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Charles P, Perrodeau É, Samson M, Bonnotte B, Néel A, Agard C, Huart A, Karras A, Lifermann F, Godmer P, Cohen P, Hanrotel-Saliou C, Martin-Silva N, Pugnet G, Maurier F, Sibilia J, Carron PL, Gobert P, Meaux-Ruault N, Le Gallou T, Vinzio S, Viallard JF, Hachulla E, Vinter C, Puéchal X, Terrier B, Ravaud P, Mouthon L, Guillevin L. Long-Term Rituximab Use to Maintain Remission of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Randomized Trial. Ann Intern Med 2020; 173:179-187. [PMID: 32479166 DOI: 10.7326/m19-3827] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Biannual rituximab infusions over 18 months effectively maintain remission after a "standard" remission induction regimen for patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). OBJECTIVE To evaluate the efficacy of prolonged rituximab therapy in preventing AAV relapses in patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) who have achieved complete remission after completing an 18-month maintenance regimen. DESIGN Randomized controlled trial. (ClinicalTrials.gov: NCT02433522). SETTING 39 clinical centers in France. PATIENTS 68 patients with GPA and 29 with MPA who achieved complete remission after the first phase of maintenance therapy. INTERVENTION Rituximab or placebo infusion every 6 months for 18 months (4 infusions). MEASUREMENTS The primary end point was relapse-free survival at month 28. Relapse was defined as new or reappearing symptoms or worsening disease, with a Birmingham Vasculitis Activity Score greater than 0. RESULTS From March 2015 to April 2016, 97 patients (mean age, 63.9 years; 35% women) were randomly assigned, 50 to the rituximab and 47 to the placebo group. Relapse-free survival estimates at month 28 were 96% (95% CI, 91% to 100%) and 74% (CI, 63% to 88%) in the rituximab and placebo groups, respectively, an absolute difference of 22% (CI, 9% to 36%) with a hazard ratio of 7.5 (CI, 1.67 to 33.7) (P = 0.008). Major relapse-free survival estimates at month 28 were 100% (CI, 93% to 100%) versus 87% (CI, 78% to 97%) (P = 0.009), respectively. At least 1 serious adverse event developed in 12 patients (24%) in the rituximab group (with 9 infectious serious adverse events occurring among 6 patients [12%]) versus 14 patients (30%) in the placebo group (with 6 infectious serious adverse events developing among 4 patients [9%]). No deaths occurred in either group. LIMITATION Potential selection bias based on previous rituximab response and tolerance. CONCLUSION Extended therapy with biannual rituximab infusions over 18 months was associated with a lower incidence of AAV relapse compared with standard maintenance therapy. PRIMARY FUNDING SOURCE French Ministry of Health and Hoffmann-La Roche.
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Affiliation(s)
- Pierre Charles
- Cochin Hospital, Paris Descartes University, and Institut Mutualiste Montsouris, Paris, France (P.C.)
| | - Élodie Perrodeau
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Université Paris Descartes, Sorbonne Paris Cité INSERM Unité 1153, Paris, France (É.P., P.R.)
| | - Maxime Samson
- Centre Hospitalier Universitaire de Dijon, INSERM, UMR 1098, University of Bourgogne Franche-Comté, FHU INCREASE, Dijon, France (M.S., B.B.)
| | - Bernard Bonnotte
- Centre Hospitalier Universitaire de Dijon, INSERM, UMR 1098, University of Bourgogne Franche-Comté, FHU INCREASE, Dijon, France (M.S., B.B.)
| | - Antoine Néel
- CRTI UMR 1064, INSERM, Université de Nantes, and Centre Hospitalier Universitaire Nantes, Nantes, France (A.N.)
| | - Christian Agard
- Centre Hospitalier Universitaire Nantes, Nantes, France (C.A.)
| | - Antoine Huart
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France (A.H., G.P.)
| | - Alexandre Karras
- Hôpital Européen Georges-Pompidou, Université Paris Descartes, Paris, France (A.K.)
| | | | - Pascal Godmer
- Centre Hospitalier Bretagne Atlantique de Vannes, Vannes, France (P.G.)
| | - Pascal Cohen
- Cochin Hospital, Paris Descartes University, Paris, France (P.C., C.V., X.P., B.T., L.M., L.G.)
| | | | | | - Grégory Pugnet
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France (A.H., G.P.)
| | | | - Jean Sibilia
- Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France (J.S.)
| | | | | | | | - Thomas Le Gallou
- Centre Hospitalier Universitaire de Rennes, Rennes, France (T.L.)
| | - Stéphane Vinzio
- Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France (S.V.)
| | | | - Eric Hachulla
- Centre Hospitalier Universitaire de Lille, Lille, France (E.H.)
| | - Christine Vinter
- Cochin Hospital, Paris Descartes University, Paris, France (P.C., C.V., X.P., B.T., L.M., L.G.)
| | - Xavier Puéchal
- Cochin Hospital, Paris Descartes University, Paris, France (P.C., C.V., X.P., B.T., L.M., L.G.)
| | - Benjamin Terrier
- Cochin Hospital, Paris Descartes University, Paris, France (P.C., C.V., X.P., B.T., L.M., L.G.)
