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Rossignol J, Marzac C, Dellal A, Solary E, Jachiet V, Belfeki N, Slaoui M, Georgin-Lavialle S, Benarroche D, Hermine O, Fain O, Mekinian A. Mutation du gène UBA1 dans l’artérite à cellules géantes. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rohmer J, Bladé J, Cony Makhoul P, Cottin V, Ebbo M, Fain O, Galicier L, Guffroy A, Hamidou M, Hunault-Berger M, Lengline E, Machelart I, Nicolini F, Tavitian S, Rousselot P, Lhomme F, Lefèvre G, Kahn J, Groh M. Caractéristiques cliniques, évolution à long terme et facteurs prédictifs de rechute après arrêt de l’Imatinib au cours de leucémie chronique à éosinophiles associée au réarrangement FIP1L1-PDGFRA : étude rétrospective à propos de 151 patients. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Martin de Frémont G, Hirsch P, Gimenez De Mestral S, Moguelet P, Ditchi Y, Emile J, Senet P, Georgin-Lavialle S, Hanslik T, Maurier F, Adedjouma A, Abisror N, Mahevas T, Malard F, Ades L, Fenaux P, Fain O, Mekinian A. Infiltrat myéloïde clonal identifié par next generation sequencing dans les lésions cutanées associées aux syndromes myélodysplasiques et leucémies myélomonocytaires chroniques. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Richier Q, Jachiet V, Carrat F, Abisror N, Jerome P, Marc G, Placais L, Fayand A, Adedjouma A, Gobert D, Riviere S, Chauchard M, Gatfosse M, Chopin D, Mahévas T, Morgand M, Meynard J, Fain O, Lacombe K, Mekinian A. Efficacité du Tocilizumab dans la COVID-19 modérée à sévère : une cohorte française exposé-non exposé. Rev Med Interne 2021. [PMCID: PMC8192027 DOI: 10.1016/j.revmed.2021.03.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction L’infection par le SARS-CoV-2 peut mener à un syndrome de détresse respiratoire aigu dont la mortalité était estimée à 50 % au début de l’épidémie. Ces formes sévères étant significativement associées à un état d’hyperinflammation, et notamment à un niveau élevé d’interleukine-6, il a été proposé que cibler la voie de signalisation de cette interleukine majoritairement pro-inflammatoire, puisse réduire la mortalité de la COVID-19. Pour autant, un an après le début de la pandémie, la place de ces inhibiteurs, dont le Tocilizumab, un anticorps monoclonal dirigé contre le récepteur de l’interleuline-6, reste à déterminer. Patients et méthodes Cohorte exposé-non exposé en vie réelle, monocentrique et menée à l’hôpital Saint-Antoine, Paris, France, avant la mise en place de l’essai randomisé CORIMUNO-TOCI. Etaient inclus les patients de plus de 18 ans qui présentaient une forme modérée à sévère de COVID-19, selon la définition de l’OMS, et qui nécessitaient une oxygéno-requerance ≥ 4 L/min, associée à un syndrome inflammatoire biologique (CRP > 50 mg/L). Etaient exclus les patients qui portaient des contre-indications au Tocilizumab (antécédent de sigmoïdite ou de diverticulite, une cytolyse hépatique supérieure à 5 N, une allergie connue au Tocilizumab, ou une infection bactérienne active.) Par ailleurs, les patients qui étaient transférés en soins intensifs dans les premières 24 h après l’injection de Tocilizumab étaient exclus de notre étude, puisque ils étaient inclus dans une étude qui évaluait le Tocilizumab en réanimation. Les patients du groupe Tocilizumab recevaient une injection de 8 mg/kg (maximum 800 mg) de Tocilizumab associée aux soins courants et les patients du groupe soins courants ne recevaient que les soins courants. Pour assurer la comparabilité des deux groupes nous avons utilisé le score de propension. Notre critère de jugement principal était le délai de sevrage en oxygène. Les critères de jugement secondaire étaient : le transfert en soins intensifs, le besoin de ventilation mécanique, le décès toutes causes confondues, le décès au dixie jour, la durée d’hospitalisation ainsi que les scores composites intubation ou décès et transfert en soins intensifs ou décès. Résultats Cinquante patients ont été inclus dans le groupe Tocilizumab et 52 patients dans le