University Paris 13, Bobigny, France.,Department of Histology, UFR Léonard de Vinci, University Paris 13, Bobigny, France
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29
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Iwata H, Vorobyev A, Koga H, Recke A, Zillikens D, Prost-Squarcioni C, Ishii N, Hashimoto T, Ludwig RJ. Meta-analysis of the clinical and immunopathological characteristics and treatment outcomes in epidermolysis bullosa acquisita patients. Orphanet J Rare Dis 2018; 13:153. [PMID: 30180870 PMCID: PMC6122731 DOI: 10.1186/s13023-018-0896-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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: 06/08/2017] [Accepted: 08/22/2018] [Indexed: 12/31/2022] Open
Abstract
Background Epidermolysis bullosa acquisita (EBA) is an orphan autoimmune disease. Several clinical phenotypes have been described, but subepidermal blistering is characteristic of all variants. Limited data on clinical and immunopathological characteristics and treatment outcomes in EBA are available. To fill this gap, we collected this information from EBA cases, meeting current diagnostic criteria, published between 1971 and 2016. Results We identified 1159 EBA cases. This number must be, however, interpreted with caution, as it is not possible to check for multiple reporting. The analysis of all cases indicated that EBA affects all age groups (median: 50 years, range: 1 to 94 years) at an equal gender distribution. Non-mechanobullous (non-MB) forms of EBA were observed in 55% of patients, whereas the mechanobullous variant (MB-EBA) or a combination of both variants was described in 38 or 7% of patients, respectively. Type VII collagen (COL7)-specific autoantibodies were primarily of the IgG isotype, but anti-COL7 IgA, IgM and IgE were also documented. Comparison of the 2 clinical EBA types showed a higher frequency of IgA deposits in non-MB EBA as opposed to MB EBA. Mucous membrane involvement was observed in 23% of patients, and 4.4% of cases were associated with other chronic inflammatory diseases. Of note, IgA deposits were more frequently observed in cases with mucous membrane involvement. Our analysis indicated that EBA is difficult to treat and that the choice of treatment varies widely. Chi square was applied to identify medications associated with complete remission (CR). Considering all EBA cases, intravenous immunoglobulin (IVIG, p = 0.0047) and rituximab (p = 0.0114) were associated with CR. Subgroup analysis demonstrated that no treatment was associated with CR for non-MB EBA, while IVIG (p = 0.003) was associated with CR in MB EBA. Conclusions Within the limitations of the study, we here document the clinical and immunopathological characteristics and treatment outcomes in a large cohort of EBA patients. The observed associations of single drugs with treatment outcome may serve as a guide to develop clinical trials. Electronic supplementary material The online version of this article (10.1186/s13023-018-0896-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiroaki Iwata
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.,Present address: Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Artem Vorobyev
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Hiroshi Koga
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.,Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Catherine Prost-Squarcioni
- Referral center for auto-immune bullous diseases, Department of Dermatology, APHP, Avicenne Hospital, Bobigny, France
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Faculty of Medicine, Osaka City University, Osaka, Japan
| | - Ralf J Ludwig
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany. .,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
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30
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Gaudin O, Seta V, Alexandre M, Bohelay G, Aucouturier F, Mignot-Grootenboer S, Ingen-Housz-Oro S, Bernardeschi C, Schneider P, Mellottee B, Caux F, Prost-Squarcioni C. Gliptin Accountability in Mucous Membrane Pemphigoid Induction in 24 Out of 313 Patients. Front Immunol 2018; 9:1030. [PMID: 29881377 PMCID: PMC5976795 DOI: 10.3389/fimmu.2018.01030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 01/27/2023] Open
Abstract
Mucous membrane pemphigoids (MMPs) and bullous pemphigoid (BP) are autoimmune bullous diseases that share physiopathological features: both can result from autoantibodies directed against BP180 or BP230 antigens. An association has been reported between BP and intake of gliptins, which are dipeptidyl peptidase-IV inhibitors used to treat type 2 diabetes mellitus. Clinical and immunological differences have been reported between gliptin-induced BPs and classical BPs: mucosal involvement, non-inflammatory lesions, and target BP180 epitopes other than the NC16A domain. Those findings accorded gliptins extrinsic accountability in triggering MMP onset. Therefore, we examined gliptin intrinsic accountability in a cohort of 313 MMP patients. To do so, we (1) identified MMP patients with gliptin-treated (challenge) diabetes; (2) selected those whose interval between starting gliptin and MMP onset was suggestive or compatible with gliptin-induced MMP; (3) compared the follow-ups of patients who did not stop (no dechallenge), stopped (dechallenge) or repeated gliptin intake (rechallenge); (4) compared the clinical and immunological characteristics of suggestive-or-compatible-challenge patients to 121 never-gliptin-treated MMP patients serving as controls; and (5) individually scored gliptin accountability as the trigger of each patient's MMP using the World Health Organization-Uppsala Monitoring Center, Naranjo- and Begaud-scoring systems. 17 out of 24 gliptin-treated diabetic MMP patients had suggestive (≤12 weeks) or compatible challenges. Complete remission at 1 year of follow-up was more frequent in the 11 dechallenged patients. One rechallenged patient's MMP relapsed. These 17 gliptin-treated diabetic MMP patients differed significantly from the MMP controls by more cutaneous, less buccal, and less severe involvements and no direct immunofluorescence IgA labeling of the basement membrane zone. Multiple autoantibody-target antigens/epitopes (BP180-NC16A, BP180 mid- and C-terminal parts, integrin α6β4) could be detected, but not laminin 332. Last, among the 24 gliptin-treated diabetic MMP patients, five had high (I4-I3), 12 had low (I2-I1) and 7 had I0 Begaud intrinsic accountability scores. These results strongly suggest that gliptins are probably responsible for some MMPs. Consequently, gliptins should immediately be discontinued for patients with a positive accountability score. Moreover, pharmacovigilance centers should be notified of these events.
