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Chevalier K, Thoreau B, Michel M, Godeau B, Agard C, Papo T, Sacre K, Seror R, Mariette X, Cacoub P, Benhamou Y, Levesque H, Goujard C, Lambotte O, Bonnotte B, Samson M, Ackermann F, Schmidt J, Duhaut P, Kahn JE, Hanslik T, Costedoat-Chalumeau N, Terrier B, Regent A, Dunogue B, Cohen P, Guern VL, Hachulla E, Chaigne B, Mouthon L. Clinical presentation, course, and prognosis of patients with mixed connective tissue disease: A multicenter retrospective cohort. J Intern Med 2024; 295:532-543. [PMID: 38013625 DOI: 10.1111/joim.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The objective of this study is to better characterize the features and outcomes of a large population of patients with mixed connective tissue disease (MCTD). METHODS We performed an observational retrospective multicenter cohort study in France. Patients who fulfilled at least one diagnostic criterion set for MCTD and none of the criteria for other differentiated CTD (dCTD) were included. RESULTS Three hundred and thirty patients (88% females, median [interquartile range] age of 35 years [26-45]) were included. The diagnostic criteria of Sharp or Kasukawa were met by 97.3% and 93.3% of patients, respectively. None met other classification criteria without fulfilling Sharp or Kasukawa criteria. After a median follow-up of 8 (3-14) years, 149 (45.2%) patients achieved remission, 92 (27.9%) had interstitial lung disease, 25 (7.6%) had pulmonary hypertension, and 18 (5.6%) died. Eighty-five (25.8%) patients progressed to a dCTD, mainly systemic sclerosis (15.8%) or systemic lupus erythematosus (10.6%). Median duration between diagnosis and progression to a dCTD was 5 (2-11) years. The presence at MCTD diagnosis of an abnormal pattern on nailfold capillaroscopy (odds ratio [OR] = 2.44, 95% confidence interval [95%CI] [1.11-5.58]) and parotid swelling (OR = 3.86, 95%CI [1.31-11.4]) were statistically associated with progression to a dCTD. Patients who did not progress to a dCTD were more likely to achieve remission at the last follow-up (51.8% vs. 25.9%). CONCLUSIONS This study shows that MCTD is a distinct entity that can be classified using either Kasukawa or Sharp criteria, and that only 25.8% of patients progress to a dCTD during follow-up.
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Affiliation(s)
- Kevin Chevalier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Marc Michel
- Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil (UPEC), Créteil, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, University of Nantes, Nantes, France
| | - Thomas Papo
- Department of Internal Medicine, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Karim Sacre
- Department of Internal Medicine, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Raphaèle Seror
- Department of Rheumatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU de Rouen, UniRouen, Rouen, France
| | - Hervé Levesque
- Department of Internal Medicine, CHU de Rouen, UniRouen, Rouen, France
| | - Cécile Goujard
- Department of Internal Medicine and Clinical Immunology, Université Paris Saclay, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, UMR1184 Inserm, CEA, Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- Department of Internal Medicine and Clinical Immunology, Université Paris Saclay, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, UMR1184 Inserm, CEA, Le Kremlin Bicêtre, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Jean Schmidt
- Department of Internal Medicine and RECIF, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Pierre Duhaut
- Department of Internal Medicine and RECIF, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Thomas Hanslik
- Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alexis Regent
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Bertrand Dunogue
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Véronique Le Guern
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, North-West National Reference Center for Rare Systemic Autoimmune Diseases iques et Auto-Immunes Rares du Nord-Ouest, Hôpital Claude Huriez, Université de Lille, Lille, France
| | - Benjamin Chaigne
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Gnaba S, Sukhachev D, Pascreau T, Ackermann F, Delcominette F, Habarou F, Védrenne A, Jolly E, Sukhacheva E, Farfour E, Vasse M. Can Haematological Parameters Discriminate COVID-19 from Influenza? J Clin Med 2023; 13:186. [PMID: 38202193 PMCID: PMC10780240 DOI: 10.3390/jcm13010186] [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] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Symptoms of COVID-19 are similar to the influenza virus, but because treatments and prognoses are different, it is important to accurately and rapidly differentiate these diseases. The aim of this study was to evaluate whether the analysis of complete blood count (CBC), including cellular population (CPD) data of leukocytes and automated flow cytometry analysis, could discriminate these pathologies. In total, 350 patients with COVID-19 and 102 patients with influenza were included between September 2021 and April 2022 in the tertiary hospital of Suresnes (France). Platelets were lower in patients with influenza than in patients with COVID-19, whereas the CD16pos monocyte count and the ratio of the CD16pos monocytes/total monocyte count were higher. Significant differences were observed for 9/56 CPD of COVID-19 and flu patients. A logistic regression model with 17 parameters, including among them 11 CPD, the haemoglobin level, the haematocrit, the red cell distribution width, and B-lymphocyte and CD16pos monocyte levels, discriminates COVID-19 patients from flu patients. The sensitivity and efficiency of the model were 96.2 and 86.6%, respectively, with an area under the curve of 0.862. Classical parameters of CBC are very similar among the three infections, but CPD, CD16pos monocytes, and B-lymphocyte levels can discriminate patients with COVID-19.
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Affiliation(s)
- Sahar Gnaba
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
| | | | - Tiffany Pascreau
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
- INSERM Hémostase Inflammation Thrombose HITh U1176, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, 92150 Suresnes, France;
| | - Frédérique Delcominette
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
| | - Florence Habarou
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
| | - Aurélie Védrenne
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
| | - Emilie Jolly
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
| | | | - Eric Farfour
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
| | - Marc Vasse
- Biology Department, Foch Hospital, 92150 Suresnes, France; (S.G.); (T.P.); (F.D.); (F.H.); (A.V.); (E.J.); (E.F.)
- INSERM Hémostase Inflammation Thrombose HITh U1176, Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
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Stammler R, Nguyen Y, Yelnik C, Le Guern V, Lambert M, Paule R, Hachulla E, Mouthon L, Dupré A, Ackermann F, Dufrost V, Wahl D, Godeau B, Leroux G, Benhamou Y, Lazaro E, Daugas E, Bezanahary H, Mekinian A, Piette JC, Morel N, Costedoat-Chalumeau N. Precipitating factors of catastrophic antiphospholipid syndrome: the role of anticoagulant treatment in a series of 112 patients. J Thromb Haemost 2023; 21:1258-1265. [PMID: 36792010 DOI: 10.1016/j.jtha.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The prevention of catastrophic antiphospholipid syndrome (CAPS), a rare complication of antiphospholipid syndrome (APS), is a major goal. OBJECTIVES We analyzed its precipitating factors, focusing on anticoagulation immediately before CAPS episodes. METHODS We retrospectively analyzed patients in the French multicenter APS/systemic lupus erythematosus database with at least 1 CAPS episode. Then we compared each patient with known APS before CAPS with 2 patients with non-CAPS APS matched for age, sex, center, and APS phenotype. RESULTS We included 112 patients with CAPS (70% women; mean age, 43 ± 15 years). At least 1 standard precipitating factor of CAPS was observed for 67 patients (64%), which were mainly infections (n = 28, 27%), pregnancy (n = 23, 22%), and surgery (n = 16, 15%). Before the CAPS episode, 67 (60%) patients already had a diagnosis of APS. Of the 61 treated with anticoagulants, 32 (48%) received vitamin K antagonists (VKAs), 23 (34%) heparin, and 2 (3%) a direct oral anticoagulant. They were less likely than their matched patients with APS without CAPS to receive VKA (48% vs 66%, p = .001). Among those treated with VKA, 72% had a subtherapeutic international normalized ratio (ie, <2) versus 28% in patients with APS without CAPS (p < .001). Finally, excluding pregnant patients (n = 14) for whom we could not differentiate the effect of treatment from that of pregnancy, we were left with 47 cases, 32 (68%) of whom had recently begun a direct oral anticoagulant, planned bridging therapy, or had VKA treatment with international normalized ratio <2. CONCLUSION These results strongly suggest that suboptimal anticoagulation management can trigger CAPS in patients with thrombotic APS.
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Affiliation(s)
- Romain Stammler
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Yann Nguyen
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Cécile Yelnik
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France
| | - Véronique Le Guern
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Marc Lambert
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France
| | - Romain Paule
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Eric Hachulla
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France
| | - Luc Mouthon
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Anastasia Dupré
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Félix Ackermann
- Department of Internal Medicine and Clinical Immunology, Foch Hospital, Referral Center for Hypereosinophilic Syndromes, Suresnes, France
| | - Virginie Dufrost
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU Nancy, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU Nancy, France
| | - Bertrand Godeau
- Department of Internal Medicine and Clinical Immunology, Mondor Hospital, Paris France
| | - Gaëlle Leroux
- Department of Internal Medicine and Clinical Immunology, AP-HP, La Pitié-Salpêtrière Hospital, Referral Center for Rare Autoimmune and Systemic Diseases, Paris, France; and Sorbonne University
| | - Ygal Benhamou
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier de Rouen, Rouen, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier de Bordeaux, Bordeaux, France
| | - Eric Daugas
- Department of Nephrology, AP-HP, Bichat Hospital, Paris, France
| | - Holy Bezanahary
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Arsène Mekinian
- Department of Internal Medicine and Clinical Immunology, APHP, Saint Antoine Hospital, Paris, France
| | - Jean-Charles Piette
- Department of Internal Medicine and Clinical Immunology, AP-HP, La Pitié-Salpêtrière Hospital, Referral Center for Rare Autoimmune and Systemic Diseases, Paris, France; and Sorbonne University
| | - Nathalie Morel
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France; Université Paris Cité, Center for Epidemiology and Statistics, Institut national de la santé et de la recherche médicale, French National Institute for Agricultural Research, Paris, France.
