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Chaigne B, Guillevin L. Unsolved questions and concerns about treatment of anti-neutrophil cytoplasm antibody-associated vasculitides. Clin Exp Rheumatol 2016; 34:S121-S128. [PMID: 27087528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/05/2016] [Indexed: 06/05/2023]
Abstract
The treatment strategy for vasculitis has changed dramatically over the last few years, but some major questions remain. Herein, after reviewing the literature, we provide answers to, or at least an analysis of, available evidence on 10 specific and practical questions concerning ANCA-associated vasculitis management.
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Affiliation(s)
- Benjamin Chaigne
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, INSERM U1016, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, University of Paris Descartes, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, INSERM U1016, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, University of Paris Descartes, Paris, France.
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202
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Guillevin L. Conférence 2. Med Sci (Paris) 2016; 32 Spec No 1:19-22. [DOI: 10.1051/medsci/201632s106] [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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203
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Diatta T, Chavade D, Degos F, d'Andon A, Guillevin L. [Hepatitis C infection: Therapeutic strategies]. Presse Med 2016; 45:495-508. [PMID: 27006245 DOI: 10.1016/j.lpm.2016.02.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022] Open
Abstract
The development of new direct acting antivirals has significantly modified strategies to treat chronic hepatitis C. Treatments were previously made of an interferon-based combination. This article aims to review the direct acting antivirals clinical data and to discuss the new regimens for the management of chronic hepatitis C. Direct acting antivirals combinations - with or without ribavirin - are the new chronic hepatitis C standard treatment regimen. These combinations often result in sustained viral response rate (>90%, including in patients with uncomplicated cirrhosis) after a 12-week treatment for most patients. The innovation could represent a new era for patients with unmet medical need (especially ineligible or non-responders to interferon and/or ribavirin patients). Further investigations are required to confirm the efficacy in specific population (complicated cirrhosis, pre- or post-transplantation, chronic renal failure, comorbidities, etc.) where clinical data are still limited. Other treatments are currently being developed and might lead to new perspectives, especially in terms of treatment duration or therapeutic simplification.
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Affiliation(s)
- Thierno Diatta
- Haute Autorité de santé, service évaluation du médicament, 5, avenue du Stade-de-France, 93218 Saint-Denis La Plaine cedex, France.
| | - Delphine Chavade
- Haute Autorité de santé, service évaluation du médicament, 5, avenue du Stade-de-France, 93218 Saint-Denis La Plaine cedex, France
| | - Françoise Degos
- Haute Autorité de santé, service évaluation du médicament, 5, avenue du Stade-de-France, 93218 Saint-Denis La Plaine cedex, France
| | - Anne d'Andon
- Haute Autorité de santé, service évaluation du médicament, 5, avenue du Stade-de-France, 93218 Saint-Denis La Plaine cedex, France
| | - Loïc Guillevin
- Haute Autorité de santé, service évaluation du médicament, 5, avenue du Stade-de-France, 93218 Saint-Denis La Plaine cedex, France
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204
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Boulouis G, de Boysson H, Zuber M, Guillevin L, Meary É, Pagnoux C, Oppenheim C, Naggara O. IRM et ARM de l’angéite cérébrale primitive du système nerveux central de l’adulte : analyse et revue imagée de la cohorte française COVAC. J Neuroradiol 2016. [DOI: 10.1016/j.neurad.2016.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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205
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de Boysson H, Martin Silva N, de Moreuil C, Néel A, de Menthon M, Meyer O, Launay D, Pagnoux C, Guillevin L, Puéchal X, Bienvenu B, Aouba A. Neutrophilic Dermatoses in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A French Multicenter Study of 17 Cases and Literature Review. Medicine (Baltimore) 2016; 95:e2957. [PMID: 26986103 PMCID: PMC4839884 DOI: 10.1097/md.0000000000002957] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A few reports suggest combination of ANCA-associated vasculitis (AAV) and neutrophilic dermatoses (ND). We aimed to describe the main characteristics of patients presenting with both AAV and ND in a French cohort and through a systematic literature review, and to discuss the possible common pathogenic process involved. We conducted a retrospective study of patients with both conditions. Patients were selected via the French Internal Medicine Society (SNFMI) and the French Vasculitis Study Group (FVSG). A literature review focusing on a combination of both conditions, concentrated only on publications with well-established diagnoses and individual detailed data. Seventeen patients diagnosed with AAV and ND were identified in this cohort. Twelve patients had granulomatosis with polyangiitis (GPA), 4 had microscopic polyangiitis (MPA) and one had eosinophilic GPA (EGPA). Eight patients, all with GPA, displayed pyoderma gangrenosum (PG). Sweet's syndrome was observed in 6 patients (4 with MPA, one with GPA and one with EGPA) and erythema elevatum diutinum in the other three (2 with GPA and 1 with MPA). The literature review identified 33 additional patients with both conditions, including 26 with GPA. Altogether, of the 50 patients (17 from our study and 33 from the literature review), 33 (66%) patients presented with PG associated with GPA in 29 cases (89%). Corticosteroids were the first-line treatment in conjunction with an immunosuppressive agent in most cases. Outcomes were good and a total of 15 patients experienced a relapse. Patients who relapsed were more likely to have ear, nose and throat manifestation than patients who did not [12/15 (80%) relapsing patients vs. 15/35 (43%) non-relapsing patients; p = 0.03)]. In our stud, the most frequent association concerned GPA and PG. ND should be considered and specifically researched within the spectrum of cutaneous manifestations observed in AAV.
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Affiliation(s)
- Hubert de Boysson
- From the Department of Internal Medicine, Caen University Hospital, Caen (HDB, NMS, BB, AA); Department of Internal Medicine, Brest University Hospital (CDM); Department of Internal Medicine, Nantes University Hospital (AN); Department of Internal Medicine, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France (MDM); Department of Rheumatology, Assistance Publique Hôpitaux de Paris, Bichat University Hospital, Paris, France (OM); Department of Internal Medicine, Lille University Hospital, France (DL); Mount Sinai Hospital, University Health Network, and University of Toronto, Toronto, Ontario, Canada (CP); and Department of Internal Medicine, Assistancec Publique Hôpitaux de Paris, Cochin Hospital, Paris, France (LG, XP)
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Charpentier E, Looten V, Fahlgren B, Barna A, Guillevin L. Meta-analytic estimation of measurement variability and assessment of its impact on decision-making: the case of perioperative haemoglobin concentration monitoring. BMC Med Res Methodol 2016; 16:7. [PMID: 26787309 PMCID: PMC4717612 DOI: 10.1186/s12874-016-0107-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Received: 06/03/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022] Open
Abstract
Background As a part of a larger Health Technology Assessment (HTA), the measurement error of a device used to monitor the hemoglobin concentration of a patient undergoing surgery, as well as its decision consequences, were to be estimated from published data. Methods A Bayesian hierarchical model of measurement error, allowing the meta-analytic estimation of both central and dispersion parameters (under the assumption of normality of measurement errors) is proposed and applied to published data; the resulting potential decision errors are deduced from this estimation. The same method is used to assess the impact of an initial calibration. Results The posterior distributions are summarized as mean ± sd (credible interval). The fitted model exhibits a modest mean expected error (0.24 ± 0.73 (−1.23 1.59) g/dL) and a large variability (mean absolute expected error 1.18 ± 0.92 (0.05 3.36) g/dL). The initial calibration modifies the bias (−0.20 ± 0.87 (−1.99 1.49) g/dL), but the variability remains almost as large (mean absolute expected error 1.05 ± 0.87 (0.04 3.21) g/dL). This entails a potential decision error (“false positive” or “false negative”) for about one patient out of seven. Conclusions The proposed hierarchical model allows the estimation of the variability from published aggregates, and allows the modeling of the consequences of this variability in terms of decision errors. For the device under assessment, these potential decision errors are clinically problematic. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0107-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emmanuel Charpentier
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France.
