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Hadjadj J, Nguyen Y, Mouloudj D, Bourguiba R, Heiblig M, Aloui H, McAvoy C, Lacombe V, Ardois S, Campochiaro C, Maria A, Coustal C, Comont T, Lazaro E, Lifermann F, Le Guenno G, Lobbes H, Grobost V, Outh R, Campagne J, Dor-Etienne A, Garnier A, Jamilloux Y, Dossier A, Samson M, Audia S, Nicolas B, Mathian A, de Maleprade B, De Sainte-Marie B, Faucher B, Bouaziz JD, Broner J, Dumain C, Antoine C, Carpentier B, Castel B, Lartigau-Roussin C, Crickx E, Volle G, Fayard D, Decker P, Moulinet T, Dumont A, Nguyen A, Aouba A, Martellosio JP, Levavasseur M, Puigrenier S, Antoine P, Giraud JT, Hermine O, Lacout C, Martis N, Karam JD, Chasset F, Arnaud L, Marianetti P, Deligny C, Chazal T, Woaye-Hune P, Roux-Sauvat M, Meyer A, Sujobert P, Hirsch P, Abisror N, Fenaux P, Kosmider O, Jachiet V, Fain O, Terrier B, Mekinian A, Georgin-Lavialle S. Efficacy and safety of targeted therapies in VEXAS syndrome: retrospective study from the FRENVEX. Ann Rheum Dis 2024:ard-2024-225640. [PMID: 38777378 DOI: 10.1136/ard-2024-225640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Vacuoles, E1 enzyme, X-linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease associated with somatic ubiquitin-like modifier-activating enzyme 1 (UBA1) mutations. We aimed to evaluate the efficacy and safety of targeted therapies. METHODS Multicentre retrospective study including patients with genetically proven VEXAS syndrome who had received at least one targeted therapy. Complete response (CR) was defined by a clinical remission, C-reactive protein (CRP) ≤10 mg/L and a ≤10 mg/day of prednisone-equivalent therapy, and partial response (PR) was defined by a clinical remission and a 50% reduction in CRP levels and glucocorticoid dose. RESULTS 110 patients (median age 71 (68-79) years) who received 194 targeted therapies were included: 78 (40%) received Janus kinase (JAK) inhibitors (JAKi), 51 (26%) interleukin (IL)-6 inhibitors, 33 (17%) IL-1 inhibitors, 20 (10%) tumour necrosis factor (TNFα) blockers and 12 (6%) other targeted therapies. At 3 months, the overall response (CR and PR) rate was 24% with JAKi, 32% with IL-6 inhibitors, 9% with anti-IL-1 and 0% with TNFα blockers or other targeted therapies. At 6 months, the overall response rate was 30% with JAKi and 26% with IL-6 inhibitors. Survival without treatment discontinuation was significantly longer with JAKi than with the other targeted therapies. Among patients who discontinued treatment, causes were primary failure, secondary failure, serious adverse event or death in 43%, 14%, 19% and 19%, respectively, with JAKi and 46%, 11%, 31% and 9%, respectively, with IL-6 inhibitors. CONCLUSIONS This study shows the benefit of JAKi and IL-6 inhibitors, whereas other therapies have lower efficacy. These results need to be confirmed in prospective trials.
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Affiliation(s)
- Jerome Hadjadj
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Yann Nguyen
- Service de médecine interne, Hôpital Beaujon, AP-HP.Nord, Université Paris Cité, Clichy, France
| | - Dalila Mouloudj
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Rim Bourguiba
- Médecine Interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
- Université Tunis el Manar, Faculté de médecine de Tunis, Tunis, Tunisia
| | - Mael Heiblig
- Hématologie, Hôpital Lyon Sud - HCL, Pierre-Bénite, France
| | - Hassina Aloui
- Médecine Interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
| | - Chloe McAvoy
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Valentin Lacombe
- Department of Internal Medicine, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | | | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy ad Rre Disesaes. IRCCS San Raffaele Hospital. Vita-Salute Vita-Salute San Raffaele University, Milan, Italy
| | - Alexandre Maria
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, Montpellier, France
| | - Cyrille Coustal
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, Montpellier, France
| | - Thibault Comont
- Service de médecine interne IUCT-Oncopole, CHU Toulouse, Université Paul Sabatier, Toulouse, France
| | - Estibaliz Lazaro
- Internal Medicine, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
| | - Francois Lifermann
- Service de médecine interne, Centre Hospitalier Dax, Dax, Nouvelle-Aquitaine, France
| | - Guillaume Le Guenno
- Médecine Interne, CHU Estaing, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Hervé Lobbes
- Médecine Interne, CHU Estaing, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Vincent Grobost
- Médecine Interne, CHU Estaing, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Roderau Outh
- Service de médecine interne et générale, Perpignan University, Perpignan, France
| | | | | | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Antoine Dossier
- Service de Médecine Interne, Hôpital Bichat-Claude-Bernard, APHP, Paris, France
| | - Maxime Samson
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Maladies Auto-immunes et Auto-inflammatoires Rares de l'adulte, CHU Dijon-Bourgogne, Dijon,France; Université de Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Sylvain Audia
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Maladies Auto-immunes et Auto-inflammatoires Rares de l'adulte, CHU Dijon-Bourgogne, Dijon,France; Université de Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Barbara Nicolas
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Maladies Auto-immunes et Auto-inflammatoires Rares de l'adulte, CHU Dijon-Bourgogne, Dijon,France; Université de Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Alexis Mathian
- French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
| | | | - Benjamin De Sainte-Marie
- Department of Internal Medicine, Centre Hospitalier Universitaire de La Timone, Marseille, France
| | - Benoit Faucher
- Department of Internal Medicine, Centre Hospitalier Universitaire de La Timone, Marseille, France
| | | | - Jonathan Broner
- Internal Medicine Department, University Hospital Centre Nimes, Nimes, France
| | - Cyril Dumain
- Internal Medicine Department, University Hospital Centre Nimes, Nimes, France
| | - Carole Antoine
- Internal Medicine, Sainte-Anne Military Teaching Hospital, Toulon, Provence-Alpes-Côte d'Azu, France
| | - Benjamin Carpentier
- Hématologie clinique, Universite Catholique de Lille Hopital Saint-Vincent de Paul, Lille, Hauts-de-France, France
| | - Brice Castel
- Service de Médecine Interne et d'Immunologie clinique, Centre Hospitalier de Lourdes, Lourdes, France
| | | | - Etienne Crickx
- Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Geoffroy Volle
- Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Damien Fayard
- University Hospital Centre Gabriel Montpied, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Paul Decker
- Médecine interne et immunologie clinique, CHU de Nancy, UMR 7365, IMoPA, Université de Lorraine, CNRS, Nancy, France
| | - Thomas Moulinet
- Médecine interne et immunologie clinique, CHU de Nancy, UMR 7365, IMoPA, Université de Lorraine, CNRS, Nancy, France
| | - Anael Dumont
- Department of Internal Medicine, University Hospital Centre Caen, Caen, Basse-Normandie, France
| | - Alexandre Nguyen
- Department of Internal Medicine, University Hospital Centre Caen, Caen, Basse-Normandie, France
| | - Achille Aouba
- Department of Internal Medicine, University Hospital Centre Caen, Caen, Basse-Normandie, France
| | | | | | - Sebastien Puigrenier
- Department of Internal Medicine, Centre hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Pascale Antoine
- Department of Internal Medicine, Centre hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | | | | | - Carole Lacout
- Department of Internal Medicine, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Nihal Martis
- Internal Medicine Department, University Hospital of Nice, Archet 1 Hospital, Nice, France
| | - Jean-Denis Karam
- Department of Internal Medicine Amiens University Hospital, Amiens, France
| | - Francois Chasset
- Sorbonne Université, Faculté de Médecine, AP-HP, Service de Dermatologie et Allergologie, Paris, France
| | - Laurent Arnaud
- Department of Rheumatology. National reference Center for rare diseases (RESO). Hôpitaux Universitaires de Strasbourg et INSERM UMR-S 1109, Strasbourg, France
| | - Paola Marianetti
- Service de médecine interne, maladies infectieuses, immunologie clinique, Reims Champagne-Ardenne University, Reims, France
| | - Christophe Deligny
- Service de Médecine Interne, University Hospital of Martinique, Fort-de-France, Martinique
| | - Thibaud Chazal
- Internal Medicine, The Fondation Adolphe de Rothschild Hospital, Paris, France
| | | | - Murielle Roux-Sauvat
- Service de médecine interne, Pierre Oudot Hospital of Bourgoin-Jallieu, Bourgoin-Jallieu, France
| | - Aurore Meyer
