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Stichelbout R, Sinzogan Eyoum C, Billoir P, Benhamou Y, Demeyere M, Miranda S. Pulmonary vascular obstruction increases the risk of recurrent thrombotic events after cessation of anticoagulation in unprovoked pulmonary embolism: A retrospective cohort study. Vasc Med 2024:1358863X241239648. [PMID: 38660787 DOI: 10.1177/1358863x241239648] [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] [Indexed: 04/26/2024]
Affiliation(s)
- Romain Stichelbout
- Service de Médecine Interne, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Calliste Sinzogan Eyoum
- Service de Médecine Interne, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Paul Billoir
- Service D'hémostase, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
- Unité EnVI, Université de Rouen Normandie, Rouen, Normandie, France
| | - Ygal Benhamou
- Service de Médecine Interne, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
- Unité EnVI, Université de Rouen Normandie, Rouen, Normandie, France
| | - Matthieu Demeyere
- Service de Radiologie, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
| | - Sebastien Miranda
- Service de Médecine Interne, Centre Hospitalier Universitaire de Rouen, Rouen, Normandie, France
- Unité EnVI, Université de Rouen Normandie, Rouen, Normandie, France
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Chevalier K, Thoreau B, Michel M, Godeau B, Agard C, Papo T, Sacre K, Seror R, Mariette X, Cacoub P, Benhamou Y, Levesque H, Goujard C, Lambotte O, Bonnotte B, Samson M, Ackermann F, Schmidt J, Duhaut P, Kahn JE, Hanslik T, Costedoat-Chalumeau N, Terrier B, Regent A, Dunogue B, Cohen P, Guern VL, Hachulla E, Chaigne B, Mouthon L. Clinical presentation, course, and prognosis of patients with mixed connective tissue disease: A multicenter retrospective cohort. J Intern Med 2024; 295:532-543. [PMID: 38013625 DOI: 10.1111/joim.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The objective of this study is to better characterize the features and outcomes of a large population of patients with mixed connective tissue disease (MCTD). METHODS We performed an observational retrospective multicenter cohort study in France. Patients who fulfilled at least one diagnostic criterion set for MCTD and none of the criteria for other differentiated CTD (dCTD) were included. RESULTS Three hundred and thirty patients (88% females, median [interquartile range] age of 35 years [26-45]) were included. The diagnostic criteria of Sharp or Kasukawa were met by 97.3% and 93.3% of patients, respectively. None met other classification criteria without fulfilling Sharp or Kasukawa criteria. After a median follow-up of 8 (3-14) years, 149 (45.2%) patients achieved remission, 92 (27.9%) had interstitial lung disease, 25 (7.6%) had pulmonary hypertension, and 18 (5.6%) died. Eighty-five (25.8%) patients progressed to a dCTD, mainly systemic sclerosis (15.8%) or systemic lupus erythematosus (10.6%). Median duration between diagnosis and progression to a dCTD was 5 (2-11) years. The presence at MCTD diagnosis of an abnormal pattern on nailfold capillaroscopy (odds ratio [OR] = 2.44, 95% confidence interval [95%CI] [1.11-5.58]) and parotid swelling (OR = 3.86, 95%CI [1.31-11.4]) were statistically associated with progression to a dCTD. Patients who did not progress to a dCTD were more likely to achieve remission at the last follow-up (51.8% vs. 25.9%). CONCLUSIONS This study shows that MCTD is a distinct entity that can be classified using either Kasukawa or Sharp criteria, and that only 25.8% of patients progress to a dCTD during follow-up.
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Affiliation(s)
- Kevin Chevalier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Marc Michel
- Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil (UPEC), Créteil, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, University of Nantes, Nantes, France
| | - Thomas Papo
- Department of Internal Medicine, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Karim Sacre
- Department of Internal Medicine, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Raphaèle Seror
- Department of Rheumatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU de Rouen, UniRouen, Rouen, France
| | - Hervé Levesque
- Department of Internal Medicine, CHU de Rouen, UniRouen, Rouen, France
| | - Cécile Goujard
- Department of Internal Medicine and Clinical Immunology, Université Paris Saclay, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, UMR1184 Inserm, CEA, Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- Department of Internal Medicine and Clinical Immunology, Université Paris Saclay, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, UMR1184 Inserm, CEA, Le Kremlin Bicêtre, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Jean Schmidt
- Department of Internal Medicine and RECIF, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Pierre Duhaut
- Department of Internal Medicine and RECIF, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Thomas Hanslik
- Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alexis Regent
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Bertrand Dunogue
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Véronique Le Guern
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, North-West National Reference Center for Rare Systemic Autoimmune Diseases iques et Auto-Immunes Rares du Nord-Ouest, Hôpital Claude Huriez, Université de Lille, Lille, France
| | - Benjamin Chaigne
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Lévesque H, Viallard JF, Houivet E, Bonnotte B, Voisin S, Le Cam-Duchez V, Maillot F, Lambert M, Liozon E, Hervier B, Fain O, Guillet B, Schmidt J, Luca LE, Ebbo M, Ferreira-Maldent N, Babuty A, Sailler L, Duffau P, Barbay V, Audia S, Benichou J, Graveleau J, Benhamou Y. Cyclophosphamide vs rituximab for eradicating inhibitors in acquired hemophilia A: A randomized trial in 108 patients. Thromb Res 2024; 237:79-87. [PMID: 38555718 DOI: 10.1016/j.thromres.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against Factor VIII, with a high mortality risk. Treatments aim to control bleeding and eradicate antibodies by immunosuppression. International recommendations rely on registers and international expert panels. METHODS CREHA, an open-label randomized trial, compared the efficacy and safety of cyclophosphamide and rituximab in association with steroids in patients with newly diagnosed AHA. Participants were treated with 1 mg/kg prednisone daily and randomly assigned to receive either 1.5-2 mg/kg/day cyclophosphamide orally for 6 weeks, or 375 mg/m2 rituximab once weekly for 4 weeks. The primary endpoint was complete remission over 18 months. Secondary endpoints included time to achieve complete remission, relapse occurrence, mortality, infections and bleeding, and severe adverse events. RESULTS Recruitment was interrupted because of new treatment recommendations after 108 patients included (58 cyclophosphamide, 50 rituximab). After 18 months, 39 cyclophosphamide patients (67.2 %) and 31 rituximab patients (62.0 %) were in complete remission (OR 1.26; 95 % CI, 0.57 to 2.78). In the poor prognosis group (FVIII < 1 IU/dL, inhibitor titer > 20 BU mL-1), significantly more remissions were observed with cyclophosphamide (22 patients, 78.6 %) than with rituximab (12 patients, 48.0 %; p = 0.02). Relapse rates, deaths, severe infections, and bleeding were similar in the 2 groups. In patients with severe infection, cumulative doses of steroids were significantly higher than in patients without infection (p = 0.03). CONCLUSION Cyclophosphamide and rituximab showed similar efficacy and safety. As first line, cyclophosphamide seems preferable, especially in poor prognosis patients, as administered orally and less expensive. FUNDING French Ministry of Health. CLINICALTRIALS gov number: NCT01808911.
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Affiliation(s)
- H Lévesque
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France.
| | - J F Viallard
- Service de Médecine Interne et Maladies Infectieuses Hôpital Haut-Lévêque, CHU Bordeaux, 5 avenue de Magellan, 33604 Pessac, France
| | - E Houivet
- Department of Biostatistics, CHU Rouen, F-76031 Rouen, France
| | - B Bonnotte
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - S Voisin
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - V Le Cam-Duchez
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - F Maillot
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - M Lambert
- CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reerence Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), F-59000 Lille, France
| | - E Liozon
- Department of Internal Medicine, Dupuytren Hospital, F-87000 Limoges, France
| | - B Hervier
- Service de Médecine Interne, Hôpital Saint-Louis, APHP, 75010 Paris & INSERM UMR-S 976, Human Immunology, Pathophysiology, Immunotherapy, Saint-Louis Research Institute, F-75000 Paris, France
| | - O Fain
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris F-75000, France
| | - B Guillet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR-S 1085, F-35000 Rennes, France
| | - J Schmidt
- Department of Internal Medicine, Amiens University Hospital, F-80000 Amiens, France
| | - L E Luca
- Department of Internal Medicine, Poitiers University Hospital, F-86000 Poitiers, France
| | - M Ebbo
- Service de Médecine Interne, Hôpital La Timone, CHU Marseille, Aix-Marseille Université, F-13000 Marseille, France
| | - N Ferreira-Maldent
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - A Babuty
- Service d'Hématologie Biologique, CRC-MHC, CHU de Nantes, Nantes Cedex 1, France
| | - L Sailler
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - P Duffau
- Service de Médecine Interne-Immunologie Clinique Hôpital Saint-André, CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France
| | - V Barbay
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - S Audia
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - J Benichou
- Department of Biostatistics, CHU Rouen and CESP UMR 1018, University of Rouen and University Paris-Saclay, F-76031 Rouen, France
| | - J Graveleau
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes, France
| | - Y Benhamou
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France
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Lebel N, Marie I, Grosjean J, Brevet P, Leclercq M, Dumont A, Levesque H, Benhamou Y, Marcelli C, Lequerre T, Vittecoq O. Potential efficacy of T and B lymphocyte-targeted therapies on articular involvement of patients with rheumatoid arthritis and systemic sclerosis overlap syndrome. Results from a 2-centre series of 22 cases. Clin Exp Rheumatol 2024:19981. [PMID: 38489323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/28/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To analyse in routine practice the efficacy of targeted therapies on joint involvement of patients with rheumatoid arthritis/systemic sclerosis (RA/SSc) overlap syndrome. METHODS This was a retrospective analysis of medical records of two academic centres over a 10-year period. Joint response to targeted therapies was measured according to EULAR criteria based on Disease Activity Score (DAS)-28. In addition, changes in CRP level and glucocorticoid consumption were recorded. RESULTS Nineteen patients were included. Methotrexate (n=11) and hydroxychloroquine (n=4) were the most used first-line treatments. Targeted therapies were frequently used (n=14). Tocilizumab was the most selected therapy (n=8), then rituximab (n=5), abatacept and anti-tumour necrosis factor (n=4). Twenty-one treatment sequences were assessed, including 18 with EULAR response criteria. Responses were "good" or "moderate" in 100% (4/4) of patients treated with abatacept, 80% (4/5) with rituximab, 40% (2/5) with tocilizumab, and 25% (1/4) with anti-TNF. T and B lymphocyte-targeted therapies (abatacept, rituximab) resulted more frequently in a "good" or "moderate" response compared to cytokine inhibitors (tocilizumab, etanercept, infliximab) with a significant decrease in DAS-28 at 6 months (-1.75; p=0.016) and a trend to a lower consumption of glucocorticoids. CCONCLUSIONS In patients with RA/SSc overlap syndrome refractory to conventional synthetic-DMARDs, T and B lymphocyte-targeted therapies seem to be a promising therapeutic option to control joint activity.
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Affiliation(s)
- Nans Lebel
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France
| | - Isabelle Marie
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Julien Grosjean
- Department of Biomedical Informatics, Rouen University, CHU de Rouen, and LIMICS U1142, Sorbonne University, Paris, France
| | - Pauline Brevet
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France
| | - Mathilde Leclercq
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Anaël Dumont
- Department of Internal Medicine, Normandie Univ, UNICAEN, CHU de Caen, France
| | - Hervé Levesque
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Christian Marcelli
- Department of Rheumatology, Normandie Univ, UNICAEN, CHU de Caen, France
| | - Thierry Lequerre
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France
| | - Olivier Vittecoq
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France.
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Chaibi S, Roy PM, Guénégou AA, Tran Y, Hugli O, Penaloza A, Couturaud F, Tromeur C, Szwebel TA, Pernod G, Elias A, Ghuysen A, Benhamou Y, Falvo N, Juchet H, Nijkeuter M, Mairuhu R, Faber LM, Mahé I, Montaclair K, Planquette B, Jimenez D, Huisman MV, Klok FA, Sanchez O. Outpatient management of cancer-associated pulmonary embolism: A post-hoc analysis from the HOME-PE trial. Thromb Res 2024; 235:79-87. [PMID: 38308882 DOI: 10.1016/j.thromres.2024.01.014] [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: 11/25/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE. METHODS In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization. RESULTS Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15-21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15-9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48-42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15-9.74). CONCLUSIONS Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes.
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Affiliation(s)
- Sérine Chaibi
- Université Paris Cité, Paris, France; Department of Pneumology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris F-75908, France
| | - Pierre-Marie Roy
- Emergency Department, CHU Angers, Angers F-49000, France; Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France; F-CRIN, INNOVTE, Saint-Etienne, France
| | - Armelle Arnoux Guénégou
- Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, Clinical research unit, Clinical Investigation Center 1418 Clinical Epidemiology, INSERM, INRIA, HeKA, Paris, France
| | - Yohann Tran
- Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, Clinical research unit, Clinical Investigation Center 1418 Clinical Epidemiology, INSERM, Paris, France
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne and Lausanne University, Lausanne, Switzerland
| | - Andréa Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; UCLouvain, Brussels, Belgium
| | - Francis Couturaud
- F-CRIN, INNOVTE, Saint-Etienne, France; Department of Internal Medicine and Chest Disease, CHU Brest, Brest, France; INSERM U1304-GETBO, CIC-INSERM1412, Univ-Brest, F20609 Brest, France
| | - Cécile Tromeur
- F-CRIN, INNOVTE, Saint-Etienne, France; Department of Internal Medicine and Chest Disease, CHU Brest, Brest, France; INSERM U1304-GETBO, CIC-INSERM1412, Univ-Brest, F20609 Brest, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, Cochin Hospital, APHP, Paris, France
| | - Gilles Pernod
- F-CRIN, INNOVTE, Saint-Etienne, France; Department of Vascular Medicine, CHU Grenoble Alpes, Grenoble, France; University Grenoble Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France
| | - Antoine Elias
- F-CRIN, INNOVTE, Saint-Etienne, France; Department of Cardiology and Vascular Medicine, Sainte Musse Hospital, Centre Hospitalier Intercommunal Toulon La Seyne sur Mer, Toulon, France
| | - Alexandre Ghuysen
- Emergency Department, Sart Tilman University Hospital, Liège, Belgium
| | - Ygal Benhamou
- F-CRIN, INNOVTE, Saint-Etienne, France; Department of Internal Medicine, CHU Charles Nicolle, Rouen, France; Normandie University, UNIROUEN, INSERM U1096 EnVI, Rouen, France
| | - Nicolas Falvo
- F-CRIN, INNOVTE, Saint-Etienne, France; Vascular Medicine Department, CHU Dijon, Dijon, France
| | - Henry Juchet
- Emergency Department, CHU Toulouse, Toulouse, France
| | - Mathilde Nijkeuter
- Department of emergency medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronne Mairuhu
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Laura M Faber
- Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, DTN, the Netherlands
| | - Isabelle Mahé
- Université Paris Cité, Paris, France; F-CRIN, INNOVTE, Saint-Etienne, France; Department of Internal Medicine, Louis Mourier Hospital, AP-HP, Colombes, France; Inserm UMR_S1140 Innovations Thérapeutiques en Hémostase, Paris, France
| | - Karine Montaclair
- F-CRIN, INNOVTE, Saint-Etienne, France; Department of Cardiology, CH Le Mans, Le Mans, France
| | - Benjamin Planquette
- Université Paris Cité, Paris, France; Department of Pneumology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris F-75908, France; F-CRIN, INNOVTE, Saint-Etienne, France; Inserm UMR_S1140 Innovations Thérapeutiques en Hémostase, Paris, France
| | - David Jimenez
- Respiratory Department and Medicine Department, Ramon y Cajal Hospital (IRYCIS) and Alcala University, CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Federikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Olivier Sanchez
- Université Paris Cité, Paris, France; Department of Pneumology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris F-75908, France; F-CRIN, INNOVTE, Saint-Etienne, France; Inserm UMR_S1140 Innovations Thérapeutiques en Hémostase, Paris, France.
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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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Laporte S, Benhamou Y, Bertoletti L, Frère C, Hanon O, Couturaud F, Moustafa F, Mismetti P, Sanchez O, Mahé I. Management of cancer-associated thromboembolism in vulnerable population. Arch Cardiovasc Dis 2024; 117:45-59. [PMID: 38065754 DOI: 10.1016/j.acvd.2023.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Although all patients with cancer-associated thrombosis (CAT) have a high morbidity and mortality risk, certain groups of patients are particularly vulnerable. This may expose the patient to an increased risk of thrombotic recurrence or bleeding (or both), as the benefit-risk ratio of anticoagulant treatment may be modified. Treatment thus needs to be chosen with care. Such vulnerable groups include older patients, patients with renal impairment or thrombocytopenia, and underweight and obese patients. However, these patient groups are poorly represented in clinical trials, limiting the available data, on which treatment decisions can be based. Meta-analysis of data from randomised clinical trials suggests that the relative treatment effect of direct oral factor Xa inhibitors (DXIs) and low molecular weight heparin (LMWH) with respect to major bleeding could be affected by advanced age. No evidence was obtained for a change in the relative risk-benefit profile of DXIs compared to LMWH in patients with renal impairment or of low body weight. The available, albeit limited, data do not support restricting the use of DXIs in patients with CAT on the basis of renal impairment or low body weight. In older patients, age is not itself a critical factor for choice of treatment, but frailty is such a factor. Patients over 70 years of age with CAT should undergo a systematic frailty evaluation before choosing treatment and modifiable bleeding risk factors should be addressed. In patients with renal impairment, creatine clearance should be assessed and monitored regularly thereafter. In patients with an eGFR<30mL/min/1.72m2, the anticoagulant treatment may need to be adapted. Similarly, platelet count should be assessed prior to treatment and monitored regularly. In patients with grade 3-4, thrombocytopenia (<50,000 platelets/μL) treatment with a LMWH at a reduced dose should be considered. For patients with CAT and low body weight, standard anticoagulant treatment recommendations are appropriate, whereas in obese patients, apixaban may be preferred.
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Affiliation(s)
- Silvy Laporte
- SAINBIOSE Inserm, unité de recherche clinique, innovation et pharmacologie, hôpital Nord, université Jean-Monnet, CHU de Saint-Étienne, Saint-Étienne, France; F-CRIN INNOVTE network, Saint-Étienne, France.
| | - Ygal Benhamou
- UNI Rouen U1096, service de médecine interne, Normandie université, CHU Charles-Nicolle, Rouen, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Laurent Bertoletti
- Service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, INSERM, CIC-1408, CHU Saint-Étienne, Saint-Étienne, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Corinne Frère
- Inserm UMRS 1166, GRC 27 GRECO, DMU BioGeMH, hôpital de la Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Olivier Hanon
- Service de Gérontologie, hôpital Broca, AP-HP, EA 4468, Université de Paris Cité, Paris, France
| | - Francis Couturaud
- Inserm U1304 - GETBO, département de médecine interne, médecine vasculaire et pneumologie, université de Brest, CHU de Brest, Brest, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Farès Moustafa
- Inrae, UNH, département urgence, hôpital de Clermont-Ferrand, université Clermont Auvergne, Clermont-Ferrand, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, Saint-Étienne, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Olivier Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Isabelle Mahé
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; F-CRIN INNOVTE network, Saint-Étienne, France
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Mahé I, Mayeur D, Couturaud F, Scotté F, Benhamou Y, Benmaziane A, Bertoletti L, Laporte S, Girard P, Mismetti P, Sanchez O. Anticoagulant treatment of cancer-associated thromboembolism. Arch Cardiovasc Dis 2024; 117:29-44. [PMID: 38092578 DOI: 10.1016/j.acvd.2023.11.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Venous thromboembolism (VTE) is a frequent and potentially fatal complication in patients with cancer. During the initial period after the thromboembolic event, a patient receiving anticoagulant treatment is exposed both to a risk of VTE recurrence and also to an elevated bleeding risk conferred by the treatment. For this reason, the choice of anticoagulant is critical. The choice should take into account patient-related factors (such as functional status, age, body mass index, platelet count and renal function), VTE-related factors (such as severity or site), cancer-related factors (such as activity and progression) and treatment-related factors (such as drug-drug interactions), which all potentially influence bleeding risk, and patient preference. These should be evaluated carefully for each patient during a multidisciplinary team meeting. For most patients, apixaban or a low molecular-weight heparin is the most appropriate initial choice for anticoagulant treatment. Such treatment should be offered to all patients with active cancer for at least six months. The patient and treatment should be re-evaluated regularly and anticoagulant treatment changed when necessary. Continued anticoagulant treatment beyond six months is justified if the cancer remains active or if the patient experienced recurrence of VTE in the first six months. In other cases, the interest of continued anticoagulant treatment may be considered on an individual patient basis in collaboration with oncologists.
