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Merhi S, Salameh P, Abboud M, Seneschal J, Eleftheriadou V, Pane I, Tran VT, Shourick J, Ezzedine K. Facial involvement is reflective of patients' global perception of vitiligo extent. Br J Dermatol 2023; 189:188-194. [PMID: 37002778 DOI: 10.1093/bjd/ljad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The involvement of visible areas in vitiligo has been found to be correlated with increased psychiatric morbidity. Although multiple tools have been developed to assess vitiligo, no cutoff for improvement or worsening of vitiligo from a patient's perspective has been established. OBJECTIVES To determine the minimal clinically important difference (MCID) of the Self-Assessment Vitiligo Extent Score (SA-VES) in patients with vitiligo and to evaluate, from the patient's perspective, the importance of the change in the involvement of visible areas (face and hands) in patients' overall perception of disease worsening or improving. METHODS This was a cross-sectional study in the context of the ComPaRe e-cohort. Adult patients with vitiligo were invited to answer online questionnaires. They completed the SA-VES twice, 1 year apart. In addition, patients answered a 5-point Likert anchor question aimed at assessing their perception of the evolution of the extent of their vitiligo. The MCID was calculated using distribution- and anchor-based approaches. Using ordinal logistic regression, the change of vitiliginous lesions on the face or hands was compared to the overall extent of vitiligo (patches on all body areas). RESULTS In total, 244 patients with vitiligo were included in the analyses; 20 (8%) were found to have an improvement in their vitiligo. The MCID in worsened patients was equal to a 1.3% body surface area [95% confidence interval (CI) 1.01-1.43] increase in the SA-VES. For participants with improved vitiligo, the MCID was equal to a decrease in total SA-VES of 1.3% (95% CI 0.867-1.697). Patients' perceptions of change in their vitiligo was increased sevenfold when it affected the face vs. the rest of the body. CONCLUSIONS Changes in the facial SA-VES were highly correlated with patients' impressions of the extent of vitiligo.
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Affiliation(s)
- Samar Merhi
- Université Paris-Est Créteil, EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
- Faculty of Nursing and Health Sciences, Notre Dame University - Louaize (NDU), Zouk Mosbeh, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Mounya Abboud
- Université Paris-Est Créteil, EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Julien Seneschal
- University of Bordeaux, CNRS UMR5164, ImmunoConCept, Bordeaux, France
- Department of Dermatology, Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, Bordeaux, France
| | - Viktoria Eleftheriadou
- Walsall Healthcare NHS Trust and The Royal Wolverhampton NHS Trust, University of Birmingham, Birmingham, UK
| | - Isabelle Pane
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université Paris Cité, INSERM UMR1153), Paris, France
| | - Viet-Thi Tran
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université Paris Cité, INSERM UMR1153), Paris, France
- Centre d'Épidémiologie Clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Jason Shourick
- Department of Epidemiology and Public Health, UMR 1027 INSERM, Toulouse University Hospital, Toulouse, France
| | - Khaled Ezzedine
- Université Paris-Est Créteil, EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France
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Servier C, Porcher R, Pane I, Ravaud P, Tran VT. Trajectories of the evolution of post COVID-19 condition, up to two years after symptoms onset. Int J Infect Dis 2023; 133:67-74. [PMID: 37182548 PMCID: PMC10176960 DOI: 10.1016/j.ijid.2023.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND We aimed to identify trajectories of the evolution of post COVID-19 condition, up to two years after symptom onset. METHODS The ComPaRe long COVID e-cohort is a prospective cohort of patients with symptoms lasting at least two months after SARS-CoV2 infection. We used trajectory modelling to identify different trajectories in the evolution of post COVID-19 condition, based on symptoms collected every 60 days using the long COVID Symptom Tool. FINDINGS A total of 2,197 patients were enrolled in the cohort between December 2020 and July 2022 when the Omicron variant was not dominant. Three trajectories of the evolution of post COVID-19 condition were identified: "high persistent symptoms" (4%), "rapidly decreasing symptoms" (5%), and "slowly decreasing symptoms" (91%). Participants with high persistent symptoms were older and more likely to report a history of systemic diseases. They often reported tachycardia, bradycardia, palpitations, and arrhythmia. Participants with rapidly decreasing symptoms were younger and more likely to report a confirmed infection. They often reported diarrhoea and back pain. Participants with slowly decreasing symptoms were more likely to have functional diseases. INTERPRETATION Most of patients with post COVID-19 condition improve slowly over time, while 5% have rapid improvement in the two years after symptom onset and 4% have a persistent condition. FUNDING The authors received no specific funding for this study.
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Affiliation(s)
- Clemence Servier
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Raphael Porcher
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, F-75004, Paris, France
| | - Isabelle Pane
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Philippe Ravaud
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, F-75004, Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| | - Viet-Thi Tran
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004 Paris, France; Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, F-75004, Paris, France.
