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Pujol P, Yauy K, Coffy A, Duforet-Frebourg N, Gabteni S, Daurès JP, Penault-Llorca FM, Collet L, Thomas F, Turnbull C, Galibert V, Rideau C, You B, Geneviève D, Hughes KS, Philippe N. Predominance of BRCA2 mutation and estrogen receptor-positive breast cancer among BRCA1/2 mutation carriers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 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
551 Background: PARP inhibitor (PARPi) agents can improve progression-free survival of patients with breast cancer (BC) who carry a germline BRCA1 or BRCA2 pathogenic or likely pathogenic variant (gBRCA1/2) in both the metastatic and adjuvant setting. Therefore, we need to redefine the criteria of women and tumor phenotype that should be tested for gBRCA1/2. Methods: We studied the relative distribution of gBRCA1 and gBRCA2 in unselected populations of women with BC and in unaffected individuals. We also analyzed the proportion of estrogen receptor (ER)-positive (ER+) tumors in unselected BC patients with gBRCA1/2.We performed a meta-analysis of studies of unselected BC that analyzed the relative contribution of gBRCA1 versus gBRCA2 and ER+ tumors among gBRCA1/2 carriers. We then performed a meta-analysis of gBRCA1/2 carriage in unaffected individuals, from genome-wide population studies, the gnomAD databank, and case–control studies. Results: The BRCA2 gene was involved in 54% of BC in unselected patients with gBRCA1/2 (n=108,699) and 59% of unaffected individuals (n=238,973) as compared with 38% of gBRCA1/2 family cohorts (n=29,700). The meta-analysis showed that 1.66% (95% CI 1.08-2.54) and 1.71% (95% CI 1.33-2.2) of unselected BC patients carried a gBRCA1 and gBRCA2, respectively. In unaffected individuals, the frequency of heterozygosity for gBRCA1 and gBRCA2 was estimated at 1/434 and 1/288, respectively. Nearly 0.5% of unaffected individuals in the studied populations carried a gBRCA1/2. Carriage of a gBRCA was 2.5% for patients with ER+ tumors (95% CI 1.5-4.1) and 5.7% (95% CI 5.1-6.2) for those with ER- tumors. Overall, 58% of breast tumors occurring in women carrying a gBRCA1/2 were ER+ (n=86,870). Conclusions: This meta-analysis showed that gBRCA2 carriage is predominant in unselected BC and in unaffected individuals. ER+ tumors among women with gBRCA1/2-related BC is predominant and has been underestimated. Because PARPi agents improve progression-free survival with ER+ gBRCA1/2 BC in both the adjuvant and metastatic setting, BC should be considered regardless of ER status for BRCA1/2 screening for therapeutic purposes.
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Affiliation(s)
- Pascal Pujol
- CREEC, UMR IRD 224-CNRS 5290 Université Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | - Frédéric Thomas
- CREEC, UMR IRD 224-CNRS 5290 Université Montpellier, Montpellier, France
| | - Clare Turnbull
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Benoit You
- Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Lyon, France
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2
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Roubille C, Coffy A, Rincheval N, Dougados M, Flipo RM, Daurès JP, Combe B. Ten-year analysis of the risk of severe outcomes related to low-dose glucocorticoids in early rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:3738-3746. [PMID: 33320245 DOI: 10.1093/rheumatology/keaa850] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/14/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To explore the 10-year tolerability profile of glucocorticoids (GC) use in patients with early RA. METHODS Analysis of 10-year outcome from the early arthritis ESPOIR cohort. Patients were stratified in two groups, without or with GC treatment at least once during their follow-up. The primary outcome was a composite of deaths, cardiovascular diseases (CVD), severe infections and fractures. The weighted Cox time-dependent analysis model was used with inverse probability of treatment weighting (IPTW) propensity score method. RESULTS Among the 608 patients [480 women, mean age of 47.5 (12.1) years], 397 (65%) received low-dose GC [median 1.9 mg/day (IQR 0.6-4.2), mean cumulative prednisone dose 8468 mg (8376), mean duration 44.6 months (40.1)]. In univariate analysis, over 95 total events (10 deaths, 18 CVDs, 32 fractures and 35 severe infections), patients taking GC experienced more events (n = 71) than those without GC (n = 24) (P =0.035). Highest cumulative exposure of GC (≥8.4 g) was associated with highest risk of occurrence of the primary outcome (24.3%, P =0.007), CVDs (7.9%, P =0.001) and severe infections (9.9%, P =0.024). The risk of events over time was significantly associated with GC, age, hypertension and ESR. The risk associated with GC treatment increased between the first follow-up visit [hazard ratio (HR) at 1 year = 0.46, 95% CI: 0.23, 0.90] and 10 years (HR = 6.83, 95% CI: 2.29, 20.35). CONCLUSION The 10-year analysis of this prospective early RA cohort supports a dose and time-dependent impact of low-dose GC treatment, with a long-term high risk of severe outcomes. TRIAL REGISTRATION (ClinicalTrials.gov Identifier: NCT03666091).
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Affiliation(s)
- Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Amandine Coffy
- Statistiques, University Institute of Clinical Research EA2415 and Clinique Beausoleil, Montpellier cedex, France
| | - Nathalie Rincheval
- Statistiques, University Institute of Clinical Research EA2415 and Clinique Beausoleil, Montpellier cedex, France.,Rheumatology Department, CHU Montpellier, Montpellier University, Montpellier, France
| | - Maxime Dougados
- Medicine Faculty and Rheumatology B Department, Paris-Descartes University, UPRES-EA 4058; APHP, Cochin Hospital, Paris, France
| | - René-Marc Flipo
- Department of Rheumatology, Roger Salengro Hospital, Lille, France
| | - Jean-Pierre Daurès
- Statistiques, University Institute of Clinical Research EA2415 and Clinique Beausoleil, Montpellier cedex, France
| | - Bernard Combe
- Rheumatology Department, CHU Montpellier, Montpellier University, Montpellier, France
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Mazard T, Cayrefourcq L, Perriard F, Senellart H, Linot B, de la Fouchardière C, Terrebonne E, François E, Obled S, Guimbaud R, Mineur L, Fonck M, Daurès JP, Ychou M, Assenat E, Alix-Panabières C. Clinical Relevance of Viable Circulating Tumor Cells in Patients with Metastatic Colorectal Cancer: The COLOSPOT Prospective Study. Cancers (Basel) 2021; 13:cancers13122966. [PMID: 34199250 PMCID: PMC8231886 DOI: 10.3390/cancers13122966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/21/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary The analysis of circulating tumor cells (CTCs) as a “real-time liquid biopsy” in epithelial tumors for personalized medicine has received tremendous attention over the past years, with important clinical implications. In metastatic colorectal cancer (mCRC), the CellSearch® system has already demonstrated its prognostic value and interest in monitoring treatment response, but the number of recovered CTCs remains low. In this article, we evaluate the early prognostic and predictive value of viable CTCs in patients with mCRC treated with FOLFIRI–bevacizumab with an alternative approach, the functional EPISPOT assay. This study shows that viable CTCs can be detected in patients with mCRC before and during FOLFIRI–bevacizumab treatment and that CTC detection at D28 and the D0–D28 CTC kinetics evaluated with the EPISPOT assay are associated with response to treatment. Abstract Background: Circulating tumor cells (CTCs) allow the real-time monitoring of tumor course and treatment response. This prospective multicenter study evaluates and compares the early predictive value of CTC enumeration with EPISPOT, a functional assay that detects only viable CTCs, and with the CellSearch® system in patients with metastatic colorectal cancer (mCRC). Methods: Treatment-naive patients with mCRC and measurable disease (RECIST criteria 1.1) received FOLFIRI–bevacizumab until progression or unacceptable toxicity. CTCs in peripheral blood were enumerated at D0, D14, D28, D42, and D56 (EPISPOT assay) and at D0 and D28 (CellSearch® system). Progression-free survival (PFS) and overall survival (OS) were assessed with the Kaplan–Meier method and log-rank test. Results: With the EPISPOT assay, at least 1 viable CTC was detected in 21% (D0), 15% (D14), 12% (D28), 10% (D42), and 12% (D56) of 155 patients. PFS and OS were shorter in patients who remained positive, with viable CTCs between D0 and D28 compared with the other patients (PFS = 7.36 vs. 9.43 months, p = 0.0161 and OS = 25.99 vs. 13.83 months, p = 0.0178). The prognostic and predictive values of ≥3 CTCs (CellSearch® system) were confirmed. Conclusions: CTC detection at D28 and the D0–D28 CTC dynamics evaluated with the EPISPOT assay were associated with outcomes and may predict response to treatment.
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Affiliation(s)
- Thibault Mazard
- IRCM, Inserm, University of Montpellier, ICM, 34000 Montpellier, France;
- Department of Medical Oncology, University Medical Center of Montpellier, St. Eloi Hospital, 34295 Montpellier, France;
- Correspondence: (T.M.); (C.A.-P.); Tel.: +33-4-67-61-30-29 (T.M.); +33-4-11-75-99-31 (C.A.-P.); Fax: +33-4-67-61-23-47 (T.M.); +33-4-67-33-52-81 (C.A.-P.)
| | - Laure Cayrefourcq
- Laboratory of Rare Human Circulating Cells, University Medical Center of Montpellier, University of Montpellier, 34093 Montpellier, France;
- CREEC, MIVEGEC, University of Montpellier, CNRS, IRD, 34000 Montpellier, France
| | - Françoise Perriard
- Biostatistiques, Nouvelles Technologies, AESIO Santé, 34394 Montpellier, France; (F.P.); (J.-P.D.)
| | - Hélène Senellart
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, 44800 Saint Herblain, France;
| | - Benjamin Linot
- Department of Oncology, Institut de Cancérologie de l’Ouest, 49100 Nantes-Angers, France;
| | | | - Eric Terrebonne
- Department of Gastroenterology, CHU Haut-Lévêque, 33600 Pessac, France;
| | | | - Stéphane Obled
- Department of Gastroenterology, University of Montpellier-Nîmes, Carémeau Hospital, 30900 Nîmes, France;
| | - Rosine Guimbaud
- Department of Oncology, Toulouse-Rangueil University Hospital, 31059 Toulouse, France;
| | - Laurent Mineur
- Oncology, Radiotherapy, Sainte-Catherine Institut, 84918 Avignon, France;
| | - Marianne Fonck
- Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France;
| | - Jean-Pierre Daurès
- Biostatistiques, Nouvelles Technologies, AESIO Santé, 34394 Montpellier, France; (F.P.); (J.-P.D.)
| | - Marc Ychou
- IRCM, Inserm, University of Montpellier, ICM, 34000 Montpellier, France;
| | - Eric Assenat
- Department of Medical Oncology, University Medical Center of Montpellier, St. Eloi Hospital, 34295 Montpellier, France;
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells, University Medical Center of Montpellier, University of Montpellier, 34093 Montpellier, France;
- CREEC, MIVEGEC, University of Montpellier, CNRS, IRD, 34000 Montpellier, France
- Correspondence: (T.M.); (C.A.-P.); Tel.: +33-4-67-61-30-29 (T.M.); +33-4-11-75-99-31 (C.A.-P.); Fax: +33-4-67-61-23-47 (T.M.); +33-4-67-33-52-81 (C.A.-P.)
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4
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Combe B, Rincheval N, Berenbaum F, Boumier P, Cantagrel A, Dieude P, Dougados M, Fautrel B, Flipo RM, Goupille P, Mariette X, Saraux A, Schaeverbeke T, Sibilia J, Vittecoq O, Daurès JP. Current favourable 10-year outcome of patients with early rheumatoid arthritis: data from the ESPOIR cohort. Rheumatology (Oxford) 2021; 60:5073-5079. [PMID: 33961011 DOI: 10.1093/rheumatology/keab398] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To report the 10-year outcome of an inception cohort of patients with early rheumatoid arthritis (RA), the ESPOIR cohort, and predictors of outcome. METHODS From 2003 to 2005, 813 patients were included if they had early arthritis (< 6 months) with a high probability of RA and had never been prescribed DMARDs. Multivariate analysis was used to evaluate predictors of outcome. RESULTS In total, 521 (64.1%) RA patients were followed up for 10 years; 35 (4.3%) died which appears similar to the French general population. Overall, 480 (92.1%) patients received a DMARD; 174 (33.4%) received at least one biologic DMARD, 13.6% within 2 years. At year 10, 273 (52.4%) patients were in DAS28 remission, 40.1% in sustained remission, 14.1% in drug-free remission, 39.7% in CDAI remission. Half of the patients achieved a HAQ-DI < 0.5. SF-36 physical component and pain were well controlled. Structural progression was weak, with a mean change from baseline in modified Sharp score of 11.0 ± 17.9. Only 34 (6.5%) patients required major joint surgery. A substantial number of patients showed new comorbidities over 10 years. Positivity for ACPA was confirmed as a robust predictor of long-term outcome. CONCLUSIONS We report a very mild 10-year outcome of a large cohort of patients with early RA diagnosed in the early 2000s, which was much better than results for a previous cohort of patients who were recruited in 1993. This current favourable outcome may be related to more intensive care for real-life patients.
