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Bouhnik Y, Pineton de Chambrun G, Lambert J, Nachury M, Seksik P, Altwegg R, Vuitton L, Stefanescu C, Nancey S, Aubourg A, Serrero M, Filippi J, Desseaux K, Viennot S, Abitbol V, Boualit M, Bourreille A, Giletta C, Buisson A, Roblin X, Dib N, Malamut G, Amiot A, Fumery M, Louis E, Elgharabawy Y, Peyrin-Biroulet L. Adalimumab in Biologic-naïve Patients With Crohn's Disease After Resolution of an Intra-abdominal Abscess: A Prospective Study From the GETAID. Clin Gastroenterol Hepatol 2023; 21:3365-3378.e5. [PMID: 36731588 DOI: 10.1016/j.cgh.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/13/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS The management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging, and surgery with delayed intestinal resection is often recommended. The aims of this study were to estimate the success rate of adalimumab (ADA) in patients with CD with an intra-abdominal abscess resolved without surgery, and to identify predictive factors for success. METHODS A multicenter, prospective study was conducted in biologic-naïve patients with CD with resolved intra-abdominal abscess treated with ADA with a 2-year follow-up. The primary endpoint was ADA failure at week (W) 24 defined as a need for steroids after W12, intestinal resection, abscess recurrence, and clinical relapse. Secondary post-hoc endpoint was the long-term success defined as the survival without abscess relapse or intestinal resection at W104. The factors associated with ADA failure at W24 and W104 were identified using a logistic and a Cox regression, respectively. RESULTS From April 2013 to December 2017, 190 patients from 27 GETAID centers were screened, and 117 were included in the analysis. Fifty-eight patients (50%) were male, and the median age at baseline was 28 years. At W24, 87 patients (74%; 95% confidence interval [CI], 65.5%-82.0%; n = 117) achieved ADA success. Among the 30 patients with ADA failure, 15 underwent surgery. At W104, the survival rate without abscess recurrence or surgery was 72.9% (95% CI, 62.1%-79.8%; n = 109). Abscess drainage was significantly associated with ADA failure at W24 (odds ratio, 4.18; 95% CI, 1.06-16.5; P =0 .043). Disease duration (hazard ratio [HR], 1.32; 95% CI, 1.09-1.59; P = .008), abscess drainage (HR, 5.59; 95% CI, 2.21-14.15; P = .001), and inflammatory changes in mesenteric fat (HR, 0.4; 95% CI, 0.17-0.94; P = .046) were significantly associated with ADA failure at W104. CONCLUSION Provided that the abscess was carefully managed before initiating medical treatment, this study showed the high efficacy of ADA in the short and long term in biologic-naïve patients with CD complicated by an intra-abdominal abscess. CLINICALTRIALS gov, Number: NCT02856763.
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Affiliation(s)
- Yoram Bouhnik
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France.
| | | | - Jérôme Lambert
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Maria Nachury
- University Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Philippe Seksik
- Département de Gastroentérologie, Hôpital Saint Antoine, Sorbonne Université, Inserm, CRSA, AP-HP, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Éloi, CHU, Montpellier, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Carmen Stefanescu
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Neuilly sur Seine, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Lyon University, Lyon, France
| | - Alexandre Aubourg
- Department of Gastroenterology, Tours University Hospital, Tours, France
| | - Mélanie Serrero
- Department of Gastroenterology, Hôpital Nord, Marseille University, Marseille, France
| | - Jérôme Filippi
- Department of Gastroenterology, Nice University Hospital, Nice, France
| | - Kristell Desseaux
- Department of statistics, INSERM U717 Saint-Louis Hospital, Paris, France
| | - Stéphanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Vered Abitbol
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Madina Boualit
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | - Arnaud Bourreille
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Department of Gastroenterology, CIC Inserm 1413, Nantes University, Nantes, France
| | - Cyrielle Giletta
- Department of Gastroenterology, Toulouse University Hospital, Hôpital Rangueil, Toulouse, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm U1071, M2iSH, CHU Clermont-Ferrand, 3iHP, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Georgia Malamut
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Creteil University, Creteil, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, Liège, Belgium
| | - Yasmine Elgharabawy
- Groupe Etude Thérapeutiques des Affections Inflammatoires Digestives, GETAID, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Brabois Hospital, Nancy University, Nancy les Vandoeuvre-lès-Nancy, France
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Brunet-Houdard S, Monmousseau F, Berthon G, Des Garets V, Laharie D, Picon L, Fotsing G, Gargot D, Charpentier C, Buisson A, Trang-Poisson C, Dib N, Rusch E, Aubourg A. How are patients' preferences for anti-TNF influenced by quality of life? A discrete choice experiment in Crohn's disease patients. Scand J Gastroenterol 2022; 57:1312-1320. [PMID: 35722732 DOI: 10.1080/00365521.2022.2085057] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Anti-TNFs have been shown to significantly improve the health-related quality of life (HRQoL) in Crohn's disease (CD) patients. The purpose of this study was to investigate to what extend the patients' preferences for these intravenous (IV) and subcutaneous (SC) treatments differ based on respondents' quality of life. An online discrete choice experiment (DCE) was conducted to understand patient trade-offs in treatment choice. METHODS Fifty-seven Crohn's disease anti-TNF naïve patients were asked to choose between two different scenarios, considering the following attributes: mode of administration (MODE), total availability for injection (TIME), speed of onset (DELAY), risk of anti-TNF administration despite a contraindication (RISK) and total monthly out-of-pocket expenses (COST). At the same time, patients completed the IBDQ-32 questionnaire. Conditional logit models without and with interaction terms were estimated to evaluate attribute weights. RESULTS Patients preferred to self-administer SC anti-TNF rather than have a primary care nurse do it, whereas the preference for IV route was negative. After adding interaction terms however, the IV route became preferred for patients with impaired HRQoL, this preference having decreased as HRQoL increased. Surprisingly, patients with impaired HRQoL were less willing to spend more time on treatment, and this effect diminished as HRQoL (overall and in each dimension) became higher. CONCLUSIONS HRQoL level changed patients' preferences for the anti-TNF treatment. The results suggest the need to optimise the management of IV infusions in the hospital and reinforce the importance of patient-reported outcome measures (PROMS) as a common practice to improve shared medical decision making.
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Affiliation(s)
- Solène Brunet-Houdard
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France.,EA7505 Education, Ethics, Health Research Unit, University of Tours, Tours, France
| | - Fanny Monmousseau
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France.,EA7505 Education, Ethics, Health Research Unit, University of Tours, Tours, France
| | - Geoffrey Berthon
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France
| | - Véronique Des Garets
- EA6296 VALLOREM Loire Valley Management Research Unit, Loire Valley University Management School, University of Tours, Tours, France
| | - David Laharie
- Department of Gastroenterology, University Hospital of Bordeaux, Pessac, France
| | - Laurence Picon
- Department of Gastroenterology, University Hospital of Tours, Chambray-lès-Tours, France
| | - Ginette Fotsing
- Department of Gastroenterology, University Hospital of Poitiers, Poitiers, France
| | - Dany Gargot
- Department of Gastroenterology, Hospital of Blois, Blois, France
| | - Cloé Charpentier
- Department of Gastroenterology, University Hospital of Rouen, Rouen, France
| | - Anthony Buisson
- Department of Gastroenterology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nina Dib
- Department of Gastroenterology, University Hospital of Angers, Angers, France
| | - Emmanuel Rusch
- Health Economic Evaluation Unit, University Hospital of Tours, Tours, France.,EA7505 Education, Ethics, Health Research Unit, University of Tours, Tours, France
| | - Alexandre Aubourg
- Department of Gastroenterology, University Hospital of Tours, Chambray-lès-Tours, France
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3
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Charbit-Henrion F, Haas M, Chaussade S, Cellier C, Cerf-Bensussan N, Malamut G, Khater S, Khiat A, Cording S, Parlato M, Dragon-Durey MA, Beuvon F, Brousse N, Terris B, Picard C, Fusaro M, Rieux-Laucat F, Stolzenberg MC, Jannot AS, Mathian A, Allez M, Malphettes M, Fieschi C, Aubourg A, Zallot C, Roblin X, Abitbol V, Belle A, Wils P, Cheminant M, Matysiak-Budnik T, Vuitton L, Pouderoux P, Abramowitz L, Castelle M, Suarez F, Hermine O, Ruemmele F, Mouthon L. Genetic Diagnosis Guides Treatment of Autoimmune Enteropathy. Clin Gastroenterol Hepatol 2022; 21:1368-1371.e2. [PMID: 35944833 PMCID: PMC10165659 DOI: 10.1016/j.cgh.2022.07.030] [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] [Received: 08/27/2021] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Fabienne Charbit-Henrion
- Université Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity, Paris, France; Department of Molecular Genetics, AP-HP, Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Manon Haas
- Université Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity, Paris, France; Department of Gastroenterology, AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology, AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Paris, France
| | - Christophe Cellier
- Department of Gastroenterology, AP-HP, Centre-Université Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | - Nadine Cerf-Bensussan
- Université Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity, Paris, France.
| | - Georgia Malamut
- Université Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity, Paris, France; Department of Gastroenterology, AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Paris, France.