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Affiliation(s)
- Isabelle Mahé
- Service de Médecine Interne, Hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Didier Mayeur
- Département d'Oncologie Médicale, Centre Georges-François-Leclerc, Dijon, France
| | - Francis Couturaud
- Département de Médecine Interne, Médecine Vasculaire et Pneumologie, CHU de Brest, Inserm U1304 -GETBO, université de Brest, Brest, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Florian Scotté
- Département Interdisciplinaire d'Organisation des Parcours Patients (DIOPP), Institut Gustave-Roussy, Villejuif, France
| | - Ygal Benhamou
- UNI Rouen U1096, service de médecine interne, Normandie université, CHU Charles-Nicolle, Rouen, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Asmahane Benmaziane
- Département d'Oncologie et de Soins de Supports, Hôpital Foch, Suresnes, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de Saint-Étienne, INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Inserm CIC-1408, Saint-Étienne, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Silvy Laporte
- SAINBIOSE INSERM U1059, unité de recherche clinique, innovation et pharmacologie, hôpital Nord, université Jean-Monnet, CHU de Saint-Étienne, Saint-Étienne, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de Pneumologie et de Soins Intensifs, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
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9
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Kentish-Barnes N, Souppart V, Cohen-Solal Z, Benhamou Y, Coppo P, Veyradier A, Azoulay E. The Metamorphosis, struggling to adapt to a new condition. The lived experience of patients with Thrombotic microangiopathies diagnosed in the ICU. A qualitative study. J Crit Care 2023; 78:154366. [PMID: 37453271 DOI: 10.1016/j.jcrc.2023.154366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Using qualitative interviews, our objective was to better understand the experience of patients with Thrombotic microangiopathies (TMA), from discovering their disease in the ICU to the psychological, emotional, and social specifics of living with this rare disorder. MATERIAL AND METHODS Patients were recruited at seven TMA centers belonging to the French national TMA referral network. A total of 15 patients, 15 relatives and 12 healthcare professionals participated. A majority of patients (n = 11/15) were women, median age was 41 (range 29-62) years, and median time elapsed since diagnosis was 6 (range 2-11) years. Interviews were analysed using thematic analysis. RESULTS We derived 3 major themes from qualitative analysis: 1) Discovering TMA: experiencing a life-threatening emergency with open eyes; 2) TMA: a complex and diverse disease and care plan; 3) Living with TMA: taming fear and loneliness. CONCLUSIONS Patients with TMA share common experiences with patients with other rare diseases, but also specific experiences related to their illness. Improved information at the onset and during the course of the illness, associated with enhanced care coordination plans would help TMA patients better cope with their illness and adhere to their care projects.
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Affiliation(s)
- Nancy Kentish-Barnes
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France.
| | - Virginie Souppart
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Zoé Cohen-Solal
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Ygal Benhamou
- French Reference Center for Thrombotic Microangiopathies, France; CHU Charles Nicolle, Internal Medicine Department, Rouen, France
| | - Paul Coppo
- French Reference Center for Thrombotic Microangiopathies, France; AP-HP, Saint-Antoine Hospital, Hematology Department, Paris, France
| | - Agnès Veyradier
- French Reference Center for Thrombotic Microangiopathies, France; AP-HP, Lariboisière Hospital, Biological Hematology, Paris, France
| | - Elie Azoulay
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; French Reference Center for Thrombotic Microangiopathies, France
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Feugray G, Dumesnil C, Grall M, Benhamou Y, Girot H, Fettig J, Brunel V, Billoir P. Lactate dehydrogenase and hemolysis index to predict vaso-occlusive crisis in sickle cell disease. Sci Rep 2023; 13:21198. [PMID: 38040880 PMCID: PMC10692321 DOI: 10.1038/s41598-023-48324-w] [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: 07/03/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy disorder associated with chronic hemolysis. A major complication is vaso-occlusive crisis (VOC), associating frequent hospitalization, morbidity and mortality. The aim of this study was to investigate whether hemolysis biomarkers were able to predict VOC risk in adult patients with SCD requiring hospitalization within 1 year. This single-center prospective study included adult patients with SCD at steady state or during VOC. A total of 182 patients with SCD were included, 151 at steady state and 31 during VOC. Among the 151 patients at steady state 41 experienced VOC within 1 year (median: 3.0 months [2.0-6.5]). We observed an increase of lactate dehydrogenase (LDH) (p = 0.01) and hemolysis index (HI) (p = 0.0043) during VOC compared to steady state. Regarding patients with VOC requiring hospitalization, LDH (p = 0.0073) and HI (p = 0.04) were increased. In unadjusted logistic regression, LDH > median (> 260 U/L) (RR = 3.6 [1.29-10.88], p = 0.0098) and HI > median (> 8 UA/L) (RR = 3.13 [1.91-5.33]; p < 0.001) were associated with VOC. The association of LDH > 260 U/L and HI > 12 UA/L presented a sensitivity of 90%, and a specificity of 72.9% to predict VOC. The association of LDH and HI cut-off was able to predict VOC risk in SCD.
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Affiliation(s)
- Guillaume Feugray
- Department of General Biochemistry, UNIROUEN, INSERM U1096, CHU Rouen, Normandie Univ, 76000, Rouen, France.
- Service de Biochimie Générale, Centre Hospitalier Universitaire Charles Nicolle, 1 Rue de Germont, 76031, Rouen, France.
| | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, 76000, Rouen, France
| | - Maximilien Grall
- Department of Internal Medicine, CHU Rouen, 76000, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, UNIROUEN, INSERM U1096, CHU Rouen, Normandie Univ, 76000, Rouen, France
| | - Helene Girot
- Department of General Biochemistry, CHU Rouen, 76000, Rouen, France
| | - Julie Fettig
- Department of General Biochemistry, CHU Rouen, 76000, Rouen, France
| | - Valery Brunel
- Department of General Biochemistry, CHU Rouen, 76000, Rouen, France
| | - Paul Billoir
- UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Normandie Univ, 76000, Rouen, France
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11
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Neuman L, Joseph A, Bouzid R, Lescroart M, Mariotte E, Ederhy S, Tuffet S, Baudel JL, Benhamou Y, Galicier L, Grangé S, Provôt F, Neel A, Pène F, Delmas Y, Presne C, Poullin P, Wynckel A, Perez P, Barbet C, Halimi JM, Chatelet V, Rebibou JM, Ojeda-Uribe M, Vigneau C, Mesnard L, Veyradier A, Azoulay E, Coppo P, Chabriat H. Predictors of acute ischemic cerebral lesions in immune-mediated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. J Neurol 2023; 270:5023-5033. [PMID: 37392208 DOI: 10.1007/s00415-023-11830-y] [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: 05/19/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND The immune form of thrombotic thrombocytopenic purpura (iTTP) and the hemolytic and uremic syndrome (HUS) are two major forms of thrombotic microangiopathy (TMA). Their treatment has been recently greatly improved. In this new era, both the prevalence and predictors of cerebral lesions occurring during the acute phase of these severe conditions remain poorly known. AIM The prevalence and predictors of cerebral lesions appearing during the acute phase of iTTP and Shiga toxin-producing Escherichia coli-HUS or atypical HUS were evaluated in a prospective multicenter study. METHODS Univariate analysis was performed to report the main differences between patients with iTTP and those with HUS or between patients with acute cerebral lesions and the others. Multivariable logistic regression analysis was used to identify the potential predictors of these lesions. RESULTS Among 73 TMA cases (mean age 46.9 ± 16 years (range 21-87 years) with iTTP (n = 57) or HUS (n = 16), one-third presented with acute ischemic cerebral lesions on magnetic resonance imagery (MRI); two individuals also had hemorrhagic lesions. One in ten patients had acute ischemic lesions without any neurological symptom. The neurological manifestations did not differ between iTTP and HUS. In multivariable analysis, three factors predicted the occurrence of acute ischemic lesions on cerebral MRI: (1) the presence of old infarcts on cerebral MRI, (2) the level of blood pulse pressure, (3) the diagnosis of iTTP. CONCLUSION At the acute phase of iTTP or HUS, both symptomatic and covert ischemic lesions are detected in one third of cases on MRI. Diagnosis of iTTP and the presence of old infarcts on MRI are associated with the occurrence of such acute lesions as well as increased blood pulse pressure, that may represent a potential target to further improve the therapeutic management of these conditions.
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Affiliation(s)
- Lisa Neuman
- Centre NeuroVasculaire Translationnel, Centre de Référence CERVCO, Département de Neurologie, Hôpital Lariboisière, GHU AP-HP Nord, Université de Paris, Paris, France
| | - Adrien Joseph
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Raïda Bouzid
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
| | - Mickael Lescroart
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Eric Mariotte
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Stéphane Ederhy
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Department of Cardiology, Saint-Antoine Hospital, GRC N° 27, Sorbonne Université, AP-HP, 75012, Paris, France
| | - Sophie Tuffet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Department of Clinical Pharmacology, Clinical Research Platform of East of Paris (Unité de Recherche Clinique (URCEST), Centre de Recherche Clinique (CRCEST), Centre de Ressources Biologiques (CRB.APHP-SU), Hôpital Saint Antoine, AP-HP, Paris, France
| | - Jean-Luc Baudel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Ygal Benhamou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Département de Médecine Interne, Hôpital Universitaire de Rouen, Université de Normandie, Rouen, France
- Service de Réanimation Médicale, CHU Charles Nicolle, Rouen, France
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'Immunologie Clinique, CHU Saint-Louis, Université de Paris, Paris, France
| | - Steven Grangé
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Médicale, CHU Charles Nicolle, Rouen, France
| | - François Provôt
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Albert-Calmette, Lille, France
| | - Antoine Neel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Médicale, CHU Hôtel-Dieu, Nantes, France
| | - Frédéric Pène
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de médecine intensive-réanimationHôpital Cochin, APHP Centre &, Université de Paris, Paris, France
| | - Yahsou Delmas
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, CHU de Bordeaux, Bordeaux, France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Nord, Amiens, France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'hémaphérèse et d'autotransfusion, Hôpital la Conception, Marseille, France
| | - Alain Wynckel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Maison Blanche, Reims, France
| | - Pierre Perez
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Polyvalente, CHU de Nancy, Nancy, France
| | - Christelle Barbet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpitaux Bretonneau et Clocheville, Tours, France
| | - Jean-Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpitaux Bretonneau et Clocheville, Tours, France
| | - Valérie Chatelet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Université, Caen, France
| | - Jean-Michel Rebibou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, CHU de Dijon, Dijon, France
| | - Mario Ojeda-Uribe
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'Hématologie et de Thérapie Cellulaire, Groupe Hospitalier Region Mulhouse-Sud-Alsace (GHRMSA), Mulhouse, France
| | - Cécile Vigneau
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Inserm, EHESP, Irset (Institut de Recherche en SantéEnvironnement et Travail)-UMR_S 1085, Université de Rennes, CHU Rennes, 35000, Rennes, France
| | - Laurent Mesnard
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Biochimie, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP, Paris, France.
- Service d'Hématologie, Centre National de Référence des Microangiopathies Thrombotiques, AP-HP.6 and Sorbonne-Université, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138, Paris, France.
| | - Hugues Chabriat
- Centre NeuroVasculaire Translationnel, Centre de Référence CERVCO, Département de Neurologie, Hôpital Lariboisière, GHU AP-HP Nord, Université de Paris, Paris, France
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12
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Amoura Z, Bader-Meunier B, Bal Dit Sollier C, Belot A, Benhamou Y, Bezanahary H, Cohen F, Costedoat-Chalumeau N, Darnige L, Drouet L, Elefant E, Harroche A, Lambert M, Martin T, Martin-Toutain I, Mathian A, Mekinian A, Pineton De Chambrun M, de Pontual L, Wahl D, Yelnik C, Zuily S. French National Diagnostic and Care Protocol for antiphospholipid syndrome in adults and children. Rev Med Interne 2023; 44:495-520. [PMID: 37735010 DOI: 10.1016/j.revmed.2023.08.004] [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: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023]
Abstract
Antiphospholipid syndrome (APS) is a chronic autoimmune disease involving vascular thrombosis and/or obstetric morbidity and persistent antibodies to phospholipids or certain phospholipid-associated proteins. It is a rare condition in adults and even rarer in children. The diagnosis of APS can be facilitated by the use of classification criteria based on a combination of clinical and biological features. APS may be rapidly progressive with multiple, often synchronous thromboses, resulting in life-threatening multiple organ failure. This form is known as "catastrophic antiphospholipid syndrome" (CAPS). It may be primary or associated with systemic lupus erythematosus (associated APS) and in very rare cases with other systemic autoimmune diseases. General practitioners and paediatricians may encounter APS in patients with one or more vascular thromboses. Because APS is so rare and difficult to diagnosis (risk of overdiagnosis) any suspected case should be confirmed rapidly and sometimes urgently by an APS specialist. First-line treatment of thrombotic events in APS includes heparin followed by long-term anticoagulation with a VKA, usually warfarin. Except in the specific case of stroke, anticoagulants should be started as early as possible. Any temporary discontinuation of anticoagulants is associated with a high risk of thrombosis in APS. A reference/competence centre specialised in autoimmune diseases must be urgently consulted for the therapeutic management of CAPS.
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Affiliation(s)
- Z Amoura
- Department of Internal Medicine, Institut E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, antiphospholipid syndrome, and other autoimmune diseases, Sorbonne University, AP-HP, Pitié Salpêtrière, boulevard de l'Hôpital, 75013 Paris, France.
| | - B Bader-Meunier
- Laboratory of Immunogenetics of Paediatric Autoimmune Diseases, Institute Imagine, University Paris Cité, Paris, France
| | - C Bal Dit Sollier
- Thrombosis and atherosclerosis research unit, vessels and blood institute (IVS), anticoagulation clinic (CREATIF), Lariboisière hospital, AP-HP, 75010 Paris, France
| | - A Belot
- Department of Pediatric Nephrology, Rheumatology, Dermatology, Reference Centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), hôpital femme mère enfant, CHU de Lyon, Bron, France
| | - Y Benhamou
- National Reference Centre of MicroAngiopathies Thrombotic, Paris, France; Department of Internal Medicine, University Hospital of Rouen, Normandie University, Rouen, France
| | - H Bezanahary
- Department of Internal Medicine and Clinical Immunology, centre hospitalier universitaire de Limoges, Limoges, France
| | - F Cohen
- Department of Internal Medicine, Institut E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, antiphospholipid syndrome, and other autoimmune diseases, Sorbonne University, AP-HP, Pitié Salpêtrière, boulevard de l'Hôpital, 75013 Paris, France
| | - N Costedoat-Chalumeau
- Department of Internal Medicine, Referral Centre for Rare Autoimmune and Systemic Diseases of Île-de-France, AP-HP, Cochin Hospital, Paris, France; Centre for Epidemiology and Statistics, Institut national de la santé et de la recherche médicale, French National Institute for Agricultural Research, University Paris Cité, Paris, France
| | - L Darnige
- Biological Hematology Department, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, Inserm, UMR-S1140, Innovative Therapies in Haemostasis, Paris, France
| | - L Drouet
- Thrombosis and atherosclerosis research unit, vessels and blood institute (IVS), anticoagulation clinic (CREATIF), Lariboisière hospital, AP-HP, 75010 Paris, France
| | - E Elefant
- Reference Center for Teratogenic Agents, hôpital Armand-Trousseau centre de référence sur les agents tératogènes, Île-de-France, Paris, France
| | - A Harroche
- Department of Hematology, Haemophilia Treatment Centre, University Hospital Necker Enfants Malades, Paris, France
| | - M Lambert
- Department of Internal Medicine and Clinical immunology, Reference Centre of Autoimmune Systemic Rare Diseases Of North And North-West of France (CeRAINO), U1167 RID-AGE, Lille University, Inserm, University hospital of Lille, 59000 Lille, France
| | - T Martin
- Department of Internal Medicine and Clinical Immunology, Strasbourg University Hospital, Strasbourg, France
| | - I Martin-Toutain
- Resource and Competence Centre for Haemorrhagic Diseases, Hospital Center of Versailles André-Mignot, Le Chesnay, France
| | - A Mathian
- Department of Internal Medicine, Institut E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, antiphospholipid syndrome, and other autoimmune diseases, Sorbonne University, AP-HP, Pitié Salpêtrière, boulevard de l'Hôpital, 75013 Paris, France
| | - A Mekinian
- Department of Internal Medicine and Inflammation-Immunopathology-Biotherapy (DMU i3), Saint-Antoine Hospital, Sorbonne University, AP-HP, 75012 Paris, France
| | - M Pineton De Chambrun
- Department of Internal Medicine, Institut E3M, CIMI-Paris, Faculty of medicine, National Reference Centre of Systemic Lupus, antiphospholipid syndrome, and other autoimmune diseases, Sorbonne University, AP-HP, Pitié Salpêtrière, boulevard de l'Hôpital, 75013 Paris, France
| | - L de Pontual
- Department of Paediatrics, Jean-Verdier Hospital, AP-HP, HUPSSD, 93140 Bondy, France
| | - D Wahl
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU de Nancy, Nancy, France
| | - C Yelnik
- Department of Internal Medicine and Clinical immunology, Reference Centre of Autoimmune Systemic Rare Diseases Of North And North-West of France (CeRAINO), U1167 RID-AGE, Lille University, Inserm, University hospital of Lille, 59000 Lille, France
| | - S Zuily
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU de Nancy, Nancy, France
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13
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Mottier D, Girard P, Couturaud F, Lacut K, Le Moigne E, Paleiron N, Guellec D, Sanchez O, Cogulet V, Laporte S, Marhic G, Mismetti P, Presles E, Robert-Ebadi H, Mahé I, Plaisance L, Reny JL, Darbellay Farhoumand P, Cuvelier C, Le Henaff C, Lambert Y, Danguy des Deserts M, Rousseau Legrand C, Boutreux S, Bleher Y, Decours R, Trinh-Duc A, Armengol G, Benhamou Y, Daumas A, Guyot SL, De Carvalho H, Lamia B, Righini M, Meyer G, Le Gal G. Enoxaparin versus Placebo to Prevent Symptomatic Venous Thromboembolism in Hospitalized Older Adult Medical Patients. NEJM Evid 2023; 2:EVIDoa2200332. [PMID: 38320142 DOI: 10.1056/evidoa2200332] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Enoxaparin to Prevent Venous Thromboembolism in Older AdultsThis trial of thromboprophylaxis in medically ill, hospitalized older adults did not demonstrate that enoxaparin reduced the risk of symptomatic VTE after 1 month. Because the trial was prematurely discontinued, larger trials are needed to definitively address this question.