| | - Vincent Looten
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
| | - Björn Fahlgren
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
| | - Alexandre Barna
- Secrétariat Scientifique du CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
| | - Loïc Guillevin
- CEDIT - Assistance Publique - Hôpitaux de Paris, 3, Avenue Victoria, Paris, F-75186, France
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207
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Groh M, Kahn JE, Puéchal X, Guillevin L. Comment on: First report ofFIP1L1-PDGFRα-positive eosinophilic granulomatosis with polyangiitis. Rheumatology (Oxford) 2015; 55:384-5. [DOI: 10.1093/rheumatology/kev425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 01/13/2023] Open
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208
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Levesque K, Morel N, Maltret A, Baron G, Masseau A, Orquevaux P, Piette JC, Barriere F, Le Bidois J, Fermont L, Fain O, Theulin A, Sassolas F, Pezard P, Amoura Z, Guettrot-Imbert G, Le Mercier D, Georgin-Lavialle S, Deligny C, Hachulla E, Mouthon L, Ravaud P, Villain E, Bonnet D, Costedoat-Chalumeau N, Bezanahary H, Bienvenu B, Blaison G, Blanche P, Bonnotte B, Cathebras P, Christides C, Cohen F, Cohen L, Devaud E, Diot E, Duhaut P, Dulac Y, Godeau B, Gournay V, Gronier C, Guillevin L, Hamidou M, Haroche J, Hayem G, Heitz F, Isnard R, Jallouli M, Korganow AS, Le Jeunne C, Lhote F, Lucron H, Lusson JR, Magnier S, Ninet J, Pangaud N, Papo T, Pellegrin JL, Pennaforte JL, Pouchot J, Sarrot-Reynauld F, Schleinitz N, Seve P, Stos B, Vital-Durand D, Wechsler B. Description of 214 cases of autoimmune congenital heart block: Results of the French neonatal lupus syndrome. Autoimmun Rev 2015; 14:1154-60. [DOI: 10.1016/j.autrev.2015.08.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 01/12/2023]
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209
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Frumholtz L, Aumaître O, Maurier F, Ruivard M, Laurent S, Puéchal X, Aractingi S, Le Jeunne C, Mouthon L, Guillevin L, Dupin N, Terrier B. Manifestations cutanées au cours des vascularites associées aux ANCA : étude dans une cohorte de 1535 patients. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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210
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Dunogué B, Briot K, Kolta S, Régent A, Cohen P, Berezne A, Puéchal X, Le Jeunne C, Mouthon L, Roux C, Guillevin L, Terrier B. La mesure de la graisse viscérale abdominale est un facteur de risque cardiovasculaire chez les patients ayant une vascularite primitive nécrosante. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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211
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Fraison JB, Sève P, Dauphin C, Mahr A, Gomard-Mennesson E, Varron L, Pugnet G, Landron C, Roblot P, Oziol E, Chalhoub G, Galempoix JM, Humbert S, Humbert P, Sbidian E, Grange F, Bayrou O, Cathebras P, Morlat P, Epaulard O, Pavese P, Huong DLT, Zoulim A, Stankovic K, Bachelez H, Smail A, Bachmeyer C, Granel B, Serratrice J, Brinchault G, Mekinian A, Costedoat-Chalumeau N, Bourgarit-Durand A, Puéchal X, Guillevin L, Piram M, Koné-Paut I, Fain O. Kawasaki disease in adults: Observations in France and literature review. Autoimmun Rev 2015; 15:242-9. [PMID: 26631821 DOI: 10.1016/j.autrev.2015.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 11/04/2015] [Accepted: 11/20/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is a vasculitis that mostly occurs in young children and rarely in adults. We analyzed the characteristics of adult-onset KD (AKD) in France. METHODS We collected retrospective and prospective data for patients with a diagnosis of KD occurring after the age of 18 years. Cases were obtained via various French medical networks and identified from the international literature. RESULTS We included 43 patients of AKD at 26 institution from 1992 to 2015, with mean (SD) age 30 (11) years (range 18-68) and sex ratio (M/F) 1.2; 34 patients met the American Heart Association criteria and 9 were incomplete AKD. The median time to diagnosis was 13 days (interquartile range 8-21). The main symptoms were fever (100%), exanthema (98%), changes in the extremities (91%), conjunctivitis (77%), oral cavity changes (89%), cervical adenitis (55%) and cardiac abnormalities (45%). Overall, 35% of patients showed large-vessel vasculitis: coronary vasculitis (26%) and coronary aneurysm (19%). Treatment was mostly intravenous immunoglobulins (79%) and aspirin (81%). Four patients showed myocardial infarction due to coronary vasculitis, but none were treated with IVIg because of late diagnosis. After a median follow-up of 5 months (range 1-117), persistent aneurysm was noted in 9% of cases. Damage was significantly lower with early treatment than late or no treatment (p=0.01). CONCLUSION Given the high frequency of cardiac involvement and complications in this series of AKD, diagnosis and treatment should not be delayed, and early IVIg treatment seems to improve the outcome.
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Affiliation(s)
- Jean-Baptiste Fraison
- Service de Médecine Interne, Hôpital Saint Louis, AP HP, Université Diderot, France.
| | - Pascal Sève
- Service de Médecine Interne, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, Université de Lyon, France
| | - Claire Dauphin
- Service de Cardiologie, Hôpital Gabriel Montpied, Université de Clermont-Ferrand, France
| | - Alfred Mahr
- Service de Médecine Interne, Hôpital Saint Louis, AP HP, Université Diderot, France
| | | | - Loig Varron
- Service de Médecine Interne, Centre Hospitalier de Montélimar, France
| | - Gregory Pugnet
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, France
| | - Cédric Landron
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, France
| | - Pascal Roblot
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, France
| | - Eric Oziol
- Service de Médecine Interne, Centre Hospitalier de Béziers, France
| | - Gihane Chalhoub
- Service de Médecine Interne, Centre Hospitalier de Metz-Thionville, France
| | - Jean-Marc Galempoix
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, France
| | - Sébastien Humbert
- Service de Médecine Interne, Centre Hospitalier Universitaire de Besançon, France
| | - Philippe Humbert
- Service de Dermatologie, Centre Hospitalier Universitaire de Besançon, University of Franche-Comté, INSERM UMR1098, SFR FED 4234 IBCT, Besançon, France
| | - Emilie Sbidian
- Service de Dermatologie, Hôpital Henri Mondor, AP HP, Université Paris Est, France
| | - Florent Grange
- Service de Dermatologie, Centre Hospitalier Universitaire de Reims, France
| | - Olivier Bayrou
- Service de Dermatologie, Hôpital Tenon, AP HP, Université Pierre et Marie Curie, France
| | - Pascal Cathebras
- Service de Médecine Interne, Centre Hospitalier Universitaire de St Etienne, France
| | - Philippe Morlat
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Bordeaux, France
| | - Olivier Epaulard
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Grenoble, France
| | - Patricia Pavese
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Grenoble, France
| | - Du Le Thi Huong
- Service de Médecine Interne 2, Hôpital La Pitié-Salpétrière, AP HP, Université Pierre et Marie Curie, France
| | - Abdelkader Zoulim
- Service de Médecine Interne, Centre Hospitalier Universitaire de Caen, France
| | - Katia Stankovic
- Service de Médecine Interne, Hôpital Tenon, AP HP, Université Pierre et Marie Curie, France
| | - Hervé Bachelez
- Service de Dermatologie, Hôpital Saint Louis, AP HP, Université Diderot, France
| | - Amar Smail
- Service de Médecine Interne, Centre Hospitalier Universitaire d'Amiens, France
| | - C Bachmeyer
- Service de Médecine Interne, Centre Hospitalier de Creil, France
| | | | | | | | - Arsène Mekinian
- Service de Médecine Interne, DHUi2B, Hôpital Saint Antoine, AP HP, Université Pierre et Marie Curie, France
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques et Autoimmunes Rares, AP HP, Université Paris Descartes, France
| | - Anne Bourgarit-Durand
- Service de Médecine Interne, Hôpital Jean Verdier, AP HP, Université Leonard de Vinci, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques et Autoimmunes Rares, AP HP, Université Paris Descartes, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques et Autoimmunes Rares, AP HP, Université Paris Descartes, France
| | - Maryam Piram
- Service de Rhumatologie Pédiatrique, Centre de Référence des Maladies Auto-Inflammatoires de l'enfant, Hôpital Bicêtre, AP HP, Université Paris Sud, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie Pédiatrique, Centre de Référence des Maladies Auto-Inflammatoires de l'enfant, Hôpital Bicêtre, AP HP, Université Paris Sud, France
| | - Olivier Fain
- Service de Médecine Interne, DHUi2B, Hôpital Saint Antoine, AP HP, Université Pierre et Marie Curie, France
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212
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Groh M, Rogowska K, Monsarrat O, Denoël A, Blanche P, Guillevin L. Interleukin-1 receptor antagonist for refractory anti-MDA5 clinically amyopathic dermatomyopathy. Clin Exp Rheumatol 2015; 33:904-905. [PMID: 26343354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/04/2015] [Indexed: 06/05/2023]
Abstract
Autoantibodies targeting the melanoma-differentiation-associated gene-5 (MDA5)-encoded ribonucleic acid helicase are associated with clinically amyopathic dermatomyopathy (CADM). Marked systemic inflammation, skin ulcers and severe interstitial lung disease seem frequent. DM treatment consists of immunosuppressants and/or intravenous immunoglobulins, but evidence-based knowledge is lacking. Anakinra (an interleukin-1 receptor antagonist (IL-1RA)) use in this setting has never been reported. Herein, we report on a case of anakinra dramatic and rapid efficacy against general and extramuscular (e.g. calcinosis, arthritis, skin ulcers) in a patient with severe and refractory CADM. Unfortunately, short-term follow-up prevented efficacy evaluation against interstitial lung disease. IL-1RA could be a promising treatment for refractory CADM.