| | | | - Sherine Khater
- Department of Immunology, AP-HP, Centre-Université Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | - Anis Khiat
- Université de Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity, Paris, France
| | - Sascha Cording
- Université de Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity, Paris, France
| | - Marianna Parlato
- Université de Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity, Paris, France
| | - Marie-Agnès Dragon-Durey
- Department of Immunology, AP-HP, Centre-Université Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | - Frédéric Beuvon
- Department of Pathology, AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Paris, France
| | - Nicole Brousse
- Department of Pathology AP-HP, Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Benoît Terris
- Department of Pathology, AP-HP, Centre-Université Paris Cité, Hôpital Cochin, Paris, France
| | - Capucine Picard
- Study Center of Primary Immunodeficiency, AP-HP, Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Mathieu Fusaro
- Study Center of Primary Immunodeficiency, AP-HP, Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Frédéric Rieux-Laucat
- Université de Paris, INSERM UMR1163 and Imagine Institute, Immunogenetics of Pediatric Autoimmune Diseases, Paris, France
| | - Marie-Claude Stolzenberg
- Université de Paris, INSERM UMR1163 and Imagine Institute, Immunogenetics of Pediatric Autoimmune Diseases, Paris, France
| | - Anne-Sophie Jannot
- Department of Clinical Investigation and Clinical Epidemiology, AP-HP-Centre-Université Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Matthieu Allez
- Department of Gastroenterology, AP-HP, Nord-Université Paris Cité, Hôpital Saint Louis, Paris, France
| | - Marion Malphettes
- Department of Clinical Immunology, AP-HP, Nord-Université Paris Cité, Hôpital Saint Louis, Paris, France
| | - Claire Fieschi
- Department of Clinical Immunology, AP-HP, Nord-Université Paris Cité, Hôpital Saint Louis, Paris, France
| | | | - Camille Zallot
- Department of Gastroenterology, CHRU de Nancy, Hôpitaux de Brabois, Nancy, France
| | - Xavier Roblin
- Department of Gastroenterology, CHU de Saint Etienne, Saint Etienne, France
| | - Vered Abitbol
- Department of Gastroenterology, AP-HP. Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Arthur Belle
- Department of Gastroenterology, AP-HP, Centre- Université de Paris, Hôpital Cochin, Paris, France
| | - Pauline Wils
- Department of Gastroenterology, CHRU de Lille, Lille, France
| | - Morgane Cheminant
- Department of Haematology, AP-HP, Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Lucine Vuitton
- Department of Gastroenterology, CHRU de Besançon, Hôpital Jean Minjoz, Besançon, France
| | - Philippe Pouderoux
- Department of Gastroenterology, CHRU de Nîmes, Hôpital universitaire Carémeau, Nîmes, France
| | - Laurent Abramowitz
- Department of Gastroenterology, AP-HP, Nord-Université Paris Cité, Hôpital Bichat, Paris, France
| | - Martin Castelle
- Department of Pediatric Immunology and Hematology, AP-HP, Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Felipe Suarez
- Department of Haematology, AP-HP. Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivier Hermine
- Department of Haematology, AP-HP, Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Frank Ruemmele
- Université de Paris Cité, INSERM UMR 1163 and Imagine Institute, Laboratory of Intestinal Immunity and Department of Paediatric Gastroenterology, AP-HP-Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, AP-HP-Centre-Université Paris Cité, Hôpital Cochin, Paris, France
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4
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Monmousseau F, Mulot L, Rusch E, Picon L, Laharie D, Fotsing G, Gargot D, Charpentier C, Buisson A, Trang-Poisson C, Dib N, DES Garets V, Brunet-Houdard S, Aubourg A. Predictors of each quality of life dimension in Crohn's disease patients initiating an anti-TNF treatment: differentiated effects of patient-, disease-, and treatment-related characteristics. Scand J Gastroenterol 2022; 57:566-573. [PMID: 35188859 DOI: 10.1080/00365521.2021.2025419] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS In Crohn's disease (CD), a composite therapeutic target was recently recommended, including both objective measurement (endoscopic remission) and Patient-Reported Outcomes (resolution of abdominal pain and normalization of bowel function). All dimensions of health-related quality of life (HRQoL) are impacted: not only bowel symptoms but also systemic symptoms, emotional wellbeing and social function. Thus, understanding the predictors of each HRQoL dimension would improve patient management. However, analysis of these factors has only been found in a few publications, with some limitations. Therefore, this study aimed to explore the evolution of the HRQoL of CD patients during six months after initiation of anti-TNF and to identify its predictors. METHODS We analyzed data of 56 patients included in a multicenter prospective cohort study (COQC-PIT). HRQoL measures (using IBDQ-32) and data related to patient, disease and treatment characteristics were collected every two months. Generalized estimating equations were used. RESULTS Overall HRQoL was significantly improved 2 months after anti-TNF initiation, and then stagnated. Patient, disease, and treatment characteristics have differentiated impacts on the overall score and on each dimension of quality of life. Subcutaneous anti-TNF had no significant effect on overall HRQoL, improving only emotional function and bowel symptoms. Concomitant use of corticosteroids and/or immunomodulators impaired almost all dimensions. Having children or working altered bowel symptoms. Disease duration and active smoking negatively impact emotional function and systemic symptoms. CONCLUSIONS Each HRQoL dimension, not only bowel symptoms, and their influencing factors should therefore be considered in medical decision-making, especially in months following the initiation of a new treatment such as anti-TNF.
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Affiliation(s)
- Fanny Monmousseau
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France.,EA7505 Education, Ethics, Health, University of Tours, Tours, France
| | - Lucile Mulot
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France
| | - Emmanuel Rusch
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France.,EA7505 Education, Ethics, Health, University of Tours, Tours, France
| | - Laurence Picon
- Gastroenterology Department, University Hospital Center of Tours, France
| | - David Laharie
- Gastroenterology Department, University Hospital Center of Bordeaux, France
| | - Ginette Fotsing
- Gastroenterology Department, University Hospital Center of Poitiers, France
| | - Dany Gargot
- Gastroenterology Department, Hospital Center of Blois, France
| | - Cloé Charpentier
- Gastroenterology Department, University Hospital Center of Rouen, France
| | - Anthony Buisson
- Gastroenterology Department, University Hospital Center of Clermont-Ferrand, France
| | | | - Nina Dib
- Gastroenterology Department, University Hospital Center of Angers, France
| | - Véronique DES Garets
- EA6296 VALLOREM, Loire Valley Management Research Unit, University of Tours, France
| | - Solène Brunet-Houdard
- Health-Economic Evaluation Unit, University Hospital Center of Tours, France.,EA7505 Education, Ethics, Health, University of Tours, Tours, France
| | - Alexandre Aubourg
- Gastroenterology Department, University Hospital Center of Tours, France
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- COQC-PIT Study Group: Dr Laura ARMENGOL DEBEIR, Dr Arnaud BOURREILLE, Juliette EVON, Margaux NISTAR, Geoffrey BERTHON
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5
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Bossuyt P, Dreesen E, Rimola J, Devuysere S, De Bruecker Y, Vanslembrouck R, Laurent V, Zappa M, Savoye-Collet C, Pariente B, Filippi J, Baert F, D'Haens G, Laharie D, Peyrin-Biroulet L, Vermeire S, Buisson A, Bouhnik Y, Woude JV, Van Hootegem P, Moreau J, Louis E, Franchimont D, De Vos M, Mana F, Brixi H, Allez M, Caenepeel P, Aubourg A, Oldenburg B, Pierik M, Chevret S. Infliximab Exposure Associates With Radiologic Evidence of Healing in Patients With Crohn's Disease. Clin Gastroenterol Hepatol 2021; 19:947-954.e2. [PMID: 32360982 DOI: 10.1016/j.cgh.2020.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/16/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Higher infliximab trough levels are associated with clinical and endoscopic remission in patients with Crohn's disease (CD). We investigated pharmacodynamic features of infliximab and radiological healing. METHODS We performed a substudy of the TAILORIX trial (patients with active luminal CD in Europe, treated with infliximab), analyzing baseline and week 54 magnetic resonance enterography (MRE) data. MREs were scored using the MaRIA score by blinded central readers. Radiologic response and remission were defined, based on MaRIA criteria in all segments, as scores below 11 and 7, respectively. We collected data on infliximab trough levels, biomarkers, and endoscopic findings. Our primary aim was to evaluate pharmacodynamic features associated with radiologic response and remission, based on MRE assessments at baseline and at 54 weeks after initiation of infliximab therapy. RESULTS We analyzed data from 36 patients (50% female; median age 35.7 years; interquartile age range, 25.6-48.6 years; median disease duration, 1.5 months; interquartile duration range, 0.6-22.4 months). At week 54 of treatment, 36.4% of patients had a radiologic response, 30.3% of patients were in remission, and 71% had endoscopic features of remission. At baseline, there was a correlation between the CD endoscopic index of severity and MaRIA scores (κ = 0.46; P = .008), but we found no correlation at week 54 (κ = 0.06; P = .75). Radiologic remission correlated with infliximab trough level at week 14 (P = .049) when the infliximab trough level cut-off value was set at 7.8 μg/mL (area under the curve, 0.74; 75% sensitivity; 86% specificity; 90% negative predictive value; 57% positive predictive value). Radiologic response correlated with infliximab trough levels at week 14 (P = .048) when the infliximab trough level cut-off value was set at 7.8 μg/mL (area under the curve, 0.73; 70% sensitivity; 90% specificity; 86% negative predictive value; 78% positive predictive value) and with continuous pharmacologic evidence of response (infliximab trough levels above 5.0 μg/mL at all time points) (P = .034). CONCLUSIONS In a substudy of data from the TAILORIX trial of patients with active luminal CD, we identified a relationship between exposure to infliximab and radiologic evidence of outcomes.
