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Greffe S, Guerrisi C, Souty C, Vilcu AM, Hayem G, Costantino F, Padovano I, Bourgault I, Trad S, Ponsoye M, Vilaine E, Debin M, Turbelin C, Blanchon T, Hanslik T. Influenza-like illness in individuals treated with immunosuppressants, biologics, and/or systemic corticosteroids for autoimmune or chronic inflammatory disease: A crowdsourced cohort study, France, 2017-2018. Influenza Other Respir Viruses 2023; 17:e13148. [PMID: 37380174 DOI: 10.1111/irv.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Influenza-like illness (ILI) incidence estimates in individuals treated with immunosuppressants and/or biologics and/or corticosteroid for an autoimmune or chronic inflammatory disease are scarce. We compared the ILI incidence among immunocompromised population and the general population. METHOD We conducted a prospective cohort study during the 2017-2018 seasonal influenza epidemic, on the GrippeNet.fr electronic platform, which allows the collection of epidemiological crowdsourced data on ILI, directly from the French general population. The immunocompromised population were adults treated with systemic corticosteroids, immunosuppressants, and/or biologics for an autoimmune or chronic inflammatory disease, recruited directly on GrippeNet.fr and also among patients of the departments of a single university hospital that were asked to incorporate GrippeNet.fr. The general population consisted of adults reporting none of the above treatments or diseases participating in GrippeNet.fr. The incidence of ILI was estimated on a weekly basis and compared between the immunocompromised population and the general population, during the seasonal influenza epidemic. RESULTS Among the 318 immunocompromised patients assessed for eligibility, 177 were included. During the 2017-2018 seasonal influenza epidemic period, immunocompromised population had 1.59 (95% CI: 1.13-2.20) higher odds to experience an ILI episode, compared to the general population (N = 5358). An influenza vaccination was reported by 58% of the immunocompromised population, compared to 41% of the general population (p < 0.001). CONCLUSION During a seasonal influenza epidemic period, the incidence of influenza-like illness was higher in patients treated with immunosuppressants, biologics, and/or corticosteroids for an autoimmune or chronic inflammatory disease, compared to the general population.
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Affiliation(s)
- Ségolène Greffe
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Caroline Guerrisi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Gilles Hayem
- Department of Rheumatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- Department of Rheumatology, Saint-Joseph Hospital, Paris, France
| | - Félicie Costantino
- Department of Rheumatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Montigny-Le-Bretonneux, France
| | - Ilaria Padovano
- Department of Rheumatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Isabelle Bourgault
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
- Department of Dermatology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Salim Trad
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Eve Vilaine
- Department of Nephrology, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - Marion Debin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Clément Turbelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Thomas Hanslik
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
- "Simone Veil - Santé" Medical School, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Montigny-le-Bretonneux, France
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Legendre P, Couture P, Ponsoye M, Marroun I, Ackermann F, Comarmond C. [Weakness and weight loss in a 62 year-old patient]. Rev Med Interne 2022; 43:444-447. [PMID: 35606201 DOI: 10.1016/j.revmed.2022.04.024] [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: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Affiliation(s)
- P Legendre
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - P Couture
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - M Ponsoye
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - I Marroun
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Ackermann
- Service de médecine interne, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - C Comarmond
- Service de médecine interne, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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Ponsoye M, Espinasse F, Coutte L, Lepeule R, Gnamien S, Hanslik T. [The use of venous catheter : Which ones to choose, how to prevent their complications?]. Rev Med Interne 2020; 42:411-420. [PMID: 33234320 DOI: 10.1016/j.revmed.2020.10.385] [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: 07/25/2019] [Revised: 09/08/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022]
Abstract
Intravenous catheters are multiple and essential for daily practice. They are also responsible for high morbidity and mortality. Simple or echo-guided peripheral venous catheters, midlines, PICCline, tunneled or non-tunneled central venous catheters, and implantable venous access device are currently at our disposal. Thus, catheter selection, duration and indications for use, and prevention and treatment of complications vary according to the situation. The objective of this update is to provide the clinician with an overview of knowledge and rules of good practice on the use of catheters.
