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Boulekbache A, Maldonado F, Kavafian R, Ferry T, Bourguignon L, Goutelle S, Lega JC, Garreau R. Comparison of daptomycin and glycopeptide efficacy and safety for the treatment of Gram-positive infections: a systematic review and meta-analysis. J Antimicrob Chemother 2024; 79:712-721. [PMID: 38323372 DOI: 10.1093/jac/dkae026] [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: 10/26/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The indications of daptomycin have been extended to off-label indications including prosthesis-related infection, and bone and joint infection (BJI). However, efficacy and safety have not been thoroughly demonstrated compared with the standard of care. This systematic review and meta-analysis aimed to compare the treatment effect of daptomycin and glycopeptides for complicated infections. MATERIALS AND METHODS MEDLINE, Embase and Web of Science were searched for randomized controlled trials (RCTs) comparing daptomycin and standard of care for Gram-positive infections, published until 30 June 2021. The primary outcome was defined as all-cause mortality. Secondary outcomes were clinical and microbiological success. The main safety outcome was any severe adverse event (SAE) (grade ≥3). RESULTS Overall, eight RCTs were included in the meta-analysis, totalling 1095 patients. Six (75%) were in complicated skin and soft-structure infections, one (12.5%) in bacteraemia and one (12.5%) in a BJI setting. Six RCTs used vancomycin as a comparator and two used either vancomycin or teicoplanin. All-cause mortality and clinical cure were not different between groups. The microbiological cure rate was superior in patients who received daptomycin [risk ratio (RR) = 1.17 (95% CI: 1.01-1.35)]. The risk of SAEs [RR = 0.57 (95% CI: 0.36-0.90)] was lower in the daptomycin arm. CONCLUSIONS While daptomycin is associated with a significantly lower risk of SAEs and a better microbiological eradication, substantial uncertainty remains about the best treatment strategy in the absence of good-quality evidence, especially in bacteraemia and endocarditis where further RCTs should be conducted.
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Affiliation(s)
- Abdelwahab Boulekbache
- Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Fanny Maldonado
- Commission du médicament et des dispositifs médicaux stériles, Hospices Civils de Lyon, Lyon 69008, France
| | - Raphael Kavafian
- Commission du médicament et des dispositifs médicaux stériles, Hospices Civils de Lyon, Lyon 69008, France
| | - Tristan Ferry
- Service de maladie infectieuse, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon 69004, France
- ISPB-Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Centre international de recherche en infectiologie, Univ Lyon, Université Claude Bernard Lyon 1, UMR 1111, Lyon 69008, France
| | - Laurent Bourguignon
- ISPB-Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Univ Lyon, Université Claude Bernard Lyon 1, UMR CNRS 5558, Villeurbanne, France
- Service de Pharmacie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon 69004, France
| | - Sylvain Goutelle
- ISPB-Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Univ Lyon, Université Claude Bernard Lyon 1, UMR CNRS 5558, Villeurbanne, France
- Service de Pharmacie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon 69004, France
| | - Jean-Christophe Lega
- Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Commission du médicament et des dispositifs médicaux stériles, Hospices Civils de Lyon, Lyon 69008, France
- ISPB-Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Univ Lyon, Université Claude Bernard Lyon 1, UMR CNRS 5558, Villeurbanne, France
| | - Romain Garreau
- ISPB-Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Univ Lyon, Université Claude Bernard Lyon 1, UMR CNRS 5558, Villeurbanne, France
- Service de Pharmacie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon 69004, France
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Moulis G, Rueter M, Duvivier A, Mahévas M, Viallard JF, Comont T, Chèze S, Audia S, Ebbo M, Terriou L, Lega JC, Jeandel PY, Hemim I, Bozzi S, Daak A, Okada H, Bonnotte B, Michel M, Lapeyre-Mestre M, Godeau B. Difficult-to-treat primary immune thrombocytopenia in adults: Prevalence and burden. Results from the CARMEN-France registry. Br J Haematol 2024; 204:1476-1482. [PMID: 38267268 DOI: 10.1111/bjh.19288] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/25/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
The aim of this study was to assess the prevalence and the burden of difficult-to-treat primary ITP (pITP), defined by the need for another ITP treatment after romiplostim and eltrombopag. Adult patients were selected in the prospective, real-world CARMEN-France registry up to December 2021. Out of 821 adult patients with pITP, 29 had difficult-to-treat ITP (3.5%; 95% confidence interval [CI]: 2.3%-4.8% in total; 7.6%; 95% CI: 4.9%-10.2% of patients needing ≥2nd line treatment). The 3-year cumulative incidence of bleeding, infection and thrombosis was 100%, 24.1% and 13.8% respectively. The median cumulative duration of hospital stays was 31 days (median follow-up: 30.3 months).
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Affiliation(s)
- Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
- Clinical Investigation Center, Toulouse University Hospital, Toulouse, France
| | - Manuela Rueter
- Clinical Investigation Center, Toulouse University Hospital, Toulouse, France
| | | | - Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Autoimmune Cytopenias, Créteil University Hospital, Créteil, France
| | | | - Thibault Comont
- Department of Internal Medicine, Toulouse Cancer University Hospital, Toulouse, France
| | - Stéphane Chèze
- Department of Hematology, Caen University Hospital, Caen, France
| | - Sylvain Audia
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Mikaël Ebbo
- Department of Internal Medicine, Marseille University Hospital, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | | | | | | | | | | | | | - Bernard Bonnotte
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Autoimmune Cytopenias, Créteil University Hospital, Créteil, France
| | - Maryse Lapeyre-Mestre
- Clinical Investigation Center, Toulouse University Hospital, Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Autoimmune Cytopenias, Créteil University Hospital, Créteil, France
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Euvrard R, Robert M, Mainbourg S, Dalle S, Lega JC. Association between immune-related adverse events and prognosis in patients treated with immune checkpoint inhibitors in melanoma: A surrogacy analysis. Fundam Clin Pharmacol 2024; 38:369-379. [PMID: 38012082 DOI: 10.1111/fcp.12966] [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: 09/28/2022] [Revised: 07/10/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) represent a breakthrough in oncology in terms of prognosis and safety. They now constitute a cornerstone in the management of metastatic melanoma. However, a new kind of adverse event called immune-related adverse events (irAE) has emerged. These irAE could be conceptually considered as an indicator of the antitumoral immune response, but the association between irAE and prognosis is still a matter of debate. OBJECTIVE The purpose of this study was to investigate the association between the overall survival (OS) and the prevalence of irAE in melanoma. METHODS MEDLINE/PubMed, WebofScience, ClinicalTrials, and WHOTrials databases were searched to identify phase 3 randomized controlled trials (RCT) assessing ICI in melanoma and published up to April 2021. A weighted regression was performed to estimate this association according to standard method of surrogacy analysis. RESULTS A total of 14 RCT including 7646 patients (median age: 59.3 years) with melanoma were included. All types of ICI were represented (ipilimumab, tremelimumab, pembrolizumab, nivolumab, atezolizumab, as well as ipilimumab and nivolumab combination). irAE were frequent but rarely fatal. The combination of ICI caused more irAE than anti-PD1 (or PDL1) and anti-CTLA4 monotherapies. No relationship was found between the occurrence of irAE and OS (beta coefficient 0.078, R2 3%, p = 0.52), nor between cutaneous irAE and OS (beta coefficient 0.080, R2 6%, p = 0.33). CONCLUSION Although limited by the heterogeneity of ICI included in the regression and the low number of included RCT, the present study suggests an absence of association between irAE and prognosis in melanoma.
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Affiliation(s)
- Romain Euvrard
- Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, France
| | - Marie Robert
- Service de Médecine Interne et d'immunologie clinique, Université de Lyon 1, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Sabine Mainbourg
- Equipe Évaluation et Modélisations des Effets Thérapeutiques, UMR CRNS 5558, Université Claude Bernard Lyon 1, Lyon, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, France
| | - Stéphane Dalle
- Service de Dermatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, France
| | - Jean-Christophe Lega
- Equipe Évaluation et Modélisations des Effets Thérapeutiques, UMR CRNS 5558, Université Claude Bernard Lyon 1, Lyon, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, France
- Service de Rhumatologie, Hôpital Lyon Sud, Hospices Civils de lyon, France
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Pradelle A, Mainbourg S, Provencher S, Massy E, Grenet G, Lega JC. Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate. Biomed Pharmacother 2024; 171:116055. [PMID: 38171239 DOI: 10.1016/j.biopha.2023.116055] [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: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to estimate the number of HCQ-related deaths worldwide. METHODS AND FINDINGS We estimated the worldwide in-hospital mortality attributable to HCQ use by combining the mortality rate, HCQ exposure, number of hospitalised patients, and the increased relative risk of death with HCQ. The mortality rate in hospitalised patients for each country was calculated using pooled prevalence estimated by a meta-analysis of published cohorts. The HCQ exposure was estimated using median and extreme estimates from the same systematic review. The number of hospitalised patients during the first wave was extracted from dedicated databases. The systematic review included 44 cohort studies (Belgium: k = 1, France: k = 2, Italy: k = 12, Spain: k = 6, Turkey: k = 3, USA: k = 20). HCQ prescription rates varied greatly from one country to another (range 16-84%). Overall, using median estimates of HCQ use in each country, we estimated that 16,990 HCQ-related in-hospital deaths (range 6267-19256) occurred in the countries with available data. The median number of HCQ-related deaths in Belgium, Turkey, France, Italy, Spain, and the USA was 240 (range not estimable), 95 (range 92-128), 199 (range not estimable), 1822 (range 1170-2063), 1895 (range 1475-2094) and 12739 (3244- 15570), respectively. CONCLUSIONS Although our estimates are limited by their imprecision, these findings illustrate the hazard of drug repurposing with low-level evidence.
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Affiliation(s)
- Alexiane Pradelle
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France
| | - Sabine Mainbourg
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Unité bases de données cliniques et épidémiologiques, Hospices Civils de Lyon, Lyon F-69310, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France
| | - Steeve Provencher
- Pulmonary Hypertension Research Group (http://phrg.ca), Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Department of medicine, Université Laval, Québec City, Canada
| | - Emmanuel Massy
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France
| | - Guillaume Grenet
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France
| | - Jean-Christophe Lega
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France.
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Séauve M, Auréal M, Laplane S, Lega JC, Cabrera N, Coury F. Risk of infections in psoriatic arthritis or axial spondyloarthritis patients treated with targeted therapies: A meta-analysis of randomized controlled trials. Joint Bone Spine 2023; 91:105673. [PMID: 38042364 DOI: 10.1016/j.jbspin.2023.105673] [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: 04/19/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To evaluate the risk of global infections in patients with psoriatic arthritis (PsA) and axial spondyloarthritis encompassing ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) treated with targeted therapies. METHODS Medline and Cochrane databases were systematically searched up to March 2021 for randomized controlled trials (RCTs) performed in patients with PsA or axial spondyloarthritis treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Global infections (any infections reported, including bacterial, viral and fungal infections, except serious infections) were the primary outcome. Secondary outcomes included serious infections defined as life-threatening infections or any infection requiring intravenous antibiotics or hospitalization. The relative risk of infections was determined by meta-analysis of RCTs. RESULTS A total of 60 RCTs were included (20,418 patients), encompassing 17 b/tsDMARDs, compared with placebo, conventional synthetic drugs (csDMARDs) or non-steroidal anti-inflammatory drugs (NSAIDs). An increased risk of any infection for patients exposed to these drugs was found (RR 1.15, 95% CI [1.06-1.25]), mainly with high doses and longer duration of treatment. Most infections were respiratory tract or ear, nose, and throat (ENT) infections. Subgroup analyses showed a statistically significant increased risk of infections for axial spondyloarthritis patients (RR 1.32, 95% CI [1.14-1.52]), but not for PsA patients (RR 1.05, 95% CI [0.97-1.14]). Infection risk was highest with TNF inhibitors (RR 1.23, 95% CI [1.11-1.37]) and IL-17 inhibitors (RR 1.30, 95% CI [1.07-1.59]). No increased risk of serious infections was shown. CONCLUSION In contrast to serious infections, the risk of global infections is moderately increased with b/tsDMARDs in spondyloarthritis, and is associated in particular with use of TNF and IL-17 inhibitors.
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Affiliation(s)
- Milène Séauve
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Mélanie Auréal
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Soline Laplane
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Jean-Christophe Lega
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Internal and Vascular Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France; University of Lyon, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, 69100 Lyon, France; Lyon Immunopathology Federation, Lyon, France
| | - Natalia Cabrera
- University of Lyon, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, 69100 Lyon, France
| | - Fabienne Coury
- University of Lyon, University Lyon 1, 69100 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Lyon Immunopathology Federation, Lyon, France; University of Lyon, Inserm UMR 1033, 69100 Lyon, France.
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Lobbes H, Lega JC, Le Guenno G, Ruivard M, Mainbourg S. Treatment strategy for acquired pure red cell aplasia: a systematic review and meta-analysis. Blood Adv 2023; 7:6451-6465. [PMID: 37624775 PMCID: PMC10632686 DOI: 10.1182/bloodadvances.2023010587] [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: 05/01/2023] [Revised: 07/22/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
The treatment of autoimmune acquired pure red cell aplasia (aPRCA) is challenging. Guidelines are based on expert recommendations in the absence of controlled trials. We assessed the efficacy of the main treatment strategy through a systematic review and meta-analysis using MEDLINE, EMBASE, and the Cochrane Library up to September 2022. The overall response rate (ORR) was pooled using random-effects models. In total, 24 observational studies (19 retrospective, median follow-up of 48 months) encompassing 753 patients (49% male) were included. Primary aPRCA represented 57% of the cases. The risk of bias was moderate to high using the ROBINS-I tool. Substantial heterogeneity (I2 > 50%) was retrieved. Corticosteroids as monotherapy as first-line treatment (186 patients, 13 studies) provided an ORR of 47% (95% confidence interval [CI], 34-60). Cyclosporine A was the most frequently used immunosuppressant agent (384 patients, 18 studies), providing an ORR of 74% (95% CI, 66-82) with a similar ORR in first- (73%) and second-line (76%) treatment and when cyclosporin was used as monotherapy (83%) or with corticosteroids (77%). A total of 112 patients (10 studies) received cyclophosphamide, with an ORR of 49% (95% CI, 35-64), which was higher when cyclophosphamide was combined with corticosteroids (48%) and used in second-line treatment (58%) than in monotherapy (31%), and in first-line treatment (44%). Sirolimus use was reported only after cyclosporine A failure and provided an ORR of 87% (95% CI, 68-100; 64 patients, 3 studies). Substantial uncertainty remains regarding the best treatment strategy in the absence of high-quality evidence. This study was registered on the PROPERO database as #CRD42022360452.
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Affiliation(s)
- Hervé Lobbes
- Service de Médecine Interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre de Compétence des cytopénies autoimmunes de l’adulte, Clermont-Ferrand, France
- Institut Pascal, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont-Ferrand, France
| | - Jean-Christophe Lega
- Lyon Immunopathology Federation, Hospices Civils de Lyon, Lyon, France
- Service de Rhumatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie évolutive, Centre National de la Recherche Scientifique, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Guillaume Le Guenno
- Service de Médecine Interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre de Compétence des cytopénies autoimmunes de l’adulte, Clermont-Ferrand, France
| | - Marc Ruivard
- Service de Médecine Interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre de Compétence des cytopénies autoimmunes de l’adulte, Clermont-Ferrand, France
- Institut Pascal, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont-Ferrand, France
| | - Sabine Mainbourg
- Lyon Immunopathology Federation, Hospices Civils de Lyon, Lyon, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie évolutive, Centre National de la Recherche Scientifique, Université Claude Bernard Lyon 1, Villeurbanne, France
- Département de Médecine Interne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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Guédon AF, Carrat F, Mouthon L, Launay D, Chaigne B, Pugnet G, Lega JC, Hot A, Cottin V, Agard C, Allanore Y, Fauchais AL, Jego P, Dhote R, Papo T, Chatelus E, Bonnotte B, Khan JE, Diot E, Bienvenu B, Magy-Bertrand N, Queyrel V, Le Quellec A, Kieffer P, Amoura Z, Harlé JR, Gaultier JB, Balquet MH, Wahl D, Lidove O, Fain O, Mékinian A, Hachulla E, Rivière S. Heart and systemic sclerosis-findings from a national cohort study. Rheumatology (Oxford) 2023:kead599. [PMID: 37944039 DOI: 10.1093/rheumatology/kead599] [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: 04/03/2023] [Revised: 10/03/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Heart involvement is one of the leading causes of death in systemic sclerosis (SSc). The prevalence of SSc-related cardiac involvement is poorly known. Our objective was to investigate the prevalence and prognosis burden of different heart diseases in a nationwide cohort of patients with SSc. METHODS We used data from a multicentric prospective study using the French SSc national database. Focusing on SSc-related cardiac involvement, we aimed to determine its incidence and risk factors. RESULTS Over the 3528 patients with SSc 312 (10.9%) had SSc-related cardiac involvement at baseline. They tended to have a diffuse SSc subtype more frequently, more severe clinical features, and presented more cardiovascular risk factors. From the 1646 patients available for follow-up analysis, SSc-related cardiac involvement was associated with an increased risk of death. There was no significant difference in overall survival between SSc-related cardiac involvement, ischaemic heart disease or pulmonary arterial hypertension. Regarding survival analysis, 98 patients developed SSc-related cardiac involvement at five years (5-year event rate: 11.15%). Regarding reduced LVEF < 50% and left ventricular diastolic dysfunction, the 5-year event rate was 2.49% and 5.84% respectively. Pericarditis cumulative incidence at five years was 3%. Diffuse SSc subtype was a risk factor for SSc-related cardiac involvement and pericarditis. Female sex was associated with less left ventricular diastolic dysfunction incidence. CONCLUSIONS Our results describe the incidence and prognostic burden of SSc-related cardiac involvement at a large scale, with gender and diffuse SSc subtype as risk factors. Further analyses should assess the potential impact of treatment on these various cardiac outcomes.
