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Farge D, Pugnet G, Allez M, Castilla-Llorente C, Chatelus E, Cintas P, Faucher-Barbey C, Labauge P, Labeyrie C, Lioure B, Maria A, Michonneau D, Puyade M, Talouarn M, Terriou L, Treton X, Wojtasik G, Zephir H, Marjanovic Z. French protocol for the diagnosis and management of hematopoietic stem cell transplantation in autoimmune diseases. Rev Med Interne 2024; 45:79-99. [PMID: 38220493 DOI: 10.1016/j.revmed.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) for severe ADs was developed over the past 25years and is now validated by national and international medical societies for severe early systemic sclerosis (SSc) and relapsing-remitting multiple sclerosis (MS) and available as part of routine care in accredited center. HSCT is also recommended, with varying levels of evidence, as an alternative treatment for several ADs, when refractory to conventional therapy, including specific cases of connective tissue diseases or vasculitis, inflammatory neurological diseases, and more rarely severe refractory Crohn's disease. The aim of this document was to provide guidelines for the current indications, procedures and follow-up of HSCT in ADs. Patient safety considerations are central to guidance on patient selection and conditioning, always validated at the national MATHEC multidisciplinary team meeting (MDTM) based on recent (less than 3months) thorough patient evaluation. HSCT procedural aspects and follow-up are then carried out within appropriately experienced and Joint Accreditation Committee of International Society for Cellular Therapy and SFGM-TC accredited centres in close collaboration with the ADs specialist. These French recommendations were performed according to HAS/FAI2R standard operating procedures and coordinated by the Île-de-France MATHEC Reference Centre for Rare Systemic Autoimmune Diseases (CRMR MATHEC) within the Filière FAI2R and in association with the Filière MaRIH. The task force consisted of 3 patients and 64 clinical experts from various specialties and French centres. These data-derived and consensus-derived recommendations will help clinicians to propose HSCT for their severe ADs patients in an evidence-based way. These recommendations also give directions for future clinical research in this area. These recommendations will be updated according to newly emerging data. Of note, other cell therapies that have not yet been approved for clinical practice or are the subject of ongoing clinical research will not be addressed in this document.
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Affiliation(s)
- D Farge
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de Médecine Interne (UF 04) : CRMR MATHEC, maladies auto-immunes et thérapie cellulaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Department of Medicine, McGill University, H3A 1A1, Montreal, Canada.
| | - G Pugnet
- Service de médecine interne et immunologie clinique, pôle hospitalo-universitaire des maladies digestives, CHU Rangueil, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - M Allez
- AP-HP, hôpital Saint-Louis, service d'hépato-gastro-entérologie, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Castilla-Llorente
- Gustave-Roussy cancer center, département d'hématologie, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - E Chatelus
- Département de rhumatologie, hôpitaux universitaires de Strasbourg, Strasbourg, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, Strasbourg, France
| | - P Cintas
- CHU Toulouse Purpan, service de neurologie, place du Dr-Baylac, 31059 Toulouse cedex 9, France
| | - C Faucher-Barbey
- Direction prélèvements et greffes de CSH, Direction médicale et scientifique, Agence de la biomédecine, 93212 St-Denis/La Plaine, France
| | - P Labauge
- CRC SEP, service de neurologie, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - C Labeyrie
- AP-HP, CHU de Bicêtre, service de neurologie, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - B Lioure
- Département d'onco-hématologie, université de Strasbourg, ICANS, Strasbourg, France
| | - A Maria
- Médecine interne & immuno-oncologie (MedI2O), Institute for Regenerative Medicine & Biotherapy (IRMB), hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, Montpellier, France; IRMB, Inserm U1183, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier, France
| | - D Michonneau
- Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, URP-3518, 75010 Paris, France; Service d'hématologie-greffe, AP-HP, hôpital Saint-Louis, institut de recherche Saint-Louis, Paris, France
| | - M Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de La-Miletrie, 86021 Poitiers, France
| | - M Talouarn
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - L Terriou
- CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre de référence des maladies auto-immunes et auto-inflammatoires rares (CERAINO), 59000 Lille, France
| | - X Treton
- Université de Paris, hôpital Beaujon, service de gastro-entérologie, MICI et assistance nutritive, DMU DIGEST, 100, boulevard Leclerc, 92110 Clichy, France
| | - G Wojtasik
- Université de Lille, Inserm, CHU de Lille, service de médecine interne et immunologie clinique, Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institut de recherche translationnelle sur l'inflammation, Lille, France
| | - H Zephir
- CHU de Lille, université de Lille, pôle des neurosciences et de l'appareil locomoteur, Lille Inflammation Research International Center (LIRIC), UMR 995, rue Émile-Laine, 59000 Lille, France
| | - Z Marjanovic
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Pugnet G. [The arguments favoring autologous haematopoietic stem cell transplantation in systemic scleroderma]. Rev Med Interne 2024; 45:104-108. [PMID: 38267322 DOI: 10.1016/j.revmed.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Autologous haematopoietic stem cell transplantation for systemic scleroderma, developed over more than 25 years, has shown in three randomised controlled clinical trials a significant impact not only in event-free survival, overall survival, cutaneous and pulmonary involvement, but also in the quality of life of patients living with recent severe diffuse cutaneous systemic scleroderma, compared with IV cyclophosphamid despite a transplant-related mortality between 2.4 and 10%. No immunosuppressants or biologics have shown such an impact on mortality in this disease. The risk of relapse is estimated between 9 and 24%, two years after transplant. On the basis of these results, French and international guidelines now position autologous haematopoietic stem cell transplantation as a level 1A evidence-based therapeutic alternative in severe early and rapidly progressive systemic scleroderma.
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Affiliation(s)
- G Pugnet
- Service de médecine interne et immunologie clinique, CHU de Toulouse, 2, rue Viguerie, 31059 Toulouse, France.
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Caminati M, Fassio A, Alberici F, Baldini C, Bello F, Cameli P, Conticini E, Cottin V, Crimi C, Dagna L, Delvino P, Deroux A, Duran E, Espigol-Frigole G, Karadag O, Maule M, Moiseev S, Monti S, Moroni L, Padoan R, Pugnet G, Taille C, Toniati P, Vaglio A, Emmi G. Eosinophilic granulomatosis with polyangiitis onset in severe asthma patients on monoclonal antibodies targeting type 2 inflammation: Report from the European EGPA study group. Allergy 2024; 79:516-519. [PMID: 37904674 DOI: 10.1111/all.15934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Marco Caminati
- Asthma Center and Allergy Unit, Department of Medicine, University and Integrated University Hospital of Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Federico Alberici
- Nephrology Unit, University of Brescia, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Chiara Baldini
- Department of Internal Medicine, U.O. Rheumatology, University of Pisa, Pisa, Italy
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Vincent Cottin
- Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, University of Lyon, INRAE, Lyon, France
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Paolo Delvino
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alban Deroux
- Departement of Internal Medicine, CHU Grenoble-Alpes, Grenoble, France
| | - Emine Duran
- Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Ankara, Turkey
| | - Georgina Espigol-Frigole
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Ankara, Turkey
| | - Matteo Maule
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Moroni
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - Gregory Pugnet
- Service de Médecine Interne et Immunologie Clinique, CHU Rangueil, Toulouse, France
| | - Camille Taille
- Respiratory Diseases Department, Rare Pulmonary Diseases Reference Centre, Bichat Hospital, Paris Cité University, Paris, France
| | - Paola Toniati
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili Brescia, Brescia, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's University Hospital - IRCCS, Firenze, Italy
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia
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Villeneuve T, Pugnet G, Lauwers-Cances V, Faguer S, Prévot G. Risk factors of pulmonary relapse in microscopic polyangiitis and granulomatosis with polyangiitis. Pulmonology 2024; 30:85-86. [PMID: 37482457 DOI: 10.1016/j.pulmoe.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023] Open
Affiliation(s)
- T Villeneuve
- Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France.
| | - G Pugnet
- Internal Medicine Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - V Lauwers-Cances
- Epidemiology and Community Health Laboratory, Faculty of Medicine, Toulouse, France
| | - S Faguer
- Nephrology and Organ Transplantation Department, National Referral Center for Rare Renal Diseases, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - G Prévot
- Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
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Rohmer J, Nguyen Y, Trefond L, Agard C, Allain JS, Berezne A, Charles P, Cohen P, Gondran G, Groh M, Huscenot T, Lacout C, Lazaro E, London J, Maurier F, Mekinian A, Mesbah R, Nubourgh I, Perard L, Puéchal X, Pugnet G, Puyade M, Queyrel V, Roux A, Rouzaud D, Durel CA, Guillevin L, Terrier B. Clinical features and long-term outcomes of patients with systemic polyarteritis nodosa diagnosed since 2005: Data from 196 patients. J Autoimmun 2023; 139:103093. [PMID: 37536165 DOI: 10.1016/j.jaut.2023.103093] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The landscape of polyarteritis nodosa (PAN) has substantially changed during the last decades. Recent data regarding causes, characteristics, and prognosis of systemic PAN in the modern era are lacking. METHODS This retrospective study included patients with systemic PAN referred to the French Vasculitis Study Group between 2005 and 2019. Characteristics, associated conditions and outcomes were collected, and predictors of relapse and death were analyzed. RESULTS 196 patients were included. Main clinical symptoms were constitutional (84%), neurological (59%), skin (58%) and musculoskeletal (58%) manifestations. Secondary PAN accounted for 55 (28%) patients, including myelodysplastic syndrome (9%), solid cancer (7%), lymphoma (4%) and autoinflammatory diseases (4%). No patient had active HBV infection. All treated patients (98.5%) received glucocorticoids (GCs), alone (41%) or in combination with immunosuppressants (59%), with remission achieved in 90%. Relapses were independently associated with age >65 years (HR 1.85; 95% CI1.12-3.08), gastrointestinal involvement (1.95; 95% CI1.09-3.52) and skin necrotic lesions (HR 1.95; 95%CI 1.24-3.05). One-, 5- and 10-year overall survival rates were 93%, 87% and 81%, respectively. In multivariate analyses, age >65 years (HR 2.80; 95%CI 1.23-6.37), necrotic purpura (HR 4.16; 95%CI 1.62-10.70), acute kidney injury (HR 4.89; 95% 1.71-13.99) and secondary PAN (HR 2.98; 95%CI 1.29-6.85) were independently associated with mortality. CONCLUSION Landscape of PAN has changed during the last decades, with the disappearance of HBV-PAN and the emergence of secondary PAN. Relapse rate remains high, especially in aged patients with gastrointestinal and cutaneous necrosis, as well as mortality.
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Affiliation(s)
- Julien Rohmer
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France; Autoimmunity Team, Immunology of Viral Infections and Autoimmune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Ludovic Trefond
- Department of Internal Medicine, CHU, Clermont Ferrand, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Service de médecine interne, F-44000, Nantes, France
| | | | - Alice Berezne
- Department of Internal Medicine, CH, Annecy, Genevois, France
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Guillaume Gondran
- Department of Internal Medicine and dermatology, CHU, Limoges, France
| | - Matthieu Groh
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes, Foch Hospital, Suresnes, France; University of Lille, INSERM U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Tessa Huscenot
- Department of Internal Medicine, Hôpital Ambroise Parée, Paris, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, CHU, Angers, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Hôpital Haut Leveque, CHU, Bordeaux, France
| | - Jonathan London
- Department of Internal Medicine, Hôpital de la Croix Saint Simon, Paris, France
| | | | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Rafik Mesbah
- Department of Internal Medicine, CH, de Boulogne sur Mer, France
| | - Isabelle Nubourgh
- Department of Internal Medicine, Université libre de Bruxelles, Belgique
| | - Laurent Perard
- Department of Internal Medicine, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Gregory Pugnet
- Department of Internal Medicine and clinical immunology, CHU, Toulouse, France
| | | | | | - Arthur Roux
- Department of Nephrology, HEGP, Paris, France
| | - Diane Rouzaud
- Department of Internal Medicine, Hôpital Bichat, Paris, France
| | | | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France; University Paris-Cité, F-75006, Paris, France.
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Boumaza X, Lafaurie M, Treiner E, Walter O, Pugnet G, Martin-Blondel G, Biotti D, Ciron J, Constantin A, Tauber M, Puisset F, Moulis G, Alric L, Renaudineau Y, Chauveau D, Sailler L. Infectious risk when prescribing rituximab in patients with hypogammaglobulinemia acquired in the setting of autoimmune diseases. Int Immunopharmacol 2023; 120:110342. [PMID: 37276827 DOI: 10.1016/j.intimp.2023.110342] [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: 02/03/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
We conducted a single-centre retrospective cohort study in a French University Hospital between 2010 and 2018 to describe the risk of severe infectious event (SIE) within 2 years after the date of first rituximab infusion (T0) prescribed after the evidence of acquired hypogammaglobulinemia (gamma globulins [GG] ≤ 6 g/L) in the setting of autoimmune diseases (AID) other than rheumatoid arthritis. SIE occurred in 26 out of 121 included patients. Two years cumulative incidence rates were 12.7 % (95 % CI 5.1-23.9) in the multiple sclerosis/neuromyelitis optica spectrum disorder group (n = 48), 27.6 % (95 % CI 15.7-40.9) in the ANCA-associated vasculitis group (n = 48) and 30.6 % (95 % CI 13.1-50.3) in the 'other AID' group (n = 25). Median GG level at T0 was 5.3 g/l (IQR 4.1-5.6) in the 'SIE' group and 5.6 g/l (IQR 4.7-5.8) in the 'no SIE' group (p = 0.04). In regression analysis, risk of SIE increased with Charlson comorbidity index ≥ 3 (OR 2.77; 95 % CI 1.01-7.57), lung disease (OR 3.20; 95 % CI 1.27-7.99), GG < 4 g/L (OR 3.39; 95 % CI 1.02-11.19), concomitant corticosteroid therapy (OR 4.13; 95 % CI 1.63-10.44), previous cyclophosphamide exposure (OR 2.69; 95 % CI 1.10-6.61), a lymphocyte count < 1000 cells/µL (OR 2.86; 95 % CI 1.12-7.21) and absence of pneumococcal vaccination (OR 3.50; 95 % CI 1.41-8.70). These results may help to inform clinical decision when considering a treatment by rituximab in immunosuppressed AID patients with hypogammaglobulinemia.