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Stammler R, Nguyen Y, Yelnik C, Le Guern V, Lambert M, Paule R, Mouthon L, Dupré A, Ackermann F, Dufrost V, Godeau B, Leroux G, Benhamou Y, Lazaro E, Daugas E, Bezanahary H, Mekinian A, Piette J, Morel N, Costedoat-Chalumeau N. Facteurs précipitants la survenue d’un syndrome catastrophique des antiphospholipides : étude du rôle du traitement anticoagulant. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.070] [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: 12/12/2022]
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Chevalier K, Thoreau B, Chaigne B, Seror R, Mariette X, Papo T, Sacre K, Lambotte O, Goujard C, Ackermann F, Paule R, Kahn J, Hanslik T, Costedoat-Chalumeau N, Terrier B, Dunogué B, Cohen P, Le Guern V, Hachulla E, Mouthon L. Présentation clinique, évolution et pronostic des patients atteints de connectivite mixte : cohorte rétrospective multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.075] [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: 12/12/2022]
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Stoeklé HC, Ackermann F, Beuzeboc P, Hervé C. Vaccine refusal and burnout: Hospitals need "emergency multidisciplinary team meetings". J Eval Clin Pract 2022; 28:493-494. [PMID: 35349216 PMCID: PMC9114915 DOI: 10.1111/jep.13676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Henri-Corto Stoeklé
- Department of Ethics and Scientific Integrity, Foch Hospital, Suresnes, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Philippe Beuzeboc
- Department of Oncology and Supportive Care, Foch Hospital, Suresnes, France
| | - Christian Hervé
- Department of Ethics and Scientific Integrity, Foch Hospital, Suresnes, France.,University of Paris Cité, Paris, France.,Veterinary Academy of France, Paris, France.,International Academy of Medical Ethics and Public Health, University of Paris, Paris, France
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Legendre P, Couture P, Ponsoye M, Marroun I, Ackermann F, Comarmond C. [Weakness and weight loss in a 62 year-old patient]. Rev Med Interne 2022; 43:444-447. [PMID: 35606201 DOI: 10.1016/j.revmed.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Affiliation(s)
- P Legendre
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - P Couture
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - M Ponsoye
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - I Marroun
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Ackermann
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - C Comarmond
- Service de médecine interne, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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Ivasilevitch A, Stoeklé HC, Ackermann F, Bizard A, Hervé C. Chapitre 8. COVID-19: the danger of blindly applying the "steepest curve". J Int Bioethique Ethique Sci 2022; Vol. 32:151-153. [PMID: 35521955 DOI: 10.3917/jibes.324.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Drawing lessons from the first wave of Covid-19, and the management of the pandemic by the French health authorities, this article questions the “steepest curve” argument –an argument that consists, in a situation of radical uncertainty, and by “precaution”, in systematically projecting the worst-case scenario. But, is this rationale of anticipating the worst that might happen pertinent for dealing with crises? This is not what practices teach us, by which gentler slopes, “average” slopes, discovered day by day in the light of experience, have emerged. This article therefore aims to defend another paradigm in the management of uncertainty: that of a phronesis, a prudence guided by practices.
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Mariette X, Hermine O, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P, Bureau S, Dougados M, Tibi A, Azoulay E, Cadranel J, Emmerich J, Fartoukh M, Guidet B, Humbert M, Lacombe K, Mahevas M, Pene F, Pourchet-Martinez V, Schlemmer F, Yazdanpanah Y, Baron G, Perrodeau E, Vanhoye D, Kedzia C, Demerville L, Gysembergh-Houal A, Bourgoin A, Dalibey S, Raked N, Mameri L, Alary S, Hamiria S, Bariz T, Semri H, Hai DM, Benafla M, Belloul M, Vauboin P, Flamand S, Pacheco C, Walter-Petrich A, Stan E, Benarab S, Nyanou C, Montlahuc C, Biard L, Charreteur R, Dupré C, Cardet K, Lehmann B, Baghli K, Madelaine C, D'Ortenzio E, Puéchal O, Semaille C, Savale L, Harrois A, Figueiredo S, Duranteau J, Anguel N, Pavot A, Monnet X, Richard C, Teboul JL, Durand P, Tissieres P, Jevnikar M, Montani D, Bulifon S, Jaïs X, Sitbon O, Pavy S, Noel N, Lambotte O, Escaut L, Jauréguiberry S, Baudry E, Verny C, Noaillon M, Lefèvre E, Zaidan M, Le Tiec CLT, Verstuyft C, Roques AM, Grimaldi L, Molinari D, Leprun G, Fourreau A, Cylly L, Virlouvet M, Meftali R, Fabre S, Licois M, Mamoune A, Boudali Y, Georgin-Lavialle S, Senet P, Pialoux G, Soria A, Parrot A, François H, Rozensztajn N, Blin E, Choinier P, Camuset J, Rech JS, Canellas A, Rolland-Debord C, Lemarié N, Belaube N, Nadal M, Siguier M, Petit-Hoang C, Chas J, Drouet E, Lemoine M, Phibel A, Aunay L, Bertrand E, Ravato S, Vayssettes M, Adda A, Wilpotte C, Thibaut P, Fillon J, Debrix I, Fellahi S, Bastard JP, Lefèvre G, Fallet V, Gottenberg JE, Hansmann Y, Andres E, Bayer S, Becker G, Blanc F, Brin S, Castelain V, Chatelus E, Chatron E, Collange O, Danion F, De Blay F, Demonsant E, Diemunsch P, Diemunsch S, Felten R, Goichot B, Greigert V, Guffroy A, Heger B, Hutt A, Kaeuffer C, Kassegne L, Korganow AS, Le Borgne P, Lefebvre N, Martin T, Mertes PM, Metzger C, Meyer N, Nisand G, Noll E, Oberlin M, Ohlmann-Caillard S, Poindron V, Pottecher J, Ruch Y, Sublon C, Tayebi H, Weill F, Mekinian A, Abisror N, Jachiet V, Chopin D, Fain O, Garnier M, Krause le Garrec J, Morgand M, Pacanowski J, Urbina T, McAvoy C, Pereira M, Aratus G, Berard L, Simon T, Daguenel-Nguyen A, Antignac M, Leplay C, Arlet JB, Diehl JL, Bellenfant F, Blanchard A, Buffet A, Cholley B, Fayol A, Flamarion E, Godier A, Gorget T, Hamada SR, Hauw-Berlemont C, Hulot JS, Lebeaux D, Livrozet M, Michon A, Neuschwander A, Penet MA, Planquette B, Ranque B, Sanchez O, Volle G, Briois S, Cornic M, Elisee V, Jesuthasan D, Djadi-Prat J, Jouany P, Junquera R, Henriques M, Kebir A, Lehir I, Meunier J, Patin F, Paquet V, Tréhan A, Vigna V, Sabatier B, Bergerot D, Jouve C, Knosp C, Lenoir O, Mahtal N, Resmini L, Lescure FX, Ghosn J, BACHELARD A, BIRONNE T, BORIE R, BOUNHIOL A, BOUSSARD C, CHAUFFiER J, CHALAL S, CHALAL L, CHANSOMBAT M, CRESPIN P, CRESTANI B, DACONCEICAO O, DECONINCK L, DIEUDE P, DOSSIER A, DUBERT M, DUCROCQ G, FUENTES A, GERVAIS A, GILBERT M, ISERNIA V, ISMAEL S, JOLY V, JULIA Z, LARIVEN S, LE GAC S, LE PLUART D, LOUNI F, NDIAYE A, PAPO T, PARISEY M, PHUNG B, POURBAIX A, RACHLINE A, RIOUX C, SAUTEREAU A, STEG G, TARHINI H, VALAYER S, VALLOIS D, VERMES P, VOLPE T, Nguyen Y, Honsel V, Weiss E, Codorniu A, Zarrouk V, De Lastours V, Uzzan M, Olivier O, Rossi G, Gamany N, Rahli R, Louis Z, Boutboul D, Galicier L, Amara Y, Archer G, Benattia A, Bergeron A, Bondeelle L, De Castro N, Clément M, Darmont M, Denis B, Dupin C, Feredj E, Feyeux D, Joseph A, Lengliné E, Le Guen P, Liégeon G, Lorillon G, Mabrouki A, Mariotte E, Martin de Frémont G, Mirouse A, Molina JM, Peffault de Latour R, Oksenhendler E, Saussereau J, Tazi A, Tudesq JJ, Zafrani L, Brindele I, Bugnet E, Celli Lebras K, Chabert J, Djaghout L, Fauvaux C, Jegu AL, Kozaliewicz E, Meunier M, Tremorin MT, Davoine C, Madeleine I, Caillat-Zucman S, Delaugerre C, Morin F, SENE D, BURLACU R, CHOUSTERMAN B, MEGARBANE B, RICHETTE P, RIVELINE JP, FRAZIER A, VICAUT E, BERTON L, HADJAM T, VASQUEZ-IBARRA MA, JOURDAINE C, JACOB A, SMATI J, RENAUD S, MANIVET P, PERNIN C, SUAREZ L, Semerano L, ABAD S, Benainous R, Bloch Queyrat C, Bonnet N, Brahmi S, Cailhol J, Cohen Y, Comparon C, Cordel H, Dhote R, Dournon N, Duchemann B, Ebstein N, Giroux-Leprieur B, Goupil de Bouille J, Jacolot A, Nunes H, Oziel J, Rathouin V, Rigal M, Roulot D, Tantet C, Uzunhan Y, COSTEDOAT-CHALUMEAU N, Ait Hamou Z, Benghanem S, BLANCHE P, CANOUI E, CARLIER N, CHAIGNE B, CONTEJEAN A, DUNOGUE B, DUPLAND P, DUREL - MAURISSE A, GAUZIT R, JAUBERT P, Joumaa H, Jozwiak M, KERNEIS S, LACHATRE M, Lafoeste H, LEGENDRE P, LUONG NGUYEN LB, MAREY J, MORBIEU C, MOUTHON L, NGUYEN L, Palmieri LJ, REGENT A, SZWEBEL TA, TERRIER B, GUERIN C, ZERBIT J, CHEREF K, CHITOUR K, CISSE MS, CLARKE A, CLAVERE G, DUSANTER I, GAUDEFROY C, JALLOULI M, KOLTA S, LE BOURLOUT C, MARIN N, MENAGE N, MOORES A, PEIGNEY I, PIERRON C, SALEH-MGHIR S, VALLET M, MICHEL M, MELICA G, LELIEVRE JD, FOIS E, LIM P, MATIGNON M, GUILLAUD C, THIEMELE A, SCHMITZ D, BOUHRIS M, BELAZOUZ S, LANGUILLE L, MEKONTSO-DESSAPS A, SADAOUI T, Mayaux J, Cacoub P, Corvol JC, Louapre C, Sambin S, Mariani LL, Karachi C, Tubach F, Estellat C, Gimeno L, Martin K, Bah A, Keo V, Ouamri S, Messaoudi Y, Yelles N, Faye P, Cavelot S, Larcheveque C, Annonay L, Benhida J, Zahrate-Ghoul A, Hammal S, Belilita R, Lecronier M, Beurton A, Haudebourg L, Deleris R, Le Marec J, Virolle S, Nemlaghi S, Bureau C, Mora P, De Sarcus M, Clovet O, Duceau B, Grisot PH, Pari MH, Arzoine J, Clarac U, Faure M, Delemazure J, Decavele M, Morawiec E, Demoule A, Dres M, Vautier M, Allenbach Y, Benveniste O, Leroux G, Rigolet A, Guillaume-Jugnot P, Domont F, Desbois AC, Comarmond C, Champtiaux N, Toquet S, Ghembaza A, Vieira M, Maalouf G, Boleto G, Ferfar Y, Charbonnier F, AGUILAR C, ALBY-LAURENT F, ALYANAKIAN MA, BAKOUBOULA P, BROISSAND C, BURGER C, CAMPOS-VEGA C, CHAVAROT N, CHOUPEAUX L, FOURNIER B, GRANVILLE S, ISSORAT E, ROUZAUD C, VIMPERE D, Geri G, Derridj N, Sguiouar N, Meddah H, Djadel M, Chambrin-Lauvray H, Duclos-Vallée JC, Saliba F, Sacleux SC, Koumis I, Michot JM, Stoclin A, Colomba E, Pommeret F, Willekens C, Sakkal M, Da Silva R, Dejean V, Mekid Y, Ben-Mabrouk I, Pradon C, Drouard L, Camara-Clayette V, Morel A, Garcia G, Mohebbi A, Berbour F, Dehais M, Pouliquen AL, Klasen A, Soyez-Herkert L, London J, Keroumi Y, Guillot E, Grailles G, El Amine Y, Defrancq F, Fodil H, Bouras C, Dautel D, Gambier N, Dieye T, Razurel A, Bienvenu B, Lancon V, Lecomte L, Beziriganyan K, Asselate B, Allanic L, Kiouris E, Legros MH, Lemagner C, Martel P, Provitolo V, Ackermann F, Le Marchand M, Clan Hew Wai A, Fremont D, Coupez E, Adda M, Duée F, Bernard L, Gros A, Henry E, Courtin C, Pattyn A, Guinot PG, Bardou M, Maurer A, Jambon J, Cransac A, Pernot C, Mourvillier B, Servettaz A, Deslée G, Wynckel A, Benoit P, Marquis E, Roux D, Gernez C, Yelnik C, Poissy J, Nizard M, Denies F, Gros H, Mourad JJ, Sacco E, Renet S. Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial. The Lancet Rheumatology 2022; 4:e24-e32. [PMID: 34812424 PMCID: PMC8598187 DOI: 10.1016/s2665-9913(21)00315-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Bayesian randomised, adaptive, phase 2/3 clinical trial, nested within the CORIMUNO-19 cohort, to test a superiority hypothesis. Patients 18 years or older hospitalised with COVID-19 in six French centres, requiring at least 3L/min of oxygen but without ventilation assistance and a WHO Clinical Progression Scale [CPS] score of 5 were enrolled. Patients were randomly assigned (1:1) via a web-based system, according to a randomisation list stratified on centre and with blocks randomly selected among 2 and 4, to receive usual care plus 400 mg of sarilumab intravenously on day 1 and on day 3 if clinically indicated (sarilumab group) or usual care alone (usual care group). Primary outcomes were the proportion of patients with WHO-CPS scores greater than 5 on the 10-point scale on day 4 and survival without invasive or non-invasive ventilation at day 14. This completed trial is closed to new participants and is registered with ClinicalTrials.gov, NCT04324073. Findings 165 patients were recruited from March 27 to April 6, 2020, and 148 patients were randomised (68 patients to the sarilumab group and 80 to the usual care group) and followed up for 90 days. Median age was 61·7 years [IQR 53·0–71·1] in the sarilumab group and 62·8 years [56·0–71·7] in the usual care group. In the sarilumab group 49 (72%) of 68 were men and in the usual care group 59 (78%) of 76 were men. Four patients in the usual care group withdrew consent and were not analysed. 18 (26%) of 68 patients in the sarilumab group had a WHO-CPS score greater than 5 at day 4 versus 20 (26%) of 76 in the usual care group (median posterior absolute risk difference 0·2%; 90% credible interval [CrI] −11·7 to 12·2), with a posterior probability of absolute risk difference greater than 0 of 48·9%. At day 14, 25 (37%) patients in the sarilumab and 26 (34%) patients in the usual care group needed ventilation or died, (median posterior hazard ratio [HR] 1·10; 90% CrI 0·69–1·74) with a posterior probability HR greater than 1 of 37·4%. Serious adverse events occurred in 27 (40%) patients in the sarilumab group and 28 (37%) patients in the usual care group (p=0·73). Interpretation Sarilumab treatment did not improve early outcomes in patients with moderate-to-severe COVID-19 pneumonia. Further studies are warranted to evaluate the effect of sarilumab on long-term survival. Funding Assistance publique—Hôpitaux de Paris
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Breillat P, Mariampillai K, Martins P, Legendre P, Dunogue B, Charuel JL, Miyara M, Vanquaethem H, Ackermann F, Benveniste O, Mouthon L, Nunes H, Allenbach Y, Uzunhan Y. POS0323 ANTI PM-SCL ASSOCIATED AUTO IMMUNE DISEASES: MULTICENTRIC COHORT OF 128 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Autoantibodies permit to classify and subgroup connective tissue diseases (CTD) in homogeneous groups of patients in terms of phenotype and prognosis. Anti PM-Scl antibodies have been associated with different CTD categories such as: idiopathic inflammatory myositis (IIM), systemic sclerosis (SSc), Sjögren’s syndrome (SjS), systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD) or undifferentiated connective tissue disease (UCTD).Objectives:To determine clinical spectrum of anti-PM-Scl associated disease and if it an homogenous condition.Methods:This multicentric (four hospitals) observational and retrospective study included all consecutive patients with positive testing for anti PM-Scl antibodies on immunoblot assay and connective tissue disease (2011 -2020). Epidemiological, biological, clinical and radiological data were collected in standard form as well as patient’s outcome.Results:One hundred twenty height patients (female n=96;75%) were included. Median [quartiles] age at diagnosis was 50 [18;84] (IQR) and follow-up duration of 7 [3.75-12] years. Seventy-six (59.3%) patients were simple anti-Pm-Scl positive, and 40.7% were associated with other antibodies: anti-SSA/Ro52 (n=13; 10.92%), SSc associated antibodies (n=21; 16.4%), anti-dsDNA for (n=9; 7%), anti-RNP (n=6; 4.7%) and anti-CCP antibodies (n=6; 4.7%). Most patients had cutaneous involvement (n=106; 83%) with skin thickening (n=47; 36%), mechanics hands (n= 28; 22%), calcinosis (n=26; 20.3%) and subcutaneous edema (n=20; 15.62%). Vascular involvement was frequent with Raynaud phenomenon (n= 89; 69%), telangiectasia (n=36; 28%), skin ulcers (n=27; 21%), pulmonary hypertension (n=8/120; 6.7%) and scleroderma renal crisis (n=2; 1.5%). A majority of patients also displayed an interstitial lung disease (ILD) (n=83; 65.8%); nonspecific interstitial pneumonia (92.7%) and/or organizing pneumonia (25.3%). ILD was characterized by a subacute onset in 37/81 (45.7%); median [quartiles] forced vital capacity (FVC) and total lung capacity (TLC) at diagnosis of 88% [73-105] and 79.5% [68.5-101] respectively. Sixty patients (47%) had muscular sign including myalgia (47%), elevated CPK (n=51; 40%) and muscular weakness (Medical Research Council score <4) (n=19/124;15%). Finally, fifty-three (41.7%) had gastroesophageal reflux. Thirty-nine patients (30.4%) experienced at least one muscular or ILD relapse and 6 (4.84%) died during follow-up (2 breast cancer, 1 pneumonia, 3 unknown etiology). Concerning patients’ prognosis, relapses were associated with skeletal (n=29, 74.4% vs n=32, 35.96%, p < 0.001) or cardiac muscle involvement (n=7, 18.4% vs n=2, 2.5%, p=0.007), and subacute ILD (n=19, 65.5% vs n=18, 34.62%, p= 0.05) with organized pneumonia pattern (n=11, 32.3% vs n=10, 13.9%, p=0.05). Strikingly, ILD occurred mainly in men (90.6% vs 57.2%, p < 0.001) and was associated with anti-Scl-70 positivity (n=14, 16.67% vs 0%, p= 0.01). Muscle involvement was associated arthralgia (n=46, 76.67% vs n=34, 50.75%, p=0.005), respiratory signs at diagnosis: dyspnea NYHA ≥3 (n=46, 75.41% vs n=30, 44.78%, p < 0.001), sub-acute ILD (n=24, 61.54% vs n=13, 30.95%, p=0.0111) with lower FVC (73% [64;88] vs 98 [76;105], p < 0.001). Ulcers were associated with Anti-Scl70 positivity (n=9, 33.33% vs n=5, 4.95%, p < 0.001), Raynaud phenomenon (n=27, 100% vs n=62, 61.39%, p < 0.001), digestive involvement (n=20, 74.07% vs n=34, 33.66%, p < 0.001), ILD with chronic onset (n=15, 78.95% vs n=29, 46.77%, p=0.027) and increased incidence of deaths (n=4, 16% vs n=2, 2.02%, p= 0.01).Conclusion:Conducted on the largest cohort of Anti-PM-Scl patients, this study highlights two main phenotypes that determine different outcome and prognosis. One was associated with muscular disease and subacute onset ILD with more frequent relapses. The second with a vascular phenotype associated with chronic ILD, digestive involvement, chronic evolution and increased incidence of death. This could lead to a reclassification of PM-Scl associated auto immune diseases.Disclosure of Interests:None declared
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Réau V, Terrier B, Ackermann F, Killian M, Hamidou M, Meyer G, Osorio-Perez F, Rohmer J, Lefèvre G, Kahn J, Groh M. Présentation clinique et facteurs de risque de rechute au cours des thromboses veineuses associées à une hyperéosinophilie : étude multicentrique rétrospective à propos de 54 patients. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Danlos FX, Ackermann F, Rohmer J, Roumier M, Marabelle A, Michot JM. High levels of TNFα in patients with COVID-19 refractory to tocilizumab. Eur J Cancer 2021; 149:102-104. [PMID: 33848711 PMCID: PMC7980142 DOI: 10.1016/j.ejca.2021.01.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 12/29/2022]
Affiliation(s)
- F X Danlos
- INSERM U1015, Gustave Roussy Villejuif, France
| | | | | | | | - A Marabelle
- INSERM U1015, Gustave Roussy Villejuif, France; Département D'Innovation Thérapeutique et D'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France.