- Service d'immunologie clinique et médecine interne, Hopitaux universitaires de Strasbourg, Strasbourg, Alsace, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'hématologie biologique, Pierre Bénite, France
| | - Pierre Hirsch
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, SIRIC8 CURAMUS, Hôpital Saint-Antoine, Service d'Hématologie Biologique, Paris, France
| | - Noemie Abisror
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Pierre Fenaux
- Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, France
| | - Vincent Jachiet
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Olivier Fain
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Benjamin Terrier
- Médecine interne, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, service de médecine interne, Hôpital Saint-Antoine, AP-HP, Paris, France
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de Valence B, Delaune M, Nguyen Y, Jachiet V, Heiblig M, Jean A, Riescher Tuczkiewicz S, Henneton P, Guilpain P, Schleinitz N, Le Guenno G, Lobbes H, Lacombe V, Ardois S, Lazaro E, Langlois V, Outh R, Vinit J, Martellosio JP, Decker P, Moulinet T, Dieudonné Y, Bigot A, Terriou L, Vlakos A, de Maleprade B, Denis G, Broner J, Kostine M, Humbert S, Lifermann F, Samson M, Pechuzal S, Aouba A, Kosmider O, Dion J, Grosleron S, Bourguiba R, Terrier B, Georgin-Lavialle S, Fain O, Mekinian A, Morgand M, Comont T, Hadjadj J. Serious infections in patients with VEXAS syndrome: data from the French VEXAS registry. Ann Rheum Dis 2024; 83:372-381. [PMID: 38071510 DOI: 10.1136/ard-2023-224819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an acquired autoinflammatory monogenic disease with a poor prognosis whose determinants are not well understood. We aimed to describe serious infectious complications and their potential risk factors. METHODS Retrospective multicentre study including patients with VEXAS syndrome from the French VEXAS Registry. Episodes of serious infections were described, and their risk factors were analysed using multivariable Cox proportional hazards models. RESULTS Seventy-four patients with 133 serious infections were included. The most common sites of infection were lung (59%), skin (10%) and urinary tract (9%). Microbiological confirmation was obtained in 76%: 52% bacterial, 30% viral, 15% fungal and 3% mycobacterial. Among the pulmonary infections, the main pathogens were SARS-CoV-2 (28%), Legionella pneumophila (21%) and Pneumocystis jirovecii (19%). Sixteen per cent of severe infections occurred without any immunosuppressive treatment and with a daily glucocorticoid dose ≤10 mg. In multivariate analysis, age >75 years (HR (95% CI) 1.81 (1.02 to 3.24)), p.Met41Val mutation (2.29 (1.10 to 5.10)) and arthralgia (2.14 (1.18 to 3.52)) were associated with the risk of serious infections. JAK inhibitors were most associated with serious infections (3.84 (1.89 to 7.81)) compared with biologics and azacitidine. After a median follow-up of 4.4 (2.5-7.7) years, 27 (36%) patients died, including 15 (56%) due to serious infections. CONCLUSION VEXAS syndrome is associated with a high incidence of serious infections, especially in older patients carrying the p.Met41Val mutation and treated with JAK inhibitors. The high frequency of atypical infections, especially in patients without treatment, may indicate an intrinsic immunodeficiency.
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Affiliation(s)
| | - Marion Delaune
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Yann Nguyen
- Médecine interne, Université Paris Cité, Hôpital Beaujon, Clichy, France
| | - Vincent Jachiet
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Mael Heiblig
- Hématologie clinique, Université Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Alexis Jean
- Médecine interne, CHU de Bordeaux, Bordeaux, France
| | | | - Pierrick Henneton
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Philippe Guilpain
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Nicolas Schleinitz
- Médecine interne, Aix-Marseille Universite, Hôpital de la Timone, Marseille, France
| | | | - Hervé Lobbes
- Médecine interne, CHU Estaing, Clermont-Ferrand, France
| | - Valentin Lacombe
- Médecine interne et immunologique clinique, CHU Angers, Angers, France
| | | | | | - Vincent Langlois
- Médecine interne et infectieuse, Hospital Group Le Havre, Le Havre, France
| | - Roderau Outh
- Service de médecine interne et générale, CH Perpignan, Perpignan, France
| | - Julien Vinit
- Médecine interne, Hospital Centre Chalon-sur-Saon, Chalon-sur-Saone, France
| | | | - Paul Decker
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Thomas Moulinet
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Yannick Dieudonné
- Immunologie Clinique et Médecine Interne, CHU de Strasbourg, Strasbourg, France
| | | | - Louis Terriou
- Médecine interne - hématologie, CHU Lille, Lille, France
| | - Alexandre Vlakos
- Médecine interne, Haute-Saône Hospital Group Vesoul Site, Vesoul, France
| | | | - Guillaume Denis
- Médecine interne et hématologie, Centre Hospitalier de Rochefort, Rochefort, France
| | | | - Marie Kostine
- Rhumatologie, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Sebastien Humbert
- Hématologie, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | | | - Susann Pechuzal
- Médecine interne-polyvalente, Hôpitaux Drôme Nord, Romans, France
| | | | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, France
| | - Jeremie Dion
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | | | - Rim Bourguiba
- Médecine interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
| | - Benjamin Terrier
- Médecine interne, Université Paris Cité, Hospital Cochin, Paris, France
| | | | - Olivier Fain
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Arsène Mekinian
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Marjolaine Morgand
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Thibault Comont
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Jerome Hadjadj
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
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Delestre F, Charles P, Karras A, Pagnoux C, Néel A, Cohen P, Aumaître O, Faguer S, Gobert P, Maurier F, Samson M, Godmer P, Bonnotte B, Cottin V, Hanrotel-Saliou C, Le Gallou T, Carron PL, Desmurs-Clavel H, Direz G, Jourde-Chiche N, Lifermann F, Martin-Silva N, Pugnet G, Quéméneur T, Matignon M, Benhamou Y, Daugas E, Lazaro E, Limal N, Ducret M, Huart A, Viallard JF, Hachulla E, Perrodeau E, Puechal X, Guillevin L, Porcher R, Terrier B. Rituximab as maintenance therapy for ANCA-associated vasculitides: pooled analysis and long-term outcome of 277 patients included in the MAINRITSAN trials. Ann Rheum Dis 2024; 83:233-241. [PMID: 37918894 DOI: 10.1136/ard-2023-224623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To compare the long-term efficacy and safety of azathioprine (AZA), 18-month fixed-schedule rituximab (RTX), 18-month tailored RTX and 36-month RTX in preventing relapses in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis who achieved a complete remission after induction therapy. Patients treated with 36-month RTX received either a fixed or a tailored regimen for the first 18 months and a fixed regimen for the last 18 months (36-month fixed/fixed RTX and 36-month tailored/fixed RTX, respectively). METHODS The Maintenance of Remission using Rituximab in Systemic ANCA-associated Vasculitis (MAINRITSAN) trials sequentially compared: 18-month fixed-schedule RTX versus AZA (MAINRITSAN); 18-month fixed-schedule RTX versus 18-month tailored-RTX (MAINRITSAN2); and extended therapy to 36 months with four additional RTX infusions after MAINRITSAN2 versus placebo (MAINRITSAN3). Patients were then followed prospectively through month 84 and their data were pooled to analyse relapses and adverse events. The primary endpoint was relapse-free survival at month 84. RESULTS 277 patients were enrolled and divided in 5 groups: AZA (n=58), 18-month fixed-schedule RTX (n=97), 18-month tailored-RTX (n=40), 36-month tailored/fixed RTX (n=42), 36-month fixed/fixed RTX (n=41). After adjustment for prognostic factors, 18-month fixed-schedule RTX was superior to AZA in preventing major relapses at month 84 (HR 0.38, 95% CI 0.20 to 0.71). The 18-month tailored-RTX regimen was associated with an increased risk of major relapse compared with fixed-schedule regimen (HR 2.92, 95% CI 1.43 to 5.96). The risk of major relapse was similar between 36-month fixed/fixed and 18-month fixed-RTX (HR 0.69, 95% CI 0.38 to 1.25). CONCLUSIONS According to these results, it appears that the 84-month remission rate is higher with an 18-month fixed RTX regimen compared with AZA and 18-month tailored RTX. Also, extending RTX to 36 months does not appear to reduce the long-term relapse rate compared with the 18-month fixed RTX regimen. However, as this study was underpowered to make this comparison, further prospective studies are needed to determine the potential long-term benefits of extending treatment in these patients.