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Affiliation(s)
- Xavier Boumaza
- Service de Médecine Interne Purpan, Centre Hospitalier Universitaire de Toulouse, France; Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, France.
| | - Margaux Lafaurie
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, France; Centre d'Investigation Clinique 1436, Equipe PEPSS, Centre Hospitalier Universitaire de Toulouse, INSERM, Toulouse, France
| | - Emmanuel Treiner
- Laboratoire d'Immunologie, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, France; Centre de Physiopathologie de Toulouse-Purpan, Centre Hospitalier Universitaire de Toulouse, France
| | - Ondine Walter
- Service de Médecine Interne Purpan, Centre Hospitalier Universitaire de Toulouse, France; Centre d'Investigation Clinique 1436, Equipe PEPSS, Centre Hospitalier Universitaire de Toulouse, INSERM, Toulouse, France
| | - Gregory Pugnet
- Service de Médecine Interne et immunologie clinique Rangueil, Centre Hospitalier Universitaire de, Toulouse, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, France
| | - Damien Biotti
- Service de Neurologie, Centre Hospitalier Universitaire de Toulouse, France
| | - Jonathan Ciron
- Service de Neurologie, Centre Hospitalier Universitaire de Toulouse, France
| | - Arnaud Constantin
- Service de Rhumatologie, Centre Hospitalier Universitaire de Toulouse, France
| | - Marie Tauber
- Service de Dermatologie, Centre Hospitalier Universitaire de Toulouse, France
| | - Florent Puisset
- Service de Pharmacologie, Institut Universitaire du Cancer Oncopole, France
| | - Guillaume Moulis
- Service de Médecine Interne Purpan, Centre Hospitalier Universitaire de Toulouse, France; Centre d'Investigation Clinique 1436, Equipe PEPSS, Centre Hospitalier Universitaire de Toulouse, INSERM, Toulouse, France
| | - Laurent Alric
- Service de Médecine Interne et immunologie clinique Rangueil, Centre Hospitalier Universitaire de, Toulouse, France
| | - Yves Renaudineau
- Laboratoire d'Immunologie, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, France
| | - Dominique Chauveau
- Service de Néphrologie et Transplantation d'Organes, Centre de Référence Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, France
| | - Laurent Sailler
- Service de Médecine Interne Purpan, Centre Hospitalier Universitaire de Toulouse, France; Centre d'Investigation Clinique 1436, Equipe PEPSS, Centre Hospitalier Universitaire de Toulouse, INSERM, Toulouse, France
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Dutertre M, Pugnet G, De Moreuil C, Bonnotte B, Benhamou Y, Chauveau D, Diot E, Duffau P, Limal N, Néel A, Urbansky G, Jourde-Chiche N, Fauchais A, Dossier A, Schleinitz N, Jilet L, Guillevin L, Abdoul H, Puéchal X, Terrier B. Efficacité à long terme des schémas d’induction de la rémission au cours de la granulomatose éosinophilique avec polyangéite : résultats de l’essai REOVAS. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.085] [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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Stuchfield-Denby E, De Sainte Marie B, Hie M, Hatchuel Y, Gerber A, Bencheikh S, Pugnet G, Groh M, Farhat M, Urbina D, Ebbo M, Schleinitz N. Uvéite associée aux IgG4. Une cohorte française et revue de la littérature. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.084] [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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Sailler L, Ly K, De Boysson H, Granel B, Samson M, Agard C, Bouillet L, Magnant J, Lambert M, Mekinian A, Tarallo L, Liozon E, Pugnet G, Daumas A, Bonnotte B, Aouba A, Boris B. Phénotypes de l’artérite à cellules géantes et diagnostic de l’aortite chez 1852 patients avant et après 2016 dans 10 CHU français. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.112] [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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Terrier B, Richert L, Pugnet G, Aumaître O, Moranne O, Diot E, Karras A, Bonnet F, De Moreuil C, Hachulla E, Le Gallou T, Lebas C, Maurier F, Rafat C, Samson M, Augusto J, Janssen C, Quéméneur T, Batteux F, Launay O. Stratégies innovantes de vaccination anti-pneumococcique par rapport au schéma standard chez les patients atteints de vascularites associées aux ANCA recevant du rituximab : essai contrôlé randomisé multicentrique (PNEUMOVAS). Rev Med Interne 2022. [PMCID: PMC9724759 DOI: 10.1016/j.revmed.2022.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Les patients recevant des glucocorticoïdes et du rituximab (RTX) présentent un risque accru d’infections, en particulier d’infections invasives à pneumocoque. Les réponses vaccinales au virus de la grippe, au Streptococcus pneumoniae et au SARS-CoV-2 sous traitement par RTX sont fortement altérées. Chez les patients atteints de maladies auto-immunes recevant de tels traitements, en particulier ceux atteints de vascularites associées aux ANCA (AAV), il est donc nécessaire de développer des stratégies vaccinales anti-pneumococciques améliorées pour augmenter la réponse immunitaire et la protection vaccinale. Patients et méthodes Cet essai multicentrique de phase 2, randomisé, ouvert, a comparé deux stratégies innovantes de vaccin anti-pneumococcique « renforcées » au schéma de vaccination standard chez des patients atteints de VAA recevant un traitement par RTX. Des patients adultes atteints de VAA nouvellement diagnostiquée ou en rechute, présentant une maladie active (BVAS ≥ 3) et devant recevoir du RTX comme traitement d’induction (375 mg/m2/semaine pendant 4 semaines consécutives), ont été randomisés avec un rapport 1:1:1 dans trois bras parallèles : schéma standard associant une dose de vaccin pneumococcique conjugué 13-valent (PCV13) au jour 0 suivie d’une dose de vaccin non conjugué 23-valent (PPV23) au mois 5 (M5) (bras 1) ; double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose de PPV23 à M5 (bras 2) ; ou 4 doses de PCV13 au jour 0 suivies d’une dose de PPV23 à M5 (bras 3). Le critère d’évaluation principal était la réponse immunitaire à M6 contre les 12 sérotypes de pneumocoque communs aux vaccins PCV13 et PPV23, classée selon quatre catégories ordonnées de réponse : réponse positive en anticorps contre 0–3, 4–6, 7–9 ou 10–12 sérotypes. Une réponse positive par sérotype était définie par un titre ELISA d’IgG spécifiques ≥ 1 μg/mL et une augmentation de deux fois par rapport au jour 0. Le critère d’évaluation primaire a été analysé dans un modèle de régression logistique à chances proportionnelles avec une correction de Bonferonni pour les 2 bras innovants. Les critères d’évaluation secondaires étaient les réactions locales et systémiques sollicitées 7 jours après chaque vaccination et tout événement indésirable lié ou pouvant être lié à l’immunisation vaccinale. Résultats Quatre-vingt-quinze participants ont été analysés dans la population modifiée en intention de traiter (âge moyen 60 ± 16,6 ans, 50 % d’hommes, 74 personnes atteintes d’une maladie nouvellement diagnostiquée, 66 d’une granulomatose avec polyangéite et 29 d’une polyangéite microscopique, BVAS moyen 15,3 ± 6,9), dont 30 affectés au bras 1, 32 au bras 2 et 33 au bras 3. À M6, une réponse immunitaire contre 0–3, 4–6, 7–9 ou 10–12 sérotypes était observée chez 83,3 %, 13,3 %, 3,3 % et 0 % dans le bras 1 ; 56,3 %, 28,1 %, 15,6 % et 0 % dans le bras 2 ; et 60,6 %, 33,3 %, 6,1 % et 0 % dans le bras 3. Les patients du bras 2 étaient significativement plus susceptibles de se trouver dans une catégorie de réponse supérieures par rapport au régime standard après ajustement sur l’âge, avec un odds ratio proportionnel (pOR) de 4,1 (IC97,5 % : 1,1–15,9, p = 0,018), tandis que le bras 3 montrait une tendance non significative à améliorer les réponses vaccinales (pOR : 3,1, IC97,5 % : 0,8–11,9, p = 0,062). Une analyse de sensibilité sur une population per-protocole excluant les patients ayant subi des vaccinations ou des prises de sang hors des délais donnait des estimations concordantes. Les réactions locales et/ou systémiques dans les 7 jours après chaque vaccination, et tout événement indésirable lié ou possiblement lié à la vaccination au cours des 6 premiers mois, sont survenus en plus grand nombre avec les schémas renforcés mais étaient principalement des réactions locales de grade 1 ou 2. Aucun événement indésirable grave lié à la vaccination n’a été observé. Au cours du suivi, 8 poussées de vascularite sont survenues chez 6 patients, en médiane 87 jours après la dernière vaccination : un patient dans le bras 1, 2 dans le bras 2, et 3 dans le bras 3. Conclusion Chez les patients atteints de VAA recevant un traitement par RTX, une stratégie innovante de vaccination anti-pneumococcique renforcée, basée sur une double dose de PCV13 au jour 0 et au jour 7 suivie d’une dose unique de PPV23 à M5, améliore significativement les réponses en anticorps contre Streptococcus pneumoniae par rapport au schéma standard.
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Affiliation(s)
- B. Terrier
- Médecine interne, hôpital Cochin, rue du Faubourg-Saint-Jacques, Paris,Auteur correspondant
| | | | - G. Pugnet
- Service de médecine interne, CHU Toulouse Purpan, Toulouse
| | - O. Aumaître
- Médecine interne, CHU Gabriel-Montpied, Clermont-Ferrand
| | - O. Moranne
- Néphrologie, hôpital de jour de Nîmes, Nîmes
| | - E. Diot
- Médecine interne, CHU de Tours, Tours
| | - A. Karras
- Néphrologie, HEGP, 15, rue Louis-Blanc, 75015 Paris
| | - F. Bonnet
- Médecine interne, hôpital Saint-André, Bordeaux
| | - C. De Moreuil
- Service de médecine interne, CHU Brest Centre de Formation, Brest
| | | | - T. Le Gallou
- Médecine interne, centre hospitalier universitaire de Rennes, Rennes
| | - C. Lebas
- Néphrologie, CHU de Lille, Lille
| | - F. Maurier
- Service de médecins interne, hôpital Belle-Isle, Metz
| | - C. Rafat
- Urgences néphrologiques et transplantation rénale, hôpital Tenon, AP–HP, Paris
| | - M. Samson
- Médecine interne et immunologie clinique, centre hospitalier universitaire F.-Mitterrand Dijon-Bourgogne, Dijon
| | | | - C. Janssen
- Maladies infectieuses, CH Annecy Genevois, Épagny Metz-Tessy
| | - T. Quéméneur
- Néphrologie-médecine interne, centre hospitalier de Valenciennes, Valenciennes
| | - F. Batteux
- Laboratoire d’immunologie, hôpital Cochin, Paris
| | - O. Launay
- Fédération d’infectiologie, hôpital Cochin, Paris
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Mettler C, Bouam S, Liva-Yonnet S, Pugnet G, Terrier B. Validation of anti-neutrophil cytoplasm antibodies associated vasculitides diagnosis codes from the electronic health records of two French university hospitals. Eur J Intern Med 2022; 103:115-117. [PMID: 35595627 DOI: 10.1016/j.ejim.2022.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Camille Mettler
- Service de Médecine Interne, Centre de Référence des maladies auto-immunes systémiques rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Samir Bouam
- Unité d'Information Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Gregory Pugnet
- Service de Médecine Interne et d'Immunologie Clinique, CHU Toulouse Rangueil, Toulouse, France; CIC 1436 PEPSS team Toulouse, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence des maladies auto-immunes systémiques rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris, F-75006 Paris, France.