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Affiliation(s)
- Alexis F Guédon
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - David Launay
- Department of Internal Medicine and Clinical Immunology, Center de Référence des maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, University of Lille, Lille, France, University of Lille, U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille F-59000, France; INSERM, Lille, France
| | - Benjamin Chaigne
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Grégory Pugnet
- Department of Internal Medicine and Clinical Immunology, Centre for Clinical Investigation (CIC BT 1436), University Hospital of Toulouse, Toulouse, France
| | - Jean-Christophe Lega
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France; Lyon immunopathology FEderation (LIFE), Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, Edouard Herriot University Hospital, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University, Lyon 1, Lyon, France
| | - Christian Agard
- Internal Medicine Department, Nantes Université, CHU Nantes, 1 place Alexis Ricordeau, Nantes, France
| | - Yannick Allanore
- Department of Rheumatology, Université de Paris, Cochin Hospital, Paris, France, INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Limoges University Hospital, CEDEX, Limoges, France
| | - Patrick Jego
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France, Univ Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Robin Dhote
- Sorbonne Paris Nord University, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
| | - Thomas Papo
- Department of Internal Medicine, Université de Paris, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Emmanuel Chatelus
- Rheumatology Department, Strasbourg University Hospital, East and South-West national reference center for auto-immune diseases, Strasbourg, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Jean-Emmanuel Khan
- Department of Internal Medicine, Hôpital Ambroise Paré, Université Versailles-Saint Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, Tours, Tours, France
| | - Boris Bienvenu
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, Caen, France
| | | | - Viviane Queyrel
- Pasteur 2 Hospital, Department of Rheumatology, Cote d'Azur University, Nice University Hospital, Nice, France
| | - Alain Le Quellec
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | | | - Zahir Amoura
- Département d'Immunologie, Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jean-Robert Harlé
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jean-Baptiste Gaultier
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier universitaire de St Etienne, saint Etienne, France
| | | | - Denis Wahl
- Department of Vascular Medicine, Referral Center for Rare Vascular Diseases, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Fain
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
| | - Arsène Mékinian
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Center de Référence des maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, University of Lille, Lille, France; University of Lille, U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille F-59000, France; INSERM, Lille, France
| | - Sebastien Rivière
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
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8
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Fall M, Grenet G, Le HH, Kassaï B, Lega JC, Boussageon R, Mainbourg S, Marchant I, Gafsi J, Dieye AM, Gueyffier F. [Does aspirin have a place in primary cardiovascular prevention by the polypill ? Simulation study on a realistic virtual population]. Therapie 2023; 78:667-678. [PMID: 36841655 DOI: 10.1016/j.therap.2023.01.011] [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: 11/05/2022] [Revised: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The polypill strategy could become widely accepted in cardiovascular prevention due to reduced costs and its simplicity, which promote compliance. Aspirin is often included as a component of the polypill for primary prevention, but three powerful recent trials failed to show any favorable net benefit even in high-risk subgroups. Our objective is to estimate the net benefit associated with aspirin in primary cardiovascular prevention. METHODS We simulated the impact of different polypill compositions combining pravastatin, ramipril, hydrochlorothiazide, with or without aspirin, on a realistic French virtual population between 35 and 65 years old. We assessed how this impact on myocardial infarction and stroke varied according to gender, diabetes, and arterial hypertension. We identified the subgroup of individuals whose specific benefit from aspirin was greater than twice the risk of serious bleeding it induced. RESULTS The absolute benefit associated with aspirin was reduced by co-prescriptions. No subgroup of women benefited from aspirin, and the subgroup of women with a clear net benefit represented 128 women out of 529,421. Men at high risk of cardiovascular death, or with diabetes and hypertension, had a benefit from aspirin exceeding the risk of bleeding induced, but this risk represented more than half of the benefit. No subgroup analyzed did show a benefit greater than twice the risk of bleeding. The proportion of men whose expected benefit from aspirin was greater than twice the risk of bleeding represented 3% of all men. An optimal polypill strategy in primary prevention between the ages of 35 and 65, combining three drugs but not aspirin, can hope to save two out of three strokes and more than one out of two myocardial infarctions. It would prevent a major cardiovascular accident every 16 to 193 individuals treated according to the subgroups considered. CONCLUSION Until proven otherwise, aspirin has only a limited place in individuals between 35 and 65 years without a cardiovascular history. We showed how simulating therapeutic strategies on a realistic virtual population could be used for best applying available evidence.
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Affiliation(s)
- Mor Fall
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Laboratoire de pharmacologie & de pharmacodynamie, UMRED université Iba Der Thiam, BP A967 Thies, Sénégal; Centre hospitalier universitaire Aristide Le Dantec, pharmacie centrale, BP 3001 Dakar, Sénégal
| | - Guillaume Grenet
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Service hospitalo universitaire de pharmaco-toxicologie, 69002 Lyon France
| | - Hai-Ha Le
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Behrouz Kassaï
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Service hospitalo universitaire de pharmaco-toxicologie, 69002 Lyon France
| | - Jean-Christophe Lega
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Rémy Boussageon
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Sabine Mainbourg
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Ivanny Marchant
- Laboratorio de Modelamiento en Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile
| | - Johanne Gafsi
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France
| | - Amadou Moctar Dieye
- Service hospitalo universitaire de pharmaco-toxicologie, 69002 Lyon France; Laboratoire de pharmacologie & de pharmacodynamie, université Cheikh Anta Diop, BP 5005 Dakar, Sénégal
| | - François Gueyffier
- Laboratoire de biologie et biométrie évolutive - équipe modélisation des effets thérapeutiques, UMR 5558 université Claude Bernard Lyon 1, 69376 Lyon, France; Pôle de santé publique, Hospices civils de Lyon, 69002 Lyon, France.
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9
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Ollier N, Piel-Julian ML, Mahévas M, Viallard JF, Comont T, Chèze S, Audia S, Ebbo M, Terriou L, Lega JC, Jeandel PY, Bonnotte B, Michel M, Lapeyre-Mestre M, Godeau B, Moulis G. Platelet count threshold for hemorrhage in patients with immune thrombocytopenia treated with antiplatelet agents. Blood 2023; 142:1099-1101. [PMID: 37478400 DOI: 10.1182/blood.2023020311] [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: 03/01/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
A significant proportion of older patients with immune thrombocytopenia (ITP) also have clinical indications for treatment of cardiovascular disease with antiplatelet agents. Ollier and colleagues sought to determine the frequency of bleeding in patients with ITP on aspirin therapy, finding that the pattern of bleeding, segregated by platelet count, is similar to that observed in other adults with ITP not on aspirin. They show that a platelet count of <20 × 109/L is associated with most bleeding in ITP patients on antiplatelet agents.
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Affiliation(s)
- Natasha Ollier
- Department of Internal Medicine, Toulouse University Hospital, France
| | | | - Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, France
| | | | - Thibault Comont
- Department of Internal Medicine, Toulouse University Institute for Cancer, France
| | - Stéphane Chèze
- Department of Hematology, Caen University Hospital, France
| | - Sylvain Audia
- Department of Internal Medicine, Dijon University Hospital, France
| | - Mikaël Ebbo
- Department of Internal Medicine, Marseille University Hospital, Assistance Publique-Hôpitaux de Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, Lille University Hospital, France
| | - Jean-Christophe Lega
- Department of Internal Medicine, Lyon University Hospital, Hôpitaux Civils de Lyon, France
| | | | - Bernard Bonnotte
- Department of Internal Medicine, Dijon University Hospital, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, France
| | - Maryse Lapeyre-Mestre
- Clinical Investigation Center 1436, Team PEPSS (PharmacoEpidemiology, Populations, cohortS, biomarkerS), Toulouse University Hospital, France
- Department of Clinical Pharmacology, Toulouse University Hospital, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est Créteil University, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, France
- Clinical Investigation Center 1436, Team PEPSS (PharmacoEpidemiology, Populations, cohortS, biomarkerS), Toulouse University Hospital, France
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10
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El Jammal T, Dhelft F, Pradat P, Bailly F, Zoulim F, Hot A, Fauter M, Drissi-Bakhkhat A, Durieu I, Lega JC, Jamilloux Y, Sève P. Diagnostic value of elevated serum angiotensin-converting enzyme and lymphopenia in patients with granulomatous hepatitis. Sarcoidosis Vasc Diffuse Lung Dis 2023; 40:e2023031. [PMID: 37712371 PMCID: PMC10540712 DOI: 10.36141/svdld.v40i3.14221] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND AIM Granulomatous hepatitis (GH) is associated with various aetiologies, especially inflammatory and infectious disorders. Sarcoidosis is a granulomatous disease in which the liver is the fourth most affected organ. Since epithelioid cell granulomas are not specific to sarcoidosis and since most patients with hepatic sarcoidosis are asymptomatic, valuable diagnostic biomarkers are needed to support the diagnosis of sarcoidosis. This study proposes to assess the diagnostic value of serum angiotensin converting enzyme (sACE) and lymphopenia in GH for sarcoidosis. METHODS We retrospectively analyzed the records of 90 patients referred to the internal medicine or hepatogastroenterology departments of the Lyon University Hospital (Lyon, France) between March 2002 and January 2020 in a context of GH. RESULTS In our tertiary center, 38 patients with sarcoidosis were identified among 73 patients with GH. Lymphopenia had a high specificity (85.7%), which increased when combined with elevated (97.0%). Interestingly, specificity increased in patients under 50 years old (100%). CONCLUSIONS Those results suggests that lymphopenia and sACE may be valuable biomarkers for sarcoidosis diagnosis in GH when combined, especially in younger patients.
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Affiliation(s)
- Thomas El Jammal
- Internal Medicine Department, Hôpital de la Croix Rousse, Lyon, France.
| | - François Dhelft
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France.
| | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France.
| | - François Bailly
- Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France..
| | - Fabien Zoulim
- Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France..
| | - Arnaud Hot
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69003, Lyon, France.
| | - Maxime Fauter
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France.
| | - Ayoub Drissi-Bakhkhat
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France.
| | - Isabelle Durieu
- Department of Internal Medicine, Hôpital Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France..
| | - Jean-Christophe Lega
- Department of Internal Medicine, Hôpital Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France..
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France.
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, F-69004, Lyon, France.
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11
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Aureal M, Seauve M, Laplane S, Lega JC, Cabrera N, Coury F. Incidence of infections in patients with psoriatic arthritis and axial spondyloarthritis treated with biological or targeted disease-modifying agents: a systematic review and meta-analysis of randomised controlled trials, open-label studies and observational studies. RMD Open 2023; 9:e003064. [PMID: 37714666 PMCID: PMC10510924 DOI: 10.1136/rmdopen-2023-003064] [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: 02/10/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To estimate the incidence of infections among patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA), two distinct phenotypes included in the large group of spondyloarthritis (SpA), treated with tumour necrosis-factor-inhibitors, interleukin-17-inhibitors, Janus kinase-inhibitors, IL-23 or IL-12/23-inhibitors (IL-12/23i), phosphodiesterase 4-inhibitors or cytotoxic T-lymphocyte associated protein 4-Ig. METHODS A meta-analysis of randomised controlled trials (RCTs), open-label extension and observational studies was conducted. Serious infections were defined as infections that were life-threatening, required intravenous antibiotics and/or hospitalisation. Non-serious infections did not meet these severity criteria. The incidence rates (IR) were reported for each diagnosis by treatment class and study type using random-effect model to create a 95% CI. RESULTS Among 23 333 PsA patients and 11 457 axSpA patients, there were 1.09 serious infections per 100 patient-years (PY) (95% CI 0.85 to 1.35) with similar IR in PsA (0.96 per 100 PY 95% CI 0.69 to 1.28) and axSpA (1.09 per 100 PY 95% CI 0.76 to 1.46). The IR was lower in RCTs (0.77 per 100 PY 95% CI 0.41 to 1.20) compared with observational studies (1.68 per 100 PY 95% CI 1.03 to 2.47). In PsA patients, the lowest IR value was observed with IL-12/23i (0.29 per 100 PY 95% CI 0.00 to 1.03). There were 53.0 non-serious infections per 100 PY (95% CI 43.47 to 63.55) in 7257 PsA patients and 5638 axSpA patients. The IR was higher in RCTs (69.95 per 100 PY 95% CI 61.59 to 78.84) compared with observational studies (15.37 per 100 PY 95% CI 5.11 to 30.97). CONCLUSION Serious infections were rare events in RCTs and real-life studies. Non-serious infections were common adverse events, mainly in RCTs. PROSPERO REGISTRATION NUMBER CRD42020196711.
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Affiliation(s)
- Melanie Aureal
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Milene Seauve
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Soline Laplane
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medicine, Hospices Civils de Lyon, Lyon, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
| | - Natalia Cabrera
- University of Lyon, Laboratoire de Biométrie et Biologie Évolutive UMR - CNRS 5558, Lyon, France
| | - Fabienne Coury
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
- University of Lyon, INSERM UMR 1033, Lyon, France
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12
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Chouik Y, Lebossé F, Plissonnier ML, Lega JC, Pradat P, Antonini T, Subic M, Hartig-Lavie K, Erard D, Villeret F, Guichon C, Payancé A, Radenne S, Rautou PE, Zoulim F, Levrero M. Circulating microRNAs improve bacterial infection diagnosis and overall survival prediction in acute decompensation of liver cirrhosis. iScience 2023; 26:107427. [PMID: 37575179 PMCID: PMC10415934 DOI: 10.1016/j.isci.2023.107427] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/23/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Bacterial infections are the most frequent precipitating event in patients with acute decompensation of cirrhosis (AD) and are associated with high mortality. Early diagnosis is challenging due to cirrhosis-related systemic inflammation. Here we investigated the potential of circulating microRNAs to diagnose bacterial infections and predict survival in cirrhotic patients with AD. High throughput profiling of circulating microRNAs was performed using the Nanostring technology in 57 AD patients and 24 patients with compensated cirrhosis (CC). Circulating miRs profiling showed that: (a) miRs differentially detected in AD vs. CC were mostly down-regulated; (b) a composite score including absolute neutrophil count, C reactive protein and miR-362-3p could diagnose bacterial infection with an excellent performance (AUC of 0.825 [95% CI = 0.671-0.980; p < 0.001]); (c) a composite score including miR-382-5p, miR-592 and MELD-Na improved 6-month survival prediction. Circulating miRs are strongly dysregulated in patients with AD and may help to improve bacterial infection diagnosis and survival prediction.
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Affiliation(s)
- Yasmina Chouik
- Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- University of Lyon Claude Bernard 1 (UCLB1), Lyon, France
| | - Fanny Lebossé
- Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- University of Lyon Claude Bernard 1 (UCLB1), Lyon, France
| | | | - Jean-Christophe Lega
- Department of Internal Medicine, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Pierre Pradat
- Clinical Research Center, GHN, Hospices Civils de Lyon, Lyon, France
| | - Teresa Antonini
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Kerstin Hartig-Lavie
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Domitille Erard
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Villeret
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- University of Lyon Claude Bernard 1 (UCLB1), Lyon, France
| | - Céline Guichon
- Department of Anesthesiology and Intensive Care, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Audrey Payancé
- Université Paris-Cité, Inserm, Centre de recherche sur l’inflammation, UMR 1149, Paris, France
| | - Sylvie Radenne
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Emmanuel Rautou
- Université Paris-Cité, Inserm, Centre de recherche sur l’inflammation, UMR 1149, Paris, France
- Service d'Hépatologie, AP-HP, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - Fabien Zoulim
- Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- University of Lyon Claude Bernard 1 (UCLB1), Lyon, France
| | - Massimo Levrero
- Cancer Research Center of Lyon (CRCL), INSERM U1052, CNRS UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- University of Lyon Claude Bernard 1 (UCLB1), Lyon, France
- Department of Medicine SCIAC and the Italian Institute of Technology (IIT) Center for Life Nanosciences (CLNS), University of Rome La Sapienza, Rome, Italy
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13
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Mai V, Gosselin C, Tremblay É, Rompré G, Lajoie AC, Weatherald J, Lega JC, Bonnet S, Provencher S. Patients' perceptions on clinical trials outcomes in pulmonary arterial hypertension therapy. Thorax 2023; 78:721-725. [PMID: 37142420 DOI: 10.1136/thorax-2022-219490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/03/2023] [Indexed: 05/06/2023]
Abstract
The value placed by patients and their caregivers on the components of composite outcomes in pulmonary arterial hypertension (PAH) remains unknown. We surveyed the importance of these outcomes from a patients' and caregivers' perspective, with participants (n=335, including 257 patients with PAH) rating individual components defining clinical worsening in PAH trials as of critical, major, mild-to-moderate or minor importance. Most outcomes were considered of major or mild-to-moderate importance to patients. Death was the only outcome considered of critical importance. Perceptions of clinical outcomes varied between patients and caregivers. Integrating patients' perception in the elaboration of clinical trials is essential.