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Affiliation(s)
- M Ponsoye
- Hôpital Foch, 40 rue Worth, 92150 Suresnes, France.
| | - F Espinasse
- AP-HP, hôpital Ambroise Paré, Equipe Opérationnelle Hygiène, 92100 Boulogne-Billancourt, France
| | - L Coutte
- AP-HP, hôpital Ambroise Paré, service de médecine interne, 92100 Boulogne-Billancourt, France
| | - R Lepeule
- Unité transversale de traitement des infections, département de virologie, bactériologie-hygiène, parasitologie-mycologie, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - S Gnamien
- AP-HP, hôpital Ambroise Paré, unité des dispositifs médicaux stériles, Pharmacie, 92100 Boulogne-Billancourt, France
| | - T Hanslik
- AP-HP, hôpital Ambroise Paré, service de médecine interne, 92100 Boulogne-Billancourt, France; Université Versailles Saint Quentin en Yvelines, UFR des sciences de la santé Simone Veil, 78000 Versailles, France
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Roumier M, Paule R, Vallée A, Rohmer J, Ballester M, Brun AL, Cerf C, Chabi ML, Chinet T, Colombier MA, Farfour E, Fourn E, Géri G, Khau D, Marroun I, Ponsoye M, Roux A, Salvator H, Schoindre Y, Si Larbi AG, Tchérakian C, Vasse M, Verrat A, Zuber B, Couderc LJ, Kahn JE, Groh M, Ackermann F. Tocilizumab for Severe Worsening COVID-19 Pneumonia: a Propensity Score Analysis. J Clin Immunol 2020; 41:303-314. [PMID: 33188624 PMCID: PMC7666405 DOI: 10.1007/s10875-020-00911-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 07/15/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Background High levels of serum interleukin-6 (IL-6) correlate with disease severity in COVID-19. We hypothesized that tocilizumab (a recombinant humanized anti-IL-6 receptor) could improve outcomes in selected patients with severe worsening COVID-19 pneumonia and high inflammatory parameters. Methods The TOCICOVID study included a prospective cohort of patients aged 16–80 years with severe (requiring > 6 L/min of oxygen therapy to obtain Sp02 > 94%) rapidly deteriorating (increase by ≥ 3 L/min of oxygen flow within the previous 12 h) COVID-19 pneumonia with ≥ 5 days of symptoms and C-reactive protein levels > 40 mg/L. They entered a compassionate use program of treatment with intravenous tocilizumab (8 mg/kg with a maximum of 800 mg per infusion; and if needed a second infusion 24 to 72 h later). A control group was retrospectively selected with the same inclusion criteria. Outcomes were assessed at D28 using inverse probability of treatment weighted (IPTW) methodology. Results Among the 96 patients included (81% male, mean (SD) age: 60 (12.5) years), underlying conditions, baseline disease severity, and concomitant medications were broadly similar between the tocilizumab (n = 49) and the control (n = 47) groups. In the IPTW analysis, treatment with tocilizumab was associated with a reduced need for overall ventilatory support (49 vs. 89%, wHR: 0.39 [0.25–0.56]; p < 0.001). Albeit lacking statistical significance, there was a substantial trend towards a reduction of mechanical ventilation (31% vs. 45%; wHR: 0.58 [0.36–0.94]; p = 0.026). However, tocilizumab did not improve overall survival (wHR = 0.68 [0.31–1.748], p = 0.338). Among the 85 (89%) patients still alive at D28, patients treated with tocilizumab had a higher rate of oxygen withdrawal (82% vs. 73.5%, wHR = 1.66 [1.17–2.37], p = 0.005), with a shorter delay before being weaned of oxygen therapy (mean 11 vs. 16 days; p < 0.001). At D28, the rate of patients discharged from hospital was higher in the tocilizumab group (70% vs. 40%, wHR = 1.82 [1.22–2.75]; p = 0.003). The levels of CRP and fibrinogen post therapy (p < 0.001 for both variables) were significantly lower in the tocilizumab group (interaction test, mixed model). Rates of neutropenia (35% vs. 0%; p < 0.001) were higher in the tocilizumab group, yet rates of infections (22% vs. 38%, p = 0.089) including ventilator-acquired pneumonia (8% vs. 26%, p = 0.022) were higher in the control group. Conclusion These data could be helpful for the design of future trials aiming to counter COVID-19-induced inflammation, especially before patients require admission to the intensive care unit. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-020-00911-6.