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Affiliation(s)
- Bernard Combe
- CHU Montpellier, Montpellier University, Montpellier, France
| | - Nathalie Rincheval
- CHU Montpellier, Montpellier University, Montpellier, France.,Statistiques, University Institute of Clinical Research, Montpellier, France
| | - Francis Berenbaum
- Sorbonne Université, INSERM CRSA, AP-HP Saint Antoine hospital, Paris, France
| | | | | | - Philippe Dieude
- Université de Paris, AP-HP, Hôpital Bichat, DMU Locomotion, UMR 1152, INSERM, Paris, France
| | - Maxime Dougados
- Paris-Descartes University; UPRES-EA 4058; Cochin Hospital, Paris
| | - Bruno Fautrel
- Sorbonne Université APHP, Pierre Louis Institute of Epidemiology and Public Health INSERM UMRS 1136, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France
| | - René-Marc Flipo
- Lille University Hospital, Lille 2 University, Lille, France
| | - Philippe Goupille
- Université de Tours, EA 7501; CHU de Tours, CIC INSERM 1415, Tours, France
| | - Xavier Mariette
- Université Paris-Saclay, AP-HP, Hôpital Bicêtre, INSERM UMR1184, Le Kremlin Bicêtre, France
| | | | | | - Jean Sibilia
- Strasbourg University Hospital, Strasbourg, France
| | - Olivier Vittecoq
- Rheumatology Department & CIC-CRB 1404, Rouen University Hospital, Inserm U1234, Rouen, Normandy, France
| | - Jean-Pierre Daurès
- Statistiques, University Institute of Clinical Research, Montpellier, France
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5
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Winter A, Landais P, Azoulay D, Disabato M, Compagnon P, Antoine C, Jacquelinet C, Daurès JP, Féray C. Should we use liver grafts repeatedly refused by other transplant teams? JHEP Rep 2020; 2:100118. [PMID: 32695966 PMCID: PMC7364172 DOI: 10.1016/j.jhepr.2020.100118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/23/2022] Open
Abstract
Background & Aims In France, liver grafts that have been refused at least 5 times can be “rescued” and allocated to a centre which chooses a recipient from its own waiting list, outside the patient-based allocation framework. We explored whether these “rescued” grafts were associated with worse graft/patient survival, as well as assessing their effect on survival benefit. Methods Among 7,895 candidates, 5,218 were transplanted between 2009 and 2014 (336 centre-allocated). We compared recipient/graft survival between patient allocation and centre allocation, considering a selection bias and the distribution of centre-allocation recipients among the transplant teams. We used a propensity score approach and a weighted Cox model using the inverse probability of treatment weighting method. We also explored the survival benefit associated with centre-allocation grafts. Results There was a significantly higher risk of graft loss/death in the centre allocation group compared to the patient allocation group (hazard ratio 1.13; 95% CI 1.05–1.22). However, this difference was no longer significant for teams that performed more than 7% of the centre-allocation transplantations. Moreover, receiving a centre-allocation graft, compared to remaining on the waiting list and possibly later receiving a patient-allocation graft, did not convey a poorer survival benefit (hazard ratio 0.80; 95% CI 0.60–1.08). Conclusions In centres which transplanted most of the centre-allocation grafts, using grafts repeatedly refused for top-listed candidates was not detrimental. Given the organ shortage, our findings should encourage policy makers to restrict centre-allocation grafts to targeted centres. Lay summary “Centre allocation” (CA) made it possible to save 6 out of 100 available liver grafts that had been refused at least 5 times for use in the top-listed candidates on the national waiting list. In this series, the largest on this topic, we showed that, in centres which transplanted most of the CA grafts, using grafts repeatedly refused for top-listed candidates did not appear to be detrimental. In the context of organ shortage, our results, which could be of interest for any country using this CA strategy, should encourage policy makers to reassess some aspects of graft allocation by restricting CA grafts to targeted centres, fostering the “best” matching between grafts and candidates on the waiting list. Centre allocation (CA) made it possible to save 6 out of 100 liver grafts. 13% higher graft loss/death for CA patients. In transplant centres performing most CA transplants, survival was not impacted.
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Key Words
- CA, centre allocation
- Centre allocation
- DCD, donation after cardiac death
- DQI, donor quality index
- ES, effect size
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- ICU, intensive care unit
- IPTW, inverse probability of treatment weighting
- LT, liver transplantation
- Liver transplantation
- MELD, model for end-stage liver disease
- PA, patient allocation
- Patient allocation
- Patient and graft survival
- Survival benefit
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Affiliation(s)
- Audrey Winter
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, France
- Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
- Medical Imaging & Informatics, Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Corresponding authors. Address: Clinical Research University Institute, EA2415 641, avenue du doyen Gaston GIRAUD, 34093 Montpellier CEDEX 5, France. Tel.: +33 (0)4 11 75 98 42.
| | - Paul Landais
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Paul Brousse, APHP, Villejuif, France
| | - Mara Disabato
- Department of Surgery, Henri Mondor University Hospital, Créteil, France
| | - Philippe Compagnon
- Department of Surgery, Henri Mondor University Hospital, Créteil, France
| | | | | | - Jean-Pierre Daurès
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, France
- Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Cyrille Féray
- Centre Hépato-Biliaire, Hôpital Paul Brousse, APHP, Villejuif, France
- Corresponding authors. Address: Clinical Research University Institute, EA2415 641, avenue du doyen Gaston GIRAUD, 34093 Montpellier CEDEX 5, France. Tel.: +33 (0)4 11 75 98 42.
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Winter A, Féray C, Antoine C, Azoulay D, Daurès JP, Landais P. Matching Graft Quality to Recipient's Disease Severity Based on the Survival Benefit in Liver Transplantation. Sci Rep 2020; 10:4111. [PMID: 32139780 PMCID: PMC7057972 DOI: 10.1038/s41598-020-60973-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/14/2020] [Indexed: 01/04/2023] Open
Abstract
Persistent shortage and heterogeneous quality of liver grafts encourages the optimization of donor-recipient matching in liver transplantation (LT). We explored whether or not there was a survival benefit (SB) of LT according to the quality of grafts assessed by the Donor Quality Index (DQI) and recipients' disease severity, using the Model for End-Stage Liver Disease (MELD) in 8387 French patients wait-listed between 2009 and 2014. SB associated with LT was estimated using the sequential stratification method in different categories of MELD and DQI. For each transplantation, a stratum was created that matched one transplanted patient with all eligible control candidates. Strata were thereafter combined, and a stratified Cox model, adjusted for covariates, was fitted in order to estimate hazard ratios that qualified the SB according to each MELD and DQI sub-group. A significant SB was observed for all MELD and DQI sub-groups, with the exception of high MELD patients transplanted with "high-risk" grafts. More specifically, in decompensated-cirrhosis patients, "high-risk" grafts did not appear to be detrimental in medium MELD patients. Interestingly, in hepatocellular-carcinoma (HCC) patients, a significant SB was found for all MELD-DQI combinations. For MELD exceptions no SB was found. In terms of SB, "low-risk" grafts appeared appropriate for most severe patients (MELD > 30). Conversely, low/medium MELD and HCC patients presented an SB while allocated "high-risk" grafts. Thus, SB based matching rules for LT candidates might improve the survival of the LT population as a whole.
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Affiliation(s)
- Audrey Winter
- University of Montpellier, Department of Biostatistics, UPRES EA2415, Clinical Reasearch University Institute, Montpellier, France. .,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France. .,Department of Radiological Sciences, Medical Imaging & Informatics, University of California, Los Angeles, CA, USA.
| | - Cyrille Féray
- Centre Hépato-Biliaire, INSERM 1193, Paul Brousse Hospital, Villejuif, France
| | | | - Daniel Azoulay
- Centre Hépato-Biliaire, INSERM 1193, Paul Brousse Hospital, Villejuif, France
| | - Jean-Pierre Daurès
- University of Montpellier, Department of Biostatistics, UPRES EA2415, Clinical Reasearch University Institute, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Paul Landais
- University of Montpellier, Department of Biostatistics, UPRES EA2415, Clinical Reasearch University Institute, Montpellier, France
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Mouterde G, Gamon E, Rincheval N, Lukas C, Seror R, Berenbaum F, Dupuy AM, Daien C, Daurès JP, Combe B. Association Between Vitamin D Deficiency and Disease Activity, Disability, and Radiographic Progression in Early Rheumatoid Arthritis: The ESPOIR Cohort. J Rheumatol 2019; 47:1624-1628. [PMID: 31839594 DOI: 10.3899/jrheum.190795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the association of baseline serum level of vitamin D with disease activity, disability, and radiographic damage over the first year in early rheumatoid arthritis (RA). METHODS Among early arthritis patients included in the ESPOIR cohort, patients with early RA were evaluated. Levels of 25-hydroxy vitamin D2 and D3 were measured at baseline. Baseline associations between vitamin D level and 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR), Health Assessment Questionnaire-Disability Index (HAQ-DI), and van der Heijde modified total Sharp score (mTSS) were assessed. Bivariate analysis was used to assess the association between vitamin D level and radiographic progression (mTSS increased by ≥ 1 point) or disability (HAQ-DI ≥ 0.5) over 12 months. Forward stepwise multiple logistic regression was used to evaluate the independent association of baseline variables and outcomes. RESULTS Among 813 patients with early arthritis, data for 645 patients with RA were analyzed. Vitamin D level was < 10 ng/mL (deficiency, group 1), 10-29.9 ng/mL (low level, group 2), and ≥ 30 ng/mL (normal, group 3) for 114 (17.7%), 415 (64.54%), and 114 (17.7%) patients, respectively. At baseline, DAS28-ESR and HAQ-DI were higher with vitamin D deficiency compared with groups 2 and 3 combined (P = 0.007 and P = 0.001, respectively), as was mean mTSS, but not significantly (p = 0.076). On multivariate analysis, baseline vitamin D deficiency was associated with HAQ-DI at 6 months (OR 1.70) and mTSS at 12 months (OR 1.76). CONCLUSION Vitamin D deficiency was associated with more active and severe disease at baseline and may predict disability and radiographic progression over 1 year in early RA patients. [ClinicalTrials.gov: NCT03666091].
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Affiliation(s)
- Gaël Mouterde
- G. Mouterde, MD, E. Gamon, MD, Cedric Lukas, MD, PhD, C. Daien, MD, Bernard Combe, MD, PhD, Rheumatology Department, CHU Montpellier, University of Montpellier, Montpellier;
| | - Etienne Gamon
- G. Mouterde, MD, E. Gamon, MD, Cedric Lukas, MD, PhD, C. Daien, MD, Bernard Combe, MD, PhD, Rheumatology Department, CHU Montpellier, University of Montpellier, Montpellier
| | - Nathalie Rincheval
- N. Rincheval, J.P. Daurès, MD, PhD, Biostatistics, University Institute of Clinical Research, EA 2415, Montpellier
| | - Cédric Lukas
- G. Mouterde, MD, E. Gamon, MD, Cedric Lukas, MD, PhD, C. Daien, MD, Bernard Combe, MD, PhD, Rheumatology Department, CHU Montpellier, University of Montpellier, Montpellier
| | - Raphaele Seror
- R. Seror, MD, PhD, Rheumatology, Hôpital Kremlin Bicêtre, Paris
| | - Francis Berenbaum
- F. Berenbaum, MD, PhD, Sorbonne Université, INSERM, DHU i2B, AP-HP, Hôpital Saint-Antoine, F-75012, Paris
| | - Anne-Marie Dupuy
- A.M. Dupuy, MD, Department of Biochemistry, CHU Montpellier, Montpellier, France
| | - Claire Daien
- G. Mouterde, MD, E. Gamon, MD, Cedric Lukas, MD, PhD, C. Daien, MD, Bernard Combe, MD, PhD, Rheumatology Department, CHU Montpellier, University of Montpellier, Montpellier
| | - Jean-Pierre Daurès
- N. Rincheval, J.P. Daurès, MD, PhD, Biostatistics, University Institute of Clinical Research, EA 2415, Montpellier
| | - Bernard Combe
- G. Mouterde, MD, E. Gamon, MD, Cedric Lukas, MD, PhD, C. Daien, MD, Bernard Combe, MD, PhD, Rheumatology Department, CHU Montpellier, University of Montpellier, Montpellier
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8
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Garrel R, Mazel M, Perriard F, Vinches M, Cayrefourcq L, Guigay J, Digue L, Aubry K, Alfonsi M, Delord JP, Lallemant B, Even C, Daurès JP, Landais P, Cupissol D, Alix-Panabières C. Circulating Tumor Cells as a Prognostic Factor in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: The CIRCUTEC Prospective Study. Clin Chem 2019; 65:1267-1275. [DOI: 10.1373/clinchem.2019.305904] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/01/2019] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
This prospective multicenter study evaluated the prognostic value of circulating tumor cells (CTCs) in relapsing nonoperable or metastatic head and neck squamous cell carcinoma (rHNSCC) treated by chemotherapy and cetuximab.
METHODS
In 65 patients suitable for analyses, peripheral blood was taken at day 0 (D0) D7, and D21 of treatment for CTC detection by CellSearch®, EPISPOT, and flow cytometry (FCM). Progression-free survival (PFS) was assessed with the Kaplan–Meier method and compared with the log-rank test (P < 0.05).
RESULTS
At D0, CTCs were detected with EPISPOT, CellSearch, and FCM in 69% (45/65), 21% (12/58), and 11% (7/61) of patients, respectively. In the patients tested with all 3 methods, EPISPOT identified 92% (36/39), 92% (35/38), and 90% (25/28) of all positive samples at D0, D7, and D21, respectively. Median PFS time was significantly lower in (a) patients with increasing or stable CTC counts (36/54) from D0 to D7 with EPISPOTEGFR (3.9 vs 6.2 months; 95% CI, 5.0–6.9; P = 0.0103) and (b) patients with ≥1 CTC detected with EPISPOT or CellSearch® (37/51) (P = 0.0311), EPISPOT or FCM (38/54) (P = 0.0480), and CellSearch or FCM (11/51) (P = 0.0005) at D7.