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Affiliation(s)
- Vicky Mai
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
- Pulmonary Hypertension Research Group (http://phrg.ca), Quebec, Quebec, Canada
| | - Camille Gosselin
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
- Pulmonary Hypertension Research Group (http://phrg.ca), Quebec, Quebec, Canada
| | - Élodie Tremblay
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
- Pulmonary Hypertension Research Group (http://phrg.ca), Quebec, Quebec, Canada
| | - Gabrielle Rompré
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
- Pulmonary Hypertension Research Group (http://phrg.ca), Quebec, Quebec, Canada
| | - Annie Christine Lajoie
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
- Pulmonary Hypertension Research Group (http://phrg.ca), Quebec, Quebec, Canada
| | - Jason Weatherald
- Department of Medicine, Division of Respiratory Medicine, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-Christophe Lega
- UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Université de Lyon, Lyon, France
- Department of Internal and Vascular Medicine, Hospices Civils de Lyon, Lyon, France
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, Lyon, France
| | - Sébastien Bonnet
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
- Pulmonary Hypertension Research Group (http://phrg.ca), Quebec, Quebec, Canada
- Department of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Steeve Provencher
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
- Pulmonary Hypertension Research Group (http://phrg.ca), Quebec, Quebec, Canada
- Department of Medicine, Université Laval, Quebec, Quebec, Canada
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Chaigne B, Bense A, Agard C, Allanore Y, Pugnet G, Hachulla E, Avouac J, Bienvenu B, Palat S, Grange C, Berthier S, Chatelus E, Rivière S, Truchetet ME, Kahn JE, Maurier F, Diot E, Berezne A, Mouthon L, Amoura Z, Aouba A, Smets P, Balquet MH, Baudet A, Bonnotte B, de Boysson H, Cazalets C, Cottin V, Couderc LJ, Dhote R, Fauchais AL, Goulenok T, Harle JR, Hot A, Imbert B, Lega JC, Lequellec A, Lidove O, Liozon E, Bertrand NM, Mékinian A, Pennaforte JL, Queyrel V, Wahl D. Mouth opening in systemic sclerosis: A longitudinal analysis from the French National Cohort Study. J Intern Med 2023. [PMID: 37376708 DOI: 10.1111/joim.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Few studies have evaluated mouth opening (MO) in systemic sclerosis (SSc). None have studied MO trajectories. OBJECTIVE To study MO trajectories in SSc. METHODS This multicentre study included patients enrolled in the French national SSc cohort with at least one MO assessment, described patients based on MO baseline measure, modeled MO trajectories, and associated MO measures with SSc prognosis. RESULTS We included 1101 patients. Baseline MO was associated with disease severity. On Kaplan-Meier analysis, MO < 30 mm was associated with worse 30-year-survival (p<0.01) and risk of pulmonary arterial hypertension (p<0.05). Individual MO trajectories were heterogenous among patients. The best model of MO trajectories according to latent-process mixed modeling showed that 88.8% patients had a stable MO trajectory and clustered patients into 3 groups that predicted SSc survival (p<0.05) and interstitial lung disease (ILD) occurrence (p<0.05). The model highlighted a cluster of 9.5% patients with diffuse cutaneous SSc (dcSSc) (p<0.05) and high but decreasing MO over 1 year (p<0.0001) who were at increased risk of poor survival and ILD. CONCLUSION MO, which is a simple and reliable measure, could be used to predict disease severity and survival in SSc. Although MO remained stable in most SSc patients, dcSSc patients with high but decreasing MO were at risk of poor survival and ILD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Ile de France, France
- APHP-CUP, Hôpital Cochin, F-75014 Paris, Université Paris Cité, France
| | - Alexandre Bense
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Ile de France, France
- APHP-CUP, Hôpital Cochin, F-75014 Paris, Université Paris Cité, France
| | - Christian Agard
- CHU Nantes, Service de Médecine interne, Nantes Université, Nantes, France
| | - Yannick Allanore
- Rheumatology Department, Cochin hospital, Paris Cité University, Paris, France
| | - Grégory Pugnet
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France
| | - Eric Hachulla
- Université de 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, France
| | - Jérôme Avouac
- Rheumatology Department, Cochin hospital, Paris Cité University, Paris, France
| | - Boris Bienvenu
- Service de Médecine Interne, Centre Hospitalier National Ophtalmologique des 15-20, Paris
| | | | - Claire Grange
- Department of Internal Medicine, Lyon Sud University Hospital, Lyon, France
| | - Sabine Berthier
- Department of internal medicine, University hospital of Dijon, Dijon, France
| | - Emmanuel Chatelus
- Rheumatology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Sébastien Rivière
- Service de Médecine Interne and Inflammation-Immunopathology, Biotherapy Department (DMU 3iD), Sorbonne Université, Hôpital Saint-Antoine, AP-HP, Paris, 75012, France
| | - Marie-Elise Truchetet
- Rheumatology Department, University Hospital of Bordeaux, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Sud-Ouest, Bordeaux, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Francois Maurier
- Department of Internal Medicine and Clinical Immunology, Hôpital Robert Schuman, Metz-Vantoux, 57070, France
| | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Alice Berezne
- Department of Internal Medicine and Infectious Diseases, CHR Annecy-Genevois Annecy France, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Ile de France, France
- APHP-CUP, Hôpital Cochin, F-75014 Paris, Université Paris Cité, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Imunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Perrine Smets
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Antoine Baudet
- Department of Internal Medicine and Infectious Diseases, CHR Annecy-Genevois Annecy France, France
| | - Bernard Bonnotte
- Department of internal medicine, University hospital of Dijon, Dijon, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Claire Cazalets
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Vincent Cottin
- Unité Mixte de Recherche 754: Infections Virales et Pathologie Comparée, Hospices Civils de Lyon, Université Lyon 1-Institut National de la Recherche Agronomique-Centre National de Référence des Maladies Pulmonaires Rares, Lyon, France
| | - Louis-Jean Couderc
- Respiratory Diseases Department, Foch Hospital, Suresnes, France; VIM Suresnes, UMR 0892 Paris-Saclay University, France
| | - Robin Dhote
- Service de Médecine Interne, AP-HP, Hôpital Avicenne, Bobigny, France
| | | | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Robert Harle
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne, Marseille, France
| | - Arnaud Hot
- Service de Médecine interne et Immunologie Clinique, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Bernard Imbert
- Département de médecine vasculaire, centre hospitalier universitaire Grenoble-Alpes, Grenoble, F-38000, France
| | - Jean-Christophe Lega
- Service de médecine interne et pathologies vasculaires, Groupe d'Etude Multidisciplinaires des Maladies Thrombotiques (GEMMAT), Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alain Lequellec
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | | | - Nadine Magy Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Arsène Mékinian
- Service de Médecine Interne and Inflammation-Immunopathology, Biotherapy Department (DMU 3iD), Sorbonne Université, Hôpital Saint-Antoine, AP-HP, Paris, 75012, France
| | - Jean-Loup Pennaforte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | | | - Denis Wahl
- Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Nancy, F-54000, France
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15
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Guillet S, Crickx E, Azzaoui I, Chappert P, Boutin E, Viallard JF, Rivière E, Gobert D, Galicier L, Malphettes M, Cheze S, Lefrere F, Audia S, Bonnotte B, Lambotte O, Noel N, Fain O, Moulis G, Hamidou M, Gerfaud-Valentin M, Marolleau JP, Terriou L, Martis N, Morin AS, Perlat A, Le Gallou T, Roy-Peaud F, Robbins A, Lega JC, Puyade M, Comont T, Limal N, Languille L, Zarrour A, Luka M, Menager M, Belmondo T, Hue S, Canoui-Poitrine F, Michel M, Godeau B, Mahévas M. Prolonged response after TPO-RA discontinuation in primary ITP: results of a prospective multicenter study. Blood 2023; 141:2867-2877. [PMID: 36893453 DOI: 10.1182/blood.2022018665] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/27/2022] [Revised: 01/30/2023] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
Sustained response off treatment (SROT) after thrombopoietin receptor agonist (TPO-RA) discontinuation has been reported in immune thrombocytopenia (ITP). This prospective multicenter interventional study enrolled adults with persistent or chronic primary ITP and complete response (CR) on TPO-RAs. The primary end point was the proportion of patients achieving SROT (platelet count >30 × 109/L and no bleeding) at week 24 (W24) with no other ITP-specific medications. Secondary end points included the proportion of sustained CR off-treatment (SCROT, platelet count >100 × 109/L and no bleeding) and SROT at W52, bleeding events, and pattern of response to a new course of TPO-RAs. We included 48 patients with a median age of 58.5 years; 30 of 48 had chronic ITP at TPO-RA initiation. In the intention-to-treat analysis, 27 of 48 achieved SROT, 15 of 48 achieved SCROT at W24; 25 of 48 achieved SROT, and 14 of 48 achieved SCROT at W52. No severe bleeding episode occurred in patients who relapsed. Among patients rechallenged with TPO-RA, 11 of 12 achieved CR. We found no significant clinical predictors of SROT at W24. Single-cell RNA sequencing revealed enrichment of a tumor necrosis factor α signaling via NF-κB signature in CD8+ T cells of patients with no sustained response after TPO-RA discontinuation, which was further confirmed by a significant overexpression of CD69 on CD8+ T cells at baseline in these patients as compared with those achieving SCROT/SROT. Our results strongly support a strategy based on progressive tapering and discontinuation of TPO-RAs for patients with chronic ITP who achieved a stable CR on treatment. This trial was registered at www.clinicaltrials.gov as #NCT03119974.
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Etienne Crickx
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM UMR U1163,Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Université de Paris Cité, Paris, France
| | - Imane Azzaoui
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pascal Chappert
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- INSERM, Institut Mondor de Recherche Biomédicale, Équipe Clinical Epidemiology and Ageing, UPEC, Créteil, France
| | - Jean-François Viallard
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Etienne Rivière
- Service de Médecine Interne, Haut-Lévêque Hôpital, Université de Bordeaux, Bordeaux, France
| | - Delphine Gobert
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Lionel Galicier
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Marion Malphettes
- Service d'Immunologie Clinique, Saint Louis Hôpital, AP-HP, Université de Paris Cité, Paris, France
| | - Stéphane Cheze
- Institut d'Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Bernard Bonnotte
- Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Olivier Lambotte
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Fain
- Service de Médecine Interne, Saint Antoine Hôpital, AP-HP, Sorbonne Université, Paris, France
| | - Guillaume Moulis
- Service de Médecine Interne, CHU de Toulouse, Toulouse, France
- CIC 1436, Équipe PEPSS, CHU de Toulouse, Toulouse, France
| | | | | | - Jean-Pierre Marolleau
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens-Picardie, Amiens, France
| | - Louis Terriou
- Service de Médecine Interne et d'Immunologie Clinique, CHU de Lille, Lille, France
| | - Nihal Martis
- Service de Médecine Interne et d'Immunologie Clinique, Hôpital de Nice, Nice, France
| | - Anne-Sophie Morin
- Service de Médecine Interne, Jean Verdier Hôpital, AP-HP, Bondy, France
| | - Antoinette Perlat
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Thomas Le Gallou
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France
| | - Frédérique Roy-Peaud
- Service de Médecine Interne-Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France
| | - Ailsa Robbins
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré Hospital, Reims University Hospitals, Reims, France
| | - Jean-Christophe Lega
- Service de Médecine Interne, Hospices Civils de Lyon, Lyon Sud Hôpital, Pierre-Bénite, France
| | - Matthieu Puyade
- Service de Médecine Interne, CHU de Poitiers, Poitiers, France
| | - Thibault Comont
- Service de Médecine Interne, CHU de Toulouse (IUCT-Oncopole), Toulouse, France
| | - Nicolas Limal
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laetitia Languille
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Anissa Zarrour
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Marine Luka
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Mickael Menager
- Université Paris Cité, Institut Imagine, Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, INSERM UMR 1163, F-75015 Paris, France
| | - Thibault Belmondo
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Sophie Hue
- Département Immunologie-Hématologie, Henri Mondor Hôpital, AP-HP, UPEC, Créteil, France
- UPEC, Faculté de Médecine, Créteil, France
- INSERM U955, Équipe 16, Institut Mondor de Recherche Biomédicale, UPEC, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (Mondor), AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
- Service de Santé Publique, AP-HP, Henri Mondor Hôpitaux Universitaires, Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Henri Mondor Hôpital, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U1151/CNRS UMS 8253, Institut Necker Enfants Malades, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est Créteil (UPEC), Créteil, France
- INSERM U955, Équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
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16
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Gombault C, Grenet G, Segurel L, Duret L, Gueyffier F, Cathébras P, Pontier D, Mainbourg S, Sanchez-Mazas A, Lega JC. Population designations in biomedical research: Limitations and perspectives. HLA 2023; 101:3-15. [PMID: 36258305 PMCID: PMC10099491 DOI: 10.1111/tan.14852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/13/2022]
Abstract
In biomedical research, population differences are of central interest. Variations in the frequency and severity of diseases and in treatment effects among human subpopulation groups are common in many medical conditions. Unfortunately, the practices in terms of subpopulation labeling do not exhibit the level of rigor one would expect in biomedical research, especially when studying multifactorial diseases such as cancer or atherosclerosis. The reporting of population differences in clinical research is characterized by large disparities in practices, and fraught with methodological issues and inconsistencies. The actual designations such as "Black" or "Asian" refer to broad and heterogeneous groups, with a great discrepancy among countries. Moreover, the use of obsolete concepts such as "Caucasian" is unfortunate and imprecise. The use of adequate labeling to reflect the scientific hypothesis needs to be promoted. Furthermore, the use of "race/ethnicity" as a unique cause of human heterogeneity may distract from investigating other factors related to a medical condition, particularly if this label is employed as a proxy for cultural habits, diet, or environmental exposure. In addition, the wide range of opinions among researchers does not facilitate the attempts made for resolving this heterogeneity in labeling. "Race," "ethnicity," "ancestry," "geographical origin," and other similar concepts are saturated with meanings. Even if the feasibility of a global consensus on labeling seems difficult, geneticists, sociologists, anthropologists, and ethicists should help develop policies and practices for the biomedical field.
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Affiliation(s)
- Caroline Gombault
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Guillaume Grenet
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Pole de Santé Publique, Hospices Civils de Lyon, Service Hospitalo-Universitaire de PharmacoToxicologie, Lyon, France
| | - Laure Segurel
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Laurent Duret
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - François Gueyffier
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Pôle de Santé Publique, Hospices Civils De Lyon, Lyon, France
| | - Pascal Cathébras
- Service de Médecine Interne, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Dominique Pontier
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Sabine Mainbourg
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils De Lyon, Lyon, France
| | - Alicia Sanchez-Mazas
- Laboratory of Anthropology, Genetics and Peopling history, Department of Genetics and Evolution, University of Geneva, Geneva, Switzerland
| | - Jean-Christophe Lega
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils De Lyon, Lyon, France
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17
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Marilly E, Cottin J, Cabrera N, Cornu C, Boussageon R, Moulin P, Lega JC, Gueyffier F, Cucherat M, Grenet G. SGLT2 inhibitors in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials balancing their risks and benefits. Diabetologia 2022; 65:2000-2010. [PMID: 35925319 DOI: 10.1007/s00125-022-05773-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 12/14/2021] [Accepted: 06/01/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Cardiovascular outcome trials (CVOTs) have demonstrated the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i). However, serious adverse drug reactions have been reported. The risk/benefit ratio of SGLT2i remains unquantified. We aimed to provide an estimation of their risk/benefit ratio in individuals with type 2 diabetes. METHODS We conducted a systematic review (MEDLINE, up to 14 September 2021) and meta-analysis. We included randomised CVOTs assessing SGLT2i in individuals with type 2 diabetes with or without other diseases. We used the Cochrane 'Risk of bias' assessment tool. The primary outcomes were overall mortality, major adverse cardiovascular events (MACE), hospitalisation for heart failure (HHF), end-stage renal disease (ESRD), amputation, diabetic ketoacidosis (DKA) and reported genital infections. For each outcome, we estimated the incidence rate ratio (IRR) with a 95% CI; we then computed the number of events expected spontaneously and with SGLT2i. RESULTS A total of 46,969 participants from five double-blind, placebo-controlled international trials (weighted mean follow-up 3.5 years) were included. The prevalence of previous CVD ranged from 40.6% to 99.2%. The definition of reported genital infections ranged from 'genital mycotic infection' to 'genital infections that led to discontinuation of the trial regimen or were considered to be serious adverse events'. The number of included studies for each outcomes was five. The use of SGLT2i decreased the risk of all-cause death (IRR 0.86 [95% CI 0.78, 0.95]), MACE (IRR 0.91 [95% CI 0.86, 0.96]), HHF (IRR 0.69 [95% CI 0.62, 0.76]) and ESRD (IRR 0.67 [95% CI 0.53, 0.84]), and increased the risk of DKA (IRR 2.59 [95% CI 1.57, 4.27]) and genital infection (IRR 3.50 [95% CI 3.09, 3.95]) but not of amputation (IRR 1.23 [95% CI 1.00, 1.51]). For 1000 individuals treated over 3.5 years, SGLT2i are expected, on average, to decrease the number of deaths from 70 to 61, to prevent nine MACE, 11 HHF and two cases of ESRD, while inducing two DKA occurrences and 36 genital infections; 778 individuals are expected to avoid all the following outcomes: MACE, HHF, ESRD, amputation, DKA and genital infection. CONCLUSIONS/INTERPRETATION Our study is limited to aggregate data. In a population of individuals with type 2 diabetes and a high CVD risk, the cardiovascular and renal benefits of SGLT2i remain substantial despite the risk of DKA and even the hypothetical risk of amputation. TRIAL REGISTRATION OSF Registries: https://doi.org/10.17605/OSF.IO/J3R7Y FUNDING: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
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Affiliation(s)
- Elisa Marilly
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Judith Cottin
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Natalia Cabrera
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | | | - Remy Boussageon
- Département de Médecine Générale, Université de Lyon, Lyon, France
| | - Philippe Moulin
- Fédération d'endocrinologie, Maladies Métaboliques, Diabète et Nutrition, Inserm UMR 1060 CARMEN Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Jean-Christophe Lega
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - François Gueyffier
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Michel Cucherat
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Guillaume Grenet
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.
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18
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Moyon Q, Pineton de Chambrun M, Gousseff M, Mathian A, Hie M, Urbanski G, Verlicchi F, Faguer S, Dossier A, Lega JC, Riviere S, Saadoun D, Graveleau J, Lucchini-Lecomte MJ, Christides C, Le Moal S, Bibes B, Malizia G, Ruivard M, Blaison G, Alric L, Agard C, Soubrier M, Viallard JF, Levesque H, Rivard GE, Tieulie N, Hot A, Lovey PY, Hanslik T, Lhote F, Eble V, Álvarez Troncoso J, Aujayeb A, Quentric P, Taieb D, Cohen-Aubart F, Lambert M, Amoura Z. Intravenous Immunoglobulins Tapering and Withdrawal in Systemic Capillary Leak Syndrome (Clarkson Disease). J Allergy Clin Immunol Pract 2022; 10:2889-2895. [PMID: 35870726 DOI: 10.1016/j.jaip.2022.07.006] [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] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The systemic capillary leak syndrome (SCLS), also known as Clarkson disease, is a very rare condition characterized by recurrent life-threatening episodes of vascular hyperpermeability in the presence of a monoclonal gammopathy. Extended intravenous immunoglobulin (IVIG) treatment is associated with fewer recurrences and improved survival, but the optimal treatment dosage and duration remain unknown. OBJECTIVE We aim to evaluate the safety of IVIG tapering and withdrawal in patients with SCLS. METHODS We conducted a retrospective multicenter study including all adult patients with monoclonal gammopathy-associated SCLS from the EurêClark registry who received at least 1 course of IVIG. The primary end point was overall survival according to IVIG withdrawal. RESULTS Fifty-nine patients of mean ± SD age 51 ± 13 years were included. Overall cumulative probabilities of 2-, 5-, 10- and 15-year survival were 100%, 85%, 72%, 44%, respectively. The IVIG was withdrawn at least once in 18 patients (31%; W+ group) and never in 41 patients (69%; W- group). Cumulative probabilities of 10-year survival in W+ versus W- groups were 50% and 83% (log rank test, P = .02), respectively. Relapse rate and the median number of relapses in the W+ versus the W- groups were 72% versus 58% (P = 0.3) and 2.5 (0.3-4) versus 1 (0-2) (P = .03), respectively. The IVIG tapering was not statistically associated with increased person-year incidence of attacks using a mixed linear model. CONCLUSIONS The IVIG withdrawal was associated with increased mortality and higher rate of recurrence in SCLS patients. The IVIG tapering might be cautiously considered in stable SCLS patients.