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Affiliation(s)
- Mathilde Roumier
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Romain Paule
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, AP-HP, Hôtel-Dieu Hospital, Paris-Descartes University, Paris, France
| | - Julien Rohmer
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Marie Ballester
- Emergency Department, Foch Hospital, F-92151, Suresnes, France
| | - Anne-Laure Brun
- Department of Radiology, Foch Hospital, F-92151, Suresnes, France
| | - Charles Cerf
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | | | - Thierry Chinet
- Department of Respiratory Medicine, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France.,Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | | | - Eric Farfour
- Department of Clinical Biology & INSERM UMRS-1176, Foch Hospital, F-92151, Suresnes, France
| | - Erwan Fourn
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Guillaume Géri
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France.,INSERM UMR 1018, Villejuif, France
| | - David Khau
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Ibrahim Marroun
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Antoine Roux
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Hélène Salvator
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Yoland Schoindre
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Anne-Gaëlle Si Larbi
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | - Colas Tchérakian
- Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Marc Vasse
- Department of Clinical Biology & INSERM UMRS-1176, Foch Hospital, F-92151, Suresnes, France
| | - Anne Verrat
- Emergency Department, Foch Hospital, F-92151, Suresnes, France
| | - Benjamin Zuber
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | - Louis-Jean Couderc
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Jean-Emmanuel Kahn
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Internal Medicine, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France.
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5
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Roupie AL, Guedon A, Terrier B, Lahuna C, Jachiet V, Regent A, de Boysson H, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Ledoult E, Clech LL, D'Aveni M, Rossignol J, Galland J, Willems L, Chiche NJ, Peterlin P, Roux-Sauvat M, Parcelier A, Wemeau M, Lambert M, Belizna C, Puechal X, Swiader L, Cohen-Valensi R, Noc V, Dao E, Thepot S, de Frémont GM, Tanguy-Schmidt A, Koka AM, Bussone G, Philipponnet C, Konate A, Cavaille G, Guilpain P, Allain JS, Broner J, Solary E, Ruivard M, de Renzis B, Corm S, Baati N, Schleinitz N, Ponsoye M, Stamatoullas-Bastard A, Ades L, Dellal A, Tchirkov A, Aouba A, Fenaux P, Fain O, Mekinian A. Vasculitis associated with myelodysplastic syndrome and chronic myelomonocytic leukemia: French multicenter case-control study. Semin Arthritis Rheum 2020; 50:879-884. [PMID: 32896704 DOI: 10.1016/j.semarthrit.2020.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/14/2020] [Revised: 06/13/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Our objective was to evaluate characteristics, treatment and outcome of vasculitis associated with myelodysplastic syndrome (MDS) and chronic myelomonicytic leukemia (CMML) PATIENTS AND METHODS: Retrospective descriptive analysis of MDS/CMML-related vasculitis and comparison with MDS/CMML patients without dysimmune features. RESULTS Seventy patients with vasculitis and MDS/CMML were included, with median age of 71.5 [21-90] years and male/female ratio of 2.3. Vasculitis was diagnosed prior to MDS/CMML in 31 patients (44%), and after in 20 patients. In comparison with MDS/CMML without autoimmune/inflammatory features, vasculitis with MDS/MPN showed no difference in MDS/CMML subtypes distribution nor International Prognostic Scoring System and CMML-specific prognostic (IPSS/CPSS) scores. Vasculitis subtypes included Giant cell arteritis in 24 patients (34%), Behçet's-like syndrome in 11 patients (20%) and polyarteritis nodosa in 6 patients (9%). Glucocorticoids (GCs) were used as first-line therapy for MDS/CMML vasculitis in 64/70 patients (91%) and 41 (59%) received combined immunosuppressive therapies during the follow-up. After a median follow-up of 33.2 months [1-162], 31 patients (44%) achieved sustained remission. At least one relapse occurred in 43 patients (61%). Relapse rates were higher in patients treated with conventional Disease Modifying Anti-Rheumatic Drug (DMARDs) (odds ratio 4.86 [95% CI 1.38 - 17.10]), but did not differ for biologics (odds ratio 0.59 [95% CI 0.11-3.20]) and azacytidine (odds ratio 1.44 [95% CI 0.21-9.76]) than under glucocorticoids. Overall survival in MDS/CMML vasculitis was not significantly different from MDS/CMML patients without autoimmune/inflammatory features (p = 0.5), but acute leukemia progression rates were decreased (log rank <0.05). CONCLUSION This study shows no correlation of vasculitis diagnoses with subtypes and severity of MDS/CMML, and no significant impact of vasculitis on overall survival. Whereas conventional DMARDs seem to be less effective, biologics or azacytidine therapy could be considered for even low-risk MDS/CMML vasculitis.