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Affiliation(s)
- Dominique Mottier
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, Département de Pneumologie, Institut Mutualiste Montsouris, Paris; F-CRIN INNOVTE, France
| | - Francis Couturaud
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Karine Lacut
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Emmanuelle Le Moigne
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, CIC INSERM 1412, F-CRIN INNOVTE, Brest, France
| | - Nicolas Paleiron
- Service de Pneumologie, Hôpital d'Instruction des Armées Saint Anne, Toulon, France
| | - Dewi Guellec
- Service de Rhumatologie, Centre d'Investigation Clinique INSERM UMR 1412, LBAI 37613, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Olivier Sanchez
- Université Paris Cité; Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, APHP Centre Université Paris Cité, INSERM UMRS 1140, Paris; F-CRIN INNOVTE, France
| | - Virginie Cogulet
- Service de la Pharmacie, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation, Pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, Hôpital Nord, SAINBIOSE INSERM U1059, Université Jean Monnet, Saint-Etienne, France; F-CRIN INNOVTE, Saint-Etienne, France
| | - Gisèle Marhic
- Centre d'Investigation Clinique, INSERM 1412, Centre Hospitalier Universitaire, Brest, France
| | - Patrick Mismetti
- Service de Médecine et Thérapeutique, Unité de Pharmacologie Clinique, Centre Hospitalo-Universitaire de Saint-Etienne, Hôpital Nord, SAINBIOSE INSERM U1059, Université Jean Monnet, Saint-Etienne, France; F-CRIN INNOVTE, Saint-Etienne, France
| | - Emilie Presles
- Unité de Recherche Clinique, Innovation, Pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, Hôpital Nord, SAINBIOSE INSERM U1059, Université Jean Monnet, Saint-Etienne, France; F-CRIN INNOVTE, Saint-Etienne, France
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva
| | - Isabelle Mahé
- Université Paris Cité, Service de Médecine Interne, Hôpital Louis Mourier, AP-HP, Colombes, France; Innovative Therapies in Haemostasis, INSERM UMR S1140, Paris; F-CRIN INNOVTE, Saint-Etienne, France
| | - Ludovic Plaisance
- Service de Médecine Interne, Hôpital Louis Mourier, AP-HP, Colombes, France
| | - Jean-Luc Reny
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland
| | - Pauline Darbellay Farhoumand
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland
| | - Clémence Cuvelier
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Thônex, Switzerland
| | - Catherine Le Henaff
- Service de Médecine Interne, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Yannick Lambert
- Service de Médecine Interne, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Marc Danguy des Deserts
- Unité de Recherche Clinique, Hôpital d'Instruction des Armées Clermont Tonnerre, Université de Bretagne Occidentale, INSERM UMR 1304-GETBO, F-CRIN INNOVTE, Brest, France
| | - Claire Rousseau Legrand
- Service de Médecine Interne, Hôpital d'Instruction des Armées Clermont Tonnerre, Brest, France
| | | | - Yves Bleher
- Service Médecine Post Urgence-Infectiologie, Hôpital La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Romain Decours
- Service Court Séjour Gériatrique, Hôpital La Roche-sur-Yon, La Roche-sur-Yon, France
| | | | - Guillaume Armengol
- Département de Médecine Interne, Centre Hospitalo-Universitaire de Rouen, Normandie Université, UNIROUEN 1096, Rouen, France
| | - Ygal Benhamou
- Département de Médecine Interne, Centre Hospitalo-Universitaire de Rouen, Normandie Université, UNIROUEN 1096, Rouen, France
| | - Aurélie Daumas
- Service de Médecine Interne, Gériatrie et Thérapeutique, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix Marseille Université, INSERM, INRAE, C2VN, Marseille, France
| | - Sarah-Lou Guyot
- Service de Médecine Polyvalente Urgence, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Hugo De Carvalho
- Service de Médecine Polyvalente Urgence, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Bouchra Lamia
- Département de Pneumologie, Centre Hospitalier du Havre, Université de Normandie, UNIROUEN EU 3830, Le Havre, France
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva
| | - Guy Meyer
- Université Paris Cité; Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, APHP Centre Université Paris Cité, INSERM UMRS 1140, Paris; F-CRIN INNOVTE, France
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa
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14
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Leclercq M, Goupillou P, Gomez H, Muraine M, Benhamou Y, Girszyn N, Gueudry J. Efficacious switching from subcutaneous to intravenous tocilizumab in patients with non-infectious non-anterior uveitis. J Ophthalmic Inflamm Infect 2023; 13:32. [PMID: 37462850 DOI: 10.1186/s12348-023-00336-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/11/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE The efficacy of tocilizumab in refractory chronic noninfectious uveitis has been previously reported, but no data comparing intravenous and subcutaneous tocilizumab in uveitis are available. RESULTS We report a case series of patients with chronic noninfectious uveitis with incomplete efficacy of subcutaneous tocilizumab, improved after switching to intravenous routes. Improvement of visual acuity was observed with intravenous tocilizumab for all patients. Half of the patients could stop corticosteroids. Rapid efficacy of intravenous tocilizumab was observed, between 2 and 3 months. CONCLUSION In uveitis, tocilizumab administration could be optimized by a switching from a subcutaneous to an intravenous administration route.
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Affiliation(s)
- Mathilde Leclercq
- CHU Rouen, Internal Medicine Department, CHU Charles Nicolle, 1, Rue de Germont, 76000, Rouen, France.
| | - Paul Goupillou
- Ophthalmology Department, CHU Rouen, 76000, Rouen, France
| | - Hélène Gomez
- CHU Rouen, Internal Medicine Department, CHU Charles Nicolle, 1, Rue de Germont, 76000, Rouen, France
| | - Marc Muraine
- Ophthalmology Department, CHU Rouen, 76000, Rouen, France
| | - Ygal Benhamou
- CHU Rouen, Internal Medicine Department, CHU Charles Nicolle, 1, Rue de Germont, 76000, Rouen, France
| | - Nicolas Girszyn
- CHU Rouen, Internal Medicine Department, CHU Charles Nicolle, 1, Rue de Germont, 76000, Rouen, France
| | - Julie Gueudry
- Ophthalmology Department, CHU Rouen, 76000, Rouen, France
- EA7510, UFR Santé, Rouen University, 76000, Rouen, France
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15
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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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16
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Zuily S, Lefèvre B, Sanchez O, Empis de Vendin O, de Ciancio G, Arlet JB, Khider L, Terriat B, Greigert H, Robert CS, Louis G, Trinh-Duc A, Rispal P, Accassat S, Thiery G, Montani D, Azarian R, Meneveau N, Soudet S, Le Mao R, Maurier F, Le Moing V, Quéré I, Yelnik CM, Lefebvre N, Martinot M, Delrue M, Benhamou Y, Parent F, Roy PM, Presles E, Goehringer F, Mismetti P, Bertoletti L, Rossignol P, Couturaud F, Wahl D, Thilly N, Laporte S. Effect of weight-adjusted intermediate-dose versus fixed-dose prophylactic anticoagulation with low-molecular-weight heparin on venous thromboembolism among noncritically and critically ill patients with COVID-19: the COVI-DOSE trial, a multicenter, randomised, open-label, phase 4 trial. EClinicalMedicine 2023; 60:102031. [PMID: 37350990 PMCID: PMC10250778 DOI: 10.1016/j.eclinm.2023.102031] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
Background Venous thromboembolism is a major complication of coronavirus disease 2019 (COVID-19). We hypothesized that a weight-adjusted intermediate dose of anticoagulation may decrease the risk of venous thromboembolism COVID-19 patients. Methods In this multicenter, randomised, open-label, phase 4, superiority trial with blinded adjudication of outcomes, we randomly assigned adult patients hospitalised in 20 French centers and presenting with acute respiratory SARS-CoV-2. Eligible patients were randomly assigned (1:1 ratio) to receive an intermediate weight-adjusted prophylactic dose or a fixed-dose of subcutaneous low-molecular-weight heparin during the hospital stay. The primary outcome corresponded to symptomatic deep-vein thrombosis (fatal) pulmonary embolism during hospitalization (COVI-DOSE ClinicalTrials.gov number: NCT04373707). Findings Between May 2020, and April 2021, 1000 patients underwent randomisation in medical wards (noncritically ill) (80.1%) and intensive care units (critically ill) (19.9%); 502 patients were assigned to receive a weight-adjusted intermediate dose, and 498 received fixed-dose thromboprophylaxis. Symptomatic venous thromboembolism occurred in 6 of 502 patients (1.2%) in the weight-adjusted dose group and in 10 of 498 patients (2.1%) in the fixed-dose group (subdistribution hazard ratio, 0.59; 95% CI, 0.22-1.63; P = 0.31). There was a twofold increased risk of major or clinically relevant nonmajor bleeding: 5.9% in the weight-adjusted dose group and 3.1% in the fixed-dose group (P = 0.034). Interpretation In the COVI-DOSE trial, the observed rate of thromboembolic events was lower than expected in patients hospitalized for COVID-19 infection, and the study was unable to show a significant difference in the risk of venous thromboembolism between the two low-molecular-weight-heparin regimens. Funding French Ministry of Health, CAPNET, Grand-Est Region, Grand-Nancy Métropole.
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Affiliation(s)
- Stéphane Zuily
- Vascular Medicine Division, Université de Lorraine, CHRU-Nancy, Rare Vascular and Systemic Autoimmune Diseases Regional Referral Center, France
- Inserm, UMR 1116 DCAC, F-54000 Nancy, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
| | - Benjamin Lefèvre
- Department of Infectious and Tropical Diseases, Université de Lorraine, CHRU-Nancy, APEMAC, F-54000 Nancy, France
| | - Olivier Sanchez
- Department of Respiratory and Intensive Care Medicine, Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- Inserm, Innovative Therapies in Haemostasis, Paris, France
| | | | | | - Jean-Benoît Arlet
- Internal Medicine Department, AP-HP, Hôpital Européen Georges Pompidou, APHP, F-75015 Paris, France
| | - Lina Khider
- Vascular Medicine Department, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Béatrice Terriat
- Department of Vascular Medicine and Angiology, Dijon University Hospital, F-21000 Dijon, France
| | - Hélène Greigert
- Department of Vascular Medicine and Angiology, Dijon University Hospital, F-21000 Dijon, France
| | - Céline S Robert
- Department of Infectious Diseases, CHR Metz-Thionville, F-57000 Metz, France
| | - Guillaume Louis
- Intensive Care Unit, CHR Metz-Thionville, F-57000 Metz, France
| | - Albert Trinh-Duc
- Internal Medicine Department, CH St Esprit, F-47000 Agen, France
| | - Patrick Rispal
- Internal Medicine Department, CH St Esprit, F-47000 Agen, France
| | - Sandrine Accassat
- Department of Vascular Medicine, CHU Saint-Etienne, F-42000 Saint-Etienne, France
| | - Guillaume Thiery
- Medical Intensive Care Unit, CHU Saint-Etienne, F-42000 Saint-Etienne, France
| | - David Montani
- Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Pulmonary Hypertension National Referral Center, F-94270 Le Kremlin-Bicêtre, France
| | - Réza Azarian
- Department of Respiratory Medicine, CH Versailles, F-78150 Le Chesnay, France
| | - Nicolas Meneveau
- Department of Cardiology, Université de Franche-Comté, CHU Jean Minjoz, EA 3929, F-25000 Besancon, France
| | - Simon Soudet
- Department of Vascular Medicine, CHU Amiens-Picardie, F-80000 Amiens, France
| | - Raphaël Le Mao
- Department of Internal Medicine, Vascular Medicine and Pulmonology, CHU Brest, F-29200 Brest, France
| | - François Maurier
- Department of Internal Medicine, UNEOS, F-57070 Metz-Vantoux, France
| | - Vincent Le Moing
- Department of Infectious and Tropical Diseases, CHRU Montpellier, F-34000 Montpellier, France
| | - Isabelle Quéré
- Department of Vascular Medicine, CHU Montpellier, IDESP, F-34000 Montpellier, France
| | - Cécile M Yelnik
- Department of Internal Medicine and Clinical Immunology, Université de Lille, CHU Lille, Inserm UMR 1167, North and North-West Systemic and Autoimmune Disease National Referral Center (CeRAINO), F-59000 Lille, France
| | - Nicolas Lefebvre
- Department of Tropical and Infectious Diseases, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Martin Martinot
- Department of Tropical and Infectious Diseases, Hôpitaux Civils de Colmar, F-68000 Colmar, France
| | - Maxime Delrue
- Hematology Laboratory and Thrombosis Unit, Lariboisière Hospital, APHP, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, Normandie Université, Université de Rouen Normandie, Inserm UMR 1096, F-76000 Rouen, France
| | - Florence Parent
- Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Pulmonary Hypertension National Referral Center, F-94270 Le Kremlin-Bicêtre, France
| | - Pierre-Marie Roy
- Department of Emergency Medicine, Université d'Angers, CHU Angers, F-49000 Angers, France
| | - Emilie Presles
- Université Jean Monnet, Inserm, U1059 SAINBIOSE, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- CHU Saint-Etienne, Unité de Recherche Clinique, Innovation, Pharmacologie, France
| | - François Goehringer
- Department of Infectious and Tropical Diseases, CHRU-Nancy, F-54000 Nancy, France
| | - Patrick Mismetti
- Université Jean Monnet, Inserm, U1059 SAINBIOSE, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- CHU Saint-Etienne, Unité de Recherche Clinique, Innovation, Pharmacologie, Service de Médecine Vasculaire et Thérapeutique, France
| | - Laurent Bertoletti
- Université Jean Monnet, Inserm, CIC-1408, CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, CIC-P 1433, CHRU-Nancy, Inserm UMR 1116, F-CRIN INI-CRCT, F-54000 Nancy, France
- Department of Medical Specialties and Nephrology-Hemodialysis, Princess Grace Hospital, and Centre d'Hémodialyse Privé de Monaco, Monaco
| | - Francis Couturaud
- Department of Internal Medicine and Chest Diseases, Université de Bretagne Occidentale, CHU Brest, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- Inserm UMR 1304 GETBO, F-29200 Brest, France
| | - Denis Wahl
- Vascular Medicine Division, Université de Lorraine, CHRU-Nancy, Rare Vascular and Systemic Autoimmune Diseases Regional Referral Center, France
| | - Nathalie Thilly
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, APEMAC, , F-54000 Nancy, France
| | - Silvy Laporte
- Université Jean Monnet, Inserm, U1059 SAINBIOSE, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- CHU Saint-Etienne, Unité de Recherche Clinique, Innovation, Pharmacologie, France
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Mekinian A, Biard L, Lorenzo D, Novikov PI, Salvarani C, Espitia O, Sciascia S, Michaud M, Lambert M, Hernández-Rodríguez J, Schleinitz N, Awisat A, Puechal X, Aouba A, Munoz Pons H, Smitienko I, Gaultier JB, Edwige LM, Benhamou Y, Perlat A, Jego P, Goulenok T, Sacre K, Lioger B, Hassold N, Broner J, Dufrost V, Sené T, Seguier J, Maurier F, Berthier S, Belot A, Frikha F, Denis G, Audemard-Verger A, Koné-Paut I, Humbert S, Woaye-Hune P, Tomelleri A, Baldissera EM, Kuwana M, Logullo A, Mukuchyan V, Dellal A, Gaches F, Zeminsky P, Galli E, Alvarado M, Boiardi L, Francesco M, Vautier M, Corrado C, Moiseev S, Vieira M, Cacoub P, Fain O, Saadoun D. Intravenous versus subcutaneous tocilizumab in Takayasu arteritis: multicentre retrospective study. RMD Open 2023; 9:e002830. [PMID: 37321669 DOI: 10.1136/rmdopen-2022-002830] [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: 10/30/2022] [Accepted: 02/02/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES In this large multicentre study, we compared the effectiveness and safety of tocilizumab intravenous versus subcutaneous (SC) in 109 Takayasu arteritis (TAK) patients. METHODS We conducted a retrospective multicentre study in referral centres from France, Italy, Spain, Armenia, Israel, Japan, Tunisia and Russia regarding biological-targeted therapies in TAK, since January 2017 to September 2019. RESULTS A total of 109 TAK patients received at least 3 months tocilizumab therapy and were included in this study. Among them, 91 and 18 patients received intravenous and SC tocilizumab, respectively. A complete response (NIH <2 with less than 7.5 mg/day of prednisone) at 6 months was evidenced in 69% of TAK patients, of whom 57 (70%) and 11 (69%) patients were on intravenous and SC tocilizumab, respectively (p=0.95). The factors associated with complete response to tocilizumab at 6 months in multivariate analysis, only age <30 years (OR 2.85, 95% CI 1.14 to 7.12; p=0.027) and time between TAK diagnosis and tocilizumab initiation (OR 1.18, 95% CI 1.02 to 1.36; p=0.034). During the median follow-up of 30.1 months (0.4; 105.8) and 10.8 (0.1; 46.4) (p<0.0001) in patients who received tocilizumab in intravenous and SC forms, respectively, the risk of relapse was significantly higher in TAK patients on SC tocilizumab (HR=2.55, 95% CI 1.08 to 6.02; p=0.033). The overall cumulative incidence of relapse at 12 months in TAK patients was at 13.7% (95% CI 7.6% to 21.5%), with 10.3% (95% CI 4.8% to 18.4%) for those on intravenous tocilizumab vs 30.9% (95% CI 10.5% to 54.2%) for patients receiving SC tocilizumab. Adverse events occurred in 14 (15%) patients on intravenous route and in 2 (11%) on SC tocilizumab. CONCLUSION In this study, we confirm that tocilizumab is effective in TAK, with complete remission being achieving by 70% of disease-modifying antirheumatic drugs-refractory TAK patients at 6 months.