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Chaves SDA, Puissant B, Porel T, Bories E, Adoue D, Alric L, Astudillo L, Huart A, Lairez O, Michaud M, Ribes D, Prévot G, Sailler L, Gaches F, Pugnet G. Clinical impact and prognosis of cryoglobulinemia and cryofibrinogenemia in systemic sclerosis. Autoimmun Rev 2022; 21:103133. [PMID: 35752439 DOI: 10.1016/j.autrev.2022.103133] [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: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION An association of systemic sclerosis (SSc) with cryoglobulin and/or cryofibrinogenemia has been described. However, clinical, biological, morphological and prognostic implications are unknown. The objective of this study was to describe the phenotype and evaluate the prognosis of cryoglobulinemia and/or cryofibrinogenemia in the progression of SSc. MATERIALS AND METHODS Patients were included from the Systemic Scleroderma Toulouse Cohort (SSTC), between June 1, 2005 and May 31, 2018, and underwent a measurement of a cryoglobulin and/or cryofibrinogen in immunology laboratory at the Toulouse University Hospital Center. Patients with and without cryoglobulinemia >50 mg/l and patients with and without cryofibrinogenemia were compared to identified the impact of cryoprcipitate on the phenotype. Mortality based on cryoprecipitate was explored. RESULTS 166 patients were included in the study. 43.3% and 46.6% had a cryoglobulinemia >50 mg/l and cryofibrinogenemia, respectively. Cryoglobulin >50 mg was not associated with microvascular damage. Cryoglobulin does not influence the phenotype. 5-and 10-years survival were 97.6% and 88.8% respectively in patients with cryoglobulinemia >50 mg/l versus 91.9% and 78.4% in patients without cryoglobulin>50 mg/l. 10-years survival was better for patients with cryoglobulinemia >50 mg/l (log-rank 0.0363). Cryofibrinogenemia was not associated with neoplasia, any clinical (in particular ischemic damage), biological or morphological features. Cryofibrinogenemia had no influence on the mortality of these patients. CONCLUSION Cryoglobulinemia and cryofibrinogenemia are frequent in SSc. The presence of cryoprecipitate (cryoglobulin or cryofibrinogen) not influence the phenotype and has not associated with a poor survival.
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Affiliation(s)
| | - Bénédicte Puissant
- Centre Hospitalier Universitaire, Laboratoire d'Immunologie, Toulouse, France
| | - Tiphaine Porel
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France
| | - Eva Bories
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France
| | - Daniel Adoue
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France
| | - Laurent Alric
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France
| | | | - Antoine Huart
- Centre Hospitalier Universitaire, Néphrologie, Toulouse, France
| | - Olivier Lairez
- Centre Hospitalier Universitaire, Cardiologie, Toulouse, France
| | - Martin Michaud
- Clinique Ambroise-Paré, Medecine Interne, Toulouse, France
| | - David Ribes
- Centre Hospitalier Universitaire, Néphrologie, Toulouse, France
| | - Grégoire Prévot
- Centre Hospitalier Universitaire, Pneumologie, Toulouse, France
| | - Laurent Sailler
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France
| | - Francis Gaches
- Hopital Joseph Ducuing, Medecine Interne, Toulouse, France
| | - Gregory Pugnet
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France; Centre Hospitalier Universitaire, Laboratoire d'Immunologie, Toulouse, France; Clinique Saint-Exupery, Medecine Interne, Toulouse, France; Centre Hospitalier Universitaire, Néphrologie, Toulouse, France; Centre Hospitalier Universitaire, Cardiologie, Toulouse, France; Clinique Ambroise-Paré, Medecine Interne, Toulouse, France; Centre Hospitalier Universitaire, Pneumologie, Toulouse, France; Hopital Joseph Ducuing, Medecine Interne, Toulouse, France; Centre D'investigation Clinique (CIC), 1436 PEPSS Team, Toulouse, France
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Pugnet G, Petermann A, Collot S, Otal P, Lansiaux P, Maria A, Ait Abdallah N, Lorillon G, Resch-Rigon M, Marjanovic Z, Farge D. POS0069 LONGITUDINAL CHANGES ON QUANTITATIVE CHEST HIGH-RESOLUTION COMPUTED TOMOGRAPHY IN EARLY DIFFUSE SYSTEMIC SCLEROSIS-RELATED INTERSTITIAL LUNG DISEASE AFTER AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4608] [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: 11/03/2022]
Abstract
BackgroundSince Burt et al. first demonstrated in the ASSIST trial (1) that lung disease high-resolution computed tomography (HRCT) volumetric measurement decreased in autologous hematopoietic stem cell transplantation (aHSCT) recipients and increased in controls receiving cyclophosphamide iv one year after starting treatment, limited data have been reported concerning the evolution of Systemic Sclerosis-Interstitial Lund disease (SSc-ILD) since and its relationship with the evolution of esophageal volume is unknown.ObjectivesTo evaluate High-Resolution Computed Computed Tomography (HRCT) interstitial lung disease (ILD) and esophageal involvement in early diffuse systemic sclerosis (dSSc)-patients before and after autologous Hematopoietic Stem Cell Transplantation (aHSCT).MethodsOverall chest HRCT, lung function and skin score changes were evaluated in 33 consecutive dSSc-patients before and after aHSCT during yearly routine follow-up between January 2000 and september 2016.Two independent radiologists blindly assessed the ILD extent using semi-quantitative Goh and Wells method (2), the widest esophageal diameter (WED) and the esophageal volume (EV) on HRCT. Patients were retrospectively classified as radiological responders or non-responders at 24 months after aHSCT according to the stability or a 5% or more decrease of HRCT ILD extent. Two by two time points comparisons after versus before aHSCT were performed using linear regressions. Survival rates were assessed for all patients by Kaplan-Meier method.ResultsTwenty-four months after aHSCT, HRCT median [IQR] ILD (-2 [-10.3; 0] points, p=0.0002) and ground-grass opacities (-2.1 [-8.3; 0] points, p=0.02) extent scores had improved, with 18 patients radiological responders (probability of response 0.78, 95% CI (0.58;0.90), whereas median WED (from 24.5 [18; 29] to 28 [19; 33] mm; p= 0.005) and EV (from 19 [13; 33] to 30 [13; 58] mm3, p=0.01) increased significantly. Kaplan-Meier analyses showed a trend towards better 5 years survival rates (100% versus 60%; HR 0.23 95%CI 0.03 to 1.62, P = 0.11) among radiological responders versus non-responders at 24 months.ConclusionReal-world data analysis confirmed significant HRCT SSc-ILD improvement 24 months after aHSCT, although esophageal dilatation worsened requiring specific attention.References[1]Burt RK, Shah SJ, Dill K, Grant T, Gheorghiade M, Schroeder J, et al. Autologous non-myeloablative haemopoietic stem-cell transplantation compared with pulse cyclophosphamide once per month for systemic sclerosis (ASSIST): an open-label, randomised phase 2 trial. Lancet Lond Engl. 6 août 2011;378(9790):498‑506.[2]Goh NSL, Desai SR, Veeraraghavan S, Hansell DM, Copley SJ, Maher TM, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med. 1 juin 2008;177(11):1248‑54.Disclosure of InterestsNone declared
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Bories E, De Almeida S, Porel T, Alric L, Astudillo L, Gaches F, Michaud M, Catros F, Prevot G, Sailler L, Adoue D, Lairez O, Pugnet G. Épidémiologie descriptive de l’atteinte cardiaque sévère dans la sclérodermie systémique : étude rétrospective bicentrique sur 459 patients. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.261] [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: 10/18/2022]
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De Almeida Chaves S, Benedicte P, Porel T, Bories E, Adoue D, Astudillo L, Alric L, Huart A, Michaud M, Ribes D, Prevot G, Sailler L, Gaches F, Pugnet G. AB0651 Clinical Impact and Prognosis of cryoglobulinemia and cryofibrinogenemia in Systemic Sclerosis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.475] [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: 11/03/2022]
Abstract
BackgroundSystemic sclerosis (SSc) is reported to be a secondary cause of cryoglobulinemia as well as cryofibrinogenemia. However, prevalence, clinical implication and associated pronostic of cryoprecipitates in SSc are unknown.ObjectivesTo describe the prevalence, the phenotype and evaluate the prognosis of cryoglobulinemia and/or cryofibrinogenemia associated with systemic sclerosis.MethodsWe included all adult (≥18 years) consecutive SSc patients from the Systemic Scleroderma Toulouse Cohort (SSTC) [1] for whom a cryoglobulin and/or cryofibrinogen measurement was carried out at the immunology laboratory of the Toulouse University Hospital between June 1, 2005 and May 31, 2018 and at least one follow-up visit. We compared SSc-patients characteristics’ with and without cryoglobulinemia > 50 mg/l and with and without cryofibrinogenemia. Survival analysis based on presence of cryoglobulin cryofibrinogen was performed using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazards models (ascending step-by-step method) were used to determine baseline variables associated with cryoglobulin or cryofibrinogen presence.Results166 patients were included in the study. 74.6% of patients were women, with a average age at diagnosis of 51.2 years-old. 24% were diffuse cutaneous subtypes and 71.6% limited cutaneous subtypes. Anti-centromere and anti-Scl70 were respectively positive in 44.5% and 21.6% of cases. All these patients were assessed for cryoglobulin detection and 75 cryofibrinogen detection in serum. 43.3% had a cryoglobulinemia >50 mg/l. 46.6% had cryofibrinogenemia. Patients with cryoglobulinemia >50 mg had more cardiac diastolic involvement (22.8% vs. 5.1% p=0.0395). In the multivariate analysis, diastolic involvement (HR=6.23; p=0.0331) was an independent predictor of cryoglobulin >50 mg/l. Survival at 10 years was better for patients with cryoglobulinemia >50 mg/l (log-rank 0.0363) (Figure 1). Survival at 5 and 10 years was 97.6% and 88.8% respectively in patients with cryoglobulinemia >50 mg/l versus 91.9% and 78.4% in patients with cryoglobulinemia <50 mg/l. In cox regression model adjusted for gender, age and type of systemic sclerosis, cryoglobulin >50 mg/l was negatively associated with mortality (HR: 0.09; p=0.03). The presence of cryofibrinogenemia was not associated with any clinical, biological or morphological features. In the multivariate analysis, no variable was predictive of the presence of cryofibrinogenemia in patients with SSc. The presence of cryofibrinogenemia had no influence on the mortality of these patients.ConclusionIn SSc patients, the presence of cryoglobulin >50 mg/l is an independent predictive factor of cardiac diastolic involvement and is associated with a better survival. However, cryofibrinogenemia does not influence clinical phenotype or impact mortality in SSc patients.References[1]De Almeida Chaves S, Porel T, Mounié M, Alric L, Astudillo L et al. Sine scleroderma, limited cutaneous, and diffused cutaneous systemic sclerosis survival and predictors of mortality. Arthritis Res Ther. 2021 Dec 7;23(1):295. doi: 10.1186/s13075-021-02672-y.Disclosure of InterestsNone declared
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Lemeu M, Lairez O, Faguer S, Pugnet G, Moulis G, Alric L, Huart A, Ribes D, Piel-Julian ML, Constantin A, Chauveau D, Sailler L. AB0521 PERICARDITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS: CHARACTERISTICS, MANAGEMENT, EVOLUTION AND PREDICTIVE FACTORS FOR RELAPSE. A MONOCENTRIC RETROSPECTIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3486] [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