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Université Paris Descartes, Sorbonne Paris Cité INSERM Unité 1153, Paris, France (É.P., P.R.)
| | - Luc Mouthon
- Cochin Hospital, Paris Descartes University, Paris, France (P.C., C.V., X.P., B.T., L.M., L.G.)
| | - Loïc Guillevin
- Cochin Hospital, Paris Descartes University, Paris, France (P.C., C.V., X.P., B.T., L.M., L.G.)
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Tan BK, Crabol Y, Tasse J, Laurent F, Nekkab N, Vinter C, Puéchal X, Guillevin L. No evident association of nasal carriage of Staphylococcus aureus or its small-colony variants with cotrimoxazole use or ANCA-associated vasculitis relapses. Rheumatology (Oxford) 2020; 59:77-83. [PMID: 31834404 DOI: 10.1093/rheumatology/kez236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To identify the role of Staphylococcus aureus (SA) or its intracellular small-colony variant phenotype (SCV) with co-trimoxazole (CTX) or ANCA-associated vasculitis (AAV) activity. METHODS All consecutive AAV patients with granulomatosis with polyangiitis (GPA), eosinophilic GPA or microscopic polyangiitis, followed at the French National Vasculitis Referral Center (09/2012-05/2013), and hospitalized non-AAV controls, exclusively for SA/SCV carriage comparisons, were enrolled. All had bilateral anterior nasal swab cultures. Nasal SA or SCV carriage was determined and associations with relapse(s), BVAS, ANCA-positivity, anti-staphylococcal and immunosuppressant use, were analysed ⩾4 years post-inclusion. RESULTS Nasal SA carriage rates did not differ among AAVs (P = 0.53): GPA (24/80; 30%), EGPA (7/28; 25%) and microscopic polyangiitis (3/11; 27.3%); and the rate was less frequent in controls than in GPA patients not taking CTX (P = 0.04). AAV patients taking CTX prophylaxis had less nasal SA carriage (8.7% vs 36.2%; P = 0.02). Nasal SA carriage or CTX use did not modify relapse rates, BVAS or ANCA-positivity at inclusion or during follow-up. Nasal SCV carriage, found in 15/207 (7.2%) patients, was similar for GPA (10/24; 41.7%), microscopic polyangiitis (2/7; 28.6%) and eosinophilic GPA (2/3; 66.7%), but higher (P = 0.02) than controls (1/14; 7.1%). SCV carriage by AAV groups did not modify relapse rates or ANCA positivity at inclusion or during follow-up; a trend towards higher BVAS was observed only for anti-PR3 ANCA patients. CONCLUSION Nasal SA or SCV carriage was comparable among AAVs but more frequent than in controls. Nasal SA or SCV carriage and CTX use did not modify AAV relapse rates.
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Affiliation(s)
- Boun Kim Tan
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris-Descartes, Paris Cedex 14, France
| | - Yoann Crabol
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris-Descartes, Paris Cedex 14, France
| | - Jason Tasse
- Department of Microbiology, French National Reference Centre for Staphylococci, Hospices Civils de Lyon, International Center of Infectiology Research, Lyon, France
| | - Frédéric Laurent
- Department of Microbiology, French National Reference Centre for Staphylococci, Hospices Civils de Lyon, International Center of Infectiology Research, Lyon, France
| | - Narimane Nekkab
- Conservatoire National des Arts et Métiers, MESuRS Laboratory, Paris, France
| | - Christine Vinter
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris-Descartes, Paris Cedex 14, France
| | - Xavier Puéchal
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris-Descartes, Paris Cedex 14, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris-Descartes, Paris Cedex 14, France
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Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, Sorensen JA, Mogensen O, Lamont RF, Bille C. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg 2016; 103:477-86. [PMID: 26994715 PMCID: PMC5069647 DOI: 10.1002/bjs.10084] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [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: 07/14/2015] [Revised: 08/16/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
Abstract
Background Postoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions. Methods This was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions. Results Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence. Conclusion Compared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet. Good for closed wounds too Video Abstract
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Affiliation(s)
- N Hyldig
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Plastic Surgery, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - H Birke-Sorensen
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - M Kruse
- Centre for Health Economics Research (COHERE), University of Southern Denmark, Odense, Denmark
| | - C Vinter
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - J S Joergensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - J A Sorensen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Plastic Surgery, Odense, Denmark