groupe soins courants. L’âge moyen était de 68,9 ± 2 ans et 71 % des patients étaient des hommes. Les patients du groupe Tocilizumab étaient plus fréquemment diabétique (34 % vs 13 % ; p = 0,02), et avaient un niveau d’oxygène moyen plus élevé (9,1 L/min vs 6,8 L/min ; p = 0,0002). Les patients du groupe Tocilizumab avaient reçu plus de corticoïdes que les patients du groupe soins courants (53 % vs 6 % ; p < 0,0001). Le délai de sevrage en oxygène n’était pas diffèrent dans les deux groupes, 14,1 [IQR 7-19] jours dans le groupe Tocilizumab versus 12,2 [IQR 7,5-14] jours dans le groupe soins courants, hazard ratio ajusté à 1,53 (IC95 % (0,96-2,45) ; p = 0,073). Il n’y avait pas non plus de différence concernant les critères de jugement secondaires. Discussion Dans cet essai, nous rapportons une absence de bénéfice du Tocilizumab dans les formes modérées à sévères de la COVID-19. L’injection de Tocilizumab à la posologie de 8 mg/kg n’améliorait pas le délai de sevrage en oxygène, et ne réduisait pas la nécessité d’intubation, de transfert en soins intensifs ou la mortalité. Cette absence de différence peut être expliquée, en partie, par le fait que les patients du groupe Tocilizumab étaient plus graves (oxygéno-requerance plus élevée) et comorbides (plus fréquemment diabétiques). En revanche, ces patients avaient reçu plus de corticoides qui est aujourd’hui un traitement recommandé dans la prise en charge des patients sous oxygène, atteints de la COVID-19. Notre étude manque aussi de puissance, une récente méta-analyse estimait à 2300 patients (dans chaque bras) le nombre de sujet nécessaire pour mettre en évidence une différence significative si celle-ci existait. Conclusion Un essai randomisé récent qui incluait un nombre de sujet suffisant, en cours de publication, a montré des résultats encourageants, avec une diminution de la mortalité à 28 jours chez les patients traités par Tocilizumab (majoritairement en associations au corticoïdes). Toutefois la question du meilleur moment de l’injection de Tocilizumab chez les patients atteints de COVID-19 reste entière.
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Gerardin C, Salem J, Fain O, Mekinian A. SAPL induit médicamenteux : analyse de 575 cas à partir de la base de données internationale OMS. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Terre A, Johanet C, Alamowitch S, Chasset F, Bornes M, Kayem G, Fain O, Mekinian A. Syndrome des antiphospholipides séronégatif : résultats de la recherche d’antiphospholipides non conventionnels dans une série rétrospective de 391 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zadro Y, Piel-Julian M, Moulis G, Pugnet G, Astudillo L, Depaire M, Oberic L, Fain O, Sailler L. Syndrome abdominal aigu survenant dans un contexte de lymphome : penser à l’angiœdème bradykinique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mekinian A, Cacoub P, Fain O, Saadoun D, Mekinian A, Lorenzo D, Resche-Rigon M, Galli E, Novikov P, Espita O, Sciscia S, Comarmond C, Michaud M, Lambert M, Hernandez Rodriguez J, Scheinlitz Masataka N. Efficacité et tolérance de TNFa et tocilizumab dans la maladie de TAKAYASU : étude multicentrique européenne de 203 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Laurent C, Marjanovic Z, Ricard L, Farge D, Soussan M, Mohty M, Fain O, Mekinian A. Autogreffe de cellules souches hématopoïétiques dans la maladie de Takayasu réfractaire, une série rétrospective du groupe de travail des maladies auto-immunes de la société européenne de greffe de moelle (EBMT). Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vigneron C, Baudel J, Pras-Landre V, Joffre J, Marjot F, Ait-Oufella H, Bige N, Maury E, Guidet B, Fain O, Mekinian A. Transfusion-related acute lung injury (TRALI) après immunoglobulines intraveineuses : étude multicentrique et revue de la littérature. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sotier M, Jachiet V, Fenaux P, Ades L, Fain O, Mekinian A. Prévalence et pronostic des manifestations thrombotiques dans les maladies inflammatoires et auto-immunes associées aux syndromes myélodysplasiques : étude cas-témoins rétrospective multicentrique française. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Charvet E, Mahevas T, Rivière S, Panayotopoulos V, Abisror N, Ghrenassia E, Arrive L, Mekinian A, Fain O. Syndrome d’occlusion paroxystique du canal thoracique : une série de 6 cas. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vieira M, Buffier S, Vautier M, Barète S, Misery L, Goulenok T, Sacré K, Fain O, Gobert D, Bouillet L, Lazaro E, Gerfaud-Valentin M, Jamilloux Y, Sève P, Cacoub P, Comarmond C, Saadoun D. Traitement par apremilast dans la maladie de Behçet: étude observationnelle multicentrique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aitmehdi R, Arnaud L, Frances C, Senet P, Monfort JB, De Risi-Pugliese T, Barbaud A, Cohen-Aubart F, Mathian A, Le Guern V, Costedoat-Chalumeau N, Mékinian A, Fain O, Haroche J, Pha M, Amoura Z, Chasset F. Efficacité et tolérance à long terme du lénalidomide dans le traitement du lupus érythémateux cutané : étude rétrospective multicentrique de 40 patients. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mahevas M, Azzaoui I, Crickx E, Canoui-Poitrine F, Gobert D, Languille L, Limal N, Croisille L, Batteux F, Baloul S, Fain O, Noizat-Pirenne F, Weill J, Reynaud C, Godeau B, Michel M. Efficacité et tolérance du traitement combinant rituximab et belimumab au cours de la thrombopénie immunologique persistante et chronique de l’adulte : résultats d’un essai de phase IIb. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gobert D, Bouillet L, Armengol G, Coppo P, Defendi F, Du-Thanh A, Hardy G, Javaud N, Jeandel PY, Launay D, Panayotopoulos V, Pelletier F, Boccon-Gibod I, Fain O. Angiœdèmes par déficit acquis en C1-inhibiteur : recommandations du CREAK pour le diagnostic et la prise en charge. Rev Med Interne 2020; 41:838-842. [DOI: 10.1016/j.revmed.2020.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
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Mekinian A, Saadoun D, Cacoub P, Fain O. Efficacité d’une combinaison de tocilizumab à la corticothérapie pour l’obtention d’une rémission chez les patients TAKAYASU naïfs de traitement : essai français non contrôlé. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Laurent C, Ricard L, Nguyen Y, Fain O, Mekinian A. Impact du profil triple positif dans le syndrome des antiphospholipides, série rétrospective de 204 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wesner N, Fenaux P, Jachiet V, Ades L, Fain O, Mekinian A. [Behçet's-like syndrome and other dysimmunitary manifestations related to myelodysplastic syndromes with trisomy 8]. Rev Med Interne 2020; 42:170-176. [PMID: 33139078 DOI: 10.1016/j.revmed.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
Myelodysplastic syndromes (MDS) are clonal hematopoietic malignancies which are also characterised by immune dysregulation. The impaired immune response is mainly due to T lymphocytes (CD8 and T regulatory cells) with increased cell apoptosis. MDS could be associated in some cases with various clinical dysimmune features; however, only MDS with trisomy 8 is correlated with particular clinical phenotype. The latter is mainly Behçet's-like disease which includes orogenital aphtosis, skin features and severe ulcerative digestive disease of ileocaecal distribution. Other clinical manifestations, such as arthritis or neutrophilic dermatosis, have been also described in MDS patients with trisomy 8. The dysimmune manifestations, and among them the Behçet's-like disease, do not impact the overall survival or the risk of progression to acute myeloid leukemia. Immunosuppressive and immunomodulatory therapies, and among them TNF-α inhibitors, are usually ineffective to control the dysimmune manifestations. Targeting the underlying clonal disease with specific therapies, such as azacitidine, seems to be the best strategy to control these disorders, even in MDS patients with low-risk disease.