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Affiliation(s)
- Quentin Moyon
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France.
| | - Marie Gousseff
- Service de médecine interne, Centre Hospitalier (CH) Bretagne Atlantique, Vannes, France
| | - Alexis Mathian
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Miguel Hie
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d'Immunologie Clinique, Centre Hospitalier Universitaire (CHU) d'Angers, Angers, France
| | | | - Stanislas Faguer
- Département de Néphrologie Et Transplantation D'organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, équipe 12), CHU de Toulouse, Toulouse, France
| | - Antoine Dossier
- Service de médecine interne, CHU Bichat, APHP, Paris, France
| | - Jean-Christophe Lega
- Service de médecine interne et pathologies vasculaires, CHU Lyon Sud, Pierre-Bénite, Lyon; Univ Lyon 1, UMR CNRS 5558 Laboratoire de Biologie et Biométrie Evolutive
| | - Sophie Riviere
- Service de médecine interne, Hôpital S(t)-Eloi, CHRU, Montpellier, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology- Immunopathology-Immunotherapy (I3), Paris, France
| | | | | | | | | | | | | | - Marc Ruivard
- Service de médecine interne, Hôpital d'Estaing, CHU de Clermont-Ferrand, France
| | - Gilles Blaison
- Service de médecine interne, Hôpital Pasteur, Colmar, France
| | - Laurent Alric
- Service de médecine interne, Pôle digestif, CHU Rangueil, Toulouse 3 University, Toulouse, France
| | - Christian Agard
- Nantes Université, CHU Nantes, service de médecine interne, F-44000 Nantes, France
| | - Martin Soubrier
- Service de rhumatologie, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, France
| | | | - Hervé Levesque
- Service de médecine interne, Normandie Université, UNIROUEN, 76031 Rouen, France
| | | | | | - Arnaud Hot
- Service de médecine interne, CHU Edouard Herriot, Lyon, France
| | | | - Thomas Hanslik
- Université Versailles Saint Quentin, APHP, CHU Ambroise Paré, Service de médecine interne, Boulogne-Billancourt, France
| | - François Lhote
- Service de médecine interne, Hôpital Delafontaine, Saint-Denis, France
| | | | - Jorge Álvarez Troncoso
- Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario La Paz, Madrid, Spain
| | - Avinash Aujayeb
- Northumbria Specialist Emergency Care Hospital, Newcastle, UK
| | - Paul Quentric
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Dov Taieb
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Marc Lambert
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France; Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France
| | - Zahir Amoura
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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19
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Douplat M, Gavoille A, Subtil F, Haesebaert J, Jacquin L, Durand G, Lega JC, Perpoint T, Potinet V, Berthiller J, Perreton N, Tazarourte K. Management and Outcome of COVID-19 Positive and Negative Patients in French Emergency Departments During the First COVID-19 Outbreak: A Prospective Controlled Cohort Study. West J Emerg Med 2022; 23:897-906. [DOI: 10.5811/westjem.2022.7.57135] [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] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
ntroduction: Few studies have investigated the management of COVID-19 cases from the operational perspective of the emergency department (ED), We sought to compare the management and outcome of COVID-19 positive and negative patients who presented to French EDs.
Methods: We conducted a prospective, multicenter, observational study in four EDs. Included in the study were adult patients (≥18 years) between March 6–May 10, 2020, were hospitalized, and whose presenting symptoms were evocative of COVID-19. We compared the clinical features, management, and prognosis of patients according to their confirmed COVID-19 status.
Results: Of the 2,686 patients included in this study, 760 (28.3%) were COVID-19 positive. Among them, 364 (48.0%) had hypertension, 228 (30.0%) had chronic cardiac disease, 186 (24.5%) had diabetes, 126 (16.6%) were obese, and 114 (15.0%) had chronic respiratory disease. The proportion of patients admitted to intensive care units (ICU) was higher among COVID-19 positive patients (185/760, 24.3%) compared to COVID-19 negative patients (206/1,926, 10.7%; P <0.001), and they required mechanical ventilation (89, 11.9% vs 37, 1.9%; P <0.001) and high-flow nasal cannula oxygen therapy (135, 18.1% vs 41, 2.2%; P < 0.001) more frequently. The in-hospital mortality was significantly higher among COVID-19 positive patients (139, 18.3% vs 149, 7.7%; P <0.001).
Conclusion: Emergency departments were on the frontline during the COVID-19 pandemic and had to manage potential COVID-19 patients. Understanding what happened in the ED during this first outbreak is crucial to underline the importance of flexible organizations that can quickly adapt the bed capacities to the incoming flow of COVID-19 positive patients.
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Affiliation(s)
- Marion Douplat
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Lyon Sud Hospital, Department of Emergency Medicine, Pierre Bénite, France
| | - Antoine Gavoille
- Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon France
| | - Fabien Subtil
- Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Emergency Medicine, Lyon, France
| | - Guillaume Durand
- Villefranche Hospital, Department of Emergency Medicine, Gleize, France
| | - Jean-Christophe Lega
- Hospices Civils de Lyon, Lyon Sud Hospital, Department of Internal and Vascular Medicine, Pierre Bénite, France
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hôpital Croix-Rousse Hospices Civils de Lyon, Lyon, France
| | - Veronique Potinet
- Hospices Civils de Lyon, Lyon Sud Hospital, Department of Emergency Medicine, Pierre Bénite, France
| | - Julien Berthiller
- Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Nathalie Perreton
- Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Karim Tazarourte
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Emergency Medicine, Lyon, France
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20
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Auroux M, Laurent B, Coste B, Massy E, Mercier A, Durieu I, Confavreux CB, Lega JC, Mainbourg S, Coury F. Réponse sérologique après vaccination contre le coronavirus chez les patients atteints de rhumatisme inflammatoire chronique traités par DMARDs : étude de cohorte et revue systématique avec méta-analyse. Revue du Rhumatisme 2022; 89:435-446. [PMID: 35821910 PMCID: PMC9262649 DOI: 10.1016/j.rhum.2022.07.002] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
Introduction La vaccination contre le coronavirus constitue l’une des pierres angulaires dans la gestion de la crise sanitaire liée au COVID-19. Alors que la vaccination confère une protection efficace chez les sujets immunocompétents, son immunogénicité dans la population atteinte de rhumatisme inflammatoire chronique (RIC) n’est pas clairement établie. Méthodes Nous avons conduit une étude monocentrique rétrospective évaluant la réponse sérologique après deux doses de vaccination contre le coronavirus chez des patients adultes atteints de RIC et traités par traitements ciblés ou biologiques (n = 123). Les titres d’anticorps IgG dirigés contre la protéine spike du coronavirus (SARS-CoV-2) ont été mesurés après la seconde dose de vaccin. De plus, nous avons conduit une recherche systématique jusqu’au 31 septembre 2021 dans les bases de données PUBMED, preprint et littérature grise non encore publiée des études observationnelles des taux sérologiques après vaccination chez des patients atteints de RIC traités par médicaments ciblés ou biologiques (numéro d’enregistrement PROSPERO : CRD42021259410). Les études rapportant la taille d’échantillon, la date, le pays d’origine, le taux de séroconversion ont été incluses. Nous avons ensuite conduit une méta-analyse afin d’identifier des facteurs associés à la séroconversion. Résultats Sur nos 123 patients (âge médian 66 ans écart interquartile (EI) 57–75), 69,9 % ont séroconverti après 2 doses de vaccination. Les patients ayant eu une séroconversion étaient plus âgés que ceux qui n’en ont pas eu. Les patients traités par rituximab sont ceux qui ont le moins répondu à la vaccination. Nous avons identifié 20 études de séroprévalence en plus de notre cohorte, représentant un total de 4423 patients dans 11 pays. La méta-analyse a confirmé un impact négatif sur le taux de séroconversion du rituximab et dans une moindre mesure de l’abatacept, du léflunomide et du méthotrexate. Conclusion Le rituximab diminue la réponse sérologique à la vaccination contre le SARS-Cov2 chez les patients atteints de RIC. Ce travail suggère également un impact négatif de l’abatacept, du méthotrexate ou du léflunomide particulièrement en cas d’association à un médicament biologique.
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21
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Tremblay É, Gosselin C, Mai V, Lajoie AC, Kilo R, Weatherald J, Lacasse Y, Bonnet S, Lega JC, Provencher S. Assessment of Clinical Worsening End Points as a Surrogate for Mortality in Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circulation 2022; 146:597-612. [PMID: 35862151 DOI: 10.1161/circulationaha.121.058635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical worsening (CW) is a composite end point commonly used in pulmonary arterial hypertension (PAH) trials. We aimed to assess the trial-level surrogacy of CW for mortality in PAH trials, and whether the various CW components were similar in terms of frequency of occurrence, treatment-related relative risk (RR) reduction, and importance to patients. METHODS We searched MEDLINE, Embase, and the Cochrane Library (January 1990 to December 2020) for trials evaluating the effects of PAH therapies on CW. The coefficient of determination between the RR for CW and mortality was assessed by regression analysis. The frequency of occurrence, RR reduction, and importance to patients of the CW components were assessed. RESULTS We included 35 independent cohorts (9450 patients). PAH therapies significantly reduced CW events (RR, 0.64 [95% CI, 0.55-0.73]), including PAH-related hospitalizations (RR, 0.61 [95% CI, 0.47-0.79]), treatment escalation (RR, 0.57 [95% CI, 0.38-0.84]) and symptomatic progression (RR, 0.58 [95% CI, 0.48-0.69]), and modestly reduced all-cause mortality when incorporating deaths occurring after a primary CW-defining event (RR, 0.860 [95% CI, 0.742-0.997]). However, the effects of PAH-specific therapies on CW only modestly correlated with their effects on mortality (R2trial, 0.35 [95% CI, 0.10-0.59]; P<0.0001), and the gradient in the treatment effect across component end points was large in the majority of trials. The weighted proportions of CW-defining events were hospitalization (33.5%) and symptomatic progression (32.3%), whereas death (6.7%), treatment escalation (5.6%), and transplantation/atrioseptostomy (0.2%) were infrequent. CW events were driven by the occurrence of events of major (49%) and mild-to-moderate (37%) importance to patients, with 14% of the events valued as critical. CONCLUSIONS PAH therapies significantly reduced CW events, but study-level CW is not a surrogate for mortality in PAH trials. Moreover, components of CW largely vary in frequency, response to therapy, and importance to patients and are thus not interchangeable. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42020178949.
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Affiliation(s)
- Élodie Tremblay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center (E.T., C.G., V.M., A.C.L., Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group Quebec City, Canada (E.T., C.G., V.M., A.C.L., S.B., S.P.)
| | - Camille Gosselin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center (E.T., C.G., V.M., A.C.L., Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group Quebec City, Canada (E.T., C.G., V.M., A.C.L., S.B., S.P.)
| | - Vicky Mai
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center (E.T., C.G., V.M., A.C.L., Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group Quebec City, Canada (E.T., C.G., V.M., A.C.L., S.B., S.P.)
| | - Annie C Lajoie
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center (E.T., C.G., V.M., A.C.L., Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group Quebec City, Canada (E.T., C.G., V.M., A.C.L., S.B., S.P.)
| | - Roubi Kilo
- Pôle De Santé Publique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69310, Pierre-Bénite, France (R.K.)
| | - Jason Weatherald
- Department of Medicine, Division of Respiratory Medicine, Libin Cardiovascular Institute, University of Calgary, Canada (J.W.)
| | - Yves Lacasse
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center (E.T., C.G., V.M., A.C.L., Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Department of Medicine (Y.L., S.B., S.P.), Université Laval, Quebec City, Canada
| | - Sebastien Bonnet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center (E.T., C.G., V.M., A.C.L., Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Department of Medicine (Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group Quebec City, Canada (E.T., C.G., V.M., A.C.L., S.B., S.P.)
| | - Jean-Christophe Lega
- Université de Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Centre national de la recherche scientifique, F-69100, Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques, Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69310, Lyon, France (J.-C.L.)
| | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center (E.T., C.G., V.M., A.C.L., Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Department of Medicine (Y.L., S.B., S.P.), Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group Quebec City, Canada (E.T., C.G., V.M., A.C.L., S.B., S.P.)
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22
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Roubertou Y, Mainbourg S, Hot A, Fouque D, Confavreux C, Chapurlat R, Debarbieux S, Jullien D, Sève P, Juillard L, Kolopp-Sarda MN, Lega JC. Cryoglobulinemia in systemic lupus erythematosus: a retrospective study of 213 patients. Arthritis Res Ther 2022; 24:167. [PMID: 35836280 PMCID: PMC9281087 DOI: 10.1186/s13075-022-02857-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The clinical value of cryoglobulinemia (CG) in systemic lupus erythematosus (SLE) is largely unknown. The aim of this retrospective study was to describe the characteristics of CG in SLE, its impact on SLE phenotype, and the features associated with cryoglobulinemic vasculitis (CryoVas) in SLE patients. Methods This retrospective study conducted in a French university hospital reviewed the data from 213 SLE patients having been screened for CG between January 2013 and December 2017. SLE patients positive for CG were compared to SLE patients without CG. Patients were classified as CryoVas using the criteria of De Vita et al. Results Of the 213 SLE patients included (mean age 29.2 years, female sex 85%), 142 (66%) had at least one positive CG in their history, 67% of them having a persistent CG at follow-up. CG was type III in 114 (80%) cases and type II in 27 (19%) cases. The mean concentration of the cryoprecipitate was 40mg/L (range 0-228). Patients with CG had significantly more C4 consumption. Among patients with CG, 21 (15%) developed a CryoVas. The clinical manifestations of patients with CryoVas were mainly cutaneous (purpura, ulcers, digital ischemia) and articular, without any death at follow-up. Severe manifestations of CG included glomerulonephritis in 1/21 (5%) patients and central nervous system involvement in 4/21 (19%) patients. A response to first-line treatments was observed in 12/13 (92%) patients, but relapses were observed for 3 of them. Conclusion CG is frequent in SLE, but mostly asymptomatic. CryoVas features involve mostly joints, skin, and general symptoms. CryoVas in SLE appears to be a specific condition, with a low prevalence of neuropathy, membranoproliferative glomerulonephritis, and severe manifestations. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02857-z. • Cryoglobulinemia is frequent in SLE, but mostly asymptomatic. • Sixty-six percent of SLE patients tested positive for cryoglobulins, and 15% of the SLE patients with cryoglobulinemia developed a cryoglobulinemic vasculitis. • Features of the cryoglobulinemic vasculitis mainly involved skin, joints, and general signs. Severe manifestations of vasculitis were rare.
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Affiliation(s)
- Yoann Roubertou
- Hospices Civils de Lyon, Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Lyon, France.,Université Lyon I, Lyon, France
| | - Sabine Mainbourg
- Hospices Civils de Lyon, Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Lyon, France.,Hospices Civils de Lyon, Lyon Immunopathology Federation, Université Lyon I, Lyon, France.,UMR 5558, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Université Lyon I, Lyon, France
| | - Arnaud Hot
- Université Lyon I, Lyon, France.,Department of Internal Medicine, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Denis Fouque
- Université Lyon I, Lyon, France.,Department of Nephrology, INSERM U1060 CarMeN, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Université Lyon I, Lyon, France
| | - Cyrille Confavreux
- Université Lyon I, Lyon, France.,Department of Rheumatology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Roland Chapurlat
- Université Lyon I, Lyon, France.,Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Sébastien Debarbieux
- Université Lyon I, Lyon, France.,Department of Dermatology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Denis Jullien
- Université Lyon I, Lyon, France.,Department of Dermatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Pascal Sève
- Université Lyon I, Lyon, France.,Hospices Civils de Lyon, Lyon Immunopathology Federation, Université Lyon I, Lyon, France.,Department of Internal Medicine, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - Laurent Juillard
- Université Lyon I, Lyon, France.,Department of Nephrology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Marie-Nathalie Kolopp-Sarda
- Université Lyon I, Lyon, France.,Hospices Civils de Lyon, Lyon Immunopathology Federation, Université Lyon I, Lyon, France.,Immunology Laboratory, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Jean-Christophe Lega
- Hospices Civils de Lyon, Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Lyon, France. .,Hospices Civils de Lyon, Lyon Immunopathology Federation, Université Lyon I, Lyon, France. .,UMR 5558, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Université Lyon I, Lyon, France.