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Affiliation(s)
- Olivier Gaudin
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - Vannina Seta
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Cochin Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Marina Alexandre
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - Gérôme Bohelay
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - Françoise Aucouturier
- Department of Immunology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Saint-Louis Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris, France
| | - Sabine Mignot-Grootenboer
- Department of Immunology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Bichat Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Henri-Mondor Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Créteil, France
| | - Céline Bernardeschi
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Cochin Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Pierre Schneider
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Saint-Louis Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris, France
| | - Benoît Mellottee
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - Frédéric Caux
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Referral Center for Autoimmune Bullous Diseases (MALIBUL), Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
- Department of Histology, UFR Léonard de Vinci, Paris 13 University, Bobigny, France
- Department of Pathology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
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31
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Prost-Squarcioni C, Caux F, Schmidt E, Jonkman MF, Vassileva S, Kim SC, Iranzo P, Daneshpazhooh M, Terra J, Bauer J, Fairley J, Hall R, Hertl M, Lehman JS, Marinovic B, Patsatsi A, Zillikens D, Werth V, Woodley DT, Murrell DF. International Bullous Diseases Group: consensus on diagnostic criteria for epidermolysis bullosa acquisita. Br J Dermatol 2018; 179:30-41. [PMID: 29165796 DOI: 10.1111/bjd.16138] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Epidermolysis bullosa acquisita (EBA) is a complex autoimmune bullous disease disease with variable clinical presentations and multiple possible diagnostic tests, making an international consensus on the diagnosis of EBA essential. OBJECTIVES To obtain an international consensus on the clinical and diagnostic criteria for EBA. METHODS The International Bullous Diseases Group (IBDG) met three times to discuss the clinical and diagnostic criteria for EBA. For the final voting exercise, 22 experts from 14 different countries voted on 50 different items. When > 30% disagreed with a proposal, a discussion was held and re-voting carried out. RESULTS In total, 48 of 50 proposals achieved consensus after discussion. This included nine diagnostic criteria, which are summarized in a flow chart. The IBDG was unable to determine one procedure that would be applicable worldwide. A limitation of the study is that differential diagnosis of bullous systemic lupus erythematosus has not been addressed. CONCLUSIONS This first international consensus conference established generally agreed-upon clinical and laboratory criteria defining the clinical classification of and diagnostic testing for EBA. Holding these voting exercises in person with the possibility of discussion prior to voting has advantages in reaching consensus over Delphi exercises with remote voting.
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Affiliation(s)
- C Prost-Squarcioni
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases, APHP, Avicenne Hospital, Bobigny, France.,Department of Histology, UFR Léonard de Vinci, University Paris 13, Bobigny, France.,Department of Pathology, APHP, Avicenne Hospital, Bobigny, France
| | - F Caux
- Department of Dermatology and Referral Center for Autoimmune Bullous Diseases, APHP, Avicenne Hospital, Bobigny, France
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - M F Jonkman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - S Vassileva
- Department of Dermatology, Medical University of Sofia, Sofia, Bulgaria
| | - S C Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - P Iranzo
- Department of Dermatology, Hospital Clinic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - M Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - J Terra
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J Bauer
- Division of Molecular Dermatology, Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - J Fairley
- Department of Dermatology, University of Iowa and Department of Veterans Affairs Medical Center, Iowa City, IA, U.S.A
| | - R Hall
- Department of Dermatology, Duke Medical Center, Durham, NC, U.S.A
| | - M Hertl
- Department of Dermatology, University Hospital, Marburg, Germany
| | - J S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, U.S.A
| | - B Marinovic
- Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - A Patsatsi
- Second University Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - V Werth
- Department of Dermatology, University of Pennsylvania and Philadelphia Department of Veterans Affairs Medical Center, Philadelphia, PA, U.S.A
| | - D T Woodley
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - D F Murrell
- Department of Dermatology at St George Hospital, University of New South Wales, Sydney, Australia
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32
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Murrell DF, Peña S, Joly P, Marinovic B, Hashimoto T, Diaz LA, Sinha AA, Payne AS, Daneshpazhooh M, Eming R, Jonkman MF, Mimouni D, Borradori L, Kim SC, Yamagami J, Lehman JS, Saleh MA, Culton DA, Czernik A, Zone JJ, Fivenson D, Ujiie H, Wozniak K, Akman-Karakaş A, Bernard P, Korman NJ, Caux F, Drenovska K, Prost-Squarcioni C, Vassileva S, Feldman RJ, Cardones AR, Bauer J, Ioannides D, Jedlickova H, Palisson F, Patsatsi A, Uzun S, Yayli S, Zillikens D, Amagai M, Hertl M, Schmidt E, Aoki V, Grando SA, Shimizu H, Baum S, Cianchini G, Feliciani C, Iranzo P, Mascaró JM, Kowalewski C, Hall R, Groves R, Harman KE, Marinkovich MP, Maverakis E, Werth VP. Diagnosis and management of pemphigus: Recommendations of an international panel of experts. J Am Acad Dermatol 2018; 82:575-585.e1. [PMID: 29438767 DOI: 10.1016/j.jaad.2018.02.021] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 01/18/2018] [Accepted: 02/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management. OBJECTIVE We now present results from a subsequent Delphi consensus to broaden the generalizability of the recommendations. METHODS A preliminary survey, based on the European Dermatology Forum and the European Academy of Dermatology and Venereology guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology conference. Following the meeting, a second survey was sent to more experts to achieve greater international consensus. RESULTS The 39 experts participated in the first round of the Delphi survey, and 54 experts from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II on the basis of Delphi results and meeting discussion. LIMITATIONS Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. CONCLUSIONS We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first-line therapy option for moderate-to-severe pemphigus.