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Affiliation(s)
- M Groh
- Department of Internal Medicine, National Referral Centre for Rare Autoimmune and Systemic Diseases, (DHU Authors), Inserm U1016, Hôpital Cochin, Université Paris Descartes, Paris, France.
| | - K Rogowska
- Department of Internal Medicine, National Referral Centre for Rare Autoimmune and Systemic Diseases, (DHU Authors), Inserm U1016, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - O Monsarrat
- Department of Nuclear Medicine, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - A Denoël
- Department of Immunology, Hôpital Bichat, Université Paris Diderot, Paris, France
| | - P Blanche
- Department of Internal Medicine, National Referral Centre for Rare Autoimmune and Systemic Diseases, (DHU Authors), Inserm U1016, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - L Guillevin
- Department of Internal Medicine, National Referral Centre for Rare Autoimmune and Systemic Diseases, (DHU Authors), Inserm U1016, Hôpital Cochin, Université Paris Descartes, Paris, France
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213
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Millet A, Martin KR, Bonnefoy F, Saas P, Mocek J, Alkan M, Terrier B, Kerstein A, Tamassia N, Satyanarayanan SK, Ariel A, Ribeil JA, Guillevin L, Cassatella MA, Mueller A, Thieblemont N, Lamprecht P, Mouthon L, Perruche S, Witko-Sarsat V. Proteinase 3 on apoptotic cells disrupts immune silencing in autoimmune vasculitis. J Clin Invest 2015; 125:4107-21. [PMID: 26436651 DOI: 10.1172/jci78182] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/27/2015] [Indexed: 12/12/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis that is associated with granulomatous inflammation and the presence of anti-neutrophil cytoplasmic antibodies (ANCAs) directed against proteinase 3 (PR3). We previously determined that PR3 on the surface of apoptotic neutrophils interferes with induction of antiinflammatory mechanisms following phagocytosis of these cells by macrophages. Here, we demonstrate that enzymatically active membrane-associated PR3 on apoptotic cells triggered secretion of inflammatory cytokines, including granulocyte CSF (G-CSF) and chemokines. This response required the IL-1R1/MyD88 signaling pathway and was dependent on the synthesis of NO, as macrophages from animals lacking these pathways did not exhibit a PR3-associated proinflammatory response. The PR3-induced microenvironment facilitated recruitment of inflammatory cells, such as macrophages, plasmacytoid DCs (pDCs), and neutrophils, which were observed in close proximity within granulomatous lesions in the lungs of GPA patients. In different murine models of apoptotic cell injection, the PR3-induced microenvironment instructed pDC-driven Th9/Th2 cell generation. Concomitant injection of anti-PR3 ANCAs with PR3-expressing apoptotic cells induced a Th17 response, revealing a GPA-specific mechanism of immune polarization. Accordingly, circulating CD4+ T cells from GPA patients had a skewed distribution of Th9/Th2/Th17. These results reveal that PR3 disrupts immune silencing associated with clearance of apoptotic neutrophils and provide insight into how PR3 and PR3-targeting ANCAs promote GPA pathophysiology.
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214
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Dion J, Terrier B, Jaïs X, Mehdaoui A, Sattler C, Amar D, Cohen P, Guillevin L, Mouthon L. Atypical vasculitis mimicking chronic thromboembolic pulmonary hypertension. Am J Med 2015; 128:e47-9. [PMID: 26071824 DOI: 10.1016/j.amjmed.2015.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/30/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jérémie Dion
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France.
| | - Xavier Jaïs
- Department of Pulmonology, National Referral Center for Pulmonary Hypertension, Bicêtre Hospital, AP-HP, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Anas Mehdaoui
- Department of Pulmonology, Evreux Hospital, Centre Hospitalier Eure et Seine, Evreux, France
| | - Caroline Sattler
- Department of Pulmonology, National Referral Center for Pulmonary Hypertension, Bicêtre Hospital, AP-HP, Université Paris Sud, Le Kremlin Bicêtre, France
| | - David Amar
- Department of Pulmonology, National Referral Center for Pulmonary Hypertension, Bicêtre Hospital, AP-HP, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Pascal Cohen
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
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Iudici M, Puéchal X, Pagnoux C, Quartier P, Agard C, Aouba A, Büchler M, Cevallos R, Cohen P, de Moreuil C, Guilpain P, Le Quellec A, Roblot P, Serratrice J, Bachmeyer C, Daugas É, Terrier B, Mouthon L, Guillevin L. Brief Report: Childhood-Onset Systemic Necrotizing Vasculitides: Long-Term Data From the French Vasculitis Study Group Registry. Arthritis Rheumatol 2015; 67:1959-65. [PMID: 25808634 DOI: 10.1002/art.39122] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/17/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the initial features and long-term outcomes of childhood-onset small vessel and medium vessel systemic necrotizing vasculitides (SNVs), including antineutrophil cytoplasmic antibody-associated vasculitides (AAVs) and polyarteritis nodosa (PAN). METHODS Data on patients with childhood-onset SNV registered in the French Vasculitis Study Group database were reviewed for demographic characteristics, clinical, laboratory, and histologic features, and outcomes. Disease activity was assessed with the Birmingham Vasculitis Activity Score and the Paediatric Vasculitis Activity Score, and damage was scored using the Vasculitis Damage Index. Relapse and survival rates and causes of death were analyzed. RESULTS Fifty-six patients (35 with AAV and 21 with PAN) (median age at database enrollment 14 years [range 2-17]) were included in the study. The median duration of followup was 96 months (range 1-336); two-thirds of the patients were followed up beyond 18 years of age. Six patients (11%) died, mostly of SNV-related causes. Relapse rates ranged from 33% for microscopic polyangiitis to 50% for eosinophilic granulomatosis with polyangiitis (Churg-Strauss) and 83% for granulomatosis with polyangiitis (Wegener's), with similar rates among AAV and PAN patients (76% and 75%, respectively); neither overall survival nor relapse-free survival differed significantly between the 2 disease groups. Rates of relapse increased after 18 years of age, both among patients with AAV and among patients with PAN. At the last followup evaluation, AAV patients had more major flares and more severe accrued damage compared with PAN patients. CONCLUSION Despite similar relapse rates, patients with childhood-onset AAVs experienced more major flares with more cumulative damage than those with pediatric PAN. Treatments aimed at reducing the rates of mortality and relapse in this patient group need to be developed and assessed.
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Affiliation(s)
- Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | | | - Pierre Quartier
- Hôpital Necker-Enfants Malades, AP-HP, Institut des Maladies Génétiques (IMAGINE), and Université Paris-Descartes, Paris, France
| | - Christian Agard
- Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Nantes, France
| | | | | | | | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | | | | | | | | | | | | | - Éric Daugas
- Hôpital Bichat, AP-HP, and Université Paris Diderot, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France
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Meibody F, Champigneulle J, Rondeau E, Guillevin L, Frémeaux-Bacchi V, Frimat L, Girerd S. Un cas de vascularite à anti-MPO positifs sous Enbrel® avec des dépôts de C3 isolés. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.253] [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: 10/23/2022]
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Guillevin L, Terrier B. Vascularites associées aux ANCA : faut-il changer de traitement d’entretien ? Rev Med Interne 2015; 36:571-2. [DOI: 10.1016/j.revmed.2015.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
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Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V, Dalhoff K, Dunogué B, Gross W, Holle J, Humbert M, Jayne D, Jennette JC, Lazor R, Mahr A, Merkel PA, Mouthon L, Sinico RA, Specks U, Vaglio A, Wechsler ME, Cordier JF, Guillevin L. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. Eur J Intern Med 2015; 26:545-53. [PMID: 25971154 DOI: 10.1016/j.ejim.2015.04.022] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 03/09/2015] [Accepted: 04/26/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To develop disease-specific recommendations for the diagnosis and management of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (EGPA). METHODS The EGPA Consensus Task Force experts comprised 8 pulmonologists, 6 internists, 4 rheumatologists, 3 nephrologists, 1 pathologist and 1 allergist from 5 European countries and the USA. Using a modified Delphi process, a list of 40 questions was elaborated by 2 members and sent to all participants prior to the meeting. Concurrently, an extensive literature search was undertaken with publications assigned with a level of evidence according to accepted criteria. Drafts of the recommendations were circulated for review to all members until final consensus was reached. RESULTS Twenty-two recommendations concerning the diagnosis, initial evaluation, treatment and monitoring of EGPA patients were established. The relevant published information on EGPA, antineutrophil-cytoplasm antibody-associated vasculitides, hypereosinophilic syndromes and eosinophilic asthma supporting these recommendations was also reviewed. DISCUSSION These recommendations aim to give physicians tools for effective and individual management of EGPA patients, and to provide guidance for further targeted research.
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Affiliation(s)
- Matthieu Groh
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), INSERM U1016, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Christian Pagnoux
- Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chiara Baldini
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Elisabeth Bel
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Paolo Bottero
- Allergy and Clinical Immunology Outpatient Clinic, Ospedale "G. Fornaroli" di Magenta, Azienda Ospedaliera di Legnano, Milan, Italy
| | - Vincent Cottin
- Department of Respiratory Medicine, National Referral Center for Rare Lung Diseases, Hôpital Louis-Pradel, Hospices Civils de Lyon, Lyon, France
| | - Klaus Dalhoff
- Medical Clinic, Department of Rheumatology, Vasculitis Center, University Clinic of Schleswig-Holstein, Lübeck and Bad Bramstedt, Germany
| | - Bertrand Dunogué
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), INSERM U1016, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Wolfgang Gross
- Medical Clinic, Department of Rheumatology, Vasculitis Center, University Clinic of Schleswig-Holstein, Lübeck and Bad Bramstedt, Germany
| | - Julia Holle
- Medical Clinic, Department of Rheumatology, Vasculitis Center, University Clinic of Schleswig-Holstein, Lübeck and Bad Bramstedt, Germany
| | - Marc Humbert
- Department of Respiratory and Critical Care Medicine, National Referral Center for Severe Pulmonary Hypertension, INSERM UMR-S 999, Hôpital Bicêtre, APHP, Université Paris-Sud, 94270 Le Kremlin-Bicêtre, France
| | - David Jayne
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, UNC Kidney Center, University of North Carolina, Chapel Hill, NC, USA
| | - Romain Lazor
- Interstitial and Rare Lung Disease Unit, Department of Respiratory Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alfred Mahr
- Department of Internal Medicine, Hôpital Saint-Louis, Université Paris 7 René Diderot, Paris, France
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), INSERM U1016, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Renato Alberto Sinico
- Clinical Immunology Unit and Renal Unit, Department of Medicine, Azienda Ospedaliera San Carlo Borromeo, Milan, Italy
| | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Augusto Vaglio
- Nephrology Unit, University Hospital of Parma, Parma, Italy
| | - Michael E Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Jean-François Cordier
- Department of Respiratory Medicine, National Referral Center for Rare Lung Diseases, Hôpital Louis-Pradel, Hospices Civils de Lyon, Lyon, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), INSERM U1016, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France.