BackgroundPericarditis is frequent in Systemic Lupus Erythematosus (SLE) and usually benign. Dedicated studies are scarce. However, recurrences can lead to repeated steroid prescriptions and further immunosuppression. The best management, including the potential benefit of colchicine, remains to be determined.ObjectivesThe aim of this study was to describe management, evolution over time and risk factor for relapse in SLE pericarditis in our University Hospital Center.MethodsCases were retrospectively collected among hospital discharge data (coding code “SLE” and “pericarditis”), from January 1997 to December 2019. All SLE cases met the ACR/EULAR 2019 classification criteria. Pericarditis cases met ESC 2015 diagnosis criteria. Patients with conditions other than lupus known to cause pericarditis were excluded as well as patients with myocarditis. A minimal follow-up of one year after pericarditis diagnosis was mandatory. Relapse- free survival was described using an actuarial survival model.ResultsAmong 103 patients identified in the database, 29 patients (women: n=25, mean age 30 +/- 13 years) were included. Median follow-up was 7 years [range: 1-22].Description of first episodes: 31% (n= 9) were inaugural of SLE; otherwise, median time elapsed since SLE diagnosis was 65 months [1.7-400]. Fifty-five percent (n=16) of first episodes occurred during a multi-systemic lupus flare. Median SLEDAI-2K was 9 [range: 4-30|. Clinical symptoms and signs were typical chest pain (93%, n=27), dyspnea (55%, n=16); pericardial rub (31%, n=9), fever (38%, n=11). EKG was abnormal in 59% of the cases (n= 17). When present, 79% of effusions (n=17/22) were circumferential, 82% (n= 18/22) were mild to moderate (<20mm), and 25% (n=7) were dry pericarditis. Two Cardiovascular Magnetic Resonance imaging were performed and were pathological.Biological data showed always high CRP levels (65mg [range: 7-460]), high-titer anti-DNA (79%, n=19) but few patients had low complement levels (C3 21% (n=4/19), C4 26%(n=5/19)).Prescribed drugs were non-steroidal anti-inflammatory drugs/acetylsalicylic acid (NSAIDs/ASA) (41%, n=12), corticosteroids (66%, n=19; mean daily prednisone dose: 57.2mg +/- 13.9), colchicine 0.5 to 1mg/day (41%; n=12). There was a significant difference in SLEDAI-2K values at pericarditis onset between those treated with NSAIDs/ASA (7.5, [range: 0-16]) and those not (12, [range: 4-30]), (p<0.05). Only 41% (n=5) of colchicine prescriptions lasted at least 3 months; they were associated with a lower SLEDAI-2K at pericarditis onset compared to pericarditis not or insufficiently treated with colchicine (respectively, 7[range: 4-9] and 11[range: 4-30], p=0.04). Immunosuppressive drugs were prescribed in 17% (n=5) of the patients, always due to extra-pericardial involvements.Recurrences were frequent (55%, 16 patients out of 29) and multiple (1 to 6, average 3 ± 1.26). Short and long-term relapse-free survival tended to be better in patients exposed to at least 3 months of colchicine (100% vs 75% at 1 year, p=0.09) (Figure 1). There was no statistical difference (p=0.25) in terms of short-term relapse-free survival in patients treated with NDAIDs/ASA compared to those who were not. Corticosteroid prescription and previous antimalarial treatment were not associated with a poorer or better outcome during the year following remission (p=0.78). No patient has progressed to constriction.Figure 1.Relapse-free survival at 12 months according to colchicine prescriptionConclusionOur conclusions are limited due to the small number of patients and lack of multivariate analysis.Further studies are necessary to confirm the potential benefit of colchicine to prevent incessant pericarditis or relapses in this population.References[1]Kruzliak P, et al. Acta Cardiol 2013;68:629–33.Disclosure of InterestsNone declared
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De Almeida Chaves S, Puissant B, Porel T, Bories E, Adoue D, Astudillo L, Alric L, Huart A, Michaud M, Ribes D, Prevot G, Sailler L, Gaches F, Pugnet G. Impact clinique et pronostique d’une cryoglobulinémie et d’une cryofibrinogénémie au cours de la sclérodermie systémique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Guédon A, Carrat F, Mouthon L, Launay D, Chaigne B, Pugnet G, Lega J, Hot A, Cottin V, Agard C, Allanore Y, Fauchais A, Jego P, Dhôte R, Papo T, Chatelus E, Fain O, Mekinian A, Hachulla E, Riviere S. Atteintes cardiaques de la sclérodermie systémique : résultats d’une étude de cohorte nationale française. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.263] [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: 10/18/2022]
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Delestre F, Charles P, Samson M, Néel A, Faguer S, Karras A, Lifermann F, Godmer P, Hanrotel-Saliou C, Martin-Silva N, Pugnet G, Maurier F, Le Gallou T, Quéméneur T, Méaux-Ruault N, Viallard J, Puéchal X, Guillevin L, Porcher R, Terrier B. Performance de modèles de prédiction du risque de rechute et d’infection sévère à la fin du traitement d’entretien par rituximab à 18 mois au cours des vascularites à ANCA. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.233] [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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Xavier B, Lafaurie M, Treiner E, Walter O, Pugnet G, Martin-Blondel G, Biotti D, Ciron J, Moulis G, Constantin A, Renaudineau Y, Chauveau D, Sailler L. POS1178 PRESCRIBING RITUXIMAB IN PATIENTS WITH AUTO-IMMUNE DISEASES AND ACQUIRED HYPOGAMMAGLOBULINEMIA: DESCRIPTION OF THE RISK OF SEVERE INFECTION IN 121 PATIENTS BEFORE THE SARS-Cov2 ERA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1194] [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
BackgroundRituximab (RTX) induces rapid, usually complete and prolonged depletion of circulating B cells, and also hypogammaglobulinemia in some patients. There are limited data regarding the risk of severe infection events (SIE) when initiating or continuing rituximab in patients with acquired hypogammaglobulinemia, especially in patients suffering from autoimmune diseases (ADs) other than rheumatoid arthritis (RA) (1).ObjectivesTo describe the risk of severe infectious events (SIE) following initiation (rituximab-naïve patients [RNP]) or continuation of RTX therapy (rituximab-continuing patients [RCP]) in patients suffering from severe ADs other than RA and acquired hypogammaglobulinemia.MethodsWe conducted a single-center retrospective cohort study at the University Hospital of Toulouse (France) between 2010 and 2018. Patients were included if they had received at least one dose of RTX in the year following the evidence of hypogammaglobulinemia (defined as gammaglobulins [GG]≤ 6g/L on serum protein electrophoresis) in the setting of ADs other than RA. The primary outcome was the occurrence of a SIE within 2 years after the date of first RTX infusion (T0) prescribed after the evidence of hypogammaglobulinemia. SIE were infections either fatal or requiring hospitalization.ResultsWe included 121 patients (37 RNP and 84 RCP): 48 had ANCA-associated vasculitis (AAV), 48 multiple sclerosis (MS, n=41) or neuromyelitis optica (NMO, n=7), and 21 another severe AD. RTX was prescribed as induction therapy in 39 patients and as maintenance therapy in 82; 112/121 patients were followed for 2 years. Mean GG level were 5.5 g/L (IQ25-75 4.6-5.7) at T0, 5.5 g/L (IQ25-75 5-6.4) at one year, 5.7g/L (IQ25-75 4.8-6.1) at two years and 8 patients had a decrease of their GG level below 4g/L. Ten patients received immunoglobulin replacement therapy (IGRT) mostly after infection (n=6).Twenty-six patients (23.2%) had at least one SIE during follow-up: 12.8 % in the MS/NMO group with a 2-year incidence at 6.9 (3.1-15.3) per 100 person-years, 29.5 % in the AAV group with a 2-year incidence at 18.3 (9.3-20.1) per 100 person-years, 33.3 % in the ‘other ADs’ group with a 2-year incidence at 22.2 (10.6-46.5) per 100 person-years. Infection was opportunistic in 8 patients (33.3%) and 4 died from SIE.Risk factors of SIE at T0 were male gender (61.5% vs. 39.5% p<0.05), lung disease (65.4% vs. 37.2% p=0.01), renal failure (59.1% vs. 28.6% p=0.01), a higher Charlson comorbidity index (p=0.001), a previous treatment by cyclophosphamide (53.8% vs. 30.2%; p=0.03), ≥ 5 mg/d prednisone (69.2% vs. 33.7%, p=0.003), lack of pneumococcal vaccination (61.5% vs 31.4%, p=0.01). GG level was 5.3 g/l [4.1-5.6] in the ‘SIE’ group vs 5.6 g/l [4.8-5.8] in the ‘no SIE’ group (p=0.04). Incidence of SIE was 46% and 20.2% among patients with GG< 4 g/L or GG≥ 4 g/L, respectively (p=0.07). No multivariable analysis provided reliable results.ConclusionOur study provides useful information for clinicians considering initiating or continuing rituximab therapy in patients with acquired hypogammaglobulinemia before Sars-Cov2 era. Prospective studies are necessary to improve the knowledge on outcome of patients treated by rituximab despite low immunoglobulins levels. Prophylactic IGRT may be appropriate in higher risk patients, especially if the GG level is below 4 G/L.References[1]Boleto G et al. Predictors of hypogammaglobulinemia during rituximab maintenance therapy in rheumatoid arthritis: A 12-year longitudinal multi-center study. Seminars in Arthritis and Rheumatism. oct 2018;48(2):149‑54.Figure 1.Two years probability of survival without serious infectious event according to pathology group (112 patients included)Disclosure of InterestsNone declared
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Sorin B, Iudici M, Guerry M, Samson M, Bielefeld P, Maillet T, Nouvier M, Karras A, Christian L, Durel C, Fabre M, Charles P, Lanteri A, Pugnet G, Riviere F, Le Gueno G, Guillevin L, Puéchal X, Terrier B. Étude des granulomatoses avec polyangéites réfractaires au traitement d’induction. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.234] [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: 10/18/2022]
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Bories E, DE Almeida Chaves S, Porel T, Alric L, Astudillo L, Gaches F, Michaud M, Catros F, Prevot G, Sailler L, Adoue D, Lairez O, Pugnet G. POS0884 DESCRIPTIVE EPIDEMIOLOGY OF SEVERE CARDIAC INVOLVEMENT IN SYSTEMIC SCLEROSIS: A BICENTRIC RETROSPECTIVE STUDY ON 459 PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2842] [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
BackgroundThe prevalence of cardiac involvement in systemic sclerosis (SSc) varies in the literature between 3% and 44% and represents a leading cause of mortality in this disease. The incidence of severe cardiac involvement and the factors associated with the occurrence of severe cardiac involvement are not known in the literature.ObjectivesThe objective of this study was to evaluate the incidence, prognosis and factors associated with the occurrence of severe cardiac involvement during SSc course.MethodsWe conducted a retrospective, bi-centric study from January 1, 1966 to December 31, 2018. The patients included had a diagnosis of SS according to the ACR/EULAR 2013 criteria. The primary endpoint was the occurrence of severe cardiac involvement. Cardiac involvement was defined by the presence of at least one of the following elements: death of cardiovascular origin, left ventricular ejection fraction less than or equal to 50%, abnormality of at least 3 measurement parameters of diastolic function, global longitudinal strain less than or equal to 18 in absolute value, ventricular tachycardia, ventricular extrasystoles requiring intervention or elevated troponin. Patients with associated myositis and whose only criterion for cardiac involvement was elevated troponin were not included in the group with cardiac involvement. Severe cardiac involvement was defined by the occurrence of hospitalization for cardiovascular reasons or by death of cardiovascular origin. Univariable and multivariable Cox proportional hazards models were used to determine variables associated with severe cardiac involvement occurrence. Survival analysis was performed using the Kaplan-Meier method with comparisons performed using the log rank test.ResultsFour hundred and fifty-nine patients with SSc were included and were followed for a median of 7.1 years [3.1; 13.3]. The median age of our population was 54 years old. There were 81% of women, 77% of patients had limited cutaneous SSc, 15% diffuse cutaneous SSc and 8% SSc sine scleroderma. Of the 459 patients, 105 (23%) had cardiac involvement and 56 (12%) severe cardiac involvement. The incidence of severe cardiac involvement was 2.42 per 100 patient years. Ninety-six hospitalizations were recorded, including 40 (42%) for acute heart failure, 19 (20%) for arrhythmia, 5 (5%) for acute pericarditis, 6 (6%) for acute myocarditis and 14 (15 %) for coronary artery disease (acute coronary syndrome, myocardial infarction or coronary revascularization). The independent factors associated with severe cardiac involvement in SSc were age over 54 years at SSc-diagnosis (OR = 3.21 95% CI [1.73; 5.95], p < 0.001), the presence of myositis (OR = 5.01 95% CI [1.89; 13.28], p = 0.001), pericardial involvement (OR = 3.79 95% CI [2.05; 7.03]; p < 0.001) or scleroderma renal crisis (OR = 4.72 95% CI [2.05; 10.92], p < 0.001). The survival rate of patients with severe cardiac involvement was 70% at 5 years and 53% at 10 years. Patients with severe cardiac involvement had a mortality risk three times greater than patients without severe cardiac involvement, HR = 3.1 (95% CI [1.7; 5.7], p<0.0001) (Figure 1). Pericardial involvement was an independent risk factor for mortality, HR = 2.0 (95% CI [1.02; 4.0], p=0.04).Figure 1.Survival of patients with severe cardiac involvement of systemic scleroderma. HR: Hazard ratio; 95% CI: 95% Confidence interval; Nb at risk: Number at riskConclusionWe need to focus our clinical attention on diagnosing and manage cardiac involvement in SSc, as severe cardiac involvement is not uncommon and is responsible for a poor prognosis.Disclosure of InterestsNone declared
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Bories E, Fortenfant F, Pugnet G, Renaudineau Y, Bost C. AB0129 MYOSITIS-SPECIFIC AUTOANTIBODIES IN CLINICAL PRACTICE: IMPROVING THE PERFORMANCES OF THE IMMUNODOT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1962] [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: 11/03/2022]
Abstract