CONCLUSIONS
CTCs can be detected before and during chemotherapy in patients with rHNSCC. D0–D7 CTC kinetics evaluated with EPISPOTEGFR are associated with the response to treatment. This study indicates that CTCs can be used as a real-time liquid biopsy to monitor the early response to chemotherapy in rHNSCC.
ClinicalTrials.gov Identifier
NCT02119559
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Affiliation(s)
- Renaud Garrel
- Department of Head Neck Cancer and Laryngology, University Medical Center of Montpellier, Montpellier, France
| | - Martine Mazel
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Center of Montpellier, Montpellier, France
| | - Françoise Perriard
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier, France
| | - Marie Vinches
- Medical Oncology Department, Institute of Cancer of Montpellier, Montpellier, France
| | - Laure Cayrefourcq
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Center of Montpellier, Montpellier, France
| | - Joël Guigay
- Medical Oncology Department, Antoine Lacassagne Cancer Research Center, Nice, France
| | - Laurence Digue
- Department of Medical Oncology, University Medical Center of Bordeaux University Hospital-CHU Bordeaux, Bordeaux, France
| | - Karine Aubry
- Department of Head and Neck Surgery, University Hospital Center of Limoges, Limoges, France
| | - Marc Alfonsi
- Department of Radiation Oncology, Clinique Sainte Catherine, Avignon, France
| | - Jean-Pierre Delord
- Medical Oncology Department, Claudius Regaud Institute Oncopole, Toulouse, France
| | - Benjamin Lallemant
- Department of Head and Neck Surgery, University Hospital Center of Nîmes, Nîmes, France
| | - Caroline Even
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Pierre Daurès
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier, France
| | - Paul Landais
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier, France
| | - Didier Cupissol
- Medical Oncology Department, Institute of Cancer of Montpellier, Montpellier, France
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Center of Montpellier, Montpellier, France
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9
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Winter A, Féray C, Audureau E, Azoulay D, Antoine C, Daurès JP, Landais P. Author Correction: A Donor Quality Index for liver transplantation: development, internal and external validation. Sci Rep 2018; 8:15109. [PMID: 30287895 PMCID: PMC6172196 DOI: 10.1038/s41598-018-30974-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Audrey Winter
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier, France. .,Beau Soleil Clinic, Montpellier, France. .,Department of Radiological Sciences, University of California, Los Angeles, CA, USA.
| | - Cyrille Féray
- Department of Hepatology, Henri Mondor Hospital, Créteil, France
| | - Etienne Audureau
- Department of Public Health, Henri Mondor Hospital, Créteil, France
| | - Daniel Azoulay
- Department of Surgery, Henri Mondor Hospital, Créteil, France
| | | | - Jean-Pierre Daurès
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier, France.,Beau Soleil Clinic, Montpellier, France
| | - Paul Landais
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier, France
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10
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Cartayrade N, Lacombe S, Daurès JP, Chiavassa H, Viala-Trentini M. Valeur discriminante de l’IRM pour le diagnostic des lésions endométriales bégnines et malignes chez les patientes ménopausées atteintes de métrorragies ou d’un épaississement endométrial asymptomatique : pré-étude prospective. Imagerie de la Femme 2018. [DOI: 10.1016/j.femme.2018.07.004] [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: 10/28/2022]
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11
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Winter A, Daurès JP, Landais P. Intention-to-treat survival benefit in liver transplantation: Comments on Lai et al. Hepatology 2018; 67:1638-1639. [PMID: 29272034 DOI: 10.1002/hep.29755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Audrey Winter
- Department of Biostatistics UPRES EA2415, Clinical Research University Institute, Montpellier, France.,Beau Soleil Clinic, Montpellier, France
| | - Jean-Pierre Daurès
- Department of Biostatistics UPRES EA2415, Clinical Research University Institute, Montpellier, France.,Beau Soleil Clinic, Montpellier, France
| | - Paul Landais
- Department of Biostatistics UPRES EA2415, Clinical Research University Institute, Montpellier, France
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12
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Quéré I, Monpeyrou F, Mercier E, Ripart-Neveu S, Tailland ML, Hoffet M, Berlan J, Daurès JP, Marès P, Gris JC. Case-control Study of the Frequency of Thrombophilic Disorders in Couples with Late Foetal Loss and no Thrombotic Antecedent. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614594] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Background: Women with familial thrombophilia have an increased risk of still birth. We postulated that the presence of asymptomatic risk factors for venous thrombosis might be a risk factor for late foetal loss. Methods: We performed a case-control study on the prevalence of heritable thrombophilic defects, of antiphospholipid-related markers and of the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with at least one episode of late unexplained foetal loss and in control women with successful pregnancies. Partners of cases and controls were also studied. Written conclusions of the pathological examination of the placentas, when available, were also reviewed. Results: We found at least one positive biological risk factor for venous thrombosis in 21.1% of the patients and in 3.9% of the controls (p <10–4). In women, the crude odds ratio for still birth associated with any positive biological risk factor for venous thrombosis was 5.5, 95% confidence interval (95%CI) [3.4-9.0]. No difference was found between partners of cases and controls (5.2% and 4.7%). Using conditional logistic regression analysis, 4 adjusted risk factors for still birth remained: protein S deficiency, positive anti β2 glycoprotein I IgG antibodies, positive anticardiolipin IgG antibodies and the factor V Leiden mutation. The C677T mutation in the MTHFR gene was not an individual risk factor but an homozygous genotype was strongly associated with the former 4 risk factors (16.8% of patients vs. 0.9% of controls). In women with such associations, still births always occurred in absence of folic acid supplementation during pregnancy. Available conclusions of pathological analysis of placentas were found to have a very high proportion of “maternal vascular disease of the placenta” in patients with at least one positive risk marker for thromboembolism, specially in case of association with the C677T MTHFR homozygous genotype, compared to patients with negative markers (p <10–4). Conclusions: Late foetal loss, through placenta thrombosis, may sometimes be the consequence of a maternal multifactorial prothrombotic state associating traditional heritable or acquired thrombosis risk factors to conditions predisposing to an acute mild hyperhomocysteinaemia (coexistence of a genetic predisposition with late pregnancy-related increased folate needs).
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13
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Fontaine C, Daurès JP, Landais P. On the censored cost-effectiveness analysis using copula information. BMC Med Res Methodol 2017; 17:27. [PMID: 28202010 PMCID: PMC5312518 DOI: 10.1186/s12874-017-0305-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 02/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background Information and theory beyond copula concepts are essential to understand the dependence relationship between several marginal covariates distributions. In a therapeutic trial data scheme, most of the time, censoring occurs. That could lead to a biased interpretation of the dependence relationship between marginal distributions. Furthermore, it could result in a biased inference of the joint probability distribution function. A particular case is the cost-effectiveness analysis (CEA), which has shown its utility in many medico-economic studies and where censoring often occurs. Methods This paper discusses a copula-based modeling of the joint density and an estimation method of the costs, and quality adjusted life years (QALY) in a cost-effectiveness analysis in case of censoring. This method is not based on any linearity assumption on the inferred variables, but on a punctual estimation obtained from the marginal distributions together with their dependence link. Results Our results show that the proposed methodology keeps only the bias resulting statistical inference and don’t have anymore a bias based on a unverified linearity assumption. An acupuncture study for chronic headache in primary care was used to show the applicability of the method and the obtained ICER keeps in the confidence interval of the standard regression methodology. Conclusion For the cost-effectiveness literature, such a technique without any linearity assumption is a progress since it does not need the specification of a global linear regression model. Hence, the estimation of the a marginal distributions for each therapeutic arm, the concordance measures between these populations and the right copulas families is now sufficient to process to the whole CEA.
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14
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Oudghiri M, Keïta H, Kouamou E, Boutonnet M, Orsini M, Desconclois C, Mandelbrot L, Daurès JP, Stépanian A, Peynaud-Debayle E, de Prost D. Reference values for rotation thromboelastometry (ROTEM®) parameters following non-haemorrhagic deliveries. Correlations with standard haemostasis parameters. Thromb Haemost 2017; 106:176-8. [DOI: 10.1160/th11-02-0058] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 03/05/2011] [Indexed: 11/05/2022]
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15
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Dossat N, Mangé A, Solassol J, Jacot W, Lhermitte L, Maudelonde T, Daurès JP, Molinari N. Comparison of Supervised Classification Methods for Protein Profiling in Cancer Diagnosis. Cancer Inform 2017. [DOI: 10.1177/117693510700300023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A key challenge in clinical proteomics of cancer is the identification of biomarkers that could allow detection, diagnosis and prognosis of the diseases. Recent advances in mass spectrometry and proteomic instrumentations offer unique chance to rapidly identify these markers. These advances pose considerable challenges, similar to those created by microarray-based investigation, for the discovery of pattern of markers from high-dimensional data, specific to each pathologic state (e.g. normal vs cancer). We propose a three-step strategy to select important markers from high-dimensional mass spectrometry data using surface enhanced laser desorption/ionization (SELDI) technology. The first two steps are the selection of the most discriminating biomarkers with a construction of different classifiers. Finally, we compare and validate their performance and robustness using different supervised classification methods such as Support Vector Machine, Linear Discriminant Analysis, Quadratic Discriminant Analysis, Neural Networks, Classification Trees and Boosting Trees. We show that the proposed method is suitable for analysing high-throughput proteomics data and that the combination of logistic regression and Linear Discriminant Analysis outperform other methods tested.
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Affiliation(s)
- Nadège Dossat
- IURC, Department of Biostatistic, Epidemiology and Clinical Research, Montpellier, France
- University of Montpellier I, Montpellier, France
| | - Alain Mangé
- University of Montpellier I, Montpellier, France
- CHU Montpellier, Hôpital Arnaud de Villeneuve, Department of Cellular Biology, Montpellier, France
- INSERM, U540, Montpellier, France
| | - Jérôme Solassol
- University of Montpellier I, Montpellier, France
- CHU Montpellier, Hôpital Arnaud de Villeneuve, Department of Cellular Biology, Montpellier, France
- INSERM, U540, Montpellier, France
| | - William Jacot
- University of Montpellier I, Montpellier, France
- CHU Montpellier, Hôpital Arnaud de Villeneuve, Department of Thoracic Oncology, Montpellier, France
| | - Ludovic Lhermitte
- University of Montpellier I, Montpellier, France
- CHU Montpellier, Hôpital Arnaud de Villeneuve, Department of Cellular Biology, Montpellier, France
- INSERM, U540, Montpellier, France
| | - Thierry Maudelonde
- University of Montpellier I, Montpellier, France
- CHU Montpellier, Hôpital Arnaud de Villeneuve, Department of Cellular Biology, Montpellier, France
- INSERM, U540, Montpellier, France
| | - Jean-Pierre Daurès
- IURC, Department of Biostatistic, Epidemiology and Clinical Research, Montpellier, France
- University of Montpellier I, Montpellier, France
- Chu Nîmes, Hôspital Caremeau, Department of Medical Information, Nîmes, France
| | - Nicolas Molinari
- IURC, Department of Biostatistic, Epidemiology and Clinical Research, Montpellier, France
- University of Montpellier I, Montpellier, France
- Chu Nîmes, Hôspital Caremeau, Department of Medical Information, Nîmes, France
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16
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Winter A, Daurès JP, Landais P. Response to why the donor risk index and Eurotransplant donor risk index may also be applicable in France; reply to Winter et al. and statistical perspective. Liver Int 2017; 37:1573. [PMID: 28940954 DOI: 10.1111/liv.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Audrey Winter
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier University, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Jean-Pierre Daurès
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier University, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Paul Landais
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, Montpellier University, Montpellier, France.,BESPIM Department of Biostatistics & Public Health, Nîmes University Hospital, Nîmes, France
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17
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Winter A, Féray C, Audureau E, Écochard R, Jacquelinet C, Roudot-Thoraval F, Duvoux C, Daurès JP, Landais P. External validation of the Donor Risk Index and the Eurotransplant Donor Risk Index on the French liver transplantation registry. Liver Int 2017; 37:1229-1238. [PMID: 28140515 DOI: 10.1111/liv.13378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/23/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS A major limitation to liver transplantation is organ shortage leading to the use of non-optimal liver grafts. The Donor Risk Index has been validated and recommended to select donors/organs. The Eurotransplant Donor Risk Index was derived from the Donor Risk Index. The objective of our study was to perform an external validation of both Donor Risk Index and Eurotransplant-Donor Risk Index against the French liver transplantation Cristal registry according to recommendations of the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis. METHODS Liver transplantations performed in France between 2009 and 2013 were used to perform the validation study for the Donor Risk Index and the Eurotransplant-Donor Risk Index respectively. We applied on the French data the models used to construct the Donor Risk Index and the Eurotransplant-Donor Risk Index respectively. RESULTS Neither the Donor Risk Index nor the Eurotransplant-Donor Risk Index were validated against this dataset. Discrimination and calibration of these scores were not preserved according to our data. Important donor and candidates differences between our dataset and the Organ Procurement and Transplantation Network or the Eurotransplant datasets may explain why the Donor Risk Index and the Eurotransplant-Donor Risk Index appeared unadapted to the French transplant registry. CONCLUSION Neither of these risk indexes were suitable to optimize the French liver allocation system. Thus, our next step will be to propose a general adaptive model for a Donor Risk Index.