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Sanges S, Launay D, Rhee RL, Sitbon O, Hachulla É, Mouthon L, Guillevin L, Rottat L, Montani D, De Groote P, Cottin V, Magro P, Prévot G, Bauer F, Bergot E, Chabanne C, Reynaud-Gaubert M, Leroy S, Canuet M, Sanchez O, Gut-Gobert C, Dauphin C, Pison C, Boissin C, Habib G, Clerson P, Conesa F, Cordier JF, Kawut SM, Simonneau G, Humbert M. A prospective study of the 6 min walk test as a surrogate marker for haemodynamics in two independent cohorts of treatment-naïve systemic sclerosis-associated pulmonary arterial hypertension. Ann Rheum Dis 2015; 75:1457-65. [PMID: 26324844 DOI: 10.1136/annrheumdis-2015-207336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 01/21/2015] [Accepted: 08/12/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Despite the wide use of the 6 min walk distance (6MWD), no study has ever assessed its validity as a surrogate marker for haemodynamics and predictor of outcome in isolated pulmonary arterial hypertension associated with systemic sclerosis (SSc-PAH). We designed this work to address this issue. METHODS Treatment-naïve patients with SSc-PAH were prospectively included from two sources: the French PAH Network (a prospective epidemiological cohort) (n=83) and randomised clinical trials submitted for drug approval (Food and Drug Administration) (n=332). Correlations between absolute values of the 6MWD and haemodynamics at baseline, as well as between variations of 6MWD and haemodynamics during follow-up, were studied in both populations. RESULTS In the French cohort, baseline cardiac output (CO) (R(2)=0.19, p=0.001) and New York Heart Association class (R(2)=0.10, p<0.001) were significantly and independently correlated with baseline 6MWD in multivariate analysis. A significant, independent, but weaker, correlation with CO was also found in the Food and Drug Administration sample (R(2)=0.04, p<0.001). During follow-up, there was no association between the changes in 6MWD and haemodynamic parameters in patients under PAH-specific treatments. CONCLUSIONS In SSc-PAH, CO independently correlates with 6MWD at baseline, but accounts for a small amount of the variance of 6MWD in both study samples. This suggests that other non-haemodynamic factors could have an impact on the walk distance. Moreover, variations of 6MWD do not reflect changes in haemodynamics among treated patients. Our results suggest that 6MWD is not an accurate surrogate marker for haemodynamic severity, nor an appropriate outcome measure to assess changes in haemodynamics during follow-up in treated SSc-PAH.
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Affiliation(s)
- Sébastien Sanges
- Université de Lille, UFR Médecine, Lille, France Département de Médecine Interne et Immunologie Clinique, CHRU Lille, Pôle Spécialités Médicales et Gérontologie, Lille Cedex, France Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille Cedex, France LIRIC, INSERM UMR 995, EA2686, Lille, France
| | - David Launay
- Université de Lille, UFR Médecine, Lille, France Département de Médecine Interne et Immunologie Clinique, CHRU Lille, Pôle Spécialités Médicales et Gérontologie, Lille Cedex, France Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille Cedex, France LIRIC, INSERM UMR 995, EA2686, Lille, France
| | - Rennie L Rhee
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olivier Sitbon
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM U999, Centre Chirurgical Marie-Lannelongue, LabEx LERMIT, Le Plessis-Robinson, France
| | - Éric Hachulla
- Université de Lille, UFR Médecine, Lille, France Département de Médecine Interne et Immunologie Clinique, CHRU Lille, Pôle Spécialités Médicales et Gérontologie, Lille Cedex, France Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille Cedex, France LIRIC, INSERM UMR 995, EA2686, Lille, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence des Vascularites Nécrosantes et de la Sclérodermie Systémique, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Centre de Référence des Vascularites Nécrosantes et de la Sclérodermie Systémique, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - Laurence Rottat
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM U999, Centre Chirurgical Marie-Lannelongue, LabEx LERMIT, Le Plessis-Robinson, France
| | - David Montani
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM U999, Centre Chirurgical Marie-Lannelongue, LabEx LERMIT, Le Plessis-Robinson, France
| | - Pascal De Groote
- Université de Lille, UFR Médecine, Lille, France Pôle Cardio-Vasculaire et Pulmonaire, Clinique de Cardiologie, CHRU de Lille, Lille, France
| | - Vincent Cottin
- Service de Pneumologie, Hospices Civils de Lyon, Centre de Compétence de l'Hypertension Pulmonaire, Centre de Référence des Maladies Pulmonaires Rares, Lyon, France
| | - Pascal Magro
- Service de Pneumologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Grégoire Prévot
- Pôle des Voies Respiratoires, Hôpital Larrey, Centre Hospitalier Universitaire, Toulouse, France
| | - Fabrice Bauer
- Service de Cardiologie, Hôpital Charles Nicolle, Centre Hospitalier Universitaire, Rouen, France
| | - Emmanuel Bergot
- Service de Pneumologie, Centre Hospitalier Universitaire Côte-de-Nacre, Caen, France
| | - Céline Chabanne
- Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes I, Rennes, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie, Centre Hospitalier Universitaire Nord, APHM, Université de la Méditerranée, Marseille, France
| | - Sylvie Leroy
- Service de Pneumologie, Hôpital Pasteur, Centre Hospitalier Universitaire, Université de Nice Sophia Antipolis, Nice, France
| | - Matthieu Canuet
- Service de Pneumologie, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Olivier Sanchez
- AP-HP, Service de Pneumologie et Soins Intensifs, Université Paris Descartes, Hôpital Européen Georges-Pompidou, INSERM UMR-S 1140, Paris, France
| | - Christophe Gut-Gobert
- Service de Médecine Interne et Pneumologie, Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
| | - Claire Dauphin
- Service de Cardiologie et Maladies Vasculaires, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Christophe Pison
- Clinique Universitaire de Pneumologie, Centre Hospitalier Universitaire, Grenoble, France Université Joseph Fourier, Grenoble, France
| | - Clément Boissin
- Service des Maladies Respiratoires, Hôpital Arnaud-de-Villeneuve, Centre Hospitalier Universitaire, Montpellier, France
| | - Gilbert Habib
- Service de Cardiologie, Hôpital de la Timone, Centre Hospitalier Universitaire, Marseille, France
| | - Pierre Clerson
- Soladis Clinical Studies, Biostatistics, Roubaix, France
| | | | - Jean-François Cordier
- Pôle Cardio-Vasculaire et Pulmonaire, Clinique de Cardiologie, CHRU de Lille, Lille, France
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gerald Simonneau
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM U999, Centre Chirurgical Marie-Lannelongue, LabEx LERMIT, Le Plessis-Robinson, France
| | - Marc Humbert
- Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France INSERM U999, Centre Chirurgical Marie-Lannelongue, LabEx LERMIT, Le Plessis-Robinson, France
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Girard C, Charles P, Terrier B, Bussonne G, Cohen P, Pagnoux C, Cottin V, Cordier JF, Guillevin L. Tracheobronchial Stenoses in Granulomatosis With Polyangiitis (Wegener's): A Report on 26 Cases. Medicine (Baltimore) 2015; 94:e1088. [PMID: 26266344 PMCID: PMC4616693 DOI: 10.1097/md.0000000000001088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tracheobronchial stenoses (TBSs) are potentially severe manifestations of granulomatosis with polyangiitis (Wegener's) (GPA) that usually respond poorly to corticosteroids and immunosuppressive agents. We describe 26 GPA patients with ≥1 tracheal (mainly subglottic, SGS) and/or bronchial stenosis(ses) (BS(s)).Sixteen patients had solitary SGS and 10 had ≥1 BS(s). The male/female sex ratio was 9:17, and the median age at GPA diagnosis was 32 years (3:13 and 28 years, respectively, for SGS patients). Antineutrophil cytoplasm antibodies were proteinase 3-positive in 65.5% of the patients (50% of those with SGS).Despite conventional GPA therapy, 62% patients experienced ≥1 stenosis relapse(s) (81% of SGS patients, for a total of 1-8 relapses per patient). None of the several systemic or endoscopic treatments prevented future relapses. Cyclophosphamide induction therapy was effective in 4/6 patients with BS(s) and in 1 patient with SGS among the 7 treated. After many relapses, rituximab achieved remission in 3/4 SGS patients. Endoscopic treatments (dilation, laser, corticosteroid injection, etc.) had only transient efficacy. Other GPA manifestations relapsed independently of TBSs. One SGS patient died of acute respiratory distress syndrome.Our findings confirmed that TBSs are severe GPA manifestations that evolve independently of other organ involvements and do not respond to conventional systemic regimens. As previously described, our population was younger and comprised more females than usual GPA patients, especially those with SGS.The small number of patients and the wide variety of local and systemic treatments prevent us from drawing definitive conclusions about the contribution of each procedure. However, cyclophosphamide seemed to effectively treat BSs, but not SGS, and rituximab may be of interest for SGS management.