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Affiliation(s)
- Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France, French Armenian research center, Erevan, Armenia
| | - Lucie Biard
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Dagna Lorenzo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pavel I Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Carlo Salvarani
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Olivier Espitia
- Department of internal and vascular medicine, Nantes Université, CHU Nantes, F-44000 Nantes, France
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Martin Michaud
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Marc Lambert
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, Lille, France
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Abid Awisat
- Rheumatology Unit, Bnei Zion Hospital, Haifa, Israel
| | - Xavier Puechal
- Université Paris Descartes, Paris, France ; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, 27 rue du Faubourg Saint-Jacques, Paris, France
| | - Achille Aouba
- Département de médecine interne, CHU Caen, Caen, France
| | - Helene Munoz Pons
- Département de médecine interne, CHU Saint Etienne, Saint-Etienne, France
| | - Ilya Smitienko
- Rheumatology Department, Medical Center K-31, Moscow, Russian Federation
| | - Jean Baptiste Gaultier
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier universitaire de St Etienne, Saint Etienne, France
| | - Le Mouel Edwige
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Ygal Benhamou
- Service de médecine interne, Université Rouen, CHU de Rouen, Rouen, France
| | - Antoinette Perlat
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Patrick Jego
- Internal Medicine and Clinical Immunology Department, CHU Rennes, Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France
| | | | - Nolan Hassold
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay, Paris, France
| | | | - Virginie Dufrost
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Nancy, France
| | - Thomas Sené
- Service de médecine interne, Rothschild, Paris, France
| | - Julie Seguier
- Département de médecine interne, CHU de La Timone, Marseille, France
| | - Francois Maurier
- Service de Médecine Interne et Immunologie Clinique Groupe Hospitalier UNEOS, Vantoux, France
| | - Sabine Berthier
- Service de médecine interne et immunologie clinique, Université Dijon, Hôpital Dijon, Dijon, France
| | - Alexandre Belot
- Service de pédiatrie et immunologie clinique, Université Lyon, Hôpital Lyon, Lyon, France
| | - Faten Frikha
- Service de Médecine interne CHU Hédi Chaker, Route El Ain 3029 Sfax -Faculté de Médecine de Sfax, Sfax, Tunisia
| | - Guillaume Denis
- Service de médecine et d'hématologie, Hopital Rochefort, Rochefort, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, University of Tours, Tours, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay, Paris, France
| | - Sebastien Humbert
- Service de médecine interne et immunologie clinique, Hôpital Besancon, Besancon, France
| | | | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Marina Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Alberto Logullo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Ospedale Piemonte, Messina, Italy
| | - Vahan Mukuchyan
- Department of Internal Medicine and Rheumatology, Nairi hospital, Erevan, Armenia
| | - Azeddine Dellal
- Service de rhumatologie, Hôpital Montfermeil, GHI Le Raincy Montfermeil, Montfermeil, France
| | - Francis Gaches
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, France
| | - Pierre Zeminsky
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Nancy, France
| | - Elena Galli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Moya Alvarado
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Boiardi
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Muratore Francesco
- Azienda USL-IRCCS; Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Mathieu Vautier
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Campochiaro Corrado
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Matheus Vieira
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
| | - Patrice Cacoub
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France, French Armenian research center, Erevan, Armenia
| | - David Saadoun
- AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Universités, Paris, France
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Feugray G, Grall M, Dumesnil C, Benhamou Y, Brunel V, Le Cam Duchez V, Lahary A, Billoir P. Hypercoagulability evaluation in congenital red blood cell disorders using thrombin generation assay. Thromb Res 2023:S0049-3848(23)00082-8. [PMID: 37024320 DOI: 10.1016/j.thromres.2023.03.008] [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: 12/01/2022] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Guillaume Feugray
- Univ Rouen Normandie, INSERM EnVI UMR 1096, F-76000 Rouen, France; Department of General Biochemistry, CHU Rouen, F-76000, France.
| | - Maximilien Grall
- Department of Internal Medecine, CHU Rouen, F-76000 Rouen, France
| | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, F-76000, France
| | - Ygal Benhamou
- Univ Rouen Normandie, INSERM EnVI UMR 1096, F-76000 Rouen, France; Department of Internal Medecine, CHU Rouen, F-76000 Rouen, France
| | - Valery Brunel
- Department of General Biochemistry, CHU Rouen, F-76000, France
| | - Véronique Le Cam Duchez
- Univ Rouen Normandie, INSERM EnVI UMR 1096, F-76000 Rouen, France; Department of Vascular Hemostasis Unit, CHU Rouen, F-76000 Rouen, France
| | - Agnès Lahary
- Department of Hematology Laboratory, CHU Rouen, F-76000 Rouen, France
| | - Paul Billoir
- Univ Rouen Normandie, INSERM EnVI UMR 1096, F-76000 Rouen, France; Department of Vascular Hemostasis Unit, CHU Rouen, F-76000 Rouen, France
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19
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Azoulay E, Souppart V, Kentish-Barnes N, Benhamou Y, Joly BS, Zafrani L, Joseph A, Canet E, Presne C, Grall M, Zerbib Y, Provot F, Fadlallah J, Mariotte E, Urbina T, Veyradier A, Coppo P. Post-traumatic stress disorder and quality of life alterations in survivors of immune-mediated thrombotic thrombocytopenic purpura and atypical hemolytic and uremic syndrome. J Crit Care 2023; 76:154283. [PMID: 36931181 DOI: 10.1016/j.jcrc.2023.154283] [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: 08/15/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023]
Abstract
Thrombotic thrombocytopenic purpura (iTTP) and atypical hemolytic-uremic syndrome (aHUS), once in remission, may cause long-term symptoms, among which mental-health impairments may be difficult to detect. We conducted telephone interviews 72 [48-84] months after ICU discharge to assess symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) and the 36-item Short Form questionnaire (SF-36). Of 103 included patients, 52 had iTTP and 51 aHUS; 74% were female, median age was 39 y (31-54), and 39 (38%) patients were still taking treatment. Symptoms of anxiety, PTSD and depression were present in 50%, 27% and 14% of patients, respectively, with no significant difference between the iTTP and aHUS groups. Patients with PTSD symptoms had significantly greater weight gain and significantly worse perceived physical and/or emotional wellbeing, anxiety symptoms, and depression symptoms. The SF-36 physical and mental components indicated significantly greater quality-of-life impairments in patients with vs. without PTSD symptoms and in those with aHUS and PTSD vs. iTTP with or without PTSD. In the aHUS group, quality of life was significantly better in patients with vs. without eculizumab treatment. Factors independently associated with PTSD symptoms were male sex (odds ratio [OR], 0.11; 95%CI, 0.02-0.53), platelet count ≤20 G/L at acute-episode presentation (OR, 2.68; 1.01-7.38), and current treatment (OR, 2.69; 95%CI, 1.01-7.36). Mental-health screening should be routine in patients with iTTP and aHUS to ensure appropriate care.
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Affiliation(s)
- Elie Azoulay
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France.
| | - Virginie Souppart
- Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France
| | - Nancy Kentish-Barnes
- Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France
| | - Ygal Benhamou
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de médecine interne, Hôpital universitaire de Rouen, Université de Normandie, Rouen, France
| | - Bérangère S Joly
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'hématologie biologique, laboratoire ADAMTS13, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France; EA3518, Institut de recherche Saint Louis, Université Paris Cité, Paris, France
| | - Lara Zafrani
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Adrien Joseph
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Emmanuel Canet
- Médecine Intensive et Réanimation, CHU de Nantes, France
| | - Claire Presne
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service de Néphrologie, Médecine Interne, Hémodialyse, Transplantation du CHU d'AMIENS PICARDIE, France
| | - Maximilien Grall
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de médecine interne, Hôpital universitaire de Rouen, Université de Normandie, Rouen, France
| | - Yoann Zerbib
- Médecine Intensive et Réanimation, CHU d'Amiens, France
| | - François Provot
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de néphrologie, dialyse et transplantation, Université de Lille, CHU de Lille, France
| | - Jehane Fadlallah
- Département d'immunologie clinique, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Eric Mariotte
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Tomas Urbina
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint-Antoine, France
| | - Agnès Veyradier
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'hématologie biologique, laboratoire ADAMTS13, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France; EA3518, Institut de recherche Saint Louis, Université Paris Cité, Paris, France
| | - Paul Coppo
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
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Stammler R, Nguyen Y, Yelnik C, Le Guern V, Lambert M, Paule R, Hachulla E, Mouthon L, Dupré A, Ackermann F, Dufrost V, Wahl D, Godeau B, Leroux G, Benhamou Y, Lazaro E, Daugas E, Bezanahary H, Mekinian A, Piette JC, Morel N, Costedoat-Chalumeau N. Precipitating factors of catastrophic antiphospholipid syndrome: the role of anticoagulant treatment in a series of 112 patients. J Thromb Haemost 2023; 21:1258-1265. [PMID: 36792010 DOI: 10.1016/j.jtha.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The prevention of catastrophic antiphospholipid syndrome (CAPS), a rare complication of antiphospholipid syndrome (APS), is a major goal. OBJECTIVES We analyzed its precipitating factors, focusing on anticoagulation immediately before CAPS episodes. METHODS We retrospectively analyzed patients in the French multicenter APS/systemic lupus erythematosus database with at least 1 CAPS episode. Then we compared each patient with known APS before CAPS with 2 patients with non-CAPS APS matched for age, sex, center, and APS phenotype. RESULTS We included 112 patients with CAPS (70% women; mean age, 43 ± 15 years). At least 1 standard precipitating factor of CAPS was observed for 67 patients (64%), which were mainly infections (n = 28, 27%), pregnancy (n = 23, 22%), and surgery (n = 16, 15%). Before the CAPS episode, 67 (60%) patients already had a diagnosis of APS. Of the 61 treated with anticoagulants, 32 (48%) received vitamin K antagonists (VKAs), 23 (34%) heparin, and 2 (3%) a direct oral anticoagulant. They were less likely than their matched patients with APS without CAPS to receive VKA (48% vs 66%, p = .001). Among those treated with VKA, 72% had a subtherapeutic international normalized ratio (ie, <2) versus 28% in patients with APS without CAPS (p < .001). Finally, excluding pregnant patients (n = 14) for whom we could not differentiate the effect of treatment from that of pregnancy, we were left with 47 cases, 32 (68%) of whom had recently begun a direct oral anticoagulant, planned bridging therapy, or had VKA treatment with international normalized ratio <2. CONCLUSION These results strongly suggest that suboptimal anticoagulation management can trigger CAPS in patients with thrombotic APS.
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Affiliation(s)
- Romain Stammler
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Yann Nguyen
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Cécile Yelnik
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France
| | - Véronique Le Guern
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Marc Lambert
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France
| | - Romain Paule
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Eric Hachulla
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et d'Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du nord et Nord-Ouest de France (CeRAINO), U1167 RID-AGE, F-59000 Lille, France
| | - Luc Mouthon
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Anastasia Dupré
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Félix Ackermann
- Department of Internal Medicine and Clinical Immunology, Foch Hospital, Referral Center for Hypereosinophilic Syndromes, Suresnes, France
| | - Virginie Dufrost
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU Nancy, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, CHRU Nancy, France
| | - Bertrand Godeau
- Department of Internal Medicine and Clinical Immunology, Mondor Hospital, Paris France
| | - Gaëlle Leroux
- Department of Internal Medicine and Clinical Immunology, AP-HP, La Pitié-Salpêtrière Hospital, Referral Center for Rare Autoimmune and Systemic Diseases, Paris, France; and Sorbonne University
| | - Ygal Benhamou
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier de Rouen, Rouen, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier de Bordeaux, Bordeaux, France
| | - Eric Daugas
- Department of Nephrology, AP-HP, Bichat Hospital, Paris, France
| | - Holy Bezanahary
- Department of Internal Medicine and Clinical Immunology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Arsène Mekinian
- Department of Internal Medicine and Clinical Immunology, APHP, Saint Antoine Hospital, Paris, France
| | - Jean-Charles Piette
- Department of Internal Medicine and Clinical Immunology, AP-HP, La Pitié-Salpêtrière Hospital, Referral Center for Rare Autoimmune and Systemic Diseases, Paris, France; and Sorbonne University
| | - Nathalie Morel
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Internal Medicine Department, AP-HP, Referral Center for Rare Autoimmune and Systemic Diseases of Ile de France, Cochin Hospital, Paris, France; Université Paris Cité, Center for Epidemiology and Statistics, Institut national de la santé et de la recherche médicale, French National Institute for Agricultural Research, Paris, France.
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21
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Comparon C, Galicier L, Rebibou JM, Coppo P, Benhamou Y. Preemptive cyclosporin A in immune-mediated thrombotic thrombocytopenic purpura. Eur J Haematol 2023; 110:157-160. [PMID: 36271897 PMCID: PMC10098822 DOI: 10.1111/ejh.13886] [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: 12/27/2021] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/19/2023]
Abstract
Survivors of immune-mediated thrombotic thrombocytopenic purpura (iTTP) are exposed to clinical relapses when a disintegrin and metalloproteinase with thrombospondin type 1 repeats, member 13 (ADAMTS13) activity decreases during follow-up. Although preemptive rituximab usually improves ADAMTS13 activity in this context, 15% of patients experience refractoriness or intolerance to rituximab and require alternative strategies. Here, we addressed whether cyclosporine A (CSA) could improve ADAMTS13 activity and prevent clinical relapses in this context. We treated preemptively with CSA 14 iTTP patients who were unresponsive (n = 11) or intolerant (n = 3) to rituximab. All patients had a severe ADAMTS13 deficiency (activity <20%) and otherwise in clinical remission. ADAMTS13 activity normalized in almost all patients (n = 13, 93%), after a median time of 2.5 months [IQR 1-6] following initiation. Median duration of CSA treatment was 17.5 months [IQR 10-34]. ADAMTS13 activity further declined to undetectable values during follow-up in five patients, but retreatment with rituximab or CSA allowed a recovery in ADAMTS13 activity in three cases. CSA could be stopped durably in two patients, while two others experienced an ADAMTS13 relapse. Severe but reversible side effects requiring cessation of the treatment occurred in two patients. CSA provides high and sustained response rates in patients who are refractory or intolerant to rituximab, with acceptable adverse events.
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Affiliation(s)
- Celine Comparon
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.,Service de Médecine Interne, CHU Avicenne, Bobigny, France
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.,Service de Médecine Interne, Hôpital Saint Joseph, Marseille, France
| | | | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.,Service d'Hématologie, APHP and Sorbonne Université, Paris, France.,INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France
| | - Ygal Benhamou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.,Département de Médecine Interne, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, CHU Rouen, Rouen, France
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22
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Dupré A, Morel N, Yelnik C, Moguelet P, Le Guern V, Stammler R, Nguyen Y, Paule R, Dufrost V, Ackermann F, Benhamou Y, Godeau B, Lambert M, Duffau P, Mekinian A, Saadoun D, Mouthon L, Hachulla E, Maillard H, Levesque H, Morell-Dubois S, Leroux G, Piette JC, Chasset F, Costedoat-Chalumeau N. Cutaneous Involvement in Catastrophic Antiphospholipid Syndrome in a Multicenter Cohort of 65 Patients. JAMA Dermatol 2022; 159:62-67. [PMID: 36477813 PMCID: PMC9856595 DOI: 10.1001/jamadermatol.2022.5221] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Catastrophic antiphospholipid syndrome (CAPS) is a severe, rare complication of antiphospholipid syndrome (APS), but cutaneous involvement has not yet been adequately described. Objective To describe cutaneous involvement during CAPS, its clinical and pathological features, and outcomes. Design, Setting, and Participants This cohort study was a retrospective analysis of patients included in the French multicenter APS/systemic lupus erythematosus register (ClinicalTrials.gov: NCT02782039) by December 2020. All patients meeting the revised international classification criteria for CAPS were included, and patients with cutaneous manifestations were analyzed more specifically. Main Outcomes and Measures Clinical and pathological data as well as course and outcome in patients with cutaneous involvement during CAPS were collected and compared with those in the register without cutaneous involvement. Results Among 120 patients with at least 1 CAPS episode, the 65 (54%) with skin involvement (43 [66%] women; median [range] age, 31 [12-69] years) were analyzed. Catastrophic antiphospholipid syndrome was the first APS manifestation for 21 of 60 (35%) patients with available data. The main lesions were recent-onset or newly worsened livedo racemosa (n = 29, 45%), necrotic and/or ulcerated lesions (n = 27, 42%), subungual splinter hemorrhages (n = 19, 29%), apparent distal inflammatory edema (reddened and warm hands, feet, or face) (n = 15, 23%), and/or vascular purpura (n = 9, 14%). Sixteen biopsies performed during CAPS episodes were reviewed and showed microthrombi of dermal capillaries in 15 patients (94%). These lesions healed without sequelae in slightly more than 90% (58 of 64) of patients. Patients with cutaneous involvement showed a trend toward more frequent histologically proven CAPS (37% vs 24%, P = .16) than those without such involvement, while mortality did not differ significantly between the groups (respectively, 5% vs 9%, P = .47). Conclusions and Relevance In this cohort study, half the patients with CAPS showed cutaneous involvement, with a wide spectrum of clinical presentations, including distal inflammatory edema. Skin biopsies confirmed the diagnosis in all but 1 biopsied patient.
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Affiliation(s)
- Anastasia Dupré
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Nathalie Morel
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Cécile Yelnik
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Philippe Moguelet
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Tenon, Service d’Anatomopathologie, Paris, France
| | - Véronique Le Guern
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Romain Stammler
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Yann Nguyen
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Romain Paule
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | - Virginie Dufrost
- Centre Hospitalier Régional et Universitaire de Nancy, Service de Médecine Vasculaire, Nancy, France
| | | | - Ygal Benhamou
- Normandie Université, UNIROUEN, U 1096, Centre Hospitalo-Universitaire, Service de Médecine Interne, Rouen, France
| | - Bertrand Godeau
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Mondor, Service de Médecine Interne, Créteil, France
| | - Marc Lambert
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Pierre Duffau
- Centre Hospitalo-Universitaire de Bordeaux, Service de Médecine Interne et Immunologie Clinique, Bordeaux, France
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Centre Hospitalo-Universitaire Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - David Saadoun
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire La Pitié, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Luc Mouthon
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Eric Hachulla
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Hélène Maillard
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Hervé Levesque
- Normandie Université, UNIROUEN, U 1096, Centre Hospitalo-Universitaire, Service de Médecine Interne, Rouen, France
| | - Sandrine Morell-Dubois
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Gaëlle Leroux
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire La Pitié, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Jean-Charles Piette
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire La Pitié, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine, Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Tenon, Service de Dermatologie, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France,Université de Paris, Centre de Recherche Épidémiologie et Biostatistiques de Sorbonne Paris Cité, Paris, France
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23
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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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24
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Murarasu A, Guettrot-Imbert G, Le Guern V, Yelnik C, Queyrel V, Schleinitz N, Ferreira-Maldent N, Diot E, Urbanski G, Pannier E, Lazaro E, Souchaud-Debouverie O, Orquevaux P, Belhomme N, Morel N, Chauvet E, Maurier F, Le Besnerais M, Abisror N, Goulenok T, Sarrot-Reynauld F, Deroux A, Pasquier E, de Moreuil C, Bezanahary H, Pérard L, Limal N, Langlois V, Calas A, Godeau B, Lavigne C, Hachulla E, Cohen F, Benhamou Y, Raffray L, de Menthon M, Tieulié N, Poindron V, Mouthon L, Larosa M, Eléfant E, Sentilhes L, Molto A, Deneux-Tharaux C, Costedoat-Chalumeau N. Characterisation of a high-risk profile for maternal thrombotic and severe haemorrhagic complications in pregnant women with antiphospholipid syndrome in France (GR2): a multicentre, prospective, observational study. Lancet Rheumatol 2022; 4:e842-e852. [PMID: 38261392 DOI: 10.1016/s2665-9913(22)00308-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prospective data about the risks of thrombotic and severe haemorrhagic complications during pregnancy and post partum are unavailable for women with antiphospholipid syndrome. We aimed to assess thrombotic and haemorrhagic events in a prospective cohort of pregnant women with antiphospholipid syndrome. METHODS This multicentre, prospective, observational study was done at 76 centres in France. To be eligible for this study, women had to have diagnosis of antiphospholipid syndrome; have conceived before April 17, 2020; have an ongoing pregnancy that had reached 12 weeks of gestation; and be included in the study before 18 weeks of gestation. Exclusion criteria were active systemic lupus erythematosus nephropathy, or a multifetal pregnancy. Severe haemorrhage was defined as the need for red blood cell transfusion or maternal intensive care unit admission because of bleeding or invasive procedures, defined as interventional radiology or surgery, to control bleeding. The GR2 study is registered with ClinicalTrials.gov, NCT02450396. FINDINGS Between May 26, 2014, and April 17, 2020, 168 pregnancies in 27 centres met the inclusion criteria for the study. 89 (53%) of 168 women had a history of thrombosis. The median term at inclusion was 8 weeks gestation. 16 (10%) of 168 women (95%CI 5-15) had a thrombotic (six [4%] women; 95% CI 1-8) or severe haemorrhagic event (12 [7%] women; 95% CI 4-12). There were no deaths during the study. The main risk factors for thrombotic events were lupus anticoagulant positivity at inclusion (six [100%] of six women with thrombosis vs 78 [51%] of 152 of those with no thrombosis; p=0·030) and placental insufficiency (four [67%] of six women vs 28 [17%] of 162 women; p=0·013). The main risk factors for severe haemorrhagic events were pre-existing maternal hypertension (four [33%] of 12 women vs 11 [7%] of 156 women; p=0·014), lupus anticoagulant positivity at inclusion (12 [100%] of 12 women vs 72 [49%] of 146 women; p<0·0001) and during antiphospholipid history (12 [100%] of 12 women vs 104 [67%] of 156 women; p=0·019), triple antiphospholipid antibody positivity (eight [67%] of 12 women vs 36 [24%] of 147 women; p=0·0040), placental insufficiency (five [42%] of 12 women vs 27 [17%] of 156 women; p=0·038), and preterm delivery at 34 weeks or earlier (five [45%] of 11 women vs 12 [8%] of 145 women; p=0·0030). INTERPRETATION Despite treatment adhering to international recommendations, a proportion of women with antiphospholipid syndrome developed a thrombotic or severe haemorrhagic complication related to pregnancy, most frequently in the post-partum period. Lupus anticoagulant and placental insufficiency were risk factors for these life-threatening complications. These complications are difficult to prevent, but knowledge of the antenatal characteristics associated with them should increase awareness and help physicians manage these high-risk pregnancies. FUNDING Lupus France, association des Sclérodermiques de France, association Gougerot Sjögren, Association Francophone contre la Polychondrite chronique atrophiante, AFM-Telethon, the French Society of Internal Medicine and Rheumatology, Cochin Hospital, the French Health Ministry, FOREUM, the Association Prix Veronique Roualet, and UCB.