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Affiliation(s)
- Florence Delestre
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Pierre Charles
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Alexandre Karras
- Université Paris Cité, Paris, France
- Department of Nephrology, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Christian Pagnoux
- University of Toronto, Toronto, Ontario, Canada
- Vasculitis clinic, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Antoine Néel
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pascal Cohen
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
| | - Olivier Aumaître
- Department of Internal Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Gobert
- Département de médecine, Hopital Général Henri-Duffaut, Avignon, France
| | - François Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Maxime Samson
- Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Pascal Godmer
- Département de Hématologie Immunologie, Centre Hospitalier Bretagne Atlantique de Vannes, Vannes, France
| | - Bernard Bonnotte
- Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Lyon, France
| | - Catherine Hanrotel-Saliou
- Department of Nephrology, Centre Hospitalier Universitaire de Brest, Hôpital la Cavale Blanche, Brest, France
| | - Thomas Le Gallou
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Pierre-Louis Carron
- Département de néphrologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | | | - Guillaume Direz
- Rheumatology Department, Le Mans General Hospital, Le Mans, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de La Conception, Aix-Marseille Université, Marseille, France
| | | | - Nicolas Martin-Silva
- Department of Internal Medicine, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Grégory Pugnet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Thomas Quéméneur
- Département de Néphrologie et de Médecine Interne, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Marie Matignon
- Nephrology and Renal Transplantation Department, Hopitaux Universitaires Henri Mondor, Créteil, France
| | - Ygal Benhamou
- Department of Internal Medicine, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France
| | - Eric Daugas
- Department of Nephrology, Hopital Bichat - Claude-Bernard, Paris, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Bordeaux University Hospital, Pessac, France
| | - Nicolas Limal
- Department of Internal Medicine, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Maïzé Ducret
- Department of Nephrology, Annecy Hospital, Annecy, France
| | - Antoine Huart
- Department of Nephrology, Hospital Rangueil, Toulouse, France
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Elodie Perrodeau
- Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
| | - Xavier Puechal
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Raphaël Porcher
- Université Paris Cité, Paris, France
- Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
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Cottu A, Groh M, Desaintjean C, Marchand-Adam S, Guillevin L, Puechal X, Beaumesnil S, Lazaro E, Samson M, Taille C, Durel CA, Diot E, Nicolas S, Guilleminault L, Ebbo M, Cathebras P, Dupin C, Yildiz H, Belfeki N, Pugnet G, Chauvin P, Jouneau S, Lifermann F, Martellosio JP, Cottin V, Terrier B. Benralizumab for eosinophilic granulomatosis with polyangiitis. Ann Rheum Dis 2023; 82:1580-1586. [PMID: 37550002 DOI: 10.1136/ard-2023-224624] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Benralizumab is effective in the treatment of eosinophilic asthma and is being investigated for the treatment of other eosinophil-associated diseases. Reports on the use of benralizumab for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) are limited to case reports and small case series. METHODS We conducted a multicentre, retrospective study including EGPA patients treated with off-label benralizumab. The primary endpoint was the rate of complete response defined as no disease activity (Birmingham Vasculitis Activity Score=0) and a prednisone dose ≤4 mg/day. Partial response was defined as no disease activity and a prednisone dose ≥4 mg/day. RESULTS Sixty-eight patients were included, including 31 (46%) who had previously received mepolizumab. The use of benralizumab was warranted by uncontrolled asthma in 54 (81%), persistent ear, nose and throat (ENT) manifestations in 27 (40%) and persistent glucocorticoids (GCs) use in 48 (74%) patients. Median (IQR) follow-up after starting benralizumab was 23 (9-34) months. Thirty-three patients (49%) achieved a complete response, 24 (36%) achieved a partial response and 10 (15%) did not respond. Among the 57 patients who initially responded, 10 (18%) eventually required further line treatments. GCs were discontinued in 23 patients (38%). Prior mepolizumab use was associated with a higher rate of primary failure (26.7% vs 5.4%, p=0.034) and less frequent GCs discontinuation (14.8% vs 55.9%, p=0.001). Vasculitis flares occurred in 7 patients (11%) and were associated with histological evidence of vasculitis and/or antineutrophil cytoplasmic antibodies positivity at benralizumab initiation (p=0.004). CONCLUSIONS Benralizumab appears to be an effective treatment for refractory asthma or ENT manifestations in EGPA and allows GC-sparing. However, its efficacy was lower after prior failure of mepolizumab.