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Affiliation(s)
- Charlotte Girard
- From the Department of Internal Medicine (CG, PaC, BT, GB, LG), National Referral Center for Rare Autoimmune and Systemic Diseases, Cochin Hospital; INSERM U1060 (CG, PaC, BT, GB, LG), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, University of Paris 5-René-Descartes, Paris; Department of Internal Medicine (CG), Department of Rheumatology, Mount Sinaï Hospital, Toronto, Ontario, Canada (CP), Edouard-Herriot University Hospital, Lyon; National Referral Center for Rare Pulmonary Diseases (VC, J-FC), Louis-Pradel Hospital, Lyon, France; and Department of Internal Medicine (PiC), Institut Mutualiste Montsouris, Paris
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Pène F, Hissem T, Bérezné A, Allanore Y, Geri G, Charpentier J, Avouac J, Guillevin L, Cariou A, Chiche JD, Mira JP, Mouthon L. Outcome of Patients with Systemic Sclerosis in the Intensive Care Unit. J Rheumatol 2015; 42:1406-12. [DOI: 10.3899/jrheum.141617] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 01/13/2023]
Abstract
Objective.Patients with systemic sclerosis (SSc) are prone to disease-specific or treatment-related life-threatening complications that may warrant intensive care unit (ICU) admission. We assessed the characteristics and current outcome of patients with SSc admitted to the ICU.Methods.We performed a single-center retrospective study over 6 years (November 2006–December 2012). All patients with SSc admitted to the ICU were enrolled. Short-term (in-ICU and in-hospital) and longterm (6-mo and 1-yr) mortality rates were studied, and the prognostic factors were analyzed.Results.Forty-one patients with a median age of 50 years [interquartile range (IQR) 40–65] were included. Twenty-nine patients (72.5%) displayed diffuse cutaneous SSc. The time from diagnosis to ICU admission was 78 months (IQR 34–128). Twenty-eight patients (71.7%) previously had pulmonary fibrosis, and 12 (31.5%) had pulmonary hypertension. The main reason for ICU admission was acute respiratory failure in 27 patients (65.8%). Noninvasive ventilation was first attempted in 13 patients (31.7%) and was successful in 8 of them, whereas others required endotracheal intubation within 24 h. Altogether, 13 patients (31.7%) required endotracheal intubation and mechanical ventilation. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 31.8%, 39.0%, 46.4%, and 61.0%, respectively. Invasive mechanical ventilation was the worst prognostic factor, associated with an in-hospital mortality rate of 84.6%.Conclusion.This study provides reliable prognostic data in patients with SSc who required ICU admission. The devastating outcome of invasive mechanical ventilation in patients with SSc requires a reappraisal of indications for ICU admission and early identification of patients likely to benefit from noninvasive ventilation.
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Humbert S, Guilpain P, Puéchal X, Terrier B, Rivière S, Mahr A, Pagnoux C, Bagnères D, Cordier JF, Le Quellec A, Altwegg R, Guillevin L. Inflammatory bowel diseases in anti-neutrophil cytoplasmic antibody-associated vasculitides: 11 retrospective cases from the French Vasculitis Study Group. Rheumatology (Oxford) 2015; 54:1970-5. [PMID: 26106214 DOI: 10.1093/rheumatology/kev199] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Coexistence of ANCA-associated vasculitis (AAV) and IBD is a rare condition that is rarely described in the literature. The aim of the study was to describe the main characteristics of patients presenting with both IBD and AAV. METHODS A retrospective study of AAV patients in the French Vasculitis Study Group cohort who also had a diagnosis of IBD was conducted. We reviewed the medical records and outcomes of these patients. RESULTS We identified 11 patients with AAV and IBD. Four patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss) also had ulcerative colitis and seven patients with granulomatosis with polyangiitis (GPA) had Crohn's disease. No Crohn's disease was observed in eosinophilic GPA and no ulcerative colitis in GPA. IBD started before AAV manifestations in six cases, simultaneously in two cases and after AAV manifestations in three cases. CONCLUSION Coexistence of IBD and AAV is a rare condition. The therapeutic management of these patients includes corticosteroids in all cases and immunosuppressive drugs in some patients. Coexistence of IBD and AAV might be explained by common underlying inflammatory responses and cytokine profiles polarized towards either Th1 or Th2. Finally, in the presence of digestive manifestations in the context of AAV, the hypothesis of IBD should be assessed.
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Affiliation(s)
- Sébastien Humbert
- Service de Médecine Interne, Université Montpellier 1, Maladies Multi-organiques, centre de compétence des maladies systémiques et auto-immunes rares de l'adulte, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier
| | - Philippe Guilpain
- Service de Médecine Interne, Université Montpellier 1, Maladies Multi-organiques, centre de compétence des maladies systémiques et auto-immunes rares de l'adulte, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier,
| | - Xavier Puéchal
- Faculté de Médecine, Université Paris Descartes, Pôle de Médecine Interne et Centre National de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Hôpital Cochin, APHP, Paris
| | - Benjamin Terrier
- Faculté de Médecine, Université Paris Descartes, Pôle de Médecine Interne et Centre National de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Hôpital Cochin, APHP, Paris
| | - Sophie Rivière
- Service de Médecine Interne, Université Montpellier 1, Maladies Multi-organiques, centre de compétence des maladies systémiques et auto-immunes rares de l'adulte, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier
| | - Alfred Mahr
- Service de Médecine Interne, Hôpital Saint-Louis, Université Paris 7, APHP, Paris
| | - Christian Pagnoux
- Faculté de Médecine, Université Paris Descartes, Pôle de Médecine Interne et Centre National de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Hôpital Cochin, APHP, Paris
| | - Denis Bagnères
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille, Marseille
| | - Jean-François Cordier
- Service de Pneumologie, Centre de Référence des Maladies Orphelines Pulmonaires, Hôpital Louis Pradel, Université Lyon I, Hospices Civils de Lyon, Lyon and
| | - Alain Le Quellec
- Service de Médecine Interne, Université Montpellier 1, Maladies Multi-organiques, centre de compétence des maladies systémiques et auto-immunes rares de l'adulte, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier
| | - Romain Altwegg
- Département d'Hépato-Gastroentérologie, Hôpital Saint-Eloi, Université Montpellier 1, CHRU de Montpellier, Montpellier, France
| | - Loïc Guillevin
- Faculté de Médecine, Université Paris Descartes, Pôle de Médecine Interne et Centre National de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Hôpital Cochin, APHP, Paris
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Charpentier E, Barna A, Guillevin L, Juliard JM. Fully bioresorbable drug-eluting coronary scaffolds: A review. Arch Cardiovasc Dis 2015; 108:385-97. [PMID: 26113479 DOI: 10.1016/j.acvd.2015.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 01/08/2015] [Revised: 03/07/2015] [Accepted: 03/12/2015] [Indexed: 12/20/2022]
Abstract
Following the development of stents, then drug-eluting stents (DES), bioresorbable scaffolds are proposed as a third evolution in coronary angioplasty, aiming to reduce the incidence of restenosis and stent thrombosis and to restore vascular physiology. At least 16 such devices are currently under development, but published clinical data were available for only three of them in September 2014. The first device is Abbott's BVS(®), a poly-L-lactic acid (PLLA)-based everolimus-eluting device, which has been tested in a registry and two non-randomized trials. Clinical results seem close to what is expected from a modern DES, but possibly with more post-procedural side-effects. Two randomized trials versus DES are underway. This device is already marketed in many European countries. The second device is Elixir's DESolve(®), a PLLA-based novolimus-eluting device, which has been evaluated in two single-arm trials. Results are not widely different from those expected from a DES. The third device is Biotronik's DREAMS(®), a metallic magnesium-based paclitaxel-eluting device, which has been assessed in an encouraging single-arm trial; its second version is currently undergoing evaluation in a single-arm trial. The available results suggest that the technological and clinical development of bioresorbable scaffolds is not yet complete: their possible clinical benefits are still unclear compared with third-generation DES; the impact of arterial physiology restoration has to be assessed over the long term; and their cost-effectiveness has to be established. From the perspective of a health technology assessment, there is no compelling reason to hasten the clinical use of these devices before the results of ongoing randomized controlled trials become available.
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Affiliation(s)
- Emmanuel Charpentier
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France.