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Affiliation(s)
- Audrey Winter
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Cyrille Féray
- Department of Hepatology, Henri Mondor University Hospital, Créteil, France
| | - Etienne Audureau
- Department of Biostatistics and Public Health, Henri Mondor University Hospital, Créteil, France
| | - René Écochard
- Laboratory Biostatistics-Health, CNRS 5558 - LBBE, Lyon, France
| | | | | | - Christophe Duvoux
- Department of Hepatology, Henri Mondor University Hospital, Créteil, France
| | - Jean-Pierre Daurès
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Paul Landais
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, Montpellier, France.,Department of Biostatistics & Public Health, Nîmes University Hospital, Montpellier, France
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18
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Nguyen TL, Collins GS, Spence J, Fontaine C, Daurès JP, Devereaux PJ, Landais P, Le Manach Y. Magnitude and direction of missing confounders had different consequences on treatment effect estimation in propensity score analysis. J Clin Epidemiol 2017; 87:87-97. [PMID: 28412467 DOI: 10.1016/j.jclinepi.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/12/2016] [Revised: 01/19/2017] [Accepted: 04/04/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Propensity score (PS) analysis allows an unbiased estimate of treatment effects but assumes that all confounders are measured. We assessed the impact of omitting confounders from a PS analysis on clinical decision making. STUDY DESIGN AND SETTING We conducted Monte Carlo simulations on hypothetical observational studies based on virtual populations and on the population from a large randomized trial (CRASH-2). In both series of simulations, PS analysis was conducted with all confounders and with omitted confounders, which were defined to have different strengths of association with the outcome and treatment exposure. After inverse probability of treatment weighting, we calculated the absolute risk differences and numbers needed to treat (NNT). RESULTS In both series of simulations, omitting a confounder that was moderately associated with the outcome and exposure led to negligible bias on the NNT scale. The bias induced by omitting strongly positive confounding variables remained less than 15 patients to treat. Major bias and reversed effects were found only when omitting highly prevalent, strongly negative confounders that were similarly associated with the outcome and exposure with odds ratios greater than 4.00 (or <0.25). This omission was accompanied by a substantial decrease in analysis power. CONCLUSION The omission of strongly negative confounding variables from a PS analysis can lead to incorrect clinical decision making. However, omitting these variables also decreases the analysis power, which may prevent the reporting of significant but misleading effects.
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Affiliation(s)
- Tri-Long Nguyen
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA 2415, Montpellier University, Montpellier, France; Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Canada
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, UK
| | - Jessica Spence
- Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Canada
| | - Charles Fontaine
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA 2415, Montpellier University, Montpellier, France
| | - Jean-Pierre Daurès
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA 2415, Montpellier University, Montpellier, France
| | - Philip J Devereaux
- Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Canada; Department of Medicine, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Paul Landais
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA 2415, Montpellier University, Montpellier, France; Department of Biostatistics, Clinical Research and Medical Informatics, Nîmes University Hospital, Nîmes, France
| | - Yannick Le Manach
- Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Canada.
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Levesque E, Winter A, Noorah Z, Daurès JP, Landais P, Feray C, Azoulay D. Impact of acute-on-chronic liver failure on 90-day mortality following a first liver transplantation. Liver Int 2017; 37:684-693. [PMID: 28052486 DOI: 10.1111/liv.13355] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/10/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND Acute-on-chronic liver failure (ACLF) is associated with a significant short-term mortality rate (23%-74%), depending on the number of organ failures. Some patients present with ACLF at the time of liver transplantation (LT). The aim of this study was to assess whether ACLF was also a prognostic factor after LT and, if applicable, to construct a score that could predict 90-day mortality. METHODS Three hundred and fifty cirrhotic patients, who underwent LT between January 2008 and December 2013, were enrolled. We used ACLF grades according to EASL-CLIF consortium criteria to categorize the cirrhotic patients. A propensity score was applied with an Inverse Probability Treatment Weighting in a Cox model. A predictive score of early mortality after LT was generated. RESULTS One hundred and forty patients (40%) met the criteria for ACLF. The overall mortality rate at 90 days post-transplant was 10.6% (37/350 patients). ACLF at the time of LT (HR: 5.78 [3.42-9.77], P<.001) was an independent predictor of 90-day mortality. Infection occurring during the month before LT, high recipient age and male recipient, the reason for LT and a female donor were also independent risk factors for early mortality. Using these factors, we have proposed a model to predict 90-day mortality after LT. CONCLUSIONS LT is feasible in cirrhotic patients with ACLF. However, we have shown that ACLF is a significant and independent predictor of 90-day mortality. We propose a score that can identify candidate cirrhotic patients in whom LT might be associated with futile LT.
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Affiliation(s)
- Eric Levesque
- Department of Anaesthesia and Surgical Intensive Care - Liver ICU, AP-HP Henri Mondor Hospital, Créteil, France.,INSERM, Unité U955, Créteil, France
| | - Audrey Winter
- UPRES EA 2415 Department of Biostatistics, Clinical Research University Institute, Montpellier University, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Zaid Noorah
- Department of Anaesthesia and Surgical Intensive Care - Liver ICU, AP-HP Henri Mondor Hospital, Créteil, France
| | - Jean-Pierre Daurès
- UPRES EA 2415 Department of Biostatistics, Clinical Research University Institute, Montpellier University, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Paul Landais
- UPRES EA 2415 Department of Biostatistics, Clinical Research University Institute, Montpellier University, Montpellier, France.,Department of Biostatistics, Epidemiology, Public Health and Medical Information, University Hospital, Nîmes, France
| | - Cyrille Feray
- Department of Hepatology, AP-HP Henri Mondor Hospital, Créteil, France
| | - Daniel Azoulay
- INSERM, Unité U955, Créteil, France.,Digestive Surgery and Liver Transplant Unit, AP-HP Henri Mondor Hospital, Créteil, France
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Nguyen TL, Collins GS, Spence J, Daurès JP, Devereaux PJ, Landais P, Le Manach Y. Double-adjustment in propensity score matching analysis: choosing a threshold for considering residual imbalance. BMC Med Res Methodol 2017; 17:78. [PMID: 28454568 PMCID: PMC5408373 DOI: 10.1186/s12874-017-0338-0] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 04/04/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Double-adjustment can be used to remove confounding if imbalance exists after propensity score (PS) matching. However, it is not always possible to include all covariates in adjustment. We aimed to find the optimal imbalance threshold for entering covariates into regression. METHODS We conducted a series of Monte Carlo simulations on virtual populations of 5,000 subjects. We performed PS 1:1 nearest-neighbor matching on each sample. We calculated standardized mean differences across groups to detect any remaining imbalance in the matched samples. We examined 25 thresholds (from 0.01 to 0.25, stepwise 0.01) for considering residual imbalance. The treatment effect was estimated using logistic regression that contained only those covariates considered to be unbalanced by these thresholds. RESULTS We showed that regression adjustment could dramatically remove residual confounding bias when it included all of the covariates with a standardized difference greater than 0.10. The additional benefit was negligible when we also adjusted for covariates with less imbalance. We found that the mean squared error of the estimates was minimized under the same conditions. CONCLUSION If covariate balance is not achieved, we recommend reiterating PS modeling until standardized differences below 0.10 are achieved on most covariates. In case of remaining imbalance, a double adjustment might be worth considering.
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Affiliation(s)
- Tri-Long Nguyen
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, Montpellier University, Montpellier, France
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, Canada
| | - Gary S. Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, UK
| | - Jessica Spence
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, Canada
| | - Jean-Pierre Daurès
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, Montpellier University, Montpellier, France
| | - P. J. Devereaux
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, Canada
- Departments of Medicine, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Paul Landais
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, Montpellier University, Montpellier, France
- Department of Biostatistics, Clinical Research and Medical Informatics, Nîmes University Hospital, Nîmes, France
| | - Yannick Le Manach
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, Canada
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Nguyen TL, Collins GS, Lamy A, Devereaux PJ, Daurès JP, Landais P, Le Manach Y. Simple randomization did not protect against bias in smaller trials. J Clin Epidemiol 2017; 84:105-113. [PMID: 28257927 DOI: 10.1016/j.jclinepi.2017.02.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/26/2017] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES By removing systematic differences across treatment groups, simple randomization is assumed to protect against bias. However, random differences may remain if the sample size is insufficiently large. We sought to determine the minimal sample size required to eliminate random differences, thereby allowing an unbiased estimation of the treatment effect. STUDY DESIGN AND SETTING We reanalyzed two published multicenter, large, and simple trials: the International Stroke Trial (IST) and the Coronary Artery Bypass Grafting (CABG) Off- or On-Pump Revascularization Study (CORONARY). We reiterated 1,000 times the analysis originally reported by the investigators in random samples of varying size. We measured the covariates balance across the treatment arms. We estimated the effect of aspirin and heparin on death or dependency at 30 days after stroke (IST), and the effect of off-pump CABG on a composite primary outcome of death, nonfatal stroke, nonfatal myocardial infarction, or new renal failure requiring dialysis at 30 days (CORONARY). In addition, we conducted a series of Monte Carlo simulations of randomized trials to supplement these analyses. RESULTS Randomization removes random differences between treatment groups when including at least 1,000 participants, thereby resulting in minimal bias in effects estimation. Later, substantial bias is observed. In a short review, we show such an enrollment is achieved in 41.5% of phase 3 trials published in the highest impact medical journals. CONCLUSIONS Conclusions drawn from completely randomized trials enrolling a few participants may not be reliable. In these circumstances, alternatives such as minimization or blocking should be considered for allocating the treatment.
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Affiliation(s)
- Tri-Long Nguyen
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France; Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Perioperative Research Group, Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, United Kingdom
| | - André Lamy
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Perioperative Research Group, Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Philip J Devereaux
- Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Perioperative Research Group, Population Health Research Institute, McMaster University, Hamilton, Canada; Department of Medicine, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jean-Pierre Daurès
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France
| | - Paul Landais
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France; Department of Biostatistics, Clinical Research and Medical Informatics, Nîmes University Hospital, Nîmes, France
| | - Yannick Le Manach
- Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Perioperative Research Group, Population Health Research Institute, McMaster University, Hamilton, Canada.
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Roubille C, Rincheval N, Dougados M, Flipo RM, Daurès JP, Combe B. Seven-year tolerability profile of glucocorticoids use in early rheumatoid arthritis: data from the ESPOIR cohort. Ann Rheum Dis 2017; 76:1797-1802. [DOI: 10.1136/annrheumdis-2016-210135] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/14/2017] [Accepted: 01/21/2017] [Indexed: 01/04/2023]
Abstract
ObjectiveTo explore the 7-year tolerability profile of glucocorticoids (GC) for early rheumatoid arthritis (RA).MethodsWe examined data for 602 patients with RA from the early arthritis Etude et Suivi des POlyarthrites Indifférenciées Récentes (ESPOIR) cohort (<6 months disease duration) stratified into two groups: with or without GC treatment at least once during follow-up (median 7 years (IQR 0.038–7.65)). The main outcome was a composite of death, cardiovascular disease (including myocardial ischaemia, cerebrovascular accident and heart failure), severe infection and fracture.ResultsAmong the 602 patients with RA (476 women (79%), mean age 48±12 years), 386 with GC (64.1%) received low-dose prednisone (mean 3.1±2.9 mg/day for the entire follow-up): 263 started GC during the first 6 months (68%), and the mean duration of total GC treatment was 1057±876 days. As compared with patients without GC (216 (35.9%)), those with GC showed greater use of non-steroidal anti-inflammatory drugs, synthetic and biological disease-modifying antirheumatic drugs and had more active disease disability, higher C reactive protein and anticitrullinated protein antibody levels. Among 65 events (7 deaths, 14 cardiovascular diseases, 19 severe infections and 25 fractures), 44 and 21 occurred in patients with and without GC (p=0.520). Infections were more frequent, although not significantly, in patients with than without GC (p=0.09). On weighted Cox proportional-hazards analysis, with use of propensity score and inverse-probability-of-treatment weighting, and including age, gender, history of hypertension and GC treatment, outcomes did not differ with and without GC (p=0.520; HR=0.889; 95% CI 0.620 to 1.273).ConclusionsThis 7-year analysis of the ESPOIR cohort supports the good safety profile of very low-dose GC for early active RA.
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Bessaoud F, Orsini M, Iborra F, Rebillard X, Faix A, Soulier M, Daurès JP, Trétarre B. [Urinary incontinence and sexual dysfunction after treatment of localized prostate cancer: Results from a population aged less than 65years old]. Bull Cancer 2016; 103:829-840. [PMID: 27692730 DOI: 10.1016/j.bulcan.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION An increasing number of patients with prostate cancer (PC) are diagnosed and treated. The aim of this study was to investigate urinary incontinence (UI) and sexual dysfunction (SD) two years after treatment for localized prostate cancer (PC). METHODS This study followed all cases of localized PC diagnosed between 2008 and 2009 in men aged≤65years old and still alive two years after treatment. In total, 437 men were recruited. Data were collected using a standardized questionnaire and by cross-checking with data from the cancer registry. Descriptive and comparative analyses were performed to evaluate persisting UI and SD at 2years. RESULTS At two years after treatment, UI was persistent in 48.8%; 41.2% had used urinary protections, and 39.2% had used at least 1 pad/day; 55.2% reported financial difficulties for purchasing protective pads. In total, 22.7% did not consult a specialist for UI. SD was persistent in 82.8%; 30.4% did not consult a specialist for SD. SD had a negative impact on the sex life of patients and their partners. After adjustment for cancer stage, prostatectomy was significantly associated with persisting UI and SD at two years. CONCLUSION Two years after treatment, rates of persisting UI and/or SD remain high. Treatment by prostatectomy was significantly associated with an increased risk of persisting adverse effects at two years. The different toxicities between treatments should be presented to patients before initiating therapy in order to encourage the patient to contributed to shared treatment decision-making.
