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Zhong X, Jin YB, Zhang Q, Liu SL, He J. Low estimated glomerular filtration rate is an independent risk factor for higher hydroxychloroquine concentration. Clin Rheumatol 2023:10.1007/s10067-023-06576-x. [PMID: 36939974 DOI: 10.1007/s10067-023-06576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND The aim of this study was to analyze the relationship of the estimated glomerular filtration rate (eGFR) to hydroxychloroquine (HCQ) blood concentrations in systemic lupus erythematosus (SLE) patients. METHOD Patients with SLE who had been taking HCQ for more than 12 months were recruited. All subjects gave written informed consent. Various clinical characteristics and laboratory values were examined. The blood concentration of HCQ was measured by high-performance liquid chromatography, and the relationship of eGFR to HCQ blood concentration was mainly investigated. RESULT In total, 115 patients with SLE receiving long-term HCQ therapy were included in the study. The median concentration of HCQ was 1096 ng/ml (range 116-8240 ng/ml). The eGFR was strongly associated with blood concentration of HCQ (P = 0.011, P < 0.05), when adjusted for age, sex, body mass index (BMI), weight-adjusted dose, prednisone use and immunosuppressive drug use. No statistically significant association were found between age, duration, BMI, weight-adjusted HCQ dose, corticosteroid use, immunosuppressant use and blood concentrations of HCQ. CONCLUSION We provided novel evidence that impaired renal function influenced the blood concentration of HCQ. Patients with low eGFR need to adjust the HCQ dosage according to the monitoring results of HCQ blood concentrations.
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Affiliation(s)
- Xue Zhong
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Yue-Bo Jin
- Department of Rheumatology & Immunology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men, Xicheng District, Beijing, China
| | - Qin Zhang
- Ophthalmology Optometry Centre, Peking University People's Hospital, Beijing, China
- Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Si-Lu Liu
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Jing He
- Department of Rheumatology & Immunology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men, Xicheng District, Beijing, China.
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Garg S, Unnithan R, Hansen KE, Costedoat-Chalumeau N, Bartels CM. Clinical Significance of Monitoring Hydroxychloroquine Levels in Patients With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2021; 73:707-716. [PMID: 32004406 DOI: 10.1002/acr.24155] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite the pivotal role that hydroxychloroquine (HCQ) plays in treating systemic lupus erythematosus (SLE), less than 50% of patients take HCQ as prescribed. Measurement of HCQ blood levels can help clinicians distinguish nonadherence versus lack of efficacy of HCQ. Our objective was to systematically review publications and perform a meta-analysis to examine the correlation between HCQ levels and 1) nonadherence and 2) Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, in SLE. METHODS A comprehensive search was performed. We included observational and interventional studies that measured HCQ levels and assessed adherence or SLEDAI scores in adults with SLE. Forest plots compared pooled estimates of correlations between HCQ levels and reported nonadherence or SLEDAI scores. RESULTS Among 604 studies screened, 17 were reviewed. We found 3-times higher odds of reported nonadherence in patients with low HCQ levels (odds ratio 2.95 [95% confidence interval (95% CI) 1.63, 5.35], P < 0.001). The mean SLEDAI score was 3.14 points higher in groups with below-threshold HCQ levels on a priori analysis (δ = 3.14 [95% CI -0.05, 6.23], P = 0.053), and 1.4 points higher in groups with HCQ levels of <500 ng/ml (δ = 1.42 [95% CI 0.07, 2.76], P = 0.039). Among 1,223 patients, those with HCQ levels ≥750 ng/ml had a 58% lower risk of active disease, and their SLEDAI score was 3.2 points lower. CONCLUSION We found a strong association between low HCQ levels and reported nonadherence. Our results suggest that HCQ levels of ≥750 ng/ml might be a potential therapeutic target.
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Affiliation(s)
- Shivani Garg
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Rachna Unnithan
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Karen E Hansen
- University of Wisconsin School of Medicine and Public Health, Madison
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3
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Chasset F, Arnaud L, Jachiet M, Monfort JB, Bouaziz JD, Cordoliani F, Bagot M, Barbaud A, Francès C. Changing antimalarial agents after inefficacy or intolerance in patients with cutaneous lupus erythematosus: A multicenter observational study. J Am Acad Dermatol 2017; 78:107-114.e1. [PMID: 29061479 DOI: 10.1016/j.jaad.2017.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/21/2017] [Accepted: 08/27/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Changing from one antimalarial (AM) agent to another is often recommended in cutaneous lupus erythematosus (CLE) when the first AM agent is ineffective or poorly tolerated. OBJECTIVE To evaluate the effect on cutaneous response of a switch from hydroxychloroquine to chloroquine, or the reverse, after failure of the first AM agent. METHODS We conducted a retrospective observational study between 1997 and September 2015. The overall cutaneous response rate and reasons for failure of the switch were assessed for up to 48 months. Kaplan-Meier survival curves were used to assess the risk for failure of the second AM agent. RESULTS A total of 64 patients with CLE (78% were women) were included; for 48 patients, the switch was for inefficacy, and for 16, it was for adverse events. Median follow-up was 42 months (range, 3-171). Of the patients changed because of inefficacy, 56% were responders at month 3; however, the response decreased over time, with a median duration before failure of the second AM agent of 9 months (95% confidence interval, 6-24). For patients switched because of adverse events, the second AM agent was well tolerated in 69% of cases. LIMITATIONS Retrospective design and subjective evaluation of cutaneous response. CONCLUSION A change of AM agent should be considered in patients with CLE when the first AM agent is ineffective or poorly tolerated.