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Affiliation(s)
- Adrien Cottu
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Matthieu Groh
- National Referral Center for Hypereosinophilic Syndrome (CEREO), Department of Internal Medicine, Hopital Foch, Suresnes, France
| | - Charlene Desaintjean
- Department of Respiratory Diseases, Hospital for Cardiologie and Pneumology Louis Pradel, Lyon, France
| | - Sylvain Marchand-Adam
- Service de pneumologie et d'explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Xavier Puechal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Stacy Beaumesnil
- Department of Internal Medicine and Infectious Diseases, University Hospital Centre, Bordeaux, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, University Hospital Centre, Bordeaux, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital Centre, Dijon, France
| | - Camille Taille
- Reference Center for Rare Pulmonary Diseases and University of Paris Cité, Inserm 1152, Hospital Bichat - Claude-Bernard, Paris, France
| | | | - Elizabeth Diot
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Sarah Nicolas
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Laurent Guilleminault
- Department of Respiratory Medicine, University Hospital Centre Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, Toulouse 2 University, Toulouse, France
| | - Mikael Ebbo
- Departement of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Clairelyne Dupin
- Reference Center for Rare Pulmonary Diseases and University of Paris Cité, Hospital Bichat - Claude-Bernard, Paris, France
| | - Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Nabil Belfeki
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Grégory Pugnet
- Department of Internal Medicine and Clinical Immunology, CHU Toulouse Rangueil, Toulouse, France
| | - Pierre Chauvin
- Department of Respiratory Diseases, University Hospital Centre Rennes, Rennes, France
| | - Stephane Jouneau
- Department of Respiratory Diseases, IRSET UMR 1085, Rennes 1 University, Pontchaillou Hospital, Rennes, France
| | | | | | - Vincent Cottin
- Department of Respiratory Diseases, Hospital for Cardiologie and Pneumology Louis Pradel, Lyon, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
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Nocturne G, Marmontel O, di Filippo M, Chretien P, Krzysiek R, Lifermann F, Rahal N, Belkhir R, Moulin P, Mariette X. Efficacy of daratumumab in refractory primary Sjögren disease. RMD Open 2023; 9:e003464. [PMID: 37730313 PMCID: PMC10510860 DOI: 10.1136/rmdopen-2023-003464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Gaetane Nocturne
- Rheumatology Department, Hôpital Bicêtre, Le Kremlin-Bicetre, France
- INSERM UMR 1184, Le Kremlin-Bicêtre, France
| | - Oriane Marmontel
- Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon, F-69677, Lyon Cedex, France, Lyon, France
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Mathilde di Filippo
- Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon, F-69677, Lyon Cedex, France, Lyon, France
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Pascale Chretien
- Laboratoire d'Immunologie, Hopital Bicetre, Le Kremlin-Bicetre, France
| | - Roman Krzysiek
- Laboratoire d'Immunologie, Hopital Bicetre, Le Kremlin-Bicetre, France
| | | | - Nawal Rahal
- Rheumatology Department, Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Rakiba Belkhir
- Rheumatology Department, Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Philippe Moulin
- Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon, F-69677, Lyon Cedex, France, Lyon, France
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Xavier Mariette
- Rheumatology Department, Hôpital Bicêtre, Le Kremlin-Bicetre, France
- INSERM UMR 1184, Le Kremlin-Bicêtre, France
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Perray L, Nguyen Y, Clavel-Refregiers G, Chazal T, Héron E, Puéchal X, Pouchelon C, Thoreau B, Régent A, Murarasu A, Dunogué B, Costedoat-Chalumeau N, Lifermann F, Deroux A, Graveleau J, Vasco C, Hié M, Froissart A, Brézin A, Terrier B. Sclérites et épisclérites associées aux anticorps anti-cytoplasme des polynucléaires neutrophiles : présentation initiale et pronostic. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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7
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Puéchal X, Iudici M, Perrodeau E, Bonnotte B, Lifermann F, Le Gallou T, Karras A, Blanchard-Delaunay C, Quéméneur T, Aouba A, Aumaître O, Cottin V, Hamidou M, Ruivard M, Cohen P, Mouthon L, Guillevin L, Ravaud P, Porcher R, Terrier B. Rituximab versus cyclophosphamide en traitement d’induction de la granulomatose avec polyangéite : essai thérapeutique émulé. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8
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Terrier B, Posseme C, Temple M, Corneau A, Carbone F, Chenevier-Gobeaux C, Lazaro E, Outh R, Le Guenno G, Lifermann F, Berleur M, Weitten T, Guillotin V, Ménager M, Duffy D, Kosmider O. Le syndrome VEXAS se caractérise par une activation des voies de l’inflammasome dans le sang et les tissus et par une dérégulation du compartiment monocytaire. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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9
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Pineton De Chambrun M, Charuel J, Dorgham K, Quentric P, Kerneis M, Lebreton G, Miyara M, Schmidt M, Luyt C, Melki I, Moyon Q, Lifermann F, Mathian A, Gorochov G, Amoura Z, Combes A, Hekimian G. Myocardites fulminantes associées aux auto-anticorps Anti-ARN-polymérases III. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Delestre F, Charles P, Samson M, Néel A, Faguer S, Karras A, Lifermann F, Godmer P, Hanrotel-Saliou C, Martin-Silva N, Pugnet G, Maurier F, Le Gallou T, Quéméneur T, Méaux-Ruault N, Viallard J, Puéchal X, Guillevin L, Porcher R, Terrier B. Performance de modèles de prédiction du risque de rechute et d’infection sévère à la fin du traitement d’entretien par rituximab à 18 mois au cours des vascularites à ANCA. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mettler C, Durel CA, Guilpain P, Bonnotte B, Cohen-Aubart F, Hamidou M, Lega JC, Guern VL, Lifermann F, Poindron V, Pugnet G, Servettaz A, Puéchal X, Guillevin L, Terrier B. Off-label use of biologics for the treatment of refractory and/or relapsing granulomatosis with polyangiitis. Eur J Intern Med 2022; 96:97-101. [PMID: 34716074 DOI: 10.1016/j.ejim.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the efficacy and safety of off-label use of biologics for refractory and/or relapsing granulomatosis with polyangiitis (GPA). METHODS We conducted a French retrospective study including GPA patients who received off-label biologics for refractory and/or relapsing disease after failure of conventional immunosuppressive regimens. RESULTS Among 26 patients included, 18 received infliximab (IFX), 2 adalimumab (ADA) and 6 abatacept (ABA). Biologics were initiated in median as 4th-line therapy (IQR 3-6) for relapsing and/or refractory disease in 23 (88%) and/or significant glucocorticoid-dependency in 8 cases (31%). At biologics initiation, median (IQR) BVAS and prednisone dose in anti- TNF-α and ABA recipients were 7 (3-8) and 2 (1-6), and 20 (13-30) mg/day and 20 (15-25) mg/day, respectively. Clinical manifestations requiring biologics were mainly pulmonary and ENT manifestations in 58% each. Anti-TNF-α and ABA were continued for a median duration of 8 months (IQR 6-13) and 11 months (IQR 6-18) respectively. Anti-TNF-α recipients showed remission, partial response and treatment failure in 10%, 30% and 60% at 6 months, and 25%, 20% and 55% at 12 months, respectively. ABA recipients showed remission, partial response and treatment failure in 17%, 33% and 50% at 6 months and 17%, 33% and 50% at 12 months. One patient treated with IFX experienced life-threatening reaction while one patient treated with ABA experienced a severe infection. CONCLUSION This real-life study suggests that off-label use of anti-TNF-α and abatacept shows efficacy in less than 50% of refractory and/or relapsing GPA.
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Affiliation(s)
- C Mettler
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - C A Durel
- Department of Internal Medicine, CHU Lyon, Lyon, France
| | - P Guilpain
- Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - B Bonnotte
- Department of Internal Medicine, Competence Center for Autoimmune Cytopenia, François Mitterrand University Hospital, Dijon, France
| | - F Cohen-Aubart
- Department of Internal Medicine 2, French National Centre for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - M Hamidou
- Department of Internal Medicine, Nantes University Hospital, 44093 Nantes, France
| | - J C Lega
- Department of Internal and Vascular Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, Université Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, LBBE, UMR CNRS 5558, France
| | - V Le Guern
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - F Lifermann
- Department of Internal Medecine, Dax - Côte d'Argent Hospital, Dax, France
| | - V Poindron
- Clinical Immunology Department, National Referral Center for Systemic Autoimmune Diseases, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - G Pugnet
- Department of Internal Medicine and Clinical Immunology, CHU Toulouse Rangueil, Toulouse, France
| | - A Servettaz
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - X Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - L Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - B Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France.