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Affiliation(s)
- Dedee F Murrell
- Department of Dermatology, St. George Hospital, University of New South Wales, Sydney, Australia.
| | - Sandra Peña
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Branka Marinovic
- Department of Dermatology and Venereology, Zagreb University Hospital Center and School of Medicine, Zagreb, Croatia
| | - Takashi Hashimoto
- Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Luis A Diaz
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Animesh A Sinha
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Aimee S Payne
- Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maryam Daneshpazhooh
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rüdiger Eming
- Department of Dermatology and Allergology, University Hospital, Philipps-Universität Marburg, Marburg, Germany
| | - Marcel F Jonkman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniel Mimouni
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Luca Borradori
- Department of Dermatology, University Hospital of Bern, Bern, Switzerland
| | - Soo-Chan Kim
- Department of Dermatology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Marwah Adly Saleh
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Donna A Culton
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Annette Czernik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John J Zone
- Department of Dermatology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - David Fivenson
- St. Joseph Mercy Health System, Department of Dermatology, Ann Arbor, Michigan
| | - Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Katarzyna Wozniak
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Ayşe Akman-Karakaş
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Philippe Bernard
- Department of Dermatology, Reims University Hospital, University of Champagne-Ardenne, Reims, France
| | - Neil J Korman
- Department of Dermatology and the Murdough Family Center for Psoriasis, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Frédéric Caux
- Department of Dermatology, Avicenne Hospital, University Paris 13, Bobigny, France
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical Faculty, University of Medicine, Sofia, Bulgaria
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Department of Histology, Reference Center for Autoimmune Bullous Diseases, Avicenne Hospital, University Paris 13, Bobigny, France
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical Faculty, University of Medicine, Sofia, Bulgaria
| | - Ron J Feldman
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Johann Bauer
- Division of Molecular Dermatology, Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Hana Jedlickova
- Department of Dermatovenereology, St. Anna University Hospital, Masaryk University, Brno, Czech Republic
| | | | - Aikaterini Patsatsi
- Second Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Soner Uzun
- Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Savas Yayli
- Dermatology Department, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Detlef Zillikens
- Department of Dermatology, University of Lubeck, Lubeck, Germany
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Michael Hertl
- Department of Dermatology, University Hospital, Marburg, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lubeck, Lubeck, Germany
| | - Valeria Aoki
- Departamento de Dermatologia, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergei A Grando
- Department of Dermatology, University of California, Irvine, California; Department of Biological Chemistry Cancer Center, University of California, Irvine, California; Research Institute, Institute for Immunology, University of California, Irvine, California
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sharon Baum
- Sheba Medical Center, Dermatology Department, Tel-Hashomer, Ramat-Gan, Israel
| | - Guiseppe Cianchini
- Department of Immunodermatology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy; Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
| | | | - Pilar Iranzo
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jose M Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cezary Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Russell Hall
- Dermatology, Duke University Medical Center, Durham
| | - Richard Groves
- St. John's Institute of Dermatology, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - Karen E Harman
- University Hospitals Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - M Peter Marinkovich
- Department of Dermatology, Stanford University School of Medicine, Stanford, California; Center for Clinical Sciences Research, Palo Alto, California; Division of Dermatology, Department of Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Emanual Maverakis
- Department of Dermatology, School of Medicine, University of California, Davis, California
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Gaudin O, Seta V, Alexandre M, Bohelay G, Oro S, Bernardeschi C, Schneider P, Mellottee B, Caux F, Prost-Squarcioni C. Pemphigoïdes des muqueuses (PM) et gliptines : étude de 24 cas. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.084] [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]
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Zehou O, Raynaud JJ, Le Roux-Villet C, Alexandre M, Airinei G, Pascal F, Heller M, Lièvre N, Laroche L, Caux F, Benamouzig R, Prost-Squarcioni C. Oesophageal involvement in 26 consecutive patients with mucous membrane pemphigoid. Br J Dermatol 2017; 177:1074-1085. [PMID: 28417469 DOI: 10.1111/bjd.15592] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Oesophageal involvement of mucous membrane pemphigoid (MMP) has not yet been thoroughly described. OBJECTIVES To characterize systematically the endoscopic lesions of a series of patients with oesophageal symptoms seen at a referral centre for autoimmune bullous diseases. METHODS Clinical, endoscopic and immunological findings of consecutively referred patients with MMP with oesophageal involvement, systemic and endoscopic treatments, and follow-up are described. RESULTS Of 477 consecutive patients with MMP consulting between 2002 and 2012, 26 (5·4%) had symptomatic oesophageal involvement. Dysphagia, observed in 23 (88%) patients, was the most frequent symptom. Oesophageal symptoms could be the first sign of MMP. Patients with oesophageal involvement had a mean of three other involved sites. At initial oesophageal endoscopy, 17 of 26 patients had active lesions (intact bullae, erosions and/or erythema), 15 had stricture(s) and 12 had other cicatricial lesions. Systemic therapy alone achieved oesophageal symptom relief for five patients. Dilatation was combined with systemic therapy for 12 patients and was successful in nine; one perforation occurred. CONCLUSIONS Symptomatic oesophageal involvement affected 5·4% of patients with MMP. Dermatologists and gastroenterologists should be aware of these mucocutaneous diseases and their oesophageal involvement, as it could lead to earlier diagnosis and better care. Oesophageal dilatation could be a therapeutic option for symptomatic stricture not relieved by optimized systemic therapy alone.