BackgroundIdiopathic inflammatory myopathies (IIM) or myositis are a group of rare autoimmune diseases that combine muscle weakness and multi-visceral damage. The discovery of IIM-specific autoantibodies (aAbs) and their associations with clinical phenotypes has improved diagnostic and classification criteria. Faced with the large number of these aAbs, multiplexed techniques have emerged. Among them, the immunodot is simple, rapid, and inexpensive, but has been several times criticized for its lack of specificity.ObjectivesOur objective was to evaluate the current interpretation criteria of the D-Tek immunodot and to propose new interpretation rules based on clinical criteria in order to improve its reliability.MethodsWere included in this retrospective study patients tested positive result on the semi-quantitative myositis/synthetase immunodots at manufacturer threshold (≥ 5 UA), for at least one of the 15 aAbs: anti-SRP, anti-NXP2, anti-TIF1, anti-SAE (1 and 2), anti-Mi2, anti-MDA5, anti-Jo1, anti-PL7, anti-PL12, anti-EJ, anti-OJ, anti-KS, anti-ZO, anti-HA. Specificity of the immunodots was further evaluated using 60 healthy and anonymous subjects (French blood bank, Toulouse, France). The clinical diagnosis and sub-classification retained by the clinician in charge of the patient was used as a reference for attribution to the myositis/non-myositis group and subgroups. For the myositis group, 7 subgroups were considered: immune-mediated necrotizing myopathy (n=4); dermatomyositis (n=66); anti-synthetase syndrome (n=36); inclusion body myositis (n=1); overlap myositis with another connective tissue disease (n=7); polymyositis (n=8); and unclassified myositis (n=6). For the non-myositis group, patients were subdivided in 4 subgroups: autoimmune or inflammatory diseases (n=72); isolated and diffuse interstitial lung disease (n=26) not associated with other myositis criteria; other non-inflammatory myopathies (n=8) including genetic, metabolic, and toxic myopathies; and other diseases (n=36). The immunodot interpretation thresholds were evaluated both in relation to the manufacturer’s threshold, and by considering the phenotypes and clinical diagnoses using a ROC method (Youden’s index).ResultsAmong 270 patients included between 01/07/2016 and 30/06/2020, 128 (47%) were classified as myositis (median age 58 years, 60% women, 52% DM and 28% AS) and 142 (53%) in non-myositis. Among the 15 aAbs analyzed, none were detected in the healthy control group but they were represented in both myositis and non-myositis group. Among them only 2 (anti-Jo1, anti-Mi2) predominate in the myositis group, and 1 (anti-TIF1) in the non-myositis group (Fisher’s test). As quantitative values were found different for 5 aAbs (Mann Whitney test), a clinical threshold was calculated to discriminate myositis from non-myositis groups (ROC curve) allowing to determine an odds ratio (OR). Accordingly, 4/15 (%) aAbs were found associated with myositis: anti-SRP (at 28UA: OR=3.24 95% CI [1.01-10.46], p=0.048), anti-MDA5 (at 15UA: OR=4.36; 95% CI [1.19-15.99], p=0.048), anti-Mi2 (at 5UA: OR =3.24; 95% CI [1.01-10.46], p=0.026), anti-Jo1 (at 5UA: OR= 12.20; 95% CI [2.78-53.52], p<0.0001). All positive predictive values were improved by using a clinical threshold although some of did not reach significance due to their infrequency.ConclusionIn this retrospective work, despite missing data, the clinical phenotypes of myositis patients and their distribution according to aAbs were comparable to those in the literature. Our study confirms the lack of specificity of D-tek immunodots for IIM-specific aAbs and allows establishing new thresholds improving their performance. Our results should encourage medical biologists to establish local rules of interpretation and reinforce the interest of the discussion between Clinicians and Biologists around the interpretation of these immunodots.Figure 1.A: Odd Ratio (OR) evaluated with the manufacturer threshold ≥ 5 and B: OR using Youden’s index (clinical threshold).Disclosure of InterestsNone declared
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Boumaza X, Lafaurie M, Treiner E, Walter O, Pugnet G, Martin-Blondel G, Biotti D, Ciron J, Moulis G, Constantin A, Tauber M, Renaudineau Y, Chauveau D, Sailler L. Description du risque infectieux chez les patients avec hypogammaglobulinémie acquise dans le cadre d’une maladie auto-immune et initiant ou poursuivant un traitement par rituximab. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.305] [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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Mettler C, Durel CA, Guilpain P, Bonnotte B, Cohen-Aubart F, Hamidou M, Lega JC, Guern VL, Lifermann F, Poindron V, Pugnet G, Servettaz A, Puéchal X, Guillevin L, Terrier B. Off-label use of biologics for the treatment of refractory and/or relapsing granulomatosis with polyangiitis. Eur J Intern Med 2022; 96:97-101. [PMID: 34716074 DOI: 10.1016/j.ejim.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the efficacy and safety of off-label use of biologics for refractory and/or relapsing granulomatosis with polyangiitis (GPA). METHODS We conducted a French retrospective study including GPA patients who received off-label biologics for refractory and/or relapsing disease after failure of conventional immunosuppressive regimens. RESULTS Among 26 patients included, 18 received infliximab (IFX), 2 adalimumab (ADA) and 6 abatacept (ABA). Biologics were initiated in median as 4th-line therapy (IQR 3-6) for relapsing and/or refractory disease in 23 (88%) and/or significant glucocorticoid-dependency in 8 cases (31%). At biologics initiation, median (IQR) BVAS and prednisone dose in anti- TNF-α and ABA recipients were 7 (3-8) and 2 (1-6), and 20 (13-30) mg/day and 20 (15-25) mg/day, respectively. Clinical manifestations requiring biologics were mainly pulmonary and ENT manifestations in 58% each. Anti-TNF-α and ABA were continued for a median duration of 8 months (IQR 6-13) and 11 months (IQR 6-18) respectively. Anti-TNF-α recipients showed remission, partial response and treatment failure in 10%, 30% and 60% at 6 months, and 25%, 20% and 55% at 12 months, respectively. ABA recipients showed remission, partial response and treatment failure in 17%, 33% and 50% at 6 months and 17%, 33% and 50% at 12 months. One patient treated with IFX experienced life-threatening reaction while one patient treated with ABA experienced a severe infection. CONCLUSION This real-life study suggests that off-label use of anti-TNF-α and abatacept shows efficacy in less than 50% of refractory and/or relapsing GPA.
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Affiliation(s)
- C Mettler
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - C A Durel
- Department of Internal Medicine, CHU Lyon, Lyon, France
| | - P Guilpain
- Department of Internal Medicine-Multiorganic Diseases, Local Referral Center for Auto-immune Diseases, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - B Bonnotte
- Department of Internal Medicine, Competence Center for Autoimmune Cytopenia, François Mitterrand University Hospital, Dijon, France
| | - F Cohen-Aubart
- Department of Internal Medicine 2, French National Centre for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - M Hamidou
- Department of Internal Medicine, Nantes University Hospital, 44093 Nantes, France
| | - J C Lega
- Department of Internal and Vascular Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, Université Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, LBBE, UMR CNRS 5558, France
| | - V Le Guern
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - F Lifermann
- Department of Internal Medecine, Dax - Côte d'Argent Hospital, Dax, France
| | - V Poindron
- Clinical Immunology Department, National Referral Center for Systemic Autoimmune Diseases, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - G Pugnet
- Department of Internal Medicine and Clinical Immunology, CHU Toulouse Rangueil, Toulouse, France
| | - A Servettaz
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - X Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - L Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France
| | - B Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Cochin Hospital, AP-HP, Paris, France.
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Muller R, Habert P, Ebbo M, Graveleau J, Groh M, Launay D, Audia S, Pugnet G, Cohen F, Perlat A, Benyamine A, Bienvenu B, Gaigne L, Chanez P, Gaubert JY, Schleinitz N. Thoracic involvement and imaging patterns in IgG4-related disease. Eur Respir Rev 2021; 30:30/162/210078. [PMID: 34615698 DOI: 10.1183/16000617.0078-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/09/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Immunoglobulin G4-related disease (IgG4-RD) is a rare orphan disease. Lung, pleura, pericardium, mediastinum, aorta and lymph node involvement has been reported with variable frequency and mostly in Asian studies. The objective of this study was to describe thoracic involvement assessed by high-resolution thoracic computed tomography (CT) in Caucasian patients with IgG4-RD. METHODS Thoracic CT scans before treatment were retrospectively collected through the French case registry of IgG4-RD and a single tertiary referral centre. CT scans were reviewed by two experts in thoracic imagery blinded from clinical data. RESULTS 48 IgG4-RD patients with thoracic involvement were analysed. All had American College of Rheumatology/European League Against Rheumatism classification scores ≥20 and comprehensive diagnostic criteria for IgG4-RD. CT scan findings showed heterogeneous lesions. Seven patterns were observed: peribronchovascular involvement (56%), lymph node enlargement (31%), nodular disease (25%), interstitial disease (25%), ground-glass opacities (10%), pleural disease (8%) and retromediastinal fibrosis (4%). In 37% of cases two or more patterns were associated. Asthma was significantly associated with peribronchovascular involvement (p=0.04). Among eight patients evaluated by CT scan before and after treatments, only two patients with interstitial disease displayed no improvement. CONCLUSION Thoracic involvement of IgG4-RD is heterogeneous and likely underestimated. The main thoracic CT scan patterns are peribronchovascular thickening and thoracic lymph nodes.
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Affiliation(s)
- Romain Muller
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France.,These authors contributed equally to this work
| | - Paul Habert
- Dept of Radiology, Aix Marseille University, APHM, CHU La Timone, Marseille, France.,These authors contributed equally to this work
| | - Mikael Ebbo
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France
| | - Julie Graveleau
- Dept of Internal Medicine, CH Saint Nazaire, Saint Nazaire, France
| | - Mathieu Groh
- Dept of Internal Medicine, CH Foch, National Referral Center for Hypereosinophilic Syndromes (CEREO), Suresnes, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | | | - Gregory Pugnet
- Dept of Internal Medicine and Clinical Immunology, CHU Toulouse, Toulouse, France
| | - Fleur Cohen
- Dept of Internal Medicine, APHP, CHU Pitié-Salpêtrière, Paris, France
| | | | - Audrey Benyamine
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU Nord, Marseille, France
| | - Boris Bienvenu
- Dept of Internal Medicine, CH St Joseph, Marseille, Marseille, France
| | - Lea Gaigne
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France
| | - Pascal Chanez
- Dept of Pneumology, Aix Marseille University, APHM, CHU Nord, Marseille, France
| | - Jean Yves Gaubert
- Dept of Radiology, Aix Marseille University, APHM, CHU La Timone, Marseille, France
| | - Nicolas Schleinitz
- Dept of Internal Medicine, Aix Marseille University, APHM, CHU La Timone, Marseille, France
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De Almeida Chaves S, Porel T, Mounié M, Alric L, Astudillo L, Huart A, Lairez O, Michaud M, Prévot G, Ribes D, Sailler L, Gaches F, Adoue D, Pugnet G. Sine scleroderma, limited cutaneous, and diffused cutaneous systemic sclerosis survival and predictors of mortality. Arthritis Res Ther 2021; 23:295. [PMID: 34876194 PMCID: PMC8650544 DOI: 10.1186/s13075-021-02672-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/08/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is associated with a variability of mortality rates in the literature. OBJECTIVE To determine the mortality and its predictors in a long-term follow-up of a bi-centric cohort of SSc patients. METHODS A retrospective observational study by systematically analyzing the medical records of patients diagnosed with SSc in Toulouse University Hospital and Ducuing Hospital. Standardized Mortality Ratio (SMR), mortality at 1, 3, 5, 10, and 15 years of disease and causes of death were described. Predictors of mortality using Cox regression were assessed. RESULTS Three hundred seventy-five patients were included: 63 with diffuse cutaneous SSc, 279 with limited cutaneous SSc, and 33 with sine scleroderma. The SMR ratio was 1.88 (95% CI 1.46-1.97). The overall survival rates were 97.6% at 1 year, 93.4% at 3 years, 87.1% at 5 years, 77.9% at 10 years, and 61.3% at 15 years. Sixty-nine deaths were recorded. 46.4% were SSc related deaths secondary to interstitial lung disease (ILD) (34.4%), pulmonary hypertension (31.2%), and digestive tract involvement (18.8%). 53.6% were non-related to SSc: cardiovascular disorders (37.8%) and various infections (35.1%) largely distanced those from cancer (13.5%). Four significant independent predictive factors were identified: carbon monoxide diffusing capacity (DLCO) < 70% (HR=3.01; p=0.0053), C-reactive protein (CRP) >5 mg/l (HR=2.13; p=0.0174), cardiac involvement (HR=2.86; p=0.0012), and the fact of being male (HR=3.25; p=0.0004). CONCLUSION Long-term data confirmed high mortality of SSc. Male sex, DLCO <70%, cardiac involvement, and CRP> 5mg/l were identified as independent predictors of mortality.