| | - J M Michot
- Département D'Innovation Thérapeutique et D'Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
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Réau V, Vallée A, Terrier B, Plessier A, Abisror N, Ackermann F, Benainous R, Bohelay G, Chabi-Charvillat ML, Cornec D, Desbois AC, Faguer S, Freymond N, Gaillet A, Hamidou M, Killian M, Le Jeune S, Marchetti A, Meyer G, Osorio-Perez F, Panel K, Rautou PE, Rohmer J, Simon N, Tcherakian C, Vasse M, Zuelgaray E, Lefevre G, Kahn JE, Groh M. Venous thrombosis and predictors of relapse in eosinophil-related diseases. Sci Rep 2021; 11:6388. [PMID: 33737704 PMCID: PMC7973521 DOI: 10.1038/s41598-021-85852-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Eosinophils have widespread procoagulant effects. Eosinophilic cardiovascular toxicity mostly consists of endomyocardial damage or eosinophilic vasculitis, while reported cases of venous thrombosis (VT) are scarce. We aimed to report on the clinical features and treatment outcomes of patients with unexplained VT and eosinophilia, and to identify predictors of relapse. This retrospective, multicenter, observational study included patients aged over 15 years with VT, concomitant blood eosinophilia ≥ 1G/L and without any other moderate-to-strong contributing factors for VT. Fifty-four patients were included. VT was the initial manifestation of eosinophil-related disease in 29 (54%) patients and included pulmonary embolism (52%), deep venous thrombosis (37%), hepatic (11%) and portal vein (9%) thromboses. The median [IQR] absolute eosinophil count at VT onset was 3.3G/L [1.6-7.4]. Underlying eosinophil-related diseases included FIP1L1-PDGFRA-associated chronic myeloid neoplasm (n = 4), Eosinophilic Granulomatosis with Polyangiitis (n = 9), lymphocytic (n = 1) and idiopathic (n = 29) variants of hypereosinophilic syndrome. After a median [IQR] follow-up of 24 [10-62] months, 7 (13%) patients had a recurrence of VT. In multivariate analysis, persistent eosinophilia was the sole variable associated with a shorter time to VT relapse (HR 7.48; CI95% [1.94-29.47]; p = 0.015). Long-term normalization of eosinophil count could prevent the recurrence of VT in a subset of patients with unexplained VT and eosinophilia ≥ 1G/L.
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Affiliation(s)
- Valériane Réau
- Department of Internal and Geriatric Medicine, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,National Reference Center for Hypereosinophilic Syndromes, CEREO, France
| | - Alexandre Vallée
- Department of Clinical Research and Innovation (DRCI), Hôpital Foch, 92150, Suresnes, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Plessier
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Noémie Abisror
- Department of Internal Medicine, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Félix Ackermann
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Ruben Benainous
- Department of Internal Medicine, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Gérôme Bohelay
- Department of Dermatology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | | | - Divi Cornec
- Department of Rheumatology, Brest University Hospital, Brest, France
| | - Anne-Claire Desbois
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stanislas Faguer
- Department of Nephrology, Toulouse University Hospital, Toulouse, France
| | | | - Antoine Gaillet
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Martin Killian
- Department of Internal Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Sylvain Le Jeune
- Department of Internal Medicine, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Anne Marchetti
- Department of Dermatology, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Guy Meyer
- Pulmonology and Intensive Care Service, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Kewin Panel
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Pierre-Emmanuel Rautou
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Julien Rohmer
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France
| | - Nicolas Simon
- Department of Internal Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Marc Vasse
- Department of Clinical Biology, Foch Hospital, Suresnes, France.,UMR-S INSERM 1176, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Elina Zuelgaray
- Department of Dermatology, Saint Louis, Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Lefevre
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France.,Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndromes, CEREO, France. .,Department of Internal Medicine, Hôpital Foch, 40, rue Worth, 92151, Suresnes Cedex, France.
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Roumier M, Paule R, Vallée A, Rohmer J, Ballester M, Brun AL, Cerf C, Chabi ML, Chinet T, Colombier MA, Farfour E, Fourn E, Géri G, Khau D, Marroun I, Ponsoye M, Roux A, Salvator H, Schoindre Y, Si Larbi AG, Tchérakian C, Vasse M, Verrat A, Zuber B, Couderc LJ, Kahn JE, Groh M, Ackermann F. Tocilizumab for Severe Worsening COVID-19 Pneumonia: a Propensity Score Analysis. J Clin Immunol 2020; 41:303-314. [PMID: 33188624 PMCID: PMC7666405 DOI: 10.1007/s10875-020-00911-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Background High levels of serum interleukin-6 (IL-6) correlate with disease severity in COVID-19. We hypothesized that tocilizumab (a recombinant humanized anti-IL-6 receptor) could improve outcomes in selected patients with severe worsening COVID-19 pneumonia and high inflammatory parameters. Methods The TOCICOVID study included a prospective cohort of patients aged 16–80 years with severe (requiring > 6 L/min of oxygen therapy to obtain Sp02 > 94%) rapidly deteriorating (increase by ≥ 3 L/min of oxygen flow within the previous 12 h) COVID-19 pneumonia with ≥ 5 days of symptoms and C-reactive protein levels > 40 mg/L. They entered a compassionate use program of treatment with intravenous tocilizumab (8 mg/kg with a maximum of 800 mg per infusion; and if needed a second infusion 24 to 72 h later). A control group was retrospectively selected with the same inclusion criteria. Outcomes were assessed at D28 using inverse probability of treatment weighted (IPTW) methodology. Results Among the 96 patients included (81% male, mean (SD) age: 60 (12.5) years), underlying conditions, baseline disease severity, and concomitant medications were broadly similar between the tocilizumab (n = 49) and the control (n = 47) groups. In the IPTW analysis, treatment with tocilizumab was associated with a reduced need for overall ventilatory support (49 vs. 89%, wHR: 0.39 [0.25–0.56]; p < 0.001). Albeit lacking statistical significance, there was a substantial trend towards a reduction of mechanical ventilation (31% vs. 45%; wHR: 0.58 [0.36–0.94]; p = 0.026). However, tocilizumab did not improve overall survival (wHR = 0.68 [0.31–1.748], p = 0.338). Among the 85 (89%) patients still alive at D28, patients treated with tocilizumab had a higher rate of oxygen withdrawal (82% vs. 73.5%, wHR = 1.66 [1.17–2.37], p = 0.005), with a shorter delay before being weaned of oxygen therapy (mean 11 vs. 16 days; p < 0.001). At D28, the rate of patients discharged from hospital was higher in the tocilizumab group (70% vs. 40%, wHR = 1.82 [1.22–2.75]; p = 0.003). The levels of CRP and fibrinogen post therapy (p < 0.001 for both variables) were significantly lower in the tocilizumab group (interaction test, mixed model). Rates of neutropenia (35% vs. 0%; p < 0.001) were higher in the tocilizumab group, yet rates of infections (22% vs. 38%, p = 0.089) including ventilator-acquired pneumonia (8% vs. 26%, p = 0.022) were higher in the control group. Conclusion These data could be helpful for the design of future trials aiming to counter COVID-19-induced inflammation, especially before patients require admission to the intensive care unit. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-020-00911-6.
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Affiliation(s)
- Mathilde Roumier
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Romain Paule
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, AP-HP, Hôtel-Dieu Hospital, Paris-Descartes University, Paris, France
| | - Julien Rohmer
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Marie Ballester
- Emergency Department, Foch Hospital, F-92151, Suresnes, France
| | - Anne-Laure Brun
- Department of Radiology, Foch Hospital, F-92151, Suresnes, France
| | - Charles Cerf
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | | | - Thierry Chinet
- Department of Respiratory Medicine, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France.,Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | | | - Eric Farfour
- Department of Clinical Biology & INSERM UMRS-1176, Foch Hospital, F-92151, Suresnes, France
| | - Erwan Fourn
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Guillaume Géri
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France.,INSERM UMR 1018, Villejuif, France
| | - David Khau
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Ibrahim Marroun
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Antoine Roux
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Hélène Salvator
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Yoland Schoindre
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Anne-Gaëlle Si Larbi
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | - Colas Tchérakian
- Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Marc Vasse
- Department of Clinical Biology & INSERM UMRS-1176, Foch Hospital, F-92151, Suresnes, France
| | - Anne Verrat
- Emergency Department, Foch Hospital, F-92151, Suresnes, France
| | - Benjamin Zuber
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | - Louis-Jean Couderc
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Jean-Emmanuel Kahn
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Internal Medicine, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France.
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15
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Rohmer J, Couteau‐Chardon A, Trichereau J, Panel K, Gesquiere C, Ben Abdelali R, Bidet A, Bladé J, Cayuela J, Cony‐Makhoul P, Cottin V, Delabesse E, Ebbo M, Fain O, Flandrin P, Galicier L, Godon C, Grardel N, Guffroy A, Hamidou M, Hunault M, Lengline E, Lhomme F, Lhermitte L, Machelart I, Mauvieux L, Mohr C, Mozicconacci M, Naguib D, Nicolini FE, Rey J, Rousselot P, Tavitian S, Terriou L, Lefèvre G, Preudhomme C, Kahn J, Groh M, Ackermann F, Adiko D, Ahwij N, Baruchel A, Beal C, Bemba M, Beylot Barry M, Beyne Rauzy O, Bielefeld P, Boisseau M, Bonmati C, Bonnote B, Borel C, Bouredji D, Brignier A, Brouillard M, Campos F, Carre M, Chalayer E, Chomel JC, Coiteux V, Contejean A, Corby A, Darre S, Dubruille V, Durel CA, El Yamani A, Etancelin P, Etienne N, Evon P, Gyan E, Hachulla E, Hermet M, Huguet F, Ianotto JC, Inchiappa L, Jdid I, Jondeau K, Joubert M, Legrand F, Lejeune C, Le Pendu C, Lidove O, Lemal R, Limal N, Lopinet E, Maloisel F, Marfaing A, Marroun I, Maurier F, Muller E, Muron T, Ojeda M, Paule R, Pignon JM, Rossi C, Roumier M, Sene D, Sene T, Simon L, Slama B, Suarez F, Tcherakian C, Torregrosa JM, Toussaint E, Vatan R, Visanica S, Voilat L, Zini JM. Epidemiology, clinical picture and long-term outcomes of FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia: Data from 151 patients. Am J Hematol 2020; 95:1314-1323. [PMID: 32720700 DOI: 10.1002/ajh.25945] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
Abstract
FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia (F/P+ MN-eo) is a rare disease: robust epidemiological data are lacking and reported issues are scarce, of low sample-size and limited follow-up. Imatinib mesylate (IM) is highly efficient but no predictive factor of relapse after discontinuation has yet been identified. One hundred and fifty-one patients with F/P+ MN-eo (143 males; mean age at diagnosis 49 years; mean annual incidence: 0.18 case per million population) were included in this retrospective nationwide study involving all French laboratories who perform the search of F/P fusion gene (study period: 2003-2019). The main organs involved included the spleen (44%), skin (32%), lungs (30%), heart (19%) and central nervous system (9%). Serum vitamin B12 and tryptase levels were elevated in 74/79 (94%) and 45/57 (79%) patients, respectively, and none of the 31 patients initially treated with corticosteroids achieved complete hematologic remission. All 148 (98%) IM-treated patients achieved complete hematologic and molecular (when tested, n = 84) responses. Forty-six patients eventually discontinued IM, among whom 20 (57%) relapsed. In multivariate analysis, time to IM initiation (continuous HR: 1,01 [0.99-1,03]; P = .05) and duration of IM treatment (continuous HR: 0,97 [0,95-0,99]; P = .004) were independent factors of relapse after discontinuation of IM. After a mean follow-up of 80 (56) months, the 1, 5- and 10-year overall survival rates in IM-treated patients were 99%, 95% and 84% respectively. In F/P+ MN-eo, prompt initiation of IM and longer treatment durations may prevent relapses after discontinuation of IM.