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Affiliation(s)
- François Chasset
- AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France; Université Paris VI Pierre et Marie Curie, Sorbonnes Universités, Paris, France.
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Université de Strasbourg, Strasbourg, France
| | - Marie Jachiet
- AP-HP, Service de Dermatologie, Hôpital Saint Louis, Paris, France
| | - Jean-Benoît Monfort
- AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France; Université Paris VI Pierre et Marie Curie, Sorbonnes Universités, Paris, France
| | | | | | - Martine Bagot
- AP-HP, Service de Dermatologie, Hôpital Saint Louis, Paris, France
| | - Annick Barbaud
- AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France; Université Paris VI Pierre et Marie Curie, Sorbonnes Universités, Paris, France
| | - Camille Francès
- AP-HP, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris, France
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4
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A Critical Review of the Effects of Hydroxychloroquine and Chloroquine on the Eye. Clin Rev Allergy Immunol 2016; 49:317-26. [PMID: 25672591 DOI: 10.1007/s12016-015-8469-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hydroxychloroquine (HCQ) and chloroquine have been used for more than 50 years to treat systemic lupus erythematosus (SLE) and other rheumatic diseases. In general, these drugs are well tolerated and rarely need to be discontinued because of an adverse systemic reaction. However, both medications can be irreversibly toxic to the retina. A new study indicates that toxicity is not as rare as once believed, but depends critically on daily dosage and duration of use, as well as other risk factors. With attention to dosage and other factors, and with proper screening for early signs of toxicity, HCQ can be prescribed with relative safety even over long periods of time.
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Jolly M, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Hulot JS, Arora S, Amoura Z, Piette JC, Costedoat-Chalumeau N. Quality of life in systemic lupus erythematosus: description in a cohort of French patients and association with blood hydroxychloroquine levels. Lupus 2016; 25:735-740. [DOI: 10.1177/0961203315627200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objectives Benefits of hydroxychloroquine (HCQ) use on physician reported outcomes are well documented in systemic lupus erythematosus (SLE). We assess for the first time the association and predictive value of blood HCQ levels towards health-related quality of life (HRQOL) in SLE. Methods Data from the PLUS study (a randomized, double-blind, placebo-controlled, multicentre study) were utilized. Blood HCQ levels were quantified by high-performance liquid chromatography along with HRQOL assessments (Medical Outcomes Study-SF-36) at baseline (V1) and month 7 (V2). Results 166 SLE patients’ data were analysed. Mean (SD) age and disease duration were 44.4 (10.7) and 9.3 (6.8) years. Eighty-seven per cent were women. Mean (SD, median, IQR) HCQ concentrations in the blood at V1 were 660 (314, 615, 424) ng/ml and increased to 1020 (632, 906, 781) ng/ml at V2 (mean difference 366 units, 95% confidence interval −472 to −260, p < 0.001). No significant correlations between HCQ concentrations with HRQOL domains at V1 or V2 were noted. There were no differences in HRQOL stratified by HCQ concentrations. HCQ concentrations at V1 or changes in HCQ concentration (V2-V1) were not predictive of HRQOL at V2 or changes in HRQOL (V2-V1). Conclusions No association of HCQ concentrations with current or longitudinal HRQOL were found in SLE.