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Gouesbet S, Kvaskoff M, Riveros C, Diard É, Pane I, Goussé-Breton Z, Valenti M, Gabillet M, Garoche C, Ravaud P, Tran VT. Patients' Perspectives on How to Improve Endometriosis Care: A Large Qualitative Study Within the ComPaRe-Endometriosis e-Cohort. J Womens Health (Larchmt) 2023; 32:463-470. [PMID: 36656556 DOI: 10.1089/jwh.2022.0323] [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] [Indexed: 01/20/2023] Open
Abstract
Background: Endometriosis is a chronic gynecological condition that affects about 10% of women of reproductive age. Despite its prevalence, diagnosis is often delayed, misdiagnosis is common, and treatment options are poor. This study aimed at capturing ideas to improve endometriosis care from the patients' perspectives. Materials and Methods: We analyzed cross-sectional data from 1,000 adult patients in ComPaRe-Endometriosis (a French prospective e-cohort focused on endometriosis) who answered to the open-ended question: "If you had a magic wand, what would you change about your health care?". The free-text responses were analyzed by qualitative thematic analysis using an inductive approach. Results: Patients had a mean age of 34.1 years (standard deviation = 8.1); 56% and 42% had stage IV disease or deep endometriosis, respectively. They elicited 2,487 ideas to improve the management of endometriosis, which were categorized into 61 areas of improvement, further grouped into 14 themes. The top five areas of improvement were mentioned by >10% of the patients and were to (1) train caregivers to develop their knowledge on the disease, (2) provide better management of daily pain and pain attacks, (3) take patient-reported symptoms seriously, (4) standardize diagnostic processes to improve early detection, and (5) have caregivers listen more to the patients. Conclusions: We identified 61 areas for improvement in endometriosis care. These results reflect patients' expectations in terms of management of their disease and will be useful to design a better global care for endometriosis from the patients' perspectives.
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Affiliation(s)
- Solène Gouesbet
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France.,Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marina Kvaskoff
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | - Carolina Riveros
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Élise Diard
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Isabelle Pane
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Zélia Goussé-Breton
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | - Michelle Valenti
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | | | | | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France
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Tran VT, Perrodeau E, Saldanha J, Pane I, Ravaud P. Efficacy of first dose of covid-19 vaccine versus no vaccination on symptoms of patients with long covid: target trial emulation based on ComPaRe e-cohort. BMJ Med 2023; 2:e000229. [PMID: 36910458 PMCID: PMC9978748 DOI: 10.1136/bmjmed-2022-000229] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/25/2022] [Indexed: 03/04/2023]
Abstract
Objective To evaluate the effect of covid-19 vaccination on the severity of symptoms in patients with long covid. Design Target trial emulation based on ComPaRe e-cohort. Data source ComPaRe long covid cohort, a nationwide e-cohort (ie, a cohort where recruitment and follow-up are performed online) of patients with long covid, in France. Methods Adult patients (aged ≥18 years) enrolled in the ComPaRe cohort before 1 May 2021 were included in the study if they reported a confirmed or suspected SARS-CoV-2 infection, symptoms persistent for >3 weeks after onset, and at least one symptom attributable to long covid at baseline. Patients who received a first covid-19 vaccine injection were matched with an unvaccinated control group in a 1:1 ratio according to their propensity scores. Number of long covid symptoms, rate of complete remission of long covid, and proportion of patients reporting an unacceptable symptom state at 120 days were recorded. Results 910 patients were included in the analyses (455 in the vaccinated group and 455 in the control group). By 120 days, vaccination had reduced the number of long covid symptoms (mean 13.0 (standard deviation 9.4) in the vaccinated group v 14.8 (9.8) in the control group; mean difference -1.8, 95% confidence interval -3.0 to -0.5) and doubled the rate of patients in remission (16.6% v 7.5%, hazard ratio 1.93, 95% confidence interval 1.18 to 3.14). Vaccination reduced the effect of long covid on patients' lives (mean score on the impact tool 24.3 (standard deviation 16.7) v 27.6 (16.7); mean difference -3.3, 95% confidence interval -5.7 to -1.0) and the proportion of patients with an unacceptable symptom state (38.9% v 46.4%, risk difference -7.4%, 95% confidence interval -14.5% to -0.3%). In the vaccinated group, two (0.4%) patients reported serious adverse events requiring admission to hospital. Conclusion In this study, covid-19 vaccination reduced the severity of symptoms and the effect of long covid on patients' social, professional, and family lives at 120 days in those with persistent symptoms of infection.
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Affiliation(s)
- Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France.,Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Elodie Perrodeau
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | | | - Isabelle Pane
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France.,Université Paris Cité, Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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Shourick J, Seneschal J, Andreu N, Meurant JM, Pane I, Ravaud P, Tran VT, Ezzedine K. Vitiligo Treatment Impact score (VITs): development and validation of a vitiligo burden of treatment questionnaire using the ComPaRe Vitiligo e-cohort. J Eur Acad Dermatol Venereol 2021; 36:279-285. [PMID: 34657353 DOI: 10.1111/jdv.17742] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo management is challenging and requires long-term adherence of patients who often complain of the burden associated with treatment. OBJECTIVE To develop and validate a patient reported measurement of the burden of treatment in vitiligo. METHODS The study was nested within the ComPaRe Vitiligo e-cohort, an online e-cohort of vitiligo patients in France. Items were derived from a literature review and from the qualitative analysis of a survey using open-ended questions of 204 patients with Vitiligo. Construct validity of the resulting instrument was assessed by comparing the instrument's score to the Dermatology Life Quality Index (DLQI), Vitiligo Impact Patient score (VIPs) and Treatment Burden Questionnaire (TBQ) scores. Reliability was assessed by test-retest with 15 ± 10 days of interval between both assessments. RESULTS In total, 343 adult participants participated in the validation of the Vitiligo Treatment Impact score (VITs). The VITs is a 19-item questionnaire assessing the burden of treatment in patients with vitiligo with results suggesting four domains ('Finding a doctor', 'Phototherapy', 'Topical treatment' and 'Impact on outdoor activities and photoprotection'). The VITs total score was well correlated with the DLQI, VIP and TBQ scores. Agreement between test and retest was good (ICC 0.705, 95% CI 0.491-0.818). CONCLUSIONS We developed a patient reported measurement of the burden of treatment in vitiligo with good psychometric properties.