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Bourguiba R, Savey L, Aouba A, Deshayes S, Fain O, Martin-Silva N, Hentgen V, Desdoits A, Grateau G, Giurgea I, Georgin-Lavialle S. [Periodic fever syndrome associated with mutations in the TNF type 1 receptor gene: A differential diagnosis of familial Mediterranean fever that should not be overlooked in patients of Mediterranean origin]. Rev Med Interne 2020; 42:459-464. [PMID: 33131906 DOI: 10.1016/j.revmed.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Tumor Necrosis Factor Type 1 Receptor Associated Periodic Syndrome (TRAPS) is a rare autosomal dominant autosomal autoinflammatory disease associated with mutations in the TNF type 1 receptor gene (TNFRSF1A). It is characterized by relatively long recurrent febrile seizures with an average duration of 7 days accompanied by arthralgia, myalgia, and usually a rash. In a patient of Mediterranean origin with recurrent fever, familial Mediterranean fever is the first diagnosis to be suspected by argument of frequency. METHODS A retrospective observational study was conducted on patients from Mediterranean origin followed for TRAPS and included in the "Juvenile Inflammatory Rheumatism" (JIR) observational cohort in the national French autoinflammatory center. The age of onset of symptoms, age of diagnosis, number of years of wandering and treatments received were collected for each index case. RESULTS Nine patients from 6 families of Mediterranean origin were included. A molecular diagnosis confirmed TRAPS in all patients. The median age at diagnosis was 26 years, the mean number of years of wandering was 17 years. The diagnosis of FMF was made first in all patients. AA amyloidosis revealed TRAPS in 2 patients. Colchicine was started without any efficacy in all cases. Five patients were treated with interleukin-1 inhibitory biotherapy with 100% efficacy. CONCLUSION In a patient of Mediterranean origin presenting with recurrent febrile abdominal pain of AA amyloidosis, the first diagnosis to be suspected is FMF. Long relapses, dominant transmission, a non-Mediterranean relative, and the ineffectiveness of colchicine should evoke TRAPS.
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Mekinian A, Pouchot J, Zenone T, Fain O. Syndrome de Cogan. Rev Med Interne 2020; 42:269-274. [PMID: 32773166 DOI: 10.1016/j.revmed.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/23/2020] [Accepted: 07/05/2020] [Indexed: 11/18/2022]
Abstract
"Typical" Cogan's syndrome is defined as a non-syphilitic interstitial keratitis associated with audio-vestibular resembling Ménière's disease with a 2-year maximum delay between these 2 organ impairment. Cogan syndrome is classified as "atypical" in the absence of interstitial keratitis and the presence of other inflammatory eye manifestations, an audio-vestibular impairment different from typical Menière-like disease, or a delay longer than 2 years between eye and audio-vestibular manifestations. Constitutional signs and large-vessel vasculitis is also possible, mostly affecting the thoracic aorta. The presence of acute-phase reactants is common, but no specific laboratory tests are available. The prognosis is dominated by the audio-vestibular impairment and in particular the risk of deafness, while other complications especially vascular complications being rare. Treatment with glucocorticoids is usually necessary and the combination to other immunosuppressive therapies or biological-targeted drugs needs to be determined.