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Affiliation(s)
- Faïza Bessaoud
- Registre des tumeurs de l'Hérault, 208, avenue des apothicaires, 34298 Montpellier, France.
| | - Mattéa Orsini
- Institut universitaire de recherche clinique (IURC), 641, avenue du Doyen-Gaston-Giraud, 34093 Montpellier cedex, France
| | - François Iborra
- Centre hospitalo-universitaire, hôpital Lapeyronie, service d'urologie, 345, rue du Muscadet, 34090 Montpellier, France
| | - Xavier Rebillard
- Clinique Beau-Soleil, service d'urologie, 119, rue de Lodève, 34070 Montpellier, France
| | - Antoine Faix
- Clinique Beau-Soleil, service d'urologie, 119, rue de Lodève, 34070 Montpellier, France
| | - Maryvonne Soulier
- Centre régional de lutte contre le cancer (CRLCC), 208, avenue des Apothicaires, 34298 Montpellier, France
| | - Jean-Pierre Daurès
- Institut universitaire de recherche clinique (IURC), 641, avenue du Doyen-Gaston-Giraud, 34093 Montpellier cedex, France
| | - Brigitte Trétarre
- Registre des tumeurs de l'Hérault, 208, avenue des apothicaires, 34298 Montpellier, France
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Landais P, Chkair S, Chevallier T, Lomma M, Le Manach Y, Daurès JP. Health-Economic Researches in Perioperative Medicine. Curr Anesthesiol Rep 2016. [DOI: 10.1007/s40140-016-0173-6] [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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Corre R, Greillier L, Le Caër H, Audigier-Valette C, Baize N, Bérard H, Falchero L, Monnet I, Dansin E, Vergnenègre A, Marcq M, Decroisette C, Auliac JB, Bota S, Lamy R, Massuti B, Dujon C, Pérol M, Daurès JP, Descourt R, Léna H, Plassot C, Chouaïd C. Use of a Comprehensive Geriatric Assessment for the Management of Elderly Patients With Advanced Non–Small-Cell Lung Cancer: The Phase III Randomized ESOGIA-GFPC-GECP 08-02 Study. J Clin Oncol 2016; 34:1476-83. [DOI: 10.1200/jco.2015.63.5839] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [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 Comprehensive geriatric assessment (CGA) is recommended to assess the vulnerability of elderly patients, but its integration in cancer treatment decision making has never been prospectively evaluated. Here, in elderly patients with advanced non–small-cell lung cancer (NSCLC), we compared a standard strategy of chemotherapy allocation on the basis of performance status (PS) and age with an experimental strategy on the basis of CGA. Patients and Methods In a multicenter, open-label, phase III trial, elderly patients ≥ 70 years old with a PS of 0 to 2 and stage IV NSCLC were randomly assigned between chemotherapy allocation on the basis of PS and age (standard arm: carboplatin-based doublet if PS ≤ 1 and age ≤ 75 years; docetaxel if PS = 2 or age > 75 years) and treatment allocation on the basis of CGA (CGA arm: carboplatin-based doublet for fit patients, docetaxel for vulnerable patients, and best supportive care for frail patients). The primary end point was treatment failure free survival (TFFS). Secondary end points were overall survival (OS), progression-free survival, tolerability, and quality of life. Results Four hundred ninety-four patients were randomly assigned (standard arm, n = 251; CGA arm, n = 243). Median age was 77 years. In the standard and CGA arms, 35.1% and 45.7% of patients received a carboplatin-based doublet, 64.9% and 31.3% received docetaxel, and 0% and 23.0% received best supportive care, respectively. In the standard and CGA arms, median TFFS times were 3.2 and 3.1 months, respectively (hazard ratio, 0.91; 95% CI, 0.76 to 1.1), and median OS times were 6.4 and 6.1 months, respectively (hazard ratio, 0.92; 95% CI, 0.79 to 1.1). Patients in the CGA arm, compared with standard arm patients, experienced significantly less all grade toxicity (85.6% v 93.4%, respectively P = .015) and fewer treatment failures as a result of toxicity (4.8% v 11.8%, respectively; P = .007). Conclusion In elderly patients with advanced NSCLC, treatment allocation on the basis of CGA failed to improve the TFFS or OS but slightly reduced treatment toxicity.
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Affiliation(s)
- Romain Corre
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Laurent Greillier
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Hervé Le Caër
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Clarisse Audigier-Valette
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Nathalie Baize
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Henri Bérard
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Lionel Falchero
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Isabelle Monnet
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Eric Dansin
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Alain Vergnenègre
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Marie Marcq
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Chantal Decroisette
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Jean-Bernard Auliac
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Suzanna Bota
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Régine Lamy
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Bartomeu Massuti
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Cécile Dujon
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Maurice Pérol
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Jean-Pierre Daurès
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Renaud Descourt
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Hervé Léna
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Carine Plassot
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
| | - Christos Chouaïd
- Romain Corre and Hervé Léna, Centre Hospitalier Universitaire de Rennes, Rennes; Laurent Greillier, Université de Médecine, Marseille; Hervé Le Caër, Centre Hospitalier de Draguignan, Draguignan; Clarisse Audigier-Valette, Centre Hospitalier Intercommunal de Toulon; Henri Bérard, Hôpital Inter Armées Sainte-Anne, Toulon; Nathalie Baize, Centre Hospitalier Universitaire d’Angers, Angers; Lionel Falchero, Centre Hospitalier de Villefranche sur Saône, Villefranche sur Saône; Isabelle Monnet and Christos
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Duranton F, Duny Y, Szwarc I, Deleuze S, Rouanet C, Selcer I, Maurice F, Rivory JP, Servel MF, Jover B, Brunet P, Daurès JP, Argilés À. Early changes in body weight and blood pressure are associated with mortality in incident dialysis patients. Clin Kidney J 2016; 9:287-94. [PMID: 26985382 PMCID: PMC4792627 DOI: 10.1093/ckj/sfv153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 09/17/2015] [Accepted: 12/18/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While much research is devoted to identifying novel biomarkers, addressing the prognostic value of routinely measured clinical parameters is of great interest. We studied early blood pressure (BP) and body weight (BW) trajectories in incident haemodialysis patients and their association with all-cause mortality. METHODS In a cohort of 357 incident patients, we obtained all records of BP and BW during the first 90 days on dialysis (over 12 800 observations) and analysed trajectories using penalized B-splines and mixed linear regression models. Baseline comorbidities and all-cause mortality (median follow-up: 2.2 years) were obtained from the French Renal Epidemiology and Information Network (REIN) registry, and the association with mortality was assessed by Cox models adjusting for baseline comorbidities. RESULTS During the initial 90 days on dialysis, there were non-linear decreases in BP and BW, with milder slopes after 15 days [systolic BP (SBP)] or 30 days [diastolic BP (DBP) and BW]. SBP or DBP levels at dialysis initiation and changes in BW occurring in the first month or during the following 2 months were significantly associated with survival. In multivariate models adjusting for baseline comorbidities and prescriptions, higher SBP value and BW slopes were independently associated with a lower risk of mortality. Hazard ratios of mortality and 95% confidence intervals were 0.92 (0.85-0.99) for a 10 mmHg higher SBP and 0.76 (0.66-0.88) for a 1 kg/month higher BW change on Days 30-90. CONCLUSIONS BW loss in the first weeks on dialysis is a strong and independent predictor of mortality. Low BP is also associated with mortality and is probably the consequence of underlying cardiovascular diseases. These early markers appear to be valuable prognostic factors.
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Affiliation(s)
- Flore Duranton
- RD – Néphrologie/EA7288, Université Montpellier, Montpellier, France
| | - Yohan Duny
- EA2415, Institut Universitaire de Recherche Clinique, Université Montpellier, Montpellier, France
| | - Ilan Szwarc
- Néphrologie Dialyse Saint Guilhem, Sète, France
| | | | | | | | | | | | | | - Bernard Jover
- EA7288, UFR Pharmacie, Université Montpellier, Montpellier, France
| | - Philippe Brunet
- Service de Néphrologie, CHU de La Conception, Université Aix – Marseille, Marseille, France
| | - Jean-Pierre Daurès
- EA2415, Institut Universitaire de Recherche Clinique, Université Montpellier, Montpellier, France
| | - Àngel Argilés
- RD – Néphrologie/EA7288, Université Montpellier, Montpellier, France
- Néphrologie Dialyse Saint Guilhem, Sète, France
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Ossima ADN, Belkacemi MC, Daurès JP. Using Adjacent-category Logits Procedure for Estimating Receiver Operating Characteristic Surface. COMMUN STAT-SIMUL C 2016. [DOI: 10.1080/03610918.2013.879888] [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: 10/25/2022]
Affiliation(s)
- Arnaud D. Nze Ossima
- Laboratoire de Biostatistiques, Épidémiologie, et Santé Publique, Institut Universitaire de Recherche Clinique, Université de Montpellier 1, Montpellier, France
| | - Mohamed C. Belkacemi
- Laboratoire de Biostatistiques, Épidémiologie, et Santé Publique, Institut Universitaire de Recherche Clinique, Université de Montpellier 1, Montpellier, France
| | - Jean-Pierre Daurès
- Laboratoire de Biostatistiques, Épidémiologie, et Santé Publique, Institut Universitaire de Recherche Clinique, Université de Montpellier 1, Montpellier, France
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Orsini M, Trétarre B, Daurès JP, Bessaoud F. Individual socioeconomic status and breast cancer diagnostic stages: a French case–control study. Eur J Public Health 2016; 26:445-50. [DOI: 10.1093/eurpub/ckv233] [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] [Indexed: 11/15/2022] Open
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Fourcadier E, Trétarre B, Gras-Aygon C, Ecarnot F, Daurès JP, Bessaoud F. Under-treatment of elderly patients with ovarian cancer: a population based study. BMC Cancer 2015; 15:937. [PMID: 26610814 PMCID: PMC4661945 DOI: 10.1186/s12885-015-1947-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly. The primary objective of this study was to compare treatment of ovarian cancer according to age. METHODS All patients with invasive cancer (n=1151) diagnosed between 1997 and 2011 in the Herault Department of southern France were included. Demographic data (age, area of residence), cancer characteristics (stage, histology, grade) and treatment modality (type, period and location of treatment) were analysed. Univariate and multivariate logistic regression was used to compare treatment by age. RESULTS Ovarian cancer was less treated in elderly compared to younger patients, regardless of the type of treatment. This difference was more pronounced for chemotherapy, and was maximal for surgery followed by chemotherapy (odds ratio (OR) for surgery for patients aged >70 vs those aged <70 years=0.47 [0.24-0.91], OR for chemotherapy, age>70 vs <70=0.30 [0.16-0.55] and OR for surgery plus chemotherapy, age>70 vs <70=0.14 [0.08-0.28]). This effect of age was independent of other variables, including stage and grade. The probability of receiving standard treatment, in accordance with recommendations, was reduced by 50% in elderly patients compared to their younger counterparts. Overall and net survival of elderly patients with standard treatment was similar to those of younger patients treated outside standard treatment. CONCLUSIONS Elderly women with ovarian cancer were therapeutically disadvantaged compared to younger women. Further studies including co morbidities are necessary to refine these results and to improve therapeutic management of elderly patients with ovarian cancer.
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Affiliation(s)
- Elisabeth Fourcadier
- Cancer Registry of Hérault Departement of France - ICM, 208, rue des apothicaires, 34298, Montpellier, Cedex 5, France.
| | - Brigitte Trétarre
- Cancer Registry of Hérault Departement of France - ICM, 208, rue des apothicaires, 34298, Montpellier, Cedex 5, France.
| | - Claudine Gras-Aygon
- Cancer Registry of Hérault Departement of France - ICM, 208, rue des apothicaires, 34298, Montpellier, Cedex 5, France.
| | - Fiona Ecarnot
- Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
| | - Jean-Pierre Daurès
- Cancer Registry of Hérault Departement of France - ICM, 208, rue des apothicaires, 34298, Montpellier, Cedex 5, France.
| | - Faïza Bessaoud
- Cancer Registry of Hérault Departement of France - ICM, 208, rue des apothicaires, 34298, Montpellier, Cedex 5, France.