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12
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Fouquet G, Larroche C, Carpentier B, Terriou L, Urbanski G, Lacout C, Lazaro E, Salmon Gandonnière C, Perlat A, Lifermann F, Sritharan N, Bonnet F, Hermine O, Bloch-Queyrat C. Splenectomy for haemophagocytic lymphohistiocytosis of unknown origin: risks and benefits in 21 patients. Br J Haematol 2021; 194:638-642. [PMID: 33961306 DOI: 10.1111/bjh.17497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Guillemette Fouquet
- Laboratory of cellular and molecular mechanisms of hematological disorders and therapeutic implications, INSERM U1163, Imagine Institut, Sorbonne Paris University, Paris, France
| | - Claire Larroche
- Internal Medicine, Groupe Hospitalier Paris Seine Saint Denis, Hôpital Avicenne, AP-HP, Bobigny, France
| | | | - Louis Terriou
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Geoffrey Urbanski
- UMR CNRS 6015-INSERM U1083, Mitolab Team, MITOVASC Institute, University, Angers, France.,Department of Internal Medicine, Angers University Hospital, Angers, France
| | - Carole Lacout
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - Estibaliz Lazaro
- CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University, Bordeaux, France.,Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Charlotte Salmon Gandonnière
- Intensive Care Medicine, INSERM CIC 1415, CRICS-TriggerSep Research Network, CHRU de Tours, 37044, Tours, France
| | - Antoinette Perlat
- Internal Medicine and Clinical Immunology, CHU Rennes, Rennes, France
| | - Francois Lifermann
- Internal Medicine and Hematological Unit, Centre Hospitalier de Dax, Dax, France
| | - Nanthara Sritharan
- Departement of Clinical Research, Paris Seine Saint Denis Hospital, Sorbonne Paris University, AP HP, Bobigny, France
| | - Fabrice Bonnet
- CHU de Bordeaux, Hôpital Saint-André, Service de Médecine Interne et Maladies Infectieuses and Université de Bordeaux, INSERM U1219, BPH, F-3300, Bordeaux, France
| | - Olivier Hermine
- Laboratory of cellular and molecular mechanisms of hematological disorders and therapeutic implications, INSERM U1163, Imagine Institut, Sorbonne Paris University, Paris, France.,Department of Clinical Hematology, Necker Children's Hospital, AP HP, Paris, France
| | - Coralie Bloch-Queyrat
- Laboratory of cellular and molecular mechanisms of hematological disorders and therapeutic implications, INSERM U1163, Imagine Institut, Sorbonne Paris University, Paris, France.,Departement of Clinical Research, Paris Seine Saint Denis Hospital, Sorbonne Paris University, AP HP, Bobigny, France
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Wesner N, Mestiri R, Crabol Y, Durel C, Lifermann F, Zenone T, Charles P, Puéchal X, Sacré K, Desprets M, Legendre P, Terrier B. Nocardioses au cours des vascularites systémiques. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.027] [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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14
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Mettler C, Durel C, Cohen-Aubart F, Guilpain P, Hamidou M, Lega J, Le Guern V, Lifermann F, Poindron V, Pugnet G, Samson M, Servettaz A, Puéchal X, Guillevin L, Terrier B. Utilisation hors-AMM des biothérapies au cours des granulomatoses avec polyangéite réfractaires ou en rechute. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.040] [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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15
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Puéchal X, Iudici M, Pagnoux C, Cohen P, Hamidou M, Aouba A, Lifermann F, Ruivard M, Aumaître O, Bonnotte B, Maurier F, Decaux O, Hachulla E, Karras A, Khouatra C, Jourde-Chiche N, Viallard J, Mouthon L, Terrier B, Guillevin L. Les granulomatoses avec polyangéite (GPA) sans ANCA ou avec ANCA anti-myéloperoxydase représentent des entités distinctes au sein des GPA. Analyse de 727 GPA du registre du Groupe Français d’Etude des Vascularites. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Puéchal X, Iudici M, Pagnoux C, Karras A, Cohen P, Maurier F, Quéméneur T, Lifermann F, Hamidou M, Mouthon L, Terrier B, Guillevin L. OP0030 GRANULOMATOSIS WITH POLYANGIITIS SUSTAINED REMISSION OFF-THERAPY: DATA FROM THE FRENCH VASCULITIS STUDY GROUP REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Data on granulomatosis with polyangiitis (GPA) sustained remission off-therapy (SROT) are limited and it is unknown whether disease characteristics or treatment regimen may affect it.Objectives:This study aimed to assess SROT of GPA patients from the French Vasculitis Study Group registry, and identify factors associated with its occurrence and durability during follow-up.Methods:GPA had to satisfy the 1990 ACR classification criteria and/or revised Chapel Hill Nomenclature for study inclusion. SROT was defined as remission (BVAS=0) without glucocorticoids (GC) or immunosuppressants (IS), the latter for ≥6 months (ie 2 consecutive visits). SROT and its duration were extracted from the database. Data from patients with 3-, 5- and 10-year SROT were analyzed. Baseline characteristics of patients with 3-year GPA SROT were compared to those of registry GPA patients with available data at 3 years but not in SROT (controls), and 3-year SROT achieving 5-year SROT vs those who relapsed between 3 & 5 years. Patients with 3-year GPA SROT follow-up +7 years were analyzed according to maintained SROT or not.Results:Among 795 database patients with new-onset GPA, 259 achieved at least 1 SROT at some time during their disease, after a median [IQR] of 36 [28–63] months post-diagnosis. The first SROT lasted a median of 14 [I8-32] months. Among 202 of those patients who had follow-up, 73 (36%) remained in SROT for a median follow-up of 34 [14-45] months post-SROT. Among 434 (54%) patients followed for ≥3 years post-diagnosis, 82% had received GC and cyclophosphamide induction therapy. At 3 years post-diagnosis, 92 (21%) patients in SROT were compared to 342 (79%) controls who had relapsed or were still taking GC or IS. Patients achieving 3-year SROT vs controls, respectively, had more frequently received intravenous cyclophosphamide as induction therapy (89% vs 77%, P=0.01), with a higher median number of infusions (7.5 vs 6; P=0.05); no other clinical or biological baseline difference was found. Among those 92 3-year SROT patients, 74 had ≥2 years of additional follow-up: 46 (62%) attained 5-year SROT and 28 (38%) had relapsed after a mean follow-up of 13 months. Baseline clinical and biological characteristics of patients achieving 5-year SROT did not differ from those of 3-year SROT patients who relapsed. Among those 92 3-year SROT patients, 16 had ≥7 additional years of follow-up: 6 (38%) achieved 10-year SROT, ie 8% of 75 GPA with available data at 10 years, and 10 (63%) had relapsed a mean 35 ± 28 months after achieving 3-year SROT.Conclusion:Only 8% of GPA patients achieved 10-year SROT after conventional induction and maintenance therapies. No baseline clinical or biological characteristics helped distinguish patients achieving or maintaining SROT and those who relapsed. However, patients achieving 3-year SROT had received more intensive induction therapy than those who relapsed or were still on GC or IS at 3 years.Disclosure of Interests:None declared
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Charles P, Dechartres A, Terrier B, Cohen P, Faguer S, Huart A, Hamidou M, Agard C, Bonnotte B, Samson M, Karras A, Jourde-Chiche N, Lifermann F, Gobert P, Hanrotel-Saliou C, Godmer P, Martin-Silva N, Pugnet G, Matignon M, Guillevin L. Réduction du nombre de perfusions de rituximab au début du traitement d’entretien des vascularites associées aux ANCA. Résultats d’une analyse post-hoc de l’essai contrôlé randomisé MAINRITSAN2. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.059] [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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18
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Puéchal X, Iudici M, Pagnoux C, Karras A, Cohen P, Maurier F, Quéméneur T, Lifermann F, Hamidou M, Mouthon L, Terrier B, Guillevin L. Rémission à distance de tout traitement au cours de la granulomatose avec polyangéite (Wegener) : données du registre du Groupe français d’étude des vascularites. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.061] [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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Favre S, Botella-Garcia C, Bijou F, Deau-Fisher B, Banos A, Rispal P, Saint-Lézer A, Fitoussi O, Lifermann F, Labouré G, Dagada C, Milpied N, Bouabdallah K. OUTCOME OF PATIENTS WITH C-MYC REARRANGED DIFFUSE LARGE B CELL LYMPHOMA ASSOCIATED OR NOT WITH BCL2 AND/OR BCL6 REARRANGEMENT: A MULTICENTRIC AND RETROSPECTIVE STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.17_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- S. Favre
- Hematology; University Hospital of Bordeaux; Pessac France
| | | | - F. Bijou
- Hematology; Bergonié Institute; Bordeaux France
| | | | - A. Banos
- Hematology; Centre Hospitalier de la Côte Basque; Bayonne France
| | - P. Rispal