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Affiliation(s)
- Anne Murarasu
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Gaëlle Guettrot-Imbert
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | - Véronique Le Guern
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | - Cécile Yelnik
- Univ Lille, Inserm, CHU Lille, Service de Médecine Interne, U1167 RID-AGE, Lille, France
| | | | - Nicolas Schleinitz
- Service de Médecine Interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | | | | | | | - Emmanuelle Pannier
- Assistance Publique-Hôpitaux de Paris, Service de Maternité Gynécologie Obstétrique Port-Royal, Université de Paris, Hôpital Cochin, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine Interne, Hôpital du Haut-Lévêque, Pessac, France
| | | | | | - Nicolas Belhomme
- Service de Médecine Interne et Immunologie Clinique, Hôpital Sud, Rennes; Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Rennes, France
| | - Nathalie Morel
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | - Elodie Chauvet
- Service de Médecine Interne, Centre Hospitalier Saint Jean, Perpignan, France
| | - François Maurier
- Service de Médecine Interne et Immunologie Clinique Groupe Hospitalier UNEOS Site Hôpital Robert Schuman, Vantoux, France
| | - Maëlle Le Besnerais
- Service de Médecine Interne, CHU Rouen, Rouen, France; INSERM U 905, Université de Rouen IFRMP, Institute for Biochemical Research, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Noemie Abisror
- Sorbonne Université, Service de Médecine Interne, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | | | - Alban Deroux
- Service de Médecine Interne, CHU Grenoble-Alpes, Grenoble, France
| | | | - Claire de Moreuil
- Service de Médecine Interne et Pneumologie, CHU de Brest, Brest, France
| | | | - Laurent Pérard
- Service de Médecine Interne, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Nicolas Limal
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, CHU Henri Mondor, Université Paris-Est Créteil, Créteil, France
| | - Vincent Langlois
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Le Havre, Le Havre, France
| | - Anne Calas
- Service de Médecine Interne, Polyclinique Saint Laurent, Rennes, Frances
| | - Bertrand Godeau
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, CHU Henri Mondor, Université Paris-Est Créteil, Créteil, France
| | | | - Eric Hachulla
- Univ Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Fleur Cohen
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de médecine interne 2, Centre national de référence maladies auto-immunes et systémiques rares, lupus et syndrome des anticorps antiphospholipides, Paris, France
| | - Ygal Benhamou
- Service de Médecine Interne, CHU Rouen, Rouen, France; INSERM U 905, Université de Rouen IFRMP, Institute for Biochemical Research, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Loïc Raffray
- Service Médecine Interne et Dermatologie, CHU Réunion-Hôpital Félix Guyon, Saint Denis, France
| | - Mathilde de Menthon
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | | | - Vincent Poindron
- Service d'Immunologie Clinique, Nouvel Hôpital Civil, Strasbourg, France; Centre de référence maladies autoimmunes rares Est Sud Ouest RESO, Strasbourg, France
| | - Luc Mouthon
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Elisabeth Eléfant
- Centre de Reference sur les Agents Tératogènes (CRAT), Hôpital Armand-Trousseau, Paris, France
| | - Loic Sentilhes
- Service de Gynécologie Obstétrique, CHU de Bordeaux, Bordeaux, France
| | - Anna Molto
- Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France; Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Hôpital Cochin, Université de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- Université de Paris, U1153 Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France.
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Stammler R, Nguyen Y, Yelnik C, Le Guern V, Lambert M, Paule R, Mouthon L, Dupré A, Ackermann F, Dufrost V, Godeau B, Leroux G, Benhamou Y, Lazaro E, Daugas E, Bezanahary H, Mekinian A, Piette J, Morel N, Costedoat-Chalumeau N. Facteurs précipitants la survenue d’un syndrome catastrophique des antiphospholipides : étude du rôle du traitement anticoagulant. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Feugray G, Kasonga F, Grall M, Dumesnil C, Benhamou Y, Brunel V, Le Cam Duchez V, Lahary A, Billoir P. Investigation of thrombin generation assay to predict vaso-occlusive crisis in adulthood with sickle cell disease. Front Cardiovasc Med 2022; 9:883812. [PMID: 36277754 PMCID: PMC9579298 DOI: 10.3389/fcvm.2022.883812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sickle cell disease (SCD) is an inherited hemoglobinopathy disorder. The main consequence is synthesis of hemoglobin S leading to chronic hemolysis associated with morbidity. The aim of this study was to investigate Thrombin Generation Assay (TGA) to assess hypercoagulability in SCD and TGA parameters as biomarkers of vaso-occlusive crisis (VOC) risk and hospitalization within 1 year. Materials and methods We performed TGA in platelet poor plasma (PPP) with 1 pM of tissue factor and 4 μM of phospholipid-standardized concentration, in duplicate for patients and controls. We measured thrombomodulin (TM), soluble endothelial Protein C Receptor and Tissue Factor Pathway Inhibitor (TFPI). Results A total of 113 adult patients with SCD, 83 at steady state and 30 during VOC, and 25 healthy controls matched on age and gender were included. Among the 83 patients at steady state, (36 S/S-1 S/β0, 20 S/Sα3.7, and 19 S/C-7 S/β+) 28 developed a VOC within 1 year (median: 4 months [2.25–6]). We observed an increase of peak and velocity associated with a shortening of lagtime and time to peak (TTP) and no difference of endogenous thrombin potential (ETP) in patients compared to controls. TFPI (p < 0.001) and TM (p = 0.006) were significantly decreased. TGA confirmed hypercoagulability in all SCD genotypes and clinical status. The association of ETP > 1,207 nM.min and peak >228.5 nM presented a sensitivity of 73.5% and a specificity of 93.9% to predict VOC development within 1 year. Conclusion We have demonstrated a hypercoagulable state in SCD associated with chronic hemolysis. These preliminary findings suggest that TGA parameters, as ETP and peak, could be used to predict VOC development within 1 year.
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Affiliation(s)
- Guillaume Feugray
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | | | | | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | - Valery Brunel
- Department of General Biochemistry, CHU Rouen, Rouen, France
| | - Véronique Le Cam Duchez
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | | | - Paul Billoir
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France,*Correspondence: Paul Billoir, ; orcid.org/0000-0001-5632-7713
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Nguyen Y, Yelnik CM, Morel N, Paule R, Stammler R, Plaçais L, Sacré K, Godeau B, Maillard H, Launay D, Morell-Dubois S, Dupré A, Lefèvre G, Devloo C, Dufrost V, Benhamou Y, Levesque H, Leroux G, Piette JC, Mouthon L, Hachulla É, Lambert M, Guern VL, Costedoat-Chalumeau N. Determination of four homogeneous subgroups of patients with antiphospholipid syndrome: a cluster analysis based on 509 cases. Rheumatology (Oxford) 2022:6747168. [PMID: 36190346 DOI: 10.1093/rheumatology/keac548] [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: 01/22/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Antiphospholipid syndrome (APS) is a heterogeneous disease with different phenotypes. Using an unsupervised hierarchical cluster analysis, we aimed to determine distinct homogeneous phenotypes among APS patients. METHODS We performed an observational, retrospective study of APS patients enrolled in the French multicentre 'APS and SLE' registry who meet the Sydney classification criteria. The clustering process involved an unsupervised multiple correspondence analysis followed by a hierarchical ascendant clustering analysis; it used 27 variables selected to cover a broad range of APS clinical and laboratory manifestations. RESULTS These analyses included 509 patients, mainly women (77.8%). Mean (± SD) age at APS diagnosis was 36.2 ± 14.6 years, and mean follow-up since diagnosis 10.3 ± 8.5 years. This hierarchical classification cluster analysis yielded four homogeneous groups of patients: cluster 1, mostly with venous thromboembolism without any associated autoimmune disease; cluster 2, older, lowest proportion of women, history of arterial events, and/or with migraines, arterial hypertension, diabetes mellitus, or dyslipidaemia; cluster 3, younger, highest proportion of women, associated SLE or other autoimmune diseases, and a history of venous thromboembolism or pregnancy morbidity; and cluster 4, mainly with a history of catastrophic antiphospholipid syndrome, aPL-associated nephropathy, and pregnancy morbidity, with frequent triple positivity and more deaths (16.7%). CONCLUSIONS Our study applied an unsupervised clustering method to distinguish four homogeneous APS patient subgroups that were predominantly venous; arterial; associated with SLE or another autoimmune disease; and arterial microthrombotic. Heterogeneous pathophysiological mechanisms may explain these findings.
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Affiliation(s)
- Yann Nguyen
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France.,Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris, Paris, France
| | - Cécile M Yelnik
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Nathalie Morel
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Romain Stammler
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Léo Plaçais
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Karim Sacré
- Department of Internal Medicine, Hôpital Bichat, AP-HP Nord, Université de Paris, Paris, France
| | - Bertrand Godeau
- Department of Internal Medicine, Hôpital Mondor, AP-HP, Université de Paris-Est Créteil, Créteil, France
| | - Hélène Maillard
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - David Launay
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Sandrine Morell-Dubois
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Anastasia Dupré
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Guillaume Lefèvre
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Cécile Devloo
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Virginie Dufrost
- Department of Internal Medicine, CHU de Rouen, UniRouen, Inserm, U1096, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Hervé Levesque
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaëlle Leroux
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Luc Mouthon
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Éric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Marc Lambert
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Véronique Le Guern
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Nathalie Costedoat-Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France.,Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris, Paris, France
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Marcellin F, Brégigeon-Ronot S, Ramier C, Protopopescu C, Gilbert C, Di Beo V, Duvivier C, Bureau-Stoltmann M, Rosenthal E, Wittkop L, Salmon-Céron D, Carrieri P, Sogni P, Barré T, Salmon D, Wittkop L, Sogni P, Esterle L, Trimoulet P, Izopet J, Serfaty L, Paradis V, Spire B, Carrieri P, Valantin M, Pialoux G, Chas J, Zaegel-Faucher O, Barange K, Naqvi A, Rosenthal E, Bicart-See A, Bouchaud O, Gervais A, Lascoux-Combe C, Goujard C, Lacombe K, Duvivier C, Neau D, Morlat P, Bani-Sadr F, Meyer L, Boufassa F, Autran B, Roque A, Solas C, Fontaine H, Costagliola D, Piroth L, Simon A, Zucman D, Boué F, Miailhes P, Billaud E, Aumaître H, Rey D, Peytavin G, Petrov-Sanchez V, Levier A, Salmon D, Usubillaga R, Sogni P, Terris B, Tremeaux P, Katlama C, Valantin M, Stitou H, Simon A, Cacoub P, Nafissa S, Benhamou Y, Charlotte F, Fourati S, Poizot-Martin I, Zaegel O, Laroche H, Tamalet C, Pialoux G, Chas J, Callard P, Bendjaballah F, Amiel C, Le Pendeven C, Marchou B, Alric L, Barange K, Metivier S, Selves J, Larroquette F, Rosenthal E, Naqvi A, Rio V, Haudebourg J, Saint-Paul M, De Monte A, Giordanengo V, Partouche C, Bouchaud O, Martin A, Ziol M, Baazia Y, Iwaka-Bande V, Gerber A, Uzan M, Bicart-See A, Garipuy D, Ferro-Collados M, Selves J, Nicot F, Gervais A, Yazdanpanah Y, Adle-Biassette H, Alexandre G, Peytavin G, Lascoux-Combe C, Molina J, Bertheau P, Chaix M, Delaugerre C, Maylin S, Lacombe K, Bottero J, Krause J, Girard P, Wendum D, Cervera P, Adam J, Viala C, Vittecocq D, Goujard C, Quertainmont Y, Teicher E, Pallier C, Lortholary O, Duvivier C, Rouzaud C, Lourenco J, Touam F, Louisin C, Avettand-Fenoel V, Gardiennet E, Mélard A, Neau D, Ochoa A, Blanchard E, Castet-Lafarie S, Cazanave C, Malvy D, Dupon M, Dutronc H, Dauchy F, Lacaze-Buzy L, Desclaux A, Bioulac-Sage P, Trimoulet P, Reigadas S, Morlat P, Lacoste D, Bonnet F, Bernard N, Hessamfar M, Paccalin J, Martell C, Pertusa M, Vandenhende M, Mercié P, Malvy D, Pistone T, Receveur M, Méchain M, Duffau P, Rivoisy C, Faure I, Caldato S, Bioulac-Sage P, Trimoulet P, Reigadas S, Bellecave P, Tumiotto C, Pellegrin J, Viallard J, Lazzaro E, Greib C, Bioulac-Sage P, Trimoulet P, Reigadas S, Zucman D, Majerholc C, Brollo M, Farfour E, Boué F, Polo Devoto J, Kansau I, Chambrin V, Pignon C, Berroukeche L, Fior R, Martinez V, Abgrall S, Favier M, Deback C, Lévy Y, Dominguez S, Lelièvre J, Lascaux A, Melica G, Billaud E, Raffi F, Allavena C, Reliquet V, Boutoille D, Biron C, Lefebvre M, Hall N, Bouchez S, Rodallec A, Le Guen L, Hemon C, Miailhes P, Peyramond D, Chidiac C, Ader F, Biron F, Boibieux A, Cotte L, Ferry T, Perpoint T, Koffi J, Zoulim F, Bailly F, Lack P, Maynard M, Radenne S, Amiri M, Valour F, Koffi J, Zoulim F, Bailly F, Lack P, Maynard M, Radenne S, Augustin-Normand C, Scholtes C, Le-Thi T, Piroth L, Chavanet P, Duong Van Huyen M, Buisson M, Waldner-Combernoux A, Mahy S, Salmon Rousseau A, Martins C, Aumaître H, Galim S, Bani-Sadr F, Lambert D, Nguyen Y, Berger J, Hentzien M, Brodard V, Rey D, Partisani M, Batard M, Cheneau C, Priester M, Bernard-Henry C, de Mautort E, Fischer P, Gantner et S Fafi-Kremer P, Roustant F, Platterier P, Kmiec I, Traore L, Lepuil S, Parlier S, Sicart-Payssan V, Bedel E, Anriamiandrisoa S, Pomes C, Touam F, Louisin C, Mole M, Bolliot C, Catalan P, Mebarki M, Adda-Lievin A, Thilbaut P, Ousidhoum Y, Makhoukhi F, Braik O, Bayoud R, Gatey C, Pietri M, Le Baut V, Ben Rayana R, Bornarel D, Chesnel C, Beniken D, Pauchard M, Akel S, Caldato S, Lions C, Ivanova A, Ritleg AS, Debreux C, Chalal L, J.Zelie, Hue H, Soria A, Cavellec M, Breau S, Joulie A, Fisher P, Gohier S, Croisier-Bertin D, Ogoudjobi S, Brochier C, Thoirain-Galvan V, Le Cam M, Carrieri P, Chalouni M, Conte V, Dequae-Merchadou L, Desvallées M, Esterle L, Gilbert C, Gillet S, Guillochon Q, Khan C, Knight R, Marcellin F, Michel L, Mora M, Protopopescu C, Roux P, Spire B, Barré T, Ramier C, Sow A, Lions C, Di Beo V, Bureau M, Wittkop L. Depressive symptoms after hepatitis C cure and socio-behavioral correlates in aging people living with HIV (ANRS CO13 HEPAVIH). JHEP Rep 2022; 5:100614. [DOI: 10.1016/j.jhepr.2022.100614] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
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Jamart C, Levesque H, Thietart S, Fain O, Rivière S, Benhamou Y, Mekinian A. Iloprost Duration for Digital Ulcers in Systemic Sclerosis: French Retrospective Study at Two Centers and Literature Review. Front Med (Lausanne) 2022; 9:878970. [PMID: 35872796 PMCID: PMC9298754 DOI: 10.3389/fmed.2022.878970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Ischemic digital ulcers (DUs) are frequent and severe complications of systemic sclerosis (SSc). Treatment options for SSc-related digital vasculopathy are based on aggressive vasodilation, with the objective to improve blood flow in ischemic areas. Intravenous prostanoids are recommended to treat active DUs. However, the level of evidence for the duration of 5 days is low. Therefore, the aim of this study was to determine whether prolonging the infusion beyond 5 days increases the rate of healing of active DUs in SSc. Methods This is an observational longitudinal retrospective bicenter study from 2000 to 2017. The objective was to compare the healing rate and time (defined by a healing of at least 50% of DUs) between two durations of iloprost administration: 5 days or less, or more than 5 days. Results Forty-one patients, with a mean age of 47 ± 15 years at diagnosis and 32 (78%) females have been included. Systemic sclerosis was diffuse in 10 (24%) cases and 13 (32%) had an interstitial lung disease. A total of 243 iloprost infusions for DUs were performed: 140 infusions for 5 days or less, and 103 infusions for more than 5 days (prolonged duration). Patients with active DUs which received >5 days of iloprost had higher modified Rodnan skin scale at the time of iloprost infusion (median 33 vs. 15; p < 0.05), more interstitial lung disease (44 vs. 27%; p < 0.05), more anti-topoisomerase I antibody positivity (59 vs. 44%; p < 0.05), and received more previous cyclophosphamide therapy (48 vs. 19%; p < 0.05). While the number of active DUs before iloprost infusion was not significantly different among those who received ≤5 days and >5 days of iloprost, the time to healing after iloprost infusion significantly decreased in SSc patients who received >5 days iloprost infusion: 48 [7–392] vs. 91 [9–365] days (p < 0.05). The proportion of SSc patients with healed DUs tended to increase in patients with >5 days iloprost infusion (log rank = 0.06). The number of patients with complete DU healing at day 90 was significantly increased in SSc who received >5 days of iloprost: 53 (51%) vs. 52 (37%) (p < 0.05). In addition, the time to healing was not significantly associated with the use of calcium channel blockers, endothelin receptor antagonists or a combination of PDE-5 inhibitors. Conclusion Prolonging duration of iloprost >5 days could improve the healing rate and the time to healing of SSc-related DUs. Prospective randomized studies are needed to confirm these data and define the optimal duration of iloprost therapy.