| | - O Mogensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - R F Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark.,Division of Surgery, University College London, Northwick Park Institute of Medical Research Campus, London, UK
| | - C Bille
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Plastic Surgery, Odense, Denmark
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Assala M, Groh M, Blanche P, Vinter C, Cohen P, Le Guern V, Puéchal X, Mouthon L, Le Jeunne C, Launay O, Kernéis S. Pneumococcal and influenza vaccination rates in patients treated with corticosteroids and/or immunosuppressive therapies for systemic autoimmune diseases: A cross-sectional study. Joint Bone Spine 2016; 84:365-366. [PMID: 27344076 DOI: 10.1016/j.jbspin.2016.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/20/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Manal Assala
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Paris Descartes University, Paris, France
| | - Philippe Blanche
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Christine Vinter
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Pascal Cohen
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Véronique Le Guern
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Paris Descartes University, Paris, France
| | - Claire Le Jeunne
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases (Vasculitis, Scleroderma), Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Paris Descartes University, Paris, France
| | - Odile Launay
- Paris Descartes University, Paris, France; Department of Infectious Diseases, CIC Cochin Pasteur, Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Inserm CIC 1417, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Solen Kernéis
- Paris Descartes University, Paris, France; Department of Infectious Diseases, CIC Cochin Pasteur, Cochin hospital, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Inserm CIC 1417, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
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Beaulieu JP, Cassan A, Kubas D, Albrow M, Bennett D, Brillant S, Caldwell JA, Calitz H, Cook K, Coutures C, Dominik M, Dominis D, Donatowicz J, Fouqué P, Greenhill J, Hill K, Hoffman M, Horne K, Jørgensen UG, Kane S, Martin R, Mientjes P, Menzies JM, Pollard K, Sahu K, Vinter C, Wambsganss J, Williams A. PLANET III: searching for Earth-mass planets via microlensing from Dome C? ACTA ACUST UNITED AC 2006. [DOI: 10.1051/eas:2005047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Beaulieu JP, Bennett DP, Fouqué P, Williams A, Dominik M, Jørgensen UG, Kubas D, Cassan A, Coutures C, Greenhill J, Hill K, Menzies J, Sackett PD, Albrow M, Brillant S, Caldwell JAR, Calitz JJ, Cook KH, Corrales E, Desort M, Dieters S, Dominis D, Donatowicz J, Hoffman M, Kane S, Marquette JB, Martin R, Meintjes P, Pollard K, Sahu K, Vinter C, Wambsganss J, Woller K, Horne K, Steele I, Bramich DM, Burgdorf M, Snodgrass C, Bode M, Udalski A, Szymański MK, Kubiak M, Wieckowski T, Pietrzyński G, Soszyński I, Szewczyk O, Wyrzykowski L, Paczyński B, Abe F, Bond IA, Britton TR, Gilmore AC, Hearnshaw JB, Itow Y, Kamiya K, Kilmartin PM, Korpela AV, Masuda K, Matsubara Y, Motomura M, Muraki Y, Nakamura S, Okada C, Ohnishi K, Rattenbury NJ, Sako T, Sato S, Sasaki M, Sekiguchi T, Sullivan DJ, Tristram PJ, Yock PCM, Yoshioka T. Discovery of a cool planet of 5.5 Earth masses through gravitational microlensing. Nature 2006; 439:437-40. [PMID: 16437108 DOI: 10.1038/nature04441] [Citation(s) in RCA: 466] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 11/14/2005] [Indexed: 11/08/2022]
Abstract
In the favoured core-accretion model of formation of planetary systems, solid planetesimals accumulate to build up planetary cores, which then accrete nebular gas if they are sufficiently massive. Around M-dwarf stars (the most common stars in our Galaxy), this model favours the formation of Earth-mass (M(o)) to Neptune-mass planets with orbital radii of 1 to 10 astronomical units (au), which is consistent with the small number of gas giant planets known to orbit M-dwarf host stars. More than 170 extrasolar planets have been discovered with a wide range of masses and orbital periods, but planets of Neptune's mass or less have not hitherto been detected at separations of more than 0.15 au from normal stars. Here we report the discovery of a 5.5(+5.5)(-2.7) M(o) planetary companion at a separation of 2.6+1.5-0.6 au from a 0.22+0.21-0.11 M(o) M-dwarf star, where M(o) refers to a solar mass. (We propose to name it OGLE-2005-BLG-390Lb, indicating a planetary mass companion to the lens star of the microlensing event.) The mass is lower than that of GJ876d (ref. 5), although the error bars overlap. Our detection suggests that such cool, sub-Neptune-mass planets may be more common than gas giant planets, as predicted by the core accretion theory.
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Affiliation(s)
- J-P Beaulieu
- PLANET/RoboNet Collaboration, CNRS, Université Pierre et Marie Curie UMR7095, 98bis Boulevard Arago, 75014 Paris, France.
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