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Affiliation(s)
- Anne Laure Roupie
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Guedon
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Constance Lahuna
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Vincent Jachiet
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Regent
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP Sorbonne Université, Hôpital Saint Antoine, 75012 Paris, France
| | - Julie Seguier
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, CHU Lille, Lille, France
| | | | | | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndromes (CEREO), Foch Hospital, Suresnes, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Rouen, France
| | - Francois Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Emmanuel Ledoult
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France
| | | | - Maud D'Aveni
- Department of Hematology, CHU Nancy, Nancy, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Joris Galland
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Lise Willems
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Noemie Jourde Chiche
- Department of Nephrology, Centre de Néphrologie et de Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital La Conception, Marseille, France
| | | | | | - Anne Parcelier
- Department of Hematology, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | | | - Marc Lambert
- Department of Internal Medicine, CHU Lille, Lille, France
| | - Cristina Belizna
- Department of Vascular Medicine, CHU d'Angers, UMR-CNRS 6015 INSERM 1083, Angers, France
| | - Xavier Puechal
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Laure Swiader
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Rolande Cohen-Valensi
- Department of Internal Medicine, CH de Martigues Hôpital des Rayettes, Martigues, France
| | - Valérie Noc
- Department of Nephrology, CH Hyères, Hyères, France
| | - Emmanuel Dao
- Department of Nephrology, CH Hyères, Hyères, France
| | | | | | | | | | - Guillaume Bussone
- Department of Internal Medicine, Hôpital Antoine Béclère, Clamart, France
| | | | - Amadou Konate
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Guilhem Cavaille
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Philippe Guilpain
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Jean-Sébastien Allain
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France; Pôle cardio vasculaire et métabolisme, CH Saint-Malo, Saint-Malo, France
| | - Jonathan Broner
- Department of Internal Medicine, CHU de Nîmes, Nîmes, France
| | - Eric Solary
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Marc Ruivard
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benoit de Renzis
- Department of Hematology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sélim Corm
- Department of Hematology, Médipôle de Savoie, Charles Les Eaux, France
| | - Nadia Baati
- Department of Hematology, CH Strasbourg, Strasbourg, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, CHU Ambroise Paré, Boulogne- Billancourt, France
| | | | - Lionel Ades
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Azeddine Dellal
- Department of Rheumatology, Montfermeil Hospital, 93370 Montfermeil, France
| | - Andrei Tchirkov
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Fenaux