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Affiliation(s)
| | - Tiphaine Porel
- Department of Internal Medicine, CHU Toulouse, Toulouse, Midi-Pyrénées, France
| | - Mickael Mounié
- INSERM UMR1027, 37 Allées Jules Guesdes, Toulouse, Midi-Pyrénées, France
| | - Laurent Alric
- Department of Internal Medicine, CHU Toulouse, Toulouse, Midi-Pyrénées, France
- Universite Toulouse III Paul Sabatier Toulouse, Occitanie, France
| | - Léonardo Astudillo
- Department of Internal Medicine, Saint Exupéry Nephrology Clinic, Toulouse, Midi-Pyrénées, France
| | - Antoine Huart
- Department of Nephrology, CHU Toulouse, Toulouse, Midi-Pyrénées, France
| | - Olivier Lairez
- Universite Toulouse III Paul Sabatier Toulouse, Occitanie, France
- Department of Cardiology, CHU Toulouse, Toulouse, Midi-Pyrénées, France
| | - Martin Michaud
- Department of Internal Medicine, Hospital Joseph Ducuing, Toulouse, France
| | - Grégoire Prévot
- Department of Pneumology, CHU Toulouse, Toulouse, Midi-Pyrénées, France
| | - David Ribes
- Department of Nephrology, CHU Toulouse, Toulouse, Midi-Pyrénées, France
| | - Laurent Sailler
- Department of Internal Medicine, CHU Toulouse, Toulouse, Midi-Pyrénées, France
- Universite Toulouse III Paul Sabatier Toulouse, Occitanie, France
| | - Francis Gaches
- Department of Internal Medicine, Hospital Joseph Ducuing, Toulouse, France
| | - Daniel Adoue
- Department of Internal Medicine, CHU Toulouse, Toulouse, Midi-Pyrénées, France
- Universite Toulouse III Paul Sabatier Toulouse, Occitanie, France
| | - Gregory Pugnet
- Department of Internal Medicine, CHU Toulouse, Toulouse, Midi-Pyrénées, France
- Universite Toulouse III Paul Sabatier Toulouse, Occitanie, France
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Lemeu M, Lairez O, Faguer S, Pugnet G, Moulis G, Alric L, Huart A, Ribes D, Piel-Julian M, Constantin A, Chauveau D, Sailler L. Péricardite lupique: caractéristiques, prise en charge, évolution et facteurs prédictifs de rechute. Une étude de cohorte rétrospective. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rouane C, Pugnet G, Paul C. Des manifestations exceptionnelles d’une pathologie exceptionnelle ! Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.149] [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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Peter E, Jean-Baptiste F, Harbaoui B, Kone-Paut I, Dauphin C, Gomard-Mennesson E, Hervier B, De Boysson H, Varron L, Pugnet G, Gobert D, Bachmeyer C, Humbert S, Roblot P, Cathébras P, Gerfaud-Valentin M, Weber E, Jamilloux Y, Fain O, Sève P. Devenir cardiovasculaire à long terme dans la maladie de Kawasaki de l’adulte. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.278] [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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Maczyta A, Zordan J, Despres J, Boumaza X, Godart M, Guinard-Brun F, Bonnet D, Pugnet G, Alric L. Forme rare de maladie de Kawasaki post-SARS-CoV-2, avec orchite et pancréatite, chez un adulte. Rev Med Interne 2021. [PMCID: PMC8192029 DOI: 10.1016/j.revmed.2021.03.067] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction Observation Discussion Conclusion
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Panhaleux M, Espitia O, Terrier B, Manson G, Maria A, Humbert S, Godbert B, Perrin J, Achille A, Arrondeau J, Kostine M, Fallet V, Pugnet G, Chaigne B, Champiat S, Lambotte O, Michot J, Forestier A. Étude SCLERONCO-1 : Étude de tolérance et de pharmacovigilance des Immune Checkpoint Inhibiteurs chez les patients ayant une SCLERodermie systémique préexistante en ONCOlogie. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.238] [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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Durel CA, Sinico RA, Teixeira V, Jayne D, Belenfant X, Marchand-Adam S, Pugnet G, Gaultier J, Le Gallou T, Titeca-Beauport D, Agard C, Barbet C, Bardy A, Blockmans D, Boffa JJ, Bouet J, Cottin V, Crabol Y, Deligny C, Essig M, Godmer P, Guilpain P, Hirschi-Santelmo S, Rafat C, Puéchal X, Taillé C, Karras A. Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA): a multicentric retrospective study of 63 biopsy-proven cases. Rheumatology (Oxford) 2021; 60:359-365. [PMID: 32856066 DOI: 10.1093/rheumatology/keaa416] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by asthma, hypereosinophilia and ANCA positivity in 40% of patients. Renal involvement is rare and poorly described, leading to this renal biopsy-proven based study in a large EGPA cohort. METHODS We conducted a retrospective multicentre study including patients fulfilling the 1990 ACR criteria and/or the 2012 revised Chapel Hill Consensus Conference criteria for EGPA and/or the modified criteria of the MIRRA trial, with biopsy-proven nephropathy. RESULTS Sixty-three patients [27 women, median age 60 years (18-83)] were included. Renal disease was present at vasculitis diagnosis in 54 patients (86%). ANCA were positive in 53 cases (84%) with anti-MPO specificity in 44 (83%). All patients had late-onset asthma. Peripheral neuropathy was present in 29 cases (46%), alveolar haemorrhage in 10 (16%). The most common renal presentation was acute renal failure (75%). Renal biopsy revealed pauci-immune necrotizing GN in 49 cases (78%). Membranous nephropathy (10%) and membranoproliferative GN (3%) were mostly observed in ANCA-negative patients. Pure acute interstitial nephritis was found in six cases (10%); important interstitial inflammation was observed in 28 (44%). All patients received steroids with adjunctive immunosuppression in 54 cases (86%). After a median follow-up of 51 months (1-296), 58 patients (92%) were alive, nine (14%) were on chronic dialysis and two (3%) had undergone kidney transplantation. CONCLUSION Necrotizing pauci-immune GN is the most common renal presentation in ANCA-positive EGPA. ANCA-negative patients had frequent atypical renal presentation with other glomerulopathies such as membranous nephropathy. An important eosinophilic interstitial infiltration was observed in almost 50% of cases.
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Affiliation(s)
- Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils De Lyon, Lyon, France
| | - Renato A Sinico
- Department of Medicine and Surgery, Universita di Milano-Biococca, Milano, Italy
| | - Vitor Teixeira
- Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - David Jayne
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Xavier Belenfant
- Department of Nephrology, Centre Hospitalier Intercommunal André Grégoire, Montreuil
| | | | - Gregory Pugnet
- Department of Internal Medicine, Hôpital Purpan, Toulouse
| | | | - Thomas Le Gallou
- Department of Internal Medicine, CHRI Rennes Site Hôpital Sud, Rennes
| | | | - Christian Agard
- Department of Internal Medicine, CHU de Nantes Site Hôtel Dieu-HME, Nantes
| | | | - Antoine Bardy
- Department of Internal Medicine, Centre Hospitalier Moulins-Yzeure, Moulins, France
| | - Daniel Blockmans
- Department of General Internal Medicine, KU Leuven, Leuven, Belgium
| | | | - Julien Bouet
- Department of Nephrology, CHPC Site Cherbourg, Cherbourg Octeville
| | - Vincent Cottin
- National Coordinating Reference Centre for Rare Pulmonary Diseases, Hôpital Louis Pradel, Hospices Civils De Lyon, University Claude Bernard Lyon 1, Lyon
| | - Yoann Crabol
- Department of Internal Medicine, CHBA Site de Vannes, Vannes
| | - Christophe Deligny
- Department of Rheumatology and Internal Medicine, CHU Martinique, Hôpital P. Zobda-Quitman, Fort-de-France
| | - Marie Essig
- Department of Nephrology, Hopital Ambroise Paré, Boulogne-Billancourt
| | - Pascal Godmer
- Department of Internal Medicine, CHBA Site de Vannes, Vannes
| | - Philippe Guilpain
- Department of Internal Medicine-Multi-Organ Diseases, Montpellier University-Saint Eloi Hospital, Montpellier
| | | | - Cédric Rafat
- Department of Nephrology, Hôpital Tenon AP-HP, Paris
| | | | | | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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Urbain F, Puyade M, Labeyrie C, Maubeuge N, Puma A, Cintas P, Pugnet G, Castilla-Llorente C, Adams D, Farge-Bancel D. Hematopoietic stem cell transplantation in chronic inflammatory demyelinating polyneuropathy: French experience about four patients, under the behalf of French society for bone marrow transplantation. J Neurol 2021; 268:1536-1539. [PMID: 33655343 DOI: 10.1007/s00415-021-10452-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Fanny Urbain
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), Assistance Publique-Hôpitaux de Paris, 75010, Paris, France.
| | - Mathieu Puyade
- Service de Médecine Interne et Maladies Infectieuses, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers cedex, France.,CIC-1402, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers cedex, France
| | - Céline Labeyrie
- Service de Neurologie, National Reference Center for Familial Amyloid Polyneuropathy and Other Rare Neuropathies, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.,U1195, INSERM, Université Paris-Saclay, 94276, Le Kremlin Bicêtre, France
| | - Nicolas Maubeuge
- Service de Neurologie, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers cedex, France
| | - Angela Puma
- Centre Hospitalier Universitaire de Nice, Système Nerveux Périphérique et Muscle, Université Côte D'Azur, Hôpital Pasteur, 2, 30 voie Romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Pascal Cintas
- Service de Neurologie, Hôpital Rangueil, CHU Toulouse, Avenue Jean Poulhes, 31300, Toulouse, France
| | - Gregory Pugnet
- Service de Médecine Interne, Hôpital Purpan, CHU Toulouse, Place du Docteur Joseph Baylac, 31300, Toulouse, France.,Faculté de Médecine de Toulouse, 37 Allée Jules Guesde, 31000, Toulouse, France
| | | | - David Adams
- Service de Neurologie, National Reference Center for Familial Amyloid Polyneuropathy and Other Rare Neuropathies, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.,U1195, INSERM, Université Paris-Saclay, 94276, Le Kremlin Bicêtre, France
| | - Dominique Farge-Bancel
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), Assistance Publique-Hôpitaux de Paris, 75010, Paris, France.,IRSL, Recherche Clinique Appliquée à l'Hématologie, EA3518, Université de Paris, Paris, France.,Department of Medicine, H3A 1A1, McGill University, Montreal, QC, Canada
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Henes J, Oliveira MC, Labopin M, Badoglio M, Scherer HU, Del Papa N, Daikeler T, Schmalzing M, Schroers R, Martin T, Pugnet G, Simoes B, Michonneau D, Marijt EWA, Lioure B, Olivier Bay J, Snowden JA, Rovira M, Huynh A, Onida F, Kanz L, Marjanovic Z, Farge D. Autologous stem cell transplantation for progressive systemic sclerosis: a prospective non-interventional study from the European Society for Blood and Marrow Transplantation Autoimmune Disease Working Party. Haematologica 2021; 106:375-383. [PMID: 31949011 PMCID: PMC7849556 DOI: 10.3324/haematol.2019.230128] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 01/09/2020] [Indexed: 12/29/2022] Open
Abstract
Three randomized controlled trials in early severe systemic sclerosis demonstrated that autologous hematopoietic stem cell transplantation was superior to standard cyclophosphamide therapy. This European Society for Blood and Marrow Transplantation multicenter, prospective, non-interventional study was designed to further decipher efficacy and safety of this procedure for severe systemic sclerosis patients in real-life practice and to search for prognostic factors. All consecutive adult patients with systemic sclerosis undergoing a first autologous hematopoietic stem cell transplant between December 2012 and February 2016 were prospectively included in the study. The primary endpoint was progression-free survival. Secondary endpoints were overall survival, non-relapse mortality, response and incidence of progression. Eighty patients with systemic sclerosis were included. The median duration of the follow-up was 24 (range, 6-57) months after stem cell transplantation using cyclophosphamide plus antithymocyte globulin conditioning for all, with CD34+ selection in 35 patients. At 2 years, the progression- free survival rate was 81.8%, the overall survival rate was 90%, the response rate was 88.7% and the incidence of progression was 11.9%. The 100-day non-relapse mortality rate was 6.25% (n=5) with four deaths from cardiac events, including three due to cyclophosphamide toxicity. Modified Rodnan skin score and forced vital capacity improved with time (P<0.001). By multivariate analysis, baseline skin score >24 and older age at transplantation were associated with lower progression-free survival (hazard ratios 3.32 and 1.77, respectively). CD34+-cell selection was associated with better response (hazard ratio 0.46). This study confirms the efficacy of autologous stem cell transplantation, using nonmyeloablative conditioning, in real-life practice for severe systemic sclerosis. Careful cardio-pulmonary assessment to identify organ involvement at the time of the patient’s referral, reduced cyclophosphamide doses and CD34+-cell selection may improve outcomes. The study was registered at ClinicalTrials.gov: NCT02516124.