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Affiliation(s)
- O Zehou
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - J-J Raynaud
- Department of Gastroenterology, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - C Le Roux-Villet
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - M Alexandre
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - G Airinei
- Department of Gastroenterology, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - F Pascal
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - M Heller
- Department of Histology and Referral Center for Auto-Immune Bullous Diseases, UFR Léonard de Vinci, University Paris 13, 93017, Bobigny, France
| | - N Lièvre
- Department of Histology and Referral Center for Auto-Immune Bullous Diseases, UFR Léonard de Vinci, University Paris 13, 93017, Bobigny, France
| | - L Laroche
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - F Caux
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - R Benamouzig
- Department of Gastroenterology, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
| | - C Prost-Squarcioni
- Department of Dermatology and Referral Center for Auto-Immune Bullous Diseases, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France.,Department of Histology and Referral Center for Auto-Immune Bullous Diseases, UFR Léonard de Vinci, University Paris 13, 93017, Bobigny, France.,Department of Pathology, Avicenne Hospital, APHP, University Paris 13, 93009, Bobigny, France
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35
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Joly P, Maho-Vaillant M, Prost-Squarcioni C, Hebert V, Houivet E, Calbo S, Caillot F, Golinski ML, Labeille B, Picard-Dahan C, Paul C, Richard MA, Bouaziz JD, Duvert-Lehembre S, Bernard P, Caux F, Alexandre M, Ingen-Housz-Oro S, Vabres P, Delaporte E, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D'Incan M, Bedane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Vermeulin T, Benichou J, Musette P. First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. Lancet 2017; 389:2031-2040. [PMID: 28342637 DOI: 10.1016/s0140-6736(17)30070-3] [Citation(s) in RCA: 347] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/07/2016] [Accepted: 11/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND High doses of corticosteroids are considered the standard treatment for pemphigus. Because long-term corticosteroid treatment can cause severe and even life-threatening side-effects in patients with this disease, we assessed whether first-line use of rituximab as adjuvant therapy could improve the proportion of patients achieving complete remission off-therapy, compared with corticosteroid treatment alone, while decreasing treatment side-effects of corticosteroids. METHODS We did a prospective, multicentre, parallel-group, open-label, randomised trial in 25 dermatology hospital departments in France (Ritux 3). Eligible participants were patients with newly diagnosed pemphigus aged 18-80 years being treated for the first time (not at the time of a relapse). We randomly assigned participants (1:1) to receive either oral prednisone alone, 1·0 or 1·5 mg/kg per day tapered over 12 or 18 months (prednisone alone group), or 1000 mg of intravenous rituximab on days 0 and 14, and 500 mg at months 12 and 18, combined with a short-term prednisone regimen, 0·5 or 1·0 mg/kg per day tapered over 3 or 6 months (rituximab plus short-term prednisone group). Follow-up was for 3 years (study visits were scheduled weekly during the first month of the study, then monthly until month 24, then an additional visit at month 36). Treatment was assigned through central computer-generated randomisation, with stratification according to disease-severity (severe or moderate, based on Harman's criteria). The primary endpoint was the proportion of patients who achieved complete remission off-therapy at month 24 (intention-to-treat analysis). This study is registered with ClinicalTrials.gov, number NCT00784589. FINDINGS Between May 10, 2010, and Dec 7, 2012, we enrolled 91 patients and randomly assigned 90 to treatment (90 were analysed; 1 patient withdrew consent before the random assignment). At month 24, 41 (89%) of 46 patients assigned to rituximab plus short-term prednisone were in complete remission off-therapy versus 15 (34%) of 44 assigned to prednisone alone (absolute difference 55 percentage points, 95% CI 38·4-71·7; p<0·0001. This difference corresponded to a relative risk of success of 2·61 (95% CI 1·71-3·99, p<0·0001), corresponding to 1·82 patients (95% CI 1·39-2·60) who would need to be treated with rituximab plus prednisone (rather than prednisone alone) for one additional success. No patient died during the study. More severe adverse events of grade 3-4 were reported in the prednisone-alone group (53 events in 29 patients; mean 1·20 [SD 1·25]) than in the rituximab plus prednisone group (27 events in 16 patients; mean 0·59 [1·15]; p=0·0021). The most common of these events in both groups were diabetes and endocrine disorder (11 [21%] with prednisone alone vs six [22%] with rituximab plus prednisone), myopathy (ten [19%] vs three [11%]), and bone disorders (five [9%] vs five [19%]). INTERPRETATION Data from our trial suggest that first-line use of rituximab plus short-term prednisone for patients with pemphigus is more effective than using prednisone alone, with fewer adverse events. FUNDING French Ministry of Health, French Society of Dermatology, Roche.