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Laurent C, Marjanovic Z, Henes J, Farge D, Badoglio M, Snowden J, Fain O, Alexander T, Oliveira MC, Mekinian A. THU0312 AUTOLOGOUS NON-MYELOABLATIVE HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR REFRACTORY TAKAYASU ARTERITIS: A RETROSPECTIVE MULTICENTRE CASE-SERIES FROM THE AUTOIMMUNE DISEASES WORKING PARTY (ADWP) OF THE EUROPEAN SOCIETY FOR BLOOD AND MARROW TRANSPLANTATION (EBMT). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Takayasu arteritis (TAK) is a chronic granulomatous large-vessel vasculitis, characterized by arterial thickening and fibrosis leading to stenosis and vascular occlusions. More than 10-20% of patients are refractory to conventional immunosuppressive therapy. Autologous hematopoietic stem cell transplantation (AHSCT) has emerged as a promising treatment option in severely affected and refractory patients with various autoimmune diseases and vasculitis, particularly ANCA-positive vasculitis and Behçet’s disease.Objectives:This study,approved by the ADWP, aims to evaluate the use and outcome of AHSCT in adult TAK patients.Methods:This is a retrospective survey of patients reported to the EBMT registry between 1998 and 2019, who received AHSCT primarily for TAK. Clinical and laboratory data, including data on diagnosis, previous lines of therapy, transplant regimen, treatment-related mortality, as well as data regarding course of disease and treatment were recorded.Results:Data from six adult patients treated with AHSCT between 2003 and 2019 for refractory Takayasu have been identified. Median (ranges) follow-up was 9.9 (1-14) years. Five patients were female (83%), median age was 25 (9-39) years at diagnosis and 28 (22-41) years at HSCT. All patients were pretreated with a median of 6 (4-8) lines of therapy, including systemic steroids (6 patients), methotrexate (5 patients), cyclophosphamide, mycophenolate mofetil or infliximab (4 patients), tocilizumab or etanercept (2 patients), and other biologic or conventional-synthetic DMARDs. Conditioning included cyclophosphamide and rabbit anti-thymocyte globulin in all patients. At six months post-transplantation, remission was obtained in all cases, which persisted at 12 months in 5 cases. Four patients reactivated TAK at a median time of 27 (7-52) months after AHSCT, and 3 resumed disease-modifying therapy. At last follow-up, all patients were alive, 2 patients were in remission (off-therapy), 2 patients improved compared to baseline, and 2 patients were in complete and partial remission, respectively, under immunosuppressive treatment.Conclusion:This small retrospective series demonstrates that AHSCT has the potential to provide significant clinical responses in TAK patients who had been unresponsive to previous immunosuppressive therapy, with an acceptable safety profile.Acknowledgments:noDisclosure of Interests:CHARLOTTE LAURENT: None declared, ZORA MARJANOVIC: None declared, Jörg Henes Grant/research support from: Novartis, Roche-Chugai, Consultant of: Novartis, Roche, Celgene, Pfizer, Abbvie, Sanofi, Boehringer-Ingelheim,, DOMNIQUE FARGE: None declared, MANUELA BADOGLIO: None declared, John SNOWDEN: None declared, olivier fain: None declared, Tobias Alexander: None declared, Maria Carolina Oliveira: None declared, Arsene Mekinian: None declared
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Ricard L, Hirsch P, Mohty M, Fain O, Gaugler B, Rossignol J, Delhommeau F, Mekinian A. AB0161 CLONAL HEMATOPOIESIS IS INCREASED AND NOT RELATED TO AGING IN SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis, microangiopathy and immune dysfunctions including dysregulation of proinflammatory cytokines. Clonal hematopoiesis of indeterminate potential (CHIP) is defined by the acquisition of somatic mutations in hematopoietic stem cells leading to detectable clones in the blood. Recent data have shown a higher risk of cardiovascular disease in patients with CHIP resulting from increased production of proinflammatory cytokines and accelerated atherosclerosis. Eventual links between CHIP and autoimmune diseases are undetermined.Objectives:The aim of our study was to evaluate the prevalence of CHIP in SSc patients and its association with clinical phenotype.Methods:Forty-one genes frequently mutated in myeloid malignancies were sequenced in peripheral blood mononuclear cells from 90 SSc