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Affiliation(s)
- J Shourick
- Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, Créteil, France.,EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris-Est Créteil, Creteil, France
| | - J Seneschal
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France.,INSERM, BMGIC, U1035, Univ. Bordeaux, Bordeaux, France
| | - N Andreu
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - J-M Meurant
- Association Française du Vitiligo, Paris, France
| | - I Pane
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université de Paris, INSERM UMR1153), Paris, France.,Centre d'épidémiologie clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - P Ravaud
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université de Paris, INSERM UMR1153), Paris, France.,Centre d'épidémiologie clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - V-T Tran
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS - Université de Paris, INSERM UMR1153), Paris, France.,Centre d'épidémiologie clinique - Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - K Ezzedine
- Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, Créteil, France.,EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris-Est Créteil, Creteil, France
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Gouesbet S, Kvaskoff M, Riveros C, Diard E, Pane I, Gabillet M, Garoche C, Ravaud P, Tran VT. P–327 Patients’ perspectives on how to improve the management of endometriosis in France: The ComPaRe-Endometriosis cohort. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.326] [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: 11/14/2022] Open
Abstract
Abstract
Study question
How should endometriosis management be improved from the patient’s point of view?
Summary answer
One thousand endometriosis patients proposed 2,587 ideas to improve the management of endometriosis that reflect three main themes: diagnosis, care, and information on the disease.
What is known already
Endometriosis is a gynecologic condition affecting 10% of reproductive-age women. The disease causes severe pelvic pain and has a dramatic impact on women’s quality of life. A mean delay of 7 years was described between onset of symptoms and diagnosis. There is an urgent need to reduce this delay and to rethink endometriosis care in order to adopt a more comprehensive and patient-centered approach, as women are often dissatisfied with the care they receive.
Study design, size, duration
This study was carried out in a random sample of endometriosis patients participating in ComPaRe (Community of Patients for Research), a prospective e-cohort of adult chronic disease patients who will be followed-up for 10 years. Participants complete monthly online questionnaires about their life with their disease(s). Recruitment began in January 2017 and is still ongoing, with currently 44,000 participants, including 10,000 endometriosis patients in the ComPaRe-Endometriosis sub-cohort.
Participants/materials, setting, methods
We selected a random sample of 1,000 participants in ComPaRe-Endometriosis, forming 3 equal groups of age (<25, 25–45, >45 years old) and education (<12, 12–14, >14 years). We conducted a qualitative study to gather their ideas for improving the management of their disease. Participants were asked: “If you had a magic wand, what would you change in your health care?”. One interviewer and two patients independently extracted ideas from the open-ended responses using thematic analysis.
Main results and the role of chance
Patients proposed a total of 2,587 ideas to improve the management of endometriosis, which we classified in three main themes: diagnosis, care, and information on the disease. To improve diagnosis, women proposed 724 ideas classified into 11 areas of improvement, including training of health professionals, taking symptoms seriously, improving the diagnosis process, and recognition of the disease by clinicians. To improve care, patients gave 1,677 ideas classified into 71 areas of improvement. For example, they asked for a better pain management, more listening from caregivers, the reimbursement of care or medical treatments, help in accessing clinicians that are expert in endometriosis, and reduced waiting times for medical appointments and exams. Finally, to improve information on the disease, participants suggested 186 ideas classified into 5 areas of improvement, covering more explanation about the disease, public recognition of endometriosis and general awareness, and more research and more explanation of research results.
Limitations, reasons for caution
The results were reviewed by three people in order to reduce the margin of interpretation in the analysis of this open-ended question, but some subjectivity remains. Generalizability may be difficult because the results are linked to the specificities of the French model of care.
Wider implications of the findings: Through the many ideas proposed by patients, we identified a total of 87 areas for improvement in endometriosis diagnosis, care, and information. These results reflect patients’ expectations in terms of management of their disease and will be useful to design a better global care for endometriosis from the patients’ perspective.
Trial registration number
Not applicable
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Affiliation(s)
- S Gouesbet
- Inserm U1018- Exposome and Heredity Team, Centre for Research in Epidemiology and Population Health CESP, Paris 15e Arrondissement, France
| | - M Kvaskoff
- Inserm U1018- Exposome and Heredity Team, Centre for Research in Epidemiology and Population Health CESP, Paris 15e Arrondissement, France
| | - C Riveros
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - E Diard
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - I Pane
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - M Gabillet
- ENDOmind France, Patient organization, Paris, France
| | - C Garoche
- The ComPaRe cohort, Volunteer patient, Gujan-Mestras, France
| | - P Ravaud
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
| | - V T Tran
- Assistance Publique-Hôpitaux de Paris AP-HP, Center for Clinical Epidemiology- Hôtel-Dieu Hospital, Paris, France
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Lukas C, Redondin M, Pane I, Soubrier M, Houvenagel E, Sibilia J, Combe B, Morel J. Cardiovascular events and change in cholesterol levels in patients with rheumatoid arthritis treated with tocilizumab: data from the REGATE Registry. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/hfceu3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cédric Lukas
- Department of Rheumatology, CHU Montpellier, Montpellier University, France
| | - Manon Redondin
- Department of Rheumatology, CHU Montpellier, Montpellier University, France
| | - Isabelle Pane
- Data Manager, Centre d’Épidémiologie Clinique, APHP, France
| | - Martin Soubrier
- Department of Rheumatology, CHU Clermont-Ferrand, Clermont-Ferrand University, France
| | - Eric Houvenagel
- Department of Rheumatology, CHU Lille, Lille University, France
| | - Jean Sibilia
- Department of Rheumatology, CHU Strasbourg, Strasbourg University, France
| | - Bernard Combe
- Department of Rheumatology, CHU Montpellier, Montpellier University, France
| | - Jacques Morel
- Department of Rheumatology, CHU Montpellier, Montpellier University, France.