- Medecine; Centre Hospitalier Agen-Nérac; Agen France
| | - A. Saint-Lézer
- Medecine; Centre Hospitalier de Mont-de-Marsan; Mont-de-Marsan France
| | - O. Fitoussi
- Hematology; Polyclinique Bordeaux Nord Aquitaine; Bordeaux France
| | | | - G. Labouré
- Hematology; Centre Hospitalier de Libourne; Libourne France
| | - C. Dagada
- Medecine; Centre hospitalier de Pau; Pau France
| | - N. Milpied
- Hematology; University Hospital of Bordeaux; Pessac France
| | - K. Bouabdallah
- Hematology; University Hospital of Bordeaux; Pessac France
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Pineton De Chambrun M, Charuel J, Hekimian G, Mathian A, Huang F, Hie M, Lifermann F, Bréchot N, Melki I, Combes A, Luyt C, Amoura Z. Myopéricardites virales associées aux anticorps anti-ARN polymérase III : une nouvelle entité ? Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.032] [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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21
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Blaison F, Lifermann F, Baudry V. Un doigt bleu. Rev Med Interne 2019; 40:197-198. [DOI: 10.1016/j.revmed.2017.12.003] [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] [Received: 11/11/2017] [Accepted: 12/14/2017] [Indexed: 11/16/2022]
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22
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Puéchal X, Pagnoux C, Baron G, Lifermann F, Geffray L, Quéméneur T, Saraux J, Wislez M, Cottin V, Ruivard M, Limal N, Guillevin L. Suivi à long-terme des patients atteints de granulomatose éosinophilique avec polyangéite inclus dans l’étude CHUSPAN2 ayant évalué l’intérêt de l’adjonction de l’azathioprine à la corticothérapie en traitement d’induction. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chilles M, Lhote R, Brillet P, Groh M, Puechal X, Cohen-Aubart F, Delbre X, Guilpain P, Barda T, De Boysson H, Duhaut P, Dominique S, Hachulla E, Hamidou M, Subra J, Lifermann F, Fain O, Cohen P, Lhote F, Nunes H, Mathian A, Catherinot E, Terrier B, Le Quellec A, Legendre C, Cottin V, Amoura Z, Couderc L, Diot E, Guillevin L, Tcherakian C. Impact des dilatations des bronches sur les caractéristiques cliniques et le pronostic des vascularites à ANCA : résultats d’une série de 61 patients. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Gusdorf L, Asli B, Barbarot S, Néel A, Masseau A, Puéchal X, Gottenberg JE, Grateau G, Blanchard-Delaunay C, Rizzi R, Lifermann F, Kyndt X, Aubin F, Bessis D, Boye T, Gayet S, Rongioletti F, Sauleau E, Fermand JP, Lipsker D. Schnitzler syndrome: validation and applicability of diagnostic criteria in real-life patients. Allergy 2017; 72:177-182. [PMID: 27564982 DOI: 10.1111/all.13035] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, and clinical, histological, and biological signs of neutrophil-mediated inflammation. The aim of this study was to assess the applicability and validity of the existing diagnostic criteria in real-life patients. METHODS This multicentric study was conducted between 2009 and 2014 in 14 hospitals in which patients with Schnitzler syndrome or controls with related disorders were followed up. We compared the sensitivities and specificities and calculated the positive and negative predictive values of the Lipsker and of the Strasbourg criteria for the patients with Schnitzler syndrome and for the controls. We included 42 patients with Schnitzler syndrome, 12 with adult-onset Still's disease, 7 with cryopyrin-associated periodic disease, 9 with Waldenström disease, and 10 with chronic spontaneous urticaria. RESULTS All patients with Schnitzler syndrome met the Lipsker criteria. According to the Strasbourg criteria, 34 patients had definite Schnitzler syndrome, five had probable Schnitzler syndrome, and three did not meet the criteria. One control met the Lipsker criteria and had probable Schnitzler syndrome according to the Strasbourg criteria. Sensitivity and specificity of the Lipsker criteria were 100% and 97%, respectively. For the Strasbourg criteria, sensitivity for definite and probable diagnosis was 81% and 93%, respectively, with a corresponding specificity of 100% and 97%. CONCLUSION Diagnostic criteria currently in use to diagnose Schnitzler syndrome are reliable. More investigations must be done to attest their efficiency in patients with recent-onset manifestations.
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Affiliation(s)
- L. Gusdorf
- Clinique Dermatologique; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - B. Asli
- Unité d'Immuno-Hématologie; Hôpital Saint-Louis; Assistance Publique-Hôpitaux de Paris; Paris France
| | - S. Barbarot
- Service de Dermatologie; CHU Hôtel-Dieu; Nantes France
| | - A. Néel
- Service de Médecine Interne; CHU Hôtel Dieu; Nantes France
| | - A. Masseau
- Service de Médecine Interne; CHU Hôtel Dieu; Nantes France
| | - X. Puéchal
- Service de Médecine Interne; Hôpital Cochin; Assistance Publique-Hôpitaux de Paris; Paris France
| | - J-E. Gottenberg
- Service de Rhumatologie; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - G. Grateau
- Service de Médecine Interne; Hôpital Tenon; Assistance Publique-Hôpitaux de Paris; Paris France
| | | | - R. Rizzi
- Department of Emergency and Organ Transplantation; Section of Hematology with Transplantation; University of Bari; Bari Italy
| | - F. Lifermann
- Service de Médecine Interne; Centre Hospitalier; Dax France
| | - X. Kyndt
- Service de Médecine Interne; Centre Hospitalier; Valenciennes France
| | - F. Aubin
- Service de Dermatologie; CHU de Besançon; Besançon France
| | - D. Bessis
- Service de Dermatologie; CHU Saint-Eloi; Montpellier France
| | - T. Boye
- Service de Dermatologie; Hôpital d'Instruction des Armées Sainte-Anne; Toulon France
| | - S. Gayet
- Service de Médecine Interne; Gériatrie et Thérapeutique; CHU de la Timone; Marseille France
| | - F. Rongioletti
- Department of Dermatology; University of Genova; Genova Italy
| | - E. Sauleau
- Service de Santé Publique; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - J-P. Fermand
- Unité d'Immuno-Hématologie; Hôpital Saint-Louis; Assistance Publique-Hôpitaux de Paris; Paris France
| | - D. Lipsker
- Clinique Dermatologique; Hôpitaux Universitaires de Strasbourg; Strasbourg France
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Pineton De Chambrun M, Gousseff M, Levesque H, Lega J, Le Moal S, Haddad F, Merceron S, Lifermann F, Christides C, Argaud L, Hatron P, Amoura Z. Dysfonction myocardique au cours des crises graves de syndrome de fuite capillaire idiopathique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.043] [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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Puéchal X, Pagnoux C, Baron G, Quémeneur T, Néel A, Agard C, Lifermann F, Liozon E, Ruivard M, Godmer P, Limal N, Mékinian A, Papo T, Ruppert AM, Bourgarit-Durand A, Bienvenu B, Geffray L, Terrier B, Groh M, Le Jeunne C, Mouthon L, Ravaud P, Guillevin L. LB0002 Does Adding Azathioprine To Glucocorticoid Induction Increase The Remission Rate and Prevent Relapses in Patients with Systemic Necrotizing Vasculitides without Poor-Prognosis Factors? A Multicenter, Double-Blind Randomized Controlled Trial. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6204] [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: 11/04/2022]
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27
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Avet-Loiseau H, Hulin C, Campion L, Rodon P, Marit G, Attal M, Royer B, Dib M, Voillat L, Bouscary D, Caillot D, Wetterwald M, Pegourie B, Lepeu G, Corront B, Karlin L, Stoppa AM, Fuzibet JG, Delbrel X, Guilhot F, Kolb B, Decaux O, Lamy T, Garderet L, Allangba O, Lifermann F, Anglaret B, Moreau P, Harousseau JL, Facon T. Chromosomal abnormalities are major prognostic factors in elderly patients with multiple myeloma: the intergroupe francophone du myélome experience. J Clin Oncol 2013; 31:2806-9. [PMID: 23796999 DOI: 10.1200/jco.2012.46.2598] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Chromosomal abnormalities, especially t(4;14) and del(17p), are major prognostic factors in patients with multiple myeloma (MM). However, this has been especially demonstrated in patients age < 66 years treated with intensive approaches. The goal of this study was to address this issue in elderly patients treated with conventional-dose chemotherapy. PATIENTS AND METHODS To answer this important question, we retrospectively analyzed a series of 1,890 patients (median age, 72 years; range, 66 to 94 years), including 1,095 with updated data on treatment modalities and survival. RESULTS This large study first showed that the incidence of t(4;14) was not uniform over age, with a marked decrease in the oldest patients. Second, it showed that both t(4;14) and del(17p) retained their prognostic value in elderly patients treated with melphalan and prednisone-based chemotherapy. CONCLUSION t(4;14) and del(17p) are major prognostic factors in elderly patients with MM, both for progression-free and overall survival, indicating that these two abnormalities should be investigated at diagnosis of MM, regardless of age.