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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Wesner N, Drevon L, Guedon A, Fraison JB, Trad S, Kahn JE, Aouba A, Gillard J, Ponsoye M, Hanslik T, Gourguechon C, Liozon E, Laribi K, Rossignol J, Hermine O, Adès L, Carrat F, Fenaux P, Mekinian A, Fain O. Inflammatory disorders associated with trisomy 8-myelodysplastic syndromes: French retrospective case-control study. Eur J Haematol 2018; 102:63-69. [PMID: 30218579 DOI: 10.1111/ejh.13174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/03/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We report cases of myelodysplastic syndrome/myeloproliferative neoplasms (MDS/MPN) with trisomy 8 associated with inflammatory and autoimmune diseases (IADs). METHOD Data for 21 patients with trisomy 8-MDS/MPN and IADs were analyzed and compared to 103 patients with trisomy 8-MDS/MPN without IADs. RESULTS The median age of MDS/MPN patients with IADs was 67 [59-80]. The IADs were Behçet's-like disease in 11 (52%) patients, inflammatory arthritis in 4 (19%) and Sjögren's syndrome, autoimmune hemolytic anemia, aseptic abscess, periarteritis nodosa, Sweet's syndrome and unclassified vasculitis in one patient each. Overall, 17/21 (81%) patients with IADs received treatment (88% with steroids), with complete and partial response in 7/17 (35%) and 8/17 (47%), respectively. The effect of MDS treatment on IADs could be assessed in seven patients receiving azacytidine: five achieved remission and two partial response. As compared with the 103 trisomy 8-MDS/MPN cases without IADs, those with IADs were more often non-European (P = 0.005) and had poor karyotype (P < 0.001). We found no difference in overall survival or acute myeloid leukemia progression between trisomy 8-associated MDS/MPN with and without IADs. CONCLUSION The spectrum of IADs associated with trisomy 8-positive MDS/MPN is dominated by Behçet's-like disease. Steroid therapy is effective, but mostly sparing therapies are necessary. Azacytidine could be an effective alternative.
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Affiliation(s)
- Nadege Wesner
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.,Sorbonne Universités, F-75012 Paris, France.,INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UMPC University Paris 06, Sorbonne Universités, Paris, France
| | - Louis Drevon
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.,Sorbonne Universités, F-75012 Paris, France.,INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UMPC University Paris 06, Sorbonne Universités, Paris, France
| | - Alexis Guedon
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | | | - Salim Trad
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | | | - Achille Aouba
- Department of Internal Medicine, CH Caen, Caen, France
| | - Jerome Gillard
- Department of Rheumatology, CH Lons le Saunier, Lons le Saunier, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Thomas Hanslik
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | | | - Eric Liozon
- Department of Internal Medicine, CHU Limoges, Limoges, France
| | - Kamel Laribi
- Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
| | - Julien Rossignol
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Olivier Hermine
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Lionel Adès
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
| | - Fabrice Carrat
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Pierre Fenaux
- INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UMPC University Paris 06, Sorbonne Universités, Paris, France
| | - Arsene Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.,Sorbonne Universités, F-75012 Paris, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.,Sorbonne Universités, F-75012 Paris, France
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Fabre-Baudouin A, Roux AL, Marin C, Lachatre M, De Laroche M, Ponsoye M, Hanslik T, Trad S. [Diagnostic issues of lymphogranuloma venereum: A case series of 5 patients]. Rev Med Interne 2017; 38:794-799. [PMID: 29128125 DOI: 10.1016/j.revmed.2017.09.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lymphogranuloma venereum (LG) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis L serovar. METHODS These five consecutive cases aim to highlight the risk of LG misdiagnosis, in case of initial presentation with isolated inguinal adenitis. RESULTS Five men (mean age: 30±7 years) were seen in an internal medicine department, for inguinal adenopathy. One patient had clinical signs of urethritis. None presented an associated rectitis. Three patients had a history of STI, and two had a discovery of related HIV disease. Urinary polymerase chain reaction (PCR) was positive for the symptomatic patient and negative for the others. Lymph node PCR was positive in all patients within a L2b serotype (searched in 4 out of 5 cases). CONCLUSION LG should be evoked in any patient with inguinal adenomegaly, particularly in case of STI history or risk factors. Negativity of urinary PCR should lead to further investigations, essentially a lymph node cytopuncture to evidence C. trachomatis.