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Rempenault C, Lukas C, Combe B, Herrero A, Pane I, Schaeverbeke T, Wendling D, Pham T, Gottenberg JE, Mariette X, Morel J. Risk of Diverticulitis and Gastrointestinal Perforation in Rheumatoid Arthritis Treated with Tocilizumab Compared to Rituximab or Abatacept. Rheumatology (Oxford) 2021; 61:953-962. [PMID: 33993216 DOI: 10.1093/rheumatology/keab438] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/14/2021] [Revised: 05/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare the risk of diverticulitis and gastrointestinal perforation (GIP) in rheumatoid arthritis treated with tocilizumab (TCZ) compared with rituximab (RTX) and abatacept (ABA). METHODS We conducted a population-based study using 3 observational French registries on TCZ, RTX and ABA in rheumatoid arthritis. Using a propensity score approach, we compared the risk of diverticulitis or GIP in these patients. RESULTS With inverse probability weighting, there was an increased risk of diverticulitis in TCZ treated patients compared with RTX or ABA treated patients (hazard ratio [HR]=3.1 [95% confidence interval 1.5-6.3], p= 0.002). Moreover, patients treated with TCZ had also an increased risk of GIP due to diverticulitis compared with those treated with RTX or ABA (HR = 3.8 [1.1-13.6], p= 0.04), resulting in an overall increased risk of GIP (HR = 2.9 [1.1-7.8], p= 0.03), while no significant increased risk of GIP due to any other aetiology was found in TCZ treated patients. Diverticulitis and GIP occurred earlier with TCZ than other drugs after the last perfusion (p= 0.01), with atypical clinical presentation (slow transit in 30%, p= 0.04) and lower acute-phase reactants at the time of the event (p= 0.005). CONCLUSION TCZ for rheumatoid arthritis was associated with increased odds of diverticulitis as well as GIP due to diverticulitis as compared with RTX and ABA. Our study confirms the increased odds of GIP in patients receiving TCZ, which might be explained by an increased risk of diverticulitis with misleading clinical presentation.
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Affiliation(s)
| | - Cédric Lukas
- Rheumatology department, CHU and University of Montpellier, France
| | - Bernard Combe
- Rheumatology department, CHU and University of Montpellier, France
| | - Astrid Herrero
- Digestive surgery department, CHU and University of Montpellier, France
| | | | | | - Daniel Wendling
- Rheumatology department, CHU of Besançon, and EA 4266 University of Franche-Comté, Besançon, France
| | - Thao Pham
- Aix Marseille Univ, APHM, CHU Sainte-Marguerite, Department of Rheumatology, Marseille, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Strasbourg University Hospital, National Center For Rare Systemic Autoimmune Diseases, CNRS, UPR3572, IBMC, University of Strasbourg, Strasbourg, France
| | - Xavier Mariette
- Université Paris-Saclay, INSERM, CEA, Centre de recherche en Immunologie des infections virales et des maladies auto-immunes; AP-HP.Université Paris-Saclay, Hôpital Bicêtre, Rheumatology department, 94270, Le Kremlin Bicêtre, France
| | - Jacques Morel
- Rheumatology department, CHU and University of Montpellier, France
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Condamina M, Shourick J, Seneschal J, Sbidian E, Andreu N, Pane I, Ravaud P, Tran VT, Ezzedine K. Factors associated with perceived stress in patients with vitiligo in the ComPaRe e-cohort. J Am Acad Dermatol 2021; 86:696-698. [PMID: 33684495 DOI: 10.1016/j.jaad.2021.02.083] [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: 10/20/2020] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Morgane Condamina
- Service de Dermatologie-Vénéréologie, CHU Robert Debré, Reims, France
| | - Jason Shourick
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Julien Seneschal
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France; INSERM U1035 Biothérapie des Maladies Génétiques Inflammatoires et Cancers, Immuno-Dermatologie ATIP AVENIR, Université de Bordeaux, Bordeaux, France
| | - Emilie Sbidian
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France
| | - Nicolas Andreu
- Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Isabelle Pane
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS-Université de Paris, INSERM UMR1153), Paris, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Philippe Ravaud
- Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Viet-Thi Tran
- Centre de Recherche Épidémiologie et StatistiqueS (CRESS-Université de Paris, INSERM UMR1153), Paris, France; Centre d'épidémiologie clinique-Hôpital Hôtel-Dieu (AP-HP), Paris, France
| | - Khaled Ezzedine
- AP-HP, Hôpital Henri-Mondor, Service de Dermatologie, Créteil, France; Université Paris-Est Créteil, EpiDermE-Epidemiology in Dermatology and Evaluation of Therapeutics, Creteil, France.