| | - Alexandre Barna
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France
| | - Loïc Guillevin
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France
| | - Jean-Michel Juliard
- Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), Assistance Publique-Hôpitaux de Paris (AP-HP), 3, avenue Victoria, 75186 Paris cedex 16, France; Département de cardiologie, département hospitalo-universitaire FIRE, université Paris-Diderot, Sorbonne Paris-Cité, Inserm U-1148, Hôpital Bichat, AP-HP, 75877 Paris, France
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225
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Jachiet M, Samson M, Le Guenno G, Khouatra C, Kahn J, Bouillet L, Besancenot J, Makhlouf F, Godeau B, Cottin V, Guillevin L, Terrier B. Efficacité et tolérance de l’omalizumab, anticorps monoclonal anti-IgE, au cours de la granulomatose éosinophilique avec polyangéite (GEPA). Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.313] [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: 10/23/2022]
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226
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Pugnet G, Puéchal X, Fillatre P, Terrier B, Decaux O, Guillevin L. FRI0264 Cardiac Manifestations of Granulomatosis with Polyangiitis at Diagnostic. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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227
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Regent A, Ly K, Groh M, Khifer C, Lofek S, Tamby M, Baud V, Labrousse F, Guillevin L, Brézin A, Le Jeunne C, Mouthon L. Implication du système de l’endothéline et intérêt potentiel du macitentan au cours de l’artérite à cellules géantes (maladie de Horton). Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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228
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De Luna G, Chauveau D, Maurier F, Hatron P, Gobert P, Karras A, Aniort J, Marchand-Adam S, Carron P, Mania A, Guillevin L, Terrier B. Profil évolutif des patients traités par échanges plasmatiques au cours des vascularites systémiques nécrosantes. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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229
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Guellec D, Cornec-Le Gall E, Groh M, Hachulla E, Karras A, Charles P, Dunogue B, Abad S, Devauchelle-Pensec V, Guillevin L, Saraux A, Cornec D. AB0560 ANCA-Associated Vasculitis in Patients with Primary SjÖgren's Syndrome: Detailed Analysis of 6 New Cases and 15 Cases from the Literature. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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230
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Quartuccio L, Corazza L, Ramos-Casals M, Retamozo S, Ragab G, Ferraccioli G, Gremese E, Tzioufas A, Voulgarelis M, Vassilopoulos D, Koutsianas C, Scarpato S, Salvarani C, Guillevin L, Terrier B, Cacoub P, Saccardo F, Gabrielli A, Fraticelli P, Tomsic M, Tavoni A, Nishimoto N, Filippini D, Scaini P, Zignego A, Ferri C, Sansonno D, Monti G, Pietrogrande M, Galli M, Bombardieri S, De Vita S. OP0274 Cryoglobulinemic Vasculitis and Primary sjögren's Syndrome are Independent Risk Factors for Lymphoma in a Large Worldwide Population of Patients with Positive Serum Cryoglobulins. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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231
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Pagnoux C, Quéméneur T, Ninet J, Diot E, Kyndt X, de Wazières B, Reny JL, Puéchal X, le Berruyer PY, Lidove O, Vanhille P, Godmer P, Fain O, Blockmans D, Bienvenu B, Rollot F, Aït el Ghaz-Poignant S, Mahr A, Cohen P, Mouthon L, Perrodeau E, Ravaud P, Guillevin L. Treatment of systemic necrotizing vasculitides in patients aged sixty-five years or older: results of a multicenter, open-label, randomized controlled trial of corticosteroid and cyclophosphamide-based induction therapy. Arthritis Rheumatol 2015; 67:1117-27. [PMID: 25693055 DOI: 10.1002/art.39011] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 12/19/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate a new therapeutic strategy, with rapid corticosteroid dose tapering and limited cyclophosphamide (CYC) exposure, for older patients with systemic necrotizing vasculitides (SNVs; polyarteritis nodosa [PAN], granulomatosis with polyangiitis [Wegnener's] [GPA], microscopic polyangiitis [MPA], or eosinophilic GPA [Churg-Strauss] [EGPA]). METHODS A multicenter, open-label, randomized controlled trial comprising patients ≥65 years old and newly diagnosed as having SNV was conducted. The experimental treatment consisted of corticosteroids for ∼9 months and a maximum of six 500-mg fixed-dose intravenous (IV) CYC pulses, every 2-3 weeks, then maintenance azathioprine or methotrexate. The control treatment included ∼26 months of corticosteroids for all patients, combined with 500 mg/m(2) IV CYC pulses, every 2-3 weeks until remission, then maintenance for all patients with GPA or MPA and for those with EGPA or PAN with a Five-Factors Score (FFS) of ≥1. Randomization used a 1:1 ratio computer-generated list and was performed centrally with sealed opaque envelopes. The primary outcome measure was ≥1 serious adverse event (SAE) occurring within 3 years of followup. Secondary outcome measures included remission and relapse rates. RESULTS Among the 108 patients randomized, 4 were excluded (early consent withdrawal or protocol violation). Mean ± SD age at diagnosis was 75.2 ± 6.3 years. Analysis at 3 years included 53 patients (21 GPA, 21 MPA, 8 EGPA, and 3 PAN) in the experimental arm and 51 patients (15 GPA, 23 MPA, 6 EGPA, and 7 PAN) in the conventional arm. In total, 32 (60%) versus 40 (78%) had ≥1 SAE (P = 0.04), most frequently infections; 6 (11%) versus 7 (14%) failed to achieve remission (P = 0.71); 9 (17%) versus 12 (24%) died (P = 0.41); and 20 (44%) of 45 versus 12 (29%) of 41 survivors in remission experienced a relapse (P = 0.15). CONCLUSION For older SNV patients, an induction regimen limiting corticosteroid exposure and with fixed low-dose IV CYC pulses reduces SAEs in comparison to conventional therapy, and does not affect the remission rate. Three-year relapse rates remain high for both arms.
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Affiliation(s)
- Christian Pagnoux
- National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris,, France
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Pagnoux C, Guillevin L. Vasculitis research: Don't slow down and plan for a life-time commitment. Presse Med 2015; 44:e221-2. [PMID: 25986939 DOI: 10.1016/j.lpm.2015.04.009] [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: 11/29/2022] Open
Affiliation(s)
- Christian Pagnoux
- University of Toronto, Mount Sinai Hospital, Department of Rheumatology, Toronto, Canada.
| | - Loïc Guillevin
- Université Paris Descartes, hôpital Cochin, Referral Center for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, 75014 Paris, France
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233
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Lhote R, Theodore C, Issoufaly T, Francois D, Kahn JE, Guillevin L, Rivaud E, Bron C, Vasse M, Couderc LJ, Tcherakian C. Successful treatment of antineutrophil cytoplasmic antibody-associated bronchiectasis with immunosuppressive therapy. Eur Respir J 2015; 46:554-7. [PMID: 25976684 DOI: 10.1183/09031936.00031115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/18/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Raphael Lhote
- Service de Pneumologie, Hôpital Foch, Suresnes, France
| | | | | | | | | | - Loïc Guillevin
- Service de Médecine Interne, Centre de Références Maladies Systémiques et Autoimmunes Rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | | | - Camille Bron
- Service de Pneumologie, Hôpital Foch, Suresnes, France
| | - Marc Vasse
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - Louis-Jean Couderc
- Service de Pneumologie, Hôpital Foch, Suresnes, France Faculté de Médecine, UFR des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-Le-Bretonneux, France UPRES EA220, Hôpital Foch, Université de Versailles Saint-Quentin-en-Yvelines, Suresnes, France
| | - Colas Tcherakian
- Service de Pneumologie, Hôpital Foch, Suresnes, France Faculté de Médecine, UFR des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-Le-Bretonneux, France UPRES EA220, Hôpital Foch, Université de Versailles Saint-Quentin-en-Yvelines, Suresnes, France
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234
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Groh M, Dunogué B, Guillevin L. Pharmacological approach to treating eosinophilic granulomatosis with polyangiitis (Churg–Strauss). Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1025748] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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235
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Guellec D, Cornec-Le Gall E, Groh M, Hachulla E, Karras A, Charles P, Dunogué B, Abad S, Alvarez F, Gérard F, Devauchelle-Pensec V, Pers JO, Puéchal X, Guillevin L, Saraux A, Cornec D. ANCA-associated vasculitis in patients with primary Sjögren's syndrome: detailed analysis of 7 new cases and systematic literature review. Autoimmun Rev 2015; 14:742-50. [PMID: 25916811 DOI: 10.1016/j.autrev.2015.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 04/05/2015] [Accepted: 04/13/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To describe the clinical presentation, management and prognosis of patients diagnosed with both primary Sjögren's syndrome (pSS) and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS French nation-wide survey completed by a systematic literature review. RESULTS This work identified 7 new cases of coexisting pSS and AAV: 2 microscopic polyangiitis (MPA), 2 granulomatosis with polyangiitis (GPA), 2 anti-myeloperoxidase (MPO)-ANCA renal-limited AAV, and 1 eosinophilic granulomatosis with polyangiitis (EGPA). The systematic literature search identified 15 previously published cases. Among the 22 patients, 19 were females. Mean age at diagnosis of AAV was 63.9±9.8years. All individuals with available information experienced at least one extra-glandular manifestation attributable to pSS. p-ANCA with anti-MPO specificity were found in 76.2% (16/21), c-ANCA with anti-PR3 specificity in 14.3% (3/21) and isolated c-ANCA in 13.6% (3/22). Vasculitis involved kidneys (n=13), lungs (n=8), skin (n=6), peripheral nerves (n=5), central nervous system (n=2), small bowel (n=1), muscle (n=1), ear chondritis (n=1) and sinuses (n=1). The mean AAV follow-up was 73.5 (±120.0) months. While on treatment, disease remission occurred in 77.3% of cases, and one death was reported in the first 6months after diagnosis. CONCLUSION This work shows that AAV may occur in patients with pSS. These are most commonly p-ANCA associated vasculitis with anti-MPO specificity. AAV may reveal an underlying pSS or arise during its evolution, but did not precede pSS in any of these cases. AAV occurrence appears to be correlated with extra-glandular manifestations of pSS.
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Affiliation(s)
| | | | - Matthieu Groh
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Eric Hachulla
- Service de Médecine Interne, Hôpital Claude Huriez, Université de Lille II, Lille, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Pierre Charles
- Service de Médecine Interne, Institut Mutualiste Montsouris, Paris, France
| | | | - Sébastien Abad
- Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
| | - Fernand Alvarez
- Service de Médecine Interne, Centre médico-chirurgical de Kourou, French Guiana
| | | | - Valérie Devauchelle-Pensec
- Service de Rhumatologie, CHRU Brest, France; EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France
| | - Jacques-Olivier Pers
- EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Alain Saraux
- Service de Rhumatologie, CHRU Brest, France; EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU Brest, France; EA2216, INSERM ESPRI, ERI29, Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, Université de Brest, Brest, France.