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Cohen Aubart F, Arnaud L, Hervier B, Besnard S, Barete S, Graffin B, Lifermann F, Ory JP, Hoang Xuan K, Benameur N, Amoura Z, Haroche J. Efficacité à moyen terme du vémurafénib dans la maladie d’Erdheim–Chester. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Broséus J, Alpermann T, Wulfert M, Florensa Brichs L, Jeromin S, Lippert E, Rozman M, Lifermann F, Grossmann V, Haferlach T, Germing U, Luño E, Girodon F, Schnittger S. Age, JAK2V617F and SF3B1 mutations are the main predicting factors for survival in refractory anaemia with ring sideroblasts and marked thrombocytosis. Leukemia 2013; 27:1826-31. [DOI: 10.1038/leu.2013.120] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/10/2013] [Indexed: 01/05/2023]
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30
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Marie J, Osorio Perez F, Saint Lezer A, Legrain Lifermann V, Lifermann F. [Red lower limb]. Rev Med Interne 2012; 34:123-4. [PMID: 22974482 DOI: 10.1016/j.revmed.2012.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/28/2012] [Indexed: 10/27/2022]
Affiliation(s)
- J Marie
- Service de médecine interne, hôpital de Dax-Côte d'Argent, France
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31
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Haroche J, Arnaud L, Cohen-Aubart F, Ly K, Carmoi T, Besnard S, Lifermann F, Costedoat-Chalumeau N, Cacoub P, Maurier F, Rigolet A, Amoura Z. Maladie d’Erdheim-Chester : suivi d’une cohorte monocentrique de 75 patients. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Gaborieau V, Simon M, Shipley E, Lifermann F, Osorio-Perez F, Lequen L, Delbrel X. Bilan d’altération de l’état général et de syndrome inflammatoire prolongé : rechercher un épaississement de la paroi aortique sur le scanner thoracique injecté. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Raffray L, Le Pellec E, Dieval C, Lifermann F, Longy-Boursier M, Viallard JF, Lequen L, Delbrel X. Manifestations hématologiques du syndrome de Goujerot-Sjögren primitif. Rev Med Interne 2007. [DOI: 10.1016/j.revmed.2007.03.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
UNLABELLED Fascioliasis is a parasitic infection caused by the ingestion of food contaminated with Fasciola hepatica. OBJECTIVE AND DESIGN We report an epidemic of eight cases of fascioliasis in southern France, and describe the clinical features, and the diagnostic and therapeutic tools. RESULTS Our series includes almost every clinical form described, apart from the pseudotumoral form. Early diagnosis relied mainly on serum assays. Among these, counter-electrophoresis was the first to be positive and therefore appears to be the most useful test, including cases where patients are asymptomatic or mildly ill. Patients were treated with the usual dose of triclabendazole, but six of them required a double dose to recover. CONCLUSION The use of 20 mg/kg triclabendazole is safe and efficient for patients with acute fascioliasis when a single dose has failed to cure them.
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Affiliation(s)
- F A Dauchy
- Service de médecine interne C, service du Docteur-Lifermann, centre hospitalier de Dax, boulevard Yves-Du-Manoir, 40100 Dax, France.
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35
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Martin K, Bentaberry F, Dumoulin C, Longy-Boursier M, Lifermann F, Haramburu F, Dehais J, Schaeverbeke T, Bégaud B, Moore N. Neuropathy associated with leflunomide: a case series. Ann Rheum Dis 2005; 64:649-50. [PMID: 15769926 PMCID: PMC1755455 DOI: 10.1136/ard.2004.027193] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Voinchet H, Lifermann F, Barlaud-Lestage V, Grenier N. [Aortic ulcer: an unusual aortitis]. Rev Med Interne 2004; 25:397-9. [PMID: 15110960 DOI: 10.1016/j.revmed.2004.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Accepted: 01/02/2004] [Indexed: 11/22/2022]
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37
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Dauchy FA, Devars D, Lifermann F. [Emphysematous cystitis]. Ann Endocrinol (Paris) 2004; 65:176-8. [PMID: 15247879 DOI: 10.1016/s0003-4266(04)95667-3] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The prevalence of urinary tract infection is high in patients with diabetes mellitus. The presence of gas in the bladder lumen or wall constitute emphysematous cystitis. This disease is usually observed in diabetic patients. Early diagnosis and treatment are important factors for the outcome and absence of after-effects. We report the case of a 85 Year old women who was admitted to the hospital because of a gastrointestinal bleeding and subsequently developed an emphysematous cystitis. We present a comprehensive review of the literature and discuss pathogenesis, diagnosis and treatment of this condition.
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Affiliation(s)
- F A Dauchy
- Service de Médecine Interne C, Centre hospitalier de Dax, 40100 Dax, France
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38
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Marco Bonnet J, Lifermann F, Legrain-Lifermann V, Dauzan Y, Vergier B. [Maculopapular eruption with fluctuating fever]. Ann Dermatol Venereol 2003; 130:215-6. [PMID: 12671590] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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39
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Delbrel X, Lifermann F, Boiron J. Disparition de lesions lytiques sous pamidronate dans le myélome une nouvelle preuve de ('action antitumorale des diphosphonates. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80202-2] [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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Fabre J, Boutinet C, Lifermann F. [Pneumothorax in distomatosis]. Presse Med 2001; 30:1587-8. [PMID: 11732466] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Distomatosis is a parasite infection following ingestion of food contaminated by Fasciola hépatica, the tropism of which is essentially hepatic. The mechanism of this exceptional complication is discussed in two cases of pneumothorax. OBSERVATIONS Two 35 and 60 year-old patients presenting spontaneous pneumothorax during distomatosis, the first revealing the disease, the second suggesting the evolution of a severe form of the disease. The surgical biopsy in the first patient revealed a granulomatous pleuro-pneumopathy rich in giant cells. DISCUSSION Pulmonary manifestations of distomatosis are frequent during the invasive phase. Their immunoallergic origin can be questioned and emphasis should be placed on lesions secondary to aberrant parasite migrations.
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Affiliation(s)
- J Fabre
- Service des Urgences, SMUR, CH de Dax, Bld Yves du Manoir, F40100 Dax
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41
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Bonnet F, Neau D, Viallard JF, Morlat P, Ragnaud JM, Dupon M, Legendre P, Imbert Y, Lifermann F, Le Bras M, Beylot J, Longy-Boursier M. Clinical and laboratory findings of cytomegalovirus infection in 115 hospitalized non-immunocompromised adults. Ann Med Interne (Paris) 2001; 152:227-35. [PMID: 11474369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We report a retrospective study of 115 hospitalized non-immunocompromised adults with proved or presumed diagnosis of cytomegalovirus infection. Clinical symptoms were fever (95%), constitutive symptoms (80%), joint and muscle pain (41%), shivering (32%), abdominal pain (26%), non-productive cough (20%), cutaneous eruption (20%), and diarrhea (10%). Examination found hepatomegaly (25%), splenomegaly (23%), cutaneous rash (20%), adenopathy (19%), pharyngitis (9%), jaundice (3%) or signs of meningeal irritation (1%). Seventeen patients had a gastrointestinal form (hepatitis, jaundice, colitis, antral gastritis or cholecystitis), eight had a pattern of hemopathy, two interstitial pneumonitis, two pericarditis, two immune thrombocytopenic purpura, two a polymyalgia rheumatica-like pattern, one thrombotic thrombocytopenic purpura, one cutaneous vasculitis and one meningoencephalitis. Sixty-four percent of the patients had atypical lymphocytosis. Hepatocellular injury occurred in 90% of the patients. Nineteen of the patients had biological immune abnormalities. Cytomegalovirus infection should be mainly suspected in any patient with persistent fever, isolated or associated with signs of poor specificity, or in some patients with visceral manifestations of initially unknown origin.