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Salmon JH, Perotin JM, Morel J, Dramé M, Cantagrel A, Ziegler LE, Ravaud P, Sibilia J, Pane I, Mariette X, Gottenberg JE. Serious infusion-related reaction after rituximab, abatacept and tocilizumab in rheumatoid arthritis: prospective registry data. Rheumatology (Oxford) 2017; 57:134-139. [PMID: 29069471 DOI: 10.1093/rheumatology/kex403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 04/20/2017] [Indexed: 11/14/2022] Open
Abstract
Objective The aim was to evaluate the incidence of serious infusion-related reactions (SIRRs) in RA treated by non-TNF-targeted biologics. Methods We analysed data from three independent prospective registers, namely autoimmunity and rituximab, Orencia (abatacept) and RA (ORA) and Registry RoAcTEmra (tocilizumab), promoted by the French Society of Rheumatology and including patients with RA. SIRRs were defined by an occurrence during or within 24 h of an infusion and requiring discontinuation of treatment. Characteristics of patients with SIRRs were extracted from the electronic database. Results Among the 4145 patients, SIRRs occurred in 100 patients: 56 patients with the rituximab cohort (2.8% or 0.7/100 patient-years), 15 with the abatacept cohort (1.5% or 0.6/100 patient-years) and 29 with tocilizumab (1.9% or 1/100 patient-years). No fatal SIRR occurred. A previous mild infusion reaction to non-TNF-targeted biologics was observed in a quarter of patients with SIRRs. After pooled multivariate analysis, positive anti-CCP was associated with a higher risk of SIRR (odds ratio = 2.5; 95% CI: 1.01, 6.17). Absence of concomitant treatment with a synthetic DMARD tended to be associated with a higher risk of SIRR (odds ratio = 1.67; 95% CI: 1.00, 2.86). Conclusion In daily practice, SIRRs are slightly more frequent than in clinical trials and rarely life threatening. In common practice, serological status (anti-CCP positivity) and absence of concomitant treatment with a synthetic DMARD increase the risk of SIRR.
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Affiliation(s)
- Jean-Hugues Salmon
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims.,Faculty of Medicine, University of Reims Champagne-Ardenne, EA, 3797
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases and Allergology, Maison Blanche Hospital, Reims University Hospitals.,INSERM UMRS 903, University of Reims Champagne-Ardenne, Reims
| | - Jacques Morel
- Department of Rheumatology, University of Montpellier and Teaching Hospital Lapeyronie, Montpellier
| | - Moustapha Dramé
- Faculty of Medicine, University of Reims Champagne-Ardenne, EA, 3797.,Department of Research and Innovation, Robert Debré Hospital, Reims University Hospitals, Reims
| | - Alain Cantagrel
- Rheumatology Department, Purpan Hospital, Paul Sabatier University, Toulouse
| | | | - Philippe Ravaud
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris
| | - Jean Sibilia
- Department of Rheumatology, L'Archet Hospital, Nice
| | - Isabelle Pane
- Rheumatology Department, National Center for Rare Systemic Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg.,INSERM UMRS_1109, Université de Strasbourg, Strasbourg
| | - Xavier Mariette
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre.,INSERM U1184, IMVA: Center of Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre
| | - Jacques-Eric Gottenberg
- Rheumatology Department, National Center for Rare Systemic Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg.,CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie et Chimie Thérapeutique/Laboratory of Excellence Medalis, Université de Strasbourg, Strasbourg, France
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11
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Latourte A, Gottenberg JE, Luxembourger C, Pane I, Claudepierre P, Richette P, Lafforgue P, Combe B, Cantagrel A, Sibilia J, Flipo RM, Gaudin P, Vittecoq O, Schaeverbeke T, Dougados M, Sellam J, Ravaud P, Mariette X, Seror R. Safety of surgery in patients with rheumatoid arthritis treated by abatacept: data from the French Orencia in Rheumatoid Arthritis Registry. Rheumatology (Oxford) 2017; 56:629-637. [PMID: 28053274 DOI: 10.1093/rheumatology/kew476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/18/2016] [Indexed: 01/04/2023] Open
Abstract
Objective To investigate the frequency and risk factors of postoperative complications in RA patients treated with abatacept (ABA). Methods The Orencia RA registry recruited 1012 patients receiving ABA for RA in routine care. Data from patients treated with ABA who underwent surgery were reviewed to describe the frequency of postoperative complications. Characteristics of patients and surgeries with and without complications were compared to identify factors associated with complications. Results We identified 205 (20.3%) patients who underwent 263 surgeries, including 176 (66.9%) orthopaedic surgeries. Nineteen (7.2%) surgeries, in 19 patients (9.3%), entailed complications, including 7 delayed wound healing (2.7% of surgeries) and 6 surgical site infections (2.3% of surgeries). The median time between the last infusion of ABA and surgery was 5.9 weeks (range: 0.3-12.0 weeks), with no significant difference between patients with and without complications. The median corticosteroids daily dosage was higher in the group with complications [10.0 (6.25-15.0) vs 6.0 (5.0-10.0) mg/day, P = 0.042]. In multivariate analysis, only the duration of ABA treatment was significantly associated with postoperative complications [adjusted odds ratio (aOR) = 0.94 (95% CI: 0.89, 0.99) for each month of treatment], as were orthopaedic surgeries compared with other kinds of surgery [aOR = 4.45 (95% CI: 1.01, 20.2)]. Conclusion In RA patients treated with ABA, the rate of surgical complications was low: 7.2% and higher in case of orthopaedic procedure and a more recent initiation of ABA. The median time between surgery and the last infusion of ABA was short and did not influence the rate of postoperative complications.