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Affiliation(s)
- Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France.
| | - Maud Maho-Vaillant
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | | | - Vivien Hebert
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, Rouen University Hospital and INSERM U1219, Normandie University, Rouen, France
| | - Sébastien Calbo
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Frédérique Caillot
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Marie Laure Golinski
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint Etienne, Saint Etienne, France
| | | | - Carle Paul
- Department of Dermatology, University of Toulouse, Toulouse, France
| | - Marie-Aleth Richard
- Department of Dermatology, Assistance Publique des Hopitaux de Marseille, Aix Marseille University, UMR 911, INSERM CRO2, Marseille, France
| | - Jean David Bouaziz
- Department of Dermatology of St Louis Hospital, Paris 7 Sorbonne Paris Cité University, Paris, France
| | - Sophie Duvert-Lehembre
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | | | - Frederic Caux
- Department of Dermatology, University of Paris XIII, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology, University of Paris XIII, Bobigny, France
| | | | - Pierre Vabres
- Department of Dermatology Dijon University Hospital, Dijon, France
| | | | - Gaelle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sebastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud; Pierre Bénite, Lyon, France
| | | | - Michel D'Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, University of Paris V, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Thomas Vermeulin
- Department of Medical Information and Informatics, Rouen University Hospital, Rouen, France
| | - Jacques Benichou
- Department of Biostatistics, Rouen University Hospital and INSERM U1219, Normandie University, Rouen, France
| | - Philippe Musette
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
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36
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Gottlieb J, Ingen-Housz-Oro S, Alexandre M, Grootenboer-Mignot S, Aucouturier F, Sbidian E, Tancrede E, Schneider P, Regnier E, Picard-Dahan C, Begon E, Pauwels C, Cury K, Hüe S, Bernardeschi C, Ortonne N, Caux F, Wolkenstein P, Chosidow O, Prost-Squarcioni C. Idiopathic linear IgA bullous dermatosis: prognostic factors based on a case series of 72 adults. Br J Dermatol 2017; 177:212-222. [PMID: 27995619 DOI: 10.1111/bjd.15244] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Linear IgA bullous dermatosis (LABD) is a clinically and immunologically heterogeneous, subepidermal, autoimmune bullous disease (AIBD), for which the long-term evolution is poorly described. OBJECTIVES To investigate the clinical and immunological characteristics, follow-up and prognostic factors of adult idiopathic LABD. METHODS This retrospective study, conducted in our AIBD referral centre, included adults, diagnosed between 1995 and 2012, with idiopathic LABD, defined as pure or predominant IgA deposits by direct immunofluorescence. Clinical, histological and immunological findings were collected from charts. Standard histology was systematically reviewed, and indirect immunofluorescence (IIF) on salt-split skin (SSS) and immunoblots (IBs) on amniotic membrane extracts using anti-IgA secondary antibodies were performed, when biopsies and sera obtained at diagnosis were available. Prognostic factors for complete remission (CR) were identified using univariate and multivariate analyses. RESULTS Of the 72 patients included (median age 54 years), 60% had mucous membrane (MM) involvement. IgA IIF on SSS was positive for 21 of 35 patients tested; 15 had epidermal and dermal labellings. Immunoelectron microscopy performed on the biopsies of 31 patients labelled lamina lucida (LL) (26%), lamina densa (23%), anchoring-fibril zone (AFz) (19%) and LL+AFz (23%). Of the 34 IgA IBs, 22 were positive, mostly for LAD-1/LABD97 (44%) and full-length BP180 (33%). The median follow-up was 39 months. Overall, 24 patients (36%) achieved sustained CR, 19 (29%) relapsed and 35% had chronic disease. CR was significantly associated with age > 70 years or no MM involvement. No prognostic immunological factor was identified. CONCLUSIONS Patients with LABD who are < 70 years old and have MM involvement are at risk for chronic evolution.