patients and from 44 healthy donors.Results:A total of 15 somatic variants was detected in 13/90 SSc patients (14%) and 4 somatic variants in 4/44 (9%) HD (p=0.58). The prevalence of CHIP was significantly higher in younger SSc patients than in HD: 25% (6/24) vs 4% (1/26) (p=0.045) under 50 years and 17% (7/42) vs 3% (1/38) (p=0.065) under 60 years. The prevalence of CHIP in patients over 70 years was similar in SSc patients and healthy donorsFor SSc patients the most common mutations occurred inDNMT3A(7 variants). Other variants involvedATM,SF3B1, SETBP1, TET2,TP53,NF1orCBL. The distribution of gene mutations was overall comparable in SSc patients and in previously described CHIP series (3)In most SSc patients, we identified a single CHIP mutation. Several mutations were detected in two SSc patients:SETBP1andNF1in one and,TET2andATMin the other Clonal mutations included missense (n=10), nonsense (n=3), frameshift (n=1) and a single splice site mutation. In all HD we detected a single CHIP mutation which occurred inDNMT3A, TP53 and CSF3RVariant allele frequencies (VAF) of CHIP mutations ranged from 2 to 18.6% and did not differ between genes (DNMT3Aor others). Mean age was the same in patients withDNMT3Amutations or with other mutations. However, C>T transversions, that have been associated with ageing were more frequent inDNMT3Avariants than in other genes, suggesting distinct mechanisms for mutation acquisition or clonal selection No major differences in clinical and laboratory data were observed between SSc patients with or without CHIP. SSc subtypes, disease duration, different organ involvements and the prevalence of ischemic events were not associated with the presence of CHIP, except less frequent pyrosis in patients with CHIP than those without. SSc patients with CHIP had significantly more anti-RNA polymerase III antibodies than those without CHIP (p=0.045) At the time of analysis, 45 SSc patients had received a treatment for SSc which consisted in low-dose steroids, hydroxychloroquine, mycophenolate mofetil, cyclophosphamide or methotrexate. SSc patients with CHIP were significantly more exposed to cyclophosphamide (3/13 vs. 3/77) (p=0.04) (5, 6.5 and 11 gram respectively between 5 years to 8 years before the NGS sequencing analysis), but among these cyclophosphamide-exposed SSc the age was over 65 in 2/3 of them. When considering all immunosuppressive drugs (cyclophosphamide, methotrexate and mycophenolate mofetil) SSc patients with CHIP were not more exposed than those without CHIP (p=0.75) No patient developed any hematologic malignancy and no cytopenia during the median follow-up of 13 months (0-24 months). One SSc patients with CHIP developed a small lung cancer few months after NGS testing.Conclusion:Whether CHIP increases the risk to develop SSc or is a consequence of a SSc-derived modified bone marrow micro-environment remains to be explored.Acknowledgments:naDisclosure of Interests:None declared
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Roupie A, Terrier B, Fenaux P, Fain O, Mekinian A. FRI0211 VASCULITIS ASSOCIATED WITH MYELODYSPLASTIC SYNDROME AND CHRONIC MYELOMONOCYTIC LEUKEMIA: FRENCH MULTICENTER CASE CONTROL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Myelodysplastic syndromes (MDS) and MDS/myeloproliferative neoplasms (MDS/MPN) can be associated with vasculitis.Objectives:In this nationwide study by the “French Network of dysimmune disorders associated with hemopathies” (MINHEMON) the objective was to evaluate characteristics, treatment and outcome of vasculitis MDS-MDS/MPN.Methods:Retrospective analysis of patients that presented a MDS/MPN associated with vasculitis and compared the overall survival and acute leukemia with MDS without vasculitis.Results:Seventy patients with vasculitis and MDS/MPN were included, with a median age of 71.5 [21-90] years and male/female ratio of 2.3. Vasculitis was diagnosed prior to MDS/MPN in 31 patients (44.3%), with a median time of 27 months [1-120] between two diagnosis, and after in 20 patients (6 months [1-59]). In comparison to 183 MDS/MPN without dysimmune features showed no difference in MDS/MPN subtypes distribution nor median IPSS/CPSS scores in patients with and without vasculitis. The vasculitis subtypes was giant-cell arteritis (GCA) in 24 patients (34%). Eleven patients (20%) had Behçet’s-like syndrome and 6 patients (9%) presented