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Mekinian A, Saadoun D, Jerome.Connault@chu-Nantes.Fr JCNF, I-Quere@chu-Montpellier.Fr IQMF, Jégo P, Nicolas.Limal@aphp.Fr NLF, Wxv W, Gottenberg JE, Vautier M, Lea.Savey@aphp.Fr LSF, Cacoub P, Fain O. AB0509 SUSPENSIVE EFFICACY OF TOCILIZUMAB IN TREATMENT-NAÏVE PATIENTS WITH TAKAYASU ARTERITIS: TOCITAKA FRENCH PROSPECTIVE MULTICENTER OPEN-LABELLED TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4592] [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
Objectives:To assess long term efficacy of tocilizumab in treatment-naive patients with Takayasu arteritis (TAK).Methods:In this multicenter, prospective, open-labelled trial, we aim to evaluate the benefit of adding tocilizumab to steroids in treatment-naïve patients with TAK, on discontinuation of steroids after 6 months of tocilizumab treatment, and to assess relapse-free survival following tocilizumab discontinuation.Results:Thirteen patients with TAK were included, with a median age of 32 years [19-45] and 12 (92%) females. Six (54%) patients met the primary end-point. Among 11 (85%) patients which achieved remission at 6 months, 6 (54%) have reached primary endpoint.. Among the 5 remaining patients which continued steroids, 3 had a prednisone-equivalent dosage < 5mg/day. A significant decrease of disease activity was observed after 6 months of tocilizumab therapy: decrease of median NIH scale (3 [3-4] at baseline, versus 1 [0-2] after 6 months; p <0.001), ITAS-2010 score (5 [2-7] versus 3 [0-8]; p = 0.002), and ITAS-A score (7 [4-10] versus 4 [1-15]; p = 0.0001)]. All patients discontinued tocilizumab after 7 infusions, and no other immunosuppressive drugs was introduced, except for 1 patient which received methotrexate. After 9 and 12 months, respectively 7 (54%) and 6 (50%) patients achieved remission with less than 7.5 mg/day of prednisone, and 9 (69%) and 9 (75%) with doses <10 mg/day. During the 12 months follow-up after tocilizumab discontinuation, a relapse occurred among 5 patients (45%) out of 11 in which achieved remission after 6 months of tocilizumab.No severe AEs were considered related to study treatment and none required tocilizumab interruption or dose reduction. No deaths have occurred during the study period.Conclusion:Tocilizumab seems an effective steroid sparing therapy in TAK but its effect appears to be suspensive.Disclosure of Interests:Arsene Mekinian: None declared, david Saadoun: None declared, jerome.connault@chu-nantes.fr jerome.connault@chu-nantes.fr: None declared, i-quere@chu-montpellier.fr i-quere@chu-montpellier.fr: None declared, Patrick Jégo: None declared, nicolas.limal@aphp.fr nicolas.limal@aphp.fr: None declared, wxv wxv: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Mathieu Vautier: None declared, lea.savey@aphp.fr>; lea.savey@aphp.fr>;: None declared, Patrice cacoub: None declared, olivier fain: None declared
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Kedra J, Seror R, Dieudé P, Constantin A, Toussirot E, Kfoury E, Masson C, Cornec D, Dubost JJ, Marguerie L, Ottaviani S, Grados F, Belkhir R, Fain O, Goupille P, Sordet C, Fautrel B, Philippe P, Piperno M, Combe B, Lambotte O, Richez C, Sellam J, Sene T, Denis G, Lequerre T, Mariette X, Nocturne G. OP0125 LYMPHOMAS COMPLICATING RHEUMATOID ARTHRITIS: RESULTS OF A FRENCH MULTI-CENTRE CASE-CONTROL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3930] [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:Rheumatoid arthritis (RA) is associated with an increased risk of non-Hodgkin B-cell lymphoma (B-cell NHL).Objectives:1)To study the characteristics of B-cell NHL complicating RA2)To identify the factors associated with their occurrence.Methods:A multi-centre case-control study was performed in France. Cases were patients with RA fulfilling the ACR-EULAR 2010 criteria, who developed a B-cell NHL after the diagnosis of RA. Cases were reported following a call for observations by the “Club Rhumatismes et Inflammation” network, registries from the French society of Rheumatology (AIR, ORA and REGATE) and the ESPOIR cohort. For each case, 2 control patients were drawn at random from patients in the ESPOIR cohort with RA fulfilling the ACR-EULAR 2010 criteria; cases and controls were matched on age (age at lymphoma diagnosis for cases and age at the 10-year ESPOIR visit for controls). Patients with associated Sjögren’s syndrome were excluded. Cases and controls