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Delestre F, Charles P, Karras A, Pagnoux C, Néel A, Cohen P, Aumaître O, Faguer S, Gobert P, Maurier F, Samson M, Godmer P, Bonnotte B, Cottin V, Hanrotel-Saliou C, Le Gallou T, Carron PL, Desmurs-Clavel H, Direz G, Jourde-Chiche N, Lifermann F, Martin-Silva N, Pugnet G, Quéméneur T, Matignon M, Benhamou Y, Daugas E, Lazaro E, Limal N, Ducret M, Huart A, Viallard JF, Hachulla E, Perrodeau E, Puechal X, Guillevin L, Porcher R, Terrier B. Rituximab as maintenance therapy for ANCA-associated vasculitides: pooled analysis and long-term outcome of 277 patients included in the MAINRITSAN trials. Ann Rheum Dis 2024; 83:233-241. [PMID: 37918894 DOI: 10.1136/ard-2023-224623] [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: 06/24/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To compare the long-term efficacy and safety of azathioprine (AZA), 18-month fixed-schedule rituximab (RTX), 18-month tailored RTX and 36-month RTX in preventing relapses in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis who achieved a complete remission after induction therapy. Patients treated with 36-month RTX received either a fixed or a tailored regimen for the first 18 months and a fixed regimen for the last 18 months (36-month fixed/fixed RTX and 36-month tailored/fixed RTX, respectively). METHODS The Maintenance of Remission using Rituximab in Systemic ANCA-associated Vasculitis (MAINRITSAN) trials sequentially compared: 18-month fixed-schedule RTX versus AZA (MAINRITSAN); 18-month fixed-schedule RTX versus 18-month tailored-RTX (MAINRITSAN2); and extended therapy to 36 months with four additional RTX infusions after MAINRITSAN2 versus placebo (MAINRITSAN3). Patients were then followed prospectively through month 84 and their data were pooled to analyse relapses and adverse events. The primary endpoint was relapse-free survival at month 84. RESULTS 277 patients were enrolled and divided in 5 groups: AZA (n=58), 18-month fixed-schedule RTX (n=97), 18-month tailored-RTX (n=40), 36-month tailored/fixed RTX (n=42), 36-month fixed/fixed RTX (n=41). After adjustment for prognostic factors, 18-month fixed-schedule RTX was superior to AZA in preventing major relapses at month 84 (HR 0.38, 95% CI 0.20 to 0.71). The 18-month tailored-RTX regimen was associated with an increased risk of major relapse compared with fixed-schedule regimen (HR 2.92, 95% CI 1.43 to 5.96). The risk of major relapse was similar between 36-month fixed/fixed and 18-month fixed-RTX (HR 0.69, 95% CI 0.38 to 1.25). CONCLUSIONS According to these results, it appears that the 84-month remission rate is higher with an 18-month fixed RTX regimen compared with AZA and 18-month tailored RTX. Also, extending RTX to 36 months does not appear to reduce the long-term relapse rate compared with the 18-month fixed RTX regimen. However, as this study was underpowered to make this comparison, further prospective studies are needed to determine the potential long-term benefits of extending treatment in these patients.
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Affiliation(s)
- Florence Delestre
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Pierre Charles
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Alexandre Karras
- Université Paris Cité, Paris, France
- Department of Nephrology, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Christian Pagnoux
- University of Toronto, Toronto, Ontario, Canada
- Vasculitis clinic, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Antoine Néel
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pascal Cohen
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
| | - Olivier Aumaître
- Department of Internal Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Gobert
- Département de médecine, Hopital Général Henri-Duffaut, Avignon, France
| | - François Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Maxime Samson
- Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Pascal Godmer
- Département de Hématologie Immunologie, Centre Hospitalier Bretagne Atlantique de Vannes, Vannes, France
| | - Bernard Bonnotte
- Département de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Lyon, France
| | - Catherine Hanrotel-Saliou
- Department of Nephrology, Centre Hospitalier Universitaire de Brest, Hôpital la Cavale Blanche, Brest, France
| | - Thomas Le Gallou
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Pierre-Louis Carron
- Département de néphrologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | | | - Guillaume Direz
- Rheumatology Department, Le Mans General Hospital, Le Mans, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de La Conception, Aix-Marseille Université, Marseille, France
| | | | - Nicolas Martin-Silva
- Department of Internal Medicine, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Grégory Pugnet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Thomas Quéméneur
- Département de Néphrologie et de Médecine Interne, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Marie Matignon
- Nephrology and Renal Transplantation Department, Hopitaux Universitaires Henri Mondor, Créteil, France
| | - Ygal Benhamou
- Department of Internal Medicine, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France
| | - Eric Daugas
- Department of Nephrology, Hopital Bichat - Claude-Bernard, Paris, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Bordeaux University Hospital, Pessac, France
| | - Nicolas Limal
- Department of Internal Medicine, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Maïzé Ducret
- Department of Nephrology, Annecy Hospital, Annecy, France
| | - Antoine Huart
- Department of Nephrology, Hospital Rangueil, Toulouse, France
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Elodie Perrodeau
- Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
| | - Xavier Puechal
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Raphaël Porcher
- Université Paris Cité, Paris, France
- Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP.Centre, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
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Le Gall A, Hoang-Thi TN, Porcher R, Dunogué B, Berezné A, Guillevin L, Le Guern V, Cohen P, Chaigne B, London J, Groh M, Paule R, Chassagnon G, Vakalopoulou M, Dinh-Xuan AT, Revel MP, Mouthon L, Régent A. Prognostic value of automated assessment of interstitial lung disease on CT in systemic sclerosis. Rheumatology (Oxford) 2024; 63:103-110. [PMID: 37074923 DOI: 10.1093/rheumatology/kead164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE Stratifying the risk of death in SSc-related interstitial lung disease (SSc-ILD) is a challenging issue. The extent of lung fibrosis on high-resolution CT (HRCT) is often assessed by a visual semiquantitative method that lacks reliability. We aimed to assess the potential prognostic value of a deep-learning-based algorithm enabling automated quantification of ILD on HRCT in patients with SSc. METHODS We correlated the extent of ILD with the occurrence of death during follow-up, and evaluated the additional value of ILD extent in predicting death based on a prognostic model including well-known risk factors in SSc. RESULTS We included 318 patients with SSc, among whom 196 had ILD; the median follow-up was 94 months (interquartile range 73-111). The mortality rate was 1.6% at 2 years and 26.3% at 10 years. For each 1% increase in the baseline ILD extent (up to 30% of the lung), the risk of death at 10 years was increased by 4% (hazard ratio 1.04, 95% CI 1.01, 1.07, P = 0.004). We constructed a risk prediction model that showed good discrimination for 10-year mortality (c index 0.789). Adding the automated quantification of ILD significantly improved the model for 10-year survival prediction (P = 0.007). Its discrimination was only marginally improved, but it improved prediction of 2-year mortality (difference in time-dependent area under the curve 0.043, 95% CI 0.002, 0.084, P = 0.040). CONCLUSION The deep-learning-based, computer-aided quantification of ILD extent on HRCT provides an effective tool for risk stratification in SSc. It might help identify patients at short-term risk of death.
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Affiliation(s)
- Aëlle Le Gall
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | | | - Raphaël Porcher
- Université de Paris, Paris, France
- Service d'Epidémiologie Clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - Bertrand Dunogué
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Alice Berezné
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Véronique Le Guern
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Jonathan London
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Matthieu Groh
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Romain Paule
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Guillaume Chassagnon
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Maria Vakalopoulou
- Centre de Vision Numérique, École Centrale Supelec, Gif-sur-Yvette, France
| | - Anh-Tuan Dinh-Xuan
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Cochin, AP-HP, Paris, France
| | - Marie Pierre Revel
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
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Liberatore J, Nguyen Y, Hadjadj J, Cohen P, Mouthon L, Puéchal X, Guillevin L, Terrier B. Risk factors for hypogammaglobulinemia and association with relapse and severe infections in ANCA-associated vasculitis: A cohort study. J Autoimmun 2024; 142:103130. [PMID: 37956529 DOI: 10.1016/j.jaut.2023.103130] [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: 04/07/2023] [Revised: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES B-cell depletion induced by rituximab (RTX) in ANCA-associated vasculitis (AAV) is a risk factor for hypogammaglobulinemia. Aggregating data on gammaglobulin levels kinetics during RTX and its association with the risk of relapse and severe infection is of interest. METHODS Gammaglobulin levels were collected before induction therapy and during RTX maintenance therapy. We used different definitions of gammaglobulin decline: 1/gammaglobulin levels <6 g/L after induction; 2/>25 % decline in gammaglobulin levels between induction and maintenance, and 3/both. Our primary objective was the impact of gammaglobulin decline on the risk of relapse and severe infections. RESULTS We included 98 patients. Patients with gammaglobulin level <6 g/L after induction and gammaglobulin decline >25 % were older (OR 3.9; 95%CI 1.1-16.1), had more frequently baseline gammaglobulin levels <10 g/L (OR 6.0; 95%CI 1.7-25.8) and received more frequent pulses of methylprednisolone at induction (OR 4.6; 95%CI 1.3-18.5). Severe infection-free survival was significantly poorer in patients with both gammaglobulin <6 g/L and gammaglobulin decline >25 % (adjusted HR 2.3; 95%CI 1.0-5.1) and in those who received pulses of methylprednisolone (HR 5.6; 95%CI 2.3-13.4). Gammaglobulin decline was in contrast not associated with the risk of relapse. CONCLUSION Older age, low gammaglobulin levels and pulses of methylprednisolone at induction increase the likelihood of gammaglobulin decline after induction therapy. Such decline was associated with an increased risk of severe infections but not lower risk of vasculitis relapse. Pulses of methylprednisolone at induction had an independent negative impact on gammaglobulin levels and the risk of severe infections.
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Affiliation(s)
- Johanne Liberatore
- Department of Internal Medicine, Centre Hospitalier d'Angoulême, Chemin du Grand Girac, 16959, Angoulême, France
| | - Yann Nguyen
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France
| | - Jérôme Hadjadj
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France
| | - Pascal Cohen
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France
| | - Luc Mouthon
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, AP-HP.Centre, Université Paris Cité, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris, Cedex 14, France; Université Paris Cité, F-75006, Paris, France.
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4
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Cottu A, Groh M, Desaintjean C, Marchand-Adam S, Guillevin L, Puechal X, Beaumesnil S, Lazaro E, Samson M, Taille C, Durel CA, Diot E, Nicolas S, Guilleminault L, Ebbo M, Cathebras P, Dupin C, Yildiz H, Belfeki N, Pugnet G, Chauvin P, Jouneau S, Lifermann F, Martellosio JP, Cottin V, Terrier B. Benralizumab for eosinophilic granulomatosis with polyangiitis. Ann Rheum Dis 2023; 82:1580-1586. [PMID: 37550002 DOI: 10.1136/ard-2023-224624] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Benralizumab is effective in the treatment of eosinophilic asthma and is being investigated for the treatment of other eosinophil-associated diseases. Reports on the use of benralizumab for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) are limited to case reports and small case series. METHODS We conducted a multicentre, retrospective study including EGPA patients treated with off-label benralizumab. The primary endpoint was the rate of complete response defined as no disease activity (Birmingham Vasculitis Activity Score=0) and a prednisone dose ≤4 mg/day. Partial response was defined as no disease activity and a prednisone dose ≥4 mg/day. RESULTS Sixty-eight patients were included, including 31 (46%) who had previously received mepolizumab. The use of benralizumab was warranted by uncontrolled asthma in 54 (81%), persistent ear, nose and throat (ENT) manifestations in 27 (40%) and persistent glucocorticoids (GCs) use in 48 (74%) patients. Median (IQR) follow-up after starting benralizumab was 23 (9-34) months. Thirty-three patients (49%) achieved a complete response, 24 (36%) achieved a partial response and 10 (15%) did not respond. Among the 57 patients who initially responded, 10 (18%) eventually required further line treatments. GCs were discontinued in 23 patients (38%). Prior mepolizumab use was associated with a higher rate of primary failure (26.7% vs 5.4%, p=0.034) and less frequent GCs discontinuation (14.8% vs 55.9%, p=0.001). Vasculitis flares occurred in 7 patients (11%) and were associated with histological evidence of vasculitis and/or antineutrophil cytoplasmic antibodies positivity at benralizumab initiation (p=0.004). CONCLUSIONS Benralizumab appears to be an effective treatment for refractory asthma or ENT manifestations in EGPA and allows GC-sparing. However, its efficacy was lower after prior failure of mepolizumab.