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Affiliation(s)
- Julien Rohmer
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine Hôpital Foch Suresnes France
| | - Amélie Couteau‐Chardon
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Intensive Care medicine Centre Hospitalier Annecy Genevois Saint‐Julien‐en‐Genevois France
| | - Julie Trichereau
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Clinical Research Department Hôpital Foch Suresnes France
| | - Kewin Panel
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Clinical Research Department Hôpital Foch Suresnes France
| | - Cyrielle Gesquiere
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
| | - Raouf Ben Abdelali
- Pole Hématologie et Oncologie Laboratoire CERBA Saint‐Ouen‐l'Aumône France
| | - Audrey Bidet
- Laboratory of Hematology CHU de Bordeaux Pessac France
| | | | - Jean‐Michel Cayuela
- Laboratory of Hematology Saint‐Louis Hospital, University of Paris Paris France
| | - Pascale Cony‐Makhoul
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Hematology Department CH Annecy Genevois Annecy France
| | - Vincent Cottin
- National Coordinating Reference Center for Rare Pulmonary Diseases Louis Pradel Hospital Lyon France
- Hospices Civils de Lyon, UMR754, University Claude Bernard Lyon 1 Lyon France
| | - Eric Delabesse
- Laboratory of Hematology Institut Universitaire du Cancer de Toulouse Oncopole, CHU de Toulouse Toulouse France
| | - Mikaël Ebbo
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Aix Marseille University, Department of Internal Medicine Hôpital de la Timone, AP‐HM, CNRS, INSERM, CIML Marseille France
| | - Olivier Fain
- Department of Internal Medicine CHU Saint Antoine Paris France
| | - Pascale Flandrin
- Laboratory of Hematology Hôpital Nord, CHU de Saint‐Étienne Saint‐Étienne France
| | - Lionel Galicier
- Department of Clinical Immunology Saint Louis hospital Paris France
| | - Catherine Godon
- Laboratoire de cytogénétique hématologique CHU de Nantes Nantes France
| | | | - Aurélien Guffroy
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (RESO), Tertiary Center for Primary Immunodeficiency Strasbourg University Hospital Strasbourg France
| | - Mohamed Hamidou
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine CHU de Nantes Nantes France
| | | | | | | | - Ludovic Lhermitte
- University of Paris, Institut National de Recherche Médicale U1151 Laboratory of Onco‐Hematology, Hôpital Necker Enfants‐Malades Paris France
| | - Irène Machelart
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine CHU de Bordeaux Bordeaux France
| | - Laurent Mauvieux
- Université de Strasbourg, INSERM U1113 Interface de Recherche Fondamentale et Appliquée en Cancérologie, Laboratoire d'hématologie du CHRU Strasbourg, Faculté de Médecine de Strasbourg Strasbourg France
| | - Catherine Mohr
- Service d'Hématologie Oncologie, CHU Groupe Hospitalier Sud Réunion Saint Pierre, Reunion France
| | - Marie‐Joelle Mozicconacci
- Institut Paoli‐Calmettes, Centre de Recherche en Cancérologie de Marseille, Biopathologie Marseille France
| | - Dina Naguib
- Laboratory of Hematology CHU Caen Caen France
| | - Franck E. Nicolini
- Department of Hematology INSERM U 1052, CRCL, Centre Léon Bérard Lyon France
| | - Jerome Rey
- Department of Hematology Institut Paoli‐Calmettes Marseille France
| | - Philippe Rousselot
- Hematology Department Versailles André Mignot Hospital, University Paris‐Saclay Le Chesnay France
| | - Suzanne Tavitian
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse‐Oncopole Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Louis Terriou
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université de Lille, CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto‐immunes Systémiques Rares du Nord et Nord‐Ouest de France (CeRAINO) Lille France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université de Lille, CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto‐immunes Systémiques Rares du Nord et Nord‐Ouest de France (CeRAINO) Lille France
| | | | - Jean‐Emmanuel Kahn
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université Paris‐Saclay, Department of Internal Medicine Ambroise Paré hospital, Boulogne Billancourt Cedex France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine Hôpital Foch Suresnes France
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16
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Lhote R, Chilles M, Groh M, Puéchal X, Guilpain P, Ackermann F, Amoura Z, Annesi-Maesano I, Barba T, Catherinot E, Cohen-Aubart F, Cohen P, Cottin V, Couderc LJ, De Boysson H, Delbrel X, Dominique S, Duhaut P, Fain O, Hachulla E, Hamidou M, Kahn JE, Legendre C, Le Quellec A, Lhote F, Lifermann F, Mathian A, Néel A, Nunes H, Subra JF, Terrier B, Mouthon L, Diot E, Guillevin L, Brillet PY, Tcherakian C. Spectrum and Prognosis of Antineutrophil Cytoplasmic Antibody-associated Vasculitis-related Bronchiectasis: Data from 61 Patients. J Rheumatol 2020; 47:1522-1531. [PMID: 31787599 DOI: 10.3899/jrheum.190313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To report on a large series of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and bronchiectasis, with a specific focus on the timeline of occurrence of both features. METHODS Retrospective nationwide multicenter study of patients diagnosed with both AAV and bronchiectasis. RESULTS Sixty-one patients were included, among whom 27 (44.25%) had microscopic polyangiitis (MPA), 27 (44.25%) had granulomatosis with polyangiitis (GPA), and 7 (11.5%) had eosinophilic GPA. Thirty-nine (64%) had myeloperoxidase (MPO)-ANCA and 13 (21%) had proteinase 3-ANCA. The diagnosis of bronchiectasis either preceded (n = 25; median time between both diagnoses: 16 yrs, IQR 4-54 yrs), was concomitant to (n = 12), or followed (n = 24; median time between both diagnoses: 1, IQR 0-6 yrs) that of AAV. Patients in whom bronchiectasis precedes the onset of AAV (B-AAV group) have more frequent mononeuritis multiplex, MPA, MPO-ANCA, and a 5-fold increase of death. The occurrence of an AAV relapse tended to be protective against bronchiectasis worsening (HR 0.6, 95% CI 0.4-0.99, P = 0.049), while a diagnosis of bronchiectasis before AAV (HR 5.8, 95% CI 1.2-28.7, P = 0.03) or MPA (HR 18.1, 95% CI 2.2-146.3, P = 0.01) were associated with shorter survival during AAV follow-up. CONCLUSION The association of bronchiectasis with AAV is likely not accidental and is mostly associated with MPO-ANCA. Patients in whom bronchiectasis precedes the onset of AAV tend to have distinct clinical and biological features and could carry a worse prognosis.
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Affiliation(s)
- Raphael Lhote
- R. Lhote, MD, Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220, and Sorbonne Université, University of Pierre and Marie Curie (UPMC), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris
| | - Marie Chilles
- M. Chilles, MD, Department of Internal Medicine, Orléans, and Department of Internal Medicine, CHU, Tours
| | - Matthieu Groh
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Xavier Puéchal
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Philippe Guilpain
- Philippe Guilpain, MD, PhD, A. Le Quellec, MD, PhD, Department of Internal Medicine, Saint Eloi Hospital, Montpellier
| | - Félix Ackermann
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Zahir Amoura
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Isabella Annesi-Maesano
- I. Annesi-Maesano, MD, PhD, Sorbonne Université, UPMC, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris
| | - Thomas Barba
- T. Barba, MD, V. Cottin, MD, PhD, Department of Pulmonology, Louis Pradel Hospital, Lyon
| | - Emilie Catherinot
- E. Catherinot, MD, PhD, L.J. Couderc, MD, C. Tcherakian, MD, PhD, 1Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220
| | - Fleur Cohen-Aubart
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Pascal Cohen
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Vincent Cottin
- T. Barba, MD, V. Cottin, MD, PhD, Department of Pulmonology, Louis Pradel Hospital, Lyon
| | - Louis-Jean Couderc
- E. Catherinot, MD, PhD, L.J. Couderc, MD, C. Tcherakian, MD, PhD, 1Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220
| | - Hubert De Boysson
- H. De Boysson, MD, Departments of Internal Medicine, University Hospital, Caen
| | - Xavier Delbrel
- X. Delbrel, MD, Department of Internal Medicine, François Mitterand Hospital, Pau
| | - Stéphane Dominique
- S. Dominique, MD, Department of Pulmonology Department, Charles Nicolle University Hospital, Rouen
| | - Pierre Duhaut
- P. Duhaut, MD, PhD, Department of Internal Medicine, University Hospital, Amiens
| | - Olivier Fain
- Olivier Fain, MD, PhD, Department of Internal Medicine, Saint Antoine Hospital, Paris
| | - Eric Hachulla
- E. Hachulla, MD, PhD, Department of Internal Medicine, Centre de Reference des Maladies Auto-immunes Systémique Rares du Nord et du Nord-Ouest de France (CeRAINO), CHRU de Lille, Université de Lille, Lille
| | - Mohamed Hamidou
- M. Hamidou, MD, PhD, A. Néel, MD, PhD, Department of Internal Medicine, CHU, Nantes
| | - Jean-Emmanuel Kahn
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Christophe Legendre
- Christophe Legendre, MD, PhD, Department of Nephrology, Necker Enfants Malades Hospital, Paris
| | - Alain Le Quellec
- Philippe Guilpain, MD, PhD, A. Le Quellec, MD, PhD, Department of Internal Medicine, Saint Eloi Hospital, Montpellier
| | - François Lhote
- F. Lhote, MD, Department of Internal Medicine, Delafontaine Hospital, Saint Denis
| | | | - Alexis Mathian
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Antoine Néel
- M. Hamidou, MD, PhD, A. Néel, MD, PhD, Department of Internal Medicine, CHU, Nantes
| | - Hilario Nunes
- H. Nunes, MD, PhD, Department of Pulmonology, Avicenne Hospital, Bobigny
| | - Jean-François Subra
- J.F. Subra, MD, PhD, Department of Nephrology-Dialysis-Transplantation, Angers University Hospital, Angers
| | - Benjamin Terrier
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Luc Mouthon
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Elisabeth Diot
- E. Diot, MD, PhD, Department of Internal Medicine, CHU, Tours
| | - Loïc Guillevin
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Pierre-Yves Brillet
- P.Y. Brillet, MD, PhD, Department of Radiology, Avicenne Hospital, Bobigny, France
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Blanchet B, Jallouli M, Allard M, Ghillani-Dalbin P, Galicier L, Aumaître O, Chasset F, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Sellam J, Mariette X, Goulvestre C, Hulot JS, Amoura Z, Vidal M, Piette JC, Jourde-Chiche N, Costedoat-Chalumeau N. Hydroxychloroquine levels in patients with systemic lupus erythematosus: whole blood is preferable but serum levels also detect non-adherence. Arthritis Res Ther 2020; 22:223. [PMID: 32977856 PMCID: PMC7517694 DOI: 10.1186/s13075-020-02291-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022] Open
Abstract
Background Hydroxychloroquine (HCQ) levels can be measured in both serum and whole blood. No cut-off point for non-adherence has been established in serum nor have these methods ever been compared. The aims of this study were to compare these two approaches and determine if serum HCQ cut-off points can be established to identify non-adherent patients. Methods HCQ levels were measured in serum and whole blood from 573 patients with systemic lupus erythematosus (SLE). The risk factors for active SLE (SLEDAI score > 4) were identified by multiple logistic regression. Serum HCQ levels were measured in 68 additional patients known to be non-adherent, i.e. with whole-blood HCQ < 200 ng/mL. Results The mean (± SD) HCQ levels were 469 ± 223 ng/mL in serum and 916 ± 449 ng/mL in whole blood. The mean ratio of serum/whole-blood HCQ levels was 0.53 ± 0.15. In the multivariate analysis, low whole-blood HCQ levels (P = 0.023), but not serum HCQ levels, were independently associated with active SLE. From the mean serum/whole-blood level ratio, a serum HCQ level of 106 ng/mL was extrapolated as the corresponding cut-off to identify non-adherent patients with a sensitivity of 0.87 (95% CI 0.76–0.94) and specificity of 0.89 (95% CI 0.72–0.98). All serum HCQ levels of patients with whole-blood HCQ below the detectable level (< 20 ng/mL) were also undetectable (< 20 ng/mL). Conclusions These data suggest that whole blood is better than serum for assessing the pharmacokinetic/pharmacodynamic relation of HCQ. Our results support the use of serum HCQ levels to assess non-adherence when whole blood is unavailable.