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Affiliation(s)
- J Gottlieb
- Dermatology Department, APHP, Henri-Mondor Hospital, Créteil, France.,Referral Center for Autoimmune Blistering Diseases, Île-de-France, France
| | - S Ingen-Housz-Oro
- Dermatology Department, APHP, Henri-Mondor Hospital, Créteil, France.,Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Université Paris-Est Créteil Val de Marne, UPEC, DHU VIC, IRM, EA 7379 EpiDermE, Créteil, France
| | - M Alexandre
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Avicenne Hospital, Bobigny, France
| | - S Grootenboer-Mignot
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Department of Autoimmunity and Hypersensitivity, APHP, Bichat Hospital, Paris, France
| | - F Aucouturier
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Immunology Department, APHP, Saint-Louis Hospital, Paris, France
| | - E Sbidian
- Dermatology Department, APHP, Henri-Mondor Hospital, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, DHU VIC, IRM, EA 7379 EpiDermE, Créteil, France.,Inserm, Centre d'Investigation Clinique 1430, Créteil, France
| | - E Tancrede
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Saint-Louis Hospital, Paris, France
| | - P Schneider
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Saint-Louis Hospital, Paris, France.,Pathology Department, APHP, Saint-Louis Hospital, Paris, France
| | - E Regnier
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Tarnier Hospital, Paris, France
| | - C Picard-Dahan
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Bichat Hospital, Paris, France
| | - E Begon
- Dermatology Department, René-Dubos Hospital, Pontoise, France
| | - C Pauwels
- Dermatology Department, Saint-Germain Hospital, Saint-Germain, France
| | - K Cury
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Tenon Hospital, Paris, France
| | - S Hüe
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Université Paris-Est Créteil Val de Marne, UPEC, DHU VIC, IRM, EA 7379 EpiDermE, Créteil, France.,Immunology Department, APHP, Henri-Mondor Hospital, Créteil, France
| | - C Bernardeschi
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Pathology Department, APHP, Saint-Louis Hospital, Paris, France
| | - N Ortonne
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Université Paris-Est Créteil Val de Marne, UPEC, DHU VIC, IRM, EA 7379 EpiDermE, Créteil, France.,Pathology Department, APHP, Henri-Mondor Hospital, Créteil, France
| | - F Caux
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France
| | - P Wolkenstein
- Dermatology Department, APHP, Henri-Mondor Hospital, Créteil, France.,Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Université Paris-Est Créteil Val de Marne, UPEC, DHU VIC, IRM, EA 7379 EpiDermE, Créteil, France
| | - O Chosidow
- Dermatology Department, APHP, Henri-Mondor Hospital, Créteil, France.,Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Université Paris-Est Créteil Val de Marne, UPEC, DHU VIC, IRM, EA 7379 EpiDermE, Créteil, France.,Inserm, Centre d'Investigation Clinique 1430, Créteil, France
| | - C Prost-Squarcioni
- Referral Center for Autoimmune Blistering Diseases, Île-de-France, France.,Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France.,Pathology Department, APHP, Avicenne Hospital, Bobigny, France
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Sobocinski V, Dridi SM, Bisson C, Jeanne S, Gaultier F, Prost-Squarcioni C, Bernard P, Pascal F, Lefevre B, Weber P, Abasq C, Agbo-Godeau S, Joly P, Ingen-Housz-Oro S, Duvert-Lehembre S. [Oral care recommendations for patients with oral autoimmune bullous diseases]. Ann Dermatol Venereol 2016; 144:182-190. [PMID: 28011091 DOI: 10.1016/j.annder.2016.09.680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 01/17/2016] [Revised: 08/14/2016] [Accepted: 09/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Autoimmune bullous diseases (AIBD) may cause chronic oral lesions that progress insidiously. AIMS To provide recommendations for optimal oral-dental management of patients presenting AIBD with oral involvement. PATIENTS AND METHODS In the absence of scientific studies with high levels of proof, these recommendations have been drawn up at two meetings by a committee of experts on AIBD comprising 7 dermatologists, 1 stomatologist, 1 maxillofacial surgeon, 2 odontologists and 4 parodontologists. RESULTS The oral lesions associated with AIBD may be classified into three grades of severity: severe (generalised erosive gingivitis affecting at least 30% of dental sites), moderate (localised erosive gingivitis affecting less than 30% of dental sites) and controlled (no erosive oral lesions). Good oral-dental hygiene suited to the severity of the oral lesions, must be practised continually by these patients so as to avoid the formation of dental plaque, which aggravates symptoms. Dental and parodontal care must be considered in accordance with the severity grade of the oral lesions: in severe cases, the dental plaque must be eliminated manually with a curette, but several types of care (descaling, treatment for tooth decay, non-urgent extractions, etc.) must be suspended until the grade of severity is moderate or until the disease is stabilised.