with polyarteritis nodosa. Steroids (60 mg/day [0-500] of prednisone equivalent) were used as first-line therapy for MDS/MPN vasculitis in 64/70 patients (91%) and 41 (59%) received combined immunosuppressive therapies during the follow-up. After the follow-up of 33.2 months [1-162], 31 patients (44%) finally experienced sustained remission. At least one relapse during the 33.2 months [1-162] follow-up occurred in 43 patients (61%). Relapse rates were higher in patients treated by DMARDs (odds ratio at 4.86 [95% CI 1.38 - 17.10]), but did not differ from biologics (odds ratio 0.59 [95% CI 0.11-3.20]) and azacytidine (odds ratio 1.44 [95% CI 0.21-9.76]) (steroids considered as reference). Overall survival and progression to acute myeloid leukemia in MDS/MPN vasculitis were not significantly different from MDS/MPN patients without any dysimmune features (p=0.5).Conclusion:This first largest study of MDS/MPN vasculitis show no correlation of vasculitis subtypes with various subtypes and severity of MDS/MPN, and no significant impact of vasculitis on overall survival and progression to acute myeloid leukemia. The high relapse rats and steroid dependence raise the question of combined therapies to steroids. Whereas DMARDs use seem to be avoid specific azacytidine therapy could be considered for even low-risk MDS/MPN vasculitis.Acknowledgments:minhemon gfm gfevDisclosure of Interests:None declared
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Mekinian A, Vautier M, Resche-Rigon M, Dagna L, Sciascia S, Olivier.Espitia@chu-Nantes.Fr OENF, Cacoub P, Fain O, Saadoun D. AB0508 EFFICACY AND SAFETY OF TNF-Α ANTAGONISTS AND TOCILIZUMAB IN TAKAYASU ARTERITIS: MULTICENTER EUROPEAN RETROSPECTIVE STUDY OF 203 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Takayasu arteritis (TA) is a chronic inflammatory large-vessel vasculitis, predominantly affecting the aorta and its main branchesObjectives:To assess safety and efficacy of biologics (i.e. TNF-α antagonists and tocilizumab) in patients with Takayasu arteritis (TA).Methods:We conducted a retrospective multicenter study in referral centers from Europe and several countries in the world about biological-targeted therapies in Takayasu arteritis during the period from January 2017 to September 2019.Results:Retrospective multicenter study of characteristics and outcome of 49 TA patients [80% of females; median age 42 [20-55] years] treated by TNF-α antagonists (80%) or tocilizumab (20%)] and fulfilling ACR and/or Ishikawa criteria. Factors associated with complete response were assessed. Eighty-eight percent of TA patients were inadequately controlled with, or intolerant to, conventional immunosuppressive therapy [median number of 3 (1-5)]. Overall response (i.e. complete and partial) to biological-targeted treatments at 6 and 12 months was of 75% and 83%, respectively. There were a significantly lower C-reactive protein levels at initiation of biological-targeted treatments [22 [10-46] mg/l vs 58 [26-76] mg/l, (p=0.006)] and a trend toward lower immunosuppressants drugs used prior biologics (p=0.054) in responders (i.e. complete and/or partial responders) relative to non-responders to biological-targeted treatments. C-reactive protein levels and daily prednisone dosage significantly decreased after 12 months of biological-targeted treatments [30 vs 6 mg/l, p<0.05 and 15 vs 7.5 mg, p<0.05, at baseline and at 12 months, respectively]. The 3-year relapse free survival was of 90.9% (83.5-99) over biologic treatment period compared to 58.7% (43.3-79.7) (p=0.0025) with DMARDs. No difference was found relative to efficacy between TNF-α antagonists and tocilizumab. After a median follow-up of 24 [2-95] months, 21% of adverse effects occurred, with biological-targeted treatments discontinuation in 6.6% of cases.Conclusion:This nationwide study shows high efficacy of biological-targeted treatments in refractory TA patients with an acceptable safety profile.Acknowledgments:NODisclosure of Interests:Arsene Mekinian: None declared, Mathieu Vautier: None declared, Matthieu resche-rigon: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Savino Sciascia: None declared, olivier.espitia@chu-nantes.fr olivier.espitia@chu-nantes.fr: None declared, Patrice cacoub: None declared, olivier fain: None declared, david Saadoun: None declared
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