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Affiliation(s)
- Benoit Blanchet
- AP-HP, Hôpital Cochin, Biologie du médicament - Toxicologie, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Moez Jallouli
- Service de Médecine interne, Hôpital Hédi Chaker, Sfax, Tunisie
| | - Marie Allard
- Université Paris-Diderot, Sorbonne Paris-Cité, F-75205, Paris, France.,AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, 46 rue Henri-Huchard, 75018, Paris, France
| | - Pascale Ghillani-Dalbin
- AP-HP, Hôpital Pitié-Salpêtrière, Département d'immunologie, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Lionel Galicier
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Saint Louis, service d'immunologie clinique, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Olivier Aumaître
- Université de Clermont-Ferrand, 63003, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de médecine interne, 58 rue Montalembert, 63003, Clermont-Ferrand cedex1, France
| | - François Chasset
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Tenon, service de dermatologie allergologie, 4 rue de la Chine, 75020, Paris, France
| | - Véronique Le Guern
- AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Frédéric Lioté
- Université de Paris, F-75205, Paris, France.,AP-HP, Hôpital Lariboisière, service de rhumatologie, DMU Locomotion, 2 rue Ambroise Paré, 75010, Paris, France
| | - Amar Smail
- CHU Amiens, Hôpital Nord, service de médecine interne, Place Victor Pauchet, 80000, Amiens, France
| | - Nicolas Limal
- AP-HP, Hôpital Henri Mondor, service de médecine interne, 51 avenue du Maréchal de Tassigny, 94000, Créteil, France
| | - Laurent Perard
- Centre Hospitalier Saint Joseph Saint Luc, service de médecine interne, 20 quai Claude Bernard, 69007, Lyon, France
| | - Hélène Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, 5 place d'Arsonval, 69003, Lyon, France
| | - Du Le Thi Huong
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence pour le Lupus Systémique et le syndrome des Antiphospholipides, service de médecine interne, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Bouchra Asli
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Saint Louis, service d'immunologie clinique, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Jean-Emmanuel Kahn
- Servie de Médecine Interne, Hôpital Ambroise Paré, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France
| | - Laurent Sailler
- Université Paul-Sabatier, Toulouse, France.,CHU Toulouse, Hôpital Purpan, Service de Médecine Interne, Place Dr Baylac, F-31059, Toulouse, France
| | - Félix Ackermann
- Hôpital Foch, Service de médecine interne, 92150, Suresnes, France
| | - Thomas Papo
- Université Paris-Diderot, Sorbonne Paris-Cité, F-75205, Paris, France.,AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, 46 rue Henri-Huchard, 75018, Paris, France
| | - Karim Sacré
- Université Paris-Diderot, Sorbonne Paris-Cité, F-75205, Paris, France.,AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, 46 rue Henri-Huchard, 75018, Paris, France
| | - Olivier Fain
- Sorbonne Université, Hôpital Saint Antoine, APHP, service de médecine interne, F 75012, Paris, France
| | - Jérôme Stirnemann
- Hôpitaux Universitaires de Genève, Service de Médecine interne Générale, Avenue Gabrielle Perret Gentil 4, CH-1211, Geneva, Switzerland
| | - Patrice Cacoub
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne 2, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Gaelle Leroux
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne 2, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Judith Cohen-Bittan
- AP-HP, Hôpital Pitié-Salpêtrière, service de gériatrie, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Jérémie Sellam
- AP-HP, Hôpital Saint Antoine, Service de Rhumatologie, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Xavier Mariette
- Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, AP-HP, Université Paris-Sud, INSERM UMR 1184, Paris, France
| | - Claire Goulvestre
- AP-HP, Hôpital Cochin, service d'immunologie biologique, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | | | - Zahir Amoura
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence pour le Lupus Systémique et le syndrome des Antiphospholipides, service de médecine interne, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Michel Vidal
- AP-HP, Hôpital Cochin, Biologie du médicament - Toxicologie, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Jean-Charles Piette
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne 2, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | | | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260 ; AP-HM, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Université Paris-Descartes, Paris, France. .,INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France.
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Groh M, Lefèvre G, Ackermann F, Étienne N, Kahn JE. [Hypereosinophilic syndromes]. Rev Prat 2019; 69:767-773. [PMID: 32233322] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hypereosinophilic syndromes. Hypereosinophilic syndromes (HES) is a protean condition defined by chronic blood eosinophilia ≥ 1.5 G/L (> 1 month) leading to eosinophilic-related organ damage. HES subtypes includes neoplastic (clonal) disorders (HESN, that comprises FIP1L1-PDGFRA- related chronic eosinophilic leukemia and myeloproliferative and myelodysplastic syndromes associated with eosinophilia) and reactive HES (HESR, that aggregates all conditions e.g. parasitic infections, adverse drug reactions, inflammatory or neoplastic diseases that lead to the production of Th2-related cytokines and thereby to non-clonal hypereosinophilia). HESR also includes the lymphoid variant of HES (HESL), a chronic clonal indolent T-cell lymphoproliferative disorder in which mature peripheral T cells secrete high amounts of IL-5, leading to the polyclonal expansion of eosinophils. Despite an extensive etiological workup, approximately 50% of HES remain of undetermined cause. HES-related clinical manifestations are highly diverse, but dermatological, respiratory and gastro-intestinal symptoms are the most frequent. The long-term prognosis is driven by cardiac involvement and, for patients with HESN and HESL, by the risk of acute transformation into high-grade hematological malignancies. Treatment of HESN relies on tyrosine kinase inhibitors (e.g. imatinib mesylate), while oral glucocorticoids are the usual the fist-line therapy for HESR (including SHEL). In this setting, second-line treatments include hydroxyurea and Peg-interferon alfa-2a. IL-5-targeted therapies are very promising (except for HESN). Yet, to date, their use is restricted to clinical trials and to a compassionate use program dedicated to severe and refractory patients.
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Affiliation(s)
- Matthieu Groh
- Centre de référence des syndromes hyperéosinophiliques (CEREO). Service de médecine interne, hôpital Foch, Suresnes, France
| | - Guillaume Lefèvre
- Centre de référence des syndromes hyperéosinophiliques (CEREO). Service de médecine interne et d'immunologie clinique, CHRU de Lille, Lille, France
| | - Félix Ackermann
- Centre de référence des syndromes hyperéosinophiliques (CEREO). Service de médecine interne, hôpital Foch, Suresnes, France
| | - Nicolas Étienne
- Centre de référence des syndromes hyperéosinophiliques (CEREO). Service de médecine interne et d'immunologie clinique, CHRU de Lille, Lille, France
| | - Jean-Emmanuel Kahn
- Centre de référence des syndromes hyperéosinophiliques (CEREO). Service de médecine interne, hôpital Ambroise-Paré, Boulogne-Billancourt ; université Versailles Saint-Quentin-en- Yvelines, France
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Venturelli G, Evrard S, Tchikviladze M, Ackermann F, Bourdain F. Neuromyélite optique inaugurale d’un lupus érythémateux systémique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Klappan A, Ackermann F, Promm M, Rösch W, Seelbach-Göbel B, Fill Malfertheiner S. Gartner's duct cysts – an interdisciplinary management is needed. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671247] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Klappan
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Regensburg- Klinik St. Hedwig, Barmherzige Brüder Regensburg, Gynäkologie und Geburtshilfe (Schwerpunkt Geburtshilfe), Regensburg, Deutschland
| | - F Ackermann
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Regensburg- Klinik St. Hedwig, Barmherzige Brüder Regensburg, Gynäkologie und Geburtshilfe (Schwerpunkt Geburtshilfe), Regensburg, Deutschland
| | - M Promm
- Klinik St. Hedwig- Barmherzige Brüder Regensburg, Klinik für Kinderurologie, Regensburg, Deutschland
| | - W Rösch
- Klinik St. Hedwig- Barmherzige Brüder Regensburg, Klinik für Kinderurologie, Regensburg, Deutschland
| | - B Seelbach-Göbel
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Regensburg- Klinik St. Hedwig, Barmherzige Brüder Regensburg, Gynäkologie und Geburtshilfe (Schwerpunkt Geburtshilfe), Regensburg, Deutschland
| | - S Fill Malfertheiner
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Regensburg- Klinik St. Hedwig, Barmherzige Brüder Regensburg, Gynäkologie und Geburtshilfe (Schwerpunkt Geburtshilfe), Regensburg, Deutschland
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21
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Fertitta L, Noel N, Ackermann F, Lerolle N, Benoist S, Rocher L, Lambotte O. Pancréatite aiguë inaugurale d’une vascularite à IgA de l’adulte : une manifestation inhabituelle. Rev Med Interne 2017; 38:691-694. [DOI: 10.1016/j.revmed.2017.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/05/2017] [Accepted: 01/19/2017] [Indexed: 02/07/2023]
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22
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Lefèvre G, Ackermann F, Kahn JE. Hypereosinophilia with asthma and systemic (non-vasculitic) manifestations: Eosinophilic granulomatosis with polyangiitis or hypereosinophilic syndrome? Autoimmun Rev 2016; 16:208-209. [PMID: 27915050 DOI: 10.1016/j.autrev.2016.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Guillaume Lefèvre
- French Eosinophil Network, France; CHU Lille, Institut d'Immunologie, Unité d'Immunologie Clinique, F-59000 Lille, France; Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France.