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Jachiet M, Flageul B, Deroux A, Le Quellec A, Maurier F, Cordoliani F, Godmer P, Abasq C, Astudillo L, Belenotti P, Bessis D, Bigot A, Doutre MS, Ebbo M, Guichard I, Hachulla E, Héron E, Jeudy G, Jourde-Chiche N, Jullien D, Lavigne C, Machet L, Macher MA, Martel C, Melboucy-Belkhir S, Morice C, Petit A, Simorre B, Zenone T, Bouillet L, Bagot M, Frémeaux-Bacchi V, Guillevin L, Mouthon L, Dupin N, Aractingi S, Terrier B. The clinical spectrum and therapeutic management of hypocomplementemic urticarial vasculitis: data from a French nationwide study of fifty-seven patients. Arthritis Rheumatol 2015; 67:527-34. [PMID: 25385679 DOI: 10.1002/art.38956] [Citation(s) in RCA: 107] [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: 05/05/2014] [Accepted: 11/06/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Hypocomplementemic urticarial vasculitis (HUV) is an uncommon vasculitis of unknown etiology that is rarely described in the literature. We undertook this study to analyze the clinical spectrum and the therapeutic management of patients with HUV. METHODS We conducted a French nationwide retrospective study that included 57 patients with chronic urticaria, histologic leukocytoclastic vasculitis, and hypocomplementemia. We assessed clinical and laboratory data and evaluated the patients' cutaneous and immunologic responses to therapy. We evaluated treatment efficacy by measuring the time to treatment failure. RESULTS Urticarial lesions were typically more pruritic than painful and were associated with angioedema in 51% of patients, purpura in 35%, and livedo reticularis in 14%. Extracutaneous manifestations included constitutional symptoms (in 56% of patients) as well as musculoskeletal involvement (in 82%), ocular involvement (in 56%), pulmonary involvement (in 19%), gastrointestinal involvement (in 18%), and kidney involvement (in 14%). Patients with HUV typically presented with low C1q levels and normal C1 inhibitor levels, in association with anti-C1q antibodies in 55% of patients. Hydroxychloroquine or colchicine seemed to be as effective as corticosteroids as first-line therapy. In patients with relapsing and/or refractory disease, rates of cutaneous and immunologic response to therapy seemed to be higher with conventional immunosuppressive agents, in particular, azathioprine, mycophenolate mofetil, or cyclophosphamide, while a rituximab-based regimen tended to have higher efficacy. Finally, a cutaneous response to therapy was strongly associated with an immunologic response to therapy. CONCLUSION HUV represents an uncommon systemic and relapsing vasculitis with various manifestations, mainly, musculoskeletal and ocular involvement associated with anti-C1q antibodies, which were found in approximately half of the patients. The best strategy for treating HUV has yet to be defined.
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Affiliation(s)
- Marie Jachiet
- Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris 5, Paris, France
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237
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Affiliation(s)
- L Guillevin
- Service de Médecine Interne, Bobigny, France
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238
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Merlin E, Mouy R, Pereira B, Mouthon L, Bourmaud A, Piette JC, Landman-Parker J, Chellun P, Layadi M, Thomas C, Guillevin L, Prieur AM, Quartier P. Long-term outcome of children with pediatric-onset cutaneous and visceral polyarteritis nodosa. Joint Bone Spine 2015; 82:251-7. [PMID: 25887252 DOI: 10.1016/j.jbspin.2015.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 10/29/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the prognostic impact of clinical presentation in children with polyarteritis nodosa (PAN). METHODS Children diagnosed between 1986 and 2006 in a tertiary care pediatric rheumatology center were classified as "cutaneous PAN" (group 1), "cutaneous PAN with significant extra-cutaneous features" (group 2) or "visceral childhood PAN" (group 3). OUTCOME MEASURES (1) clinical remission off-therapy at last follow-up, (2) requirement and length of glucocorticoid therapy, (3) presence of disease-related sequelae. RESULTS Twenty-nine children were included. Sixteen met the Ankara criteria for PAN. Nine patients were qualified as group 1, 11 as group 2, and 9 as group 3. At last follow-up, 15 children were in clinical remission off-therapy: 4 from group 1 (44%), 4 from group 2 (36%) and 7 from group 3 (78%). Glucocorticoid therapy was required for 8 (89%), 7 (64%) and 7 (78%) patients from groups 1, 2 and 3, respectively. Seven children did not require any glucocorticoid therapy. Time-dependent probability of achieving glucocorticoid-free clinical remission was similar between the three groups. Three patients (one from each group) had digital ischemia leading to amputation. There were no significant between-group differences in outcome based on the three outcome measures addressed. CONCLUSION Outcome was not strikingly predictable from initial presentation in children with PAN. The organ distribution-based distinction between cutaneous and visceral PAN had little prognostic power in this series.
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Affiliation(s)
- Etienne Merlin
- Service de Pédiatrie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Inserm CIC 1405, Centre de Recherche Chez l'Enfant, Clermont-Ferrand, France
| | - Richard Mouy
- Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Bruno Pereira
- Service de Pédiatrie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, AP-HP, Paris, France; Université Paris-Descartes, Paris, France
| | - Aurélie Bourmaud
- Département de Santé Publique, Institut Cancérologique de la Loire, Saint-Étienne, France
| | - Jean-Charles Piette
- Service de Médecine Interne, Université Pierre-et-Marie-Curie, Paris-6, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | | | | | - Mustapha Layadi
- Service de Pédiatrie, hôpital Mère-Enfant, CHU de Limoges, Limoges, France
| | - Caroline Thomas
- Service d'Hématologie-Oncologie, Hôpital Mère-Enfants, Nantes, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, AP-HP, Paris, France; Université Paris-Descartes, Paris, France
| | - Anne-Marie Prieur
- Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France
| | - Pierre Quartier
- Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France; Université Paris-Descartes, Paris, France; Institut Hospitalo-Universitaire IMAGINE, Paris, France.
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De Parisot A, Puéchal X, Langrand C, Raverot G, Gil H, Perard L, Le Guenno G, Berthier S, Tschirret O, Eschard JP, Vinzio S, Guillevin L, Sève P. Pituitary involvement in granulomatosis with polyangiitis: report of 9 patients and review of the literature. Medicine (Baltimore) 2015; 94:e748. [PMID: 25906106 PMCID: PMC4602700 DOI: 10.1097/md.0000000000000748] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pituitary dysfunction is a rare manifestation of granulomatosis with polyangiitis (GPA) (Wegener). The main aim of this multicenter retrospective study was to describe the characteristics and outcomes of pituitary manifestations in patients with GPA included in the French Vasculitis Study Group database.Among the 819 GPA patients included in the database, 9 (1.1%) had pituitary involvement. The median age at diagnosis of GPA and pituitary involvement was 46 and 50.8 years, respectively. Pituitary involvement was present at onset of GPA in 1 case and occurred later in 8 patients after a median follow up of 58.5 months. When pituitary dysfunction occurred, 8 patients had active disease at other sites including ENT (n = 6), eye (n = 4), or central nervous system (n = 3) involvement. The most common hormonal dysfunctions were diabetes insipidus (n = 7) and hypogonadism (n = 7). Magnetic resonance imaging was abnormal in 7 patients. The most common lesions were an enlargement of the pituitary gland, thickening of the pituitary stalk, and loss of posterior hypersignal on T1-weighed images. All patients were treated with corticosteroid therapy and 8 patients received immunosuppressive agents for the pituitary involvement, including cyclophosphamide (n = 3), rituximab (n = 2), and methotrexate (n = 3). After a median follow-up of 9.2 years, GPA was in complete remission in 7 patients, but 8 patients were still under hormone replacement therapy. Among the 5 patients who had a subsequent MRI, 2 had complete resolution of pituitary lesions.By combining our study and the literature review, the frequency of hypogonadism and diabetes insipidus, among the patients with pituitary dysfunction, can be estimated at 78% and 71% respectively. Despite a high rate of systemic disease remission on maintenance therapy, 86% of the patients had persistent pituitary dysfunction. The patients who recovered from pituitary dysfunction had all been treated by cyclophosphamide.Pituitary disease in GPA occurs mostly several months or years after diagnosis. There is no correlation between hormonal, radiologic, and systemic outcome. Although immunosuppressive drugs improve the systemic disease, hormonal deficiencies usually persist. It is therefore important to shorten diagnostic delays and treat these patients early in the course of disease before irreversible damage occur.