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Affiliation(s)
- Joerg Henes
- University Hospital Tuebingen; Intenal Medicine II, Tuebingen, Germany
| | | | - Myriam Labopin
- Saint Antoine Hospital, Université Pierre et Marie Curie, Paris, France
| | | | - Hans Ulrich Scherer
- Leiden University Medical Center, Department of Rheumatology; Leiden, Netherlands
| | - Nicoletta Del Papa
- Scleroderma Clinic, Osp. G. Pini, Department of Rheumatology, Milan, Italy
| | - Thomas Daikeler
- University and University Hospital of Basel, Department of Rheumatology, Basel, Switzerland
| | - Marc Schmalzing
- University Hospital of Wuerzburg, Department of Rheumatology/Immunology, Wuerzburg, Germany
| | | | - Thierry Martin
- Service de Medecine Interne et Immunologie Clinique, Hopitaux Universitaires de Strasbourg, France
| | - Gregory Pugnet
- CHU de Toulouse, Hopital Purpan, Service de Medecine Interne, Toulouse, France
| | - Belinda Simoes
- Dept. of Hematology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - David Michonneau
- Dept. of Hematology, Hopital Saint Louis and Université Paris 7, Denis Diderot, Paris, France
| | - Erik W A Marijt
- Leiden University Medical Center, Department of Hematology, Leiden, Netherlands
| | - Bruno Lioure
- Strasbourg University Hospital, Department of Hematology, Strasbourg, France
| | | | - John A Snowden
- Dept. of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Montserrat Rovira
- Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Anne Huynh
- UCT Oncopole, Department of Haematology, Toulouse, France
| | - Francesco Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano Italy
| | - Lothar Kanz
- University Hospital Tuebingen, Department of Internal Medicine II, Tuebingen, Germany
| | - Zora Marjanovic
- Saint Antoine Hospital, Department of Haematology, Paris, France
| | - Dominique Farge
- Assistance Publique-Hopitaux de Paris, Saint-Louis Hospital, Paris, France
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Gouin A, Ribes D, Colombat M, Chauveau D, Prevot G, Lairez O, Pugnet G, Fremeaux-Bacchi V, Huart A, Belliere J, Faguer S. Role of C5 inhibition in Idiopathic Inflammatory Myopathies and Scleroderma Renal Crisis-Induced Thrombotic Microangiopathies. Kidney Int Rep 2021; 6:1015-1021. [PMID: 33912751 PMCID: PMC8071645 DOI: 10.1016/j.ekir.2021.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/19/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Connective tissue diseases, including systemic sclerosis and idiopathic inflammatory myopathies (IIMs), are a very rare cause of thrombotic microangiopathies (TMAs). Whether dysregulation of the complement pathways underlies these secondary forms of TMA and may be targeted by complement blocking agents remains elusive. Methods Kidney pathology and outcomes of 18 critically ill patients with TMA related to inflammatory myopathy flare-up (IIM, n=7) or scleroderma renal crisis (SRC, n=11; biopsy n=9) are assessed. Results IIM-TMA is characterized by acute thrombotic lesions only, whereas SRC-TMA patients also harbored chronic vascular lesions and more interstitial fibrosis. C5b9 deposits, a marker of complement component 5 (C5) cleavage, were observed in the 2 subgroups at the junction of media and intima of arterioles, colocalizing with subendothelial edema. Thus, kidney biopsy distinguished between acute and chronic renal phenotypes that may help to individualize treatment. Treatment of IIM-TMA patients with combined full-code organ support, corticosteroids, B-cell depletion, and complement C5 blocking led to 1-year survival of 72%, compared with 19% in historical cohorts. Treatment of SRC-TMA was more heterogenous and relied on conversion enzyme inhibitor only or with eculizumab (n=6) and immunosuppressor (n=5). One-year survival of SRC-TMA patients was 52%, a result similar to historical cohorts. Eculizumab was followed by a rapid dramatic improvement of TMA in all the treated patients. Conclusion C5 blocking may reverse hematologic abnormalities in IIM- and SRC-TMA, and adding an early and aggressive immunosuppressive regimen may improve the survival of IIM-TMA. Underlying chronic vascular and interstitial lesions mitigate renal response in SRC-TMA.
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Affiliation(s)
- Anna Gouin
- Département de Néphrologie et transplantation d'Organes-Unité de Réanimation, Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire, Institut National de la Santé et de la Recherche Médicale U1048 (Institut des Maladies Métaboliques et Cardiovasculaires), Toulouse, France
| | - David Ribes
- Département de Néphrologie et transplantation d'Organes-Unité de Réanimation, Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire, Institut National de la Santé et de la Recherche Médicale U1048 (Institut des Maladies Métaboliques et Cardiovasculaires), Toulouse, France
| | - Magali Colombat
- Service d'anatomopathologie, Institut Universitaire du Cancer de Toulouse - Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Dominique Chauveau
- Département de Néphrologie et transplantation d'Organes-Unité de Réanimation, Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire, Institut National de la Santé et de la Recherche Médicale U1048 (Institut des Maladies Métaboliques et Cardiovasculaires), Toulouse, France
| | - Gregoire Prevot
- Service de Pneumologie, Centre Hospitalier Universitaire, Toulouse, France
| | - Olivier Lairez
- Fédération de Cardiologie, Centre Hospitalier Universitaire, Toulouse, France
| | - Gregory Pugnet
- Service de Médecine Interne, Centre Hospitalier Universitaire, Toulouse, France
| | | | - Antoine Huart
- Département de Néphrologie et transplantation d'Organes-Unité de Réanimation, Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire, Institut National de la Santé et de la Recherche Médicale U1048 (Institut des Maladies Métaboliques et Cardiovasculaires), Toulouse, France
| | - Julie Belliere
- Département de Néphrologie et transplantation d'Organes-Unité de Réanimation, Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire, Institut National de la Santé et de la Recherche Médicale U1048 (Institut des Maladies Métaboliques et Cardiovasculaires), Toulouse, France
| | - Stanislas Faguer
- Département de Néphrologie et transplantation d'Organes-Unité de Réanimation, Centre de référence des maladies rénales rares, Centre Hospitalier Universitaire, Institut National de la Santé et de la Recherche Médicale U1048 (Institut des Maladies Métaboliques et Cardiovasculaires), Toulouse, France
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Cosse C, Kernéis S, Lescoat A, Pugnet G, Truchetet ME, Priollet P, Diot E, Martin M, Maurier F, Viallard JF, Agard C, Granel B, Berthier S, Fagedet D, Watelet B, Toquet S, Luque Paz D, Giret C, Cerles O, Dion J, Nguyen C, Raffray L, Bertolino J, Jourde W, Le Jeunne C, Mouthon L, Chaigne B. Osteitis in Systemic Sclerosis: a nationwide case-control retrospective study (SCLEROS Study). Arthritis Care Res (Hoboken) 2020; 74:809-817. [PMID: 33278067 DOI: 10.1002/acr.24530] [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: 06/18/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an autoimmune (AI) connective tissue disorder characterized by skin fibrosis, vasculopathy and dysimmunity. Data regarding osteitis in SSc are scarce. METHOD We performed a nationwide multicentre retrospective case-control study including patients with SSc according to the 2013 ACR/EULAR classification, with a diagnosis of osteitis. The objectives of the study were to describe, to characterize, and to identify associated factors for osteitis in patients with SSc. RESULTS Forty-eight patients were included. Twenty-six patients (54.1%) had osteitis beneath digital tip ulcers. Physical symptoms included: pain (36/48, 75%), erythema (35/48, 73%), and local warmth (35/48, 73%). Thirty-one (65%) patients had C-reactive protein levels >2 mg/L (8 [2.7 - 44.3] mg/L). On X-ray, CT-scans or MRI, osteitis was characterized by swelling or abscess of soft tissues with acro-osteolysis or lysis in 28 patients (58%). Microbiological sampling was performed in 45 (94%) patients. Most pathogens were Staphylococcus aureus (43.8%); anaerobes and Enterobacteriaceae (29.1%) and Pseudomonas aeruginosa (10.4%). Management comprised antibiotics in 37 (77.1%) patients and/or surgery in 26 (54.2%). Fluoroquinolones were used in 22 (45.8%) patients and amoxicillin + beta-lactamase inhibitor in 7 (14.6%). Six (12.6%) patients relapsed, 6 (12.6%) patients had osteitis recurrence, 15 (32%) sequelae, and 2 patients had septic shock and died. CONCLUSION This study confirmed digital tip ulcers as an associated factor for osteitis, and revealed a high rate of functional sequelae. Antimicrobial therapy with oral fluoroquinolone or intravenous amoxicillin and beta-lactamase inhibitor are used as first-line antibiotherapy in SSc patients with osteitis.
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Affiliation(s)
- Cyril Cosse
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Solen Kernéis
- Antimicrobial Stewardship Team, APHP, Cochin hospital, University of Paris, Paris, France
| | - Alain Lescoat
- Université Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, 35203, Rennes, France
| | - Gregory Pugnet
- Service de Médecine Interne, CHU Toulouse, Toulouse, France ; Centre d'Investigation Clinique 1436, CHU Toulouse, Toulouse, France
| | - Marie-Elise Truchetet
- Rheumatology department and national center of reference for rare autoimmune diseases, Bordeaux University Hospital, France
| | - Pascal Priollet
- Service de médecine vasculaire, Hôpital Saint Joseph, Paris, France
| | - Elisabeth Diot
- Service de médecine Interne, Hôpital Bretonneau, Tours Cedex, France
| | - Mickael Martin
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France
| | - François Maurier
- Centre de compétence des maladies rares, Hôpitaux privés de Metz, Metz, France
| | - Jean François Viallard
- Département de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire Haut Lévêque, Université de Bordeaux, Pessac, France
| | - Christian Agard
- Service de médecine interne, Hôtel-Dieu, CHU Nantes, Hôpital, Université de Nantes, France
| | - Brigitte Granel
- Service de Médecine Interne, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Sabine Berthier
- Service de Médecine Interne et Immunologie Clinique, CHU F MITTERRAND, Dijon, France
| | - Dorothée Fagedet
- Service de Médecine Interne - CHICAS, hôpital de GAP, Paris, France
| | | | | | - David Luque Paz
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, France, Rennes
| | - Cloé Giret
- Service de médecine Interne, Hôpital Bretonneau, Tours Cedex, France
| | - Olivier Cerles
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jérémie Dion
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Christelle Nguyen
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France.,Université de Paris, Faculté de Santé, UFR Médecine Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France.,INSERM UMRS 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs, UFR Sciences Fondamentales et Biomédicales, Centre Universitaire des Saints-Pères, 75006, Paris, France
| | - Loïc Raffray
- Service Médecine Interne et Dermatologie, CHU Réunion- Hôpital Félix Guyon, Saint Denis, France
| | - Julien Bertolino
- Service de Médecine Interne, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Wendy Jourde
- Département de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire Haut Lévêque, Université de Bordeaux, Pessac, France
| | - Claire Le Jeunne
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Zadro Y, Piel-Julian M, Moulis G, Pugnet G, Astudillo L, Depaire M, Oberic L, Fain O, Sailler L. Syndrome abdominal aigu survenant dans un contexte de lymphome : penser à l’angiœdème bradykinique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sorin B, Maillet T, Samson M, Guerry M, Bielefeld P, Pineton De Chambrun M, Cacoub P, Riviere F, Le Guenno G, Pugnet G, Charles P, Puéchal X, Karras A, Nouvier M, Lavigne C, Guillevin L, Terrier B. Étude des formes réfractaires au traitement d’induction au cours des vascularites associées aux ANCA. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.014] [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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Mettler C, Durel C, Cohen-Aubart F, Guilpain P, Hamidou M, Lega J, Le Guern V, Lifermann F, Poindron V, Pugnet G, Samson M, Servettaz A, Puéchal X, Guillevin L, Terrier B. Utilisation hors-AMM des biothérapies au cours des granulomatoses avec polyangéite réfractaires ou en rechute. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rigal J, Pugnet G, Ciron J, Lépine Z, Biotti D. Off-label use of tocilizumab in neuromyelitis optica spectrum disorders and MOG-antibody-associated diseases: A case-series. Mult Scler Relat Disord 2020; 46:102483. [DOI: 10.1016/j.msard.2020.102483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 01/06/2023]
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Bertrand PJ, Jamilloux Y, Kodjikian L, Errera MH, Perard L, Pugnet G, Tieulie N, Andre M, Bielefeld P, Bron AM, Decullier E, Bin S, Seve P. Quality of life in patients with uveitis: data from the ULISSE study (Uveitis: cLInical and medico-economic evaluation of a Standardised Strategy for the Etiological diagnosis). Br J Ophthalmol 2020; 105:935-940. [PMID: 32709757 DOI: 10.1136/bjophthalmol-2020-315862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/12/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022]
Abstract
AIMS To assess vision-related (VR-QOL) and health-related quality of life (HR-QOL) in a large series of patients with de novo uveitis at baseline and 6-month follow-up. METHODS Non-inferiority, prospective, multicentre, cluster randomised controlled trial registered under the Unique Identifier: NCT01162070. VR-QOL and HR-QOL were assessed by the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) and the Medical Outcomes Study 36-item Short Form Survey (SF-36). RESULTS At inclusion, 466 patients completed the VFQ-25. The mean composite score was 80.0 (±16.7). In multivariate analysis, higher age, female sex and insidious onset were significantly associated with lower QOL. At 6 months, 138 patients completed the VFQ-25, with a significantly higher mean composite score of 82.6 (±16.7). SF-36 mental component was 42.9 (±11.3) and physical component was 47.2 (±8.5) at inclusion (n=425). HR-QOL improvement at 6 months was not clinically significant. CONCLUSION QOL seems relatively well preserved in this cohort; only VR-QOL improved significantly at 6 months, especially in patients with low initial visual acuity.