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Affiliation(s)
- Augustin Latourte
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre.,Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
| | - Jacques-Eric Gottenberg
- Centre National de Référence des Maladies Auto-Immunes Rares, Fédération de Médecine Translationelle de Strasbourg, University Hospital of Strasbourg, Strasbourg University, Strasbourg
| | | | - Isabelle Pane
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris
| | | | - Pascal Richette
- Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris
| | - Pierre Lafforgue
- Rheumatology Department, Hopital de la Conception, University of Marseille, Marseille
| | - Bernard Combe
- Rheumatology Department, Lapeyronie University Hospital, Montpellier University, Montpellier
| | - Alain Cantagrel
- Rheumatology Center, Purpan Hospital, Paul Sabatier University, Toulouse
| | - Jean Sibilia
- Centre National de Référence des Maladies Auto-Immunes Rares, Fédération de Médecine Translationelle de Strasbourg, University Hospital of Strasbourg, Strasbourg University, Strasbourg
| | - René-Marc Flipo
- Rheumatology Department, CHRU de Lille, Université de Lille-2, Lille
| | | | - Olivier Vittecoq
- Rheumatology Department, Rouen University Hospital & Inserm U905, Rouen
| | | | - Maxime Dougados
- Department of Rheumatology - Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris Descartes University.,INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité
| | - Jeremie Sellam
- Inflammation-Immunopathology-Biotherapy Department (I2B), Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris 06, Paris, France
| | - Philippe Ravaud
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris
| | - Xavier Mariette
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre
| | - Raphaèle Seror
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre
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12
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Salmon JH, Cacoub P, Combe B, Sibilia J, Pallot-Prades B, Fain O, Cantagrel A, Dougados M, Andres E, Meyer O, Carli P, Pertuiset E, Pane I, Maurier F, Ravaud P, Mariette X, Gottenberg JE. Late-onset neutropenia after treatment with rituximab for rheumatoid arthritis and other autoimmune diseases: data from the AutoImmunity and Rituximab registry. RMD Open 2015; 1:e000034. [PMID: 26509060 PMCID: PMC4612695 DOI: 10.1136/rmdopen-2014-000034] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 01/12/2023] Open
Abstract
Objectives To evaluate the prevalence of late-onset neutropenia and its complications in patients treated with rituximab (RTX) for rheumatoid arthritis (RA) and other autoimmune diseases (AIDs) in a prospective registry. Methods The AutoImmunity and Rituximab registry is an independent 7-year prospective registry promoted by the French Society of Rheumatology. For each episode of neutropenia, data were validated by the clinician in charge of the patient. Results Among 2624 patients treated with RTX for refractory AIDs, and at least 1 follow-up visit (a total follow-up of 4179 patient-years in RA and 987 patient-years in AIDs), late-onset neutropenia was observed in 40 patients (25 RA (1.3% of patients with RA, 0.6/100 patient-years), and AIDs in 15 (2.3% of patients with AIDs, 1.5/100 patient-years)). 6 patients (15%) had neutrophils <500/mm3, 8 (20%) had neutrophils between 500 and 1000/mm3, and 26 (65%) had neutrophils between 1000 and 1500/mm3. Neutropenia occurred after a median period of 4.5 (3–6.5) months after the last RTX infusion in patients with RA, and 5 (3–6.5) months in patients with AIDs. 5 patients (12.5%), 4 of them with neutrophils lower than 500/mm3, developed a non-opportunistic serious infection and required antibiotics and granulocyte colony-stimulating factor injections, with a favourable outcome. After resolution of their RTX-related neutropenia, 19 patients (47.5%) were re-treated, and neutropenia reoccurred in 3 of them. Conclusions Late-onset neutropenia might occur after RTX and may result in serious infections. Thus, monitoring of white cell count should be performed after RTX. However, in this large registry of patients with AIDs, the frequency of RTX-induced neutropenia was much lower than that previously reported in patients treated for blood malignancies or AIDs.
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Affiliation(s)
- J H Salmon
- Rheumatology Department, CHU Reims, Reims, France
| | - P Cacoub
- Departement Hospitalo-Universitaire I2B, UPMC Univ Paris 06, CNRS, UMR 7211, INSERM, UMR_S 959, Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière (AP-HP), Paris, France
| | - B Combe
- Rheumatology Department, Lapeyronie University Hospital, Montpellier I, University, UMR5535, Montpellier, France
| | - J Sibilia
- Rheumatology department, National Center for Rare Systemic Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, INSERM UMRS_1109, Université de Strasbourg, Strasbourg, France
| | - B Pallot-Prades
- Rheumatology Department, CHU Saint-Etienne, Saint-Etienne, France
| | - O Fain
- Department of Internal Medicine, Hôpital Jean Verdier, Bondy, France
| | - A Cantagrel
- Rheumatology Center, Purpan Hospital, Paul Sabatier University, Toulouse, France
| | - M Dougados
- Medicine Faculty, Paris-Descartes University, Paris, UPRES-EA 4058, Cochin Hospital, Rheumatology B, Paris, France
| | - E Andres
- Department of Internal Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - O Meyer
- Rheumatology Department, GroupeHospitalier Bichat-Claude Bernard (AP-HP), Paris, France
| | - P Carli
- Department of Internal Medicine, Hôpital D'Instruction des Armeés Sainte-541 Anne, Toulon, France
| | - E Pertuiset
- Rheumatology Department, CH René Dubos, Pontoise, France
| | - I Pane
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris, France
| | - F Maurier
- Department of Internal Medicine, CHR Metz, Metz, France
| | - P Ravaud
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris, France
| | - X Mariette