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Affiliation(s)
- Adrien Cottu
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Matthieu Groh
- National Referral Center for Hypereosinophilic Syndrome (CEREO), Department of Internal Medicine, Hopital Foch, Suresnes, France
| | - Charlene Desaintjean
- Department of Respiratory Diseases, Hospital for Cardiologie and Pneumology Louis Pradel, Lyon, France
| | - Sylvain Marchand-Adam
- Service de pneumologie et d'explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Xavier Puechal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
| | - Stacy Beaumesnil
- Department of Internal Medicine and Infectious Diseases, University Hospital Centre, Bordeaux, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, University Hospital Centre, Bordeaux, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital Centre, Dijon, France
| | - Camille Taille
- Reference Center for Rare Pulmonary Diseases and University of Paris Cité, Inserm 1152, Hospital Bichat - Claude-Bernard, Paris, France
| | | | - Elizabeth Diot
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Sarah Nicolas
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Laurent Guilleminault
- Department of Respiratory Medicine, University Hospital Centre Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, CNRS U5282, Toulouse 2 University, Toulouse, France
| | - Mikael Ebbo
- Departement of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Clairelyne Dupin
- Reference Center for Rare Pulmonary Diseases and University of Paris Cité, Hospital Bichat - Claude-Bernard, Paris, France
| | - Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Nabil Belfeki
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Grégory Pugnet
- Department of Internal Medicine and Clinical Immunology, CHU Toulouse Rangueil, Toulouse, France
| | - Pierre Chauvin
- Department of Respiratory Diseases, University Hospital Centre Rennes, Rennes, France
| | - Stephane Jouneau
- Department of Respiratory Diseases, IRSET UMR 1085, Rennes 1 University, Pontchaillou Hospital, Rennes, France
| | | | | | - Vincent Cottin
- Department of Respiratory Diseases, Hospital for Cardiologie and Pneumology Louis Pradel, Lyon, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hospital Cochin, Paris, France
- Université Paris Cité, Paris, France
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5
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Amsler J, Everts-Graber J, Martin KR, Roccabianca A, Lopes C, Tourneur L, Mocek J, Karras A, Naccache JM, Bonnotte B, Samson M, Hanslik T, Puéchal X, Terrier B, Guillevin L, Néel A, Mouthon L, Witko-Sarsat V. Dysregulation of neutrophil oxidant production and interleukin-1-related cytokines in granulomatosis with polyangiitis. Rheumatology (Oxford) 2023:kead578. [PMID: 37947315 DOI: 10.1093/rheumatology/kead578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Neutrophils play a key role in ANCA-associated vasculitis, both as targets of autoimmunity and facilitators of vascular damage. In granulomatosis with polyangiitis (GPA), data regarding the production of reactive oxygen species (ROS) in neutrophils are unclear. Further, recent data suggests that ROS production could have an anti-inflammatory effect through the regulation of the inflammasome and IL-1-related cytokines. We aimed to analyse the ROS production in neutrophils from patients with GPA and investigate its association with IL-1-related cytokines and the autoantigen proteinase 3 (PR3). METHODS Seventy-two GPA patients with disease flare were included in the NEUTROVASC prospective cohort study. ROS production was evaluated in whole blood of patients with active GPA and compared with the same patients in remission or healthy controls. Associations between ROS production, PR3 membrane expression on neutrophils, serum levels of IL-1-related cytokines as well as inflammasome-related proteins were analyzed. RESULTS We observed a robust defect in ROS production by neutrophils from patients with active GPA compared with healthy controls, independent of glucocorticoid treatment. Serum levels of IL-1-related cytokines were significantly increased in GPA patients, particularly in patients with kidney involvement, and levels of these cytokines returned to normal after patients achieved remission. Further, inflammasome-related proteins were significantly dysregulated in the cytosol of neutrophils as well as the serum from GPA patients. CONCLUSION Our data suggests that ROS production and regulation of the inflammasome in neutrophils from patients with GPA are disturbed and may be a potential therapeutic target. CLINICAL TRIAL REGISTRATION NUMBER NCT01862068, clinicaltrials.gov, https://www.clinicaltrials.gov.
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Affiliation(s)
- Jennifer Amsler
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Rheumatology and Immunology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Judith Everts-Graber
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Rheumatology and Immunology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katherine R Martin
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Inflammation division, WEHI and Department of Medical Biology, University of Melbourne, Parkville, Australia
| | - Arnaud Roccabianca
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Chloé Lopes
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Léa Tourneur
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Julie Mocek
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Marc Naccache
- Department of Pulmonology-Allergology-Thoracic Oncology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Bernard Bonnotte
- Service de Médecine Interne et immunologie Clinique, CHU Dijon, Dijon, France
| | - Maxime Samson
- Service de Médecine Interne et immunologie Clinique, CHU Dijon, Dijon, France
| | - Thomas Hanslik
- Service de Médecine Interne, Hôpital Ambroise-Paré, AP-HP, Boulogne Billancourt, France
| | - Xavier Puéchal
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Benjamin Terrier
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Loïc Guillevin
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Antoine Néel
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Luc Mouthon
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
- Department of Internal Medicine, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Cochin Hospital, AP-HP, Paris, France
| | - Véronique Witko-Sarsat
- INSERM U1016 Cochin Institute, CNRS UMR 8104, Paris, France
- Université Paris Cité, Paris, France
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6
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Sorin B, Iudici M, Guerry MJ, Samson M, Bielefeld P, Maillet T, Nouvier M, Karras A, Meyer L, Lavigne C, Régent A, Durel CA, Fabre M, Charles P, Raimbourg Q, Lanteri A, Pugnet G, Rivière F, Pineton de Chambrun M, Cacoub P, Le Guenno G, Jourdain P, Mekinian A, Paule R, Dion J, Legendre P, Cohen P, Guillevin L, Puéchal X, Terrier B. Induction failure in granulomatosis with polyangiitis: a nationwide case-control study of risk factors and outcomes. Rheumatology (Oxford) 2023; 62:3662-3671. [PMID: 36847447 DOI: 10.1093/rheumatology/kead098] [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: 11/22/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE To identify characteristics of granulomatosis with polyangiitis (GPA) associated with induction failure, describe salvage therapies and their efficacy. METHODS We conducted a nationwide retrospective case-control study of GPA with induction failure between 2006 and 2021. Each patient with induction failure was randomly paired to three controls matched for age, sex and induction treatment. RESULTS We included 51 patients with GPA and induction failure (29 men and 22 women). At induction therapy, median age was 49 years. Twenty-seven patients received intravenous cyclophosphamide (ivCYC) and 24 rituximab (RTX) as induction therapy. Patients with ivCYC induction failure more frequently had PR3-ANCA (93% vs 70%, P = 0.02), relapsing disease (41% vs 7%, P < 0.001) and orbital mass (15% vs 0%, P < 0.01) compared with controls. Patients with disease progression despite RTX induction therapy more frequently had renal involvement (67% vs 25%, P = 0.02) with renal failure (serum creatinine >100 µmol/l in 42% vs 8%, P = 0.02) compared with controls. After salvage therapy, remission was achieved at 6 months in 35 (69%) patients. The most frequent salvage therapy was switching from ivCYC to RTX (or vice versa), showing an efficacy in 21/29 (72%). Remission was achieved in nine (50%) patients with inappropriate response to ivCYC, while in patients with progression after RTX induction, remission was achieved in four (100%) who received ivCYC (with or without immunomodulatory therapy), but only in three (50%) after adding immunomodulatory therapy alone. CONCLUSION In patients with induction failure, characteristics of GPA, salvage therapies and their efficacy vary according to induction therapy and failure modality.
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Affiliation(s)
- Boris Sorin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Michele Iudici
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Mary-Jane Guerry
- Department of Nephrology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Hôpital François Mitterrand, Dijon, France
| | - Philip Bielefeld
- Department of Nephrology and Systemic Diseases, Hôpital François Mitterrand, Dijon, France
| | - Thibault Maillet
- Department of Internal Medicine and Clinical Immunology, Hôpital François Mitterrand, Dijon, France
| | - Mathilde Nouvier
- Department of Nephrology, Centre Hospitalier Lyon Sud, Lyon, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Lara Meyer
- Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Christian Lavigne
- Department of Internal Medicine-Clinical Immunology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marc Fabre
- Department of Internal Medicine, Centre Hospitalier Pierre Oudot, Bourgouin, France
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Quentin Raimbourg
- Department of Nephrology, Hôpital Bichat Claude Bernard, Paris, France
| | - Aurélia Lanteri
- Department of Internal Medicine-Infectious Diseases, Centre Hospitalier d'Antibes, Antibes, France
| | - Grégory Pugnet
- Department of Internal Medicine and Clinical Immunology, Hôpital Rangueil, Toulouse, France
| | - Frédéric Rivière
- Department of Pneumology, Hôpital d'Instruction des Armées Percy, Clamart, France
| | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Hôpital Pitié Salpêtrière, Paris, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Hôpital d'Estaing, Clermont-Ferrand, France
| | - Pierre Jourdain
- Department of Nephrology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Jérémie Dion
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Paul Legendre
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
- Department of Clinical Immunology, Centre Hospitalier du Mans, Le Mans, France
| | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
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7
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Akdime F, Habib S, Regard L, Terrier B, Cohen P, Mouthon L, Guillevin L, Burgel PR, Honore I, Puéchal X, Roche N. [Anti-IL-5 in severe asthma associated with eosinophilic granulomatosis with polyangiitis. Real-life study]. Rev Mal Respir 2023; 40:732-742. [PMID: 37923651 DOI: 10.1016/j.rmr.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/17/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of necrotizing vasculitis affecting small vessels and typically characterized by severe glucocorticoid (GC)-dependent eosinophilic asthma. While mepolizumab, which is indicated at a dose of 100mg/4weeks in severe eosinophilic asthma, has been shown to be an effective treatment for EGPA-related asthma at a dose of 300mg/4weeks, it was only recently approved at this dose. METHODS This retrospective, single-center, observational study was conducted to investigate over a 5-year period (2014-2019) the effect of mepolizumab 100mg/4weeks at 12months in patients with EGPA and glucocorticoid-dependant severe asthma. Response to treatment was defined as reduction in daily dose of oral corticosteroids to at most 5mg/day or reduction in annual exacerbation by at least 50%. RESULTS Thirty patients were included, of whom twenty-three were treated (two were not fully evaluable). Among the 21 evaluable treated patients, 13 (62%) had responded at 12months. At baseline, non-responders had lower FEV1 levels and lower blood eosinophil levels than responders. CONCLUSIONS Mepolizumab at a "severe asthma" dose (100mg/4weeks) is effective in treatment of GC-dependent severe asthma in most patients with EGPA.
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Affiliation(s)
- F Akdime
- Service de pneumologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Paris, France
| | - S Habib
- Service de pneumologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Paris, France
| | - L Regard
- Service de pneumologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France
| | - B Terrier
- Service de médecine interne, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France, hôpital Cochin, université Paris Cité, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France
| | - P Cohen
- Service de médecine interne, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France, hôpital Cochin, université Paris Cité, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France
| | - L Mouthon
- Service de médecine interne, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France, hôpital Cochin, université Paris Cité, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France
| | - L Guillevin
- Service de médecine interne, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France, hôpital Cochin, université Paris Cité, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France
| | - P R Burgel
- Service de pneumologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France
| | - I Honore
- Service de pneumologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Paris, France
| | - X Puéchal
- Service de médecine interne, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France, hôpital Cochin, université Paris Cité, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France
| | - N Roche
- Service de pneumologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Paris, France; Institut Cochin, Inserm UMR1016, université Paris Cité, Paris, France.
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8
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Khoudour N, Delestre F, Jabot-Hanin F, Jouinot A, Nectoux J, Letouneur F, Izac B, Vidal M, Guillevin L, Puéchal X, Charles P, Terrier B, Blanchet B. Association Between Plasma Rituximab Concentration and the Risk of Major Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitides During Rituximab Maintenance Therapy. Arthritis Rheumatol 2023; 75:2003-2013. [PMID: 37134130 DOI: 10.1002/art.42556] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Interindividual variability in response to rituximab remains unexplored in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Rituximab pharmacokinetics (PK) and pharmacodynamics (PD) as well as genetic polymorphisms could contribute to variability. This ancillary study of the MAINRITSAN 2 trial aimed to explore the relationship between rituximab plasma concentration, genetic polymorphisms in PK/PD candidate genes, and clinical outcomes. METHODS Patients included in the MAINRITSAN2 trial (ClinicalTrials.gov identifier: NCT01731561) were randomized to receive a 500-mg fixed-schedule rituximab infusion or an individually tailored regimen. Rituximab plasma concentrations at month 3 (CM3) were assessed. DNA samples (n = 53) were genotyped for single-nucleotide polymorphisms within 88 putative PK/PD candidate genes. The relationship between PK/PD outcomes and genetic variants was investigated using logistic linear regression in additive and recessive genetic models. RESULTS One hundred and thirty-five patients were included. The frequency of underexposed patients (<4 μg/ml) in the fixed-schedule group was statistically lower compared to that in the tailored-infusion group (2.0% versus 18.0%; P = 0.02, respectively). Low rituximab plasma concentration at 3 months (CM3 <4 μg/ml) was an independent risk factor for major relapse (odds ratio 6.56 [95% confidence interval (95% CI) 1.26-34.09]; P = 0.025) at month 28 (M28). A sensitivity survival analysis also identified CM3 <4 μg/ml as an independent risk factor for major relapse (hazard ratio [HR] 4.81 [95% CI 1.56-14.82]; P = 0.006) and relapse (HR 2.70 [95% CI 1.02-7.15]; P = 0.046). STAT4 rs2278940 and PRKCA rs8076312 were significantly associated with CM3 but not with major relapse onset at M28. CONCLUSION These results suggest that drug monitoring could be useful to individualize the schedule of rituximab administration within the maintenance phase.
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Affiliation(s)
- Nihel Khoudour
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, CARPEM, Paris, France
| | - Florence Delestre
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabienne Jabot-Hanin
- Bioinformatic Platform, INSERM UMR 1163, Institut Imagine, and Bioinformatics Core Facility, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS 3633, Université Paris Cité, Paris, France
| | - Anne Jouinot
- Institut du Cancer Paris CARPEM, AP-HP, APHP Centre, Department of Medical Oncology, ARIANE, Cochin Hospital, and INSERM U-1016, CNRS UMR-8104, Université Paris Cité, Institut Cochin, Paris, France
| | - Juliette Nectoux
- Fédération de Génétique et Médecine Génomique, Hôpital Cochin, AP-HP, Centre-Université Paris Cité, 27 rue du Faubourg-Saint-Jacques, Paris, France, and Université Paris Cité, Paris, France
| | - Franck Letouneur
- INSERM U-1016, CNRS UMR-8104, Université Paris Cité, Institut Cochin, Paris, France
| | - Brigitte Izac
- INSERM U-1016, CNRS UMR-8104, Université Paris Cité, Institut Cochin, Paris, France
| | - Michel Vidal
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, UMR8038 CNRS, U1268 INSERM, Faculté de Pharmacie, PRES Sorbonne Paris Cité, CARPEM, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, Paris, France
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, Paris, France
| | - Benoit Blanchet
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, UMR8038 CNRS, U1268 INSERM, Faculté de Pharmacie, PRES Sorbonne Paris Cité, CARPEM, Paris, France
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9
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Delestre F, Brun AL, Thoreau B, Taillé C, Limal N, Puéchal X, Mouthon L, Guillevin L, Revel MP, Terrier B. Clinico-radiological correlation and prognostic value of baseline chest computed tomography in eosinophilic granulomatosis with polyangiitis. Rheumatology (Oxford) 2023; 62:3350-3357. [PMID: 36790066 DOI: 10.1093/rheumatology/kead077] [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: 11/16/2022] [Revised: 01/02/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES While chest high-resolution CT (HRCT) is correlated to severity and prognosis in asthma, it has not been studied in eosinophilic granulomatosis with polyangiitis (EGPA). Our objective is to study the prognostic value of baseline HRCT in EGPA patients. METHODS Retrospective, multicentre observational study in three French hospitals, including EGPA patients with available chest HRCT before any systemic treatment. Two experienced radiologists blinded to clinical data evaluated HRCT images using semi-quantitative scoring. HRCT characteristics were correlated with clinical features and outcome. RESULTS Among 46 patients, 38 (82.6%) had abnormal parenchymal findings on HRCT, including bronchial wall thickening (69.6%), mosaic perfusion (63.0%), ground-glass opacities (32.6%), bronchiectasis (30.4%), mucous plugging (21.7%) and consolidations (17.4%). Patients were clustered into three groups depending on HRCT features: ground-glass pattern, i.e. with ground-glass opacities with or without bronchial abnormalities (group 1, 28.3%), bronchial pattern (group 2, 41.3%) and extra-pulmonary pattern with no significant abnormality (group 3, 30.4%). Group 2 showed less frequent cardiac involvement (31.6 vs 46.2 and 42.9% in groups 1 and 3), more frequent positive ANCA (52.6 vs 0.0 and 14.3%) and higher eosinophil count (median 7510 vs 4000 and 4250/mm3). Group 1 showed worse prognosis with more frequent steroid-dependency (58.3 vs 11.1 and 28.6%) and requirement for mepolizumab (25.0 vs 11.1 and 7.1%). Conversely, group 2 showed a better outcome with higher rates of remission (88.9 vs 41.6 and 71.4%). CONCLUSION Chest HRCT at diagnosis of EGPA may have prognostic value and help clinicians better manage these patients.