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Affiliation(s)
- Céline Jamart
- Service de Médecine Interne, Hôpital Rouen, Université de Rouen, Rouen, France
| | - Hervé Levesque
- Service de Médecine Interne, Hôpital Rouen, Université de Rouen, Rouen, France
| | - Sara Thietart
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
| | - Olivier Fain
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
| | - Sébastien Rivière
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
| | - Ygal Benhamou
- Service de Médecine Interne, Hôpital Rouen, Université de Rouen, Rouen, France
| | - Arsène Mekinian
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
- INSERM U938, Centre de Recherche Saint-Antoine, Paris, France
- *Correspondence: Arsène Mekinian,
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Mirouse A, Deltour S, Leclerc D, Pouchelon C, Comarmond C, Kahn J, Benhamou Y, Mirault T, Mekinian A, Lambert M, Cacoub P, Biard L, Saadoun D. Accidents cérébraux ischémiques au cours de la maladie de Takayasu. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lévesque H, Guillet B, Benhamou Y. [Acquired hemophilia and pregnancy: A necessarily multidisciplinary approach]. Rev Med Interne 2022; 43:494-497. [PMID: 35637030 DOI: 10.1016/j.revmed.2022.04.012] [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: 02/15/2022] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 11/19/2022]
Abstract
The occurrence of acquired hemophilia during pregnancy or postpartum is rare (2 to 10 % in series). It is generally suspected in the presence of haemorrhagic manifestations (especially subcutataneous or mucosal bleeding) associated with an isolated prolongation of the activated partial thromboplastin time (APTT). The diagnosis is confirmed by the association of a low level of factor VIII (FVIII) and the presence of an anti-FVIII inhibitor. Postpartum management is similar to that of other acquired haemophilias: correction of a severe haemorrhagic syndrome by "bypassing" agents, eradication of the inhibitor by corticosteroids alone or in combination with another immunosuppressive agent depending on the residual level of FVIII and the titer of the inhibitor. Management of the forms occurring during pregnancy is based on rare experiences or expert opinions. The management of childbirth is particularly delicate in terms of haemorrhage, especially if the anti-FVIII inhibitor is still present, and must be prepared in a multidisciplinary manner. Finally, as with any acquired hemophilia, a relapse is possible, especially in the year following remission. During a subsequent pregnancy, the risk of recurrence is possible but should not be a contraindication to a new pregnancy.
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Affiliation(s)
- H Lévesque
- Service de médecine interne, Normandie université, UNIROUEN, Interne, 76031 Rouen, France.
| | - B Guillet
- Centre de traitement des maladies hémorragiques, CHU de Rennes, Rennes, France; Inserm, EHESP, IRSET (institut de recherche en santé, environnement et travail) - UMR_S 1085, Université Rennes, CHU de Rennes, 35000 Rennes, France
| | - Y Benhamou
- Service de médecine interne, Normandie université, UNIROUEN, Interne, 76031 Rouen, France
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Feugray G, Kasonga F, Grall M, Benhamou Y, Bobée-Schneider V, Buchonnet G, Daliphard S, Le Cam Duchez V, Lahary A, Billoir P. Assessment of Reticulocyte and Erythrocyte Parameters From Automated Blood Counts in Vaso-Occlusive Crisis on Sickle Cell Disease. Front Med (Lausanne) 2022; 9:858911. [PMID: 35492334 PMCID: PMC9044919 DOI: 10.3389/fmed.2022.858911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 12/18/2022] Open
Abstract
Sickle cell disease is a complex genetic disease involving cell adhesion between red blood cells, white blood cells, platelets and endothelial cells, inducing painful vaso-occlusive crisis (VOC). We assessed reticulocyte and erythrocyte parameters in a cohort of confirmed SCD patients, and investigated whether a combination of these routine laboratory biomarkers of haemolysis could be used to predict VOC development. Reticulocyte and erythrocyte parameters were evaluated using the Sysmex XN-9000 analyser. A total of 98 patients with SCD were included, 72 in steady state and 26 in VOC. Among the 72 patients in steady state, 22 developed a VOC in the following year (median: 3 months [2-6]). The following parameters were increased in SCD patients with VOC development compared to SCD patients without VOC development in the following year: reticulocyte count (94.6 109/L [67.8-128] vs. 48.4 109/L [24.9-87.5]), immature reticulocyte count (259 109/L [181-334] vs. 152 109/L [129-208]) reticulocyte/immature reticulocyte fraction (IRF) ratio (6.63 109/(L*%) [4.67-9.56] vs. 4.94 109/(L*%) [3.96-6.61]), and medium fluorescence reticulocytes (MFR) (19.9% [17.4-20.7] vs. 17.1% [15.95-19.75]). The association of a reticulocyte count of >189.4 109/L and an MFR of >19.75% showed a sensitivity of 81.8% and a specificity of 88% to predict VOC development in the following year. Based on our findings, a combination of routine laboratory biomarkers, as reticulocyte count, immature reticulocyte count and fluorescent reticulocyte fraction at steady state, could be used to predict VOC development in SCD.
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Affiliation(s)
- Guillaume Feugray
- General Biochemistry, Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Rouen, France
| | | | | | - Ygal Benhamou
- Department of Internal Medecine, Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Rouen, France
| | | | | | | | - Véronique Le Cam Duchez
- Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France
| | | | - Paul Billoir
- Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France
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Moschetti L, Dal Pozzolo L, Le Guern V, Morel N, Yelnik CM, Lambert M, Hachulla E, Benhamou Y, Nalli C, Fredi M, Franceschini F, Andreoli L, Costedoat-Chalumeau N, Tincani A. Gender differences in primary antiphospholipid syndrome with vascular manifestations in 433 patients from four European centres. Clin Exp Rheumatol 2022; 40 Suppl 134:19-26. [PMID: 35349408 DOI: 10.55563/clinexprheumatol/9royri] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Gender can influence incidence and clinical course of autoimmune diseases (ADs). Antiphospholipid syndrome (APS) is a rare AD characterised by thromboses and/or pregnancy morbidities and antiphospholipid antibodies (aPL) positivity. Our aim is to conduct a gender-oriented analysis of primary thrombotic APS (t-APS). METHODS Consecutive patients diagnosed with primary t-APS, followed from 1967 to 2019 in four European Centres, were enrolled. RESULTS The cohort included 296 women and 137 men. Median age at onset [31 (24-46) vs. 41 (29-53) years, p<0.001] was lower in females. In women, venous thromboses were more frequent while, among males, arterial events prevailed. During follow-up, 14% of patients suffered at least two relapses and this occurred especially among males (22% vs. 10%, p=0.001). No gender differences were found in the aPL profile (33% single, 24% double and 43% triple aPL positivity). Most patients had concomitant risk factors (RFs) for thrombosis: established cardiovascular RFs were represented especially among men while estrogenic exposure was the main RF in women. CONCLUSIONS Women presented mostly with venous thromboses at a younger age, while men with arterial events, later in life and suffered more recurrent events. This different frequency of arterial and venous thromboses could be attributed mainly to the presence of additional RFs rather than to biological gender-specific issues. However, some RFs are exclusive or more represented in one gender rather than the other, so assessing the link of causality between gender and manifestations of t-APS remains difficult.
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Affiliation(s)
- Liala Moschetti
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy.
| | - Luisa Dal Pozzolo
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Veronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'île de France; Université de Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'île de France; Université de Paris, France
| | - Cecile M Yelnik
- Université de Lille, INSERM and CHU LILLE, Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Marc Lambert
- Université de Lille, INSERM and CHU LILLE, Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Eric Hachulla
- Université de Lille, INSERM and CHU LILLE, Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Ygal Benhamou
- Département de Médecine Interne, CHU Charles Nicolle and Normandie University, UNIROUEN, INSERM U1096 EnVI, Rouen, France
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'île de France, Université de Paris, France
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Mirouse A, Deltour S, Leclercq D, Squara PA, Pouchelon C, Comarmond C, Kahn JE, Benhamou Y, Mirault T, Mekinian A, Lambert M, Chiche L, Koskas F, Cluzel P, Redheuil A, Cacoub P, Biard L, Saadoun D. Cerebrovascular Ischemic Events in Patients With Takayasu Arteritis. Stroke 2022; 53:1550-1557. [PMID: 35354303 DOI: 10.1161/strokeaha.121.034445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Takayasu arteritis (TA) is a large vessel vasculitis that may complicate with cerebrovascular ischemic events. The objective was to describe clinical and vascular features of TA patients with cerebrovascular ischemic events and to identify risk factors for these events. METHODS We analyzed the prevalence and type of stroke/transient ischemic attack (TIA), factors associated with cerebrovascular ischemic events, and stroke-free survival in a large cohort fulfilling the American College of Rheumatology or Ishikawa criteria of TA. RESULTS Among 320 patients with TA (median age at diagnosis, 36 [25-47] years; 261 [86%] women), 63 (20%) had a stroke (n=41; 65%) or TIA (n=22; 35%). Ischemic event localized in the carotid territory for 55 (87%) patients and the vertebral artery territory in 8 (13%) patients. Multiple stenosis were observed in 33 (52%) patients with a median number of stenosis of 2 (minimum, 0 to maximum, 11), and aneurysms were observed in 10 (16%) patients. A history of stroke or TIA before TA diagnosis (hazard ratio [HR], 4.50 [2.45-8.17]; P<0.0001), smoking (HR, 1.75 [1.01-3.02]; P=0.05), myocardial infarction history (HR, 0.21 [0.05-0.89]; P=0.039), thoracic aorta involvement (HR, 2.05 [1.30-3.75]; P=0.023), time from first symptoms to diagnosis >1 year (HR, 2.22 [1.30-3.80]; P=0.005), and aspirin treatment (HR, 1.82 [1.04-3.19]; P=0.035) were associated with cerebrovascular ischemic event. In multivariate analysis, time from first symptoms to TA diagnosis >1 year (HR, 2.16 [1.27-3.70]; P=0.007) was independently associated with cerebrovascular ischemic events in patients with TA. The HR for cerebrovascular ischemic event in patients who already experienced a stroke/TIA was 5.11 (2.91-8.99; P<0.0001), compared with those who had not. CONCLUSIONS Carotid stroke/TIA is frequent in TA. We identified factors associated with cerebrovascular ischemic events.
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Affiliation(s)
- Adrien Mirouse
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Sandrine Deltour
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Service de Neurologie, Hôpital Raymond Poincaré, APHP, Université Versailles Saint Quentin en Yvelines, Garches, France (S.D.)
| | - Delphine Leclercq
- Service de Neuro-Radiologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (D.L.)
| | - Pierre-Alexandre Squara
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - Clara Pouchelon
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.)
| | - Cloé Comarmond
- Département de Médecine Interne et Immunologie Clinique, Hôpital Lariboisière APHP, Paris, France. (C.C.)
| | - Jean-Emmanuel Kahn
- Service de Médecine Interne, Hôpital Ambroise Paré, APHP, Boulogne, France (J.-E.K.)
| | - Ygal Benhamou
- Service de Médecine Interne, Vasculaire et Thrombose, CHU de Rouen, France (Y.B.)
| | - Tristan Mirault
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, APHP, Paris, France. (T.M.)
| | - Arsène Mekinian
- Service de Médecine Interne, Hôpital Saint-Antoine, APHP, Paris, France. (A. Mekinian).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Marc Lambert
- Service de Médecine Interne, CHRU de Lille, France (M.L.)
| | - Laurent Chiche
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.)
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (L.C., F.K.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Philippe Cluzel
- Service de Radiologie Interventionnelle, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (P. Cluzel).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Alban Redheuil
- Service de Radiologie et Imagerie Cardio-Vasculaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France. (A.R.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, APHP, Paris, France. (A. Mirouse, C.P., P. Cacoub, D.S.).,Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy, Paris, France (A. Mirouse, C.P., P. Cacoub, D.S.).,Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
| | - Lucie Biard
- AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Université de Paris, France (P.-A.S., L.B.)
| | - David Saadoun
- Sorbonne Université, Paris, France (A. Mirouse, A. Mekinian, F.K., P. Cluzel, A.R., P. Cacoub, D.S.)
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Barré T, Mercié P, Lions C, Miailhes P, Zucman D, Aumaître H, Esterle L, Sogni P, Carrieri P, Salmon-Céron D, Marcellin F, Salmon D, Wittkop L, Sogni P, Esterle L, Trimoulet P, Izopet J, Serfaty L, Paradis V, Spire B, Carrieri P, Valantin MA, Pialoux G, Chas J, Poizot-Martin I, Barange K, Naqvi A, Rosenthal E, Bicart-See A, Bouchaud O, Gervais A, Lascoux-Combe C, Goujard C, Lacombe K, Duvivier C, Neau D, Morlat P, Bani-Sadr F, Meyer L, Boufassa F, Autran B, Roque AM, Solas C, Fontaine H, Costagliola D, Piroth L, Simon A, Zucman D, Boué F, Miailhes P, Billaud E, Aumaître H, Rey D, Peytavin G, Petrov-Sanchez V, Levier A, Usubillaga R, Terris B, Tremeaux P, Katlama C, Valantin MA, Stitou H, Cacoub P, Nafissa S, Benhamou Y, Charlotte F, Fourati S, Zaegel O, Laroche H, Tamalet C, Callard P, Bendjaballah F, Le Pendeven C, Marchou B, Alric L, Metivier S, Selves J, Larroquette F, Rio V, Haudebourg J, Saint-Paul MC, De Monte A, Giordanengo V, Partouche C, Martin A, Ziol M, Baazia Y, Iwaka-Bande V, Gerber A, Uzan M, Garipuy D, Ferro-Collados MJ, Nicot F, Yazdanpanah Y, Adle-Biassette H, Alexandre G, Molina JM, Bertheau P, Chaix ML, Delaugerre C, Maylin S, Bottero J, Krause J, Girard PM, Wendum D, Cervera P, Adam J, Viala C, Vittecocq D, Quertainmont Y, Teicher E, Pallier C, Lortholary O, Rouzaud C, Lourenco J, Touam F, Louisin C, Avettand-Fenoel V, Gardiennet E, Mélard A, Ochoa A, Blanchard E, Castet-Lafarie S, Cazanave C, Malvy D, Dupon M, Dutronc H, Dauchy F, Lacaze-Buzy L, Desclaux A, Bioulac-Sage P, Reigadas S, Lacoste D, Bonnet F, Bernard N, Hessamfar M, J, Paccalin F, Martell C, Pertusa MC, Vandenhende M, Mercié P, Pistone T, Receveur MC, Méchain M, Duffau P, Rivoisy C, Faure I, Caldato S, Bellecave P, Tumiotto C, Pellegrin JL, Viallard JF, Lazzaro E, Greib C, Majerholc C, Brollo M, Farfour E, Devoto JP, Kansau I, Chambrin V, Pignon C, Berroukeche L, Fior R, Martinez V, Abgrall S, Favier M, Deback C, Lévy Y, Dominguez S, Lelièvre JD, Lascaux AS, Melica G, Raffi F, Allavena C, Reliquet V, Boutoille D, Biron C, Lefebvre M, Hall N, Bouchez S, Rodallec A, Le Guen L, Hemon C, Peyramond D, Chidiac C, Ader F, Biron F, Boibieux A, Cotte L, Ferry T, Perpoint T, Koffi J, Zoulim F, Bailly F, Lack P, Maynard M, Radenne S, Amiri M, Valour F, Augustin-Normand C, Scholtes C, Le-Thi TT, Van Huyen PCMD, Buisson M, Waldner-Combernoux A, Mahy S, Rousseau AS, Martins C, Galim S, Lambert D, Nguyen Y, Berger JL, Hentzien M, Brodard V, Partisani M, Batard ML, Cheneau C, Priester M, Bernard-Henry C, de Mautort E, Fischer P, Gantner P, Fafi-Kremer S, Roustant F, Platterier P, Kmiec I, Traore L, Lepuil S, Parlier S, Sicart-Payssan V, Bedel E, Anriamiandrisoa S, Pomes C, Mole M, Bolliot C, Catalan P, Mebarki M, Adda-Lievin A, Thilbaut P, Ousidhoum Y, Makhoukhi FZ, Braik O, Bayoud R, Gatey C, Pietri MP, Le Baut V, Rayana RB, Bornarel D, Chesnel C, Beniken D, Pauchard M, Akel S, Lions C, Ivanova A, Ritleg AS, Debreux C, Chalal L, Zelie J, Hue H, Soria A, Cavellec M, Breau S, Joulie A, Fisher P, Gohier S, Croisier-Bertin D, Ogoudjobi S, Brochier C, Thoirain-Galvan V, Le Cam M, Chalouni M, Conte V, Dequae-Merchadou L, Desvallees M, Gilbert C, Gillet S, Knight R, Lemboub T, Marcellin F, Michel L, Mora M, Protopopescu C, Roux P, Tezkratt S, Barré T, Rojas TR, Baudoin M, Di Beo MSV, Nishimwe M. HCV cure: an appropriate moment to reduce cannabis use in people living with HIV? (ANRS CO13 HEPAVIH data). AIDS Res Ther 2022; 19:15. [PMID: 35292069 PMCID: PMC8922772 DOI: 10.1186/s12981-022-00440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thanks to direct-acting antivirals, hepatitis C virus (HCV) infection can be cured, with similar rates in HCV-infected and HIV-HCV co-infected patients. HCV cure is likely to foster behavioral changes in psychoactive substance use, which is highly prevalent in people living with HIV (PLWH). Cannabis is one substance that is very commonly used by PLWH, sometimes for therapeutic purposes. We aimed to identify correlates of cannabis use reduction following HCV cure in HIV-HCV co-infected cannabis users and to characterize persons who reduced their use. METHODS We used data collected on HCV-cured cannabis users in a cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients, to perform logistic regression, with post-HCV cure cannabis reduction as the outcome, and socio-behavioral characteristics as potential correlates. We also characterized the study sample by comparing post-cure substance use behaviors between those who reduced their cannabis use and those who did not. RESULTS Among 140 HIV-infected cannabis users, 50 and 5 had reduced and increased their use, respectively, while 85 had not changed their use since HCV cure. Cannabis use reduction was significantly associated with tobacco use reduction, a decrease in fatigue level, paying more attention to one's dietary habits since HCV cure, and pre-HCV cure alcohol abstinence (p = 0.063 for alcohol use reduction). CONCLUSIONS Among PLWH using cannabis, post-HCV cure cannabis reduction was associated with tobacco use reduction, improved well-being, and adoption of healthy behaviors. The management of addictive behaviors should therefore be encouraged during HCV treatment.