- Rheumatology Department, Hôpitaux Universitaires Paris-Sud, AP-HP, INSERM U1184, IMVA: Center of Immunology of Viral Infections and Autoimmune Diseases, Paris, France
| | - J E Gottenberg
- Rheumatology Department, National Center for Rare Systemic Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie et Chimie Thérapeutique/Laboratory of Excellence Medalis, Université de Strasbourg, Strasbourg, France
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Salmon JH, Gottenberg JE, Ravaud P, Cantagrel A, Combe B, Flipo RM, Schaeverbeke T, Houvenagel E, Gaudin P, Loeuille D, Rist S, Dougados M, Sibilia J, Le Loët X, Meyer O, Solau-Gervais E, Marcelli C, Bardin T, Pane I, Baron G, Perrodeau E, Mariette X. Predictive risk factors of serious infections in patients with rheumatoid arthritis treated with abatacept in common practice: results from the Orencia and Rheumatoid Arthritis (ORA) registry. Ann Rheum Dis 2015; 75:1108-13. [PMID: 26048170 DOI: 10.1136/annrheumdis-2015-207362] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 01/27/2015] [Accepted: 05/14/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Little data are available regarding the rate and predicting factors of serious infections in patients with rheumatoid arthritis (RA) treated with abatacept (ABA) in daily practice. We therefore addressed this issue using real-life data from the Orencia and Rheumatoid Arthritis (ORA) registry. METHODS ORA is an independent 5-year prospective registry promoted by the French Society of Rheumatology that includes patients with RA treated with ABA. At baseline, 3 months, 6 months and every 6 months or at disease relapse, during 5 years, standardised information is prospectively collected by trained clinical nurses. A serious infection was defined as an infection occurring during treatment with ABA or during the 3 months following withdrawal of ABA without any initiation of a new biologic and requiring hospitalisation and/or intravenous antibiotics and/or resulting in death. RESULTS Baseline characteristics and comorbidities: among the 976 patients included with a follow-up of at least 3 months (total follow-up of 1903 patient-years), 78 serious infections occurred in 69 patients (4.1/100 patient-years). Predicting factors of serious infections: on univariate analysis, an older age, history of previous serious or recurrent infections, diabetes and a lower number of previous anti-tumour necrosis factor were associated with a higher risk of serious infections. On multivariate analysis, only age (HR per 10-year increase 1.44, 95% CI 1.17 to 1.76, p=0.001) and history of previous serious or recurrent infections (HR 1.94, 95% CI 1.18 to 3.20, p=0.009) were significantly associated with a higher risk of serious infections. CONCLUSIONS In common practice, patients treated with ABA had more comorbidities than in clinical trials and serious infections were slightly more frequently observed. In the ORA registry, predictive risk factors of serious infections include age and history of serious infections.
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Affiliation(s)
- J H Salmon
- Rheumatology Department, CHU Reims, Reims, France
| | - J E Gottenberg
- Rheumatology Department, National Center for Rare Systemic Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie et Chimie Thérapeutique/Laboratory of Excellence Medalis, Université de Strasbourg, Strasbourg, France
| | - P Ravaud
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris, France
| | - A Cantagrel
- Rheumatology Center, Purpan Hospital, Paul Sabatier University, Toulouse, France
| | - B Combe
- Rheumatology Department, Lapeyronie University Hospital, Montpellier I University, Montpellier, France
| | - R M Flipo
- Rheumatology Department, CHRU de Lille, Université de Lille-2, Lille, France
| | | | - E Houvenagel
- Rheumatology Department, CHU Lomme, Lomme, France
| | - P Gaudin
- Rheumatology Department, CHU Grenoble, Grenoble, France
| | - D Loeuille
- Rheumatology Department, CHU Nancy, Nancy, France
| | - S Rist
- Rheumatology Department, CHR Orléans, Orléans, France
| | - M Dougados
- Medicine Faculty, Paris-Descartes University, Paris, UPRES-EA 4058, Cochin Hospital, Rheumatology B, Paris, France
| | - J Sibilia
- Rheumatology department, National Center for Rare Systemic Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, INSERM UMRS_1109, Université de Strasbourg, Strasbourg, France
| | - X Le Loët
- Rheumatology Department, Rouen University Hospital & Inserm U905, Rouen, France
| | - O Meyer
- Rheumatology Department, Groupe Hospitalier Bichat-Claude Bernard (AP-HP), Paris, France
| | | | - C Marcelli
- Rheumatology Department, CHU Caen, Caen, France
| | - T Bardin
- Rheumatology Department, Hôpital Lariboisière, Paris, France
| | - I Pane
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris, France
| | - G Baron
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris, France
| | - E Perrodeau
- Centre de Recherche en Epidémiologie et Statistiques, INSERM U1153, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris (AP-HP), Descartes University, Paris, France
| | - X Mariette
- Rheumatology Department, Hôpitaux Universitaires Paris-Sud, AP-HP, INSERM U1184, IMVA: Center of Immunology of Viral Infections and Autoimmune Diseases, Paris, France