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23
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Rossignol J, Ouedrani A, Livideanu CB, Barete S, Terriou L, Launay D, Lemal R, Greco C, Frenzel L, Meni C, Bodemere-Skandalis C, Polivka L, Collange AF, Hachichi H, Bouzourine S, Messaoud DN, Negretto M, Vendrame L, Jambou M, Gousseff M, Durupt S, Lega JC, Durand JM, Gaudy C, Damaj G, Gourin MP, Hamidou M, Bouillet L, Le Mouel E, Maria A, Zunic P, Cabrera Q, Vincent D, Lavigne C, Riviere E, Gourguechon C, Courbebaisse M, Lebeaux D, Parfait B, Friedlander G, Brignier A, Lhermitte L, Molina TJ, Bruneau J, Agopian J, Dubreuil P, Ranta D, Mania A, Arock M, Staropoli I, Tournilhac O, Lortholary O, Schwartz O, Chatenoud L, Hermine O. Effective Anti-SARS-CoV-2 Immune Response in Patients With Clonal Mast Cell Disorders. J Allergy Clin Immunol Pract 2022; 10:1356-1364.e2. [PMID: 35074600 PMCID: PMC8780123 DOI: 10.1016/j.jaip.2021.12.038] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/05/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mast cells are key players in innate immunity and the TH2 adaptive immune response. The latter counterbalances the TH1 response, which is critical for antiviral immunity. Clonal mast cell activation disorders (cMCADs, such as mastocytosis and clonal mast cell activation syndrome) are characterized by abnormal mast cell accumulation and/or activation. No data on the antiviral immune response in patients with MCADs have been published. OBJECTIVE To study a comprehensive range of outcomes in patients with cMCAD with PCR- or serologically confirmed coronavirus disease 2019 and to characterize the specific anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune response in this setting. METHODS Clinical follow-up and outcome data were collected prospectively over a 12-month period by members of the French Centre de Référence des Mastocytoses rare disease network. Anti-SARS-CoV-2-specific T-cell activity was measured with an ELISA, and humoral responses were evaluated by assaying circulating levels of specific IgG, IgA, and neutralizing antibodies. RESULTS Overall, 32 patients with cMCAD were evaluated. None required noninvasive or mechanical ventilation. Two patients were admitted to hospital for oxygen and steroid therapy. The SARS-CoV-2-specific immune response was characterized in 21 of the 32 patients. Most had high counts of circulating SARS-CoV-2-specific, IFN-γ-producing T cells and high titers of neutralizing antispike IgGs. The patients frequently showed spontaneous T-cell IFN-γ production in the absence of stimulation; this production was correlated with basal circulating tryptase levels (a marker of the mast cell burden). CONCLUSIONS Patients with cMCADs might not be at risk of severe coronavirus disease 2019, perhaps due to their spontaneous production of IFN-γ.
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Affiliation(s)
- Julien Rossignol
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Amani Ouedrani
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France; Laboratory of Immunoregulation and Immunopathology, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Cristina Bulai Livideanu
- French Reference Center for Mastocytosis (CEREMAST), Department of Dermatology, Hôpital Larrey, Toulouse University Hospital, Toulouse, France
| | - Stéphane Barete
- French Reference Center for Mastocytosis (CEREMAST), Department of Dermatology, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Louis Terriou
- University Lille, INSERM, CHU Lille, Department of Internal Medicine and Clinical Immunology, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - David Launay
- University Lille, INSERM, CHU Lille, Department of Internal Medicine and Clinical Immunology, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Richard Lemal
- Adult Clinical Hematology, Clermont-Ferrand University Hospital, INSERM CIC501, EA 7453-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Celine Greco
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Laurent Frenzel
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Cecile Meni
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Christine Bodemere-Skandalis
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Laura Polivka
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Anne-Florence Collange
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Hassiba Hachichi
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Sonia Bouzourine
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Djazira Nait Messaoud
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Mathilde Negretto
- French Reference Center for Mastocytosis (CEREMAST), Department of Dermatology, Hôpital Larrey, Toulouse University Hospital, Toulouse, France
| | - Laurence Vendrame
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France
| | - Marguerite Jambou
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France
| | - Marie Gousseff
- Department of Internal Medicine, Bretagne Atlantique Hospital, Vannes, France
| | - Stéphane Durupt
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Lega
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France
| | - Jean-Marc Durand
- Department of Internal Medicine, Aix-Marseille University, Timone University Hospital, Marseille, France
| | - Caroline Gaudy
- Department of Internal Medicine, Aix-Marseille University, Timone University Hospital, Marseille, France
| | - Gandhi Damaj
- Haematology Institute, Normandy University School of Medicine, Caen, France
| | | | - Mohamed Hamidou
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Laurence Bouillet
- Clinical Immunology/Internal Medicine Department, National Reference Center for Angioedema, Grenoble University Hospital, Grenoble, France
| | - Edwige Le Mouel
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Alexandre Maria
- Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
| | - Patricia Zunic
- Department of Haematology, Sud Réunion University Hospital, Saint Pierre, La Réunion, France
| | - Quentin Cabrera
- Department of Haematology, Sud Réunion University Hospital, Saint Pierre, La Réunion, France
| | - Denis Vincent
- Department of Pneumology and Internal Medicine, Caremeau University Hospital, Nimes, France
| | - Christian Lavigne
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - Etienne Riviere
- Department of Internal Medicine, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | | | - Marie Courbebaisse
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France; Department of Physiology-Functional Renal Explorations, Hôpital Européen Georges Pompidou University Hospital, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France; Université de Paris, Paris, France
| | - Béatrice Parfait
- Centre de Ressources Biologiques, Hôpital Cochin, Paris, France; Paris University, Institut Cochin INSERM UMR1016, Paris, France
| | - Gérard Friedlander
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France
| | - Anne Brignier
- Therapeutic Apheresis Unit, Saint-Louis University Hospital, APHP, Paris, France
| | - Ludovic Lhermitte
- Laboratory of Onco-Hematology, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Thierry Jo Molina
- Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France; Pathology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Julie Bruneau
- Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France; Pathology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Julie Agopian
- CRCM, [Signaling, Hematopoiesis and Mechanism of Oncogenesis, CEREMAST, AFIRMM], INSERM U1068, Marseille, France; Institut Paoli-Calmettes, Marseille, France; Aix-Marseille Univ, UM105, Marseille, France; CNRS, UMR7258, Marseille, France
| | - Patrice Dubreuil
- CRCM, [Signaling, Hematopoiesis and Mechanism of Oncogenesis, CEREMAST, AFIRMM], INSERM U1068, Marseille, France; Institut Paoli-Calmettes, Marseille, France; Aix-Marseille Univ, UM105, Marseille, France; CNRS, UMR7258, Marseille, France
| | - Dana Ranta
- Department of Haematology, Nancy University Hospital, Nancy, France
| | - Alexandre Mania
- Adult Clinical Hematology, Clermont-Ferrand University Hospital, INSERM CIC501, EA 7453-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Michel Arock
- Laboratory of Haematology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Isabelle Staropoli
- Virus & Immunity Unit, Department of Virology, Institut Pasteur, CNRS UMR3569, Paris, France
| | - Olivier Tournilhac
- Adult Clinical Hematology, Clermont-Ferrand University Hospital, INSERM CIC501, EA 7453-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Olivier Lortholary
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Olivier Schwartz
- Virus & Immunity Unit, Department of Virology, Institut Pasteur, CNRS UMR3569, Paris, France
| | - Lucienne Chatenoud
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France; Laboratory of Immunoregulation and Immunopathology, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Olivier Hermine
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France.
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24
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Pineton de Chambrun M, Moyon Q, Faguer S, Urbanski G, Mathian A, Zucman N, Werner M, Luyt CE, Verlicchi F, Amoura Z, Gousseff M, Mauhin W, Hot A, Lega JC, Lambert M, Riviere S, Dossier A, Ruivard M, Lhote F, Blaison G, Merceron S, Zapella N, Alric L, Agard C, Lacout M, Saadoun D, Graveleau J, Soubrier M, Haroche J, Boileau J, Lucchini-Lecomte MJ, Hanslik T, Christides C, Levesque H, Talasczka A, Bulte C, Hachulla E, Decaux O, Sonneville R, Ibouanga F, Arnulf B, Benedit M, Viallard JF, Tieulie N, Haddad F, Moulin B, Cohen-Aubert F, Lovey PY, le Moal S, Bibes B, Rivard GE, Rondeau E, Malizia G, Debourdeau P, Abgueguen P, Bosseray A, Devaquet J, Presne C, Liferman F, Limal N, Argaud L, Hernu R, de la Salle S, Faguer S, Urbanski G, Zucman N, Werner M, Luyt CE, Moyon Q, Verlicchi F, Troncoso JÁ, Harty J, Godmer P, Hie M, Papo T, Hatron PY, Mathian A, Amoura Z. The consequences of COVID-19 pandemic on patients with monoclonal gammopathy-associated systemic capillary leak syndrome (Clarkson disease). J Allergy Clin Immunol Pract 2022; 10:626-629. [PMID: 34890829 PMCID: PMC8648572 DOI: 10.1016/j.jaip.2021.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France,Corresponding author: Marc Pineton de Chambrun, MD, MSc, Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris Cedex 13, France
| | - Quentin Moyon
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, Équipe 12), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d’Immunologie Clinique, Centre Hospitalier Universitaire, Angers, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Noémie Zucman
- Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, APHP, DMU ESPRIT, Université de Paris, Colombes, France
| | - Marie Werner
- Service de Réanimation Chirurgicale Adulte, AP-HP, Hôpital Bicêtre, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
| | | | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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25
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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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Béra S, Jamilloux Y, Gerfaud-Valentin M, Durupt S, Nove-Josserand R, Lega JC, Durieu I, Hot A, Sève P. Inflammation of Unknown Origin: Evaluation and Prognosis of 57 Cases. J Clin Med 2021; 11:jcm11010032. [PMID: 35011773 PMCID: PMC8745449 DOI: 10.3390/jcm11010032] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Background: there are few studies on the inflammation of unknown origin (IUO). We sought to determine the etiologies and prognosis of IUO, as well as the contribution of complementary examinations. (2) Methods: this retrospective study analyzed patients meeting the Vanderschueren’s criteria in the Hospices Civils de Lyon from 2005 to 2020. (3) Results: a total of 57 patients (mean age: 67 years; interquartile range: 55–79) were included. Final diagnoses were made for 26 (46%) patients. Non-infectious inflammatory diseases were the most common diagnoses (13/26, 50%), followed by neoplasms (10/26, 38%; 8/10 hematological malignancies), infections (2/26, 8%), and miscellaneous causes (1/26, 4%). Moreover, 18-FDG-PET/CT was contributory in 12/42 cases. Anti-neutrophil cytoplasmic antibodies, serology, temporal biopsies, and bone marrow aspirates were contributory in 3/41, 1/57, 5/23, and 3/19 cases, respectively. At last follow-up (mean follow-up duration: 48 months), 8/31 undiagnosed patients were cured (five received an empirical treatment), and 5/31 died (one death was related to the empirical treatment). (4) Conclusion: more than half of the IUO remained undiagnosed. Non-infectious inflammatory diseases and hematological malignancies were the most common etiologies. Moreover, 18-FDG-PET/CT had the highest diagnostic value. Most IUO without final diagnosis persisted. The role of empirical treatments remains to be explored.
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Affiliation(s)
- Suzanne Béra
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (S.B.); (Y.J.); (M.G.-V.)
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (S.B.); (Y.J.); (M.G.-V.)
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
- Lyon Immunology Federation (LIFE), 69000 Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (S.B.); (Y.J.); (M.G.-V.)
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
| | - Stéphane Durupt
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
- Department of Internal Medicine, Hôpital Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Raphaèle Nove-Josserand
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
- Department of Internal Medicine, Hôpital Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Jean-Christophe Lega
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
- Department of Internal Medicine, Hôpital Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Isabelle Durieu
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
- Department of Internal Medicine, Hôpital Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Arnaud Hot
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
- Department of Internal Medicine, Hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (S.B.); (Y.J.); (M.G.-V.)
- Université Claude Bernard Lyon 1, 69000 Lyon, France; (S.D.); (R.N.-J.); (J.-C.L.); (I.D.); (A.H.)
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, 69003 Lyon, France
- Correspondence:
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Roussotte M, Gerfaud-Valentin M, Hot A, Audia S, Bonnotte B, Thibault T, Lobbes H, Le Guenno G, Goulabchand R, Cathebras P, Varron L, Dufour JF, Deroux A, Compain C, Baudet A, Karkowski L, Pérard L, Ebbo M, Lega JC, Sève P. Immune thrombocytopenia with clinical significance in systemic lupus erythematosus: a retrospective cohort study of 90 patients. Rheumatology (Oxford) 2021; 61:3627-3639. [PMID: 34918048 DOI: 10.1093/rheumatology/keab925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/26/2021] [Revised: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the characteristics, treatment, and outcome of patients with immune thrombocytopenia with clinical significance (ITPCS) associated with systemic lupus erythematosus (SLE). METHODS This retrospective multicentre study included SLE patients who experienced ≥1 ITPCS (defined as ITP with attributable bleeding disorders and/or a platelet count <30 x109/L). Other causes of secondary thrombocytopenia were excluded. Major bleeding event (MBG) was defined as Khellaf score>8 and/or WHO score>2. RESULTS A total of 90 patients were included, the median (range) follow-up duration was 80 (6-446) months. ITP was diagnosed before SLE in 25 patients. They presented high rate of autoimmune haemolytic anaemia (15%), antiphospholipid antibody (62%), and antiphospholipid syndrome (19%). The 25 (28%) patients who experienced MBG had significantly more bleedings at ITP diagnosis and higher bleeding scores, and serositis and thrombosis during follow-up. They required significantly more treatment lines, transfusions, and hospitalizations. The 11 (12%) patients who experienced no bleeding event presented a significantly more restricted SLE phenotype (cutaneous and/or articular). Patients received a mean (range) of 4.2 (1-11) treatment lines. Corticosteroids and hydroxychloroquine allowed ITPCS overall response in one third of patients. The median relapse-free survival of rituximab (n = 34), azathioprine (n = 19), mycophenolate mofetil (n = 8), thrombopoietin-receptor agonists (n = 16), and splenectomy (n = 19) were 53, 31.5, 61, 24.5, and 78 months, respectively. Four patients experienced thrombotic events after splenectomy and one occurred under thrombopoietin-receptor agonist treatment. CONCLUSION SLE-ITCS patients displayed a high rate of haematological abnormalities and MBG patients exhibited higher morbidity. Management of thrombocytopenia was highly heterogeneous and many options seem viable.
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Affiliation(s)
| | | | - Arnaud Hot
- Department of Internal Medicine, Hospices Civils de Lyon, France
| | - Sylvain Audia
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Thomas Thibault
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, France
| | - Hervé Lobbes
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - Radjiv Goulabchand
- Department of Internal Medicine, Centre Hospitalier Universitaire de Montpellier, France
| | - Pascal Cathebras
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Loig Varron
- Department of Internal Medicine, Centre Hospitalier de Montélimar, France
| | | | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, France
| | - Caroline Compain
- Department of Internal Medicine, Centre Hospitalier de Chambéry, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre Hospitalier d'Annecy, France
| | - Ludovic Karkowski
- Department of Internal Medicine, Centre Hospitalier Militaire de Desgenettes, Lyon, France
| | - Laurent Pérard
- Department of Internal Medicine, Centre Hospitalier de St. Joseph St. Luc, Lyon, France
| | - Mikael Ebbo
- Department of Internal Medicine, Centre Hospitalier de La Timone, Marseille, France
| | | | - Pascal Sève
- Department of Internal Medicine, Hospices Civils de Lyon, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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Tan BK, Mainbourg S, Friggeri A, Bertoletti L, Douplat M, Dargaud Y, Grange C, Lobbes H, Provencher S, Lega JC. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax 2021; 76:970-979. [PMID: 33622981 PMCID: PMC7907632 DOI: 10.1136/thoraxjnl-2020-215383] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [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: 05/26/2020] [Revised: 10/07/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. METHODS In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020. RESULTS We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I2=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I2=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I2=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I2=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I2=95%; pinteraction<0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, pinteraction=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I2=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I2=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I2=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates. CONCLUSIONS Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.
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Affiliation(s)
- Boun Kim Tan
- Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Sabine Mainbourg
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Claude Bernard University Lyon 1, VIlleurbanne, France
| | - Arnaud Friggeri
- Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de Saint-Étienne, Saint-Étienne, France
- Université Jean-Monnet, UMR 1059, SAINBIOSE; INSERM CIC 1408, Saint-Étienne, France
| | - Marion Douplat
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Yesim Dargaud
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques, Hospices Civils de Lyon, Lyon, France
- Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Claire Grange
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hervé Lobbes
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Department of Internal Medicine, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Claude Bernard University Lyon 1, VIlleurbanne, France
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques, Hospices Civils de Lyon, Lyon, France
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Cottin V, Lega JC, Coury F, Nasser M. A call for evidence in connective tissue diseases-associated interstitial lung disease. Joint Bone Spine 2021; 89:105274. [PMID: 34536627 DOI: 10.1016/j.jbspin.2021.105274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, IVPC, INRAE, Claude Bernard University Lyon 1, member of ERN-LUNG, 28, avenue Doyen Lepine, 69677 Lyon cedex, France.
| | - Jean-Christophe Lega
- University of Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, 69100 Villeurbanne, France; Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Fabienne Coury
- Inserm UMR1033 LYOS, University of Lyon I, 69003 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, 69310 Pierre-Bénite, France
| | - Mouhamad Nasser
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, IVPC, INRAE, Claude Bernard University Lyon 1, member of ERN-LUNG, 28, avenue Doyen Lepine, 69677 Lyon cedex, France
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Aussedat M, Lobbes H, Samson M, Euvrard R, Lega JC, Mainbourg S. Epidemiology of major relapse in giant cell arteritis: A study-level meta-analysis. Autoimmun Rev 2021; 21:102930. [PMID: 34481940 DOI: 10.1016/j.autrev.2021.102930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The relapse rate of giant cell arteritis (GCA) is around 48%. Major relapse of GCA is defined by the European League Against Rheumatism as severe ischemic or aortic (stenosis, aneurysm, or aortic dissection) disease of GCA. The objective of the present study was to determine the prevalence and incidence, as well as the spectrum of major relapse in GCA using published data. METHODS The MEDLINE and Cochrane databases were searched up to March 2020. Studies that included patients with newly diagnosed or relapsed GCA receiving glucocorticoids (GC) alone and/or GC-sparing therapy, detailing the number of relapsing patients and the characteristics of relapses were included. The prevalence and incidence of major relapse were pooled using a random-effects model. RESULTS Twenty-six studies (including eight randomised controlled trials) involving 2754 patients with GCA were included. The prevalence and incidence of major relapse in this population was 3.3% (95%CI [1.7;5.6]; I2 = 86%) and 14.5/100 patient-years (95%CI [5.2;27.2]; I2 = 90%). The clinical manifestations were jaw claudication (44.3%), ophthalmological involvement (32.7%), peripheral limb ischemia (12.5%), aortic (7.7%), and neurological involvements (4.8%). In the meta-regression analysis, the duration of follow-up was negatively associated with the incidence of major relapse (Beta = -0.015, 95%CI [-0.026; -0.0042]; p = 0.0063). The incidence of major relapse was significantly higher in prospective studies (55.2/100 person-years, 95%CI [15.3;114.3] than in retrospective studies (4.1/100 patient-years, 95%CI[1.1;8.4]; pinteraction = 0.000.2). CONCLUSION This study found that there was heterogeneity among studies, and this is partially related to study design. Jaw claudication was frequent and increases the prevalence and incidence of relapses major.