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Dougados M, Etcheto A, Molto A, Alonso S, Bouvet S, Daurès JP, Landais P, d’Agostino MA, Berenbaum F, Breban M, Claudepierre P, Combe B, Fautrel B, Feydy A, Goupille P, Richette P, Pham T, Roux C, Treluyer JM, Saraux A, van der Heijde D, Wendling D. Clinical presentation of patients suffering from recent onset chronic inflammatory back pain suggestive of spondyloarthritis: The DESIR cohort. Joint Bone Spine 2015; 82:345-51. [DOI: 10.1016/j.jbspin.2015.02.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/04/2015] [Indexed: 01/06/2023]
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Morisot A, Bessaoud F, Landais P, Rébillard X, Trétarre B, Daurès JP. Prostate cancer: net survival and cause-specific survival rates after multiple imputation. BMC Med Res Methodol 2015. [PMID: 26216355 PMCID: PMC4517373 DOI: 10.1186/s12874-015-0048-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Estimations of survival rates are diverse and the choice of the appropriate method depends on the context. Given the increasing interest in multiple imputation methods, we explored the interest of a multiple imputation approach in the estimation of cause-specific survival, when a subset of causes of death was observed. Methods By using European Randomized Study of Screening for Prostate Cancer (ERSPC), 20 multiply imputed datasets were created and analyzed with a Multivariate Imputation by Chained Equation (MICE) algorithm. Then, cause-specific survival was estimated on each dataset with two methods: Kaplan-Meier and competing risks. The two pooled cause-specific survival and confidence intervals were obtained using Rubin’s rules after complementary log-log transformation. Net survival was estimated using Pohar-Perme’s estimator and was compared to pooled cause-specific survival. Finally, a sensitivity analysis was performed to test the robustness of our constructed multiple imputation model. Results Cause-specific survival performed better than net survival, since this latter exceeded 100 % for almost the first 2 years of follow-up and after 9 years whereas the cause-specific survival decreased slowly and than stabilized at around 94 % at 9 years. Sensibility study results were satisfactory. Conclusions On our basis of prostate cancer data, the results obtained by cause-specific survival after multiple imputation appeared to be better and more realistic than those obtained using net survival. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0048-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adeline Morisot
- University of Montpellier, Laboratory of Biostatistics, Epidemiology and Public Health (EA2415), 641, avenue du doyen Gaston Giraud, Montpellier Cedex 5, 34093, France.
| | - Faïza Bessaoud
- Hérault Cancer Registry, 208, rue des Apothicaires, Montpellier Cedex 5, 34298, France
| | - Paul Landais
- University of Montpellier, Laboratory of Biostatistics, Epidemiology and Public Health (EA2415), 641, avenue du doyen Gaston Giraud, Montpellier Cedex 5, 34093, France
| | - Xavier Rébillard
- Department of Urology - BeauSoleil Clinic, 119 avenue de Lodève, Montpellier, 34070, France
| | - Brigitte Trétarre
- Hérault Cancer Registry, 208, rue des Apothicaires, Montpellier Cedex 5, 34298, France
| | - Jean-Pierre Daurès
- University of Montpellier, Laboratory of Biostatistics, Epidemiology and Public Health (EA2415), 641, avenue du doyen Gaston Giraud, Montpellier Cedex 5, 34093, France
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Wang Y, Zhu R, Liu G, Li W, Chen H, Daurès JP, Chiriac AM, Demoly P. Prevalence of uncontrolled allergic rhinitis in Wuhan, China: a prospective cohort study. Am J Rhinol Allergy 2015; 28:397-403. [PMID: 25198026 DOI: 10.2500/ajra.2014.28.4079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is a highly prevalent disease that affects the quality of life, especially in the "severe chronic upper airway disease" (SCUAD) group of patients who still have severe symptoms after adequate treatment. This study investigated the prevalence of uncontrolled AR and SCUAD consulting in the Allergy Department of Tongji Hospital, Wuhan, China. METHODS In this prospective cohort study, all patients consulting for AR were prospectively assessed using visual analog scale (VAS) and Allergic Rhinitis Control Test (ARCT) and put on standardized treatment based on the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines. After 15 days, they were reevaluated by a telephone interview using a numerical scale (NS) and ARCT. A score of ARCT of <20 defined uncontrolled AR and a score of NS of ≥5 at day 15 defined SCUAD patients. RESULTS A total of 252 patients were included. Moderate/severe AR (VAS ≥ 5) was diagnosed in 82.9% of the patients which had an impact on sleep (86.9%), work life (84.9%), social activities (81%), and physical activities (90.1%). Patients with uncontrolled AR (27.7%) at day 15 more frequently presented a higher weight (p = 0.042), history of ear, nose, and throat (ENT) infection or antibiotics intake for respiratory infection in the last 12 months (62.3% versus 45.6%; p = 0.018), smoking (15.9% versus 6.7%; p = 0.024), and smell disturbance (26.1% versus 11.7%; p = 0.005). Patients with SCUAD (24.5%) more frequently presented a history of ENT infection or antibiotics intake for respiratory infection in the last 12 months (63.9% versus 45.7%; p = 0.014) and smell disturbance (27.9% versus 11.7%; p = 0.003), and less commonly had atopic dermatitis (13.1% versus 28.2%; p = 0.017). CONCLUSION Uncontrolled AR and SCUAD patients are numerous. VAS and ARCT are simple and quantitative methods and self-completion questionnaires that can be used for a global evaluation of the severity and control of AR.
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Affiliation(s)
- Youna Wang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Duranton F, Duny Y, Szwarc I, Deleuze S, Rouanet C, Selcer I, Maurice F, Rivory JP, Jover B, Servel MF, Brunet P, Daurès JP, Argilés A. FP699LOW BLOOD PRESSURE AND MARKED WEIGHT LOSS IN INCIDENT DIALYSIS PATIENTS ARE ASSOCIATED WITH HIGH MORTALITY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv183.17] [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: 11/14/2022] Open
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Duranton F, Brunet P, Laville M, Landais P, Daurès JP, Mourad G, Bustins M, Argilés A. Prévention de la maladie rénale chronique en France : intérêt, faisabilité et difficultés. Nephrol Ther 2014; 10:492-9. [DOI: 10.1016/j.nephro.2014.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/15/2014] [Accepted: 06/11/2014] [Indexed: 10/24/2022]
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Mouterde G, Lukas C, Goupille P, Flipo RM, Rincheval N, Daurès JP, Combe B. Association of anticyclic citrullinated peptide antibodies and/or rheumatoid factor status and clinical presentation in early arthritis: results from the ESPOIR cohort. J Rheumatol 2014; 41:1614-22. [PMID: 25028372 DOI: 10.3899/jrheum.130884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the initial clinical, biological, and radiographic findings of early arthritis by positivity for rheumatoid factor (RF) and/or anticyclic citrullinated peptide antibodies (anti-CCP), and to validate a patient profile based on this serologic information. METHODS The ESPOIR cohort comprises patients presenting synovitis of at least 2 joints for 6 weeks to 6 months. Patients underwent testing for IgM rheumatoid factor (IgM-RF) and anti-CCP2 antibodies and were divided into 4 groups: RF- and anti-CCP- (group 1), RF+ and anti-CCP- (group 2), RF- and anti-CCP+ (group 3), RF+ and anti-CCP+ (group 4). We compared the groups in terms of clinical, biological, and radiographic features (baseline scores and 6-month and 12-month progression). RESULTS Of the 813 recruited patients, 406 (50%) were in group 1, 91 (11.2%) in group 2, 34 (4.1%) in group 3, and 281 (34.6%) in group 4. Mean baseline erythrocyte sedimentation rate and C-reactive protein were higher for anti-CCP+ groups (groups 3 and 4) than for other groups (p < 0.001), and van der Heijde-modified Sharp score for radiographs was higher for group 4 than for other groups (p < 0.001). Clinical presentation was not consistently associated with serologic profile. Radiographic progression at 1 year was higher for anti-CCP+ groups than other groups (p < 0.001). CONCLUSION The phenotype of patients with early arthritis with or without anti-CCP and/or RF positivity did not correspond to a particular clinical presentation. However, baseline acute-phase reactants and short-term radiographic progression were high in patients with anti-CCP positivity, which may be associated with the inflammatory process and progressive disease in patients with early arthritis.
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Affiliation(s)
- Gaël Mouterde
- From the Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535, Montpellier; Department of Rheumatology, University Hospital of Tours; and UMR CNRS 7292, François Rabelais University, Tours; Rheumatology Department, Roger Salengro Hospital, Lille 2 University, Lille; and Biostatistics, Epidemiology and Clinical Research Unit, IURC, Montpellier and Nîmes, France.G. Mouterde, MD, Rheumatologist; C. Lukas, MD, PhD, Rheumatologist; Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University; R.M. Flipo, MD, PhD, Rheumatologist, Rheumatology Department, Roger Salengro Hospital, Lille 2 University; P. Goupille, Rheumatologist, MD, PhD; Department of Rheumatology, University Hospital of Tours; UMR CNRS 7292, François Rabelais University; N. Rincheval, MS2Biostatistics, Biostatistician; J.P. Daurès, MD, PhD, Biostatistician, Biostatistics, Epidemiology and Clinical Research Unit, IURC; B. Combe, MD, PhD, Rheumatologist, Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535
| | - Cédric Lukas
- From the Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535, Montpellier; Department of Rheumatology, University Hospital of Tours; and UMR CNRS 7292, François Rabelais University, Tours; Rheumatology Department, Roger Salengro Hospital, Lille 2 University, Lille; and Biostatistics, Epidemiology and Clinical Research Unit, IURC, Montpellier and Nîmes, France.G. Mouterde, MD, Rheumatologist; C. Lukas, MD, PhD, Rheumatologist; Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University; R.M. Flipo, MD, PhD, Rheumatologist, Rheumatology Department, Roger Salengro Hospital, Lille 2 University; P. Goupille, Rheumatologist, MD, PhD; Department of Rheumatology, University Hospital of Tours; UMR CNRS 7292, François Rabelais University; N. Rincheval, MS2Biostatistics, Biostatistician; J.P. Daurès, MD, PhD, Biostatistician, Biostatistics, Epidemiology and Clinical Research Unit, IURC; B. Combe, MD, PhD, Rheumatologist, Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535
| | - Philippe Goupille
- From the Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535, Montpellier; Department of Rheumatology, University Hospital of Tours; and UMR CNRS 7292, François Rabelais University, Tours; Rheumatology Department, Roger Salengro Hospital, Lille 2 University, Lille; and Biostatistics, Epidemiology and Clinical Research Unit, IURC, Montpellier and Nîmes, France.G. Mouterde, MD, Rheumatologist; C. Lukas, MD, PhD, Rheumatologist; Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University; R.M. Flipo, MD, PhD, Rheumatologist, Rheumatology Department, Roger Salengro Hospital, Lille 2 University; P. Goupille, Rheumatologist, MD, PhD; Department of Rheumatology, University Hospital of Tours; UMR CNRS 7292, François Rabelais University; N. Rincheval, MS2Biostatistics, Biostatistician; J.P. Daurès, MD, PhD, Biostatistician, Biostatistics, Epidemiology and Clinical Research Unit, IURC; B. Combe, MD, PhD, Rheumatologist, Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535
| | - René-Marc Flipo
- From the Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535, Montpellier; Department of Rheumatology, University Hospital of Tours; and UMR CNRS 7292, François Rabelais University, Tours; Rheumatology Department, Roger Salengro Hospital, Lille 2 University, Lille; and Biostatistics, Epidemiology and Clinical Research Unit, IURC, Montpellier and Nîmes, France.G. Mouterde, MD, Rheumatologist; C. Lukas, MD, PhD, Rheumatologist; Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University; R.M. Flipo, MD, PhD, Rheumatologist, Rheumatology Department, Roger Salengro Hospital, Lille 2 University; P. Goupille, Rheumatologist, MD, PhD; Department of Rheumatology, University Hospital of Tours; UMR CNRS 7292, François Rabelais University; N. Rincheval, MS2Biostatistics, Biostatistician; J.P. Daurès, MD, PhD, Biostatistician, Biostatistics, Epidemiology and Clinical Research Unit, IURC; B. Combe, MD, PhD, Rheumatologist, Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535
| | - Nathalie Rincheval
- From the Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535, Montpellier; Department of Rheumatology, University Hospital of Tours; and UMR CNRS 7292, François Rabelais University, Tours; Rheumatology Department, Roger Salengro Hospital, Lille 2 University, Lille; and Biostatistics, Epidemiology and Clinical Research Unit, IURC, Montpellier and Nîmes, France.G. Mouterde, MD, Rheumatologist; C. Lukas, MD, PhD, Rheumatologist; Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University; R.M. Flipo, MD, PhD, Rheumatologist, Rheumatology Department, Roger Salengro Hospital, Lille 2 University; P. Goupille, Rheumatologist, MD, PhD; Department of Rheumatology, University Hospital of Tours; UMR CNRS 7292, François Rabelais University; N. Rincheval, MS2Biostatistics, Biostatistician; J.P. Daurès, MD, PhD, Biostatistician, Biostatistics, Epidemiology and Clinical Research Unit, IURC; B. Combe, MD, PhD, Rheumatologist, Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535
| | - Jean-Pierre Daurès
- From the Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535, Montpellier; Department of Rheumatology, University Hospital of Tours; and UMR CNRS 7292, François Rabelais University, Tours; Rheumatology Department, Roger Salengro Hospital, Lille 2 University, Lille; and Biostatistics, Epidemiology and Clinical Research Unit, IURC, Montpellier and Nîmes, France.G. Mouterde, MD, Rheumatologist; C. Lukas, MD, PhD, Rheumatologist; Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University; R.M. Flipo, MD, PhD, Rheumatologist, Rheumatology Department, Roger Salengro Hospital, Lille 2 University; P. Goupille, Rheumatologist, MD, PhD; Department of Rheumatology, University Hospital of Tours; UMR CNRS 7292, François Rabelais University; N. Rincheval, MS2Biostatistics, Biostatistician; J.P. Daurès, MD, PhD, Biostatistician, Biostatistics, Epidemiology and Clinical Research Unit, IURC; B. Combe, MD, PhD, Rheumatologist, Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535
| | - Bernard Combe
- From the Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535, Montpellier; Department of Rheumatology, University Hospital of Tours; and UMR CNRS 7292, François Rabelais University, Tours; Rheumatology Department, Roger Salengro Hospital, Lille 2 University, Lille; and Biostatistics, Epidemiology and Clinical Research Unit, IURC, Montpellier and Nîmes, France.G. Mouterde, MD, Rheumatologist; C. Lukas, MD, PhD, Rheumatologist; Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University; R.M. Flipo, MD, PhD, Rheumatologist, Rheumatology Department, Roger Salengro Hospital, Lille 2 University; P. Goupille, Rheumatologist, MD, PhD; Department of Rheumatology, University Hospital of Tours; UMR CNRS 7292, François Rabelais University; N. Rincheval, MS2Biostatistics, Biostatistician; J.P. Daurès, MD, PhD, Biostatistician, Biostatistics, Epidemiology and Clinical Research Unit, IURC; B. Combe, MD, PhD, Rheumatologist, Rheumatology Department, Lapeyronie Hospital, Montpellier 1 University, UMR 5535.