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Affiliation(s)
- M Jolly
- Rush University Medical Center, Chicago, IL, USA
| | - L Galicier
- Université Paris Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Saint Louis, service d’immunologie clinique, Paris, France
| | - O Aumaître
- Université de Clermont-Ferrand and CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de médecine interne, Clermont-Ferrand, France
| | - C Francès
- UPMC, Université Paris 6 and AP-HP, Hôpital Tenon, service de dermatologie allergologie, Paris, France
| | - V Le Guern
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
| | - F Lioté
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Lariboisière, service de rhumatologie, Paris, France
| | - A Smail
- CHU Amiens, Hôpital Nord, service de médecine interne, Amiens, France
| | - N Limal
- UPEC; AP-HP, Hôpital Henri Mondor, service de médecine interne, Créteil, France
| | - L Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, Lyon, France
| | - H Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, Lyon, France
| | - D L T H Boutin
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - B Asli
- Université Paris Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Saint Louis, service d’immunologie clinique, Paris, France
| | - J-E Kahn
- Hôpital Foch, service de médecine interne, Suresnes, France
| | - J Pourrat
- Université Paul-Sabatier and CHU Toulouse, Hôpital Rangueil, service de néphrologie, Toulouse, France
| | - L Sailler
- Université Paul-Sabatier and CHU Toulouse, Hôpital Purpan, service de médecine interne, Toulouse, France
| | - F Ackermann
- Hôpital Foch, service de médecine interne, Suresnes, France
| | - T Papo
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, Paris, France
| | - K Sacré
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, Paris, France
| | - O Fain
- Hôpital Saint Antoine, DHU i2B, service de médecine interne, Université Paris 6
| | - J Stirnemann
- Division of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - P Cacoub
- APHP, Département de Médecine Interne et Immunologie clinique, Groupe Hospitalier Pitié Salpétriére Paris, France; DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI, France; UMR 7211 (UPMC/CNRS), UMR S-959 (INSERM)
| | - M Jallouli
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
| | - G Leroux
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - J Cohen-Bittan
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de gériatrie Pr Verny, Paris, France
| | - J-S Hulot
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Institute of Cardiometabolism and Nutrition (ICAN), F-75013, Paris, France
| | - S Arora
- Rush University Medical Center, Chicago, IL, USA
| | - Z Amoura
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - J-C Piette
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - N Costedoat-Chalumeau
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
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6
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Chasset F, Arnaud L, Costedoat-Chalumeau N, Zahr N, Bessis D, Francès C. The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study. J Am Acad Dermatol 2016; 74:693-9.e3. [DOI: 10.1016/j.jaad.2015.09.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/23/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
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7
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Jallouli M, Galicier L, Zahr N, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Sellam J, Mariette X, Blanchet B, Hulot JS, Amoura Z, Piette JC, Costedoat-Chalumeau N. Determinants of hydroxychloroquine blood concentration variations in systemic lupus erythematosus. Arthritis Rheumatol 2015; 67:2176-84. [PMID: 25989906 DOI: 10.1002/art.39194] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/05/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations. METHODS We conducted a retrospective analysis of patient data, including data from the Plaquenil Lupus Systemic (PLUS) study, to determine the association of epidemiologic, clinical, and biologic factors with blood HCQ concentrations. Data for nonadherent patients (blood HCQ concentration <200 ng/ml) were excluded. RESULTS To examine homogeneous pharmacologic data, we restricted the analyses of the PLUS data to the 509 SLE patients receiving 400 mg/day. We found no association of ethnicity or smoking with blood HCQ concentrations and no pharmacokinetic drug-drug interaction with antacids or with inhibitors or inducers of cytochrome P450 enzymes. On multivariate analysis, high body mass index (P = 0.008), no treatment with corticosteroids (P = 0.04), increased time between the last tablet intake and measurement of blood HCQ concentrations (P = 0.017), low platelet count (P < 0.001), low neutrophil count (P < 0.001), and high estimated creatinine clearance (P < 0.001) were associated with low blood HCQ concentrations. In 22 SLE patients with chronic renal insufficiency (median serum creatinine clearance 52 ml/minute [range 23-58 ml/minute]) who received 400 mg/day HCQ, the median blood HCQ concentration was significantly higher than that in the 509 patients from the PLUS study (1,338 ng/ml [range 504-2,229 ng/ml] versus 917 ng/ml [range 208-3316 ng/ml]) (P < 0.001). CONCLUSION We provide a comprehensive analysis of determinants of blood HCQ concentrations. Because this measurement is increasingly being used, these data might be useful for clinicians.
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Affiliation(s)
- M Jallouli
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - L Galicier
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - N Zahr
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - O Aumaître
- Université de Clermont-Ferrand and Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - C Francès
- Université Pierre et Marie Curie and AP-HP, Hôpital Tenon, Paris, France
| | - V Le Guern
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - F Lioté
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Lariboisière, Paris, France
| | - A Smail
- CHU Amiens, Hôpital Nord, Amiens, France
| | - N Limal
- AP-HP, Hôpital Henri Mondor, Créteil, France
| | - L Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - H Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - D Le Thi Huong
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - B Asli
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - J-E Kahn
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - J Pourrat
- Université Paul Sabatier and CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | - L Sailler
- Université Paul Sabatier and CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - F Ackermann
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - T Papo
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - K Sacré
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - O Fain
- Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and AP-HP, Hôpital St. Antoine, Paris, France
| | | | - P Cacoub
- Sorbonne Universités, Université Pierre et Marie Curie, UMR 7211, and Inflammation Immunopathology Biotherapy Department, AP-HP, Hôpital Pitié-Salpêtrière, Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, INSERM UMRS 959, and CNRS, FRE3632, Paris, France
| | - G Leroux
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | | | - J Sellam
- AP-HP, Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and INSERM UMRS 938, Paris, France
| | - X Mariette
- Université Paris-Sud, INSERM U1012, and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - J S Hulot
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Z Amoura
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - J C Piette
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - N Costedoat-Chalumeau
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
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