Montpellier, France
Montpellier, France

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Payet S.,Clermont Ferrand Teaching Hospital | Soubrier M.,Clermont Ferrand Teaching Hospital | Perrodeau E.,Strasbourg Teaching Hospital | Bardin T.,Bicetre Teaching Hospital | And 9 more authors.
Arthritis Care and Research | Year: 2014

Objective. The aim of this study was to compare the efficacy and safety of rituximab (RTX) as a function of patient age. Methods. We included all rheumatoid arthritis patients in the AutoImmunity and Rituximab registry with a 2-year followup. Results. Of the 1,709 patients, 191 were age ≥75 years, 417 were ages 65-74 years, 907 were ages 50-64 years, and 194 were age <50 years. At baseline, the elderly and very elderly patients presented with longer disease duration, a higher incidence of erythrocyte sedimentation rate and C-reactive protein level, a lower incidence of previous tumor necrosis factor α (TNFα) therapy, and a smaller number of previously used TNFα agents. Disease activity, rheumatoid factor (RF), or anti-cyclic citrullinated peptide (anti-CCP) antibodies and corticosteroid therapy were not statistically different among the groups. At 24 months, no significant difference was shown among the groups for RTX discontinuation rates (36.1% if age <50 years, 32.6% if ages 50-64 years, 34.5% if ages 65-74 years, and 32.5% if age >75 years). The reasons for discontinuation (inefficacy, adverse events) were the same in all 4 groups. Infections were more common in the elderly. Patients ages 65-75 years were more likely to be good responders than nonresponders at 1 year of followup than patients age ≥75 years (odds ratio 3.81, 95% confidence interval 1.14-12.79) after adjustment on disease duration, RF/anti-CCP positivity, corticosteroids, anti-TNF use, and baseline Disease Activity Score in 28 joints (DAS28). After the sixth month, the decrease in DAS28 score was less marked in the population age >75 years than in the group age <50 years. Conclusion. The efficacy and safety of RTX is affected by age. Copyright © 2014 by the American College of Rheumatology.


Duflos C.M.,Economic Evaluation Unit at Montpellier Teaching Hospital | Duflos C.M.,Montpellier University | Solecki K.,Montpellier Teaching Hospital | Papinaud L.,Information Assurance | And 4 more authors.
PLoS ONE | Year: 2016

Background We aimed to classify patients with heart failure (HF) by the style of primary care they receive. Methods and Results We used the claim data (SNIIRAM: Système National d'Information Inter-Régime de l'Assurance Maladie) of patients living in a French region. We evaluated three concepts. First, baseline clinical status with age and Charlson index. Second, primary care practice style with mean delay between consultations, quantity of nursing care, and variability of diuretic dose. Third, clinical outcomes with death during follow-up, readmission for HF, and rate of unforeseen consultations. The baseline clinical status and the clinical outcomes were included to give an insight in the reasons for, and performance of, primary care practice style. Patients were classified using a hierarchical ascending classification based on principal components. A total of 2,751 patients were included in this study and were followed for a median of 22 months. The mean age was 78 y (SD: 12); 484 (18%) died, and 818 (30%) were readmitted for HF. We found three different significant groups characterized by their need for care and the intensity of practice style: group 1 (N = 734) was "low need-low intensity"; group 2 (N = 1,060) was "high need-low intensity"; and group 3 (N = 957) was "high need-high intensity". Their readmission rates were 17%, 41% and 28%, respectively. Conclusions This study evaluated the link between primary care, clinical status and main clinical outcomes in HF patients. In higher need patients, a low-intensity practice style was associated with poorer clinical outcomes. © 2016 Duflos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Solassol J.,Montpellier Teaching Hospital | Solassol J.,Montpellier University | Burcia V.,Guy Of Chauliac Hospital | Burcia V.,Montpellier University | And 24 more authors.
British Journal of Cancer | Year: 2010

Background: Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT-PCR) has produced encouraging results, the more discriminating markers remain to be identified.Methods: Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT-PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC.Results: SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (P<0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (P<0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases.Conclusion: PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT-PCR. © 2010 Cancer Research UK All rights reserved.


PubMed | Montpellier Teaching Hospital
Type: Journal Article | Journal: British journal of cancer | Year: 2010

Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT-PCR) has produced encouraging results, the more discriminating markers remain to be identified.Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT-PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC.SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (P<0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (P<0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases.PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT-PCR.


PubMed | Information Assurance, Economic evaluation unit at Montpellier teaching hospital, Montpellier teaching hospital and Montpellier University
Type: Journal Article | Journal: PloS one | Year: 2016

We aimed to classify patients with heart failure (HF) by the style of primary care they receive.We used the claim data (SNIIRAM: Systme National dInformation Inter-Rgime de lAssurance Maladie) of patients living in a French region. We evaluated three concepts. First, baseline clinical status with age and Charlson index. Second, primary care practice style with mean delay between consultations, quantity of nursing care, and variability of diuretic dose. Third, clinical outcomes with death during follow-up, readmission for HF, and rate of unforeseen consultations. The baseline clinical status and the clinical outcomes were included to give an insight in the reasons for, and performance of, primary care practice style. Patients were classified using a hierarchical ascending classification based on principal components. A total of 2,751 patients were included in this study and were followed for a median of 22 months. The mean age was 78 y (SD: 12); 484 (18%) died, and 818 (30%) were readmitted for HF. We found three different significant groups characterized by their need for care and the intensity of practice style: group 1 (N = 734) was low need-low intensity; group 2 (N = 1,060) was high need-low intensity; and group 3 (N = 957) was high need-high intensity. Their readmission rates were 17%, 41% and 28%, respectively.This study evaluated the link between primary care, clinical status and main clinical outcomes in HF patients. In higher need patients, a low-intensity practice style was associated with poorer clinical outcomes.

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