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Affiliation(s)
- Marie Aussedat
- Institut du Vieillissement I-Vie, Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France
| | - Hervé Lobbes
- Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, F-63100 Clermont-Ferrand, France
| | - Maxime Samson
- Service de médecine interne et d'immunologie clinique, CHU Dijon Bourgogne, Hôpital François Mitterrand, F-21000 Dijon, France
| | - Romain Euvrard
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69495 Pierre-Bénite, France
| | - Jean-Christophe Lega
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69495 Pierre-Bénite, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France; Lyon immunopathology FEderation (LIFE), Hospices Civils de Lyon, F-69003 Lyon, France
| | - Sabine Mainbourg
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69495 Pierre-Bénite, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France; Lyon immunopathology FEderation (LIFE), Hospices Civils de Lyon, F-69003 Lyon, France.
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Kilo R, Laporte S, Arab R, Mainbourg S, Provencher S, Grenet G, Bertoletti L, Villeneuve L, Cucherat M, Lega JC. Meta-regression of randomized control trials with antithrombotics: weak correlation between net clinical benefit and all cause-mortality. Sci Rep 2021; 11:14728. [PMID: 34282198 PMCID: PMC8290002 DOI: 10.1038/s41598-021-94160-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to explore the validity of the use of the net clinical benefit (NCB), i.e. the sum of major bleeding and thrombotic events, as a potential surrogate for all-cause mortality in clinical trials assessing antithrombotics. Published randomized controlled trials testing anticoagulants in the prevention or treatment of venous thromboembolism (VTE) and non-valvular atrial fibrillation (NVAF) were systematically reviewed. The validity of NCB as a surrogate endpoint was estimated by calculating the strength of correlation of determination (R2) and its 95% confidence interval (CI) between the relative risks of NCB and all-cause mortality. Amongst the 125 trials retrieved, the highest R2trial values were estimated for NVAF (R2trial = 0.41, 95% CI [0.03; 0.48]), and acute VTE (R2trial = 0.30, 95% CI [0.04; 0.84]). Conversely, the NCB did not correlate with all-cause mortality in prevention studies with medical (R2trial = 0.12, 95% CI [0.00; 0.36]), surgical (R2trial = 0.05, 95% CI [0.00; 0.23]), and cancer patients (R2trial = 0.006, 95% CI [0.00; 1.00]). A weak correlation between NCB and all cause-mortality was found in NVAF and acute VTE, whereas no correlation was observed in clinical situations where the mortality rate was low. Consequently, NCB should not be considered a surrogate outcome for all cause-mortality in anticoagulation trials.
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Affiliation(s)
- Roubi Kilo
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Recherche Et D'Epidémiologie Cliniques, Lyon, France. .,Univ Lyon, Université Claude Bernard Lyon 1 - UMR CNRS 5558, Laboratoire de Biométrie Evolutive, Equipe Evaluation Et Modélisation Des Effets Thérapeutiques, Lyon, France. .,Pôle de Santé Publique, Hospices Civils de Lyon, Hôpital Lyon Sud, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| | - Silvy Laporte
- Unité De Recherche Clinique, Innovation, Pharmacologie, Hôpital Nord, CHU De Saint-Étienne, Saint-Etienne, France.,INSERM, UMR1059, Equipe Dysfonction Vasculaire Et Hémostase, Université Jean-Monnet, Saint-Etienne, France
| | - Rama Arab
- Univ Lyon, Université Claude Bernard Lyon 1 - UMR CNRS 5558, Laboratoire de Biométrie Evolutive, Equipe Evaluation Et Modélisation Des Effets Thérapeutiques, Lyon, France
| | - Sabine Mainbourg
- Service De Médecine Interne Et Vasculaire, Hospices Civils De Lyon, Hôpital Lyon Sud, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1 - UMR CNRS 5558, Laboratoire de Biométrie Evolutive, Equipe Evaluation Et Modélisation Des Effets Thérapeutiques, Lyon, France
| | - Steeve Provencher
- Pneumologue, Centre De Recherche De L'institut Universitaire De Cardiologie Et De Pneumologie De Québec, Québec, Canada
| | - Guillaume Grenet
- Service Hospitalo Universitaire de PharmacoToxicologie, Pôle de Santé Publique, Hopsices Civils De Lyon, Lyon, France
| | - Laurent Bertoletti
- Service De Médecine Vasculaire Et Thérapeutique, Chu de Saint-Étienne, France.,INSERM, UMR1059, Equipe Dysfonction Vasculaire Et Hémostase, Université Jean-Monnet; INSERM, CIC-1408, CHU Saint-Etienne, 42055, Saint-Etienne, France
| | - Laurent Villeneuve
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Recherche Et D'Epidémiologie Cliniques, 69495, Pierre-Bénite, France.,Université Lyon-1, EA 3738 CICLY, 69921, Oullins Cedex, Lyon, France
| | - Michel Cucherat
- Univ Lyon, Université Claude Bernard Lyon 1 - UMR CNRS 5558, Laboratoire de Biométrie Evolutive, Equipe Evaluation Et Modélisation Des Effets Thérapeutiques, Lyon, France
| | - Jean-Christophe Lega
- Service De Médecine Interne Et Vasculaire, Hospices Civils De Lyon, Hôpital Lyon Sud, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1 - UMR CNRS 5558, Laboratoire de Biométrie Evolutive, Equipe Evaluation Et Modélisation Des Effets Thérapeutiques, Lyon, France
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Mai V, Tan BK, Mainbourg S, Potus F, Cucherat M, Lega JC, Provencher S. Venous thromboembolism in COVID-19 compared to non-COVID-19 cohorts: A systematic review with meta-analysis. Vascul Pharmacol 2021; 139:106882. [PMID: 34087481 PMCID: PMC8169236 DOI: 10.1016/j.vph.2021.106882] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/12/2020] [Revised: 04/04/2021] [Accepted: 05/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many studies confirmed an association between COVID-19 and venous thromboembolism (VTE). Whether the risk of VTE significantly differed between COVID-19 cohorts and non-COVID-19 cohorts with similar disease severity remains unknown. OBJECTIVES The aim of this systematic review with meta-analysis was to compare the rate of VTE between COVID-19 and non-COVID-19 cohorts with similar disease severity. METHODS A systematic literature search (MEDLINE, Embase and Google Scholar) was conducted from January 1, 2020 to March 31, 2021 to identify studies reporting VTE in COVID-19. Relative risks (RR) were estimated for the effect measure with 95% confidence intervals. RESULTS Seven studies (41,768 patients) evaluated VTE in COVID-19 cohorts compared to non-COVID-19 cohorts. The overall risk of VTE (RR 1.18; 95%CI 0.79-1.77; p = 0.42; I2 = 54%), pulmonary embolism (RR 1.25; 95%CI 0.77-2.03; p = 0.36; I2 = 52%) and deep venous thrombosis (RR 0.92; 95%CI 0.52-1.65; p = 0.78; I2 = 0%) did not significantly differ between COVID-19 and non-COVID-19 cohorts. However, subgroup analyses suggested an increased risk of VTE amongst CODID-19 versus non COVID-19 cohorts when only patients hospitalized within the intensive care unit (ICU) were considered (RR 3.10; 95%CI 1.54-6.23), which was not observed in cohorts of predominantly non-ICU patients (RR 0.95; 95%CI 0.81-1.11) (Pinteraction = 0.001). CONCLUSION There was no signal for a difference in VTE in COVID-19 cohorts compared to non-COVID-19 cohorts, except for the subgroup of patients hospitalized in the ICU. These results should be viewed as exploratory and further studies are needed to confirm these results.
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Affiliation(s)
- Vicky Mai
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada; Pulmonary Hypertension Research Group (http://phrg.ca)
| | - Boun Kim Tan
- Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, F-69310 Pierre-Bénite, France
| | - Sabine Mainbourg
- Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, F-69100, Villeurbanne, France; Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69310, Pierre-Bénite, France
| | - François Potus
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada; Pulmonary Hypertension Research Group (http://phrg.ca); Department of Medicine, Université Laval, Quebec City, Canada
| | - Michel Cucherat
- University of Lyon, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Claude Bernard University Lyon 1, F-69100, France; Departement of Pharmacotoxicology, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Jean-Christophe Lega
- Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, F-69100, Villeurbanne, France; Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69310, Pierre-Bénite, France; Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, France
| | - Steeve Provencher
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada; Pulmonary Hypertension Research Group (http://phrg.ca); Department of Medicine, Université Laval, Quebec City, Canada.
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Mai V, Mainbourg S, Tan BK, Lega JC, Provencher S. Significant Major Bleeding in Hospitalized Patients with COVID-19 Receiving Thromboprophylaxis. Thromb Haemost 2021; 121:1670-1673. [PMID: 33831962 DOI: 10.1055/a-1477-4027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
No Abstract
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Affiliation(s)
- Vicky Mai
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group, Quebec, Cananda
| | - Sabine Mainbourg
- Laboratoire de Biométrie et Biologie Evolutive, Univ Lyon, UMR 5558, Villeurbanne, France.,Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Boun Kim Tan
- Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jean-Christophe Lega
- Laboratoire de Biométrie et Biologie Evolutive, Univ Lyon, UMR 5558, Villeurbanne, France.,Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, Pierre-Bénite, France
| | - Steeve Provencher
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada.,Pulmonary Hypertension Research Group, Quebec, Cananda.,Department of Medicine, Université Laval, Quebec City, Canada
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Gendreau S, Porcher R, Thoreau B, Paule R, Maurier F, Goulenok T, Frumholtz L, Bernigaud C, Ingen-Housz-Oro S, Mekinian A, Audemard-Verger A, Gaillet A, Perard L, Samson M, Sonneville R, Arlet JB, Mirouse A, Kahn JE, Charpentier J, Hachulla É, Hummel A, Pires T, Carron PL, Durel CA, Jourde W, Puechal X, Lega JC, Sarrot-Reynauld F, Tieulie N, Diot E, Guillevin L, Terrier B. Characteristics and risk factors for poor outcome in patients with systemic vasculitis involving the gastrointestinal tract. Semin Arthritis Rheum 2021; 51:436-441. [PMID: 33711774 DOI: 10.1016/j.semarthrit.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastrointestinal (GI) involvement was described to be a poor prognostic factor in systemic necrotizing vasculitis. Its prognostic significance may vary according to clinical presentation and vasculitis subtype. AIMS This study investigated risk-factors associated to poor outcome in GI-involvement of vasculitis. METHODS Patients with systemic vasculitis as defined by the 2012 Chapel Hill Consensus Conference and presenting with GI involvement were retrospectively included. Baseline characteristics, treatments and outcome were recorded. Primary endpoint was a composite of admission to intensive care unit (ICU), emergency surgical procedure, or death. RESULTS Two hundred and thirteen patients were included. Vasculitis were distributed as follows: 41% IgA vasculitis, 27% ANCA-associated vasculitis, 17% polyarteritis nodosa (PAN), and 15% other vasculitis. Eighty-three (39%) patients fulfilled the composite primary endpoint within 6 months. Predictive factors associated with the primary endpoint included PAN subtype (OR 3.08, 95% CI 1.29-7.34), performance status (OR 1.40, 1.05-1.87), use of morphine (OR 2.51, 0.87-7.24), abdominal guarding (OR 3.08, 1.01-9.37), ileus (OR 2.29, 0.98-5.32), melena (OR 2.74, 1.17-6.42), increased leukocytes (per G/L, OR 1.05, 1.00-1.10), low hemoglobin (per g/dL, OR 0.80, 0.71-0.91) and increased CRP (log mg/L, OR 1.21, 0.94-1.56). A risk prediction model for the achievement of primary endpoint had a very good performance [C-statistics 0.853 (0.810 to 0.895], and for overall survival as well. CONCLUSIONS Vasculitis presenting with GI involvement have a poor outcome in more than one third of cases. An easy-to-use risk prediction model had a very good performance to predict the admission to ICU, emergency surgical procedure, or death.
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Affiliation(s)
- Ségolène Gendreau
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Raphael Porcher
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Hôtel-Dieu, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - François Maurier
- Department of Internal Medicine, Hôpital Sainte-Blandine De Metz, Metz, France
| | - Tiphaine Goulenok
- Department of Internal Medicine, Hôpital Bichat - Claude-Bernard, AP-HP, Paris, France
| | - Laure Frumholtz
- Department of Dermatology, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, AP-HP, Paris, France
| | | | - Antoine Gaillet
- Intensive-care unit, Hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - Laurent Perard
- Department of Internal Medicine, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Maxime Samson
- Department of Clinical Immunology and Internal Medicine, CHU de Dijon, Dijon, France
| | - Romain Sonneville
- Intensive-care unit, Hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - Jean-Benoît Arlet
- Department of Internal Medicine, Hôpital européen Georges Pompidou, AP-HP, Paris, France
| | | | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Hôpital Ambroise Paré, AP-HP, Boulogne, France
| | | | - Éric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, Lille, France
| | - Aurélie Hummel
- Department of Nephrology, Hôpital Necker, AP-HP, Paris, France
| | - Thomas Pires
- Department of Internal Medicine, CHU Bordeaux, Bordeaux, France
| | | | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | - Wendy Jourde
- Department of Internal Medicine, CHU Bordeaux, Bordeaux, France
| | - Xavier Puechal
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Jean-Christophe Lega
- Department of Internal Medicine, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | | | | | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France
| | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France.
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Grenet G, Mekhaldi S, Mainbourg S, Auffret M, Cornu C, Cracowski JL, Gueyffier F, Lega JC, Cucherat M. DPP-4 Inhibitors and Respiratory Infection: A Systematic Review and Meta-analysis of the Cardiovascular Outcomes Trials. Diabetes Care 2021; 44:e36-e37. [PMID: 33436399 DOI: 10.2337/dc20-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Guillaume Grenet
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France .,Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Samia Mekhaldi
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Sabine Mainbourg
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France.,Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Marine Auffret
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Catherine Cornu
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France.,CIC1407 INSERM, Hospices Civils de Lyon, Lyon, France
| | - Jean-Luc Cracowski
- HP2, INSERM, Université Grenoble Alpes, and Centre régional de pharmacovigilance de Grenoble, Grenoble, France
| | - François Gueyffier
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Jean-Christophe Lega
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France.,Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Michel Cucherat
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
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36
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Lobbes H, Mainbourg S, Lega JC. Prevention of venous thromboembolism in nephrotic syndrome: the quest towards precision medicine. Nephrol Dial Transplant 2020; 36:gfaa337. [PMID: 33367807 DOI: 10.1093/ndt/gfaa337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Sabine Mainbourg
- Service de médecine interne et médecine vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon 1, Lyon, France
| | - Jean-Christophe Lega
- Service de médecine interne et médecine vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon 1, Lyon, France
- Groupe d'Etude Multidisciplinaire en Maladie Thrombotique (GEMMAT), Hospices Civils de Lyon, Lyon, France
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37
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Rousset P, Bischoff E, Charlot M, Grangeon F, Dubernard G, Paparel P, Lega JC, Golfier F. Bladder endometriosis: Preoperative MRI analysis with assessment of extension to ureteral orifices. Diagn Interv Imaging 2020; 102:255-263. [PMID: 33339775 DOI: 10.1016/j.diii.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively evaluate the performance of magnetic resonance imaging (MRI) in locating endometriosis implants within the bladder wall with assessment of ureteral orifice extension using surgical findings as standard of reference. MATERIALS AND METHODS MRI examinations of 39 consecutive women (mean age: 31.2±5.5 [SD] years; age range: 22-42years) operated in 3 university hospitals for bladder endometriosis over a 6-year period were reviewed by 2 independent readers. Interobserver agreement was assessed using Kappa tests. Results of consensus reading were used to calculate sensitivity, specificity and accuracy of MRI for the diagnosis, location and extent of endometriosis implants using surgical findings as the standard of reference. RESULTS Mean bladder repletion volume was 134±110 [SD] mL (range: 21-479mL). The mean largest endometriosis implant diameter was 30±7 [SD] mm (range: 19-41mm). On MR images, 34/39 (87%) endometriosis implants were present in the two anterior thirds of the dome (k=0.45), 31/39 (79%) extended or were present in the posterior third pouch (k=0.92) and 25/39 (64%) extended into the bladder base (k=0.84) with sensitivities of 100% (31/31; 95% confidence interval [CI]: 89-100%), 100% (30/30; 95% CI: 88-100%) and 90% (19/21; 95% CI: 69-98%), respectively, specificities of 83% (5/6, 95% CI: 36-100), 88% (7/8, 95% CI: 47-100%), 87% (13/15; 95% CI: 52-96), respectively and accuracies of 97% (36/37, 95% CI: 86-100%), 97% (37/38; 95% CI: 86-100%), and 89% (32/36; 95% CI: 74-97%), respectively. In 9 (9/25; 36%) patients with bladder base involvement, a zero distance was reported between endometriosis implants and ureteral orifices, all but one presenting with low-to-moderate bladder volumes. In the two patients who needed ureteral resection-reimplantation, ureteral dilation was associated with a zero distance. External adenomyosis was reported in 26/39 (66%) patients (k=0.94). CONCLUSION A dedicated preoperative MRI work-up for bladder endometriosis helps accurately depict and locate endometriosis implants. Adequate bladder filling is needed to improve appropriate estimate of the distance between endometriosis implants and ureteral orifices to better predict requirement of ureteral resection-reimplantation.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude-Bernard University, EMR 3738, Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France.
