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David E, Belot A, Lega JC, Durieu I, Rousset-Jablonski C. [Human papillomavirus and systemic lupus erythematosus]. Rev Med Interne 2021; 42:498-504. [PMID: 33485700 DOI: 10.1016/j.revmed.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 01/27/2023]
Abstract
Infection with human papillomavirus (HPV) is one of the most widespread sexually transmitted diseases and the main risk factor for cervical cancer. Underlying conditions, like immunosuppression, favour the persistence and the progression of cervical lesions to an aggressive form. Patients with autoimmune diseases, and particularly systemic lupus erythematosus (SLE), may be prone to HPV infection and cervical dysplasia. However, the risk factors for developing persistent HPV-related infection, dysplasia and cancer are not identified for patients with SLE. The existence of an increased risk of cervical cancer compared to the general population remains debated. Thus, HPV vaccine is recommended for SLE patients as well as for the general population. Vaccine coverage of SLE patients is not known in France. Adolescents with chronic health condition seem to be insufficiently vaccinated regarding their vulnerability to infectious diseases. Strategies are required to decrease HPV vaccination barriers.
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Affiliation(s)
- E David
- Service de médecine interne et pathologie vasculaire, centre hospitalier Lyon Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France.
| | - A Belot
- Service de rhumatologie, néphrologie et dermatologie pédiatrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, hôpital Femme-mère-enfant, Lyon, France
| | - J-C Lega
- Service de médecine interne et pathologie vasculaire, centre hospitalier Lyon Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - I Durieu
- EA 7425 HESPER, médecine interne et pathologie vasculaire, groupement hospitalier Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - C Rousset-Jablonski
- Service de médecine interne, service de gynécologie-oncologie, centre Léon-Bérard, centre hospitalier Lyon Sud, hospices civils de Lyon, Lyon, France; EA 7425 HESPER, université Claude-Bernard Lyon 1, Lyon, France.
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Tamirou F, Arnaud L, Talarico R, Scirè CA, Alexander T, Amoura Z, Avcin T, Bortoluzzi A, Cervera R, Conti F, Cornet A, Devilliers H, Doria A, Frassi M, Fredi M, Govoni M, Houssiau F, Lladò A, Macieira C, Martin T, Massaro L, Moraes-Fontes MF, Pamfil C, Paolino S, Tani C, Tas SW, Tektonidou M, Tincani A, Van Vollenhoven RF, Bombardieri S, Burmester G, Eurico FJ, Galetti I, Hachulla E, Mueller-Ladner U, Schneider M, Smith V, Cutolo M, Mosca M, Costedoat-Chalumeau N. Systemic lupus erythematosus: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000793. [PMID: 30564454 PMCID: PMC6269635 DOI: 10.1136/rmdopen-2018-000793] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is the paradigm of systemic autoimmune diseases characterised by a wide spectrum of clinical manifestations with an unpredictable relapsing-remitting course. The aim of the present work was to identify current available clinical practice guidelines (CPGs) for SLE, to provide their review and to identify physicians’ and patients’ unmet needs. Twenty-three original guidelines published between 2004 and 2017 were identified. Many aspects of disease management are covered, including global disease management, lupus nephritis and neuropsychiatric involvement, management of pregnancies, vaccinations and comorbidities monitoring. Unmet needs relate with disease management of some clinical manifestations and adherence to treatment. Many patient’s unmet needs have been identified starting with faster diagnosis, need for more therapeutic options, guidelines on lifestyle issues, attention to quality of life and adequate education.