characteristics were compared for parameters associated with the occurrence of lymphoma.Results:A total of 54 cases were included and matched to 108 controls. Lymphomas were mostly diffuse large B-cell lymphomas (n=26, 48.2%)(Figure 1). EBV positivity was found in 4 cases among 27 tested (14.8%). Cases had a mean age of 63.5 years (SD=10.9), and had a mean RA duration of 12.4 years (SD=10.5) at the time of diagnosis of lymphoma; there was no significant difference with controls (p=0.47 and p=0.40 respectively). The mean duration of follow-up after the diagnosis of lymphoma was 5.2 years (SD=5.8). In univariate analysis, factors associated with occurrence of B-cell NHL were: male gender (OR=3.3, 95%CI: 1.7-6.7), positive ACPA (OR=5.1, 95%CI: 2.0-15.7), positive Rheumatoid Factor (RF) (OR=3.9, 95%CI=1.6-12.2), erosions on X-rays (OR=15.4, 95%CI: 6.9-37.7) and DAS28 (OR=2.0, 95%CI: 1.5-2.7). Methotrexate, TNF-blockers and the number of previous biologics were not associated with the occurrence of B-cell NHL. Hydroxychloroquine and sulfasalazine were more frequent in cases versus control, which could be linked to a date bias. Erosions and DAS28 remained significant in multivariate analysis(Table 1).Conclusion:This study revealed an association between markers of activity (DAS28), severity (erosions) and autoimmune B-cell activation (RF and ACPA) and the risk of B-cell NHL in patients with RA, supporting the continuum between autoimmunity and lymphomagenesis in RA.Figure 1.lymphomas histologyTable 1.association between RA characteristics and B-cell NHL in univariate and multivariate analysisVariablesCases (N=54)Controls (N=108)Univariate analysisMultivariate analysisOR (95%CI)p-valueOR (95%CI)p-valueMale gender, N (%)27 (50.0)25 (23.2)3.3(1.7-6.7)0.00062.2(0.8-6.1)0.13Positive ACPA, N (%)49 (90.7)71 (65.7)5.1(2.0-15.7)0.0006--Positive RF, N (%)49 (90.7)77 (71.3)3.9(1.6-12.2)0.005--Positive RF or ACPA, N (%)49 (90.7)80 (74.1)3.4(1.3-10.6)0.012.9(0.7-15.0)0.16Erosions on X-rays, N (%)44 (81.5)26 (24.1)15.4(6.9-37.7)< 0.00019.8(3.8-28.2)< 0.0001DAS28 at B-cell NHL diagnosis/at the 10th year visit*, mean(SD)4.1 (1.6)2.6 (1.4)2.0(1.5-2.7)< 0.00011.9(1.3-2.8)0.0007*B-cell NHL diagnosis for cases, 10thyear visit for controlsDisclosure of Interests:Joanna KEDRA: None declared, Raphaèle Seror Consultant of: BMS UCB Pfizer Roche, Philippe Dieudé: None declared, Arnaud Constantin: None declared, ERIC TOUSSIROT: None declared, Elias Kfoury: None declared, Charles Masson: None declared, Divi Cornec: None declared, Jean-Jacques Dubost: None declared, Laurent Marguerie: None declared, Sebastien Ottaviani: None declared, Franck Grados: None declared, Rakiba Belkhir: None declared, olivier fain: None declared, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Christelle Sordet: None declared, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Peggy Philippe: None declared, Muriel PIPERNO: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Olivier Lambotte Consultant of: BMS France, MSD, Astra Zeneca, Incyte, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Jérémie SELLAM: None declared, Thomas Sene: None declared, Guillaume Denis: None declared, Thierry Lequerre: None declared, Xavier Mariette Consultant of: BMS, Gilead, Medimmune, Novartis, Pfizer, Servier, UCB, Gaetane Nocturne: None declared
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Bourguiba R, Savey L, Aouba A, Martin-Silva N, Fain O, Giurgea I, Grateau G, Georgin-Lavialle S. Le syndrome de fièvre prolongée associée aux mutations du gène du récepteur au TNF de type 1 : un diagnostic différentiel de la fièvre méditerranéenne familiale à ne pas méconnaître chez les patients méditerranéens. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roupie A, Fain O, Mekinian A, Terrier B, Regent A, de Boysson H, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Decaux O, Le Clech L, d’Aveni M, Rossignol J, Gal J. Vascularites associées aux syndromes myélodysplasiques : étude de cas multicentrique française. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vigneron C, Lécluse A, Ronzière T, Bouillet L, Boccon-Gibod I, Gayet S, Doche E, Smadja D, Di Legge S, Dumont F, Gaudron M, Ion I, Marcel S, Sévin M, Vlaicu MB, Launay D, Arnaud I, Girard-Madoux P, Héroum C, Lefèvre S, Marc G, Obadia M, Sablot D, Sibon I, Suissa L, Gobert D, Detante O, Alamowitch S, Fain O, Javaud N. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study. J Intern Med 2019; 286:702-710. [PMID: 31319000 DOI: 10.1111/joim.12962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. OBJECTIVES To clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke. METHODS In a case-control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin-mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema. RESULTS Fifty-three thrombolysis-related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin-mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin-converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ICU; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis-related AE were female sex [odds ratio (OR), 3.04; 95% confident interval (CI), 1.32-7.01; P = 0.009] and treatment with angiotensin-converting enzyme inhibitors [(OR), 6.08; 95% (CI), 2.17-17.07; P < 0.001]. CONCLUSIONS This case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.
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Abisror N, Mariozo L, Esteve Valderde E, De Moreuil C, Billoir P, Pleguezuelo Garrote D, Carbillon L, Kayem G, Bornes M, Johanet C, Nicaise P, Urbanski G, Zigon P, Bezananary H, Mayer Pickel K, Benhamou Y, Fain O, Alijotas-Reig J, Mekinian A. SAPL séronégatif obstétrical : caractéristiques et prise en charge à partir d’une étude européenne. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.095] [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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Jachiet V, Moulis G, Seguier J, Schleinitz N, Vey N, Hadjadj J, Sacré K, Godeau B, Laribi K, Lambotte O, Broner J, Frédérique R, Salvado C, Le Clech L, Peterlin P, Versini M, Ades L, Fenaux P, Fain O, Mekinian A. Caractéristiques cliniques, évolution et prise en charge des thrombopénies immunologiques associées aux syndromes myélodysplasiques et leucémies myélomonocytaires chroniques : une étude multicentrique rétrospective comparative. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.020] [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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Bonnet P, Moguelet P, Abisror N, Itzykson R, Bouaziz JD, Hirsch P, Barbaud A, Haroche J, Mekinian A, Hélias-Rodzewicz Z, Clappier E, Fenaux P, Fain O, Tazi A, Emile JF, Chasset F. Identification de mutations clonales identiques dans les xanthélasma palpébraux de maladie d’Erdheim-Chester associés à des leucémies myélomonocytaires chroniques: à propos de 3 cas. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Catano J, Guedon A, Riviere S, Carrat F, Mahevas T, Fain O, Mekinian A. [Cancers in systemic sclerosis : risk factors, impact on survival and literature review]. Rev Med Interne 2019; 40:637-644. [PMID: 31255252 DOI: 10.1016/j.revmed.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patients with systemic sclerosis (SSc) have an increased risk of malignancy. In this study, we aimed to analyze the prevalence of cancer, the risk factors and the impact on overall survival. PATIENTS AND METHODS We analyzed clinical (history of cancer, toxic exposition, organ involvement), immunological and treatment data in a monocentric cohort of SSc patients followed between January 2004 and December 2017. RESULTS Two hundred and ten patients with SSc were included. During the follow-up, twenty-one patients (10 %) were diagnosed with malignancies. The underlying malignancies were breast adenocarcinoma (n=6, 28%), lung cancer (n=6, 28%), colorectal (colic adenocarcinoma, carcinoid tumor of the appendix), ovarian and cervix uteri, melanoma, kidney and papillary thyroid carcinoma (one of each). The median time between the first visit and the diagnosis of cancer was 4 [2-10] years. The overall survival in SSc patients with cancer was not significantly different from patients without cancer, with median survival during the first quartile (75%) at 12 years for patients with cancer and 11.6 years for those without cancer (P=0.9). The history of renal scleroderma crisis (HR 10.99, IC95% [1.95-62.07]; P=0.006) and the presence of anti-topoisomerase I antibodies (HR 5.5, IC95% [1.40-21.67]; P=0.01) were associated with an increased risk of cancer, whereas the presence of gastroesophageal reflux was inversely associated with the cancer occurrence (HR 0.22, IC95% [0.056-0.867]; P=0.03). CONCLUSION The history of renal scleroderma crisis and the positivity of anti-topoisomerase I antibodies were associated with an increased risk of cancer in SSc patients in this monocentric study.