| | - Elodie Bischoff
- Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France
| | - Mathilde Charlot
- Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France
| | - Flavia Grangeon
- Lyon 1 Claude-Bernard University, EMR 3738, Hospices Civils de Lyon, Lyon Sud University Hospital, Department of Radiology, 69495 Pierre-Bénite, France
| | - Gil Dubernard
- Lyon 1 Claude-Bernard University, LabTAU, Hospices Civils de Lyon, Croix-Rousse Hospital, Obstetrics and Gynaecology Department, 69004 Lyon, France
| | - Philippe Paparel
- Lyon 1 Claude-Bernard University, Hospices Civils de Lyon, Lyon Sud University Hospital, Urology Department, 69495 Pierre-Bénite, France
| | - Jean-Christophe Lega
- Lyon 1 Claude-Bernard University, UMR CNRS 5558, Hospices Civils de Lyon, Lyon Sud University Hospital, Internal and Vascular Medicine Department, 69495 Pierre-Bénite, France
| | - François Golfier
- Lyon 1 Claude-Bernard University, EMR 3738, Hospices Civils de Lyon, Lyon Sud University Hospital, Gynecological Oncological, and Obstetrics Department, 69495 Pierre-Bénite, France
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Mai V, Marceau-Ferron E, Bertoletti L, Lacasse Y, Bonnet S, Lega JC, Provencher S. Direct oral anticoagulants in the treatment of acute venous thromboembolism in patients with obesity: A systematic review with meta-analysis. Pharmacol Res 2020; 163:105317. [PMID: 33246169 DOI: 10.1016/j.phrs.2020.105317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Direct oral anticoagulants' (DOAC) pharmacokinetics are affected by obesity. Their efficacy and safety in obesity (BMI≥30 kg/m2) and morbid obesity (BMI≥40 kg/m2) are still unclear in the treatment of venous thromboembolism (VTE). OBJECTIVES To compare the efficacy/safety of DOAC versus vitamin K antagonist (VKA)/low molecular weight heparin (LMWH) for the treatment of VTE in patients with obesity and morbid obesity. The primary efficacy/safety outcomes were VTE recurrence and major bleeding (MB). Clinically relevant non-MB and mortality were also evaluated. METHODS A systematic literature search (MEDLINE, EMBASE, CENTRAL, Web of Science) identified studies evaluating DOAC in the treatment of VTE in patients with obesity and reporting one of the outcomes. Relative risks (RR) and 95 % confidence intervals (CI) were estimated using the Mantel-Haenszel method. RESULTS We included 21 studies (50,360pts) of which 16,150 patients had a BMI≥30 kg/m2 and 6443 patients had a BMI≥40 kg/m2. VTE recurrence was similar with DOAC compared to VKA/LMWH in patients with obesity (RR 1.03;95 %CI 0.93-1.15;p = 0.55) and morbid obesity (RR 1.06;95 %CI 0.94-1.19;p = 0.35). DOAC were also associated with a reduction in MB (RR 0.57;95 %CI 0.34-0.94;p = 0.03 and RR 0.71;95 %CI 0.50-1.00;p = 0.05 in patients with obesity and morbid obesity, respectively). Subgroup analyses comparing randomized controlled trials to observational studies showed consistent results. No difference was observed in regards of clinically relevant non-MB and mortality. CONCLUSION There is no signal for differences in VTE recurrence in patients with obesity and morbid obesity treated with DOAC compared to VKA/LMWH, while DOAC likely reduce the risk of MB compared to VKA/LMWH.
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Affiliation(s)
- V Mai
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada; Pulmonary Hypertension Research Group, (http://phrg.ca)
| | - E Marceau-Ferron
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada
| | - L Bertoletti
- Department of Vascular and Therapeutic Medicine, CHU de St-Etienne, Saint-Etienne, France; Université Jean-Monnet, UMR 1059, SAINBIOSE, St-Etienne, France; INSERM CIC 1408, St-Etienne, France; Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, France
| | - Y Lacasse
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada; Department of Medicine, Université Laval, Quebec City, Canada
| | - S Bonnet
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada; Pulmonary Hypertension Research Group, (http://phrg.ca); Department of Medicine, Université Laval, Quebec City, Canada
| | - J C Lega
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, France; Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, F-69100, Villeurbanne, France; Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69310, Pierre-Bénite, France
| | - S Provencher
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Université Laval, Quebec City, Canada; Pulmonary Hypertension Research Group, (http://phrg.ca); Department of Medicine, Université Laval, Quebec City, Canada.
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Hadjadj J, Castro CN, Tusseau M, Stolzenberg MC, Mazerolles F, Aladjidi N, Armstrong M, Ashrafian H, Cutcutache I, Ebetsberger-Dachs G, Elliott KS, Durieu I, Fabien N, Fusaro M, Heeg M, Schmitt Y, Bras M, Knight JC, Lega JC, Lesca G, Mathieu AL, Moreews M, Moreira B, Nosbaum A, Page M, Picard C, Ronan Leahy T, Rouvet I, Ryan E, Sanlaville D, Schwarz K, Skelton A, Viallard JF, Viel S, Villard M, Callebaut I, Picard C, Walzer T, Ehl S, Fischer A, Neven B, Belot A, Rieux-Laucat F. Early-onset autoimmunity associated with SOCS1 haploinsufficiency. Nat Commun 2020; 11:5341. [PMID: 33087723 PMCID: PMC7578789 DOI: 10.1038/s41467-020-18925-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 03/01/2020] [Accepted: 09/08/2020] [Indexed: 11/09/2022] Open
Abstract
Autoimmunity can occur when a checkpoint of self-tolerance fails. The study of familial autoimmune diseases can reveal pathophysiological mechanisms involved in more common autoimmune diseases. Here, by whole-exome/genome sequencing we identify heterozygous, autosomal-dominant, germline loss-of-function mutations in the SOCS1 gene in ten patients from five unrelated families with early onset autoimmune manifestations. The intracellular protein SOCS1 is known to downregulate cytokine signaling by inhibiting the JAK-STAT pathway. Accordingly, patient-derived lymphocytes exhibit increased STAT activation in vitro in response to interferon-γ, IL-2 and IL-4 that is reverted by the JAK1/JAK2 inhibitor ruxolitinib. This effect is associated with a series of in vitro and in vivo immune abnormalities consistent with lymphocyte hyperactivity. Hence, SOCS1 haploinsufficiency causes a dominantly inherited predisposition to early onset autoimmune diseases related to cytokine hypersensitivity of immune cells.
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Affiliation(s)
- Jérôme Hadjadj
- Université de Paris, Imagine institute, laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 24 boulevard du Montparnasse, 75015, Paris, France.,Université de Paris, IHU-Imagine, 24 boulevard du Montparnasse, Paris, 75015, France
| | - Carla Noemi Castro
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maud Tusseau
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France
| | - Marie-Claude Stolzenberg
- Université de Paris, Imagine institute, laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 24 boulevard du Montparnasse, 75015, Paris, France.,Université de Paris, IHU-Imagine, 24 boulevard du Montparnasse, Paris, 75015, France
| | - Fabienne Mazerolles
- Université de Paris, Imagine institute, laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 24 boulevard du Montparnasse, 75015, Paris, France.,Université de Paris, IHU-Imagine, 24 boulevard du Montparnasse, Paris, 75015, France
| | - Nathalie Aladjidi
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), CIC 1401, Inserm CICP, Bordeaux, France.,Pediatric Oncology Hematology Unit, University Hospital, place Amélie Raba Léon, CIC 1401, Inserm, CICP, Bordeaux, France
| | | | - Houman Ashrafian
- Experimental Therapeutics, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Georg Ebetsberger-Dachs
- Department of Pediatrics, Kepler University Hospital and School of Medicine, Johannes Kepler University, Linz, Austria
| | | | - Isabelle Durieu
- Internal Medicine and Vascular Pathology Department, Adult Cystic Fibrosis Center, Groupement Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EA 7425 HESPER. Université de Lyon, Lyon, France
| | - Nicole Fabien
- Immunology laboratory; Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Fusaro
- Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France
| | - Maximilian Heeg
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yohan Schmitt
- Genomic Core Facility, INSERM UMR1163, Imagine Institute, Paris, France
| | - Marc Bras
- Université de Paris, IHU-Imagine, 24 boulevard du Montparnasse, Paris, 75015, France
| | - Julian C Knight
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,National Referee Centre for Pediatric-Onset Rheumatism and Autoimmune Diseases (RAISE), Lyon, France.,UMR 5558, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon 1, Lyon, France
| | - Gaetan Lesca
- Service de Génétique, Hospices Civils de Lyon - GHE, and Institut Neuromyogène, CNRS UMR 5310 - INSERM U1217, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne-Laure Mathieu
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France
| | - Marion Moreews
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France
| | - Baptiste Moreira
- Immunology Laboratory, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Audrey Nosbaum
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France.,Allergy and Clinical Immunology department, Groupement Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Matthew Page
- Translational Medicine, UCB Pharma, Braine-l'Alleud, Belgium
| | - Cécile Picard
- Institut de Pathologie Multisite, Groupement Hospitalier Est, Hospices Civils de Lyon, UCBL Lyon 1 University, Lyon, France
| | - T Ronan Leahy
- Department of Paediatric Immunology and Infectious Diseases, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Isabelle Rouvet
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France
| | - Ethel Ryan
- Department of Paediatrics, University Hospital Galway, Co, Galway, Ireland
| | - Damien Sanlaville
- Service de Génétique, Hospices Civils de Lyon - GHE, and Institut Neuromyogène, CNRS UMR 5310 - INSERM U1217, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Klaus Schwarz
- Institute for Transfusion Medicin, University Ulm and Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg-Hessen, 89081, Ulm, Germany
| | - Andrew Skelton
- Translational Medicine, UCB Pharma, Slough, United Kingdom
| | - Jean-Francois Viallard
- Département de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire Haut Lévêque, Université de Bordeaux, Pessac, France
| | - Sebastien Viel
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France.,Service d'Immunologie Biologique, Groupement Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marine Villard
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France
| | - Isabelle Callebaut
- Sorbonne Université, Muséum National d'Histoire Naturelle, Centre National de la Recherche Scientifique Unité Mixte de Recherche 7590, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie, Paris, France
| | - Capucine Picard
- Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France.,Université de Paris, Imagine institute, laboratory of Iymphocyte activation and susceptibility to EBV, INSERM UMR 1163, 24 boulevard du Montparnasse, Paris, 75015, France
| | - Thierry Walzer
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,CIBSS - Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Alain Fischer
- Université de Paris, IHU-Imagine, 24 boulevard du Montparnasse, Paris, 75015, France.,Paediatric Immuno-Haematology and Rheumatology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France.,Collège de France, Paris, France
| | - Bénédicte Neven
- Université de Paris, Imagine institute, laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 24 boulevard du Montparnasse, 75015, Paris, France.,Université de Paris, IHU-Imagine, 24 boulevard du Montparnasse, Paris, 75015, France.,Paediatric Immuno-Haematology and Rheumatology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Alexandre Belot
- Centre International de Recherche en Infectiologie, CIRI, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, University of Lyon, Lyon, France. .,National Referee Centre for Pediatric-Onset Rheumatism and Autoimmune Diseases (RAISE), Lyon, France. .,Hospices Civils de Lyon, Paediatric Nephrology, Rheumatology, Dermatology Unit, Mother and Children University Hospital, Bron, France.
| | - Frédéric Rieux-Laucat
- Université de Paris, Imagine institute, laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, 24 boulevard du Montparnasse, 75015, Paris, France. .,Université de Paris, IHU-Imagine, 24 boulevard du Montparnasse, Paris, 75015, France.
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Rousset P, Buisson G, Lega JC, Charlot M, Gallice C, Cotte E, Milot L, Golfier F. Rectal endometriosis: predictive MRI signs for segmental bowel resection. Eur Radiol 2020; 31:884-894. [PMID: 32851441 DOI: 10.1007/s00330-020-07170-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/31/2020] [Accepted: 08/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To retrospectively determine the accuracy of MRI rectal and pararectal signs in predicting the necessity for segmental resection in the case of lesions located in the rectum. METHODS MR images of consecutive patients treated for rectal endometriosis over a 5-year period were reviewed in consensus by two blinded readers. A systematic analysis of 7 rectal (lesion length, transverse axis, thickness and circumference, and presence of a convex base, submucosal oedema and hyperintense cystic areas) and 4 pararectal (posterior vaginal fornix, parametrial, ureteral and sacro-recto-genital septum involvements) signs was performed for each lesion. MRI results were compared to the surgical procedure performed (shaving versus segmental resection). RESULTS Among 61 patients studied, 32 received a segmental resection and 29, a shaving. Receiver operating characteristic curve analysis allowed determining cut-off values for length (≥ 32 mm), transverse axis (≥ 22 mm), thickness (≥ 14 mm) and circumference (≥ 3/8 radii). The 7 rectal signs, and only the sacro-recto-genital septum pararectal sign, were significantly associated with segmental resection in univariate analysis, nodular thickness ≥ 14 mm and circumference ≥ 3/8 radii being the most predictive signs (odds ratio 94.5 and 60.4, respectively). These 2 signs remained positively associated with segmental resection in multivariate analysis and, when combined, were predictive of segmental resection with an accuracy of 90.2%. CONCLUSION Assessing MRI rectal and pararectal signs may accurately predict the need for segmental resection versus a more conservative approach such as shaving for rectal lesion management. KEY POINTS • MRI analysis of rectal endometriosis, taking into account rectal and pararectal signs, may assist surgeons in the decision-making process, in counselling patients regarding the surgical procedure and in adequately allocating resources. • Among rectal signs, nodular thickness ≥ 14 mm and a circumference ≥ 38% were the most predictive signs of segmental resection. • Among pararectal signs, only the sacro-recto-genital septum involvement was significantly associated with segmental resection.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude Bernard University, Villeurbanne, France. .,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. .,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France.
| | - Guillaume Buisson
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Jean-Christophe Lega
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Internal and Vascular Medicine Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Mathilde Charlot
- Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Colin Gallice
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Gynecological Oncological and Obstetrics Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Eddy Cotte
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Oncologic and General Surgery Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Laurent Milot
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - François Golfier
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Gynecological Oncological and Obstetrics Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
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Lobbes H, Reynaud Q, Mainbourg S, Lega JC, Durieu I, Durupt S. [Tryptase: A practical guide for the physician]. Rev Med Interne 2020; 41:748-755. [PMID: 32712042 DOI: 10.1016/j.revmed.2020.06.006] [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: 05/04/2020] [Revised: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022]
Abstract
Tryptase is the most abundant endopeptidase released by mast cells degranulation, involved in many pro and anti-inflammatory processes. Normal serum tryptase range is 0-11.4 μg/L. Tryptase is a useful diagnostic tool for anaphylaxis, systemic mastocytosis (SM) and mast cell activation syndrome (MCAS), where specific threshold values must be used. SM diagnosis criteria include evidence of dense mast cell infiltrate either in the bone marrow or the affected organ (such as skin), presence of KIT D816V mutation and elevated serum tryptase level (>20 μg/L). In SM, tryptase level is correlated with the burden of mast cells in bone marrow. MCAS should be considered in case of severe and recurrent typical clinical signs of systemic mast cell activation involving at least two organs, associated with an increase in serum tryptase level of 20% + 2 μg/L from the individual's baseline. Anaphylaxis is the most severe among hypersensitivity reactions. A clonal mast cell disorder is a central question in anaphylaxis and appropriate explorations should be conducted in these patients. Triggers for anaphylactic reactions vary significantly in the general population and in patients with MS or MCAS. Finally, physicians must be aware of the many pathological and physiological situations that affect tryptase levels.
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Affiliation(s)
- H Lobbes
- Service de Médecine Interne, Hôpital Estaing, CHU de Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France; Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France.
| | - Q Reynaud
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - S Mainbourg
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - J C Lega
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - I Durieu
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - S Durupt
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
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Weber E, Lega JC. Response to: Paradoxical embolism as a cause of renal and/or splenic infarction. QJM 2020; 113:444. [PMID: 31681947 DOI: 10.1093/qjmed/hcz286] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Weber
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Médecine Interne et Médecine Vasculaire, F-69310 Pierre-Bénite, France
| | - J C Lega
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Médecine Interne et Médecine Vasculaire, F-69310 Pierre-Bénite, France
- Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon, F-69100 Lyon, France
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, F-69003 Lyon, France
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Cabrera N, Avila-Pedretti G, Belot A, Larbre JP, Mainbourg S, Duquesne A, Janiaud P, Kassai B, Cucherat M, Lega JC. The benefit–risk balance for biological agents in juvenile idiopathic arthritis: a meta-analysis of randomized clinical trials. Rheumatology (Oxford) 2020; 59:2226-2236. [DOI: 10.1093/rheumatology/keaa170] [Citation(s) in RCA: 4] [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: 08/27/2019] [Revised: 02/05/2020] [Accepted: 02/22/2020] [Indexed: 12/28/2022] Open
Abstract
Abstract
Objective
To assess the net benefit of biological agents (BA) used in JIA.
Methods
We systematically searched databases up to March 2019 for randomized controlled trials (RCT) performed in JIA disease. Separate random-effects meta-analyses were conducted for efficacy (ACR paediatric score 30%, ACRpedi30) and serious adverse events for safety. In order to standardize the baseline risk, we performed a meta-analysis of baseline risk in the control group (for both efficacy and safety meta-analysis). The net benefit was determined as the risk difference of efficacy subtracted by the risk difference of safety.
Results
We included 19 trials: 11 parallel RCTs (754 patients) and 8 withdrawal RCTs (704 patients). The net benefit ranged from 2.4% (adalimumab) to 17.6% (etanercept), and from 2.4% (etanercept) to 36.7%, (abatacept) in parallel and withdrawal trials assessing non-systemic JIA, respectively. In the systemic JIA category, the net benefit ranged from 22.8% (rilonacept) to 70.3% (canakinumab), and from 32.3% (canakinumab) to 58.2% (tocilizumab) in parallel and withdrawal trials, respectively.
Conclusion
The results suggest that a greater number of patients experienced therapeutic success without serious adverse events in the systemic onset JIA category compared with the BAs for non-systemic JIA categories. Baseline risk, design of trial and JIA categories impact the measure of net benefit of BAs in JIA patients.