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Affiliation(s)
- A Fabre-Baudouin
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - A L Roux
- Laboratoire de microbiologie, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France; UMR1173, Inserm, UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - C Marin
- Laboratoire d'anatomopathologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - M Lachatre
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - M De Laroche
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Laboratoire d'anatomopathologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - M Ponsoye
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Laboratoire d'anatomopathologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin-en-Yvelines (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France.
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Pais A, de Luna G, Arlet JB, Chennebault H, Michon A, Nochy D, Pouchot J, Paule R, Ponsoye M. [Edema and fever in a 31-year-old woman]. Rev Med Interne 2016; 38:214-217. [PMID: 27639915 DOI: 10.1016/j.revmed.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- A Pais
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - G de Luna
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - H Chennebault
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - D Nochy
- Service d'anatomie pathologique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - R Paule
- Service de médecine interne, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Ponsoye
- Service de médecine interne, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
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Ruzehaji N, Frantz C, Ponsoye M, Avouac J, Pezet S, Guilbert T, Luccarini JM, Broqua P, Junien JL, Allanore Y. Pan PPAR agonist IVA337 is effective in prevention and treatment of experimental skin fibrosis. Ann Rheum Dis 2016; 75:2175-2183. [PMID: 26961294 PMCID: PMC5136696 DOI: 10.1136/annrheumdis-2015-208029] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 06/04/2015] [Revised: 02/03/2016] [Accepted: 02/21/2016] [Indexed: 12/13/2022]
Abstract
Background The pathogenesis of systemic sclerosis (SSc) involves a distinctive triad of autoimmune, vascular and inflammatory alterations resulting in fibrosis. Evidence suggests that peroxisome proliferator-activated receptors (PPARs) play an important role in SSc-related fibrosis and their agonists may become effective therapeutic targets. Objective To determine the expression of PPARs in human fibrotic skin and investigate the effects of IVA337, a pan PPAR agonist, in in vitro and in vivo models of fibrosis. Methods The antifibrotic effects of IVA337 were studied using a bleomycin-induced mouse model of dermal fibrosis. The in vivo effect of IVA337 on wound closure and inflammation were studied using an excisional model of wound healing. Results Low levels of PPARα and PPARγ were detected in the skin of patients with SSc compared with controls. In mice, IVA337 was associated with decreased extracellular matrix (ECM) deposition and reduced expression of phosphorylated SMAD2/3—intracellular effector of transforming growth factor (TGF)-β1. Although the antifibrotic effect of pan PPAR was similar to that of PPARγ agonist alone, a significant downregulation of several markers of inflammation was associated with IVA337. Despite its anti-inflammatory and antifibrotic properties, IVA337 did not interfere with wound closure. In vitro effects of IVA337 included attenuation of transcription of ECM genes and alteration of canonical and non-canonical TGF-β signalling pathways. Conclusions These findings indicate that simultaneous activation of all three PPAR isoforms exerts a dampening effect on inflammation and fibrosis, making IVA337 a potentially effective therapeutic candidate in the treatment of fibrotic diseases including SSc.