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Martin de Frémont G, Gimenez de Mestral S, Jubault V, Chauchard M, Mekinian A, Fain O. [Polyarteritis nodosa, an alternative diagnosis of giant cell arteritis in cases of temporal arteritis]. Rev Med Interne 2019; 40:533-535. [PMID: 31201015 DOI: 10.1016/j.revmed.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/11/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Weight loss, myalgias, neurologic manifestations and arterial hypertension are common features of polyarteritis nodosa (PAN) at diagnosis. Temporal arteritis is a rarer manifestation of PAN, more suggestive of giant cell arteritis (GCA). CASE We report the case of a 77-year-old woman who presented with fatigue, weight loss, fever, neck pain, jaw claudication and cough, diagnosed with giant cell arteritis. Diagnosis was reconsidered in favour of a medium and small-sized vessels necrotizing vasculitis corresponding to PAN because of steroid dependence, mononeuritis and suggestive histological features. CONCLUSION Although temporal arteritis is suggestive of GCA, other causes of temporal arteritis can be identified with temporal artery biopsy.
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Jachiet V, Ricard L, Malard F, Grignano E, Dulphy N, Adès L, Mohty M, Fain O, Fenaux P, Gaugler B, Mekinian A. Manifestations auto-immunes et inflammatoires associées aux syndromes myélodysplasiques : effet de l’azacitidine sur les différentes populations immunitaires. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.088] [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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Bigot W, Mekinian A, Fain O. Efficacité du rituximab chez les patients atteints de neutropénie auto-immune (NAI). Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roupie A, De Boysson H, Carrat F, Seguier J, Terriou L, Maurier F, Versini M, Groh M, Benhamou Y, Fain O, Mekinian A. Artérite à cellules géantes associées aux syndromes myélodysplasiques : étude cas contrôle multicentrique française. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kolanska K, Suner L, Cohen J, Ben Kraiem Y, Placais L, Fain O, Mathieu D’argent E, Daraï E, Chabbert-Buffet N, Antoine J, Kayem G, Mekinian A, Rosefort A, Bornes M, Selleret L, Delhommeau F, Féger F, Sédille L. Lymphocytes cytotoxiques Natural Killers et grands lymphocytes granuleux T sanguins dans les fausses couches et des échecs d’implantation à répétition inexpliquées. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.367] [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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Ricard L, Jachiet V, Couture P, Malard F, Riviere S, Senet P, Monfort J, Fain O, Mohty M, Gaugler B, Mekinian A. Les lymphocytes T folliculaires helper circulants sont augmentés dans la sclérodermie systémique et activent la différenciation des plasmablastes à l’aide de l’IL-21 qui peut être inhibée par le ruxolitinib. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Maillet F, Wolff D, Soria A, Adnet F, Panayotopoulos V, Gobert D, Lapostolle F, Reuter P, Ghazali A, Caux F, Fain O, Javaud N. Facteurs associés aux rechutes parmi les patients traités pour urticaire aiguë. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.255] [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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Savey L, Bachmeyer C, Fain O, Loi V, Fayand A, Chauchard M, Louvrier C, Giurgea I, Amselem S, Grateau G, Georgin Lavialle S. Péritonite encapsulée chronique et mésothéliome péritonéal associés à la fièvre méditerranéenne familiale : à propos de 20 cas. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Martin De Frémont G, Larivière D, Dogaru M, Boffa J, Ossmane R, Buob D, Molina T, Fain O, Mekinian A. Une présentation granulomateuse de maladie associée aux IgG4 ganglionnaire, rénale, testiculaire et cutanée. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Deshayes S, Khellaf M, Zarour A, Fain O, Terriou L, Viallard J, Cheze S, Graveleau J, Slama B, Audia S, Michel M, Godeau B. Efficacité et tolérance d’un retraitement par rituximab chez 30 patients adultes atteints de purpura thrombopénique immunologique : résultats à partir du registre prospectif national PTI-RITUX. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.277] [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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Kolanska K, Dechartres A, Cohen J, Ben Kraiem Y, Selleret L, Mathieu D’argent E, Suner L, François D, Antoine J, Fain O, Kayem G, Mekinian A, Placais L, Rosefort A, Sedille L. Fausses couches ou/et échecs d’implantation répétés inexpliqués : étude prospective multicentrique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ghelfenstein Ferreira T, Delhommeau F, Johanet C, Cohen J, Bornes M, Kayem G, Gerotziafas G, Fain O, Planche V, Mekinian A. L’intérêt de la résistance à l’Annexine-A5 et des anticorps non conventionnels dans le diagnostic du syndrome des antiphospholipides séronégatif. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feray S, Fain O, Kayem G, Sabourdin N, Constant I, Rigouzzo A. Repeated attacks of type III hereditary angioedema with factor XII mutation during pregnancy. Int J Obstet Anesth 2018; 36:114-118. [DOI: 10.1016/j.ijoa.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/17/2018] [Accepted: 07/27/2018] [Indexed: 11/24/2022]
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Cacciatore C, Riviere S, Cohen A, Gatfosse M, Ederhy S, Fain O, Mekinian A. Sclérodermie systémique : efficacité des immunoglobulines intraveineuses pour l’atteinte cardiaque sévère ? Rev Med Interne 2018; 39:594-596. [DOI: 10.1016/j.revmed.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/28/2017] [Accepted: 12/28/2017] [Indexed: 01/22/2023]
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Mekinian A, Vicaut E, Cohen J, Bornes M, Kayem G, Fain O. [Hydroxychloroquine to obtain pregnancy without adverse obstetrical events in primary antiphospholipid syndrome: French phase II multicenter randomized trial, HYDROSAPL]. ACTA ACUST UNITED AC 2018; 46:598-604. [PMID: 30041771 DOI: 10.1016/j.gofs.2018.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 01/10/2023]
Abstract
Antiphospholipid syndrome is defined by the presence of thrombosis and/or obstetrical adverse events (≥3 recurrent early miscarriage or fetal death or a prematurity<34 weeks of gestation) associated with persistent antiphospholipid antibodies. The pregnancy outcome has been improved by the conventional treatment (aspirin 100mg/day with low molecular weight heparin [LMWH] from 30 to 75% of uncomplicated pregnancies. In PROMISSE study, 19% of pregnancies had at least one obstetrical adverse event despite treatment (maternal, fetal or neonatal complications) in relation with APS. In the European registry of babies born from APS mothers, maternal and foetal adverse events were observed in 13% of cases, with prematurity in 14% despite treatment. The presence of lupus erythematosus, a history of thrombosis, presence of lupus anticoagulant and APL triple positivity are considered as factors associated with unfavorable obstetrical outcome. Hydroxychloroquine (HCQ) has anti-inflammatory and anti-thrombotic properties. Studies in vitro have shown that HCQ is able to restore the placental expression of Annexin V, which has an anticoagulant effect and to prevent the placental injury induced by APL. HCQ used for lupus erythematosus decrease the thrombotic risk and its value for thrombotic APS has been raised in an open labelled French study. In European retrospective study, the addition of HCQ to conventional treatment improved refractory obstetrical APS. Its use during the pregnancy of patients with lupus erythematosus, the evidence of good safety during the pregnancy and follow-up of children born to mothers exposed to HCQ demonstrate an overall good safety profile for mothers and the fetus. This clinical trial is designed to assess the interest of the addition of hydroxychloroquine to conventional treatment in APS during the pregnancy.
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