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Affiliation(s)
- Florence Delestre
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP)-Centre Université de Paris (CUP), Paris, France
- Université de Paris, Paris, France
| | | | - Benjamin Thoreau
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP)-Centre Université de Paris (CUP), Paris, France
- Université de Paris, Paris, France
| | - Camille Taillé
- Université de Paris, Paris, France
- Service de Pneumologie, Hôpital Bichat, AP-HP-Nord Université de Paris (NUP), Paris, France
| | - Nicolas Limal
- Service de Médecine Interne, Hôpital Henri Mondor, Université Paris Est Créteil, AP-HP, Créteil, France
| | - Xavier Puéchal
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP)-Centre Université de Paris (CUP), Paris, France
- Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP)-Centre Université de Paris (CUP), Paris, France
- Université de Paris, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP)-Centre Université de Paris (CUP), Paris, France
- Université de Paris, Paris, France
| | - Marie-Pierre Revel
- Université de Paris, Paris, France
- Service de Radiologie, Hôpital Cochin, AP-HP.CUP, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP)-Centre Université de Paris (CUP), Paris, France
- Université de Paris, Paris, France
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10
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Romand X, Paclet MH, Chuong MV, Gaudin P, Pagnoux C, Guillevin L, Terrier B, Baillet A. Serum calprotectin and renal function decline in ANCA-associated vasculitides: a post hoc analysis of MAINRITSAN trial. RMD Open 2023; 9:e003477. [PMID: 37903568 PMCID: PMC10619089 DOI: 10.1136/rmdopen-2023-003477] [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: 07/07/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE Serum calprotectin appears to be an interesting biomarker associated with renal vascular disease activity in antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). The aim of this study was to assess whether serum calprotectin levels can predict decline in renal function in AAV patients receiving maintenance therapy. METHODS Serum calprotectin levels were assessed at inclusion and month 6 in AAV patients, in complete remission after induction therapy, randomly assigned to rituximab or azathioprine. Renal function decline was defined as a 25% decrease in estimated glomerular filtration rate (eGFR) and a change in the eGFR category, or a decrease of 15 mL/min/1.73 m2. Relapse was defined as a Birmingham Vasculitis Activity Score >0 attributable to active vasculitis. RESULTS Seventy-six AAV were included. Serum calprotectin increased from baseline to month 6 in patients with renal function decline (7940 (-226.0, 28 691) ng/ml vs -4800 (-18 777, 3708) ng/ml; p<0.001). An increase of calprotectin level was associated with a higher risk of subsequent renal function decline even after adjustment (OR 6.50 (95% CI 1.7 to 24.9) p=0.006). A significantly higher risk of relapse was observed in proteinase 3- AAV patients with an increase of serum calprotectin levels (OR 5.6 (95% CI 1.0 to 31.2), p=0.03). CONCLUSION An increase in serum calprotectin by month 6 compared with inclusion during remission-maintenance therapy in AAV was associated with a higher risk of renal function decline in the following 12 months. TRIAL REGISTRATION NUMBER NCT00748644.
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Affiliation(s)
- Xavier Romand
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | - Marie Hélène Paclet
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | - Minh Vu Chuong
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | - Philippe Gaudin
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
| | | | - Loïc Guillevin
- Université de Paris, Paris, France
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hopital Cochin APHP-Centre Université Paris (CUP), Paris, France
| | - Benjamin Terrier
- Université de Paris, Paris, France
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hopital Cochin APHP-Centre Université Paris (CUP), Paris, France
| | - Athan Baillet
- CNRS, UMR 5525, T-RAIG, TIMC, CHU Grenoble Alpes, Universite Grenoble Alpes, Grenoble, France
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11
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Rohmer J, Nguyen Y, Trefond L, Agard C, Allain JS, Berezne A, Charles P, Cohen P, Gondran G, Groh M, Huscenot T, Lacout C, Lazaro E, London J, Maurier F, Mekinian A, Mesbah R, Nubourgh I, Perard L, Puéchal X, Pugnet G, Puyade M, Queyrel V, Roux A, Rouzaud D, Durel CA, Guillevin L, Terrier B. Clinical features and long-term outcomes of patients with systemic polyarteritis nodosa diagnosed since 2005: Data from 196 patients. J Autoimmun 2023; 139:103093. [PMID: 37536165 DOI: 10.1016/j.jaut.2023.103093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The landscape of polyarteritis nodosa (PAN) has substantially changed during the last decades. Recent data regarding causes, characteristics, and prognosis of systemic PAN in the modern era are lacking. METHODS This retrospective study included patients with systemic PAN referred to the French Vasculitis Study Group between 2005 and 2019. Characteristics, associated conditions and outcomes were collected, and predictors of relapse and death were analyzed. RESULTS 196 patients were included. Main clinical symptoms were constitutional (84%), neurological (59%), skin (58%) and musculoskeletal (58%) manifestations. Secondary PAN accounted for 55 (28%) patients, including myelodysplastic syndrome (9%), solid cancer (7%), lymphoma (4%) and autoinflammatory diseases (4%). No patient had active HBV infection. All treated patients (98.5%) received glucocorticoids (GCs), alone (41%) or in combination with immunosuppressants (59%), with remission achieved in 90%. Relapses were independently associated with age >65 years (HR 1.85; 95% CI1.12-3.08), gastrointestinal involvement (1.95; 95% CI1.09-3.52) and skin necrotic lesions (HR 1.95; 95%CI 1.24-3.05). One-, 5- and 10-year overall survival rates were 93%, 87% and 81%, respectively. In multivariate analyses, age >65 years (HR 2.80; 95%CI 1.23-6.37), necrotic purpura (HR 4.16; 95%CI 1.62-10.70), acute kidney injury (HR 4.89; 95% 1.71-13.99) and secondary PAN (HR 2.98; 95%CI 1.29-6.85) were independently associated with mortality. CONCLUSION Landscape of PAN has changed during the last decades, with the disappearance of HBV-PAN and the emergence of secondary PAN. Relapse rate remains high, especially in aged patients with gastrointestinal and cutaneous necrosis, as well as mortality.
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Affiliation(s)
- Julien Rohmer
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France; Autoimmunity Team, Immunology of Viral Infections and Autoimmune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Ludovic Trefond
- Department of Internal Medicine, CHU, Clermont Ferrand, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Service de médecine interne, F-44000, Nantes, France
| | | | - Alice Berezne
- Department of Internal Medicine, CH, Annecy, Genevois, France
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Guillaume Gondran
- Department of Internal Medicine and dermatology, CHU, Limoges, France
| | - Matthieu Groh
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes, Foch Hospital, Suresnes, France; University of Lille, INSERM U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Tessa Huscenot
- Department of Internal Medicine, Hôpital Ambroise Parée, Paris, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, CHU, Angers, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Hôpital Haut Leveque, CHU, Bordeaux, France
| | - Jonathan London
- Department of Internal Medicine, Hôpital de la Croix Saint Simon, Paris, France
| | | | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Rafik Mesbah
- Department of Internal Medicine, CH, de Boulogne sur Mer, France
| | - Isabelle Nubourgh
- Department of Internal Medicine, Université libre de Bruxelles, Belgique
| | - Laurent Perard
- Department of Internal Medicine, Hôpital Saint Joseph Saint Luc, Lyon, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Gregory Pugnet
- Department of Internal Medicine and clinical immunology, CHU, Toulouse, France
| | | | | | - Arthur Roux
- Department of Nephrology, HEGP, Paris, France
| | - Diane Rouzaud
- Department of Internal Medicine, Hôpital Bichat, Paris, France
| | | | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP.Centre, Université Paris Cité, Paris, France; University Paris-Cité, F-75006, Paris, France.
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David C, Hamel Y, Smahi A, Diot E, Benhamou Y, Girszyn N, Le Gallou T, Lifermann F, Godmer P, Maurier F, Cottin V, Grados A, Aumaitre O, Néel A, Pugnet G, Masson C, Puéchal X, Mouthon L, Guillevin L, Bienvenu T, Terrier B. Identification of EPX Variants in Human Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss). J Allergy Clin Immunol Pract 2023; 11:1960-1963.e3. [PMID: 36868475 DOI: 10.1016/j.jaip.2023.02.019] [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] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Clémence David
- Service de Médecine Interne, Hôpital Cochin, Paris, France; Centre de Référence National des Maladies Auto-Immunes et Systémiques Rares, Hôpital Cochin, Paris, France
| | - Yamina Hamel
- INSERM, UMR 1163, Imagine Institute, Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Asma Smahi
- INSERM, UMR 1163, Imagine Institute, Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau, Tours, France
| | - Ygal Benhamou
- Service de Médecine Interne, CHU de Rouen, Rouen, France
| | | | | | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier Dax-Côte d'Argent, Dax, France
| | - Pascal Godmer
- Service de Médecine Interne, CH Bretagne Atlantique, Vannes, France
| | | | - Vincent Cottin
- Service de Pneumologie, Hôpital Louis Pradel, Lyon, France
| | - Aurélie Grados
- Service de Médecine Interne, Centre Hospitalier de Niort, Niort, France
| | - Olivier Aumaitre
- Service de Médecine Interne, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Antoine Néel
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Grégory Pugnet
- Service de Médecine Interne, CHU Toulouse Purpan, Toulouse, France
| | - Cecile Masson
- Plateforme de Bioinformatique, INSERM UMR1163, Université de Paris, Imagine Institute, Paris, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Paris, France; Centre de Référence National des Maladies Auto-Immunes et Systémiques Rares, Hôpital Cochin, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Paris, France; Centre de Référence National des Maladies Auto-Immunes et Systémiques Rares, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Paris, France; Centre de Référence National des Maladies Auto-Immunes et Systémiques Rares, Hôpital Cochin, Paris, France
| | - Thierry Bienvenu
- Médecine Génomique des Maladies de Système et d'Organe, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Paris, France; Centre de Référence National des Maladies Auto-Immunes et Systémiques Rares, Hôpital Cochin, Paris, France.
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13
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Emmi G, Bettiol A, Gelain E, Bajema IM, Berti A, Burns S, Cid MC, Cohen Tervaert JW, Cottin V, Durante E, Holle JU, Mahr AD, Del Pero MM, Marvisi C, Mills J, Moiseev S, Moosig F, Mukhtyar C, Neumann T, Olivotto I, Salvarani C, Seeliger B, Sinico RA, Taillé C, Terrier B, Venhoff N, Bertsias G, Guillevin L, Jayne DRW, Vaglio A. Evidence-Based Guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis. Nat Rev Rheumatol 2023; 19:378-393. [PMID: 37161084 DOI: 10.1038/s41584-023-00958-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/11/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, characterized by asthma, eosinophilia and granulomatous or vasculitic involvement of several organs. The diagnosis and management of EGPA are often challenging and require an integrated, multidisciplinary approach. Current practice relies on recommendations and guidelines addressing the management of ANCA-associated vasculitis and not specifically developed for EGPA. Here, we present evidence-based, cross-discipline guidelines for the diagnosis and management of EGPA that reflect the substantial advances that have been made in the past few years in understanding the pathogenesis, clinical subphenotypes and differential diagnosis of the disease, as well as the availability of new treatment options. Developed by a panel of European experts on the basis of literature reviews and, where appropriate, expert opinion, the 16 statements and five overarching principles cover the diagnosis and staging, treatment, outcome and follow-up of EGPA. These recommendations are primarily intended to be used by healthcare professionals, pharmaceutical industries and drug regulatory authorities, to guide clinical practice and decision-making in EGPA. These guidelines are not intended to limit access to medications by healthcare agencies, nor to impose a fixed order on medication use.
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Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ingeborg M Bajema
- Department of Pathology, Groningen University Medical Center, Groningen, the Netherlands
| | - Alvise Berti
- Rheumatology, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Trento, Italy
| | - Stella Burns
- Vasculitis and Lupus Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Jan W Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, IVPC, INRAE, ERN-LUNG, Lyon, France
| | - Eugenia Durante
- APACS, Associazione Pazienti con Sindrome di Churg Strauss, Arosio, Italy
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster/Kiel, Germany
| | - Alfred D Mahr
- Department of Rheumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marcos Martinez Del Pero
- Vasculitis and Lupus Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- ENT Department, West Suffolk Hospital, Bury St Edmunds, UK
| | - Chiara Marvisi
- Rheumatology Unit, Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Sergey Moiseev
- Tareev Clinic of Internal Disease, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster/Kiel, Germany
| | - Chetan Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Thomas Neumann
- Department of Rheumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Iacopo Olivotto
- Meyer Children Hospital and Careggi University Hospital, University of Florence, Florence, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Benjamin Seeliger
- Department of Respiratory Medicine and German Centre of Lung Research, Hannover Medical School, Hannover, Germany
| | - Renato A Sinico
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Renal Unit, ASST-Monza, Monza, Italy
| | - Camille Taillé
- Reference center for rare respiratory diseases, Bichat Hospital, AP-HP-Nord, University Paris Cité, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Nils Venhoff
- Clinic for Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Crete, Greece
- Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Crete, Greece
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP, University of Paris, Paris, France
| | - David R W Jayne
- University of Cambridge, Box 118, Addenbrooke's Hospital, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.