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Affiliation(s)
- Nadira Ruzehaji
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France
| | | | | | - Jerome Avouac
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sonia Pezet
- INSERM, U1016, Institut Cochin, Paris, France
| | - Thomas Guilbert
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | | | | | - Yannick Allanore
- INSERM, U1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Ponsoye M, Frantz C, Ruzehaji N, Nicco C, Elhai M, Ruiz B, Cauvet A, Pezet S, Brandely ML, Batteux F, Allanore Y, Avouac J. Treatment with abatacept prevents experimental dermal fibrosis and induces regression of established inflammation-driven fibrosis. Ann Rheum Dis 2016; 75:2142-2149. [PMID: 26912566 DOI: 10.1136/annrheumdis-2015-208213] [Citation(s) in RCA: 48] [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: 07/10/2015] [Revised: 12/15/2015] [Accepted: 01/31/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Activated T cells are the main component of the inflammatory skin infiltrates that characterise systemic sclerosis (SSc). Our aim was to investigate the efficacy of abatacept, which tempers T-cell activation, in reducing skin fibrosis in complementary mouse models of SSc. METHODS The antifibrotic properties of abatacept were evaluated in the mouse models of bleomycin-induced dermal fibrosis and sclerodermatous chronic graft-versus-host disease, reflecting early and inflammatory stages of SSc. Thereafter, we studied the efficacy of abatacept in tight skin (Tsk-1) mice, an inflammation-independent mouse model of skin fibrosis. RESULTS Abatacept efficiently prevented bleomycin-induced skin fibrosis and was also effective in the treatment of established fibrosis. In this model, abatacept decreased total and activated T-cell, B-cell and monocyte infiltration in the lesional skin. Abatacept did not protect CB17-SCID mice from the development of bleomycin-induced dermal fibrosis, which supports that T cells are necessary to drive the antifibrotic effects of abatacept. Upon bleomycin injections, skin interleukin (IL) 6 and IL-10 levels were significantly reduced upon abatacept treatment. Moreover, treatment with abatacept ameliorated fibrosis in the chronic graft-versus-host disease model, but demonstrated no efficacy in Tsk-1 mice. The tolerance of abatacept was excellent in the three mouse models. CONCLUSIONS Using complementary models, we demonstrate that inhibition of T-cell activation by abatacept can prevent and induce the regression of inflammation-driven dermal fibrosis. Translation to human disease is now required, and targeting early and inflammatory stages of SSc sounds the most appropriate for positioning abatacept in SSc.
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Affiliation(s)
- Matthieu Ponsoye
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Camelia Frantz
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Nadira Ruzehaji
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Carole Nicco
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Muriel Elhai
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Barbara Ruiz
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Anne Cauvet
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Sonia Pezet
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Marie Laure Brandely
- Service de Pharmacie Clinique, GH Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
| | - Frédéric Batteux
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France.,Laboratoire d'Immunologie biologique, Hôpital Cochin, AP-HP, Paris, France
| | - Yannick Allanore
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Service de Rhumatologie A, Hôpital Cochin, Paris, France
| | - Jérôme Avouac
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Service de Rhumatologie A, Hôpital Cochin, Paris, France
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Ponsoye M, Frantz C, Ruzehaji N, Elhai M, Ruiz B, Cauvet A, Allanore Y, Avouac J. FRI0438 Treatment with Abatacept Prevents Experimental Dermal FIBrosis and Induces Regression of Established Fibrosis in a Preclinical Model of Systemic Sclerosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ruzehaji N, Frantz C, Ponsoye M, Avouac J, Konstantinova I, Fromond C, Broqua P, Junien J, Allanore Y. AB0206 Pan-Ppar Agonist IVA337 is Effective in Prevention and Treatment of Experimental Skin Fibrosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Trad S, Paule R, Ponsoye M, Jondeau K, Hanslik T, Caraman PL. [Arthralgia and weight loss in an 84-year-old woman]. Rev Med Interne 2011; 33:54-6. [PMID: 21816520 DOI: 10.1016/j.revmed.2011.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/16/2011] [Indexed: 11/18/2022]
Affiliation(s)
- S Trad
- Service de médecine interne, hôpital Ambroise-Paré, 92104 Boulogne-Billancourt cedex, France.
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