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Fares Y, Sinzogan Y, Bogaert A, Kerleau J, Benhamou Y, Miranda S. Dépistage des thromboses veineuses profondes par écho Doppler portatif chez les patients hospitalisés pour une infection au COVID-19 (COVID-TVP). JMV-Journal de Médecine Vasculaire 2022. [PMCID: PMC8865900 DOI: 10.1016/j.jdmv.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction & Objectifs La pandémie au COVID-19 s’accompagne d’une forte prévalence de la maladie thromboembolique veineuse (MTEV). Celle-ci s’explique par un état d’hypercoagulabilité soulevant la question de l’intérêt d’un dépistage systématique des thromboses veineuses profondes (TVP) proximales chez les patients hospitalisés pour une infection au COVID-19. Méthodologie Dans cette étude prospective bicentrique contrôlée, une échographie 4 points était réalisée par un échographe portatif chez les patients hospitalisés pour une infection au COVID-19 en unité conventionnelle et en réanimation et chez un groupe contrôle de patients hospitalisés pour une affection inflammatoire médicale aiguë. L’objectif était de déterminer l’intérêt du dépistage systématique des TVP permettant l’adaptation précoce de la prise en charge de la MTEV. Résultats Entre avril et mai 2020, 155 patients étaient inclus dont 78 dans le groupe COVID+ et 77 dans le groupe contrôle, au CHU de Rouen et au CH de Dieppe. On ne retrouvait pas de différence significative entre le taux de TVP proximales du groupe COVID+ et celui du groupe contrôle (3,84 % vs 1,29 % ; p = 0,62). Le taux de MTEV et d’embolies pulmonaires (EP) était significativement plus élevé dans le groupe COVID+ (12,82 % vs 1,29 % ; p = 0,009). La présence d’une TVP était toujours associée à la présence d’une EP, mais seulement 30 % des EP étaient associées à une TVP. L’augmentation de la mortalité dans le groupe COVID+ (7,69 %) n’était pas significative (p = 0,276). Conclusion Le dépistage systématique par échographie portable de la TVP chez les patients hospitalisés pour une infection au COVID-19 n’est pas utile, malgré une plus grande prévalence d’évènements thrombotiques au sein de cette population. De nouvelles études devront être réalisées pour confirmer l’hypothèse d’un processus microthrombotique pulmonaire localisé in situ, pouvant orienter la prise en charge vers d’autres cibles thérapeutiques.
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Leclercq M, Vannier M, Benhamou Y, Liard A, Gilard V, Auquit-Auckbur I, Levesque H, Sibert L, Schneider P. Identification des facteurs associés à la réussite aux examens cliniques objectifs et structurés dans la faculté de médecine de Rouen. Rev Med Interne 2022; 43:278-285. [DOI: 10.1016/j.revmed.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
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Deghmani I, Miranda S, Guerrot D, Nouhaud F, Benhamou Y, Levesque H, Armengol G. Fibrose rétropéritonéale: analyse descriptive retrospective d’une cohorte de 56 patients. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.317] [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: 11/17/2022]
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Nassarmadji K, Miranda S, Billoir P, Benhamou Y. Prévalence et facteurs associés à la récidive thrombotique dans le syndrome des antiphospholipides. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.260] [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: 11/29/2022]
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De gail S, Levesque H, Jardin F, Manuel E, Tamion F, Benhamou Y, Grall M. Caractéristiques et profil évolutif des lymphohistiocytoses hémophagogytaires : étude rétrospective monocentrique au CHU de Rouen entre 2010 et 2020. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Morel N, Bonnet C, Mehawej H, Le Guern V, Pérard L, Roumier M, Brezin A, Godeau B, Haroche J, Benhamou Y, Lambert M, Yelnik CM, Maillard N, Bodaghi B, Piette JC, Costedoat-Chalumeau N. CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME AND POSTERIOR OCULAR INVOLVEMENT: Case Series of 11 Patients and Literature Review. Retina 2021; 41:2332-2341. [PMID: 33840791 DOI: 10.1097/iae.0000000000003185] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome. METHODS Retrospective case series of patients presenting with catastrophic antiphospholipid syndrome and posterior segment ocular manifestations. The main outcomes were the type of posterior segment manifestations at catastrophic antiphospholipid syndrome diagnosis, specifically retinal vascular occlusion, vasculitis, or choroidopathy, and the final best-corrected visual acuity. RESULTS This study included 23 patients (11 cases treated by the authors and 12 published case reports); 21 (91%) of them female. Their median age at diagnosis was 28 years (range, 16-79 years). Ophthalmologic manifestations were usually bilateral (n = 19, 83%) and involved vascular occlusive retinopathy (n = 17, 74%), choroidopathy (n = 11, 48%), or retinal vasculitis (n = 1, 4%). Final best-corrected visual acuity was not significantly worse than the best-corrected visual acuity at diagnosis (P = 0.16). Retinal vascular occlusions were associated with poorer final visual acuity than choroidopathy (P = 0.002). After a median follow-up of 14 months (range, 2-132 months), nearly half the patients (n = 11, 48%) had permanent vision loss including best-corrected visual acuity of <20/400 for 4 patients. CONCLUSION Posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome were mainly bilateral retinal vascular occlusion, which had the worst visual prognosis, followed by choroidopathy and retinal vasculitis. Permanent visual loss was common.
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Affiliation(s)
- Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Clémence Bonnet
- Université Paris-Descartes, Paris, France
- Ophthalmology Department, AP-HP, Cochin Hospital, Paris, France
| | - Hanane Mehawej
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Laurent Pérard
- Centre Hospitalier Saint Joseph Saint Luc, Internal Medicine Department, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | | | - Antoine Brezin
- Ophthalmology Department, AP-HP, Cochin Hospital, Paris, France
| | - Bertrand Godeau
- Internal Medicine Department, AP-HP, Henri Mondor Hospital, Creteil, France
| | - Julien Haroche
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, Vascular and Thrombosis Unit, Normandie Université, UNIROUEN, Rouen University Hospital, Rouen, France
| | - Marc Lambert
- Internal Medicine Department, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University Lille, INSERM U1167, CHU Lille, Lille, France
| | - Cécile M Yelnik
- Internal Medicine Department, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University Lille, INSERM U1167, CHU Lille, Lille, France
| | - Nicolas Maillard
- Department of Internal Medicine, CHU, de Saint-Etienne, France; and
| | - Bahram Bodaghi
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Charles Piette
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
- AP-HP, Cochin Hospital, Internal Medicine department, Centre de référence maladies auto-immunes et systémiques rares de l'Ile de France, INSERM U 1153, Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Université Paris Descartes-Sorbonne Paris Cité, Paris, France
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42
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Adham S, Armengol G, Cailleux-Talbot N, Levesque H, Benhamou Y, Miranda S. Bilateral deep vein thrombosis: Time to screen for occult cancer? Vasc Med 2021; 26:660-661. [PMID: 34533078 DOI: 10.1177/1358863x211034919] [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] [Indexed: 11/17/2022]
Affiliation(s)
- Salma Adham
- Département de génétique, Centre de référence des maladies vasculaires rares, Hôpital européen George Pompidou, AP-HP, Paris, France.,Faculté de médecine Paris Descartes, Université Paris Centre, Paris, France
| | - Guillaume Armengol
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | | | - Hervé Levesque
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, Inserm U1096 EnVI, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, Inserm U1096 EnVI, Rouen, France
| | - Sébastien Miranda
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, Inserm U1096 EnVI, Rouen, France
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Abisror N, Nguyen Y, Marozio L, Esteve Valverde E, Udry S, Pleguezuelo DE, Billoir P, Mayer-Pickel K, Urbanski G, Zigon P, De Moreuil C, Hoxha A, Bezanahary H, Carbillon L, Kayem G, Bornes M, Yelnik C, Johanet C, Nicaise-Roland P, Lambert M, Salle V, Latino OJ, Hachulla E, Benedetto C, Bourrienne MC, Benhamou Y, Alijotas-Reig J, Fain O, Mekinian A. Obstetrical outcome and treatments in seronegative primary APS: data from European retrospective study. RMD Open 2021; 6:0. [PMID: 32848089 PMCID: PMC7507995 DOI: 10.1136/rmdopen-2020-001340] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 07/23/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To compare characteristics, pregnancies and treatments during pregnancies of seronegative and seropositive antiphospholipid syndrome (APS), to analyse factors associated with obstetrical outcome. PATIENTS AND METHODS Inclusion criteria were: (1) thrombotic and/or obstetrical APS (Sydney criteria); (2) absence of conventional antiphospholipid antibodies (APL); (3) at least one persistent non-conventional APL among IgA anticardiolipin antibodies, IgA anti-B2GPI, anti-vimentin G/M, anti-annexin V G/M, anti-phosphatidylethanolamine G/M and anti-phosphatidylserine/prothrombin G/M antibodies. The exclusion criteria were: (1) systemic lupus erythematosus ( SLE) or SLE-like disease; and (2) other connective tissue disease. RESULTS A total of 187 women (mean 33±5 years) with seronegative APS were included from 14 centres in Austria, Spain, Italy, Slovenia and France and compared with 285 patients with seropositive APS. Seronegative APS has more obstetrical rather than thrombotic phenotypes, with only 6% of venous thrombosis in comparison to seropositive APS. Cumulative incidence of adverse obstetrical events was similar in seronegative and seropositive APS patients, although higher rates of intrauterine deaths (15% vs 5%; p=0.03), of preeclampsia (7% vs 16%, p=0.048) and lower live birth term (36±3 vs 38±3 weeks of gestation; p=0.04) were noted in seropositive APS. The cumulative incidence of adverse obstetrical events was significantly improved in treated versus untreated seronegative APS (log rank<0.05), whereas there was no difference between patients who received aspirin or aspirin-low-molecular weighted heparin combination. CONCLUSION Several non-criteria APL can be detected in patients with clinical APS features without any conventional APL, with various rates. The detection of non-criteria APL and thus the diagnosis of seronegative APS could discuss the therapeutic management similar to seropositive APS, but well-designed controlled studies are necessary.
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Affiliation(s)
- Noemie Abisror
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, AP-HP Nord, Beaujon Hospital, Paris University,Clichy, France
| | - Luca Marozio
- Department of Surgical Sciences, Obstetrics and Gynecology, University of Torino, Turin, Italy
| | | | - Sebastian Udry
- 5Autoimmune, Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr Carlos G Durand", Buenos Aires, Argentina
| | | | - Paul Billoir
- Department of Internal Medicine, Vascular and Thrombosis Unit, Rouen University Hospital, Normandie University, UNIROUEN, INSERM, Rouen, France
| | | | - Geoffrey Urbanski
- Service Department of internal medicine, CHU d'Angers, Angers, France
| | - Polona Zigon
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Claire De Moreuil
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France.,EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Ariela Hoxha
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
| | - Holy Bezanahary
- Department of Internal Medicine, University Hospital of Limoges, Limoges, France
| | - Lionel Carbillon
- Department of Obstetrics, Gynecology and Reproductive Medicine Centers, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris, Bondy, France.,University of Paris 13, Sorbonne University,Bobigny, France
| | - Gilles Kayem
- Service de Gynécologie Obstétrique, Hôpital Trousseau, AP-HP, Paris, France.,Sorbonne Université,Paris, France
| | - Marie Bornes
- Department of Gynaecology and Obstetrics and Reproductive Medicine, Tenon Hospital, Assistance Publique - Paris Hospitals,Paris, France
| | - Cecile Yelnik
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest (CeRAINO), Univ. Lille, CHU Lille, Lille, France
| | | | | | - Marc Lambert
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest (CeRAINO), Univ. Lille, CHU Lille, Lille, France
| | - Valéry Salle
- Department of Internal Medicine, University Hospital of Amiens, Amiens, France
| | - Omar Jose Latino
- 5Autoimmune, Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr Carlos G Durand", Buenos Aires, Argentina
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest (CeRAINO), Univ. Lille, CHU Lille, Lille, France
| | - Chiara Benedetto
- Department of Surgical Sciences, Obstetrics and Gynecology, University of Torino, Turin, Italy
| | - Marie Charlotte Bourrienne
- Université de Paris, INSERM UMR_S1148, Paris cedex 18, France.,Laboratoire d'Hématologie, AP-HP, Hôpital Bichat, Paris cedex 18, France
| | - Ygal Benhamou
- Department of Internal Medicine, Vascular and Thrombosis Unit, Rouen University Hospital, Normandie University, UNIROUEN, INSERM, Rouen, France
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine-1, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, Universitat Autönoma de Barcelona, Barcelona, Spain
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
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Roy PM, Penaloza A, Hugli O, Klok FA, Arnoux A, Elias A, Couturaud F, Joly LM, Lopez R, Faber LM, Daoud-Elias M, Planquette B, Bokobza J, Viglino D, Schmidt J, Juchet H, Mahe I, Mulder F, Bartiaux M, Cren R, Moumneh T, Quere I, Falvo N, Montaclair K, Douillet D, Steinier C, Hendriks SV, Benhamou Y, Szwebel TA, Pernod G, Dublanchet N, Lapebie FX, Javaud N, Ghuysen A, Sebbane M, Chatellier G, Meyer G, Jimenez D, Huisman MV, Sanchez O. Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. Eur Heart J 2021; 42:3146-3157. [PMID: 34363386 PMCID: PMC8408662 DOI: 10.1093/eurheartj/ehab373] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/02/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.
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Affiliation(s)
- Pierre-Marie Roy
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Andrea Penaloza
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,UCLouvain, Brussels, Belgium
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, DTN, Leiden University Medical Center, Leiden, the Netherlands
| | - Armelle Arnoux
- Computing, Statistics and Public Health & CIC1418, Hôpital Européen Georges Pompidou, APHP, Paris, France.,University of Paris, Paris, France
| | - Antoine Elias
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Cardiology and Vascular Medicine, CH Sainte Musse - Toulon, Toulon, France
| | - Francis Couturaud
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Internal Medicine and Chest Disease, CHU Brest, Brest, France.,EA3878-GETBO, CIC-INSERM1412, Univ-Brest, Brest, France
| | - Luc-Marie Joly
- Emergency Department, CHU Rouen, Normandy Univ, UNIROUEN, Rouen, France
| | - Raphaëlle Lopez
- Emergency Department, Sart Tilman University Hospital, Liège, Belgium
| | - Laura M Faber
- Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, DTN, the Netherlands
| | - Marie Daoud-Elias
- Department of Cardiology and Vascular Medicine, CH Sainte Musse - Toulon, Toulon, France
| | - Benjamin Planquette
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Pneumology and Intensive Care, Hôpital Europeen Georges Pompidou, APHP, Paris, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France
| | - Jérôme Bokobza
- Emergency Department, Hôpital Cochin, APHP, Paris, France
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes, Grenoble, France.,HP2 INSERM U 1042 Laboratory, University of Grenoble-Alpes, Grenoble, France
| | - Jeannot Schmidt
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Henry Juchet
- Emergency Department, CHU Toulouse, Toulouse, France
| | - Isabelle Mahe
- F-CRIN, INNOVTE, Saint-Etienne, France.,Internal Medicine Department, HU Paris Nord, Louis Mourier Hospital, APHP, Colombes, France.,Inserm UMR_S1140 Hemostasis Therapeutical Innovations, University of Paris, Colombes, France
| | - Frits Mulder
- Department of Internal Medicine, Tergooi Hospital, Hilversum, the Netherlands
| | - Magali Bartiaux
- Emergency Department, Saint-Pierre Hospital, Brussels, Belgium
| | - Rosen Cren
- Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thomas Moumneh
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Isabelle Quere
- F-CRIN, INNOVTE, Saint-Etienne, France.,Vascular Medicine Department, CHU Montpellier, EA2992, CIC 1001, University of Montpellier, Montpellier, France
| | - Nicolas Falvo
- Vascular Medicine Department, CHU Dijon, Dijon, France
| | - Karine Montaclair
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Cardiology, CH Le Mans, Le Mans, France
| | - Delphine Douillet
- Emergency Department, CHU Angers, 4 rue Larrey, Angers, France, F-49000.,Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France.,F-CRIN, INNOVTE, Saint-Etienne, France
| | - Charlotte Steinier
- Emergency Department, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stephan V Hendriks
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Charles Nicolle, Rouen, France.,Normandie University, UNIROUEN, INSERM U1096 EnVI, Rouen, France
| | - Tali-Anne Szwebel
- Department of Internal Medicine, Cochin Hospital, APHP, Paris, France
| | - Gilles Pernod
- F-CRIN, INNOVTE, Saint-Etienne, France.,Department of Vascular Medicine, CHU Grenoble Alpes, Grenoble, France.,University Grenoble Alpes, CNRS / TIMC-IMAG UMR 5525 / Themas, Grenoble, France
| | - Nicolas Dublanchet
- Emergency Department, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | | | - Nicolas Javaud
- Emergency Department, CréAk, Louis Mourier Hospital, APHP, University of Paris, Colombes, France
| | - Alexandre Ghuysen
- Emergency Department, Sart Tilman University Hospital, Liège, Belgium
| | - Mustapha Sebbane
- F-CRIN, INNOVTE, Saint-Etienne, France.,Emergency Department, Lapeyronie Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Gilles Chatellier
- Computing, Statistics and Public Health & CIC1418, Hôpital Européen Georges Pompidou, APHP, Paris, France.,University of Paris, Paris, France
| | - Guy Meyer
- Department of Pneumology and Intensive Care, Hôpital Europeen Georges Pompidou, APHP, Paris, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France
| | - David Jimenez
- Respiratory Department and Medicine Department, Ramon y Cajal Hospital IRYCIS Alcal de Henares University, Madrid, Spain
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Olivier Sanchez
- F-CRIN, INNOVTE, Saint-Etienne, France.,University of Paris, INSERM UMR-S 1140 Innovaties Therapies in Haemostasis, Paris, France.,Pneumology Department and Intensive Care, Hôpital Européen Georges Pompidou, APHP, 20-40 rue Leblanc, Paris, France, F-75908
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Mekinian A, Biard L, Dagna L, Novikov P, Salvarani C, Espita O, Sciscia S, Michaud M, Lambert M, Hernández-Rodríguez J, Schleinitz N, Awisat A, Puéchal X, Aouba A, Pons HM, Smitienko I, Gaultier JB, Edwige LM, Benhamou Y, Perlat A, Jego P, Goulenok T, Sacre K, Lioger B, Nolan H, Broner J, Dufrost V, Sene T, Seguier J, Maurier F, Berthier S, Belot A, Frikha F, Denis G, Audemard-Verger A, Pault IK, Humbert S, Woaye-Hune P, Tomelleri A, Baldissera E, Kuwana M, Logullo A, Gaches F, Zeminsky P, Galli E, Alvarado M, Luigi PB, Francesco M, Vautier M, Campochiaro C, Moiseev S, Cacoub P, Fain O, Saadoun D. Efficacy and safety of TNF-α antagonists and tocilizumab in Takayasu arteritis: Multicenter retrospective study of 209 patients. Rheumatology (Oxford) 2021; 61:1376-1384. [PMID: 34363461 DOI: 10.1093/rheumatology/keab635] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess safety and efficacy of TNF-α antagonists and tocilizumab in patients with Takayasu arteritis (TAK). METHODS AND RESULTS Two-hundred nine patients with TAK [median age of 29 years [7-62], and 186 (89%) females] were included. They received either TNF-α antagonists [n = 132 (63%) with 172 lines; infliximab (n = 109), adalimumab (n = 45), golimumab (n = 8), certolizumab (n = 6) and etanercept (n = 5)], or tocilizumab [n = 77 (37%) with 121 lines; intravenous and subcutaneous in 95 and 26 cases, respectively]. A complete response at 6 months was evidenced in 101/152 (66%) on TNF-α antagonists and 75/107 (70%) on tocilizumab, respectively. Age ≥ 30 years [OR = 2.09 [1.09; 3.99]] was associated with complete response, whereas vascular signs [0.26 [0.1; 0.65]], baseline prednisone ≥ 20 mg/day [0.51 [0.28; 0.93]] were negatively associated with the complete response to TNF-α antagonists or tocilizumab. During a median follow-up of 36 months, 103 relapses were noted. Supra-aortic branches and thoracic aorta involvements [HR 2.44 (1.06; 5.65) and 3.66 (1.18; 11.4), respectively], and systemic signs at baseline [HR 2.01 (1.30; 3.11)] were significantly associated with relapse. The cumulative incidence of treatment discontinuation and relapse were similar in TNFα antagonists and tocilizumab. Fifty-eight (20%) adverse effects occurred on biological-targeted therapies of whom 37 (21%) and 21 (17%), (p= 0.4) on TNF-α antagonists and tocilizumab, respectively. CONCLUSION This large multicentre study shows high efficacy of biological-targeted treatments in refractory TAK. Efficacy, relapse and drug retention rate were equivalent with TNF-α antagonists and tocilizumab.