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14
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Guillevin L. The targeted-biotherapy revolution for vasculitis treatment: major advances but certain concerns persist. Clin Exp Rheumatol 2023; 41:780-783. [PMID: 36995330 DOI: 10.55563/clinexprheumatol/r5j8ci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Loïc Guillevin
- Referral Center for Rare Autoimmune and Systemic Diseases, French Vasculitis Study Group, Hôpital Cochin, University of Paris, France.
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15
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Benichou N, Charles P, Terrier B, Jones RB, Hiemstra T, Mouthon L, Bajema I, Berden A, Thervet E, Guillevin L, Jayne D, Karras A. PROTEINURIA AND HEMATURIA AFTER REMISSION INDUCTION ARE ASSOCIATED WITH OUTCOME IN ANCA-ASSOCIATED VASCULITIS. Kidney Int 2023; 103:1144-1155. [PMID: 36940799 DOI: 10.1016/j.kint.2023.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/09/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/22/2023]
Abstract
In anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), hematuria and proteinuria are biomarkers reflecting kidney involvement at diagnosis. Yet, the prognostic value of their persistence after immunosuppressive induction therapy, reflecting kidney damage or persistent disease, remains uncertain. To study this, our post-hoc analysis included participants of five European randomized clinical trials on AAV (MAINRITSAN, MAINRITSAN2, RITUXVAS, MYCYC, IMPROVE). Urine protein-creatinine ratio (UPCR) and hematuria of spot urine samples collected at the end of induction therapy (four-six months after treatment initiation) were correlated with the occurrence of a combined endpoint of death and/or kidney failure, or relapses during follow-up. Among 571 patients (59% men, median age 60), 60% had anti-proteinase 3-ANCA and 35% had anti-myeloperoxidase-ANCA, while 77% had kidney involvement. After induction therapy, 157/526 (29.8%) had persistent hematuria and 165/481 (34.3%) had UPCR of 0.05 g/mmol or more. After a median follow-up of 28 months (inter quartile range 18-42), and adjustment for age, ANCA type, maintenance therapy, serum creatinine and persistent hematuria after induction, a UPCR of 0.05 g/mmol or more after induction was associated with significant risk of death/kidney failure (adjusted Hazard Ratio (HR) 3.06, 95% confidence interval (1.09-8.59) and kidney relapse (adjusted subdistribution HR 2.22, 1.16-4.24). Persistent hematuria was associated with significant kidney relapse (adjusted subdistribution HR 2.16, (1.13-4.11) but not with relapse affecting any organ nor with death/kidney failure. Thus, in this large cohort of patients with AAV, persistent proteinuria after induction therapy was associated with death/kidney failure and kidney relapse, whereas persistent hematuria was an independent predictor of kidney relapse. Hence, these parameters must be considered to assess long-term kidney prognosis of patients with AAV.
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Affiliation(s)
- Nicolas Benichou
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Benjamin Terrier
- Université de Paris, Paris, France; Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Rachel B Jones
- Lupus and Vasculitis Clinic, Department of Renal Medicine, Addenbrooke's Hospital, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK
| | - Thomas Hiemstra
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Luc Mouthon
- Université de Paris, Paris, France; Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Ingeborg Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Annelies Berden
- Department of Rheumatology and Clinical immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Loïc Guillevin
- Université de Paris, Paris, France; Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - David Jayne
- Lupus and Vasculitis Clinic, Department of Renal Medicine, Addenbrooke's Hospital, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
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- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
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16
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Guillevin L. Advances in the maintenance of ANCA vasculitis remission. Best Pract Res Clin Rheumatol 2023; 37:101842. [PMID: 37407419 DOI: 10.1016/j.berh.2023.101842] [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: 03/30/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
The maintenance treatment of ANCA-associated vasculitides (AAVs) has benefited from the results of several prospective clinical trials focusing on the evaluation of new drugs, therapeutic strategies, and adjuvant treatments. They also showed that rituximab was the most effective agent to maintain remission. However, because treatments can induce adverse events, including facilitating infections, therapeutic strategies should be adapted to find the optimal dose(s) and their administration duration(s) and to make them commensurate to the expected severity of relapse. That task is not easy to achieve because we have not yet been able to identify the clinical or biological parameters that can predict when a relapse will occur and its severity. Among AAVs, eosinophilic granulomatosis with polyangiitis (EGPA) has pathogenic and clinical specificities, and new drugs directly address those features. If rituximab could have a place such as in other AAVs, anti-IL5 biotherapies could also be prescribed successfully for maintenance. Another aim of vasculitis maintenance therapy is to control the disease with less prednisone than in the past. Herein, we emphasize the importance of individually devising a maintenance regimen adapted to the objectives of keeping the patient in remission without the adverse events related to the prescribed treatment(s).
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Affiliation(s)
- Loïc Guillevin
- Department of Internal Medicine, Center for Rare Systemic and Autoimmune Diseases, French Vasculitis Study Group, Hôpital Cochin, University of Paris, 27, Rue du Faubourg Saint-Jacques, Paris, France.
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Koren J, Lambert JLW, Thomsen SF, McAteer H, Fabbrocini G, Corazza V, Jullien D, Augustin M, Warren RB, de Rie MA, Lazaridou E, Puig L, Guillevin L, Grosser M, Boehncke WH. Elevating the Standard of Care for Patients with Psoriasis: 'Calls to Action' from Epicensus, a Multistakeholder Pan-European Initiative. Dermatol Ther (Heidelb) 2023; 13:245-268. [PMID: 36484915 PMCID: PMC9734585 DOI: 10.1007/s13555-022-00846-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/27/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Despite advances in treatment options and the management of patients with psoriasis, considerable unmet needs remain. Our objective was to identify ways to elevate the standard of care for patients with psoriasis by combining the perspectives of three important stakeholders: patients, clinicians and payors, and define 'Calls to Action' designed to achieve the identified changes. METHODS Eight themes relevant to elevating the standard of care were identified from an insights-gathering questionnaire completed by all three stakeholder groups. A modified Delphi exercise gained consensus on statements informed by the insights. Statements were then used to inspire 'Calls to Action' - practical steps that could be taken to realise the desired changes and elevate the standard of care. RESULTS In total, 18 European experts (10 dermatologists, 3 payors and 5 patient representatives) took part in the Delphi process. Consensus was reached on statements relating to all eight themes: improve healthcare systems to better support multidisciplinary team working and digital services, real-world data generation and optimal use, improve patient access, elevate quality-of-life measures as the most important outcomes, involve patients in patient-centred and personalised approaches to care, improve the relevance and reach of guidelines, education, and multistakeholder engagement. 'Calls to Action' common to all three stakeholder groups recognised the need to capitalise on the shift to digital healthcare, the need for consistent input into registries to generate real-world evidence to support guideline development, and the necessity of educating patients on the benefits of reporting outcomes to generate real-world data. The enormous quality-of-life burden and psychological impact of psoriasis, as well as the clinical needs of patients must be better understood, including by healthcare commissioners, so that funding priorities are assessed appropriately. CONCLUSION This unique initiative identified a practical 'Call-to-Action Framework' which, if implemented, could help improve the standard of care for patients with psoriasis.
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Affiliation(s)
| | - Jo L W Lambert
- Department of Dermatology, Ghent University, Vijverpark Ingang 52 - UZ Gent, De Pintelaan 185, 9000, Gent, Belgium.
| | - Simon F Thomsen
- Department of Dermatology, Department of Biomedical Sciences, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Valeria Corazza
- Italian Psoriatic Association Friends of the Corazza Foundation (APIAFCO), Bologna, Italy
| | - Denis Jullien
- Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, 69003, Lyon, France
- INSERM U1111 - CIRI, Lyon-1 University, 69007, Lyon, France
| | - Matthias Augustin
- Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard B Warren
- Dermatology Centre, Manchester NIHR Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Menno A de Rie
- Amsterdam UMC, Department of Dermatology, University of Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth Lazaridou
- 2nd Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Loïc Guillevin
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Marius Grosser
- German Psoriasis Association, Seewartenstraße 10, 20459, Hamburg, Germany
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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18
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Dutertre M, Pugnet G, De Moreuil C, Bonnotte B, Benhamou Y, Chauveau D, Diot E, Duffau P, Limal N, Néel A, Urbansky G, Jourde-Chiche N, Fauchais A, Dossier A, Schleinitz N, Jilet L, Guillevin L, Abdoul H, Puéchal X, Terrier B. Efficacité à long terme des schémas d’induction de la rémission au cours de la granulomatose éosinophilique avec polyangéite : résultats de l’essai REOVAS. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Puéchal X, Iudici M, Perrodeau E, Bonnotte B, Lifermann F, Le Gallou T, Karras A, Blanchard-Delaunay C, Quéméneur T, Aouba A, Aumaître O, Cottin V, Hamidou M, Ruivard M, Cohen P, Mouthon L, Guillevin L, Ravaud P, Porcher R, Terrier B. Rituximab versus cyclophosphamide en traitement d’induction de la granulomatose avec polyangéite : essai thérapeutique émulé. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Puéchal X, Iudici M, Perrodeau E, Bonnotte B, Lifermann F, Le Gallou T, Karras A, Blanchard-Delaunay C, Quéméneur T, Aouba A, Aumaître O, Cottin V, Hamidou M, Ruivard M, Cohen P, Mouthon L, Guillevin L, Ravaud P, Porcher R, Terrier B. Rituximab vs Cyclophosphamide Induction Therapy for Patients With Granulomatosis With Polyangiitis. JAMA Netw Open 2022; 5:e2243799. [PMID: 36441554 PMCID: PMC9706346 DOI: 10.1001/jamanetworkopen.2022.43799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Results of randomized clinical trials have demonstrated rituximab's noninferiority to cyclophosphamide as induction therapy for antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV), with neither treatment having a specific advantage for granulomatosis with polyangiitis (GPA). However, post hoc analysis results have suggested that rituximab might be more effective than cyclophosphamide in inducing remission in patients with proteinase 3-positive AAV. OBJECTIVE To compare the effectiveness of rituximab and cyclophosphamide in inducing GPA remission in a large population of unselected patients. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used multicenter target trial emulation observational data from 32 French hospitals in the French Vasculitis Study Group Registry. Groups were determined according to treatments received, without any intervention from the investigators. Inverse probability of treatment weighting was used to correct for baseline imbalance between groups. Participants included patients with newly diagnosed or relapsing GPA who satisfied American College of Rheumatology classification criteria and/or Chapel Hill Consensus Conference nomenclature. Data were analyzed from October 1, 2021, to May 31, 2022. EXPOSURES At least 1 infusion of rituximab or cyclophosphamide for induction therapy between April 1, 2008, and April 1, 2018. MAIN OUTCOMES AND MEASURES The primary outcome was remission rate at month 6 (±2 months), with remission defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 and prednisone dose of 10 mg/d or less. The BVAS is a validated tool for small-vessel vasculitis and used to assess the level of disease activity, with a numerical weight attached to each involved organ system. The BVAS has a range of 0 to 63 points; a score of 0 indicates no disease activity. Subgroup analyses included the primary outcome for patients with a new diagnosis, for most recently treated patients, and for patients with myeloperoxidase-ANCA positivity. RESULTS Among 194 patients with GPA included in the analysis (mean [SD] age, 54 [15] years; 110 men [56.7%]), 165 (85.1%) had a new diagnosis, and 147 of 182 with data available (80.8%) had proteinase 3-ANCA positivity. Sixty-one patients received rituximab and 133 received cyclophosphamide for induction therapy. In the weighted analysis, the primary outcome was reached for 73.1% of patients receiving rituximab vs 40.1% receiving cyclophosphamide (relative risk [RR], 1.82 [95% CI, 1.22-2.73]; risk difference, 33.0% [95% CI, 12.2%-53.8%]; E value for RR, 3.05). Similar results were observed in the subgroup of patients with newly diagnosed GPA and those with a more recent treatment. In the subset of 27 patients with myeloperoxidase-ANCA-positive GPA, 8 of 10 rituximab recipients and 8 of 17 cyclophosphamide recipients met the primary end point (unweighted RR, 1.73 [95% CI, 0.96-3.11]). CONCLUSIONS AND RELEVANCE In this comparativeness effectiveness study using clinical data, rituximab induction therapy for GPA was more frequently associated with remission than cyclophosphamide. These results inform clinical decision-making concerning the choice of remission induction therapy for this subset of patients with AAV.
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Affiliation(s)
- Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | - Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
- Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Geneva, Switzerland
| | | | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, François Mitterrand University Hospital, Dijon, France
| | - François Lifermann
- Department of Internal Medicine, Centre Hospitalier Côte-d’Argent, Dax, France
| | - Thomas Le Gallou
- Department of Internal Medicine and Clinical Immunology, Rennes-Sud University Hospital, Rennes, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | | | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, Centre Hospitalier, Valenciennes, France
| | - Achille Aouba
- Department of Internal Medicine, Côte-de-Nacre University Hospital, Caen, France
| | - Olivier Aumaître
- Department of Internal Medicine, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Vincent Cottin
- National Referral Center for Rare Pulmonary Diseases, Louis-Pradel Hospital, Claude-Bernard University Lyon 1, Lyon, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Marc Ruivard
- Department of Internal Medicine, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
| | | | | | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (AP-HP) Centre, Université Paris Cité, Paris, France
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Puéchal X, Guillevin L. How best to manage relapse and remission in ANCA-associated vasculitis. Expert Rev Clin Immunol 2022; 18:1135-1143. [PMID: 36102147 DOI: 10.1080/1744666x.2022.2122954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION A 2-stage therapeutic approach is now applied as standard-of-care to treat ANCA-associated vasculitides (AAVs): first, glucocorticoids (GCs) combined with cyclophosphamide (CYC) or rituximab (RTX) to induce remission, then relapse prevention with remission-maintenance therapy. Nonetheless, a substantial risk of relapse persists. AREAS COVERED The authors provide an overview of the current state of maintenance therapies, and discuss new strategies recommended to prevent and treat relapses, focusing on granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). EXPERT OPINION For remission-induction after GPA or MPA relapse with organ-threatening manifestations, reintroduction or intensification of the GC dose in combination with CYC or RTX cycle is recommended; we prefer RTX in light of its superior responses obtained in patients with relapsing disease. Rapid tapering of GCs has been shown not to alter AAV evolution while decreasing the risk of serious infections. In contrast, for non-severe, active MPA, we recommend GCs alone as first-line therapy. For patients whose MPA remains uncontrolled by GCs alone, immunosuppressant adjunction can be a GC-sparing option or to counter GC intolerance. Once remission is achieved, we recommend prolonged maintenance therapy with preemptive low-dose (500 mg) RTX infusion biannually.