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Affiliation(s)
- Farah Tamirou
- Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Belgium
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Referencedes Maladies Auto-immunes et Systémiques Rares RESO, Strasbourg, France
| | | | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children'sHospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Fabrizio Conti
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italy
| | | | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - Micol Frassi
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Frederic Houssiau
- Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique deLouvain, Bruxelles, Belgium
| | - Ana Lladò
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalarde Lisboa Central, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Thierry Martin
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Laura Massaro
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Università degliStudi di Roma La Sapienza, Rome, Italy
| | - Maria Francisca Moraes-Fontes
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalarde Lisboa Central, Lisbon, Portugal
| | - Cristina Pamfil
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | | | - Sander W Tas
- Amsterdam UMC, Department of Clinical Immunology & Rheumatology and Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Meibergdreef 9, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Tektonidou
- Joint Rheumatology Academic Program, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Ronald F Van Vollenhoven
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Fonseca João Eurico
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Ilaria Galetti
- FESCA - Federation of European Scleroderma Association, Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy.,Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine Department, Cochin Hospital, Referral center for rare autoimmune and systemic diseases, Paris, France.,Paris Descartes Sorbonne, Paris Cité University, Paris, France.,INSERM U 1153, Center for Epidemiology andStatistics Sorbonne Paris Cité (CRESS), Paris, France
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Costedoat-Chalumeau N, Groh M, Piette JC, Launay O. [How to minimize the risk of infection in systemic lupus erythematosus?]. Rev Med Interne 2018; 40:347-350. [PMID: 29937299 DOI: 10.1016/j.revmed.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- N Costedoat-Chalumeau
- Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'Île-de-France, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Université Paris Descartes-Sorbonne Paris Cité, 75013 Paris, France; Inserm U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), 75006 Paris, France.
| | - M Groh
- Service de médecine interne, hôpital Foch, 92150 Suresnes, France
| | - J-C Piette
- Département de médecine interne et d'immunologie clinique, hôpital Pitié-Salpêtrière, affilié au Centre de référence maladies auto-immunes et systémiques rares de l'Île-de-France, AP-HP, 75013 Paris, France; Université Paris Descartes-Sorbonne Paris Cité, 75013 Paris, France
| | - O Launay
- Université Paris Descartes-Sorbonne Paris Cité, hôpital Cochin, AP-HP, 75014 Paris, France; Inserm, CIC 1417, F-CRIN I-REIVAC, 75014 Paris, France
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6
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Grabar S, Groh M, Bahuaud M, Le Guern V, Costedoat-Chalumeau N, Mathian A, Hanslik T, Guillevin L, Batteux F, Launay O. Pneumococcal vaccination in patients with systemic lupus erythematosus: A multicenter placebo-controlled randomized double-blind study. Vaccine 2017; 35:4877-4885. [PMID: 28784280 DOI: 10.1016/j.vaccine.2017.07.094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Invasive pneumococcal disease and respiratory tract infections are both frequent and severe in patients with systemic lupus erythematosus (SLE). This study aimed to compare the immunological efficacy and safety of pneumococcal vaccination with the 23-valent polysaccharide (PPS) vaccine alone to a sequential immunization with the 7-valent pneumococcal conjugate (PnCj) vaccine followed by PPS in patients with SLE and stable diseaase. METHODS Multicenter randomized placebo-controlled double-blind trial: PPS vaccine alone (placebo-PPS group) or PnCj vaccine followed by PPS vaccine (PnCj-PPS group) 24weeks later. The primary endpoint was the rate of responders at week 28 to at least 5 of the 7 serotypes (4, 6B, 9V, 14, 18C, 19F and 23F) shared by both PPS and PnCj. Pneumococcal IgG antibodies' opsonophagocytic activity (OPA) were also assessed. RESULTS Twenty-five patients in the placebo-PPS group and 17 in the PnCj-PPS group were included in a modified intention-to-treat analysis. The primary endpoint was reached in 72% (18/25) in the placebo-PPS and 76% (13/17) in the PnCj-PPS group (p=0.75). There was no difference in the rates of responders with OPA. At week 52, 13/18 (72%) patients in the placebo-PPS group and 10/13 (77%) patients in the PnCj-PPS group (p=0.77) that met the primary endpoint at week 28 were still responders to ≥5/7 serotypes shared by both PPS and PnCj vaccines. Nine SLE flares were reported in 6 patients (4 in the placebo-PPS and 2 in the PnCj-PPS groups respectively, p=0.70). CONCLUSION Sequential administration of PnCj vaccine followed by PPS vaccine is safe and shows short-term immunological efficacy in patients with SLE but was not superior to the PPS vaccine alone. TRIAL REGISTRATION www.clinicaltrials.gov, NCT NCT00611663.