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Affiliation(s)
| | - Yvan Jamilloux
- Internal Medicine, Hopital De La Croix-Rousse,Lyon, France
| | - Laurent Kodjikian
- Ophthalmology, Croix Rousse University Hospital, Hospices Civils De Lyon, Lyon, France
| | | | - Laurent Perard
- Internal Medicine, Edouart Herriot University Hospital, Hospices Civils De Lyon, Lyon, France
| | - Gregory Pugnet
- Department of Internal Medicine, Purpan University Hospital, Toulouse, France
| | | | - Marc Andre
- Médecine Interne, Hopital Gabriel Montpied, Clermont-Ferrand,France
| | - Philip Bielefeld
- Médecine Interne, Centre Hospitalier Universitaire De Dijon, Dijon, France
| | - Alain M Bron
- Ophthalmology, University Hospital, Dijon, France
| | | | - Sylvie Bin
- Pole IMER Lyon, Hospices Civils de Lyon, Lyon, France
| | - Pascal Seve
- Internal Medicine, Hospices Civils De Lyon, Lyon, France
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Porel T, DE Almeida Chaves S, Adoue D, Astudillo L, Ribes D, Prévôt G, Gaches F, Michaud M, Alric L, Sailler L, Pugnet G. SAT0339 NERVOUS SYSTEM INVOLVEMENT IN SYSTEMIC SCLEROSIS: A COHORT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6142] [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: 11/03/2022]
Abstract
Background:Nervous system involvement is considered to be rare in systemic sclerosis (SSc). Its prevalence is highly variable in SSc cohort studies and its prognosis is not well established.Objectives:To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) and central nervous system (CNS) disease in a cohort of systemic sclerosis patients.Methods:We have carried out a retrospective observational study by systematically analyzing the medical records of patients diagnosed with SSc in Toulouse University Hospital and Ducuing Hospital, south west France. We included patients who met the following inclusion criteria: being over 18 years of age on diagnosis, meeting the ACR /EULAR 2013 classification criteria, being diagnosed after 01/01/1966 and before 31/12/2018, at least 12 months of follow-up. Patients were followed until 31/12/2019. Nervous system involvement associated with SSc was included when there was involvement on or after diagnosis and after exclusion of all other causes. Only symptomatic clinical involvement was included. Ischemic or hemorrhagic strokes were excluded. We calculated the incidence of CNS and/or PNS disease during the follow-up period per 1,000 person-years. Kaplan-Meier curves were plotted to determine the cumulative incidence of nervous system disease. We evaluated associated factors of CNS and/or PNS disease using multivariable Cox regression.Results:Of 447 SSc patients, 79.8% were female, 68 (15%) were diffuse cutaneous SSc, 342 (77%) were limited cutaneous SSc and 37 (8%) were sine scleroderma SSc. The mean ± SD age at diagnosis was 52.9 ± 14.3 years.During the study period, 82 (18%) patients experienced a PNS disease, 29 (6%) a CNS disease. The incidence was 28 per 1,000 patient-years of any nervous system disease, with 22 per 1,000 patient-years and 6 per 1,000 patient-years of PNS disease and CNS disease, respectively. The most frequent were carpal tunnel syndrome (63%) and polyneuropathies (12%) for PNS disease, and headache (45%) and seizures (10%) for CNS disease.Three significant independent associated factors with PNS disease occurrence were identified using multivariable Cox regression: BMI>23.1kg/m2(HR = 1.06 [1.01-1.12]), joint involvement (HR = 2.7 [1.3-5.5]), and an alteration in the left ventricular ejection fraction (HR = 3.8 [1.4-10.3]).Four significant independent associated factors with CNS disease occurrence were identified: age > 54 years (HR = 2.5 [1.1-6.0]), positive anti-PmScl testing (HR = 6.4 [1.5-28.2]), Caucasian origin (HR = 0.2 [0.1-0.5]) and hemoglobin < 12g/dl (HR = 0.2 [0.04-0.8]).Nervous system disease occurrence did not appear to have a negative impact on the survival of SSc patients (log-rank p=0.56).Conclusion:This study shows that specific nervous system disease in SSc is not uncommon and does not appear to increase mortality, but it could have an impact on functional prognosis and needs to be monitored.Disclosure of Interest:None declared
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Bertolino J, Jouve E, Skopinski S, Agard C, Achille A, Thoreau B, Diot E, Sanges S, Berthier S, Chaigne B, Régent A, Martin T, Pugnet G, Benyamine A, Rossi P, Launay D, Mouthon L, Granel B. Characteristics of patients with systemic sclerosis suffering from a lower limb amputation: Results of a French collaborative study. J Scleroderma Relat Disord 2020; 5:224-230. [PMID: 35382523 DOI: 10.1177/2397198320913689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/16/2020] [Indexed: 11/15/2022]
Abstract
Objective Systemic sclerosis mainly affects the microvascular network. However, macrovascular manifestations have been reported. We aimed to investigate the characteristics of systemic sclerosis patients with an amputation of a lower limb segment. Methods We designed a retrospective, case-control, multicentric study on systemic sclerosis patients with amputation of a lower limb segment secondary to critical ischemia via the French Research Group on Systemic Sclerosis. For each case, a control (systemic sclerosis patient without lower limb symptom) was matched with sex, age (±5 years), and cutaneous subset of systemic sclerosis. Results In total, 26 systemic sclerosis patients (mean age of 67.2 ± 10.9 years, 20 females, 21 limited cutaneous forms) with a lower limb amputation and 26 matched controls (mean age of 67.3 ± 11.2 years, 20 females, 22 limited cutaneous forms) were included. At the time of amputation, the mean disease duration was 12.8 (±8.6) years. In comparison to controls, systemic sclerosis patients with amputation had more digital ulcers (p = 0.048), history of digital ulcers (p = 0.026), and a higher prevalence of pulmonary arterial hypertension (p = 0.024). Systemic sclerosis patients with amputation were more often smokers (p = 0.008) and under corticosteroids (p = 0.015). In the multivariate model, pulmonary arterial hypertension, smoking status, and corticosteroids were independent markers associated with lower limb amputation in systemic sclerosis. In the follow-up, 10 patients (38.5%) had recurrent ischemia requiring a new limb amputation, and five patients (19.2%) had an amputation of the contralateral limb. Conclusion This study identifies some markers associated with lower limb amputation in systemic sclerosis such as digital ulcers and pulmonary arterial hypertension and points out the high risk associated with tobacco consumption and corticosteroid use.
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Affiliation(s)
- Julien Bertolino
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
| | - Elisabeth Jouve
- Medical Evaluation Service, AP-HM, CIC-CPCET, Marseille, France
| | - Sophie Skopinski
- Vascular Medicine Department, Hôpital St André, Bordeaux, France
| | | | | | | | | | - Sebastien Sanges
- University of Lille, U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, CHU Lille, Internal Medicine and Clinical Immunology Department, Lille, France, Referral Center for Rare Systemic Autoimmune Diseases North and North-West of France, Lille, France
| | - Sabine Berthier
- Internal Medicine and Clinical Immunology Department, CHU Dijon, Dijon, France
| | - Benjamin Chaigne
- Internal Medicine Department, Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexis Régent
- Internal Medicine Department, Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Thierry Martin
- Clinical Immunology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Gregory Pugnet
- Internal Medicine Department, Hôpital Purpan, CHU Toulouse, Toulouse, France
| | - Audrey Benyamine
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
| | - Pascal Rossi
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
| | - David Launay
- University of Lille, U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, CHU Lille, Internal Medicine and Clinical Immunology Department, Lille, France, Referral Center for Rare Systemic Autoimmune Diseases North and North-West of France, Lille, France
| | - Luc Mouthon
- Internal Medicine Department, Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Brigitte Granel
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
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Charles P, Dechartres A, Terrier B, Cohen P, Faguer S, Huart A, Hamidou M, Agard C, Bonnotte B, Samson M, Karras A, Jourde-Chiche N, Lifermann F, Gobert P, Hanrotel-Saliou C, Godmer P, Martin-Silva N, Pugnet G, Matignon M, Guillevin L. Réduction du nombre de perfusions de rituximab au début du traitement d’entretien des vascularites associées aux ANCA. Résultats d’une analyse post-hoc de l’essai contrôlé randomisé MAINRITSAN2. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Guille M, Michaud M, Hitzel A, Lairez O, Catros F, Ancellin S, Pugnet G, Debard A, Prevot G, Gaches F. Intérêt du TEP-TDM au 18F-FDG dans le bilan étiologique des péricardites. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.039] [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: 10/25/2022]
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47
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Jamilloux Y, De Parisot A, Kodjikian L, Sedira N, Héron E, Rivière S, Pugnet G, Cathébras P, Bodaghi B, David S, Tieulie N, Andre M, Bielefeld P, Bienvenu B, Guerre P, Sève P. Évaluation médico-économique d’une stratégie standardisée pour le diagnostic étiologique des uvéites : résultats de l’étude ULISSE. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.118] [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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48
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Bertolino J, Jouve E, Skopinski S, Agard C, Achille A, Thoreau B, Diot E, Sanges S, Berthier S, Chaigne B, Regent A, Martin T, Pugnet G, Benyamine A, Rossi P, Launay D, Mouthon L, Granel B. Caractéristiques des patients atteints de sclérodermie systémique souffrant d’une amputation d’un segment d’un membre inférieur. Étude collaborative au sein du GFRS. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.084] [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: 10/25/2022]
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49
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Maquet J, Paricaud K, Bories E, Couture G, Zabraniecki L, Nougarolis F, Beck C, Aizel G, Astudillo L, Pugnet G, Moulis G, Sailler L. Paraostéoarthropathie neurogène : une cause rare de fièvre prolongée chez le paraplégique. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.304] [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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50
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Durel CA, Hot A, Trefond L, Aumaitre O, Pugnet G, Samson M, Abad S, Belot A, Blanchard-Delaunay C, Cohen P, Cohen-Aubard F, Cottin V, Crestani B, Moreuil CD, Durupt S, Garzaro M, Girszyn N, Godeau B, Hachulla E, Jamilloux Y, Jego P, Killian M, Lazaro E, Le Gallou T, Liozon E, Martin T, Papo T, Perlat A, Pillet P, Guillevin L, Terrier B. Orbital mass in ANCA-associated vasculitides: data on clinical, biological, radiological and histological presentation, therapeutic management, and outcome from 59 patients. Rheumatology (Oxford) 2019; 58:1565-1573. [DOI: 10.1093/rheumatology/kez071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/04/2019] [Indexed: 12/15/2022] Open
Abstract
Abstract
Objective
Orbital mass is a rare and sight-threatening manifestation of ANCA-associated vasculitides, which remains a therapeutic challenge. We aimed to describe the presentation, therapeutic management and outcome of ANCA-associated vasculitides-related orbital mass.
Methods
We conducted a French nationwide retrospective study of patients with orbital mass in the setting of ANCA-associated vasculitides according to ACR criteria and/or Chapel Hill Consensus Conference definitions.
Results
Fifty-nine patients [33 women, median age 46 (range 7–90) years] were included. Fifty-six (95%) patients had granulomatosis with polyangiitis, two eosinophilic granulomatosis with polyangiitis and one microscopic polyangiitis. Orbital mass was unilateral in 47 (80%) cases, and seemed to develop from ENT involvement in most cases. Orbital mass biopsy was available in 32 (54%) patients, showing lymphoplasmacytic infiltration in 65%, fibrosis in 55%, granulomas in 48% and vasculitis in 36%. All patients but one received glucocorticoids as first-line therapy associated with immunosuppressive agents in 82%, mainly cyclophosphamide. Response to therapy was noted in 52% of patients treated with cyclophosphamide compared with 91% of those treated with rituximab. Twenty-seven (46%) patients required a second-line therapy because of relapse (59%) or refractory course (41%). Sequelae included visual impairment in 28%, with definitive blindness in 17%. Refractory course was associated with PR3-ANCA positivity, visual loss and contiguous pachymeningitis.
Conclusion
Orbital mass is associated with refractory course and high frequency of sequelae, especially blindness. Refractory course is associated with PR3-ANCA positivity, visual loss and contiguous pachymeningitis.
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Affiliation(s)
| | - Arnaud Hot
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon
| | - Ludovic Trefond
- Department of Internal Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand
| | - Olivier Aumaitre
- Department of Internal Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand
| | - Gregory Pugnet
- Department of Internal Medicine, Hôpital Purpan, Toulouse
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, CHU Dijon Bourgogne, Dijon
| | - Sébastien Abad
- AP-HP, Hôpital Avicennes, Department of Internal Medicine, Université Paris 13, Sorbonne, Paris Cité, Faculté de Médecine Bobigny, Paris
| | - Alexandre Belot
- Department of Pediatric Nephrology, Rheumatology, Dermatology, National Referral Center for Inflammatory Rheumatism and Autoimmune Diseases, Hôpital Femme Mère Enfant, Bron
| | | | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, Paris
| | - Fleur Cohen-Aubard
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital de la Pitié-Salpêtrière, Paris
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Lyon
| | | | - Claire De Moreuil
- Department of Internal Medicine, Hôpital de la Cavale Blanche, Brest
| | - Stéphane Durupt
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Lyon
| | | | - Nicolas Girszyn
- Department of Internal Medicine, Hôpital Charles Nicolle, Rouen
| | - Bertrand Godeau
- Department of Internal Medicine, Referral Center for Adult Autoimmune Cytopenias, Hôpital Henri Mondor, Créteil
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, National Referral Center for Systemic Autoimmune Diseases North and North-West of France, Université de Lille, Lille
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Lyon
| | - Patrick Jego
- Department of Internal Medicine, Hôpital Sud, Rennes
| | - Martin Killian
- Department of Internal Medicine, Hôpital Nord, Saint-Etienne
| | - Estibaliz Lazaro
- Department of Internal Medicine, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac
| | | | - Eric Liozon
- Department of Internal Medicine, Hôpital de Limoges, Limoges
| | - Thierry Martin
- Department of Clinical Immunology, HIV, and Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases RESO, Nouvel Hôpital Civil, Strasbourg
| | - Thomas Papo
- Department of Internal Medicine, Hôpital Bichat, Paris
| | | | - Pascal Pillet
- Department of Medical Pediatrics, CHU de Bordeaux – GH Pellegrin, Bordeaux
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital de la Pitié-Salpêtrière, Paris
- Hôpital Cochin, National Referral Center for Systemic and Autoimmune Diseases, Paris
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital de la Pitié-Salpêtrière, Paris
- Hôpital Cochin, National Referral Center for Systemic and Autoimmune Diseases, Paris
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
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