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Affiliation(s)
- Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP).Centre, Université Paris Cité, Paris, France.,French Vasculitis Study Group, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP).Centre, Université Paris Cité, Paris, France.,French Vasculitis Study Group, Hôpital Cochin, Paris, France
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Thietart S, Karras A, Augusto JF, Philipponnet C, Carron PL, Delbrel X, Mesbah R, Blaison G, Duffau P, El Karoui K, Smets P, London J, Mouthon L, Guillevin L, Terrier B, Puéchal X. Evaluation of Rituximab for Induction and Maintenance Therapy in Patients 75 Years and Older With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. JAMA Netw Open 2022; 5:e2220925. [PMID: 35802372 PMCID: PMC9270693 DOI: 10.1001/jamanetworkopen.2022.20925] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Older patients are underrepresented in studies of rituximab for the treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Little is known about outcomes and adverse events associated with the use of rituximab therapy among patients 75 years and older with ANCA-associated vasculitis. OBJECTIVE To examine outcomes and adverse events associated with the use of rituximab therapy in patients 75 years and older with ANCA-associated vasculitis, specifically granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study involved 93 patients 75 years and older with ANCA-associated vasculitis from 36 university and nonuniversity hospitals in France. Data were obtained from the French Vasculitis Study Group database between January 1, 2000, and July 1, 2018, and a call for observation sent to French Vasculitis Study Group members on June 6, 2019. Data analysis was performed from November 15 to December 31, 2021. Inclusion criteria included a diagnosis of GPA or MPA according to European Medicines Agency classification criteria and receipt of treatment with rituximab after age 75 years. Patients were excluded if they were missing relevant clinical or biological data. Data on race and ethnicity were not reported because inclusion of this information was not authorized by the ethics committee. EXPOSURE At least 1 infusion of rituximab as induction or maintenance therapy. MAIN OUTCOMES AND MEASURES Occurrence of remission, relapse, drug discontinuation, death, and serious infections (including types of serious infections). RESULTS Of 238 patients screened, 93 were included (median [IQR] age, 79.4 [76.7-83.1] years; 51 women [54.8%]); 52 patients (55.9%) had a diagnosis of GPA, and 41 (44.1%) had a diagnosis of MPA. Thirty patients (32.3%) received rituximab as induction therapy in combination with high-dose glucocorticoid regimens, 27 (29.0%) received rituximab as maintenance therapy, and 36 (38.7%) received rituximab as both induction and maintenance therapy. The median (IQR) follow-up was 2.3 (1.1-4.0) years. Among 66 patients who received rituximab as induction therapy, 57 (86.4%) achieved remission, and 2 (3.0%) experienced relapses. The incidence of serious infection was significantly higher when rituximab was used as induction therapy vs maintenance therapy (46.6 [95% CI, 24.8-79.7] per 100 patient-years vs 8.4 [95% CI, 3.8-15.9] per 100 patient-years; P = .004). Most infections (12 of 22 [54.5%]) were gram-negative bacterial infections. The incidence of death was 19.7 (95% CI, 7.2-42.9) per 100 patient-years among those who received rituximab as induction therapy and 5.3 (95% CI, 1.9-11.6) per 100 patient-years among those who received rituximab as maintenance therapy. CONCLUSIONS AND RELEVANCE In this cohort study, rituximab therapy was associated with achievement and maintenance of remission in most patients 75 years and older with ANCA-associated vasculitis. The incidence of serious infections and death was high when rituximab was used as induction therapy in combination with high-dose glucocorticoid regimens but not when rituximab was used as maintenance therapy. Efforts might focus on reducing serious infections during the first months of therapy.
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Affiliation(s)
- Sara Thietart
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Department of Geriatrics, Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Jean-François Augusto
- Department of Nephrology, Dialysis, and Transplantation, Centre Hospitalier Universitaire, Angers, France
| | - Carole Philipponnet
- Department of Nephrology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Pierre-Louis Carron
- Department of Nephrology, Dialysis, and Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Xavier Delbrel
- Department of Internal Medicine, Centre Hospitalier de Pau, Pau, France
| | - Rafik Mesbah
- Department of Nephrology, Centre Hospitalier, Boulogne-sur-Mer, France
| | - Gilles Blaison
- Department of Internal Medicine, Louis Pasteur Colmar Hospital, Colmar, France
| | - Pierre Duffau
- Department of Internal Medicine, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Khalil El Karoui
- Department of Nephrology and Renal Transplantation, Hôpital Henri-Mondor, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Perrine Smets
- Department of Internal Medicine, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Jonathan London
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Department of Internal Medicine, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
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Delestre F, Charles P, Samson M, Néel A, Faguer S, Karras A, Lifermann F, Godmer P, Hanrotel-Saliou C, Martin-Silva N, Pugnet G, Maurier F, Le Gallou T, Quéméneur T, Méaux-Ruault N, Viallard J, Puéchal X, Guillevin L, Porcher R, Terrier B. Performance de modèles de prédiction du risque de rechute et d’infection sévère à la fin du traitement d’entretien par rituximab à 18 mois au cours des vascularites à ANCA. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sorin B, Iudici M, Guerry M, Samson M, Bielefeld P, Maillet T, Nouvier M, Karras A, Christian L, Durel C, Fabre M, Charles P, Lanteri A, Pugnet G, Riviere F, Le Gueno G, Guillevin L, Puéchal X, Terrier B. Étude des granulomatoses avec polyangéites réfractaires au traitement d’induction. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jeantin L, Lenfant T, Bataille P, De Boysson H, Cathébras P, Agard C, Faguer S, Deschartres A, Poindron V, Ruivard M, Martin-Silva N, Monge M, Guillevin L, Puéchal X, Terrier B, Charles P. Atteintes valvulaires cardiaques des vascularites à ANCA : étude multicentrique rétrospective et revue systématique de la littérature. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Delvino P, Sardanelli F, Monti S, Cohen P, Puéchal X, Mouthon L, Montecucco C, Guillevin L, Terrier B. Remission and Low-Disease Activity in Granulomatosis with Polyangiitis and Microscopic Polyangiitis: Prevalence and Impact on Damage Accrual. Arthritis Care Res (Hoboken) 2022; 75:1158-1165. [PMID: 35604889 DOI: 10.1002/acr.24958] [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: 05/18/2021] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the prevalence and impact on damage accrual of different levels of disease activity in patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). METHODS Patients with GPA and MPA followed for ≥5 years in two different centers were included. Disease activity and damage were assessed using Birmingham Vasculitis Activity Score (BVAS) and Vasculitis Damage Index (VDI), respectively. Three levels of remission were defined: complete remission (CR) [(BVAS=0), negative ANCA, off treatment], clinical remission off therapy [(BVAS=0), positive ANCA] (CROffT) and clinical remission on therapy [(BVAS=0), +/-ANCA, glucocorticoids ≤5 mg/day and/or immunosuppressant] (CROnT). Low-disease activity state (LDAS) was defined as 0<BVAS≤3, low-dose glucocorticoids (≤7.5 mg/day) and/or immunosuppressant. Remission or LDAS were defined as prolonged when lasting ≥2 consecutive years. RESULTS 167 patients were included: 128 (76.6%) GPA, 39 (23.4%) MPA, mean age 51.0±16.7 years. During 5-year follow-up, 10 (6.0%) patients achieved prolonged CR, 6 (3.6%) prolonged CROffT, 89 (53.3%) prolonged CROnT, 42 (25.1%) prolonged LDAS and 20 (12.0%) never achieved LDAS. VDI at 5 years progressively worsened according to increasing levels of disease activity targets (CR, CROffT, CROnT, LDAS). Mean 5-year VDI was higher in patients not achieving prolonged remission compared to those who did (3.7±2.0 vs. 2.2±1.9, P<0.0001). By multivariate analysis, baseline ENT (P=0.006) and lung involvement (P=0.047) were negative predictors of prolonged remission. CONCLUSION More than 60% of GPA/MPA achieved prolonged remission, which was associated with better long-term outcomes. In contrast, prolonged LDAS correlated with increased damage accrual and was not a sufficient treatment target.
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Affiliation(s)
- Paolo Delvino
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy.,University of Pavia, PhD in Experimental Medicine
| | | | - Sara Monti
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Xavier Puéchal
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, 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), Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, Paris, France
| | - Carlomaurizio Montecucco
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Loïc Guillevin
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, Paris, France
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Guillevin L, Terrier B. Optimising ANCA-associated vasculitis management and infectious risks during the COVID-19 pandemic. Clin Exp Rheumatol 2022; 40:688-690. [DOI: 10.55563/clinexprheumatol/ixatxh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, Université Paris-Descartes, Paris, France.
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Université Paris-Descartes, Paris, France
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Puéchal X, Iudici M, Pagnoux C, Cohen P, Hamidou M, Aouba A, Lifermann F, Ruivard M, Aumaître O, Bonnotte B, Maurier F, Le Gallou T, Hachulla E, Karras A, Khouatra C, Jourde-Chiche N, Viallard JF, Blanchard-Delaunay C, Godmer P, Le Quellec A, Quéméneur T, de Moreuil C, Mouthon L, Terrier B, Guillevin L. Comparative study of granulomatosis with polyangiitis subsets according to ANCA status: data from the French Vasculitis Study Group Registry. RMD Open 2022; 8:rmdopen-2021-002160. [PMID: 35296533 PMCID: PMC8928389 DOI: 10.1136/rmdopen-2021-002160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To investigate whether antineutrophil cytoplasm antibody (ANCA)-negative and myeloperoxidase (MPO)-ANCA–positive granulomatosis with polyangiitis (GPA) differ from proteinase-3 (PR3)-ANCA–positive GPA. Methods Diagnostic characteristics and outcomes of newly diagnosed French Vasculitis Study Group Registry patients with ANCA-negative, MPO-ANCA–positive or PR3-ANCA–positive GPA satisfying American College of Rheumatology criteria and/or Chapel Hill Conference Consensus Nomenclature were compared. Results Among 727 GPA, 62 (8.5%) were ANCA-negative, 119 (16.4%) MPO-ANCA–positive and 546 (75.1%) PR3-ANCA–positive. ANCA-negative patients had significantly (p<0.05) more limited disease (17.7% vs 5.8%) and less kidney involvement (35.5% vs 58.9%) than those PR3-ANCA–positive or MPO-ANCA–positive, with comparable relapse-free (RFS) and overall survival (OS). MPO-ANCA–positive versus PR3-ANCA–positive and ANCA-negative patients were significantly more often female (52.9% vs 42.1%), older (59.8 vs 51.9 years), with more frequent kidney involvement (65.5% vs 55.2%) and less arthralgias (34.5% vs 55.1%), purpura (8.4% vs 17.1%) or eye involvement (18.5% vs 28.4%); RFS was similar but OS was lower before age adjustment. PR3-positive patients’ RFS was significantly lower than for ANCA-negative and MPO-positive groups combined, with OS higher before age adjustment. PR3-ANCA–positivity independently predicted relapse for all GPA forms combined but not when comparing only PR3-ANCA–positive versus MPO-ANCA–positive patients. Conclusions Based on this large cohort, ANCA-negative versus ANCA-positive patients more frequently had limited disease but similar RFS and OS. MPO-ANCA–positive patients had similar RFS but lower OS due to their older age. PR3-ANCA–positive GPA patients’ RFS was lower than those of the two other subsets combined but that difference did not persist when comparing only PR3 versus MPO-ANCA–positive patients.