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Affiliation(s)
- Natalia Cabrera
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
| | | | - Alexandre Belot
- Department of Paediatric Rheumatology, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Lyon University Hospital, University of Lyon, Lyon
| | - Jean-Paul Larbre
- Department of Rheumatology, Hospices Civils de Lyon, Lyon University Hospital, University of Lyon, Pierre-Bénite
| | - Sabine Mainbourg
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hospices Civils de Lyon, University of Lyon, Pierre-Bénite
| | - Agnès Duquesne
- Department of Paediatric Rheumatology, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Lyon University Hospital, University of Lyon, Lyon
| | - Perrine Janiaud
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
| | - Behrouz Kassai
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
- Department of Pharmaco-toxicology, Clinical Investigation Centre 1407 - INSERM, Hospices Civils de Lyon, Lyon, France
| | - Michel Cucherat
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
| | - Jean-Christophe Lega
- Laboratoire de Biométrie et Biologie Évolutive (UMR - CNRS 5558), University of Lyon, Lyon, France
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hospices Civils de Lyon, University of Lyon, Pierre-Bénite
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Mainbourg S, Cucherat M, Lega JC. Analysis of incidence of thrombotic complications in the presence of competing risks. Thromb Res 2020; 191:152. [PMID: 32386984 DOI: 10.1016/j.thromres.2020.04.045] [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] [Received: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sabine Mainbourg
- Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France; Département de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Michel Cucherat
- Département de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Département de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Lega
- Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France; Département de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, Lyon, France.
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Thery-Casari C, Euvrard R, Mainbourg S, Durupt S, Reynaud Q, Durieu I, Belot A, Lobbes H, Cabrera N, Lega JC. Severe infections in patients with anti-neutrophil cytoplasmic antibody-associated vasculitides receiving rituximab: A meta-analysis. Autoimmun Rev 2020; 19:102505. [PMID: 32173512 DOI: 10.1016/j.autrev.2020.102505] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The efficacy of rituximab (RTX) for remission induction and maintenance in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) is now established, but the safety, particularly concerning severe infection risk, is not well known. OBJECTIVE The purpose of this meta-analysis is to assess the prevalence and incidence of severe infections and the factors explaining heterogeneity in AAV patients treated with RTX. METHODS PubMed and Embase were searched up to December 2017. Prevalence and incidence was pooled using a random-effects model in case of significant heterogeneity (I2 > 50%). Severe infection was defined as severe when it led to hospitalization, intravenous antibiotics therapy, and/or death. The heterogeneity was explored by subgroup analyses and meta-regression. RESULTS The included studies encompassed 1434 patients with a median age of 51.9 years. The overall prevalence and incidence of severe infections was 15.4% (95% CI [8.9; 23.3], I2 = 90%, 33 studies) and 6.5 per 100 person-years (PY) (95% CI [2.9; 11.4], I2 = 76%, 18 studies), respectively. The most common infections were bacterial (9.4%, 95% CI [5.1; 14.8]). The prevalence of opportunistic infection was 1.5% (95% CI [0.5; 3.1], I2 = 58%) including pneumocytis jirovecii infections (0.2%, 95% CI [0.0; 0.6], I2 = 0), irrespective of prophylaxis administration. Mortality related to infection was estimated at 0.7% (95% CI [0.2; 1.2], I2 = 27%). The RTX cumulative dose was positively associated with prevalence of infections (13 studies, prevalence increase of 4% per 100 mg, p < .0001). The incidence of infection was negatively associated with duration of follow-up (8 studies, incidence decrease of 9% per year, p = .03). CONCLUSION Prevalence and incidence of severe infections, mainly bacterial ones, were high in AAV patients treated with RTX. This meta-analysis highlights the need for prospective studies to stratify infectious risk and validate cumulative RTX dose and duration of follow-up as modifying factors.
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Affiliation(s)
- Clémence Thery-Casari
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Faculty of Medicine, Université de Lyon, Université Lyon 1, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France
| | - Romain Euvrard
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Faculty of Medicine, Université de Lyon, Université Lyon 1, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France
| | - Sabine Mainbourg
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Faculty of Medicine, Université de Lyon, Université Lyon 1, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France
| | - Stéphane Durupt
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France
| | - Quitterie Reynaud
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Faculty of Medicine, Université de Lyon, Université Lyon 1, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France; Univ Lyon, Health Services and Performance Research EA7425, Claude Bernard University Lyon, F-69003, France
| | - Isabelle Durieu
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Faculty of Medicine, Université de Lyon, Université Lyon 1, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France; Univ Lyon, Health Services and Performance Research EA7425, Claude Bernard University Lyon, F-69003, France
| | - Alexandre Belot
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Faculty of Medicine, Université de Lyon, Université Lyon 1, France; INSERM U1111, National Referral Centre for rare Juvenile Rheumatological and Autoimmune Diseases (RAISE) and Department of Paediatric Rheumatology, Lyon University Hospital, University of Lyon, France
| | - Hervé Lobbes
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Internal Medicine Department, University Hospital Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - Natalia Cabrera
- Faculty of Medicine, Université de Lyon, Université Lyon 1, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medicine, National Referral Centre for Rare Juvenile Rheumatological and Autoimmune Diseases (RAISE), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Faculty of Medicine, Université de Lyon, Université Lyon 1, France; Lyon Immunopathology Federation (LIFE), University of Lyon, Hospices Civils de Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, F-69622 Villeurbanne, France.
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Weber E, Grangeon F, Reynaud Q, Hot A, Sève P, Jardel S, Tazarourte K, Fouque D, Juillard L, Salles G, Grange C, Durieu I, Rousset P, Lega JC. Acute renal and splenic infarctions: a review. QJM 2020; 113:186-193. [PMID: 31593227 DOI: 10.1093/qjmed/hcz252] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Renal and splenic infarctions are close entities, with few data concerning their clinical, biological and radiological features. AIM The aim of this study was to compare the clinical presentations, etiologies and outcomes of acute renal infarctions (RI) and splenic infarctions (SI). DESIGN A retrospective multicentric cohort study included patients of the 6 university hospitals in Lyon with RI, SI, or associated RI-SI infarctions was conducted. METHODS All consecutive cases diagnosed by CT imaging, between January 2013 and October 2016, were included. The exclusion criteria were causes of infarction that did not require additional investigations. RESULTS A total of 161 patients were selected for analysis: 34 patients with RI, 104 patients with SI and 23 patients with both RI-SI. Mean ± SD age of patients was 63.2 ± 16.6 years; 59.6% were male. Only 5/161 (3.1%) were healthy prior to the event. The main symptoms were diffuse abdominal pain (26.4%), followed by nausea/vomiting (18.3%) and fever (16.4%).The causes of RI or SI varied significantly within the three groups. Hypercoagulable state was associated with SI, and embolic disease and arterial injury were associated with RI. Extensive (i.e.>2/3 of organ volume) (OR 6.22, 95%CI 2.0119.22) and bilateral infarctions (OR 15.05, 95%CI 1.79-126.78) were significantly associated with hemodynamic shocks. The survival at 1 month follow-up did not significantly differ between the three groups. CONCLUSION Acute RI and SI are heterogenous entities in regards to their clinical presentation, etiology, associated venous or arterial thrombosis, but prognoses were not different at short term follow-up.
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Affiliation(s)
- E Weber
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
| | - F Grangeon
- Service de radiologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
| | - Q Reynaud
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, Health Services and Performance Research EA7425, Claude Bernard University Lyon, F-69003 Lyon
| | - A Hot
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69003 Lyon
| | - P Sève
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Service de médecine interne, Hospices Civils de Lyon, Hôpital de la Croix Rousse, F-69004 Lyon
| | - S Jardel
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
| | - K Tazarourte
- Service d'accueil des Urgences, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69003 Lyon
| | - D Fouque
- Service de Néphrologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
| | - L Juillard
- Service de Néphrologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69310 Lyon
| | - G Salles
- Service d'Hématologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
| | - C Grange
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, Lyon
| | - I Durieu
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Univ Lyon, Health Services and Performance Research EA7425, Claude Bernard University Lyon, F-69003 Lyon
| | - P Rousset
- Service de radiologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
| | - J C Lega
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, Lyon
- Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University, F-69003 Lyon, France
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Ledoult E, Launay D, Béhal H, Mouthon L, Pugnet G, Lega JC, Agard C, Allanore Y, Jego P, Fauchais AL, Harlé JR, Berthier S, Aouba A, Mekinian A, Diot E, Truchetet ME, Boulon C, Duhamel A, Hachulla E, Sobanski V. Early trajectories of skin thickening are associated with severity and mortality in systemic sclerosis. Arthritis Res Ther 2020; 22:30. [PMID: 32070422 PMCID: PMC7029583 DOI: 10.1186/s13075-020-2113-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/08/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a severe and highly heterogeneous disease. The modified Rodnan skin score (mRSS) is a widely used tool for the assessment of the extent and degree of skin thickness. This study aimed to identify the classes of patients with early similar skin thickening trajectories without any a priori assumptions and study their associations with organ involvement and survival. METHODS From the French SSc national cohort, patients with a disease duration of less than 2 years at inclusion and with at least 2 mRSS available within the first 4 years of follow-up were enrolled. Classes of patients with similar mRSS trajectories were identified based on a latent class mixed model. The clinical characteristics and survival rate were compared between the obtained classes. RESULTS A total of 198 patients fulfilled the inclusion criteria, with a total of 641 mRSS available. The median disease duration and follow-up were 0.8 (interquartile range 0.4; 1.2) and 6.3 (3.8; 8.9) years, respectively. Individual trajectories of mRSS were highly heterogeneous between patients. Models with 1-6 latent classes of trajectories were sequentially assessed, and the 5-class model represented the best fit to data. Each class was characterized by a unique global trajectory of mRSS. The median disease duration did not differ significantly between classes. Baseline organ involvement was more frequent in classes with significant change over time (classes 2-5) than in class 1 (low baseline mRSS without significant change over time). Using Cox regression, we observed a progressively increasing risk of death from classes 1 to 5. CONCLUSIONS Early identification of clinical phenotype based on skin thickening trajectories could predict morbi-mortality in SSc. This study suggested that mRSS trajectories characterization might be pivotal for clinical practice and future trial designs.
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Affiliation(s)
- Emmanuel Ledoult
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - David Launay
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - Hélène Béhal
- Univ. Lille, CHU Lille, EA 2694-Santé publique, épidémiologie et qualité des soins, Unité de Biostatistiques, F-59000, Lille, France
| | - Luc Mouthon
- Hôpital Cochin-APHP, Service de Médecine Interne, Paris, France
| | - Grégory Pugnet
- CHU Toulouse, Service de Médecine Interne, Toulouse, France
| | | | | | | | - Patrick Jego
- CHU Rennes, Service de Médecine Interne, Rennes, France
| | | | - Jean-Robert Harlé
- Hôpital de la Timone, Service de Médecine Interne, Marseille, France
| | - Sabine Berthier
- CHU Dijon, Service de Médecine Interne et Immunologie Clinique, Dijon, France
| | | | - Arsène Mekinian
- Hôpital Saint-Antoine-APHP, Service de Médecine Interne, Paris, France
| | | | | | - Carine Boulon
- CHU Bordeaux, Service de Médecine vasculaire, Bordeaux, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, EA 2694-Santé publique, épidémiologie et qualité des soins, Unité de Biostatistiques, F-59000, Lille, France
| | - Eric Hachulla
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - Vincent Sobanski
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France. .,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France. .,INSERM, U1286, F-59000, Lille, France.
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Belot A, Rice GI, Omarjee SO, Rouchon Q, Smith EMD, Moreews M, Tusseau M, Frachette C, Bournhonesque R, Thielens N, Gaboriaud C, Rouvet I, Chopin E, Hoshino A, Latour S, Ranchin B, Cimaz R, Romagnani P, Malcus C, Fabien N, Sarda MN, Kassai B, Lega JC, Decramer S, Abou-Jaoude P, Bruce IN, Simonet T, Bardel C, Rollat-Farnier PA, Viel S, Reumaux H, O'Sullivan J, Walzer T, Mathieu AL, Marenne G, Ludwig T, Genin E, Ellingford J, Bader-Meunier B, Briggs TA, Beresford MW, Crow YJ. Contribution of rare and predicted pathogenic gene variants to childhood-onset lupus: a large, genetic panel analysis of British and French cohorts. Lancet Rheumatol 2020; 2:e99-e109. [PMID: 38263665 DOI: 10.1016/s2665-9913(19)30142-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a rare immunological disorder and genetic factors are considered important in its causation. Monogenic lupus has been associated with around 30 genotypes in humans and 60 in mice, while genome-wide association studies have identified more than 90 risk loci. We aimed to analyse the contribution of rare and predicted pathogenic gene variants in a population of unselected cases of childhood-onset SLE. METHODS For this genetic panel analysis we designed a next-generation sequencing panel comprising 147 genes, including all known lupus-causing genes in humans, and potentially lupus-causing genes identified through GWAS and animal models. We screened 117 probands fulfilling American College of Rheumatology (ACR) criteria for SLE, ascertained through British and French cohorts of childhood-onset SLE, and compared these data with those of 791 ethnically matched controls from the 1000 Genomes Project and 574 controls from the FREX Consortium. FINDINGS After filtering, mendelian genotypes were confirmed in eight probands, involving variants in C1QA, C1QC, C2, DNASE1L3, and IKZF1. Seven additional patients carried heterozygous variants in complement or type I interferon-associated autosomal recessive genes, with decreased concentrations of the encoded proteins C3 and C9 recorded in two patients. Rare variants that were predicted to be damaging were significantly enriched in the childhood-onset SLE cohort compared with controls; 25% of SLE probands versus 5% of controls were identified to harbour at least one rare, predicted damaging variant (p=2·98 × 10-11). Inborn errors of immunity were estimated to account for 7% of cases of childhood-onset SLE, with defects in innate immunity representing the main monogenic contribution. INTERPRETATION An accumulation of rare variants that are predicted to be damaging in SLE-associated genes might contribute to disease expression and clinical heterogeneity. FUNDING European Research Council.
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Affiliation(s)
- Alexandre Belot
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France; CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France.
| | - Gillian I Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sulliman Ommar Omarjee
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Quentin Rouchon
- Data Mining and Modelling for Biomedicine, VIB Center for Inflammation Research, Ghent, Belgium; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Eve M D Smith
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Marion Moreews
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Maud Tusseau
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Cécile Frachette
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France; CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Raphael Bournhonesque
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Nicole Thielens
- University of Grenoble Alpes, CNRS, CEA, IBS, F-38000 Grenoble, France
| | | | - Isabelle Rouvet
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Emilie Chopin
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Akihiro Hoshino
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, INSERM UMR 1163, Paris, France
| | - Sylvain Latour
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, INSERM UMR 1163, Paris, France; University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Bruno Ranchin
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France
| | - Rolando Cimaz
- Rheumatology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Paula Romagnani
- Nephrology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Christophe Malcus
- Service d'Immunologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon, France
| | - Nicole Fabien
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Marie-Nathalie Sarda
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Behrouz Kassai
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, Hospices Civils de Lyon & Université Lyon 1, 69677, Bron, France
| | - Jean-Christophe Lega
- Internal Medicine Unit, CHLS, Hospices Civils de Lyon, Pierre Benite, Université de Lyon 1, Lyon, France
| | - Stéphane Decramer
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre De Référence des Maladies Rénales Rares du Sud Ouest & Inserm U1048, France
| | - Pauline Abou-Jaoude
- Department of Paediatric Nephrology, St George Hospital, University Medical Center, Beirut, Lebanon
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Thomas Simonet
- Department of Biostatistics-bioinformatics, Hospices Civils de Lyon, 69677, Bron, France
| | - Claire Bardel
- Department of Biostatistics-bioinformatics, Hospices Civils de Lyon, 69677, Bron, France; CNRS UMR5558, Biometry and evolutionary biology lab, Lyon University, Lyon 1 University, F-69622 Villeurbanne, France
| | - Pierre Antoine Rollat-Farnier
- CNRS UMR5558, Biometry and evolutionary biology lab, Lyon University, Lyon 1 University, F-69622 Villeurbanne, France
| | - Sebastien Viel
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | | | - James O'Sullivan
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Thierry Walzer
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Anne-Laure Mathieu
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Gaelle Marenne
- Inserm, Univ Brest, EFS, UMR 1078, GGB, F-29200 Brest, France
| | - Thomas Ludwig
- Inserm, Univ Brest, EFS, UMR 1078, GGB, F-29200 Brest, France; CHU Brest, Brest, France
| | | | - Jamie Ellingford
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Brigitte Bader-Meunier
- Paediatric Rheumatology and Immunology Unit, Necker Hospital, Imagine Institution, Paris, France
| | - Tracy A Briggs
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael W Beresford
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Yanick J Crow
- Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Paris, France; Paris Descartes University, Sorbonne-Paris-Cité, Institut Imagine, Paris, France; Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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Olivier-Gougenheim L, Freychet C, Collardeau-Frachon S, Roure-Sobas C, Di Filippo S, Riva R, Lega JC, Belot A. A quest for Q fever. Lancet 2019; 394:419. [PMID: 31379332 DOI: 10.1016/s0140-6736(19)31675-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/08/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Olivier-Gougenheim
- Department of Paediatric Rheumatology, Nephrology, and Dermatology, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Caroline Freychet
- Department of Paediatric Rheumatology, Nephrology, and Dermatology, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sophie Collardeau-Frachon
- Pathology Department, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Chantal Roure-Sobas
- Microbiology Department, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sylvie Di Filippo
- Paediatric and Congential Cardiology Department, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Roberto Riva
- Department of Interventional Neuroradiology, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Alexandre Belot
- Department of Paediatric Rheumatology, Nephrology, and Dermatology, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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50
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Mai V, Guay CA, Perreault L, Bonnet S, Bertoletti L, Lacasse Y, Jardel S, Lega JC, Provencher S. Extended Anticoagulation for VTE. Chest 2019; 155:1199-1216. [DOI: 10.1016/j.chest.2019.02.402] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/27/2019] [Accepted: 02/19/2019] [Indexed: 12/19/2022] Open
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