| | - Félix Ackermann
- French Eosinophil Network, France; Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Jean-Emmanuel Kahn
- French Eosinophil Network, France; Univ. Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France; Service de Médecine Interne, Hôpital Foch, Suresnes, France
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23
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Subran B, Ackermann F, Marroun I, Bletry O, Kahn J. Efficacité et tolérance au long cours du mépolizumab chez 20 patients atteints d’un syndrome hyperéosinophilique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.226] [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: 10/21/2022]
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Jolly M, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Hulot JS, Arora S, Amoura Z, Piette JC, Costedoat-Chalumeau N. Quality of life in systemic lupus erythematosus: description in a cohort of French patients and association with blood hydroxychloroquine levels. Lupus 2016; 25:735-740. [DOI: 10.1177/0961203315627200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objectives Benefits of hydroxychloroquine (HCQ) use on physician reported outcomes are well documented in systemic lupus erythematosus (SLE). We assess for the first time the association and predictive value of blood HCQ levels towards health-related quality of life (HRQOL) in SLE. Methods Data from the PLUS study (a randomized, double-blind, placebo-controlled, multicentre study) were utilized. Blood HCQ levels were quantified by high-performance liquid chromatography along with HRQOL assessments (Medical Outcomes Study-SF-36) at baseline (V1) and month 7 (V2). Results 166 SLE patients’ data were analysed. Mean (SD) age and disease duration were 44.4 (10.7) and 9.3 (6.8) years. Eighty-seven per cent were women. Mean (SD, median, IQR) HCQ concentrations in the blood at V1 were 660 (314, 615, 424) ng/ml and increased to 1020 (632, 906, 781) ng/ml at V2 (mean difference 366 units, 95% confidence interval −472 to −260, p < 0.001). No significant correlations between HCQ concentrations with HRQOL domains at V1 or V2 were noted. There were no differences in HRQOL stratified by HCQ concentrations. HCQ concentrations at V1 or changes in HCQ concentration (V2-V1) were not predictive of HRQOL at V2 or changes in HRQOL (V2-V1). Conclusions No association of HCQ concentrations with current or longitudinal HRQOL were found in SLE.
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Affiliation(s)
- M Jolly
- Rush University Medical Center, Chicago, IL, USA
| | - L Galicier
- Université Paris Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Saint Louis, service d’immunologie clinique, Paris, France
| | - O Aumaître
- Université de Clermont-Ferrand and CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de médecine interne, Clermont-Ferrand, France
| | - C Francès
- UPMC, Université Paris 6 and AP-HP, Hôpital Tenon, service de dermatologie allergologie, Paris, France
| | - V Le Guern
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
| | - F Lioté
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Lariboisière, service de rhumatologie, Paris, France
| | - A Smail
- CHU Amiens, Hôpital Nord, service de médecine interne, Amiens, France
| | - N Limal
- UPEC; AP-HP, Hôpital Henri Mondor, service de médecine interne, Créteil, France
| | - L Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, Lyon, France
| | - H Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, Lyon, France
| | - D L T H Boutin
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - B Asli
- Université Paris Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Saint Louis, service d’immunologie clinique, Paris, France
| | - J-E Kahn
- Hôpital Foch, service de médecine interne, Suresnes, France
| | - J Pourrat
- Université Paul-Sabatier and CHU Toulouse, Hôpital Rangueil, service de néphrologie, Toulouse, France
| | - L Sailler
- Université Paul-Sabatier and CHU Toulouse, Hôpital Purpan, service de médecine interne, Toulouse, France
| | - F Ackermann
- Hôpital Foch, service de médecine interne, Suresnes, France
| | - T Papo
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, Paris, France
| | - K Sacré
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, Paris, France
| | - O Fain
- Hôpital Saint Antoine, DHU i2B, service de médecine interne, Université Paris 6
| | - J Stirnemann
- Division of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - P Cacoub
- APHP, Département de Médecine Interne et Immunologie clinique, Groupe Hospitalier Pitié Salpétriére Paris, France; DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI, France; UMR 7211 (UPMC/CNRS), UMR S-959 (INSERM)
| | - M Jallouli
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
| | - G Leroux
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - J Cohen-Bittan
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de gériatrie Pr Verny, Paris, France
| | - J-S Hulot
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Institute of Cardiometabolism and Nutrition (ICAN), F-75013, Paris, France
| | - S Arora
- Rush University Medical Center, Chicago, IL, USA
| | - Z Amoura
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - J-C Piette
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - N Costedoat-Chalumeau
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
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Perrin F, Néel A, Magot A, Darrieutort C, Agard C, Mussini JM, Hamidou M, Ackermann F. Une biopsie musculaire qui passe mal. Rev Med Interne 2015; 36:780-2. [DOI: 10.1016/j.revmed.2015.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/30/2022]
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Jallouli M, Galicier L, Zahr N, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Sellam J, Mariette X, Blanchet B, Hulot JS, Amoura Z, Piette JC, Costedoat-Chalumeau N. Determinants of hydroxychloroquine blood concentration variations in systemic lupus erythematosus. Arthritis Rheumatol 2015; 67:2176-84. [PMID: 25989906 DOI: 10.1002/art.39194] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/05/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations. METHODS We conducted a retrospective analysis of patient data, including data from the Plaquenil Lupus Systemic (PLUS) study, to determine the association of epidemiologic, clinical, and biologic factors with blood HCQ concentrations. Data for nonadherent patients (blood HCQ concentration <200 ng/ml) were excluded. RESULTS To examine homogeneous pharmacologic data, we restricted the analyses of the PLUS data to the 509 SLE patients receiving 400 mg/day. We found no association of ethnicity or smoking with blood HCQ concentrations and no pharmacokinetic drug-drug interaction with antacids or with inhibitors or inducers of cytochrome P450 enzymes. On multivariate analysis, high body mass index (P = 0.008), no treatment with corticosteroids (P = 0.04), increased time between the last tablet intake and measurement of blood HCQ concentrations (P = 0.017), low platelet count (P < 0.001), low neutrophil count (P < 0.001), and high estimated creatinine clearance (P < 0.001) were associated with low blood HCQ concentrations. In 22 SLE patients with chronic renal insufficiency (median serum creatinine clearance 52 ml/minute [range 23-58 ml/minute]) who received 400 mg/day HCQ, the median blood HCQ concentration was significantly higher than that in the 509 patients from the PLUS study (1,338 ng/ml [range 504-2,229 ng/ml] versus 917 ng/ml [range 208-3316 ng/ml]) (P < 0.001). CONCLUSION We provide a comprehensive analysis of determinants of blood HCQ concentrations. Because this measurement is increasingly being used, these data might be useful for clinicians.
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Affiliation(s)
- M Jallouli
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - L Galicier
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - N Zahr
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - O Aumaître
- Université de Clermont-Ferrand and Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - C Francès
- Université Pierre et Marie Curie and AP-HP, Hôpital Tenon, Paris, France
| | - V Le Guern
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - F Lioté
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Lariboisière, Paris, France
| | - A Smail
- CHU Amiens, Hôpital Nord, Amiens, France
| | - N Limal
- AP-HP, Hôpital Henri Mondor, Créteil, France
| | - L Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - H Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - D Le Thi Huong
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - B Asli
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - J-E Kahn
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - J Pourrat
- Université Paul Sabatier and CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | - L Sailler
- Université Paul Sabatier and CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - F Ackermann
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - T Papo
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - K Sacré
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - O Fain
- Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and AP-HP, Hôpital St. Antoine, Paris, France
| | | | - P Cacoub
- Sorbonne Universités, Université Pierre et Marie Curie, UMR 7211, and Inflammation Immunopathology Biotherapy Department, AP-HP, Hôpital Pitié-Salpêtrière, Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, INSERM UMRS 959, and CNRS, FRE3632, Paris, France
| | - G Leroux
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | | | - J Sellam
- AP-HP, Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and INSERM UMRS 938, Paris, France
| | - X Mariette
- Université Paris-Sud, INSERM U1012, and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - J S Hulot
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Z Amoura
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - J C Piette
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - N Costedoat-Chalumeau
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
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Schoindre Y, Jallouli M, Tanguy ML, Ghillani P, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z, Souberbielle JC, Costedoat-Chalumeau N. Lower vitamin D levels are associated with higher systemic lupus erythematosus activity, but not predictive of disease flare-up. Lupus Sci Med 2014; 1:e000027. [PMID: 25379192 PMCID: PMC4213833 DOI: 10.1136/lupus-2014-000027] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/03/2014] [Accepted: 05/08/2014] [Indexed: 01/11/2023]
Abstract
Objectives Growing evidence suggests that vitamin D plays a key role in the pathogenesis and progression of autoimmune diseases, including systemic lupus erythematosus (SLE). Recent studies have found an association between lower serum 25-hydroxyvitamin D (25(OH)D) levels and higher SLE activity. We studied the relationship between 25(OH)D levels and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and we assessed for the first time the role of vitamin D in predicting SLE flare-ups. Methods Serum 25(OH)D levels were measured in 170 patients with SLE who were prospectively followed up for 6 months (Plaquenil LUpus Systemic study, ClinicalTrials.gov number NCT00413361). Results The mean SLEDAI score was 2.03±2.43 and 12.3% patients had active disease (SLEDAI ≥6). The mean 25(OH)D level was 20.6±9.8 ng/mL. Deficiency (25(OH)D <10 ng/mL) was observed in 27 (15.9%), insufficiency (10≤25(OH)D<30) in 112 (65.9%) and optimal vitamin D status (25(OH)D≥30) in 31 (18.2%) patients. In multivariate analysis, female gender (p=0.018), absence of defined antiphospholipid syndrome (p=0.002) and higher creatinine clearance (p=0.004) were predictive of lower 25(OH)D levels. In multivariate analysis, lower 25(OH)D levels were associated with high SLE activity (p=0.02). Relapse-free survival rate was not statistically different according to the vitamin D status during the 6-month follow-up (p=0.22). Conclusions We found a low vitamin D status in the majority of patients with SLE, and a modest association between lower 25(OH)D levels and high disease activity. There was no association between baseline 25(OH)D levels and relapse-free survival rate.