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Affiliation(s)
- Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP.Centre, University of Paris, Paris, France
| | - Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP.Centre, University of Paris, Paris, France.,Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Pagnoux
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP.Centre, University of Paris, Paris, France.,Vasculitis Clinic, Mont Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP.Centre, University of Paris, Paris, France
| | - Mohamed Hamidou
- Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Achille Aouba
- Internal Medicine, Côte-de-Nacre Hospital, University of Caen Normandy, Caen, France
| | | | - Marc Ruivard
- Internal Medicine, Clermont-Ferrand University Hospitals, Clermont-Ferrand, France
| | - Olivier Aumaître
- Internal Medicine, Clermont-Ferrand University Hospitals, Clermont-Ferrand, France
| | - Bernard Bonnotte
- Internal Medicine and Clinical Immunology, François Mitterrand Hospital, University of Burgundy, Dijon, France
| | | | - Thomas Le Gallou
- Internal Medicine and Clinical Immunology, University of Rennes 1, Rennes, France
| | - Eric Hachulla
- Internal Medicine, Claude-Huriez Hospital, Lille University School of Medicine, Lille, France
| | - Alexandre Karras
- Nephrology, European Hospital Georges Pompidou, AP-HP.Centre, University of Paris, Paris, France, Paris, France
| | - Chahéra Khouatra
- Respiratory Medicine, Louis Pradel Hospital, University of Claude Bernard Lyon 1, Lyon, France
| | | | | | | | - Pascal Godmer
- Internal Medicine, Bretagne -Atlantique Hospital, Vannes, France
| | - Alain Le Quellec
- Internal Medicine, Saint Eloi Hospital, University of Montpellier 1, Montpellier, France
| | - Thomas Quéméneur
- Nephrology and Internal Medicine, Valenciennes Hospital, Valenciennes, France
| | - Claire de Moreuil
- Internal Medicine, La Cavale Blanche University Hospital, Brest, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP.Centre, University of Paris, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP.Centre, University of Paris, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP.Centre, University of Paris, Paris, France
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Puéchal X, Iudici M, Calich AL, Vivot A, Terrier B, Régent A, Cohen P, Jeunne CL, Mouthon L, Ravaud P, Guillevin L. Corrigendum to: Rituximab for induction and maintenance therapy of granulomatosis with polyangiitis: a single-centre cohort study on 114 patients. Rheumatology (Oxford) 2022; 61:3505. [PMID: 35237803 DOI: 10.1093/rheumatology/keac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Ana Luisa Calich
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Alexandre Vivot
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, APHP.,UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), INSERM, Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Alexis Régent
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Claire Le Jeunne
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Philippe Ravaud
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, APHP.,UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), INSERM, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
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30
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Nezam D, Porcher R, Grolleau F, Morel P, Titeca-Beauport D, Faguer S, Karras A, Solignac J, Jourde-Chiche N, Maurier F, Sakhi H, El Karoui K, Mesbah R, Carron PL, Audard V, Ducloux D, Paule R, Augusto JF, Aniort J, Tiple A, Rafat C, Beaudreuil S, Puéchal X, Gobert P, Massy Z, Hanrotel C, Bally S, Martis N, Durel CA, Desbuissons G, Godmer P, Hummel A, Perrin F, Néel A, De Moreuil C, Goulenok T, Guerrot D, Grange S, Foucher A, Deroux A, Cordonnier C, Guilbeau-Frugier C, Modesto-Segonds A, Nochy D, Daniel L, Moktefi A, Rabant M, Guillevin L, Régent A, Terrier B. Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges. J Am Soc Nephrol 2022; 33:628-637. [PMID: 35074934 PMCID: PMC8975074 DOI: 10.1681/asn.2021060771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. METHODS We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). RESULTS No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. CONCLUSIONS PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
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Affiliation(s)
- Dorian Nezam
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Raphaël Porcher
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - François Grolleau
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - Pauline Morel
- Service de dialyse et aphérèse, AURA Paris Plaisance, Paris, France
| | | | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’organes, Hôpital Rangueil, Toulouse, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Justine Solignac
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - François Maurier
- Hôpital Belle-Isle, Groupe Hospitalier Associatif UNEOS, Metz, France
| | - Hamza Sakhi
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Rafik Mesbah
- Service de Néphrologie, Centre Hospitalier, Boulogne-sur-mer, France
| | | | - Vincent Audard
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Didier Ducloux
- Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, France
| | - Romain Paule
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | | | - Julien Aniort
- Service de Néphrologie, Dialyse et Transplantation rénale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Aurélien Tiple
- Service de Néphrologie, CHU Jacques Lacarin, Vichy, France
| | - Cédric Rafat
- Unité de Néphrologie, Transplantation Rénale, Hôpital Tenon (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Séverine Beaudreuil
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Pierre Gobert
- Service de Médecine Interne et Immunologie clinique, Clinique Rhône Durance, Avignon, France
| | - Ziad Massy
- Département de Néphrologie, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Catherine Hanrotel
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital La Cavale Blanche, Brest, France
| | - Stéphane Bally
- Service de Néphrologie Dialyse, Centre Hospitalier Métropole Savoie, Chambery, France
| | | | - Cécile-Audrey Durel
- Service de Médecine, Interne Hôpital Edouard Herriot, Hospices civils de Lyon, France
| | | | - Pascal Godmer
- Service de Médecine Interne, CHBA site de Vannes, Vannes, France
| | - Aurélie Hummel
- Service de Néphrologie et Transplantation Rénale, Hôpital Necker-Enfants Malades (Assistance Publique des Hôpitaux de Paris), Paris, France
| | | | - Antoine Néel
- Service de Médecine Interne, CHU de Nantes, France
| | | | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Dominique Guerrot
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Steven Grange
- Service de Réanimation médicale, CHU Charles Nicolle, Rouen, France
| | - Aurélie Foucher
- Service de Médecine Interne, CHU site Sud Saint-Pierre, Saint-Pierre, France
| | - Alban Deroux
- Service de Médecine Interne, CHU de Grenoble, France
| | - Carole Cordonnier
- Service d’anatomie et de cytologie pathologiques, Hôpital Nord, CHU d’Amiens, France
| | - Céline Guilbeau-Frugier
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Anne Modesto-Segonds
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Dominique Nochy
- Service d’Anatomie et Cytologie Pathologiques, Hôpital Européen Georges Pompidou (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Laurent Daniel
- Service d’Anatomie et cytologie pathologiques, Hôpital La Timone (APHM), Marseille, France
| | - Anissa Moktefi
- Assistance Publique des Hôpitaux de Paris, Department of Pathology, Groupe Hospitalier Henri-Mondor 94010 Creteil, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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Thietart S, Beinse G, Smets P, Karras A, Philipponnet C, Augusto JF, El Karoui K, Mesbah R, Titeca-Beauport D, Hamidou M, Carron PL, Maurier F, Sacre K, Cohen P, Liozon E, Blanchard-Delaunay C, Kostianovsky A, Pagnoux C, Mouthon L, Guillevin L, Terrier B, Puéchal X. Patients of 75 years and over with ANCA-associated vasculitis have a lower relapse risk than younger patients: A multicentre cohort study. J Intern Med 2022; 291:350-363. [PMID: 34755398 DOI: 10.1111/joim.13417] [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: 11/29/2022]
Abstract
BACKGROUND Little is known about antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in older patients. We aim to study relapse risk of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) in patients diagnosed after 75 years and compare it with those of patients aged 65-75 years. METHODS Data from AAV patients aged ≥65 years were extracted from the French Vasculitis Study Group (FVSG) database and from a call for observation to FVSG members. Cox and Fine-Gray models were used to assess relapse risk, taking death into account either as a censoring or a competing event, respectively. RESULTS The analysis included 219 patients aged ≥75 years (median 79) and 80 patients aged 65-75 years (median 70), of those 155 had GPA (52%), 136 MPA (45%), with 95 (32%) anti-proteinase 3 positivity and 179 (61%) anti-myeloperoxidase. Patients aged ≥75 years had a lower relapse risk in multivariate analysis (cause-specific hazards ratio [CSHR] 0.54, 95% CI [0.33-0.89], p = 0.016, Cox model; subdistribution hazard ratio [SHR] 0.46, 95% CI [0.29-0.74], p = 0.001, Fine-Gray model) after taking into account vasculitis type. Patients aged ≥75 years had a lower probability of being treated for remission maintenance with a combination of glucocorticoids and immunosuppressants (vs. glucocorticoids alone, HR 0.28, 95% CI [0.11-0.68], p = 0.005) after adjusting to Five Factor Score, although relapse-free survival was significantly longer when receiving such combination (CSHR 0.40, 95% [CI 0.24-0.67], p < 0.001). CONCLUSIONS AAV patients ≥75 years have a lower relapse risk than patients aged 65-75 years despite a lower probability of having received maintenance therapy with a combination of glucocorticoids and immunosuppressants, but they still benefit from such treatment regimen.
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Affiliation(s)
- Sara Thietart
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Guillaume Beinse
- Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université INSERM, Team Personalized Medicine, Pharmacogenomics and Therapeutic Optimization (MEPPOT), Paris, France
| | - Perrine Smets
- Department of Internal Medicine, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Carole Philipponnet
- Department of Nephrology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Jean-François Augusto
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire, Angers, France
| | - Khalil El Karoui
- Department of Nephrology and Renal transplantation, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rafik Mesbah
- Department of Nephrology, Centre Hospitalier, Boulogne-sur-Mer, France
| | | | - Mohamed Hamidou
- Department of Internal Medicine, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France
| | - Pierre-Louis Carron
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - François Maurier
- Department of Internal Medicine and Immunology, Groupe Hospitalier UNEOS, Metz-Vantoux, France
| | - Karim Sacre
- Department of Internal Medicine, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Eric Liozon
- Department of Internal Medicine and Clinical Immunology, Dupuytren University Hospital, Limoges, France
| | | | - Alex Kostianovsky
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Christian Pagnoux
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | -
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Puéchal X, Cottin V, Faguer S, Guillevin L, Jourde-Chiche N, Karras A, Mouthon L, Néel A, Pugnet G, Samson M, Taillé C, Terrier B. French Vasculitis Study Group recommendations for the management of COVID-19 vaccination and prophylaxis in patients with systemic vasculitis. Presse Med 2022; 51:104107. [PMID: 34958887 PMCID: PMC8704893 DOI: 10.1016/j.lpm.2021.104107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/06/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP) Centre - Université de Paris, 27 rue du faubourg Saint-Jacques, Paris 75014, France.
| | - Vincent Cottin
- Pneumology Department, Center for Rare Pulmonary Diseases, Lyon Civil Hospices-Claude Bernard Lyon University-East Hospital Group-Louis Pradel Hospital, Lyon, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre de Référence des Maladies Rénales Rares, Hôpital Rangueil, Institut National de la Santé et de la Recherche Médicale, UMR 1297, and Université Paul Sabatier - Toulouse 3, Toulouse, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP) Centre - Université de Paris, 27 rue du faubourg Saint-Jacques, Paris 75014, France
| | - Noémie Jourde-Chiche
- Department of Nephrology, Centre Hospitalier Universitaire de la Conception, Aix-Marseille Université, C2VN, INSERM 1263, INRAE 1260, AP-HM, Marseille, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP) Centre - Université de Paris, 27 rue du faubourg Saint-Jacques, Paris 75014, France
| | - Antoine Néel
- Department of Internal Medicine, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France
| | - Gabriel Pugnet
- Department of Internal Medicine and Clinical Immunology, CHU Toulouse Rangueil, Toulouse, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| | - Camille Taillé
- Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, AP-HP Nord-Université de Paris, Hôpital Bichat, Inserm UMR 1152, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP) Centre - Université de Paris, 27 rue du faubourg Saint-Jacques, Paris 75014, France
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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de 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M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, 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Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Dejaco C, Guillevin L. New Classification Criteria for Small-Vessel Vasculitis: Is Antineutrophil Cytoplasmic Antibody Inclusion Their Major Advance? Arthritis Rheumatol 2022; 74:383-385. [PMID: 35106953 DOI: 10.1002/art.41984] [Citation(s) in RCA: 1] [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: 03/04/2021] [Revised: 03/28/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Christian Dejaco
- Medical University of Graz, Graz, Austria, and Hospital of Brunico (SABES-ASDAA), Brunico, Italy
| | - Loïc Guillevin
- French Vasculitis Study Group and University Paris Descartes, Paris, France
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35
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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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36
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Delapierre A, Terrier B, Pillebout E, Baudart P, Jourde-Chiche N, Lioger B, Martis N, Moulis G, Rivière E, Le Gouellec N, Raffray L, Urbanski G, Sanges S, Maurier F, Deroux A, Mekinian A, Monteiro R, Marcelli C, Guillevin L, Maillot F, Lucas B, Aouba A, Audemard-Verger A. Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement. Clin Rheumatol 2022; 41:1483-1491. [PMID: 35041109 DOI: 10.1007/s10067-021-05937-8] [Citation(s) in RCA: 2] [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: 02/10/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile. METHODS We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays. RESULTS Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80-0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18-3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1 pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5 pg/ml; p = 0.076). CONCLUSION Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement. Key Points • Joint involvement in adult IgAV is a frequent manifestation. • Joint involvement is associated with more frequent gastrointestinal manifestations. • Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV. • IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.
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Affiliation(s)
- Alice Delapierre
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Benjamin Terrier
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Baudart
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie Et Transplantation Rénale, CHU de La Conception, AP-HM, Marseille, France
| | - Bertrand Lioger
- Department of Internal Medicine, Hôpital Saint Louis, APHP, Paris, France
| | - Nihal Martis
- Department of Internal Medicine, CHU, Nice, France
| | | | | | - Noémie Le Gouellec
- Department of Internal Medicine and Nephrology, Valenciennes, CH, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU, La Réunion, France
| | | | - Sébastien Sanges
- Département de Médecine Interne Et Immunologie Clinique, CHU Lille, 59000, Lille, France.,Univ. Lille, INSERM, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | | | - Alban Deroux
- Department of Internal Medicine, CHU de Grenoble, Grenoble, France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Renato Monteiro
- Center of Research On Inflammation INSERM U1149, CNRS ERL8252, Paris Diderot University, Paris, France
| | - Christian Marcelli
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France.,University of Tours, Tours, France
| | - Bruno Lucas
- Paris Descartes University, Cochin Institute, CNRS UMR8104, INSERM U1016, Paris, France
| | - Achille Aouba
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France. .,University of Tours, Tours, France.
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Guillevin L. Systemic sclerosis: What does the future hold? Presse Med 2021; 50:104106. [PMID: 34922680 DOI: 10.1016/j.lpm.2021.104106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Loïc Guillevin
- Hôpital Cochin, Université Paris-Descartes, Paris, France.
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38
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Sorin B, Samson M, Durel CA, Diot E, Guichard I, Grados A, Limal N, Régent A, Cohen P, Dion J, Legendre P, Le Guern V, Mouthon L, Guillevin L, Terrier B. Rituximab plus methotrexate combination as a salvage therapy in persistently active granulomatosis with polyangiitis. Rheumatology (Oxford) 2021; 61:2619-2624. [PMID: 34698818 DOI: 10.1093/rheumatology/keab791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/20/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe the efficacy and safety of rituximab and methotrexate (RTX/MTX) combination therapy in ANCA-associated vasculitides (AAV). METHODS A retrospective French nationwide study was conducted in patients with AAV who received RTX/MTX combination therapy for persistently active disease. RESULTS Seventeen patients were included. All patients had granulomatosis with polyangiitis (GPA), with positive ANCA in 76% mainly with PR3-ANCA specificity. Sixteen (94%) were still active after rituximab and 11 (65%) after cyclophosphamide (oral and/or intravenous). Patients had experienced a median of 3 (2-4) flares. Manifestations requiring RTX/MTX combination therapy were subglottic or bronchial stenosis in 6 patients (35%), orbital mass in 6 (35%), disabling ENT involvement in 2 (12%), and epiduritis and pachymeningitis in 1 case each (6%). Median follow-up with combination was 11 months (11-26 months). At 6 months, global response was achieved in 15 patients (88%), including partial response in 11 (65%) and complete response in 4 (24%). At last evaluation, global response was achieved in 16 patients (94%). Seven patients (41%) experienced severe adverse events (grade 3 or 4), including infections in 4 (24%) and hepatitis in 2 (12%). Combination therapy was withdrawn in 4 patients (24%) but never for safety concerns. In contrast, MTX dose was decreased in 2 patients (12%) because of adverse events. One patient died of an unknown cause. CONCLUSION RTX/MTX combination therapy could be an effective salvage therapy to treat persistently active GPA with granulomatous manifestations, with an acceptable safety profile.