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Affiliation(s)
- Peter Bossuyt
- Department of Gastroenterology, Imelda GI Clinical Research Center, Imelda General Hospital, Bonheiden, Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium.
| | - Erwin Dreesen
- Department of Pharmaceutical and Pharmacological Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Sofie Devuysere
- Department of Radiology, Imelda General Hospital, Bonheiden, Belgium
| | - Yves De Bruecker
- Department of Radiology, Imelda General Hospital, Bonheiden, Belgium
| | - Ragna Vanslembrouck
- Department of Radiology, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium
| | - Valérie Laurent
- INSERM U947 and Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Magaly Zappa
- Department of Radiology, Beaujon Hospital, Clichy, France
| | - Céline Savoye-Collet
- Department of Radiology, Rouen University Hospital, Normandy University, UNIROUEN, Rouen, France
| | - Benjamin Pariente
- Department of Gastroenterology, Hospital Claude Huriez, Lille, France
| | - Jérôme Filippi
- Department of Gastroenterology, Hospital Archet, Nice, France
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Geert D'Haens
- Department of Gastroenterology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - David Laharie
- Department of Gastroenterology, Hôpital Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Laurent Peyrin-Biroulet
- INSERM U1256 NGERE and Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium
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6
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Moreau J, Hammoudi N, Marthey L, Trang-Poisson C, Nachury M, Altwegg R, Grimaud JC, Orempuller S, Hébuterne X, Aubourg A, Baudry C, Seksik P, Roblin X, Nahon S, Savoye G, Mesnard B, Stefanescu C, Simon M, Coffin B, Fumery M, Carbonnel F, Peyrin-Biroulet L, Desseaux K, Allez M. Impact of an Education Programme on IBD Patients' Skills: Results of a Randomised Controlled Multicentre Study [ECIPE]. J Crohns Colitis 2021; 15:432-440. [PMID: 32969469 DOI: 10.1093/ecco-jcc/jjaa195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Better patient knowledge on inflammatory bowel disease [IBD] could improve outcome and quality of life. The aim of this study was to assess if an education programme improves IBD patients' skills as regards their disease. METHODS The GETAID group conducted a prospective multicentre randomised controlled study. IBD patients were included at diagnosis, or after a significant event in the disease course. Patients were randomised between 'educated' or control groups for 6 months. Education was performed by trained health care professionals. A psycho-pedagogic score [ECIPE] was evaluated by a 'blinded' physician at baseline and after 6 and 12 months [M6 and M12]. The primary endpoint was the increase of ECIPE score at M6 of more than 20%. RESULTS A total of 263 patients were included in 19 centres (male:40%; median age:30.8; Crohn's disease [CD]:73%). Of these, 133 patients were randomised into the educated group and 130 into the control group. The median relative increase in ECIPE score at M6 was higher in the educated group as compared with the control group (16.7% [0-42.1%] vs 7% [0-18.8%], respectively, p = 0.0008). The primary endpoint was met in 46% vs 24% of the patients in the educated and control groups, respectively [p = 0.0003]. A total of 92 patients met the primary endpoint. In multivariate analysis, predictors of an increase of at least 20% of the ECIPE score were randomisation in the educated group (odds ratio [OR] = 2.59) and no previous surgery [OR = 1.92]. CONCLUSIONS These findings support the set-up of education programmes in centres involved in the management of IBD patients.
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Affiliation(s)
- J Moreau
- Gastroenterology Department, Hôpital Rangueil, Toulouse, France
| | - N Hammoudi
- Gastroenterology Department, APHP, Hôpital Saint-Louis, INSERM UMRS 1160, Université Paris Diderot, Sorbonne Paris-Cité University, Paris, France
| | - L Marthey
- Gastroenterology Department, Hôpital du Kremlin-Bicetre, Kremlin Bicetre, France
| | | | - M Nachury
- CHU Lille, Maladies de l'appareil digestif, Lille, France
| | - R Altwegg
- Gastroenterology Department, Hôpital St-Eloi, Montpellier, France
| | - J C Grimaud
- Gastroenterology Department, Hôpital Nord, Marseille, France
| | - S Orempuller
- Gastroenterology Department, Hôpital Rangueil, Toulouse, France
| | - X Hébuterne
- Gastroenterology Department, Hôpital Archet, Nice, France
| | - A Aubourg
- Gastroenterology Department, Hôpital Trousseau, Tours, France
| | - C Baudry
- Gastroenterology Department, APHP, Hôpital Saint-Louis, INSERM UMRS 1160, Université Paris Diderot, Sorbonne Paris-Cité University, Paris, France
| | - P Seksik
- Department of Gastroenterology, Centre de recherche Saint-Antoine, Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - X Roblin
- Gastroenterology Department, Hôpital de St-Etienne, St-Etienne, France
| | - S Nahon
- Gastroenterology Department, Hôpital de Montfermeil, Montfermeil, France
| | - G Savoye
- Gastroenterology Department, Hôpital Charles Nicolle, Rouen, France
| | - B Mesnard
- Gastroenterology Department, Hôpital Dron, Tourcoing, France
| | - C Stefanescu
- Gastroenterology Department, Hôpital Beaujon, Clichy, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Monsouris, Paris, France
| | - B Coffin
- Gastroenterology Department, Hôpital Louis Mourier, Colombes, France
| | - M Fumery
- Gastroenterology Department, Hôpital Nord, Amiens, France
| | - F Carbonnel
- Gastroenterology Department, Hôpital du Kremlin-Bicetre, Kremlin Bicetre, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - K Desseaux
- SBIM, Hôpital Saint-Louis, Paris, France
| | - M Allez
- Gastroenterology Department, APHP, Hôpital Saint-Louis, INSERM UMRS 1160, Université Paris Diderot, Sorbonne Paris-Cité University, Paris, France
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7
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Anon B, Aubourg A, Moussata D, Babuty D, Picon L. Hypercontractile esophagus resolved after radiofrequency catheter ablation for atrial fibrillation: About a case. Neurogastroenterol Motil 2020; 32:e13886. [PMID: 32483908 DOI: 10.1111/nmo.13886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/07/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/01/2023]
Abstract
The pathophysiology of jackhammer esophagus is complex and remains unclear. Radiofrequency catheter ablation is indicated for highly symptomatic and drug-refractory atrial fibrillation. This technique can induce esophageal and nerve lesions, due to thermal injury. In this report, we describe a case of hypercontractile esophagus diagnosed by HRM (high-resolution manometry). Esophageal symptoms and HRM normalized immediately after RFCA, and we discuss the pathophysiology of hypercontractile esophagus.
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Affiliation(s)
- Benjamin Anon
- Department of Gastroenterology, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Alexandre Aubourg
- Department of Gastroenterology, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Driffa Moussata
- Department of Gastroenterology, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Dominique Babuty
- Department of Cardiology, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Laurence Picon
- Department of Gastroenterology, Hôpital Trousseau, CHRU de Tours, Tours, France
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8
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Monmousseau F, Mulot L, Rusch E, Picon L, Brunet-Houdard S, Aubourg A. Étude des facteurs influençant la qualité de vie et chacune de ses dimensions chez des patients atteints de la maladie de Crohn initiant un traitement par anti-TNF. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.057] [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] Open
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9
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Ternant D, Passot C, Aubourg A, Goupille P, Desvignes C, Picon L, Lecomte T, Mulleman D, Paintaud G. Model-Based Therapeutic Drug Monitoring of Infliximab Using a Single Serum Trough Concentration. Clin Pharmacokinet 2019; 57:1173-1184. [PMID: 29236229 DOI: 10.1007/s40262-017-0621-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The pharmacokinetics of infliximab are highly variable and influence clinical response in chronic inflammatory diseases. The goal of this study was to build a Bayesian model allowing predictions of upcoming infliximab concentrations and dosing regimen adjustment, using only one concentration measurement and information regarding the last infliximab infusion. METHODS This retrospective study was based on data from 218 patients treated with infliximab in Tours University Hospital who were randomly assigned to learning (two-thirds) or validation (one-third) data subsets. One-compartment pharmacokinetic and time since last dose (TLD) models were built and compared using learning and validation subsets. From these models, Bayesian pharmacokinetic and TLD models using one concentration measurement (1C-PK and 1C-TLD) were designed. The predictive performances of the 1C-TLD model were tested on two external validation cohorts. RESULTS Pharmacokinetic and TLD models described the data satisfactorily and provided accurate parameter estimations. Comparable predictions of infliximab concentrations were obtained from pharmacokinetic versus TLD models, as well as from Bayesian 1C-PK versus 1C-TLD models. The 1C-TLD model showed satisfactory prediction of future infliximab concentrations and provided satisfactory predictions of infliximab steady-state concentration for up to three upcoming visits after a blood sample. CONCLUSIONS Accurate individual concentration predictions can be obtained using a single infliximab concentration measurement and information regarding only the last infusion. The 1C-TLD model may help to optimize the dosing regimen of infliximab in routine therapeutic drug monitoring.