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Affiliation(s)
- V Sobocinski
- Clinique dermatologique, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - S-M Dridi
- Service d'odontologie, hôpital Henri-Mondor, 51, avenue du maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Bisson
- Service d'odontologie, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - S Jeanne
- Service d'odontologie, CHRU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - F Gaultier
- Service d'odontologie, hôpital Henri-Mondor, 51, avenue du maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Prost-Squarcioni
- Service de dermatologie, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - P Bernard
- Service de dermatologie, hôpital Robert-Debré, rue du général-Koening, 51100 Reims, France
| | - F Pascal
- Service de dermatologie, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - B Lefevre
- Service d'odontologie, hôpital Robert-Debré, rue du général-Koening, 51100 Reims, France
| | - P Weber
- Service de dermatologie, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - C Abasq
- Service de dermatologie, hôpital Morvan, 2, avenue maréchal-Foch, 29200 Brest, France
| | - S Agbo-Godeau
- Service de stomatologie et chirurgie maxillo-faciale, hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - P Joly
- Clinique dermatologique, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, 51, avenue du maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - S Duvert-Lehembre
- Service de dermatologie, hôpital de Dunkerque, 130, avenue Louis-Herbeaux, 59240 Dunkerque, France
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Roussel B, Levy A, Prost-Squarcioni C, Laroche L, Schischmanoff P, Caux F. 184 Perilipin 3 is a new partner of ABHD5 and may be involved in the pathomechanism of Dorfman-Chanarin syndrome. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.202] [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]
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Seta V, Aucouturier F, Bonnefoy J, Le Roux-Villet C, Pendaries V, Alexandre M, Grootenboer-Mignot S, Heller M, Lièvre N, Laroche L, Caux F, Titeux M, Hovnanian A, Prost-Squarcioni C. Comparison of 3 type VII collagen (C7) assays for serologic diagnosis of epidermolysis bullosa acquisita (EBA). J Am Acad Dermatol 2016; 74:1166-72. [DOI: 10.1016/j.jaad.2016.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/26/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
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Seta V, Alexandre M, Zumelzu C, Oro S, Bernardeschi C, Schneider P, Le Roux-Villet C, Pascal F, Weber P, Doan S, Soued I, Raynaud J, Benamouzig R, Vibert J, Tancrède E, Dupin N, Laroche L, Caux F, Tubach F, Prost-Squarcioni C, Gault N. Morbidité et facteurs pronostiques dans la pemphigoïde cicatricielle : étude de cohorte rétrospective. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Seta V, Gault N, Alexandre M, Zumelzu C, Oro S, Bernardeschi C, Schneider P, Le Roux Villet C, Pascal F, Weber P, Doan S, Soued I, Raynaud JJ, Lièvre N, Heller M, Tancrède E, Benamouzig R, Vibert JF, Dupin N, Wolkenstein P, Laroche L, Caux F, Tubach F, Prost-Squarcioni C. Morbidité et facteurs pronostiques dans la pemphigoïde cicatricielle : étude rétrospective sur 121 patients. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.054] [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: 10/22/2022]
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Hebert V, Boulard C, Houivet E, Duvert Lehembre S, Borradori L, Della Torre R, Feliciani C, Fania L, Zambruno G, Camaioni D, Didona B, Marinovic B, Schmidt E, Schumacher N, Hünefeld C, Schanz S, Johannes Steffen Kern J, Hofmann S, Bouyeure A, Picard-Dahan C, Prost-Squarcioni C, Caux F, Alexandre M, Ingen-Housz-Oro S, Bagot M, Tancrede-Bohin E, Bouaziz J, Franck N, Vabres P, Labeille B, Aleth Richard M, Delaporte E, Dupuy A, D’Incan M, Quereux G, Skowron F, Paul C, Bulai Livideanu C, Beylot-Barry M, Doutre M, Avenel-Audran M, Bedane C, Bernard P, Machet L, Maillard H, Jullien D, Debarbieux S, Sassolas B, Misery L, Abasq C, Dereure O, Lagoutte P, Ferranti V, Werth V, Murrell D, Hertl M, Benichou J, Joly P. Reproductibilité inter-observateur des scores de sévérité du pemphigus ABSIS et PDAI. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Houivet E, Hebert V, Boulard C, Vaillant M, Duvert Lehembre S, Borradori L, Della Torre R, Feliciani C, Fania L, Zambruno G, Camaioni D, Didona B, Marinovic B, Schmidt E, Schumacher N, Hünefeld C, Schanz S, Johannes Steffen Kern J, Hofmann S, Bouyeure A, Picard-Dahan C, Prost-Squarcioni C, Caux F, Alexandre M, Ingen-Housz-Oro S, Bagot M, Tancrede-Bohin E, Bouaziz J, Franck N, Vabres P, Labeille B, Aleth Richard M, Delaporte E, Dupuy A, D’Incan M, Quereux G, Skowron F, Paul C, Bulai Livideanu C, Beylot-Barry M, Doutre M, Avenel-Audran M, Bedane C, Bernard P, Machet L, Maillard H, Jullien D, Debarbieux S, Sassolas B, Misery L, Abasq C, Dereure O, Lagoutte P, Ferranti V, Werth V, Murrell D, Hertl M, Benichou J, Joly P. Corrélation entre les scores de sévérité clinique (ABSIS, PDAI, PGA), la qualité de vie (DLQI) et les taux d’Ac anti-desmogléine 1 et 3 dans le suivi du pemphigus. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.048] [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: 11/15/2022]