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Affiliation(s)
- Boris Sorin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Maxime Samson
- Department of Internal Medicine and clinical immunology, Dijon University Hospital, Dijon, France
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Elisabeth Diot
- Department of Internal Medicine, Hôpital Bretonneau, Tours, France
| | - Isabelle Guichard
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, France
| | - Aurélie Grados
- Department of Internal Medicine, Centre Hospitalier de Niort, France
| | - Nicolas Limal
- Department of Internal Medicine, Hôpital Henri Mondor, Créteil, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Jérémie Dion
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Paul Legendre
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | | | - Luc Mouthon
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
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39
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Nassarmadji K, Brigante A, Larroche C, Cacoub P, Costedoat-Chalumeau N, LE Guern V, Guillevin L. Antiphospholipid syndrome: the burden of inadequate anticoagulation management. Clin Exp Rheumatol 2021; 40:1812-1813. [DOI: 10.55563/clinexprheumatol/gobuor] [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: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Kladoum Nassarmadji
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Alejandro Brigante
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Claire Larroche
- Department of Internal Medicine, APHP, Hôpital Avicenne, Université de Paris, Bobigny, France
| | - Patrice Cacoub
- Department of Internal Medicine, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Veronique LE Guern
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Cochin, Université Paris Descartes, Paris, France.
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40
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Iudici M, Pagnoux C, Courvoisier DS, Cohen P, Néel A, Aouba A, Lifermann F, Ruivard M, Aumaître O, Bonnotte B, Maurier F, Le Gallou T, Hachulla E, Karras A, Khouatra C, Jourde-Chiche N, Viallard JF, Blanchard-Delaunay C, Godmer P, Le Quellec A, Quéméneur T, de Moreuil C, Régent A, Terrier B, Mouthon L, Guillevin L, Puéchal X. Localised Versus Systemic Granulomatosis with Polyangiitis: Data from the French Vasculitis Study Group Registry. Rheumatology (Oxford) 2021; 61:2464-2471. [PMID: 34542599 DOI: 10.1093/rheumatology/keab719] [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: 07/06/2021] [Revised: 09/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the main features at diagnosis and evolution over time of patients with localised granulomatosis with polyangiitis (L-GPA) compared to those of systemic GPA (S-GPA). METHODS EULAR definitions of L-GPA, i.e., upper and/or lower respiratory tract involvement, and S-GPA were applied to patients from the French Vasculitis Study Group Registry. L-GPA and S-GPA patients' characteristics at diagnosis and long-term outcomes were analyzed and compared. RESULTS Among the 795 Registry patients, 79 (10%) had L-GPA. Their main clinical manifestations were rhinitis, lung nodules, sinusitis and otitis. L-GPA versus S-GPA patients at diagnosis, respectively, were younger, more frequently had saddle nose deformity or subglottic stenosis and were less often PR3-ANCA-positive. L-GPA versus S-GPA induction therapy less frequently included cyclophosphamide but more often a combination of methotrexate and glucocorticoids; 64% of methotrexate-treated patients experienced disease progression within 18 months post-diagnosis. L- and S-GPA patients' estimated relapse-free-survival probabilities, relapse rates and refractory disease rates at each time point were comparable, but L-GPA patients had more frequent ENT and lung relapses, and higher overall survival rates (P <0.02). Over a median follow-up of 3.5 years, 18 (22.8%) L-GPA progressed to S-GPA, either as a relapse after a period in remission or more frequently in the context of refractory disease. L-GPA patients experienced more ENT-related damage. CONCLUSIONS The relapse risks of L-GPA and S-GPA were similar, but relapse patterns differed and L-GPA overall survival rate was higher. About one-quarter of L-GPA patients developed S-GPA over time, but without end-stage organ involvement.
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Affiliation(s)
- Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Christian Pagnoux
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Delphine S Courvoisier
- Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Antoine Néel
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Nantes, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Côte-de-Nacre, Caen, France
| | | | - Marc Ruivard
- Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France
| | - Olivier Aumaître
- Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France
| | - Bernard Bonnotte
- Department of Internal Medicine, CHU François Mitterrand, Dijon, France
| | - François Maurier
- Service of Internal Medicine, Groupe Hospitalier UNEOS, Metz-Vantoux, France
| | - Thomas Le Gallou
- Department of Internal Medicine and Immunology, CHU, Rennes, France
| | - Eric Hachulla
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine and Clinical Immunology, CHU Claude Huriez, Lille, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Chahéra Khouatra
- Department of Respiratory Medicine, CHU Louis-Pradel and UMR754, Université Claude-Bernard Lyon 1, Lyon, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM 1263, INRAE 1260, APHM, Department of Nephrology, CHU de la Conception, Marseille, France
| | | | | | - Pascal Godmer
- Department of Internal Medicine, CH Bretagne-Atlantique, Vannes, France
| | - Alain Le Quellec
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, CH, Valenciennes, France
| | - Claire de Moreuil
- Department of Internal Medicine, CHU La Cavale Blanche, Brest, France
| | - Alexis Régent
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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Samson M, Greigert H, Ciudad M, Gerard C, Ghesquière T, Trad M, Corbera-Bellalta M, Genet C, Ouandji S, Cladière C, Thebault M, Ly KH, Liozon E, Maurier F, Bienvenu B, Terrier B, Guillevin L, Charles P, Quipourt V, Devilliers H, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Saas P, Audia S, Cid MC, Bonnotte B. Improvement of Treg immune response after treatment with tocilizumab in giant cell arteritis. Clin Transl Immunology 2021; 10:e1332. [PMID: 34532040 PMCID: PMC8435365 DOI: 10.1002/cti2.1332] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/20/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives To study the percentage, suppressive function and plasticity of Treg in giant cell arteritis (GCA), and the effects of glucocorticoids and tocilizumab. Methods Blood samples were obtained from 40 controls and 43 GCA patients at baseline and after treatment with glucocorticoids + IV tocilizumab (n = 20) or glucocorticoids (n = 23). Treg percentage and phenotype were assessed by flow cytometry. Suppressive function of Treg was assessed by measuring their ability to inhibit effector T‐cell (Teff) proliferation and polarisation into Th1 and Th17 cells. Results Treg (CD4+CD25highFoxP3+) frequency in total CD4+ T cells was decreased in active GCA patients when compared to controls (2.5% vs. 4.7%, P < 0.001) and increased after treatment with tocilizumab but worsened after treatment with glucocorticoids alone. Treg lacking exon 2 of FoxP3 were increased in GCA patients when compared to controls (23% vs. 10% of total Treg, P = 0.0096) and normalised after treatment with tocilizumab + glucocorticoids but not glucocorticoids alone. In GCA patients, Treg were unable to control Teff proliferation and induced ˜50% increase in the amount of IL‐17+ Teff, which was improved after in vitro blockade of the IL‐6 pathway by tocilizumab. Conclusion This study reports quantitative and functional disruptions in the regulatory immune response of GCA patients and demonstrates that, unlike glucocorticoids, tocilizumab improves Treg immune response.
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Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marion Ciudad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claire Gerard
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Malika Trad
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Coraline Genet
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Sethi Ouandji
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Marine Thebault
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Kim Heang Ly
- Department of Internal Medicine CHU de Limoges Limoges France
| | - Eric Liozon
- Department of Internal Medicine CHU de Limoges Limoges France
| | - François Maurier
- Department of Internal Medicine HP-Metz Site Belle Isle Metz France
| | - Boris Bienvenu
- Department of Internal Medicine Hôpital Saint-Joseph Marseille France
| | - Benjamin Terrier
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Loïc Guillevin
- Department of Internal Medicine National Referral Center for Systemic and Rare Autoimmune Diseases Hôpital Cochin APHP Paris France
| | - Pierre Charles
- Department of Internal Medicine Institut Mutualiste Montsouris Paris France
| | - Valérie Quipourt
- Department of Geriatric Internal Medicine Dijon University Hospital Dijon France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases Dijon University Hospital Dijon France.,INSERM CIC 1432 Clinical Epidemiology Unit Dijon France
| | | | | | - Georges Tarris
- Department of Pathology Dijon University Hospital Dijon France
| | - Laurent Martin
- Department of Pathology Dijon University Hospital Dijon France
| | - Philippe Saas
- Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France.,CIC-1431 INSERM Besançon University Hospital EFS Besançon France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
| | - Maria Cinta Cid
- Vasculitis Research Unit Department of Autoimmune Diseases Hospital Clinic University of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) CRB-CELLEX Barcelona Spain
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology Dijon University Hospital Dijon France.,Université Bourgogne Franche-Comté INSERM EFS BFC UMR1098 RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique Dijon France
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Beydon M, Rodriguez C, Karras A, Cez A, Rafat C, Jourde-Chiche N, Fain O, Philipponnet C, Puéchal X, Dossier A, Dupin N, Levy D, Aureau I, Guillevin L, Terrier B. Bartonella and Coxiella infections presenting as systemic vasculitis: case series and review of literature. Rheumatology (Oxford) 2021; 61:2609-2618. [PMID: 34500468 DOI: 10.1093/rheumatology/keab691] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Coxiella and Bartonella sp. display particular tropism for endothelial or endocardial tissues and an abnormal host response to infections with induced autoimmunity. We aimed, through a case series combined with a comprehensive literature review, to outline characteristics of Coxiella and Bartonella infections presenting as systemic vasculitis. METHODS We retrospectively included cases of definite Coxiella and Bartonella infections presenting with vasculitis features and performed a comprehensive literature review. RESULTS Six cases of Bartonella infections were added to 18 cases from literature review. Causative pathogens were mainly B. henselae. Bartonella infection mimicked anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis in 83% with PR3-ANCA and presented as cryoglobulinemic vasculitis in 8%. Glomerulonephritis was present in 92%, and 88% had endocarditis. Complement fractions were low in 82% and rheumatoid factor positive in 85%. Kidney biopsies showed cell proliferation, mostly crescentic, with pauci-immune glomerulonephritis in 29%. Outcome was favorable, with the use of antibiotics alone in one third. Five cases of Coxiella infections were added to 16 from literature review. Sixteen had small-vessel vasculitides, mainly cryoglobulinemia vasculitis in 75%. One patient had polyarteritis nodosa-like vasculitis and four large-vessel vasculitis. Outcome was good except for one death. A highly sensitive next generation sequencing analysis on 3 Coxiella and 2 Bartonella-related vasculitides biopsies did not find any bacterial DNA. CONCLUSION Coxiella and Bartonella are both able to induce vasculitis but display distinct vasculitis features. Bartonella mimics PR3-ANCA-associated vasculitis in the setting of endocarditis, whereas Coxiella may induce vasculitis involving all vessel sizes.
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Affiliation(s)
- Maxime Beydon
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Rodriguez
- Departement de Virologie, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Alexandre Karras
- Unité de Néphrologie, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, F-75006, France
| | - Alexandre Cez
- Service de néphrologie et dialyse, Hôpital Tenon (AP-HP), Paris, France
| | - Cédric Rafat
- Service des urgences Néphrologiques et Transplantation rénale, Assistance Publique-Hôpital de Paris, Paris, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Centre de Néphrologie et de Transplantation Rénale, Hôpital de la Conception AP-HM, Marseille, France
| | - Olivier Fain
- Département de Médecine interne, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carole Philipponnet
- Département de néphrologie et de dialyse CHU Clermont Ferrand, Clermont Ferrand, France
| | - Xavier Puéchal
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Dossier
- Service de médecine interne, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Dupin
- Département de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dan Levy
- Service de rhumatologie, CHU Strasbourg, Strasbourg, France
| | - Inès Aureau
- Service de médecine interne, Centre Hospitalier de Pau, Pau, France
| | - Loïc Guillevin
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Terrier
- Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, F-75006, France
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43
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Rasmussen C, Abitbol V, El Karoui K, Bourrier A, Paule R, Vuitton L, Maurier F, Laharie D, Fuméry M, Agard C, Collins M, Nancey S, Rafat C, Kervegant AG, Queyrel-Moranne V, Moulis G, Pigneur B, Régent A, Gay C, Morbieu C, Durel CA, Ducloux D, Aubin F, Voicu M, Joher N, Szwebel T, Martinez-Vinson C, Koch S, Guillevin L, Peyrin-Biroulet L, Terrier B. IgA Vasculitis in Patients with Inflammatory Bowel Disease: new insights into the role of TNF-α blockers. Rheumatology (Oxford) 2021; 61:1957-1965. [PMID: 34427590 DOI: 10.1093/rheumatology/keab662] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Association of IgA vasculitis (IgAV) and inflammatory bowel diseases (IBD) is rarely described, mainly during anti-TNF-α therapy. We aimed to describe the association of IgAV and IBD. METHODS We retrospectively analyzed the association of IgAV and IBD through the implication of the GETAID and FVSG networks. Characteristics of IBD and IgAV were collected using a standardized case report form. RESULTS Forty-three cases were included. IBD (mainly Crohn's disease (CD) in 58%) preceded IgAV in 38 (88%), with median interval of 9.2 (IQR 5.4-15.4) years. In these 38 patients, at IgAV diagnosis, 5 (13%) had active IBD and 28 (74%) were treated with anti-TNF-α for a median duration of 31.5 (IQR 19-56) months. Main IgAV manifestations were purpura all patients (100%), joints in 20/35 (57%), renal in 15/35 (43%) and gastrointestinal in 11/35 (31%) involvement. IgAV was treated with glucocorticoids in 25 (66%), colchicine in 6 (16%), cyclophosphamide in 6 (16%), and anti-TNF-α were discontinued in 15/28 (54%). No IgAV relapse occurred when TNF-α blockers were stopped, vs 23% in patients pursuing it. Conversely, 5 (33%) had IBD flare or complication after anti-TNF-α cessation vs 1 (8%) in those continuing biologics. Anti-TNF-α were resumed in 6 (40%), with subsequent IgAV relapse in 4 (67%). CONCLUSIONS This large cohort suggests that TNF-α blockers may promote the onset of IgAV in IBD. Discontinuation of anti-TNF-α was associated with vasculitis remission but increased risk of IBD relapses, whereas continuation of anti-TNF-α was associated with IBD remission but vasculitis relapse.