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Affiliation(s)
- David Ternant
- Laboratory of Pharmacology-Toxicology, Université François-Rabelais de Tours, CNRS, UMR 7292, CHRU de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex, France. .,Laboratory of Pharmacology-Toxicology, CHRU de Tours, Tours, France.
| | - Christophe Passot
- Laboratory of Pharmacology-Toxicology, Université François-Rabelais de Tours, CNRS, UMR 7292, CHRU de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex, France.,Laboratory of Pharmacology-Toxicology, CHRU de Tours, Tours, France
| | | | - Philippe Goupille
- Laboratory of Pharmacology-Toxicology, Université François-Rabelais de Tours, CNRS, UMR 7292, CHRU de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex, France.,Department of Rheumatology, CHRU de Tours, Tours, France
| | - Céline Desvignes
- Laboratory of Pharmacology-Toxicology, Université François-Rabelais de Tours, CNRS, UMR 7292, CHRU de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex, France.,Laboratory of Pharmacology-Toxicology, CHRU de Tours, Tours, France
| | - Laurence Picon
- Department of Gastroenterology, CHRU de Tours, Tours, France
| | - Thierry Lecomte
- Laboratory of Pharmacology-Toxicology, Université François-Rabelais de Tours, CNRS, UMR 7292, CHRU de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex, France.,Department of Gastroenterology, CHRU de Tours, Tours, France
| | - Denis Mulleman
- Laboratory of Pharmacology-Toxicology, Université François-Rabelais de Tours, CNRS, UMR 7292, CHRU de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex, France.,Department of Rheumatology, CHRU de Tours, Tours, France
| | - Gilles Paintaud
- Laboratory of Pharmacology-Toxicology, Université François-Rabelais de Tours, CNRS, UMR 7292, CHRU de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex, France.,Laboratory of Pharmacology-Toxicology, CHRU de Tours, Tours, France
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10
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Auzoux J, Boschetti G, Anon B, Aubourg A, Caulet M, Poisson L, Besson P, Lecomte T, Roger S, Picon L, Nancey S, Moussata D, Flourie B. Usefulness of confocal laser endomicroscopy for predicting postoperative recurrence in patients with Crohn's disease: a pilot study. Gastrointest Endosc 2019; 90:151-157. [PMID: 30849396 DOI: 10.1016/j.gie.2019.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/19/2018] [Accepted: 02/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Confocal laser endomicroscopy (CLE) has been shown to predict relapse in inflammatory bowel disease, but its value in the detection of postoperative recurrence in Crohn's disease (CD) is unknown. The aims of this pilot study performed in patients with CD after ileocolonic resection were to compare the macroscopic appearance of the neoterminal ileum, according to the endoscopic Rutgeerts score, with the microscopic findings provided by CLE 6 to 12 months after surgery and to assess the predictive values of CLE-generated parameters for predicting further recurrence in patients with postoperative endoscopic remission. METHODS In 25 consecutive patients with CD within 6 to 12 months of surgery, the neoterminal ileum was examined by standard white-light endoscopy (Rutgeerts scale) followed by CLE (Watson grade). Only patients without endoscopic recurrence (Rutgeerts i0 and i1) were then followed endoscopically and clinically (median follow-up 38 months). RESULTS At the time of the first postoperative colonoscopy, 18 patients (72%) were in endoscopic remission, and 7 (28%) experienced an endoscopic recurrence (Rutgeerts ≥i2). The Rutgeerts score was significantly correlated with the Watson score (ρ = 0 .73; P < .0001). The Watson scores at baseline were significantly higher in patients with further endoscopic recurrence (median 2.0; interquartile range [IQR] 1.5-2.0) than in those with endoscopic remission (median 1.0; IQR 1.0-1.0; P = .032) and were significantly higher in patients with clinical relapse (medium 2.0, IQR 2.0-2.0) compared with those in clinical remission (median 1.0; IQR 1.0-1.0; P = .036). CONCLUSIONS CLE could be useful in monitoring patients with CD after intestinal resection. Further studies with a larger population are necessary to confirm these preliminary results.
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Affiliation(s)
- Julie Auzoux
- Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France
| | - Gilles Boschetti
- Department of Hepato-Gastroenterology, Lyon-Sud Hospital, Hospices Civils of Lyon, Pierre-Bénite and University Claude Bernard Lyon 1, Lyon, France
| | - Benjamin Anon
- Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France
| | - Alexandre Aubourg
- Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France
| | - Morgane Caulet
- Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France
| | | | | | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France
| | | | - Laurence Picon
- Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France
| | - Stephane Nancey
- Department of Hepato-Gastroenterology, Lyon-Sud Hospital, Hospices Civils of Lyon, Pierre-Bénite and University Claude Bernard Lyon 1, Lyon, France
| | - Driffa Moussata
- Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France; INSERM Unit 1069, Tours University, Tours, France
| | - Bernard Flourie
- Department of Hepato-Gastroenterology, Lyon-Sud Hospital, Hospices Civils of Lyon, Pierre-Bénite and University Claude Bernard Lyon 1, Lyon, France
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11
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Pineton de Chambrun G, Pariente B, Seksik P, Altwegg R, Vuitton L, Stefasnescu C, Nancey S, Aubourg A, Serrero M, Peyrin-Biroulet L, Filippi J, Viennot S, Abitbol V, Boualit M, Boureille A, Moreau J, Buisson A, Roblin X, Nachury M, Zappa M, Lambert J, Bouhnik Y. Adalimumab for patients with Crohn's disease complicated by intra-abdominal abscess: a multicentre, prospective, observational cohort study. J Crohns Colitis 2019; 13:S616. [PMID: 30794285 DOI: 10.1093/ecco-jcc/jjz045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 01/09/2023]
Abstract
doi:10.1093/ecco-jcc/jjy222 Abstract P528 from the 'Poster presentations' section of the main abstract book has been withdrawn and re-inserted as DOP63 in the 'Late-breaking abstracts' section.
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Affiliation(s)
| | - B Pariente
- Lille University Hospital, Gastroenterology, Lille, France
| | - P Seksik
- Saint-Antoine University Hospital, Gastroenterology, Paris, France
| | - R Altwegg
- Montpellier University Hospital, Gastroenterology, Montpellier, France
| | - L Vuitton
- Besancon University Hospital, Gastroenterology, Besancon, France
| | - C Stefasnescu
- Beaujon University Hospital, Gastroenterology, Clichy, France
| | - S Nancey
- Lyon University Hospital, Gastroenterology, Lyon, France
| | - A Aubourg
- Tours University Hospital, Gastroenterology, Tours, France
| | - M Serrero
- Marseille University Hospital, Gastroenterology, Marseille, France
| | - L Peyrin-Biroulet
- Nancy University Hospital, Gastroenterology, Vandoeuvre-les-Nancy, France
| | - J Filippi
- Nice University Hospital, Gastroenterology, Nice, France
| | - S Viennot
- Caen University Hospital, Gastroenterology, Caen, France
| | - V Abitbol
- Cochin University Hospital, Gastroenterology, Paris, France
| | - M Boualit
- Valenciennes General Hospital, Gastroenterology, Valenciennes, France
| | - A Boureille
- Nantes University Hospital, Gastroenterology, Nantes, France
| | - J Moreau
- Toulouse University Hospital, Gastroenterology, Toulouse, France
| | - A Buisson
- Clermont-Ferrand University Hospital, Gastroenterology, Clermont-Ferrand, France
| | - X Roblin
- Saint-Etienne University Hospital, Gastroenterology, Saint-Etienne, France
| | - M Nachury
- Lille University Hospital, Gastroenterology, Lille, France
| | - M Zappa
- Beaujon University Hospital, Radiology, Clichy, France
| | - J Lambert
- Saint-Louis University Hospital, Biostatistics, Paris, France
| | - Y Bouhnik
- Beaujon University Hospital, Gastroenterology, Clichy, France
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12
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Grimaux X, Leducq S, Goupille P, Aubourg A, Miquelestorena-Standley E, Samimi M. Ulcérations buccales aphtoïdes inaugurales d’une maladie inflammatoire chronique de l’intestin induite par le sécukinumab. Ann Dermatol Venereol 2018; 145:676-682. [DOI: 10.1016/j.annder.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/22/2018] [Accepted: 07/13/2018] [Indexed: 01/27/2023]
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13
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Le Baut G, Peyrin-Biroulet L, Bouguen G, Gornet JM, Stefanescu C, Amiot A, Laharie D, Altwegg R, Fumery M, Trang C, Vuitton L, Simon M, Gilletta de Saint Joseph C, Nahon S, Caillo L, Del Tedesco E, Plastaras L, Aubourg A, Pineton de Chambrun G, Seksik P, Viennot S. Anti-TNF therapy for genital fistulas in female patients with Crohn's disease: a nationwide study from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID). Aliment Pharmacol Ther 2018; 48:831-838. [PMID: 30194687 DOI: 10.1111/apt.14946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/27/2018] [Revised: 03/16/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genital fistulas represent a devastating complication of Crohn's disease. Only studies with small sample sizes have evaluated the efficacy of anti-TNF therapy for this complication. AIMS To assess the efficacy of anti-TNF therapy for genital fistulas complicating Crohn's disease and to identify predictive factors associated with clinical response at 1 year. METHODS Consecutive patients treated with anti-TNF therapy for genital fistulas complicating Crohn's disease from 1999 to 2016 in 19 French centres from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif were included in a retrospective cohort study. Outcome was clinical fistula closure at 1 year. RESULTS Among the 204 women with genital fistulas who received anti-TNF therapy, 131 were analysed. The first anti-TNF given was infliximab (79%), adalimumab (20%), or certolizumab (1%). At start of anti-TNF therapy, 56% of patients had seton drainage and 53% had concomitant immunosuppressive treatment. A complementary surgery was performed during the first year in 10 patients (8%). At 1 year, 37% of patients had complete clinical fistula closure, 22% had a partial response, and 41% had no response. Among patients without complementary surgery, 34% (41/121) had complete clinical fistula closure. Only complementary surgery was associated with better response on multivariate analysis (adjusted relative risk: 2.02, 95% CI: 1.25-3.26, P = 0.0043). CONCLUSIONS In the anti-TNF era, approximately one-third of patients with genital fistula in Crohn's disease had complete fistula closure at 1 year. Collaboration between surgeons and gastroenterologists appears to be very important to improve the rate of fistula closure.