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Affiliation(s)
- Audrey De Parisot
- From the Department of Internal Medicine, Hôpital de La Croix-Rousse and University Claude Bernard Lyon 1, 103 Grande rue de la Croix-Rousse 69317 Lyon Cedex 04 (ADP, PS); Department of Internal Medicine, Centre de Référence des maladies systémiques autoimmunes rares, Hôpital Cochin, University Paris-Descartes, Assistance Publique - Hôpitaux de Paris, Paris (XP, LG); Department of Endocrinology, Groupement Hospitalier Est and University Claude Bernard Lyon 1, 59 Boulevard Pinel 69677 Bron Cedex, Lyon (CL, GR); Department of Internal Medicine, Centre Hospitalier Régional Universitaire de Besançon, 2 Place Saint-Jacques, Besançon (HG); Department of Internal Medicine, Hôpital Edouard Herriot and University Claude Bernard Lyon 1, Lyon (LP); Department of Internal Medicine, Hôpital de Hautepierre, 1 Avenue Molière, Strasbourg (LG); Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, 14 rue Paul Gaffarel, Dijon (SB); Department of Neuroradiology, Groupement Hospitalier Est and University Claude Bernard Lyon 1, 59 Boulevard Pinel 69677 Bron Cedex, Lyon (OT); Department of Rheumatology, Hôpital de la Maison Blanche, 45 rue Cognacq-Jay 51092 Reims Cedex (JPE); and Department of Internal Medicine, Groupe Hospitalier Mutualiste de Grenoble, 8 Rue Docteur Calmette 38000 Grenoble, France (SV)
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Tamirou F, D'Cruz D, Sangle S, Remy P, Vasconcelos C, Fiehn C, Ayala Guttierez MDM, Gilboe IM, Tektonidou M, Blockmans D, Ravelingien I, le Guern V, Depresseux G, Guillevin L, Cervera R, Houssiau FA. Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis. Ann Rheum Dis 2015; 75:526-31. [PMID: 25757867 PMCID: PMC4789692 DOI: 10.1136/annrheumdis-2014-206897] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/15/2014] [Indexed: 01/28/2023]
Abstract
Objective To report the 10-year follow-up of the MAINTAIN Nephritis Trial comparing azathioprine (AZA) and mycophenolate mofetil (MMF) as maintenance therapy of proliferative lupus nephritis, and to test different definitions of early response as predictors of long-term renal outcome. Methods In 2014, data on survival, kidney function, 24 h proteinuria, renal flares and other outcomes were collected for the 105 patients randomised between 2002 and 2006, except in 13 lost to follow-up. Results Death (2 and 3 in the AZA and MMF groups, respectively) and end-stage renal disease (1 and 3, respectively) were rare events. Time to renal flare (22 and 19 flares in AZA and MMF groups, respectively) did not differ between AZA and MMF patients. Patients with good long-term renal outcome had a much more stringent early decrease of 24 h proteinuria compared with patients with poor outcome. The positive predictive value of a 24 h proteinuria <0.5 g/day at 3 months, 6 months and 12 months for a good long-term renal outcome was excellent (between 89% and 92%). Inclusion of renal function and urinalysis in the early response criteria did not impact the value of early proteinuria decrease as long-term prognostic marker. Conclusions The long-term follow-up data of the MAINTAIN Nephritis Trial do not indicate that MMF is superior to AZA as maintenance therapy in a Caucasian population suffering from proliferative lupus nephritis. Moreover, we confirm the excellent positive predictive value of an early proteinuria decrease for long-term renal outcome. Trial registration number NCT00204022.
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Affiliation(s)
- Farah Tamirou
- Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - David D'Cruz
- Louise Coote Lupus Unit, St Thomas' Hospital, London, UK
| | - Shirish Sangle
- Louise Coote Lupus Unit, St Thomas' Hospital, London, UK
| | - Philippe Remy
- Nephrology Department, Hôpital Henri Mondor, Créteil, France
| | - Carlos Vasconcelos
- Clinical Immunology Unit, Hospital Santo Antonio, ICBAS, Porto, Portugal
| | | | | | | | - Maria Tektonidou
- First Department of Internal Medicine, National University of Athens, Athens, Greece
| | - Daniel Blockmans
- General Internal Medicine Department, UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | - Geneviève Depresseux
- Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Loïc Guillevin
- General Internal Medicine Department, Hôpital Cochin, Paris, France
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Frédéric A Houssiau
- Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Benarous L, Terrier B, Puéchal X, Dunogué B, Cohen P, Le Jeunne C, Mouthon L, Guillevin L. Tobacco differentially affects the clinical-biological phenotypes of ANCA-associated vasculitides. Clin Exp Rheumatol 2015; 33:S-116-21. [PMID: 26016761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 04/17/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe the clinical-biological phenotype of ANCA-associated vasculitides (AAV) according to tobacco consumption. METHODS We conducted a descriptive study to describe that phenotype at diagnosis according to tobacco use. AAV patients entered in the French Vasculitis Study Group database with data on smoking habits were analysed. The clinical-biological phenotypes at diagnosis were compared according to current tobacco use (current smokers) or not (including previous and never smokers). RESULTS AAV diagnoses were: granulomatosis with polyangiitis (GPA) for 583 (50%), eosinophilic granulomatosis with polyangiitis (EGPA) for 326 (28%) and microscopic polyangiitis (MPA) for 256 (22%). Among them, 973 patients (84%) never smoked, 116 (10%) were previous smokers and only 76 (6%) were current smokers. Current smokers were younger age (p=0.01), male gender (p=0.004), less frequently EGPA (p=0.017) and MPA (p=0.036), and had less frequent kidney involvement (p=0.10). Among GPA patients, current smokers, compared to non-current smokers, were younger age (p=0.02), male gender (p=0.08), more frequent skin involvement (p=0.03) and less frequent ENT involvement (p=0.06). Among EGPA patients, current smokers, compared to non-current smokers, were also younger (p=0.028) and had less frequent constitutional symptoms (p=0.02), arthralgias (p=0.04), renal involvement (p=0.025) and MPO-ANCA (p=0.02). Finally, analysis of MPA patients was impossible because only 6 (2%) were current smokers. CONCLUSIONS These results suggest that tobacco use could differentially affect GPA and EGPA clinical-biological phenotypes, and support the role of environmental exposures in AAV development and its phenotype.
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Affiliation(s)
- L Benarous
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - B Terrier
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - X Puéchal
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - B Dunogué
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - P Cohen
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - C Le Jeunne
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - L Mouthon
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - L Guillevin
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases,Cochin Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
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242
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Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shönlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev 2015; 14:579-85. [PMID: 25688001 DOI: 10.1016/j.autrev.2015.02.003] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 12/20/2022]
Abstract
Immunoglobulin A (IgA) vasculitis, formerly called Henoch-Schönlein purpura, is an immune complex vasculitis affecting small vessels with dominant IgA deposits. Clinical manifestations mainly involve cutaneous purpura, arthralgias and/or arthritis, acute enteritis and glomerulonephritis. IgA vasculitis is more common among children than adults, with more severe disease in adults. Gastrointestinal and renal involvements represent the principal causes of morbidity and mortality in adults. Factors associated with long-term end-stage renal disease (ESRD) include baseline renal function impairment and baseline proteinuria >1 or 1.5 g/day, and on renal biopsy degree of interstitial fibrosis, sclerotic glomeruli and fibrinoid necrosis. Management of IgA vasculitis in adults is rendered difficult for clinicians because of the absence of correlation between initial presentation and long-term renal outcome, and the possible occurrence of spontaneous remission in patients with severe presentation or, in contrast, possible evolution to ESRD in patients with mild symptoms. Treatment is often symptomatic because disease course is usually benign. Treatment of severe involvement, including severe gastrointestinal complications or proliferative glomerulonephritis, remains controversial, with no evidence that corticosteroids or immunosuppressive agents improved long-term outcome. Prospective, randomized, controlled trials are thus needed to analyze the benefit-risk ratio of such treatments.
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Affiliation(s)
- Alexandra Audemard-Verger
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France.
| | - Evangeline Pillebout
- Department of Nephrology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
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Abstract
Most patients presenting with systemic necrotizing vasculitides improve when they are adequately treated. The presence of life-threatening manifestations or visceral involvement modifying organ function characterizes severe vasculitis, confirmed by disease-severity scores. Sequelae cannot always be predicted and prevented but organ involvement present at disease onset requires rapid therapeutic intervention. Some patients present a persistent active disease, which does not respond to treatments and deserve other drugs or combination of drugs. The therapeutic options for severe and/or relapsing and refractory diseases are described.
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Affiliation(s)
- Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, INSERM U1060, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, University of Paris Descartes, 27, rue du faubourg Saint-Jacques, 75679, Paris Cedex 14, France,
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Mohammad AJ, Hot A, Arndt F, Moosig F, Guerry MJ, Amudala N, Smith R, Sivasothy P, Guillevin L, Merkel PA, Jayne DRW. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg–Strauss). Ann Rheum Dis 2014; 75:396-401. [DOI: 10.1136/annrheumdis-2014-206095] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/15/2014] [Indexed: 12/19/2022]
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247
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De Parisot A, Raverot G, Langrand C, Gil H, Vinzio S, Berthier S, Le G, Perard L, Ninet J, Cordier J, Guillevin L, Sève P. Atteinte hypothalamohypophysaire au cours de la granulomatose avec polyangéite : analyse rétrospective de six cas et revue de la littérature. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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248
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Regent A, Ly K, Groh M, Khifer C, Clary G, Broussard C, Federici C, Baud V, Le Jeunne C, Witko-Sarsat V, Guillevin L, Mouthon L. Analyse protéomique et génomique des cellules musculaires lisses vasculaires au cours de l’artérite à cellules géantes (maladie de Horton). Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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249
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De Luna G, Karras A, Jourde-Chiche N, Marchand-Adam S, Bally S, Aumaître O, Puéchal X, Le Jeunne C, Mouthon L, Guillevin L, Terrier B. Utilisation des échanges plasmatiques au cours de vascularites nécrosantes systémiques. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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250
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Samson M, Puéchal X, Devilliers H, Cohen P, Bienvenu B, Ly K, Ruivard M, Hamidou M, Terrier B, Pagnoux C, Mouthon L, Guillevin L. Périartérite noueuse et polyangéite microscopique avec facteur de mauvais pronostic : suivi au long cours de 65 patients inclus dans un essai prospectif. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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