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Affiliation(s)
- Camille Rasmussen
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
| | - Vered Abitbol
- Department of Gastroenterology, Hopital Cochin, APHP-CUP, Paris
| | | | - Anne Bourrier
- Department of Gastroenterology, Hôpital Saint-Antoine, AP-HP, Paris
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes
| | | | | | | | | | | | - Michael Collins
- Department of Gastroenterology, Hopital Bicêtre, AP-HP, Le Kremlin-Bicêtre
| | | | - Cédric Rafat
- Department of Nephrology, Hôpital Tenon, AP-HP, Paris
| | | | | | | | - Bénédicte Pigneur
- Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker, AP-HP
- Université de Paris, Paris
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | - Claire Gay
- Department of Gastroenterology, CHRU, Besançon
| | - Caroline Morbieu
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | - Cécile Audrey Durel
- Department of Internal Medicine, Hopital Edouard Herriot, Hospices Civils de Lyon, Lyon
| | | | | | - Mickaela Voicu
- Department of Internal Medicine, CHRU Besançon, Besançon
| | - Nizar Joher
- Department of Nephrology, Hôpital Henri Mondor, AP-HP, Créteil
| | - Tali Szwebel
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
| | | | | | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | | | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
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London J, Dumoitier N, Lofek S, Dion J, Chaigne B, Mocek J, Thieblemont N, Cohen P, Le Jeunne C, Guillevin L, Witko-Sarsat V, Varin-Blank N, Terrier B, Mouthon L. Skewed peripheral B- and T-cell compartments in patients with ANCA-associated vasculitis. Rheumatology (Oxford) 2021; 60:2157-2168. [PMID: 33026090 DOI: 10.1093/rheumatology/keaa432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/04/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To characterize lymphocytes dysregulation in patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). METHODS Using flow cytometry, we analysed B- and T-cell subsets in peripheral blood from 37 untreated patients with active disease (29 GPA and 8 MPA) and 22 healthy controls (HCs). RESULTS GPA patients had increased Th2 (1.8 vs 1.0%, P = 0.02), Th9 (1.1 vs 0.2%, P = 0.0007) and Th17 (1.4 vs 0.9%, P = 0.03) cells compared with HC. Patients with MPO-ANCAs had significantly more CD21- B cells than HC or PR3-ANCA patients (6.9 vs 3.3% and 4.4%, P = 0.01). CD69 expressing B cells were significantly higher in GPA and MPA (3.0 and 5.9 vs 1.4%, P = 0.02 and P = 0.03, respectively) compared with HC, whereas B-cell activating factor-receptor expression was decreased in GPA and MPA (median fluorescence intensity ratio 11.8 and 13.7 vs 45.1 in HC, P < 0.0001 and P = 0.003, respectively). Finally, IL-6-producing B cells were increased in GPA vs HC (25.8 vs 14.9%, P < 0.0001) and decreased in MPA vs HC (4.6 vs 14.9%, P = 0.005), whereas TNF-α-producing B cells were lower in both GPA and MPA patients compared with controls (15 and 8.4 vs 30%, P = 0.01 and P = 0.006, respectively). CONCLUSION Skewed T-cell polarization towards Th2, Th9 and Th17 responses characterizes GPA, whereas B-cell populations are dysregulated in both GPA and MPA with an activated phenotype and a decreased B-cell activating factor-receptor expression. Finally, inflammatory B cells producing IL-6 are dramatically increased in GPA, providing an additional mechanism by which rituximab could be effective.
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Affiliation(s)
- Jonathan London
- INSERM U1016/CNRS UMR 8104, Institut Cochin.,Université Paris Descartes.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
| | - Nicolas Dumoitier
- INSERM U1016/CNRS UMR 8104, Institut Cochin.,Université Paris Descartes.,LABEX Inflamex.,Université Paris Diderot, Paris
| | | | - Jérémie Dion
- INSERM U1016/CNRS UMR 8104, Institut Cochin.,Université Paris Descartes.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
| | - Benjamin Chaigne
- INSERM U1016/CNRS UMR 8104, Institut Cochin.,Université Paris Descartes.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
| | | | | | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
| | - Claire Le Jeunne
- Université Paris Descartes.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
| | - Loïc Guillevin
- Université Paris Descartes.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
| | | | - Nadine Varin-Blank
- Université Paris XIII, UFR Santé Médecine Biologie Humaine, Bobigny.,INSERM U978, Bobigny, France
| | - Benjamin Terrier
- INSERM U1016/CNRS UMR 8104, Institut Cochin.,Université Paris Descartes.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
| | - Luc Mouthon
- INSERM U1016/CNRS UMR 8104, Institut Cochin.,Université Paris Descartes.,Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris.,LABEX Inflamex
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Sartorelli S, Chassagnon G, Cohen P, Dunogué B, Puéchal X, Régent A, Mouthon L, Guillevin L, Terrier B. Revisiting characteristics, treatment and outcome of cardiomyopathy in eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Rheumatology (Oxford) 2021; 61:1175-1184. [PMID: 34156464 DOI: 10.1093/rheumatology/keab514] [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: 02/22/2021] [Revised: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing eosinophil-rich vasculitis. Specific cardiomyopathy (CM) was described in old studies as the most important predictor of mortality. We aimed to revisit EGPA-related CM and its outcome in recent decades. METHODS We reviewed all EGPA patients managed from 2000 to 2019 in our vasculitis clinic. Baseline characteristics and outcomes were analyzed. EGPA-related CM was defined as clinical or extra-clinical manifestations of patent myocardial involvement, after exclusion of other causes. RESULTS We included 176 patients. Median age was 47 years (IQR 36-58 years). Specific CM was observed in 70 patients (40%). Cardiac symptoms were observed in 81% of CM+ patients, including mainly typical or atypical chest pain and peripheral edema. Abnormal EKG, TTE and cardiac magnetic resonance imaging (CMRI) were found in 72%, 72% and 99% in CM+ patients, respectively, contrasting with abnormalities in 32%, 38% and 60% in CM-negative patients. Late gadolinium enhancement (LGE) was the most frequent abnormality on CMRI (70%). CM+ patients were less frequently ANCA-positive, had less frequent peripheral neuropathy and had higher eosinophil count. Major adverse cardiovascular events (MACE) occurred in 13%, both in CM+ and CM- patients. Abnormal EKG and LGE on CMRI were associated with the occurrence of MACE. Four patients died, but none from cardiac causes. CONCLUSIONS Specific cardiomyopathy is frequent in EGPA, especially in ANCA-negative patients with high eosinophil counts. Long-term outcome was better than previously reported. Abnormal EKG and LGE on CMRI were associated with the occurrence of MACE.
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Affiliation(s)
- Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare disease, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Guillaume Chassagnon
- Department of Radiology, Cochin Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Bertrand Dunogué
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Luc Mouthon
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
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46
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Iudici M, Puéchal X, Pagnoux C, Courvoisier DS, Hamidou M, Blanchard-Delaunay C, Maurier F, Ruivard M, Quemeneur T, Aumaitre O, Guillevin L, Terrier B. Significance of eosinophilia in granulomatosis with polyangiitis: data from the French Vasculitis Study Group Registry. Rheumatology (Oxford) 2021; 61:1211-1216. [PMID: 34142135 DOI: 10.1093/rheumatology/keab495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe disease presentation and long-term outcome of granulomatosis with polyangiitis (GPA) patients according to blood eosinophils count (Eos) at vasculitis diagnosis. METHODS Data from newly diagnosed GPA patients registered in the French Vasculitis Study Group database with available eosinophil count at diagnosis were reviewed. Disease characteristics, rate and type of relapses and overall survival were analyzed according to Eos, categorized as normal (<500/mm3), mild-to-moderate hypereosinophilia (HE) between 500 and 1500/mm3 and severe HE > 1500/mm3. RESULTS Three hundred and fifty-four patients were included. At diagnosis, 90 (25.4%) patients had HE ≥ 500/mm3; they were more likely male (73% vs 56%, p= 0.006) and had more frequent cutaneous manifestations (49% vs 33%, p= 0.01), peripheral neuropathy (32% vs 17%, p= 0.004) and higher BVAS (21 vs 18, p= 0.01), compared with those with Eos <500/mm3. Patients with severe HE (n = 28; median Eos 2355, range 1500-9114) had more frequent renal function worsening at presentation (p= 0.008). After a median follow-up of 3.95 (IQR 1.95-6.76) years, no difference was found in overall relapse rates according to baseline Eos, but those with HE experienced more neurologic (p= 0.013) and skin (p= 0.024) relapses and had more frequently peripheral neuropathy as damage at last follow-up (p= 0.02). Overall survival difference was not significantly different in patients with normal Eos or HE at diagnosis. (p= 0.08). CONCLUSIONS Blood HE at diagnosis, observed in about one quarter of GPA patients, identifies a subgroup of patients with a more severe disease and higher rate of skin and neurological involvement both at presentation and during follow-up.
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Affiliation(s)
- Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris.,Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Delphine S Courvoisier
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | | | - François Maurier
- Service de médecine interne, Groupe Hospitalier UNEOS, Metz-Vantoux, France
| | - Marc Ruivard
- Service de médecine interne, CHU, Clermont-Ferrand, France
| | - Thomas Quemeneur
- Département de médecine interne, Centre Hospitalier, Valenciennes, France
| | | | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris.,Université de Paris, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), France, Paris.,Université de Paris, Paris, France
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47
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Quirins M, Théaudin M, Cohen-Aubart F, Créange A, Mouthon L, Genty S, Kahn JE, Bérezné A, Rigolet A, Adams D, Adam C, Amoura Z, Benveniste O, Authier FJ, Guillevin L, Maisonobe T, Terrier B. Nonsystemic vasculitic neuropathy: Presentation and long-term outcome from a French cohort of 50 patients. Autoimmun Rev 2021; 20:102874. [PMID: 34118457 DOI: 10.1016/j.autrev.2021.102874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Marion Quirins
- Department of Neurology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Marie Théaudin
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fleur Cohen-Aubart
- Department of Internal Medicine 2, Hôpital Pitié-Salpétrière, Paris, France
| | - Alain Créange
- Department of Neurology, Hôpital Henri Mondor, Créteil, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; Université de Paris, F-75006, Paris, France
| | - Solène Genty
- Department of Neurology, Hôpital André Mignot, Versailles, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Alice Bérezné
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; Université de Paris, F-75006, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine 1, Hôpital Pitié-Salpétrière, Paris, France
| | - David Adams
- Department of Neurology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Clovis Adam
- Department of Neurology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Zahir Amoura
- Department of Internal Medicine 2, Hôpital Pitié-Salpétrière, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine 1, Hôpital Pitié-Salpétrière, Paris, France
| | | | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris; Université de Paris, F-75006, Paris, France
| | - Thierry Maisonobe
- Department of Neuropathology, Hôpital Pitié-Salpétrière, Paris, France
| | - Benjamin Terrier
- Department of Neurology, Hôpital Henri Mondor, Créteil, France; Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris.
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48
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Sorin B, Samson M, Durel C, Diot E, Guichard I, Grados A, Limal N, Régent A, Cohen P, Dion J, Legendre P, Le Guern V, Mouthon L, Guillevin L, Terrier B. Étude de l’association rituximab et methotrexate dans les vascularites associées aux ANCA. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Papo M, Friedrich C, Delaval L, de Boysson H, Viallard JF, Bachmeyer C, Sené T, Humbert S, Duffau P, Contis A, Agard C, Gombert B, Puyade M, Foucher A, Alary AS, Danlos FX, Régent A, Mouthon L, Guillevin L, Samson M, Kosmider O, Terrier B. Myeloproliferative neoplasms and clonal hematopoiesis in patients with giant cell arteritis: a case-control and exploratory study. Rheumatology (Oxford) 2021; 61:775-780. [PMID: 33836046 DOI: 10.1093/rheumatology/keab337] [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: 01/05/2021] [Revised: 04/02/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Giant cell arteritis (GCA) is a large vessel vasculitis for which triggering factors remain unknown. Clonal hematopoiesis (CH) was associated with atherosclerosis through the induction of inflammation in myeloid cells, and data suggest that CH expansion and inflammation may support each other to induce a proinflammatory loop. Our objective was to describe the impact of JAK2p.V617F-mutated myeloproliferative neoplasms (MPN) on GCA and to screen MPN-free patients for CH mutations. METHODS We performed a retrospective case-control study comparing characteristics of 21 GCA patients with MPN and 42 age and gender-matched GCA patients without MPN. Also, 18 GCA patients were screened for CH through Next Generation Sequencing. RESULTS The most frequent associated MPN was essential thrombocythemia (ET) (n = 11). Compared to controls, GCA patients with MPN had less frequent cephalic symptoms (71.4 vs. 97.6%, p = 0.004) and higher platelets count at baseline [485 (346-586) vs. 346 [IQR 296-418] x 109/L, p = 0.02). There was no difference between groups for other clinical features. Overall survival was significantly shorter in patients with MPN compared to controls [HR 8.2 (95% CI 1.2-56.6), p = 0.03]. Finally, screening for CH using NGS in 15 GCA patients without MPN revealed CH in 33%. CONCLUSION GCA patients with MPN display higher platelets count and shorter overall survival than controls. This association could not be fortuitous given the possible pathophysiological relationship between the two diseases. CH was found in one third of GCA patients, which may be higher than the expected prevalence for similar age, what should be confirmed in a larger cohort.
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Affiliation(s)
- Matthias Papo
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Chloé Friedrich
- Laboratory of Hematology, Cochin Institute, Paris University, AP-HP, Paris, France
| | - Laure Delaval
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, UNICAEN, EA4650 SEILIRM, Caen Normandie University Hospital, Caen, France
| | - Jean-François Viallard
- Department of Internal Medicine and Infectious Diseases, Haut Lévêque University Hospital, Bordeaux University, Pessac, France
| | - Claude Bachmeyer
- Department of Internal Medicine, AP-HP, Tenon Hospital, Sorbonne University, Paris, France
| | - Thomas Sené
- Department of Internal Medicine, Rothschild Foundation Hospital, Paris, France
| | - Sébastien Humbert
- Internal Medicine Department, University Hospital Besancon, Besançon, France
| | - Pierre Duffau
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, 33000 Bordeaux, France; CNRS UMR 5164, Immuno ConcEpT, Bordeaux University, 33076 Bordeaux, France
| | - Anne Contis
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, 33000 Bordeaux, France; CNRS UMR 5164, Immuno ConcEpT, Bordeaux University, 33076 Bordeaux, France
| | | | - Bruno Gombert
- Department of Rheumatology, La Rochelle Hospital, La Rochelle, France
| | - Mathieu Puyade
- Department of Internal Medicine and Infectious Diseases, Poitiers Universitary Hospital, Poitiers, France
| | - Aurélie Foucher
- Department of Internal Medicine, CHU de La Réunion, Saint Pierre, France
| | - Anne-Sophie Alary
- Laboratory of Hematology, Cochin Institute, Paris University, AP-HP, Paris, France
| | - François-Xavier Danlos
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France
| | - Olivier Kosmider
- Laboratory of Hematology, Cochin Institute, Paris University, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
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50
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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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