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Combe B, Logeart I, Belkacemi MC, Dadoun S, Schaeverbeke T, Daurès JP, Dougados M. Comparison of the long-term outcome for patients with rheumatoid arthritis with persistent moderate disease activity or disease remission during the first year after diagnosis: data from the ESPOIR cohort. Ann Rheum Dis 2014; 74:724-9. [DOI: 10.1136/annrheumdis-2013-204178] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Foucher Y, Akl A, Rousseau V, Trébern-Launay K, Lorent M, Kessler M, Ladrière M, Legendre C, Kreis H, Rostaing L, Kamar N, Mourad G, Garrigue V, Morelon E, Buron F, Daurès JP, Soulillou JP, Giral M. An alternative approach to estimate age-related mortality of kidney transplant recipients compared to the general population: results in favor of old-to-old transplantations. Transpl Int 2013; 27:219-25. [DOI: 10.1111/tri.12241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/21/2013] [Accepted: 11/10/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Yohann Foucher
- EA 4275 Biostatistics; Clinical Research and Subjective Measures in Health Sciences; Nantes University; Nantes France
- Institut de Transplantation Urologie Néphrologie (ITUN); Nantes Hospital and University; INSERM 1064; CENTAURE; Nantes France
| | - Ahmed Akl
- Institut de Transplantation Urologie Néphrologie (ITUN); Nantes Hospital and University; INSERM 1064; CENTAURE; Nantes France
- Urology and Nephrology Center; Mansoura Egypt
| | - Vanessa Rousseau
- IURC; Biostatistics Department; Montpellier University; Montpellier France
| | - Katy Trébern-Launay
- EA 4275 Biostatistics; Clinical Research and Subjective Measures in Health Sciences; Nantes University; Nantes France
- Institut de Transplantation Urologie Néphrologie (ITUN); Nantes Hospital and University; INSERM 1064; CENTAURE; Nantes France
| | - Marine Lorent
- EA 4275 Biostatistics; Clinical Research and Subjective Measures in Health Sciences; Nantes University; Nantes France
- Institut de Transplantation Urologie Néphrologie (ITUN); Nantes Hospital and University; INSERM 1064; CENTAURE; Nantes France
| | - Michèle Kessler
- Nephrology and renal transplantation Department; Brabois University Hospital; Nancy France
| | - Marc Ladrière
- Nephrology and renal transplantation Department; Brabois University Hospital; Nancy France
| | | | - Henri Kreis
- University of Paris Descartes & Necker Hospital; AP-HP; Paris France
| | - Lionel Rostaing
- Department of Nephrology, Dialysis, and Organ Transplantation; University Paul Sabatier; Toulouse France
| | - Nassim Kamar
- Department of Nephrology, Dialysis, and Organ Transplantation; University Paul Sabatier; Toulouse France
| | - Georges Mourad
- Nephrology and transplantation department; Montpellier University Hospital; Montpellier France
| | - Valérie Garrigue
- Nephrology and transplantation department; Montpellier University Hospital; Montpellier France
| | - Emmanuel Morelon
- Nephrology and transplantation department; Hospices Civils de Lyon; Lyon University; Lyon France
| | - Fanny Buron
- Nephrology and transplantation department; Hospices Civils de Lyon; Lyon University; Lyon France
| | - Jean-Pierre Daurès
- IURC; Biostatistics Department; Montpellier University; Montpellier France
| | - Jean-Paul Soulillou
- Institut de Transplantation Urologie Néphrologie (ITUN); Nantes Hospital and University; INSERM 1064; CENTAURE; Nantes France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie (ITUN); Nantes Hospital and University; INSERM 1064; CENTAURE; Nantes France
- CIC Biotherapy; CHU de Nantes; Nantes France
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Duranton F, Lundin U, Gayrard N, Mischak H, Aparicio M, Mourad G, Daurès JP, Weinberger KM, Argilés A. Plasma and urinary amino acid metabolomic profiling in patients with different levels of kidney function. Clin J Am Soc Nephrol 2013; 9:37-45. [PMID: 24235289 DOI: 10.2215/cjn.06000613] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with CKD display altered plasma amino acid profiles. This study estimated the association between the estimated GFR and urinary and plasma amino acid profiles in CKD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Urine and plasma samples were taken from 52 patients with different stages of CKD, and plasma samples only were taken from 25 patients on maintenance hemodialysis. Metabolic profiling was performed by liquid chromatography coupled with tandem mass spectrometry after phenylisothiocyanate derivatization. RESULTS Most plasma amino acid concentrations were decreased in hemodialysis patients, whereas proline, citrulline, asparagine, asymmetric dimethylarginine, and hydroxykynurenine levels were increased (P<0.05). Both plasma levels and urinary excretion of citrulline were higher in the group of patients with advanced CKD (CKD stages 2 and 3 versus CKD stages 4 and 5; in plasma: 35.9±16.3 versus 61.8±23.6 µmol/L, P<0.01; in urine: 1.0±1.2 versus 7.1±14.3 µmol/mol creatinine, P<0.001). Plasma asymmetric dimethylarginine levels were higher in advanced CKD (CKD stages 2 and 3, 0.57±0.29; CKD stages 4 and 5, 1.02±0.48, P<0.001), whereas urinary excretion was lower (2.37±0.93 versus 1.51±1.43, P<0.001). Multivariate analyses adjusting on estimated GFR, serum albumin, proteinuria, and other covariates revealed associations between diabetes and plasma citrulline (P=0.02) and between serum sodium and plasma asymmetric dimethylarginine (P=0.03). Plasma tyrosine to phenylalanine and valine to glycine ratios were lower in advanced CKD stages (P<0.01). CONCLUSION CKD patients have altered plasma and urinary amino acid profiles that are not corrected by dialysis. Depending on solutes, elevated plasma levels were associated with increased or decreased urinary excretion, depicting situations of uremic retention (asymmetric dimethylarginine) or systemic overproduction (citrulline). These results give some insight in the CKD-associated modifications of amino acid metabolism, which may help improve their handling.
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Affiliation(s)
- Flore Duranton
- RD Néphrologie, Montpellier, France;, †BIOCRATES Life Sciences AG, Innsbruck, Austria;, ‡Mosaiques Diagnostics and Therapeutics AG, Hannover, Germany;, §Centre Hospitalier Universitaire et Université Bordeaux II, Bordeaux, France;, ‖Néphrologie, Dialyse et Transplantation, Université de Montpellier, Hôpital Lapeyronie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France;, ¶Laboratoire de Recherche en Biostatistique, Epidemiologie et Recherche Clinique, Institut Universitaire de Recherche Clinique, Montpellier, France, *Néphrologie Dialyse St. Guilhem, Sète, France
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Brun-Micaleff E, Coffy A, Rey V, Didelot MN, Combecal J, Doutre S, Daurès JP, Segondy M, Boulle N. Cervical cancer screening by cytology and human papillomavirus testing during pregnancy in French women with poor adhesion to regular cervical screening. J Med Virol 2013; 86:536-45. [PMID: 24114972 DOI: 10.1002/jmv.23764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 07/26/2013] [Indexed: 11/08/2022]
Abstract
In France, cervical screening is opportunistic and approximately 40% of women do not attend regular screening programs. The aim of this study was (1) to assess the prevalence of human papillomavirus (HPV) cervical infection and of cytological abnormalities in a population of young pregnant women with poor adherence to cervical cancer screening and (2) to evaluate the adherence to a screening strategy combining HPV testing and cytology during pregnancy. For this purpose, pregnant women benefited from a cervical smear associated with HPV DNA detection. High-risk HPV types were detected and identified using the HC2 assay and the INNO-LiPA HPV genotyping Extra assay. Two hundred forty-seven women (mean age 26.6 ± 5.1 years) were enrolled. Among them, 76.8% did not attend regular cervical cancer screening programs. High-risk HPV types were detected in 50 (20.2%) samples, HPV 16 being the most frequent (N = 12; 14.5%), with multiple HPV infection in 17 samples (27%). Nine (3.6%) abnormal cervical smears were diagnosed. Follow-up of women with abnormal cytology and/or infection with high-risk HPV was obtained in 29 cases (55.8%), showing 12 persistent high-risk HPV infections. Nine women had colposcopy with a final diagnosis of four normal cervixes, three cervical intraepithelial neoplasia grade 1 and two cervical intraepithelial neoplasia grade 2. Overall, women adherence to the free post-partum follow-up visit was 53.5%. This study suggests that a screening program combining HPV testing with cervical cytology during pregnancy may be one option to target young women with poor adhesion to regular cervical cancer screening.
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Affiliation(s)
- Elisabeth Brun-Micaleff
- Prenatal Care Center (PMI), Montpellier, France; Department of Gynecology and Obstetrics, CHRU de Montpellier, Montpellier, France
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Mahamat A, Daurès JP, de Wzieres B. Additive preventive effect of influenza and pneumococcal vaccines in the elderly: results of a large cohort study. Hum Vaccin Immunother 2013; 9:128-35. [PMID: 23442587 DOI: 10.4161/hv.22550] [Citation(s) in RCA: 31] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Elderly people are at increased risk of influenza and pneumococcal diseases. Influenza increases clinical pneumococcal disease incidence. Pneumococcal vaccination could therefore be a supplement to influenza vaccination. This study evaluated all-cause mortality and antibiotic consumption according to elderly people's influenza and pneumococcal vaccination status. Its goal was to demonstrate that vaccination with both Influenza and pneumococcal vaccines decrease all-cause mortality and antibiotic consumption. From 2004-10-01 to 2004-12-31 (3 mo), elderly people (≥ 65 y) who lived in the Gard department (South of France) were offered both vaccinations. Among the 68,897 subjects followed-up one year after this vaccination campaign, 21,303 (30.9%) were vaccinated with both vaccines, 18,651 (27.1%) with influenza vaccine alone, 3,769 (5.5%) with pneumococcal vaccine alone; 25,174 (36.5%) subjects were unvaccinated. Mortality rate (per 1,000 inhabitants-year) adjusted on gender, age and prior underlying chronic disease was 17.9 (95% CI: 16.3-19.6), 20.8 (19.0-22.8), 22.5 (19.0-26.6) and 24.7 (22.7-26.8), respectively. It was 42.1 (38.8-45.8) in elderly people with underlying chronic disease who received both vaccines vs. 58.1 (53.7-62.9) in unvaccinated elderly people. The decrease in mortality rate was 27.0% (20.0-34.0) in subjects who received both vaccines and 16.0% (6.0-24.0) in those who received influenza vaccine. No significant reduction in mortality rate was seen with the pneumococcal vaccine alone. Influenza and/or pneumococcal vaccinations did not decrease antibiotic consumption that drastically increases during the winter period. An additive effect was observed in the prevention of all-cause mortality with influenza and pneumococcal vaccines given together in elderly people, including in those with underlying chronic disease.
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Affiliation(s)
- Aba Mahamat
- Infectious Diseases and Tropical Medicine Department, Cayenne General Hospital, Cayenne, French Guiana.
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Combe B, Rincheval N, Benessiano J, Berenbaum F, Cantagrel A, Daurès JP, Dougados M, Fardellone P, Fautrel B, Flipo RM, Goupille P, Guillemin F, Le Loët X, Logeart I, Mariette X, Meyer O, Ravaud P, Saraux A, Schaeverbeke T, Sibilia J. Five-year Favorable Outcome of Patients with Early Rheumatoid Arthritis in the 2000s: Data from the ESPOIR Cohort. J Rheumatol 2013; 40:1650-7. [DOI: 10.3899/jrheum.121515] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective.To report the 5-year outcome of a large prospective cohort of patients with very early rheumatoid arthritis (RA), and to identify factors predictive of outcome.Methods.Patients were recruited if they had early arthritis of < 6 months’ duration, had a high probability of developing RA, and had never been prescribed disease-modifying antirheumatic drugs (DMARD) or steroids. Logistic regression analysis was used to determine factors that predict outcome.Results.We included 813 patients from December 2002 to April 2005. Age was 48.1 ± 12.6 years, delay before referral 103.1 ± 52.4 days, 28-joint Disease Activity Score (DAS28) 5.1 ± 1.3, Health Assessment Questionnaire (HAQ) 1.0 ± 0.7; 45.8% and 38.7% had rheumatoid factor or antibodies to cyclic citrullinated peptide (anti-CCP), respectively; 22% had hand or foot erosions; 78.5% fulfilled the American College of Rheumatology/European League Against Rheumatism criteria for RA at baseline and 93.8% during followup. At 5 years, 573 patients were evaluated. The outcome was mild for most patients: disease activity (median DAS28 = 2.5) and HAQ disability (median 0.3) were well controlled over time; 50.6% achieved DAS28 remission and 64.7% low disease activity. Radiographic progression was low (2.9 Sharp unit/year) and only a few patients required joint surgery. Nevertheless, some patients developed new comorbidities. During the 5 years, 82.7% of patients had received at least 1 DMARD (methotrexate, 65.9%), 18.3% a biological DMARD, and about 60% prednisone at least once. Anti-CCP was the best predictor of remaining in the cohort for 5 years, of prescription of synthetic or biologic DMARD, and of radiographic progression.Conclusion.The 5-year outcome of an early RA cohort in the 2000s was described. Anti-CCP was a robust predictor of outcome. The generally good 5-year outcome could be related to early referral and early effective treatment, key processes in the management of early RA in daily practice.