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14
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D'Haens G, Vermeire S, Lambrecht G, Baert F, Bossuyt P, Pariente B, Buisson A, Bouhnik Y, Filippi J, Vander Woude J, Van Hootegem P, Moreau J, Louis E, Franchimont D, De Vos M, Mana F, Peyrin-Biroulet L, Brixi H, Allez M, Caenepeel P, Aubourg A, Oldenburg B, Pierik M, Gils A, Chevret S, Laharie D. Increasing Infliximab Dose Based on Symptoms, Biomarkers, and Serum Drug Concentrations Does Not Increase Clinical, Endoscopic, and Corticosteroid-Free Remission in Patients With Active Luminal Crohn's Disease. Gastroenterology 2018; 154:1343-1351.e1. [PMID: 29317275 DOI: 10.1053/j.gastro.2018.01.004] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [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: 07/06/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS A combination of infliximab and immunomodulators is the most efficacious treatment for Crohn's disease (CD). Patients have the best outcomes when their serum concentrations of these drugs are above a determined therapeutic threshold. We performed a prospective, randomized trial to determine whether therapeutic drug monitoring (TDM) to maintain serum levels of infliximab above 3 μg/mL produced higher rates of clinical and endoscopic remission than adapting dose based only on symptoms. METHODS We performed a double-blind trial in which 122 biologic-naïve adult patients with active CD (71 female, median age 29.8 years) received induction treatment with infliximab in combination with an immunosuppressant, from July 2012 through September 2015 at 27 centers in Europe. At week 14 of treatment, patients were randomly assigned (1:1:1) to 3 infliximab maintenance groups: dose increases (2 maximum) in steps of 2.5 mg/kg based on clinical symptoms and biomarker analysis and/or serum infliximab concentrations (dose intensification strategy [DIS]1 group); dose increase from 5 to 10 mg/kg based on the same criteria (DIS2 group); dose increase to 10 mg/kg based on clinical symptoms alone (controls). Patients' CD activity index scores, levels of C-reactive protein, fecal levels of calprotectin, and serum concentrations of infliximab were determined at baseline and at weeks 2, 4, 6, 12, and 14 of treatment, and then every 4 weeks thereafter until week 54. The primary endpoint was sustained corticosteroid-free clinical remission (CD activity index <150) from weeks 22 through 54 with no ulcers at week 54. RESULTS The primary endpoint was reached by 15 (33%) of 45 patients in the DIS1 group, 10 (27%) of 37 patients in the DIS2 group, and 16 (40%) of 40 patients in the control group (P = .50). CONCLUSIONS In a prospective randomized exploratory trial of patients with active CD, we found increasing dose of infliximab based on a combination of symptoms, biomarkers, and serum drug concentrations does not lead to corticosteroid-free clinical remission in a larger proportion of patients than increasing dose based on symptoms alone. EUDRACT NUMBER 2011-003038-14.
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Affiliation(s)
- Geert D'Haens
- Academic Medical Centre, Amsterdam, the Netherlands.
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15
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Tadbiri S, Peyrin-Biroulet L, Serrero M, Filippi J, Pariente B, Roblin X, Buisson A, Stefanescu C, Trang-Poisson C, Altwegg R, Marteau P, Vaysse T, Bourrier A, Nancey S, Laharie D, Allez M, Savoye G, Gilletta C, Gagniere C, Vuitton L, Viennot S, Aubourg A, Pelletier AL, Bouguen G, Abitbol V, Fumery M, Claudepierre P, Bouhnik Y, Amiot A. Impact of vedolizumab therapy on extra-intestinal manifestations in patients with inflammatory bowel disease: a multicentre cohort study nested in the OBSERV-IBD cohort. Aliment Pharmacol Ther 2018; 47:485-493. [PMID: 29250803 DOI: 10.1111/apt.14419] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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: 07/30/2017] [Revised: 08/26/2017] [Accepted: 10/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effectiveness of vedolizumab as a treatment for extraintestinal manifestations (EIM) is questionable due to its gut-specificity. AIM To assess effectiveness of vedolizumab for EIM in patients with inflammatory bowel disease (IBD) in a large real-life experience cohort. METHODS Between June and December 2014, 173 patients with Crohn's disease and 121 with ulcerative colitis were treated with vedolizumab. Patients were followed until week 54. EIM activity was assessed at weeks 0, 6, 14, 22, 30 and 54 by using a 3-step scale: complete remission, partial response and no response. RESULTS At baseline, 49 (16.7%) patients had EIMs of which 47 had inflammatory arthralgia/arthritis, four had cutaneous lesions and two had both rheumatologic and skin EIM. At week 54, 21 (44.7%) patients had complete remission for inflammatory arthralgia/arthritis and three (75%) for cutaneous EIM. In multivariate analysis, complete remission of inflammatory arthralgia/arthritis was associated with clinical remission of IBD (OR = 1.89, IC95% [1.05-3.41], P = .03) and recent onset of inflammatory arthralgia/arthritis (OR = 1.99, IC95% [1.12-3.52], P = .02). During the follow-up period, 34 (13.8%) patients without any EIM at baseline, developed incident cases of inflammatory arthralgia/arthritis consisting mostly of peripheral arthralgia without evidence of arthritis and 14 (4.8%) incident cases of paradoxical skin manifestation. CONCLUSION Vedolizumab therapy is commonly associated with improvement in EIM. This was associated with quiescent IBD and recent EIM. However, paradoxical skin manifestation and inflammatory arthralgia/arthritis may occur upon vedolizumab therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - P Marteau
- Lariboisière hospital, Paris, France
| | | | | | | | | | - M Allez
- Saint Louis hospital, Paris, France
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Amiot A, Serrero M, Peyrin-Biroulet L, Filippi J, Pariente B, Roblin X, Buisson A, Stefanescu C, Trang-Poisson C, Altwegg R, Marteau P, Vaysse T, Bourrier A, Nancey S, Laharie D, Allez M, Savoye G, Moreau J, Vuitton L, Viennot S, Aubourg A, Pelletier AL, Bouguen G, Abitbol V, Gagniere C, Bouhnik Y. One-year effectiveness and safety of vedolizumab therapy for inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2017; 46:310-321. [PMID: 28593685 DOI: 10.1111/apt.14167] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [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: 03/23/2017] [Revised: 04/23/2017] [Accepted: 05/09/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND We recently showed that vedolizumab is effective in patients with Crohn's disease (CD) and ulcerative colitis (UC) with prior anti-TNF failure in a multicentre compassionate early-access programme before marketing authorisation was granted to vedolizumab. AIMS To assess effectiveness and safety of vedolizumab at week 54 in patients UC and CD. METHODS Between June and December 2014, 173 patients with Crohn's disease (CD) and 121 with ulcerative colitis (UC) were treated with vedolizumab induction therapy. Among those 294 patients, 272 completed the induction period and were evaluated at the week 14 visit (161 patients with CD and 111 with UC). Disease activity was assessed using the Harvey-Bradshaw Index for CD and the partial Mayo Clinic score for UC. The primary outcome was steroid-free clinical remission at week 54. RESULTS At week 54, steroid-free clinical remission rates at week 54 were 27.2% and 40.5% in patients with CD and UC respectively. In addition, the sustained steroid-free clinical remission (from week 14 to week 54) rates were 8.1% and 19.0% respectively. No deaths were observed. Severe adverse events occurred in 17 (7.2%) patients, including six (2.5%) leading to vedolizumab discontinuation. CONCLUSION Vedolizumab is able to maintain steroid-free clinical remission in up to one-third of patients with UC and CD at week 54 with a reasonable safety profile. A significant number of patients experienced loss of response during the first year of treatment, particularly in patients with CD.