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Affiliation(s)
- Sophie Grabar
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Unité de Biostatistique et Epidémiologie, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Paris, France; INSERM, UPMC Université Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| | - Matthieu Groh
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Mathilde Bahuaud
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Département d'Immunologie Biologique, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Paris, France
| | - Véronique Le Guern
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Nathalie Costedoat-Chalumeau
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Alexis Mathian
- Université Pierre et Marie Curie, Sorbonne Paris Cité AP-HP, Service de Médecine Interne 2, Centre de Référence National pour le Lupus et le Syndrome des Antiphospholipides, institut E3M, Paris, France
| | - Thomas Hanslik
- Université Versailles Saint-Quentin-en-Yvelines, APHP, Service de Médecine Interne, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Loïc Guillevin
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Service de Médecine Interne, Centre de Référence National pour les Maladies Auto-Immunes Rares (Vascularites et Sclérodermie Systémique), Paris, France
| | - Frédéric Batteux
- Université Paris Descartes, Sorbonne Paris Cité AP-HP, Département d'Immunologie Biologique, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Paris, France
| | - Odile Launay
- Inserm, CIC 1417, Paris, France; Université Paris Descartes, Sorbonne Paris Cité AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Fédération d'Infectiologie, Paris, France; Inserm, F-CRIN I-REIVAC, France.
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International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus. Autoimmun Rev 2017; 16:650-657. [PMID: 28434948 DOI: 10.1016/j.autrev.2017.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/PURPOSE Despite conventional immunosuppressants, active and steroid-dependent systemic lupus erythematosus (SLE) represents a therapeutic challenge. Only one biologic, belimumab, has been approved, but other biologics are sometimes used off-label. Given the lack of evidence-based data in some clinical situations encountered in real life, we developed expert recommendations for the use of biologics for SLE. METHODS The recommendations were developed by a formal consensus method. This method aims to formalize the degree of agreement among experts by identifying, through iterative ratings with feedback, the points on which experts agree, disagree or are undecided. Hence, the recommendations are based on the agreed-upon points. We gathered the opinion of 59 French-speaking SLE experts from 3 clinical networks dedicated to systemic autoimmune diseases (FLEUR, IMIDIATE, FAI2R) from Algeria, Belgium, France, Italy, Morocco, Switzerland and Tunisia. Represented medical specialities were internal medicine (49%), rheumatology (34%), nephrology (7%), dermatology (5%), pediatrics (3%) and cardiology (2%). Two methodologists and 3 strictly independent SLE expert groups contributed to developing these recommendations: a steering group (SG) (n=9), an evaluation group (EG) (n=28) and a reading group (RG) (n=22). Preliminary recommendations were drafted by the SG, then proposed to the EG. Each EG member rated the degree of agreement from 1 to 9 (1: lowest; 9: strongest) for each recommendation. After 2 rating rounds, the SG submitted a new version of the recommendations to the RG. With comments from the RG, the SG finalised the recommendations. RESULTS A total of 17 final recommendations were formulated by the SG, considering all agreement scores and comments by the EG and RG members and the two methodologists. These recommendations define the subset of patients who require a biologic; the type of biologics to use (belimumab, rituximab, etc.) depending on the organ involvement and associated co-treatments; what information should be given to patients; and how to evaluate treatment efficacy and when to consider discontinuation. CONCLUSION Overall, 17 recommendations for the good use of biologics in SLE were formulated by a large panel of SLE experts to provide guidance for clinicians in daily practice. These recommendations will be regularly updated according to the results of new randomized trials and increasing real life experience.
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