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Denève E, Riethdorf S, Ramos J, Nocca D, Coffy A, Daurès JP, Maudelonde T, Fabre JM, Pantel K, Alix-Panabières C. Capture of viable circulating tumor cells in the liver of colorectal cancer patients. Clin Chem 2013; 59:1384-92. [PMID: 23695297 DOI: 10.1373/clinchem.2013.202846] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence and number of circulating tumor cells (CTCs) in the peripheral blood of colorectal cancer patients are lower than in other cancer types, which may point to a particular biology of colorectal cancer affecting CTC detection. METHODS We detected CTCs in the peripheral and mesenteric blood of colorectal cancer patients by use of 2 independent technologies on the basis of different biological properties of colon cancer cells. Seventy-five patients diagnosed with localized (M0, n = 60) and metastatic (M1, n = 15) colorectal cancer were included. Peripheral and mesenteric blood samples were collected before tumor resection. We performed CTC enumeration with an EpCAM-independent enrichment method followed by the Epispot assay that detected only viable CK19-releasing CTCs. In parallel, we used the FDA-cleared EpCAM-dependent CellSearch® as the reference method. RESULTS The enumeration of CK19-releasing cells by the CK19-Epispot assay revealed viable CTCs in 27 of 41 (65.9%) and 41 of 74 (55.4%) (P = 0.04) patients in mesenteric and peripheral blood, respectively, whereas CellSearch detected CTCs in 19 of 34 (55.9%) and 20 of 69 (29.0%) (P = 0.0046) patients. In mesenteric blood, medians of 4 (range 0-247) and 2.7 CTCs (range 0-286) were found with Epispot and CellSearch (P = 0.2), respectively, whereas in peripheral blood, Epispot and CellSearch detected a median of 1.2 (range 0-92) and 0 CTCs (range 0-147) (P = 0.002). CONCLUSIONS A considerable portion of viable CTCs detectable by the Epispot assay are trapped in the liver as the first filter organ in CRC patients.
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Affiliation(s)
- Eric Denève
- Department of Digestive Surgery, Saint-Eloi Hospital, Montpellier, France
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Duranton F, Rodriguez-Ortiz ME, Duny Y, Rodriguez M, Daurès JP, Argilés A. Vitamin D treatment and mortality in chronic kidney disease: a systematic review and meta-analysis. Am J Nephrol 2013; 37:239-48. [PMID: 23467111 DOI: 10.1159/000346846] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [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: 11/26/2012] [Accepted: 01/07/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Hypovitaminosis D has been associated with an increased cardiovascular mortality in the general population and in patients with chronic kidney disease (CKD). Still, whether prescribing vitamin D reduces the risk of mortality in renal patients remains controversial. METHODS We searched PubMed, ClinicalTrials.gov and the Cochrane Library for long-term longitudinal studies comparing vitamin D compounds (25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and synthetic derivatives) to placebo or no treatment in renal patients, and which evaluated mortality, to perform a meta-analysis. Data concerning study quality, population and effect size were extracted independently by two investigators using predefined forms. RESULTS Fourteen observational studies (194,932 patients) met all eligibility criteria. Most studies were performed in hemodialysis patients and all used calcitriol or synthetic analogues. In a random effects meta-analysis, receiving any vitamin D therapy significantly reduced the risk of all-cause mortality (relative risk 0.73, 95% CI 0.65-0.82). The relative risk of death was 0.72 (95% CI 0.65-0.80) after 3 years of therapy and 0.67 (95% CI 0.45-0.98) after 5 years. In meta-regression, the risk reduction was shown to be greater in patients with higher parathyroid hormone serum levels (p = 0.01). The risk of cardiovascular mortality was also significantly reduced in patients receiving any vitamin D derivative (relative risk 0.63, 95% CI 0.44-0.92). CONCLUSION Therapies with 1,25-dihydroxyvitamin D and analogues are associated with reduced mortality in CKD patients, and particularly in those suffering from secondary hyperparathyroidism. These results, based on observational evidence, are supportive of prescribing vitamin D therapies to CKD patients, while respecting good practice guidelines.
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Affiliation(s)
- Flore Duranton
- RD-Néphrologie, Institut Universitaire de Recherche Clinique, Montpellier, France
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Pujol JL, Plassot C, Mérel JP, Arnaud E, Launay M, Daurès JP, Boulze I. Post-Traumatic Stress Disorder and Health-Related Quality of Life in Patients and Their Significant Others Facing Lung Cancer Diagnosis: Intrusive Thoughts as Key Factors. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/psych.2013.46a1001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Daïen CI, Fabre S, Rittore C, Soler S, Daïen V, Tejedor G, Cadart D, Molinari N, Daurès JP, Jorgensen C, Touitou I. TGF beta1 polymorphisms are candidate predictors of the clinical response to rituximab in rheumatoid arthritis. Joint Bone Spine 2012; 79:471-5. [DOI: 10.1016/j.jbspin.2011.10.007] [Citation(s) in RCA: 25] [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: 07/25/2011] [Accepted: 10/14/2011] [Indexed: 11/26/2022]
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Funakoshi N, Duny Y, Valats JC, Ségalas-Largey F, Flori N, Bismuth M, Daurès JP, Blanc P. Meta-analysis: beta-blockers versus banding ligation for primary prophylaxis of esophageal variceal bleeding. Ann Hepatol 2012; 11:369-83. [PMID: 22481457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To perform an updated meta-analysis comparing β-blockers (BB) with endoscopic variceal banding ligation (EVBL) in the primary prophylaxis of esophageal variceal bleeding. MATERIAL AND METHODS Randomized controlled trials were identified through electronic databases, article reference lists and conference proceedings. Analysis was performed using both fixed-effect and random-effect models. Heterogeneity and publication bias were systematically taken into account. Main outcomes were variceal bleeding rates and all-cause mortality, calculated overall and at 6, 12, 18 and 24 months. RESULTS 19 randomized controlled trials were analyzed including a total of 1,483 patients. Overall bleeding rates were significantly lower for the EVBL group: odds ratio (OR) 2.06, 95% confidence interval (CI) [1.55-2.73], p < 0.0001, without evidence of publication bias. Bleeding rates were also significantly lower at 18 months (OR 2.20, 95% CI [1.04-4.60], P = 0.04), but publication bias was detected. When only high quality trials were taken into account, results for bleeding rates were no longer significant. No significant difference was found for either bleeding-related mortality or for all-cause mortality overall or at 6, 12, 18 or 24 months. BB were associated with more frequent severe adverse events (OR 2.61, 95% CI 1.60-4.40, P < 0.0001) whereas fatal adverse events were more frequent with EVBL (OR 0.14, 95% CI 0.02-0.99, P = 0.05). CONCLUSION EVBL appears to be superior to BB in preventing the first variceal bleed, although this finding may be biased as it was not confirmed by high quality trials. No difference was found for mortality. Current evidence is insufficient to recommend EVBL over BB as first-line therapy.
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Affiliation(s)
- Natalie Funakoshi
- Department of Hepato-gastroenterology B, Hôpital Saint Eloi, Centre Hospitalier Universitaire de Montpellier, France
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Daïen CI, Duny Y, Barnetche T, Daurès JP, Combe B, Morel J. Effect of TNF inhibitors on lipid profile in rheumatoid arthritis: a systematic review with meta-analysis. Ann Rheum Dis 2012; 71:862-8. [PMID: 22267329 DOI: 10.1136/annrheumdis-2011-201148] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease. Lipid changes related to inflammation have been described in RA. Tumour necrosis factor α (TNFα) inhibitor (TNFi) treatment is effective in controlling inflammation and decreasing the number of cardiovascular events. OBJECTIVE To assess the change in lipid levels with TNFi treatment in patients with RA by systematic review and meta-analysis. METHODS A Medline search was performed for articles published up to March 2011. Reports describing values for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), atherogenic index (AI) and apolipoprotein B/A (apoB/A) collected before and after TNFi initiation were included. Data were analysed according to short-, mid- and long-term treatment. Statistical analysis of pre-post data was performed by comprehensive meta-analysis. A random effects model was used when there was evidence of heterogeneity. RESULTS The search retrieved 32 articles, of which 13 prospective before/after studies were analysed. Long-term TNFi treatment was associated with increased levels of HDL (+0.27 mmol/l, p<0.0001) and TC (+0.27 mmol/l, p=0.03), whereas LDL levels and AI remained unchanged. After long-term treatment, TG levels increased (+0.28 mmol/l, p<0.001) and apoB/A decreased (-0.3, p<0.0001). CONCLUSION The presumed cardioprotective effects of TNFi in RA do not seem to be explained by quantitative lipid changes since long-term treatment has no effect on LDL levels or on AI. Increased HDL levels could have some beneficial effects, but this needs to be confirmed by prospective studies with long-term follow-up.
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Affiliation(s)
- Claire Immediato Daïen
- Département de Rhumatologie, Hôpital Lapeyronie, Université de Montpellier 1, Montpellier, France
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Molinier L, Castelli C, Bauvin E, Rebillard X, Soulié M, Daurès JP, Grosclaude P. Cost study of the clinical management of prostate cancer in France: results on the basis of population-based data. Eur J Health Econ 2011; 12:363-371. [PMID: 20549536 DOI: 10.1007/s10198-010-0250-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 04/19/2010] [Indexed: 05/29/2023]
Abstract
Prostate cancer is an important disease in terms of economic implications because of its increasing incidence and health care costs. We assessed the direct costs of the clinical management of prostate cancer in France. A retrospective study based on population-based data was carried out. Eight hundred and seventy-nine cases of prostate cancer diagnosed in five departments were included in a 5-year follow-up study. The economic analysis adopted the health-care payer's perspective and took into account only the direct costs. The mean cost of managing patients was estimated at euro12,731. It is composed of 49 to 82% of initial treatments according to the therapeutic strategy. The follow-up constituted between 3 and 11%, the costs of treatments for side effects between 1 and 3% and the travel cost between 3 and 7%. Cumulative total costs over 5 years for each treatment group showed variation in costs. Costs were highest for patients who were treated with external-beam radiotherapy and lowest for those with watchful waiting. The cost burden of prostate cancer is high and varies according to the treatment type. This study yielded a cost analysis of the different management practices of patients with prostate cancer.
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Dougados M, d'Agostino MA, Benessiano J, Berenbaum F, Breban M, Claudepierre P, Combe B, Dargent-Molina P, Daurès JP, Fautrel B, Feydy A, Goupille P, Leblanc V, Logeart I, Pham T, Richette P, Roux C, Rudwaleit M, Saraux A, Treluyer JM, van der Heijde D, Wendling D. The DESIR cohort: a 10-year follow-up of early inflammatory back pain in France: study design and baseline characteristics of the 708 recruited patients. Joint Bone Spine 2011; 78:598-603. [PMID: 21458351 DOI: 10.1016/j.jbspin.2011.01.013] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/31/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The French Society of Rheumatology has initiated a large national multicenter, longitudinal, prospective follow-up of patients presenting with early inflammatory back pain in order to set up a database to facilitate several investigations on diagnosis, prognosis, epidemiology, pathogenesis and medico-economics in the field of early inflammatory back pain and spondyloarthritis. METHODS Patients were recruited if they had inflammatory back pain of more than 3 months and less than 3 years. Patients will be followed every 6 months during the first 2 years then every year during at least 5years. Apart from information collected on a Case Report Form (demographics, disease activity, severity, co-morbidities, socio-economics, treatments, radiological and MRI evaluation of the spine and the pelvis according to the local investigators, and for some centers bone densitometry and ultrasonography of entheses), the digital X-rays and MRI of the spine and pelvis are stored using a specific software (Carestream) and the biological samples (DNA, RNA, sera, urines) are centralized at the Biological Resources Center (Bichat Hospital). RESULTS The recruitment period of the 708 patients (mean age: 34±9years, female 54%, HLA-B27 positive: 57%) in the 25 centers was 26 months (from December 2007 to April 2010). The modified New York criteria, Amor criteria, ESSG criteria and axial ASAS criteria were fulfilled by 26%, 77%, 76% and 67% of the patients at entry, respectively. A history or current symptoms suggestive of peripheral arthritis, acute anterior uveitis and inflammatory bowel disease were observed in 21%, 9% and 4% of the patients, respectively. The disease was active (BASDAI: 45±20) despite an NSAID intake in 66% of the patients. CONCLUSION This large cohort should facilitate the conduct of researches in different areas (clinical, medico-economics, translational) in order to improve our knowledge on the pathogenesis and natural history of axial spondyloarthritis.
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Affiliation(s)
- Maxime Dougados
- Paris-Descartes University, Medicine Faculty, Rheumatology B Department, Paris 14, France.
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