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Bacq Y, le Besco M, Lecuyer AI, Gendrot C, Potin J, Andres CR, Aubourg A. Ursodeoxycholic acid therapy in intrahepatic cholestasis of pregnancy: Results in real-world conditions and factors predictive of response to treatment. Dig Liver Dis 2017; 49:63-69. [PMID: 27825922 DOI: 10.1016/j.dld.2016.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 07/08/2016] [Revised: 09/30/2016] [Accepted: 10/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ursodeoxycholic acid (UDCA) therapy is commonly used in intrahepatic cholestasis of pregnancy (ICP). AIM To evaluate the efficacy and tolerance of UDCA in real-world conditions and to search for factors predictive of response to treatment. METHODS This observational study included 98 consecutive patients suffering from pruritus during pregnancy associated with increased ALT levels or total bile acid (TBA) concentrations, without other causes of cholestasis. The entire ABCB4 gene coding sequence was analyzed by DNA sequencing. RESULTS UDCA was prescribed until delivery in all patients (mean dose 14.0mg/kg/day; mean duration 30.4 days). Pruritus improved in 75/98 (76.5%) patients, and totally disappeared before delivery in 25/98 (25.5%). After 2-3 weeks of treatment, ALT levels decreased by more than 50% of base line in 67/86 (77.9%) patients and normalized in 34/86 (39.5%), and TBA concentrations decreased in 28/81 (34.6%). Only one patient stopped the treatment before delivery. On multivariate analysis, ALT >175IU/l before treatment was associated with improvement of pruritus (OR 2.97, 95% CI 1.12-7.89, P=0.029) and with decreased ALT (OR 18.61, 95% CI 3.94-87.99, P=0.0002). ABCB4 gene mutation was not associated with response to treatment. CONCLUSION This study supports the use of UDCA as first line therapy in ICP.
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Affiliation(s)
- Yannick Bacq
- Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France.
| | - Matthieu le Besco
- Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France
| | - Anne-Isabelle Lecuyer
- Department of Public Health and Medical Information, University Hospital of Tours, Tours, France
| | - Chantal Gendrot
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Tours, Tours, France
| | - Jérôme Potin
- Department of Obstetrics and Gynecology, University Hospital of Tours, Tours, France
| | - Christian R Andres
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Tours, Tours, France
| | - Alexandre Aubourg
- Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France
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Amiot A, Grimaud JC, Peyrin-Biroulet L, Filippi J, Pariente B, Roblin X, Buisson A, Stefanescu C, Trang-Poisson C, Altwegg R, Marteau P, Vaysse T, Bourrier A, Nancey S, Laharie D, Allez M, Savoye G, Moreau J, Gagniere C, Vuitton L, Viennot S, Aubourg A, Pelletier AL, Bouguen G, Abitbol V, Bouhnik Y. Effectiveness and Safety of Vedolizumab Induction Therapy for Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2016; 14:1593-1601.e2. [PMID: 26917043 DOI: 10.1016/j.cgh.2016.02.016] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [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: 12/21/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Phase 3 trials have shown the efficacy of vedolizumab, which binds to integrin α4β7, in patients with Crohn's disease (CD) or ulcerative colitis (UC). We investigated the effectiveness and safety of vedolizumab in patients who failed anti-tumor necrosis factor therapy. METHODS From June through December 2014, there were 173 patients with CD and 121 patients with UC who were included in a multicenter nominative compassionate early access program granted by French regulatory agencies. This program provided patients with access to vedolizumab before it was authorized for marketing. Vedolizumab (300 mg) was administered intravenously at weeks 0, 2, and 6, and then every 8 weeks. Disease activity was assessed using the Harvey-Bradshaw Index for CD and the partial Mayo Clinic score for UC. We report results obtained after the 14-week induction phase. RESULTS Among the 294 patients treated with vedolizumab (mean age, 39.5 ± 14.0 y; mean disease duration, 10.8 ± 7.6 y; concomitant steroids, 44% of cases), 276 completed the induction period, however, 18 discontinued vedolizumab because of a lack of response (n = 14), infusion-related reaction (n = 2), or infections (n = 2). At week 14, 31% of patients with CD were in steroid-free clinical remission and 51% had a response; among patients with UC, 36% were in steroid-free clinical remission and 50% had a response. No deaths were reported. Severe adverse events occurred in 24 patients (8.2%), including 15 (5.1%) that led to vedolizumab discontinuation (1 case of pulmonary tuberculosis and 1 rectal adenocarcinoma). CONCLUSIONS In a cohort of patients with CD or UC who failed previous anti-tumor necrosis factor therapy, approximately one third of patients achieved steroid-free clinical remission after 14 weeks of induction therapy with vedolizumab. This agent had an acceptable safety profile in these patients.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, EC2M3-Equipe Universitaire, Paris Est-Créteil Val de Marne University, Creteil, France.
| | - Jean-Charles Grimaud
- Hôpital Nord, Centre d'Investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | | | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Université Lille Nord de France, Lille, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Caroline Trang-Poisson
- Department of Gastroenterology, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes University, Nantes, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Philippe Marteau
- Medicosurgical Department of Digestive Diseases, Hôpital Lariboisière, AP-HP, University Denis Diderot, Paris, France
| | - Thibaud Vaysse
- Department of Gastroenterology, Bicetre University Hospital, APHP, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Inserm/UMRS 7203, UPMC Université Paris, Paris, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Matthieu Allez
- Department of Gastroenterology, Hôpital Saint Louis APHP, Paris, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University and Hospital, Rouen, France
| | - Jacques Moreau
- Department of Gastroenterology, Hôpital Rangueil, University of Toulouse, Toulouse, France
| | - Charlotte Gagniere
- Department of Gastroenterology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, EC2M3-Equipe Universitaire, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Alexandre Aubourg
- Department of Gastroenterology, Trousseau University Hospital, Tours, France
| | - Anne-Laure Pelletier
- Department of HepatoGastroenterology, Bichat Hospital, Paris 7 Denis Diderot, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
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Abitbol Y, Laharie D, Cosnes J, Allez M, Nancey S, Amiot A, Aubourg A, Fumery M, Altwegg R, Michetti P, Chanteloup E, Seksik P, Baudry C, Flamant M, Bouguen G, Stefanescu C, Bourrier A, Bommelaer G, Dib N, Bigard MA, Viennot S, Hébuterne X, Gornet JM, Marteau P, Bouhnik Y, Abitbol V, Nahon S. Negative Screening Does Not Rule Out the Risk of Tuberculosis in Patients with Inflammatory Bowel Disease Undergoing Anti-TNF Treatment: A Descriptive Study on the GETAID Cohort. J Crohns Colitis 2016; 10:1179-85. [PMID: 27402916 DOI: 10.1093/ecco-jcc/jjw129] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 02/08/2016] [Accepted: 05/26/2016] [Indexed: 12/13/2022]
Abstract
AIM to describe the characteristics of incident cases of tuberculosis [TB] despite negative TB screening tests, in patients with inflammatory bowel disease [IBD] undergoing anti-TNF treatment, and to identify the risk factors involved. METHODS A retrospective descriptive study was conducted at GETAID centers on all IBD patients undergoing anti-TNF treatment who developed TB even though their initial screening test results were negative. The following data were collected using a standardized anonymous questionnaire: IBD, and TB characteristics and evolution, initial screening methods and results, and time before anti-TNF treatment was restarted. RESULTS A total of 44 IBD patients [including 23 men; median age 37 years] were identified at 20 French and Swiss centers at which TB screening was performed [before starting anti-TNF treatment] based on Tuberculin Skin Tests [n = 25], Interferon Gamma Release Assays [n = 12], or both [n = 7]. The median interval from the start of anti-TNF treatment to TB diagnosis was 14.5 months (interquartile range [IQR] 25-75: 4.9-43.3). Pulmonary TB involvement was observed in 25 [57%] patients, and 40 [91%] had at least one extrapulmonary location. One TB patient died as the result of cardiac tamponade. Mycobacterium tuberculosis exposure was thought to be a possible cause of TB in 14 cases [32%]: 7 patients [including 6 health care workers] were exposed to occupational risks, and 7 had travelled to endemic countries. Biotherapy was restarted on 27 patients after a median period of 11.2 months [IQR 25-75: 4.4-15.2] after TB diagnosis without any recurrence of the infection. CONCLUSION Tuberculosis can occur in IBD patients undergoing anti-TNF treatment, even if their initial screening results were negative. In the present population, TB was mostly extrapulmonary and disseminated. TB screening tests should be repeated on people exposed to occupational risks and/or travelers to endemic countries. Restarting anti-TNF treatment seems to be safe.