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Poirier E, Soued I, Alexandre M, Boussoura S, Lamberto C, Uzunhan Y, Gharbi N, Pascal F, Doan S, Brillet PY, Caux F, Laroche L, Prost-Squarcioni C. Pemphigoïde des muqueuses avec sténoses laryngées ou trachéales : série de 11 cas. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.091] [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: 10/24/2022]
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Dumas M, Warzocha U, Schischmanoff PO, Guyot A, Safa G, Prost-Squarcioni C, Lévy A, Roulot D, Laroche L, Caux F. Syndrome de Dorfman-Chanarin : analyse d’une série de 10 patients. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.327] [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]
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Gottlieb J, Oro S, Alexandre M, Sbidian E, Aucouturier F, Tancrede E, Schneider P, Regnier E, Picard-Dahan C, Begon E, Pauwels C, Cury K, Bernadeschi C, Ortonne N, Grootenboer-Mignot S, Caux F, Chosidow O, Wolkenstein P, Prost-Squarcioni C. Les dermatoses à IgA linéaires (DIgAL) idiopathiques de l’adulte : 72 cas. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.092] [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: 10/24/2022]
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Seta V, Aucouturier F, Bonnefoy J, Le Roux C, Mignot S, Pendaries V, Alexandre M, Heller M, Caux F, Lièvre N, Titeux M, Hovnanian A, Prost-Squarcioni C. L’Elisa-collagène 7 (C7) sur la protéine entière (Elisa-C7 total) est plus sensible que celui sur les domaines NC1 et NC2 (Elisa-C7-NC1/NC2) pour le diagnostic d’épidermolyse bulleuse acquise (EBA). Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.051] [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]
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Bernard P, Antonicelli F, Bedane C, Joly P, Le Roux-Villet C, Duvert-Lehembre S, Rousselle P, Prost-Squarcioni C. Prevalence and clinical significance of anti-laminin 332 autoantibodies detected by a novel enzyme-linked immunosorbent assay in mucous membrane pemphigoid. JAMA Dermatol 2013; 149:533-40. [PMID: 23426192 DOI: 10.1001/jamadermatol.2013.1434] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A rare variant of mucous membrane pemphigoid (MMP) is characterized by circulating anti-laminin 332 (Lam332) autoantibodies and seems to be associated with concurrent malignant neoplasms. OBJECTIVE To determine the prevalence and clinical significance of anti-Lam332 autoantibody detection from a large series of patients with MMP. DESIGN Multicenter retrospective study. SETTING Four French national centers for autoimmune bullous diseases. PARTICIPANTS One hundred fifty-four patients with MMP and 89 individuals serving as controls were included. INTERVENTIONS Serum samples were analyzed by a new Lam332 enzyme-linked immunosorbent assay (ELISA); clinical and immunopathologic data were obtained from the patients' medical records. MAIN OUTCOME MEASURES The Lam332 ELISA scores were evaluated with respect to clinical characteristics, standard and salt-split indirect immunofluorescence, and bullous pemphigoid (BP) 230 and BP180-NC16A ELISAs. RESULTS The Lam332 ELISA score was positive (≥9 U/mL) in 20.1% of serum samples from patients with MMP, 1 of 50 patients with bullous pemphigoid (BP), none of 7 with pemphigus, and 3 of 32 other controls. No relationship was evidenced between a positive ELISA Lam332 score and age; sex ratio; oral, ocular, genital, skin, or esophageal/laryngeal involvement; internal malignant neoplasm; or BP180 ELISA score. Salt-split skin indirect immunofluorescence and ELISA BP230 results were more frequently positive when Lam332 ELISA results were positive (P = .04 and .02, respectively). Patients with a positive Lam332 ELISA score frequently had more severe MMP (67.8% vs 47.2%; P = .04). CONCLUSIONS AND RELEVANCE Results of this novel ELISA showed that serum anti-Lam332 autoantibodies are detected in 20.1% of patients with MMP. Anti-Lam332 autoantibodies are mainly detected in patients with severe MMP but not preferentially in those with a malignant neoplasm. The association between anti-Lam332 and anti-BP230 autoantibodies might arise from an epitope-spreading phenomenon.
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Affiliation(s)
- Philippe Bernard
- Department of Dermatology, Reims University Hospital, University of Reims-Champagne-Ardenne, Reims, France.
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Munyangango E, Le Roux-Villet C, Doan S, Pascal F, Soued I, Alexandre M, Heller M, Lièvre N, Aucouturier F, Caux F, Laroche L, Prost-Squarcioni C. Oral cyclophosphamide without corticosteroids to treat mucous membrane pemphigoid. Br J Dermatol 2013; 168:381-90. [DOI: 10.1111/bjd.12041] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Ingen-Housz-Oro S, Alexandre M, Le Roux-Villet C, Picard-Dahan C, Tancrède-Bohin E, Wallet-Faber N, Mahé E, Begon E, Francès C, Sigal M, Grootenboer-Mignot S, Aucouturier F, André C, Wolkenstein P, Chosidow O, Prost-Squarcioni C. Pemphigus in elderly adults: clinical presentation, treatment, and prognosis. J Am Geriatr Soc 2012; 60:1185-7. [PMID: 22690997 DOI: 10.1111/j.1532-5415.2012.03987.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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