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Affiliation(s)
- Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75012, France
| | - Lucie Biard
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy.,Unit of Rheumatology, Università di Modena e Reggio Emilia, Italy
| | - Olivier Espita
- Service de Médecine Interne, CHU Hôtel-Dieu, Nantes, 44093, France
| | - Savino Sciscia
- Center of Research of Immunopathology and Rare Diseases-Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, Nephrology and Dialysis, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Martin Michaud
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, 31076
| | - Marc Lambert
- Service de médecine interne, CHU Lille, Université Lille II, Lille, France
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS, University of Barcelona, Barcelona, Spain )
| | | | - Abid Awisat
- Rheumatology unit, Bnai Zion medical center, Haifa, Israel
| | - Xavier Puéchal
- Université Paris Descartes, Paris, France; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Achille Aouba
- Département de médecine interne, CHU, Caen, Caen, France
| | - Helene Munoz Pons
- Département de médecine interne, CHU, Saint Etienne, Saint Etienne, France
| | - Ilya Smitienko
- Rheumatology department, Medical Center, Moscow, K-31, Russia
| | - Jean Baptiste Gaultier
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier universitaire de St Etienne, saint Etienne cedex 2, 42055, France
| | - Le Mouel Edwige
- Département de médecine interne, CHU de Rennes, Rennes, France
| | - Ygal Benhamou
- Service de médecine interne, Université Rouen, CHU de Rouen, Rouen, France
| | | | - Patrick Jego
- Département de médecine interne, CHU de Rennes, Rennes, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, INSERM U1149, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, INSERM U1149, France
| | | | - Hassold Nolan
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay
| | | | - Virginie Dufrost
- University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, F-54000, France
| | - Thomas Sene
- Service de médecine interne, Rothschild, Paris, France
| | - Julie Seguier
- Département de médecine interne, CHU de La Timone, Marseille, France
| | - Francois Maurier
- Service de Médecine Interne et Immunologie Clinique Groupe Hospitalier UNEOS Metz-Vantoux, France
| | - Sabine Berthier
- Service de médecine interne et immunologie clinique, Université Dijon, Hôpital Dijon, Dijon, France
| | - Alexandre Belot
- Service de pédiatrie et immunologie clinique, Université Lyon, Hôpital Lyon, Lyon, France
| | - Faten Frikha
- Service de Médecine interne CHU Hédi Chaker, Route El Ain, Sfax -Faculté de Médecine de Sfax, 3029, Tunisie
| | - Guillaume Denis
- Service de médecine et d'hématologie, Hopital Rochefort, Rochefort, France
| | | | - Isabelle Kone Pault
- Service de Rhumatologie pédiatrique et centre de référence des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, hôpital de Bicêtre, APHP, France, université de Paris Sud-Saclay
| | - Sebastien Humbert
- Service de médecine interne et immunologie clinique, Hôpital Besancon, Besancon, France
| | | | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Alberto Logullo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Ospedale Piemonte, Messina, Italy
| | - Francis Gaches
- Médecine Interne, Hôpital Joseph Ducuing, Toulouse, 31076
| | - Pierre Zeminsky
- University of Lorraine, Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, F-54000, France
| | - Elena Galli
- Unit of Rheumatology, Università di Modena e Reggio Emilia, Italy
| | - Moya Alvarado
- Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | | | | | - Mathieu Vautier
- Université de Paris, AP-HP, Hôpital Saint Louis, Service de Biostatistique et Information Médicale (DMU PRISME), INSERM U1153 Team ECSTRRA, Paris, France
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Patrice Cacoub
- Sorbonne Université, AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75013, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75012, France
| | - David Saadoun
- Sorbonne Université, AP-HP, Hôpital Pitié Salpetrière, Department of Internal Medicine and Clinical Immunology France, Centre national de référence maladies Autoimmunes Systémiques rares, Centre national de référence maladies Autoinflammatoires et Amylose, and Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, F-75013, France
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Daumas A, Magalon J, Jouve E, Casanova D, Philandrianos C, Abellan Lopez M, Mallet S, Veran J, Auquit-Auckbur I, Farge D, Levesque H, Benhamou Y, Arnaud L, Giraudo L, Dumoulin C, Giverne C, Boyer O, Giuliani A, Bourgarel V, Harlé JR, Schleinitz N, Brunet J, Pers YM, Ferreira R, Cras A, Bocara D, Larghero J, Château J, Hot A, Dignat-George F, Magalon G, Sabatier F, Granel B. Adipose tissue-derived stromal vascular fraction for treating hands of patients with systemic sclerosis: a multicentre randomized trial. Rheumatology (Oxford) 2021; 61:1936-1947. [PMID: 34297066 DOI: 10.1093/rheumatology/keab584] [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: 05/17/2021] [Revised: 06/25/2021] [Accepted: 07/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the superiority of adipose tissue-derived stromal vascular fraction (AD-SVF) injection into the fingers vs placebo in reducing hand disability in systemic sclerosis (SSc) patients. METHODS We performed a double-blind, multicentre, phase II trial from October 2015 to January 2018 in France. SSc patients with a Cochin Hand Function Scale (CHFS) ≥20/90 were randomized 1:1 to receive injection of AD-SVF or placebo. AD-SVF was obtained using the automated processing Celution®800/CRS system. The placebo was lactated Ringer's solution. The primary efficacy end point was the change of the CHFS score from baseline to 3 months. Secondary efficacy endpoints included the CHFS score at 6 months, hands function, vasculopathy, hands pain, skin fibrosis, sensitivity of the finger' pulps, Scleroderma Health Assessment Questionnaire, patients and physician satisfaction and the safety. RESULTS 40 patients were randomized. The AD-SVF and placebo groups were comparable for age, sex ratio, disease duration, skin fibrosis of the hands and main cause of hand disability. After 3 month-follow-up, hand function significantly improved in both groups with no between-group difference of CHFS (mean change of -9.2 ± 12.2 in the AD-SVF group vs -7.6 ± 13.2 in the placebo group). At 6 months, hand function improved in both groups. CONCLUSION This study showed an improvement of hand function in both groups other time, with no superiority of the AD-SVF. Considering the limits of this trial, studies on a larger population of patients with homogeneous phenotype and hand handicap, should be encouraged to accurately assess the benefit of AD-SVF therapy. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT02558543. Registered on September 24, 2015.
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Affiliation(s)
- Aurélie Daumas
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE.,Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE
| | - Jérémy Magalon
- Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE.,Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Elisabeth Jouve
- Pharmacometry CIC- CPCET, Clinical Pharmacology and Pharmacovigilance Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Dominique Casanova
- Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Cécile Philandrianos
- Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Maxime Abellan Lopez
- Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Stéphanie Mallet
- Department of Dermatology, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Julie Veran
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Isabelle Auquit-Auckbur
- Normandie Univ, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Plastic, reconstructive and hand surgery, ROUEN, FRANCE
| | - Dominique Farge
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R); Université de Paris, PARIS, EA, 3518, FRANCE.,Department of Medicine, McGill University, Montreal, QC, CANADA
| | - Hervé Levesque
- Department of Internal Medicine, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen University Hospital, ROUEN, FRANCE
| | - Ygal Benhamou
- Department of Internal Medicine, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen University Hospital, ROUEN, FRANCE
| | - Laurent Arnaud
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Laurent Giraudo
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Chloé Dumoulin
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Camille Giverne
- Normandie Univ, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Immunology and Biotherapy, ROUEN, FRANCE
| | - Olivier Boyer
- Normandie Univ, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Immunology and Biotherapy, ROUEN, FRANCE
| | - Alexandra Giuliani
- Health research department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Véronique Bourgarel
- Health research department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE.,Cancer Research Center of Marseille (CRCM), INSERM UMR1068, CNRS UMR7258, Aix-Marseille University, MARSEILLE, France
| | - Jean-Robert Harlé
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Nicolas Schleinitz
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Julie Brunet
- Health research department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Yves-Marie Pers
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, MONTPELLIER, France.,IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, MONTPELLIER, France
| | - Rosanna Ferreira
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, MONTPELLIER, France
| | - Audrey Cras
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, PARIS, France.,INSERM U976 et CIC de Biothérapies CBT501, Université de Paris, PARIS, France
| | - David Bocara
- Department of Plastic, Reconstructive, and Esthetic Surgery, Saint Louis Hospital, Paris; Paris Diderot University, Sorbonne, Paris, France
| | - Jérome Larghero
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, PARIS, France.,INSERM UMR1140 et CIC de Biothérapies CBT501, Université de Paris, PARIS, France
| | - Joseph Château
- Department of Hand Surgery ICMMS, Medipole Hospital Lyon Villeurbanne; Department of plastic, reconstructive and aesthetic surgery, Hospital Jean Mermoz Lyon; CRIOac Lyon, Regional Reference center for the management of complex bone and joint infection, Hospices Civils de Lyon, LYON, France
| | - Arnaud Hot
- Service de Médecine Interne, Hôpital Edouard Herriot, LYON, F-69003, France
| | - Françoise Dignat-George
- Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE.,Hematology and Vascular Biology Laboratory, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, FRANCE
| | - Guy Magalon
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE.,Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Florence Sabatier
- Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE.,Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Brigitte Granel
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE.,Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE
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47
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Grall M, Daviet F, Chiche NJ, Provot F, Presne C, Coindre JP, Pouteil-Noble C, Karras A, Guerrot D, François A, Benhamou Y, Veyradier A, Frémeaux-Bacchi V, Coppo P, Grangé S. Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre. BMC Nephrol 2021; 22:267. [PMID: 34284729 PMCID: PMC8293501 DOI: 10.1186/s12882-021-02470-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gemcitabine is a broadly prescribed chemotherapy, the use of which can be limited by renal adverse events, including thrombotic microangiopathy (TMA). METHODS This study evaluated the efficacy of eculizumab, a monoclonal antibody targeting the terminal complement pathway, in patients with gemcitabine-induced TMA (G-TMA). We conducted an observational, retrospective, multicenter study in 5 French centres, between 2011 and 2016. RESULTS Twelve patients with a G-TMA treated by eculizumab were included. The main characteristics were acute renal failure (100%), including stage 3 acute kidney injury (AKI, 58%) and renal replacement therapy (17%), hypertension (92%) and diffuse oedema (83%). Eculizumab was started after a median of 15 days (range 4-44) following TMA diagnosis. A median of 4 injections of eculizumab was performed (range 2-22). Complete hematological remission was achieved in 10 patients (83%) and blood transfusion significantly decreased after only one injection of eculizumab (median of 3 packed red blood cells (range 0-10) before treatment vs 0 (range 0-1) after one injection, P < 0.001). Two patients recovered completely renal function (17%), and 8 achieved a partial remission (67%). Compared to a control group of G-TMA without use of eculizumab, renal outcome was more favourable. At the end of the follow up, median eGFR was 45 vs 33 ml/min/1.73m2 respectively in the eculizumab group and in the control group. CONCLUSIONS These results suggest that eculizumab is efficient on haemolysis and reduces transfusion requirement in G-TMA. Moreover, eculizumab may improve renal function recovery.
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Affiliation(s)
- Maximilien Grall
- Medical Intensive Care Unit, Rouen University Hospital, 37 boulevard Gambetta, 76031, Rouen Cedex, France
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
| | - Florence Daviet
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Conception University Hospital, APHM, Marseille, France
| | - Noémie Jourde Chiche
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Conception University Hospital, APHM, Marseille, France
| | - François Provot
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Lille University Hospital, Lille, France
| | - Claire Presne
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Amiens University Hospital, Amiens, France
| | - Jean-Philippe Coindre
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Le Mans General Hospital, Le Mans, France
| | - Claire Pouteil-Noble
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, E. Herriot Hospital, Lyon I university, Lyon, France
| | - Alexandre Karras
- Department of Nephrology, Georges Pompidou Hospital, APHP, Paris, France
| | | | - Arnaud François
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Ygal Benhamou
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Agnès Veyradier
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Biological Hematology, Lariboisière University Hospital, APHP, Paris, France
| | - Véronique Frémeaux-Bacchi
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of immunology, Georges Pompidou Hospital, APHP, Paris, France
| | - Paul Coppo
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Hematology, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 boulevard Gambetta, 76031, Rouen Cedex, France.
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France.
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48
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Travert B, Dossier A, Jamme M, Cointe A, Delmas Y, Malot S, Wynckel A, Seguin A, Presne C, Hie M, Benhamou Y, Ribes D, Choukroun G, Grangé S, Hertig A, Le Gall EC, Galicier L, Daugas E, Bouadma L, Weill FX, Azoulay E, Fakhouri F, Veyradier A, Bonacorsi S, Hogan J, Frémeaux-Bacchi V, Rondeau E, Mariani-Kurkdjian P, Coppo P. Shiga Toxin-Associated Hemolytic Uremic Syndrome in Adults, France, 2009-2017. Emerg Infect Dis 2021; 27:1876-1885. [PMID: 34152955 PMCID: PMC8237898 DOI: 10.3201/eid2707.204638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We conducted a retrospective study on hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli (STEC) in 96 adults enrolled in the cohort of the National Reference Center for Thrombotic Microangiopathies network in France during 2009–2017. Most infections were caused by STEC strains not belonging to the O157 or O104 serogroups. Thirty (31.3%) patients had multiple risk factors for thrombotic microangiopathy. In total, 61 (63.5%) patients required dialysis, 50 (52.1%) had a serious neurologic complication, 34 (35.4%) required mechanical ventilation, and 19 (19.8%) died during hospitalization. We used multivariate analysis to determine that the greatest risk factors for death were underlying immunodeficiency (hazard ratio 3.54) and severe neurologic events (hazard ratio 3.40). According to multivariate analysis and propensity score-matching, eculizumab treatment was not associated with survival. We found that underlying conditions, especially immunodeficiency, are strongly associated with decreased survival in adults who have hemolytic uremic syndrome caused by STEC.
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49
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Fares Y, Sinzogan-Eyoum YC, Billoir P, Bogaert A, Armengol G, Alexandre K, Lammens J, Grall M, Levesque H, Benhamou Y, Miranda S. Systematic screening for a proximal DVT in COVID-19 hospitalized patients: Results of a comparative study. J Med Vasc 2021; 46:163-170. [PMID: 34238510 PMCID: PMC8118667 DOI: 10.1016/j.jdmv.2021.05.003] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The COVID-19 pandemic is associated with a high incidence of venous thromboembolism questioning the utility of a systematic screening for deep venous thrombosis (DVT) in hospitalised patients. METHODS In this prospective bicentric controlled study, 4-point ultrasound using a pocket device was used to screen for DVT, in patients with SARS-CoV-2 infection and controls admitted for acute medical illness not related to COVID-19 hospitalised in general ward, in order to assess the utility of a routine screening and to estimate the prevalence of VTE among those patients. RESULTS Between April and May 2020, 135 patients were screened, 69 in the COVID+ group and 66 in the control one. There was no significant difference in the rate of proximal DVT between the two groups (2.2% vs. 1.5%; P=0.52), despite the high rate of PE diagnosed among COVID-19 infected patients (10.1% vs. 1.5%, P=0.063). No isolated DVT was detected, 37.5% of PE was associated with DVT. Mortality (7.2% vs. 1.5%) was not different (P=0.21) between COVID-19 patients and controls. CONCLUSION The systematic screening for proximal DVT was not found to be relevant among COVID-19 patients hospitalized in general ward despite the increase of VTE among this population. Further studies are needed to confirm the hypothesis of a local pulmonary thrombosis which may lead to new therapeutic targets.
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Affiliation(s)
- Y Fares
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - Y C Sinzogan-Eyoum
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - P Billoir
- Department of vascular haemostasis, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - A Bogaert
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - G Armengol
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - K Alexandre
- Department of infectious diseases, Rouen university hospital, 76000 Rouen, France
| | - J Lammens
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - M Grall
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France; Department of medical intensive care unit, Rouen university hospital, 76000 Rouen, France
| | - H Levesque
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - Y Benhamou
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - S Miranda
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France.
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50
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Costentin G, Ozkul-Wermester O, Triquenot A, Cam-Duchez VL, Massy N, Benhamou Y, Massardier E. Acute Ischemic Stroke Revealing ChAdOx1 nCov-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia: Impact on Recanalization Strategy. J Stroke Cerebrovasc Dis 2021; 30:105942. [PMID: 34175640 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105942] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Vaccine-induced immune thrombotic thrombocytopenia is a rare syndrome following the ChAdOx1 nCov-19 or Ad26.COV2.S vaccine. Reported patients developed mainly venous thrombosis. We describe a case of a young healthy women suffering from acute ischemic stroke due to large vessel occlusion without cerebral venous thrombosis 8 days after vaccination and its consequences on recanalization strategy. Considering the thrombocytopenia, intravenous thrombolysis was contraindicated. She underwent mechanical thrombectomy with complete recanalization and dramatically improved clinically. Positive detection of anti-PF4-heparin-antibodies confirmed vaccine-induced immune thrombotic thrombocytopenia diagnosis. In case of acute ischemic stroke after recent ChAdOx1 nCov-19 or Ad26.COV2.S vaccine, platelet count should be systematically checked before giving thrombolysis, and direct mechanical thrombectomy should be proposed in patients with large vessel occlusion.
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Affiliation(s)
| | | | - Aude Triquenot
- Department of Neurology, Rouen University Hospital, Rouen F-76000, France
| | - Véronique Le Cam-Duchez
- Rouen University Hospital, Vascular Hemostasis Unit, Normandie University, UNIROUEN, INSERM U1096, Rouen F76031, France
| | - Nathalie Massy
- Department of Pharmacovigilance, Rouen University Hospital, Rouen F-76000, France
| | - Ygal Benhamou
- Department of Internal Medicine, Rouen University Hospital, Rouen F-76000, France
| | - Evelyne Massardier
- Department of Neurology, Rouen University Hospital, Rouen F-76000, France
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