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Affiliation(s)
- Yael Abitbol
- Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - David Laharie
- Department of Hepato-Gastroenterology, Hôpital Haut-Lévêque, Pessac, France
| | - Jacques Cosnes
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Matthieu Allez
- Department of Hepato-Gastroenterology, Hôpital Saint Louis, France
| | - Stéphane Nancey
- Department of Hepato-Gastroenterology Hôpital Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Aurélien Amiot
- Department of Hepato-Gastroenterology, Hôpital Mondor, Créteil, France
| | - Alexandre Aubourg
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Mathurin Fumery
- Department of Hepato-Gastroenterology, Hôpital Nord, Amiens, France
| | - Romain Altwegg
- Department of Hepato-Gastroenterology, Hôpital Saint-Eloi, Montpellier, France
| | - Pierre Michetti
- Department of Hepato-Gastroenterology, Hôpital La Source-Beaulieu, Lausanne, Suisse
| | - Elise Chanteloup
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Paris, France
| | - Philippe Seksik
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Clotilde Baudry
- Department of Hepato-Gastroenterology, Hôpital Saint Louis, France
| | - Mathurin Flamant
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Guillaume Bouguen
- Department of Hepato-Gastroenterology, Hôpital Pontchaillou, Rennes, France
| | - Carmen Stefanescu
- Department of Hepato-Gastroenterology, Hôpital Beaujon, Clichy, France
| | - Anne Bourrier
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Gilles Bommelaer
- Department of Hepato-Gastroenterology, Hôpital Hôtel Dieu, Clermont Ferrand, France
| | - Nina Dib
- Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marc André Bigard
- Department of Hepato-Gastroenterology, Hôpital de Brabois, Nancy, France
| | - Stephanie Viennot
- Department of Hepato-Gastroenterology, Hôpital Côte de Nacre, Caen, France
| | - Xavier Hébuterne
- Department of Hepato-Gastroenterology, Hôpital de l'Archet, Nice, France
| | - Jean-Marc Gornet
- Department of Hepato-Gastroenterology, Hôpital Saint Louis, France
| | - Philippe Marteau
- Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
| | - Yoram Bouhnik
- Department of Hepato-Gastroenterology, Hôpital Beaujon, Clichy, France
| | - Vered Abitbol
- Department of Hepato-Gastroenterology, Hôpital Cochin, Paris, France
| | - Stéphane Nahon
- Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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Passot C, Mulleman D, Bejan-Angoulvant T, Aubourg A, Willot S, Lecomte T, Picon L, Goupille P, Paintaud G, Ternant D. The underlying inflammatory chronic disease influences infliximab pharmacokinetics. MAbs 2016; 8:1407-1416. [PMID: 27589009 DOI: 10.1080/19420862.2016.1216741] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Infliximab is an anti-tumor necrosis factor monoclonal antibody approved in chronic inflammatory diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), Crohn's disease (CD) and ulcerative colitis (UC). Infliximab pharmacokinetics is variable between patients, but influence of the underlying disease was never assessed. This study aimed at assessing this influence using a cohort of patients monitored in a single center and with the same assay. Infliximab trough concentrations were determined on samples collected between weeks 0 and 22 after treatment initiation in 218 patients treated for RA, PsA, AS, CD or UC. Infliximab pharmacokinetics was analyzed by a one-compartment population model with first-order elimination rate constant. In AS patients, volume of distribution (V) and elimination clearance (CL) were 5.4 L and 0.24 L/day, respectively. In CD and UC patients, V was 49% and 52% higher than in AS, respectively, and CL was 47% and 60% higher than in AS, respectively. In RA patients, CL was 49% higher than in AS patients. Simulations showed that without methotrexate, a 3 mg/kg dosing regimen would lead only 16% of RA patients to reach the target concentration (2.5 mg/L) at week 22, whereas target concentrations would be reached in approximately half of RA patients cotreated with methotrexate, as well as half of CD (3.5 mg/L) and UC (3.7 mg/L) patients. The suboptimality of approved dosing regimens supports the development of dosing optimization based on concentration measurements.
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Affiliation(s)
- Christophe Passot
- a Université François Rabelais de Tours, CNRS, UMR, "Genetics, Immunotherapy, Chemistry and Cancer ," Tours , France.,b Laboratoire de Pharmacologie-Toxicologie , Tours , France
| | - Denis Mulleman
- a Université François Rabelais de Tours, CNRS, UMR, "Genetics, Immunotherapy, Chemistry and Cancer ," Tours , France.,c Service de Rhumatologie , Tours , France
| | - Theodora Bejan-Angoulvant
- a Université François Rabelais de Tours, CNRS, UMR, "Genetics, Immunotherapy, Chemistry and Cancer ," Tours , France.,d Service de Pharmacologie Clinique , Tours , France
| | | | | | - Thierry Lecomte
- a Université François Rabelais de Tours, CNRS, UMR, "Genetics, Immunotherapy, Chemistry and Cancer ," Tours , France.,e Service de Gastro-entérologie , Tours , France
| | | | - Philippe Goupille
- a Université François Rabelais de Tours, CNRS, UMR, "Genetics, Immunotherapy, Chemistry and Cancer ," Tours , France.,c Service de Rhumatologie , Tours , France
| | - Gilles Paintaud
- a Université François Rabelais de Tours, CNRS, UMR, "Genetics, Immunotherapy, Chemistry and Cancer ," Tours , France.,b Laboratoire de Pharmacologie-Toxicologie , Tours , France
| | - David Ternant
- a Université François Rabelais de Tours, CNRS, UMR, "Genetics, Immunotherapy, Chemistry and Cancer ," Tours , France.,b Laboratoire de Pharmacologie-Toxicologie , Tours , France
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21
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Lucas E, Aubourg A, Bacq Y, Perarnau JM. Coil extrusion from a gastric varice during sorafenib treatment for hepatocellular carcinoma. Dig Liver Dis 2011; 43:920. [PMID: 21763223 DOI: 10.1016/j.dld.2011.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/16/2011] [Revised: 05/16/2011] [Accepted: 05/29/2011] [Indexed: 12/11/2022]
Affiliation(s)
- Elodie Lucas
- Hepatogastroenterology Department, Hopital Trousseau CHRU Tours 37044 Tours Cedex 9, France
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Aubourg A, Benboubker L, Picon L, Goupille P, Maillot F. Successful autologous stem cell transplantation in Gaucher disease patient with multiple myeloma. Am J Hematol 2011; 86:529-30. [PMID: 21509799 DOI: 10.1002/ajh.22028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Guillod-Maximin E, Roy AF, Vacher CM, Aubourg A, Bailleux V, Lorsignol A, Pénicaud L, Parquet M, Taouis M. Adiponectin receptors are expressed in hypothalamus and colocalized with proopiomelanocortin and neuropeptide Y in rodent arcuate neurons. J Endocrinol 2009; 200:93-105. [PMID: 18971219 DOI: 10.1677/joe-08-0348] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Adiponectin is involved in the control of energy homeostasis in peripheral tissues through Adipor1 and Adipor2 receptors. An increasing amount of evidence suggests that this adipocyte-secreted hormone may also act at the hypothalamic level to control energy homeostasis. In the present study, we observed the gene and protein expressions of Adipor1 and Adipor2 in rat hypothalamus using different approaches. By immunohistochemistry, Adipor1 expression was ubiquitous in the rat brain. By contrast, Adipor2 expression was more limited to specific brain areas such as hypothalamus, cortex, and hippocampus. In arcuate and paraventricular hypothalamic nuclei, Adipor1, and Adipor2 were expressed by neurons and astrocytes. Furthermore, using transgenic green fluorescent protein mice, we showed that Adipor1 and Adipor2 were present in pro-opiomelanocortin (POMC) and neuropeptide Y (NPY) neurons in the arcuate nucleus. Finally, adiponectin treatment by intracerebroventricular injection induced AMP-activated protein kinase (AMPK) phosphorylation in the rat hypothalamus. This was confirmed by in vitro studies using hypothalamic membrane fractions. In conclusion, Adipor1 and Adipor2 are both expressed by neurons (including POMC and NPY neurons) and astrocytes in the rat hypothalamic nuclei. Adiponectin is able to increase AMPK phosphorylation in the rat hypothalamus. These data reinforced a potential role of adiponectin and its hypothalamic receptors in the control of energy homeostasis.
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Vacher CM, Crépin D, Aubourg A, Couvreur O, Bailleux V, Nicolas V, Férézou J, Gripois D, Gertler A, Taouis M. A putative physiological role of hypothalamic CNTF in the control of energy homeostasis. FEBS Lett 2008; 582:3832-8. [PMID: 18950628 DOI: 10.1016/j.febslet.2008.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/26/2008] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
Administration of CNTF durably reduces food intake and body weight in obese humans and rodent models. However, the involvement of endogenous CNTF in the central regulation of energy homeostasis needs to be elucidated. Here, we demonstrate that CNTF and its receptor are expressed in the arcuate nucleus, a key hypothalamic region controlling food intake, and that CNTF levels are inversely correlated to body weight in rats fed a high-sucrose diet. Thus endogenous CNTF may act, in some individuals, as a protective factor against weight gain during hypercaloric diet and could account for individual differences in the susceptibility to obesity.
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Affiliation(s)
- C-M Vacher
- Laboratoire de Neuroendocrinologie Moléculaire de la Prise Alimentaire, UMR 1197 INRA, Université Paris 11, Bâtiment 447, 91405 Orsay, France.
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Roy AF, Benomar Y, Bailleux V, Vacher CM, Aubourg A, Gertler A, Djiane J, Taouis M. Lack of cross-desensitization between leptin and prolactin signaling pathways despite the induction of suppressor of cytokine signaling 3 and PTP-1B. J Endocrinol 2007; 195:341-50. [PMID: 17951545 DOI: 10.1677/joe-07-0321] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hyperprolactinemia and hyperleptinemia occur during gestation and lactation with marked hyperphagia associated with leptin resistance. Prolactin (PRL) induces the expression of orexigenic neuropeptide Y (NPY) through the activation of JAK-2/STAT-3 signaling pathway in hypothalamic paraventricular nucleus (PVN) leading to hyperphagia. PRL may also act through the inhibition of anorexigenic effect of leptin via induction of suppressor of cytokine signaling 3 (SOCS-3). This paper aimed to co-localize PRL (PRL-R) and leptin (ObRb) receptors in the hypothalamus of female rats and investigate the possible cross-desensitization between PRL-R and ObRb. We showed that: 1) PRL-R and ObRb are expressed in the PVN and co-localized in the same neurons; 2) in lactating females leptin failed to activate JAK-2/STAT-3 signaling pathway; 3) in Chinese Hamster Ovary (CHO) stably co-expressing PRL-R and ObRb, overexposure to PRL did not affect leptin signaling but totally abolished PRL-dependent STAT-5 phosphorylation. The overexposure to leptin produces similar results with strong alteration of leptin-dependent STAT-3 phosphorylation, whereas PRL-dependent STAT-5 was not affected; and 4) CHO-ObRb/PRL-R cells overexposure to leptin or PRL induces the expression of negative regulators SOCS-3 and PTP-1B. Thus, we conclude that these negative regulators affect specifically the inducer signaling pathway; for instance, SOCS-3 induced by PRL will affect PRL-R signaling but not ObRb signaling and vice versa. Finally, the lack of cross-desensitization between PURL-R and ObRb suggests that hyperphagia observed during gestation and lactation may be attributed to a direct effect of PRL on NPYexpression, and is most likely exacerbated by the physiological leptin resistance state.