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Affiliation(s)
- Yoland Schoindre
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne 1, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Moez Jallouli
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Marie-Laure Tanguy
- AP-HP, Hôpital Pitié-Salpêtrière, Unité de recherche clinique, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Pascale Ghillani
- AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire d'Immunochimie, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Lionel Galicier
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Saint-Louis, Service d'Immunologie Clinique, 1 avenue Claude Vellefaux , Paris , France
| | - Olivier Aumaître
- Université de Clermont-Ferrand , Clermont-Ferrand , France ; CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de Médecine Interne , Clermont-Ferrand, Cedex , France
| | - Camille Francès
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Tenon, Service de Dermatologie Allergologie , Paris , France
| | - Véronique Le Guern
- Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Cochin, Service de Médecine Interne , Paris , France
| | - Frédéric Lioté
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Lariboisière, Service de Rhumatologie , Paris , France
| | - Amar Smail
- CHU Amiens, Hôpital Nord, Service de Médecine Interne, Place Victor Pauchet , Amiens , France
| | - Nicolas Limal
- AP-HP, Hôpital Henri Mondor, Service de Médecine Interne , Créteil , France
| | - Laurent Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Médecine Interne , Lyon , France
| | - Hélène Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Médecine Interne , Lyon , France
| | - Du Le Thi Huong
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Bouchra Asli
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Saint-Louis, Service d'Immunologie Clinique, 1 avenue Claude Vellefaux , Paris , France
| | - Jean-Emmanuel Kahn
- Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Foch, Service de Médecine Interne , Suresnes, Cedex , France
| | - Laurent Sailler
- Université Paul-Sabatier , Toulouse , France ; CHU Toulouse, Hôpital Purpan, Service de Médecine Interne, Place Dr Baylac , Toulouse , France
| | - Félix Ackermann
- Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Foch, Service de Médecine Interne , Suresnes, Cedex , France
| | - Thomas Papo
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Bichat Claude-Bernard, Service de Médecine Interne , Paris , France
| | - Karim Sacré
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Bichat Claude-Bernard, Service de Médecine Interne , Paris , France
| | - Olivier Fain
- Université Paris Nord , Sorbonne Paris Cité , France ; AP-HP, Hôpital Jean-Verdier, Service de Médecine Interne , Bondy , France
| | - Jérôme Stirnemann
- Université Paris Nord , Sorbonne Paris Cité , France ; AP-HP, Hôpital Jean-Verdier, Service de Médecine Interne , Bondy , France
| | - Patrice Cacoub
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Gaëlle Leroux
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne 1, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Judith Cohen-Bittan
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Sébastien Hulot
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Pharmacologie , Paris, Cedex , France
| | - Philippe Lechat
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Pharmacologie , Paris, Cedex , France
| | - Lucile Musset
- AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire d'Immunochimie, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Charles Piette
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Zahir Amoura
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Claude Souberbielle
- Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Necker-Enfants Malades, Laboratoire de Physiologie , Paris , France
| | - Nathalie Costedoat-Chalumeau
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
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Jolly M, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin D, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Tanguy ML, Hulot JS, Musset L, Amoura Z, Piette JC, Costedoat-Chalumeau N. FRI0434 Blood Hydroxychloroquine (HCQ) Levels do not PREDICT Quality of Life in Systemic Lupus Erythematosus (SLE). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cochereau D, Ackermann F, Nochy D, Pouchot J, de Jauréguiberry JP. Encore un qu’aurait mieux fait de rester chez lui…. Rev Med Interne 2014; 35:144-7. [DOI: 10.1016/j.revmed.2013.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/20/2013] [Indexed: 10/25/2022]
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Pindi Sala T, Michot J, Fardet L, Aumont C, Rivoisy C, Lerolle N, Chavekadtze C, Ackermann F, Goujard C, Delfraissy J, Lambotte O. Mortalité du syndrome d’activation macrophagique de l’adulte en 2013. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Drevon L, Ackermann F, Osman D, Lerolle N, Desthieux C, Anguel N, Lambotte O. Traitement par eculizumab d’une microangiopathie thrombotique secondaire à une autogreffe de cellules souches hématopoïétiques conditionnée par BEAM. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Henriquez S, Tcherakian C, Roumier M, Sené T, Marroun I, Ackermann F, Haroche J, Bletry O, Kahn JE. Hypertension artérielle pulmonaire induite par l’interféron au cours d’une maladie d’Erdheim-Chester. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.181] [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: 10/26/2022]
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Fassnacht F, Ackermann F, Sene T, Marroun I, Bletry O, Kahn J. Transplantation cardiaque pour une fibrose endomyocardique liée à une leucémie chronique à éosinophiles. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.154] [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: 10/26/2022]
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Legrand F, Renneville A, Ackermann F, Fain O, Michel M, Hamidou M, Hatron PY, Lidove O, Bletry O, Rousselot P, Prin L, Kahn J.E. Arrêt de l’imatinib dans la leucémie chronique à éosinophiles FIP1L1-PDGFRA en rémission moléculaire : résultats d’une étude rétrospective chez 11 patients. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.054] [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: 10/27/2022]
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Georgin-Lavialle S, Roux X, Ackermann F, Durant C, Ranque B, Arlet JB. Intérêt de la PET en médecine interne : étude multicentrique prospective de 161 cas. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Costedoat-Chalumeau N, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Tanguy ML, Hulot JS, Lechat P, Musset L, Amoura Z, Piette JC. Hydroxychloroquine in systemic lupus erythematosus: results of a French multicentre controlled trial (PLUS Study). Ann Rheum Dis 2012; 72:1786-92. [DOI: 10.1136/annrheumdis-2012-202322] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Crickx E, Veyrie C, Bouilloud F, Marroun I, Schoindre Y, Ackermann F, Piette AM, Bletry O, Kahn JE. Polyarthrite induite par les inhibiteurs de dipeptidylpeptidase 4 : à propos de trois cas. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.148] [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: 10/15/2022]
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Charles P, Ackermann F, Brousse C, Piette AM, Blétry O, Kahn JE. [Spontaneous streptococcal arthritis of the pubic symphysis]. Rev Med Interne 2010; 32:e88-90. [PMID: 20851507 DOI: 10.1016/j.revmed.2010.08.004] [Citation(s) in RCA: 7] [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: 04/01/2010] [Revised: 07/19/2010] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
Abstract
Septic arthritis of the pubic symphysis is uncommon, and usually occurs in patients with predisposing conditions (female incontinence surgery, sports). Staphylococcus aureus and Pseudomonas aeruginosa are the main bacteria responsible of these infections. Streptococcal infections of the pubic symphysis are uncommon. We report three cases of streptococcal infections of the pubic symphysis that occurred in the absence of predisposing condition such as surgery or endocarditis. The diagnosis of septic arthritis was difficult, particularly in one patient who underwent an orchidopexy for a suspected of spermatic cord torsion before diagnosis was corrected. All three patients had a favourable outcome after an antibiotic treatment combining amoxicillin and rifampicin. Septic arthritis of the pubic symphysis should be suspected in patients with sudden groin pain, pubic tenderness and fever to avoid traumatic treatments and useless investigations.
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Affiliation(s)
- P Charles
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92151 Suresnes cedex, France.
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Piette AM, Beaudouin C, Charles P, Ackermann F, François D, Leport J, Guth A, Blétry O, Kahn JE, Geffray L. Sale temps pour une grenouille. Rev Med Interne 2010; 31:570-4. [DOI: 10.1016/j.revmed.2010.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/08/2010] [Indexed: 12/23/2022]
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Costedoat-Chalumeau N, Galicier L, Francès C, Aumaitre O, Lioté F, Le Guern V, Limal N, Smail A, Ninet J, Perard L, Le Huong Thi D, Asli B, Grandpeix C, Sailler L, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Jallouli M, Leroux G, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Étude des facteurs associés à une concentration basse d’hydroxychloroquine chez 523 patients inclus dans l’étude Plaquénil Lupus Systémique (PLUS, étude française multicentrique). Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Costedoat-Chalumeaum N, Galicier L, Aumaitre O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Grandpeix C, Pourrat J, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Cohen J, Jallouli M, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Données épidémiologiques d’une cohorte française multicentrique de 569 patients lupiques. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.407] [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: 10/19/2022]
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42
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Costedoat-Chalumeau N, Jallouli M, Galicier L, Aumaître O, Francès C, Le Guern V, Liote F, Smail A, Limal N, Pérard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Grandpeix C, Pourrat J, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Cohen J, Tanguy ML, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Description des patients lupiques inclus dans l’étude PLUS (Plaquénil Lupus Systémique, étude française multicentrique) en fonction de leur origine ethnique. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.406] [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: 10/19/2022]
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43
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Kahn JE, Grandpeix-Guyodo C, Ackermann F, Charles P, Legrand F, Blétry O. Syndromes hyperéosinophiliques : actualités physiopathologiques et thérapeutiques. Rev Med Interne 2010; 31:268-76. [DOI: 10.1016/j.revmed.2009.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 05/11/2009] [Accepted: 05/25/2009] [Indexed: 01/21/2023]
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44
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Charles P, Ackermann F, Brousse C, Piette AM, Blétry O, Kahn JE. Trois cas d’arthrites septiques à streptocoque de la symphyse pubienne ou l’intérêt de la palpation pubienne dans l’examen physique. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.280] [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: 10/20/2022]
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45
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Ackermann F, Charles P, Piette AM, Bletry O, Kahn JE. Maladie de Rendu-Osler : un nouveau succès de l’Avastin®. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Ackermann F, Gadhoum H, Charles P, Ohresser M, Mouly S, Lidove O, Piette A, Bletry O, Kahn J. Bilan étiologique des surdités de perception : une démarche justifiée ? Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Blétry O, Sene T, Kahn JE, Ackermann F, Charles P, Leport J, Piette AM. Quoi de neuf en médecine interne ? Ann Dermatol Venereol 2009; 136 Suppl 7:S417-25. [DOI: 10.1016/s0151-9638(09)73383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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48
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Colombier M, Charles P, Ackermann F, Bourdain F, Boulin A, Bletry O, Kahn JE. Un épanchement sous dural bilatéral: une complication exceptionnelle de la pachyméningite au cours de la granulomatose de Wegener. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.344] [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: 10/20/2022]
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49
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Ackermann F, Bergmann H, Schleichert U. Monitoring of heavy metals in coastal and estuarine sediments ‐ a question of grain‐size: <20 μm versus <60 μm. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/09593338309384212] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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