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Affiliation(s)
- F Bonnet
- Fédération de Médecine Interne, Maladies Infectieuses et Pathologies Tropicales, Hôpital Saint-André, 33075 Bordeaux Cedex.
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42
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Abstract
Anti-Jo-1 antibody is associated with an overlap syndrome usually described as the association of idiopathic inflammatory myopathy, pulmonary fibrosis and polyarthritis. We report three observations illustrating different aspects of arthropathy associated with anti-Jo-1 antibody. Two patients presented with a deforming and erosive arthritis affecting the hands, periarticular calcifications and dislocation of the interphalangeal (IP) joint of the thumb. The third patient, who had a short disease course, presented only with a mild non-erosive polyarthritis of both hands, metacarpophalangeal joint narrowing and periarticular calcifications. All the patients had interstitial pulmonary syndrome. Only two of them had myositis. An arthropathy characterized by erosive arthritis of the fingers, with dislocation of the IP joint of the thumb and periarticular calcifications, seems to be specifically associated with anti-Jo-1 antibody.
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Affiliation(s)
- X Delbrel
- Service de médecine interne et maladies tropicales, h pital Saint-André, Bordeaux, France.
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43
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Bonnet F, Morlat P, Neau D, Viallard JF, Ragnaud JM, Dupon M, Legendre P, Imbert Y, Lifermann F, Le Bras M, Beylot J, Longy-Boursier M. [Hematologic and immunologic manifestations of primary cytomegalovirus infections in non-immunocompromised hospitalized adults]. Rev Med Interne 2000; 21:586-94. [PMID: 10942974 DOI: 10.1016/s0248-8663(00)80003-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Cytomegalovirus (CMV) infection in non-immunocompromised adults can sometimes induce hematological and immunological disorders that may mislead diagnosis. METHODS Case reports of hospitalized non-immunocompromised adults with positive serology for CMV including the presence of immunoglobulin M or seroconversion were assessed in a retrospective study (1981-1998). We focused on clinical and biological abnormalities showing the role of CMV in disruption of functioning of hematological and immunological systems. RESULTS Among 115 patients, lymphoma-like syndrome with large adenopathies and/or splenomegaly was diagnosed in eight patients, uncovering underlying CMV infection. Lymphoma was accompanied by hematoma in two patients. Three patients presented leg purpura (with thrombotic thrombocytopenic purpura in one case), one patient had cutaneous vasculitis and on other a Still's disease. Blood abnormalities were mononucleosis (64%), anemia (20%), and thrombopenia (25%) often of peripheral or hemolytic origin or due to hypersplenia. Electrophoresis of serum proteins showed an increase in immune globulins in 56% of the cases and monoclonal abnormality in nine cases. Immunological assessment was conducted in 18 patients. At least one abnormality was depicted in ten patients, consisting of either antinuclear, anti-platelet or anti smooth muscle antibodies, cryoglobulinemia, rheumatoid factor, or reduced complement fixation. CONCLUSION Testing for CMV infection can be of value in case of blood or immunological disorders associated with clinical or biological signs. Although hematological disorders occur early, they are rarely severe. Immunological disorders are rarely symptomatic, but often raise issues regarding the potential genesis of immune diseases in at-risk patients.
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Affiliation(s)
- F Bonnet
- Fédération de médecine interne, maladies infectieuses et pathologies tropicales, hôpital Saint-André, Bordeaux, France
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Mercié P, Viallard JF, Faure I, Trimoulet P, Vital A, Lifermann F, Leng B, Pellegrin JL. Hepatitis C virus infection with and without cryoglobulinemia as a case of Churg-Strauss syndrome. J Rheumatol 2000; 27:814-7. [PMID: 10743831] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Chronic hepatitis C virus (HCV) infection may be associated with numerous immune disorders, with vasculitis including polyarteritis nodosa, or with both. Cryoglobulinemia, which is often present, can also be expressed by vasculitis. We describe 2 cases of Churg-Strauss syndrome (CSS) in patients with HCV infection. We found no previous case of CSS accompanying HCV infection in the literature. The current patients were women aged 40 and 66 years. In both cases, a clinical and laboratory pattern suggesting CSS was found before the HCV infection was discovered. One patient had cryoglobulinemia. One patient was successfully treated with interferon (IFN). The other was treated for 18 months with IFN and corticosteroids. Second-line therapy consisting of IFN with ribavirin was successful. The emergence of HCV infection may have led to an induced form of CSS. The relationship among HCV, cryoglobulinemia, and CSS is not clear, but may be similar to that existing between polyarteritis nodosa and hepatitis B virus. These observations suggest that IFN-alpha therapy may be effective against CSS in HCV infected patients with or without cryoglobulinemia.
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Affiliation(s)
- P Mercié
- Clinique de Médecine Interne et Maladies Infectieuses, Hôpital Haut Lévêque, Pessac, France.
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Bonichon N, Lifermann F, Fossats A, Canteloup B, Dauzan Y. [Autoimmune hemolytic anemia disclosing splenic lymphoma with villous lymphocyte]. Presse Med 1997; 26:270. [PMID: 9122126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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46
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Bonnet F, Mercié P, Morlat P, Loiseau H, Lifermann F, Lacoste D, Bernard N, Vital C, Beylot J. [Isolated involvement of the trigeminal nerve of sarcoidosis origin]. Rev Neurol (Paris) 1997; 153:59-61. [PMID: 9296157] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sarcoidosic neurological manifestations are uncommon. Isolated cranial nerve's injury is exceptional. The authors report the case of a 29 year-old woman with a trigeminal nerve tumor. Surgery and anatomopathology led to the diagnosis of sarcoidosic infiltration. No other neurological or extra-neurological localization was found. Cranial fifth nerve injury was observed in 14 cases of the literature. In all cases, trigeminal nerve injury was described as associated with another disease's localization (neurological and/or extra-neurological). This observation seems unusual due to isolated nature of the presentation and complete resolution after surgery. This case illustrated the diagnosis and nosologic difficulties raised by granulomatous lesions, symptomatic or not, in the absence of systemic localization.
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Affiliation(s)
- F Bonnet
- Service de Médecine Interne, Hôpital Saint-André, Bordeaux
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47
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Mayet T, Lacoste D, Morlat P, Lifermann F, Bernard N, Boffa GA, Brun G, Beylot J, De Mascarel A. [Polycythemia secondary to pelvic leiomyosarcoma. Apropos of a case]. Ann Med Interne (Paris) 1995; 146:134-135. [PMID: 7598342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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48
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Bernard N, Lacoste D, Lifermann F, Morlat P, Labouyrie E, Broustet A, Beylot J. [Multiple splenic abscesses in a 42-year-old man. Uncommon manifestation of myeloma]. Ann Med Interne (Paris) 1995; 146:337-338. [PMID: 8526323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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49
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Mayet T, Lifermann F, Puel V, Le Metayer P, Clementy J. [Acute pericardo-myocarditis revealing typhoid fever]. Presse Med 1994; 23:1270. [PMID: 7971864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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50
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Lifermann F, Ellie E, Tabarin A, Julien J, Roger P. [Mental deterioration and hypertension: uncommon manifestation of corticotropin insufficiency and functional carboxymethyl oxidase block]. Rev Med Interne 1994; 15:336-9. [PMID: 8059160 DOI: 10.1016/s0248-8663(05)81441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a new case of muscle contractures associated with adrenocortical deficiency. Outstanding features were the diffusion of the contractures, rhabdomyolysis and an encephalopathy which disappeared with hormonal therapy. Endocrinological investigations revealed a functional carboxymethyl oxidase type II defect which could, in part, explain our patient's neuromuscular symptoms.
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Affiliation(s)
- F Lifermann
- Service de médecine interne, hôpital Saint-André, Bordeaux, France
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