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Affiliation(s)
- A F Roy
- Neuroendocrinologie Moléculaire de la Prise Alimentaire, UMR 1197 INRA/Université Paris XI, IBAIC Bât. 447, Orsay 91405, France
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Aubourg A, d'Alteroche L, Senecal D, Gaudy C, Bacq Y. [Autoimmune thrombopenia associated with hepatitis B reactivation (reverse seroconversion) after autologous hematopoietic stem cell transplantation]. ACTA ACUST UNITED AC 2007; 31:97-9. [PMID: 17273140 DOI: 10.1016/s0399-8320(07)89335-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report a case of autoimmune thrombocytopenia associated with acute reverse seroconversion of hepatitis B in a patient who was initially hepatitis B virus surface antigen negative and hepatitis B virus surface antibody positive. Reactivation occurred 9 months after chemotherapy with anti-CD 20 monoclonal antibodies and autologous hematopoietic stem cell transplantation for lymphoma had been performed. After non specific polyglobulin injections and treatment with adefovir dipivoxil, thrombocytopenia and viral replication were controlled. Seroconversion for both HBe and HBs occurred at 5 months. Adefovir was stopped 4 months later with no relapse during fifteen months of follow-up. This case shows that patients who have had previous contact with hepatitis B virus should be monitored if they become immunosuppressed, even if anti-HBs were initially present.
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Aubourg A, Ayoub J, Bacq Y, Arbeille P. [Asymptomatic pneumothorax diagnosis on pre-biopsy sonogram of the liver]. ACTA ACUST UNITED AC 2006; 87:667-99. [PMID: 16788542 DOI: 10.1016/s0221-0363(06)74061-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Liver biopsy is an invasive procedure which is widely used for the management of liver diseases. An asymptomatic pneumothorax was detected on sonography prior to biopsy for chronic hepatitis C. The complications from biopsy, potentially severe, are decreased by ultrasound guidance. Currently, ultrasound guidance is recommended at the time of liver biopsy.
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Affiliation(s)
- A Aubourg
- Service d'Hépato-Gastroentérologie, CHU Trousseau 37044 Tours Cedex.
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Lkhider M, Pétridou B, Aubourg A, Ollivier-Bousquet M. Prolactin signalling to milk protein secretion but not to gene expression depends on the integrity of the Golgi region. J Cell Sci 2001; 114:1883-91. [PMID: 11329375 DOI: 10.1242/jcs.114.10.1883] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Prolactin added to the incubation medium of lactating mammary epithelial cells is transported from the basal to the apical region of cells through the Golgi region and concomitantly stimulates arachidonic acid release and protein milk secretion. We report that when PRL is added after disorganisation of the Golgi apparatus by brefeldin A treatment, prolactin signalling to expression of genes for milk proteins and prolactin endocytosis are not affected. However, prolactin transport to the apical region of cells (transcytosis), as well as prolactin-induced arachidonic acid release and subsequent stimulation of the secretion of caseins, which are located in a post-Golgi compartment, are inhibited. This inhibition was not a consequence of damage to the secretory machinery, as under the same conditions, protein secretion could be stimulated by the addition of arachidonic acid to the incubation medium. Thus, it is possible to discriminate between prolactin-induced actions that are dependent (signalling to milk protein secretion) or independent (signalling to milk gene expression) on the integrity of the Golgi apparatus. These results suggest that these two biological actions may be transduced via distinct intracellular pathways, and support the hypothesis that prolactin signals may be emitted at various cellular sites.
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Affiliation(s)
- M Lkhider
- Faculté des Sciences, UCD, El Jadida, Maroc
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Pauloin A, Delpal S, Chanat E, Lavialle F, Aubourg A, Ollivier-Bousquet M. Brefeldin A differently affects basal and prolactin-stimulated milk protein secretion in lactating rabbit mammary epithelial cells. Eur J Cell Biol 1997; 72:324-36. [PMID: 9127732] [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] [Indexed: 02/04/2023] Open
Abstract
When lactating mammary epithelial cells were treated with prolactin in vitro, numerous small vesicles rapidly accumulated in the Golgi area, and secretion of milk proteins increased. The effects of brefeldin A on these intracellular events were investigated. As observed by electron microscopy, stacks of the median Golgi were not altered after incubation in the presence of 50 nM brefeldin A but were dissociated when the drug concentration was > or = 500 nM. Small vesicles did not accumulate in the Golgi area when mammary cells were incubated in medium containing both prolactin and brefeldin A, whatever the concentration of the latter. Immunofluorescence experiments showed that 50 nM brefeldin A did not modify the localization of the CTR 433 median Golgi protein, but it induced redistribution of trans-Golgi network-associated proteins such as TGN38, AP-1 adaptor and clathrin. These effects occurred in the presence of brefeldin A plus prolactin. Pulse-chase experiments showed that brefeldin A concentrations > or = 100 nM induced the intracellular accumulation of milk proteins, provoked the appearance of immature forms of caseins, and inhibited milk protein secretion. In contrast, concentrations of brefeldin A of < or = 50 nM did not affect basal casein secretion but inhibited the secretagogue effect of prolactin. These data show not only that several biochemical events in the transport of milk proteins which are sensitive to different brefeldin A concentrations occur in lactating mammary epithelial cells, but also that it is possible to inhibit a hormonal stimulus in a selective manner, while the machinery responsible for basal secretion is still active.
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Affiliation(s)
- A Pauloin
- INRA, Centre de Recherche de Jouy, France
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Seddiki T, Delpal S, Aubourg A, Ollivier-Bousquet M. Two monoclonal antibodies against prolactin-receptor are internalized in epithelial mammary cells without mimetic prolactin effect on casein secretion. Biol Cell 1994; 81:227-35. [PMID: 7696976 DOI: 10.1016/0248-4900(94)90005-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prolactin exerts an early stimulatory effect on casein secretion which was qualified as a secretagogue effect. After binding to its receptor, the hormone transits intracellularly through the mammary epithelial cell. When this transit is slowed down the secretagogue effect does not occur. Different monoclonal antibodies which bind to the rabbit prolactin receptor have been previously developed. One of them (A917) mimics prolactin effect on casein gene expression. Another (M110) blocks this prolactin effect. In order to study the respective role of the hormone and its receptor, we have examined the binding of the two monoclonal antibodies (M110 and A917), labeled with biotin or colloidal gold, to the receptor of lactating rabbit mammary epithelial cells in incubation. Subsequently, the intracellular movement of these antibodies and the secretory response have been measured. Irrespective of the labeling (biotin or colloidal gold) or the preparation of tissues (fragments or enzymatically dissociated cells), M110 and A917 bound to the basal membrane of mammary epithelial cells. However, only M110 bound to apical membrane of dissociated cell when this membrane was in direct contact with the incubation medium, showing that the two antibodies discriminate the receptor located on the apical membrane. Following internalization, each antibody was carried via a peculiar pathway. M110 remained associated with the cells during a 1-h incubation, mainly in endosomes, multivesicular bodies and lysosomes like vesicles. In contrast, A917 was very quickly detectable in endosomes, multivesicular bodies and vesicles of the Golgi region and was carried throughout the cell to the lumen of the acini. M110 and A917 were extremely rare in secretory vesicles containing casein micelles.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T Seddiki
- Laboratoire de Biologie Cellulaire et Moléculaire, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
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Ollivier-Bousquet M, Aubourg A. The possible involvement of protein kinase C(s) and inositol phosphate metabolism in the basal but not in the prolactin stimulated casein release by the lactating rabbit mammary epithelial cell. Reprod Nutr Dev 1992; 32:441-51. [PMID: 1292481 DOI: 10.1051/rnd:19920504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The secretagogue effect of prolactin (PRL) on casein release by epithelial mammary cells has been previously related to stimulation of the phospholipase A2-arachidonic acid cascade. In order to determine whether other intracellular pathways are implicated in this secretagogue effect, different agents acting on protein kinase C (PKC) and phospholipase C (PLC) activity have been assessed in vitro in lactating rabbit mammary gland fragments. Phorbol ester (20 nm TPA and 1-oleoyl-2-acetyl-sn-glycerol (10 microM (OAG) stimulated newly synthesized casein secretion and potentiated the PRL secretatogue effect. However, 100 microM quercetin, 100 microM H-7 and 5 and 20 nM staurosporine did not inhibit the latter effect. Exogenous PLC did not stimulate casein secretion. PRL did not affect production of inositol phosphates (IPs) during 10 or 60 min exposure. These results show that PKC activation may increase basal levels of casein secretion, and demonstrate that PRL does not act primarily via PKC activation or by PLC activation to stimulate casein secretion.
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Affiliation(s)
- M Ollivier-Bousquet
- INRA, Laboratoire de Biologie Cellulaire et Moléculaire, Jouy-en-Josas, France
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