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Salliot C, Beaudoin C, Chauffier K, Gilson M, Séror R, Sordet C, Sparsa L, Pane I, Ravaud P, Gottenberg J. FRI0070 Prevalence and Evolution of Monoclonal Gammapathy of Undetermined Significance in Patients with Rheumatoid Arthritis Patients Treated with Abatacept: Data from the ORA Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gottenberg J, Morel J, Ravaud P, Bardin T, Cacoub P, Cantagrel A, Combe B, Constantin A, Dougados M, Flipo R, Godeau B, Hachulla E, Le Loet X, Schaeverbeke T, Sibilia J, Pane I, Baron G, Mariette X. FRI0154 Incidence of Cancers in Patients with Rheumatoid Arthritis and a History of Cancer Treated with Rituximab or Abatacept. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gottenberg JE, Morel J, Ravaud P, Bardin T, Cacoub P, Cantagrel A, Combe B, Constantin A, Dougados M, Flipo R, Godeau B, Hachulla E, Le Loet X, Schaeverbeke T, Sibilia J, Pane I, Baron G, Mariette X. OP0035 Tolerance of Rituximab, Abatacept and Tocilizumab in Common Practice: Analysis of the 3 Registries of the French Society of Rheumatology (Air, Ora and Regate). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sagez F, Ravaud P, Afif N, Benmansour A, Constantin A, Dernis E, Dougados M, Flipo R, Jamard B, Legrand J, Morel J, Redeker S, Richez C, Scotto C, Solau-Gervais E, Pane I, Mariette X, Gottenberg J. AB0460 Remission After Discontinuation of Abatacept for Good Response: Results from the ORA Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Godot S, Gottenberg JE, Paternotte S, Pane I, Combe B, Sibilia J, Flipo RM, Schaeverbeke T, Ravaud P, Toussirot E, Berenbaum F, Mariette X, Wendling D, Sellam J. Safety of surgery after rituximab therapy in 133 patients with rheumatoid arthritis: data from the autoimmunity and rituximab registry. Arthritis Care Res (Hoboken) 2014; 65:1874-9. [PMID: 23754822 DOI: 10.1002/acr.22056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/12/2013] [Accepted: 05/23/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We used data from the AutoImmunity and Rituximab (AIR) registry to investigate the safety of surgery for patients with rheumatoid arthritis receiving rituximab (RTX) in routine care. METHODS Data for patients included in the AIR registry and undergoing surgery during the year following an infusion of RTX were reviewed to describe the frequency of postsurgical complications, compare patients with and without complications, and identify factors associated with complications. RESULTS We examined data for 133 patients with a known date of surgery and at least 1 followup visit, corresponding to 140 procedures, including 94 orthopedic surgeries (67%) and 23 abdominal surgeries (16.5%). The median delay between surgery and the last RTX infusion was 6.4 months (interquartile range 4.3– 8.7 months), without any difference between patients with and without complications. Nine patients (6.7%) experienced 12 complications (8.5%), including 8 surgical site infections (5.7%) and 1 death due to septic shock. Postoperative complications occurred after 4.3% of abdominal surgeries (1 of 23) and 7.4% of orthopedic surgeries (7 of 95). On univariate analysis, spine surgery was associated with postoperative complications (P = 0.048). CONCLUSION In common practice, the risk of complications may be more important in case of spine surgery, but does not seem to be linked to the time between the last RTX infusion and surgery.
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Godot S, Gottenberg J, Paternotte S, Pane I, Combe B, Sibilia J, Flipo RM, Schaeverbeke T, Ravaud P, Toussirot E, Berenbaum F, Mariette X, Wendling D, Sellam J. THU0122 Safety of surgery in patients with rheumatoid arthritis treated by rituximab in routine care: Data from the french air registry:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Salmon JH, Ravaud P, Bardin T, Cacoub P, Cantagruel A, Combe B, Dougados M, Flipo RM, Godeau B, Guillevin L, Le Loët X, Hachulla E, Schaeverbeke T, Sibilia J, Pane I, Baron G, Mariette X, Gottenberg JE. FRI0246 Serious infusion-related reactions after rituximab in patients with rheumatoid arthritis: data from the autoimmunity and rituximab registry. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1373] [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: 11/04/2022]
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Gottenberg JE, Ravaud P, Cantagrel A, Combe B, Flipo RM, Schaeverbeke T, Houvenagel E, Gaudin P, Loeuille D, Rist S, Dougados M, Sibilia J, Le Loët X, Marcelli C, Bardin T, Pane I, Baron G, Mariette X. Positivity for anti-cyclic citrullinated peptide is associated with a better response to abatacept: data from the 'Orencia and Rheumatoid Arthritis' registry. Ann Rheum Dis 2012; 71:1815-9. [PMID: 22615458 DOI: 10.1136/annrheumdis-2011-201109] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Very limited data are available regarding the efficacy of abatacept (ABA) in real life. The aims of this study were to determine the efficacy of ABA in rheumatoid arthritis and predicting factors of efficacy in common practice. METHODS The Orencia and Rheumatoid Arthritis" (ORA) prospective registry, promoted by the French Society of Rheumatology, has included 1003 patients with RA. RESULTS 773 patients had already fulfilled the 6-month follow-up visit. Only 21.3% of patients would have fulfilled inclusion criteria used in pivotal controlled trials. The European League Against Rheumatism (EULAR) response, was observed in 330 (59.1%) of the 558 assessed patients (good response: 20.4%, moderate response: 38.7%) and was similar in patients who did and in patients who did not fulfill inclusion criteria of controlled trials. Among EULAR responders, initial 28-joint disease activity score (5.4 (4.7-6.5) in responders vs 4.9 (4.0-6.0) in non responders, p< 0.0001), the proportion of rheumatoid factor (75.6% vs 66.7%, p= 0.03) and the proportion of anti-cyclic citrullinated peptide antibody (anti-CCP)-positivity (75.9% vs 62.2%, p= 0.001) were significantly higher. In multivariate analysis adjusted on initial 28-joint disease activity score and CRP, anti-CCP positivity was associated with EULAR response (OR=1.9;95% CI=1.2 to 2.9, p=0.007), but not rheumatoid factor (OR=1.0;95% CI=0.6 to 1.6, p=0.9). Anti-CCP positivity was also significantly associated with a higher ABA retention rate at 6 months. CONCLUSIONS Real life efficacy of ABA in the ORA registry was similar as that reported in clinical trials. Anti-CCP positivity was associated with a better response to ABA, independently from disease activity.
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Affiliation(s)
- J E Gottenberg
- Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre de Référence National des Maladies Auto-Immunes Systémique Rares, EA 4438 Physiopathologie des Arthrites, Strasbourg, France.
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