ABSTRACT
We conducted a multicenter, retrospective cohort study of hospitalized patients with serologically proven nephropathia epidemica (NE) living in Ardennes Department, France, during 2000-2014 to develop a bioclinical test predictive of severe disease. Among 205 patients, 45 (22.0%) had severe NE. We found the following factors predictive of severe NE: nephrotoxic drug exposure (p = 0.005, point value 10); visual disorders (p = 0.02, point value 8); microscopic or macroscopic hematuria (p = 0.04, point value 7); leukocyte count >10 × 109 cells/L (p = 0.01, point value 9); and thrombocytopenia <90 × 109/L (p = 0.003, point value 11). When point values for each factor were summed, we found a score of <10 identified low-risk patients (3.3% had severe disease), and a score >20 identified high-risk patients (45.3% had severe disease). If validated in future studies, this test could be used to stratify patients by severity in research studies and in clinical practice.
Subject(s)
Hemorrhagic Fever with Renal Syndrome/diagnosis , Adult , Biomarkers , Comorbidity , Diagnostic Tests, Routine , Female , Hemorrhagic Fever with Renal Syndrome/epidemiology , Hospitalization , Humans , Male , Middle Aged , Odds Ratio , Prognosis , ROC Curve , Retrospective Studies , Severity of Illness Index , Symptom Assessment , Young AdultABSTRACT
OBJECTIVES: To compare efficacy and tolerance of infliximab versus rituximab to treat refractory Wegener's granulomatosis (WG), and clarify their respective indications. METHODS: Patients with systemic WG refractory to, or intolerant to steroids and consecutive immunosuppressant lines, including oral cyclophosphamide, were randomly assigned to receive infliximab or rituximab and their ongoing regimen. The primary endpoint was partial (PR) or complete remission (CR) at month 12. The secondary endpoint was the occurrence of adverse events. Long-term follow-up data were subjected to post-hoc analysis. RESULTS: Between 2004 and 2007, 9 infliximab and 8 rituximab patients were included. At M12, we observed 2 infliximab and 4 rituximab CR, 1 infliximab and 1 rituximab PR, 5 infliximab and 2 rituximab failures and 2 deaths (NS). Post-hoc analysis was conducted after 30.6±15.4 months of follow-up. Among the 15 survivors, 2 infliximab patients and 1 rituximab patient relapsed. Among 5 infliximab non-responders, 4 were successfully switched to rituximab. During follow-up, one patient from each group died. Over the long term, 10/17 (59%) patients responded to rituximab, 1 to infliximab, 2 to other strategies and 2 died. Despite the 2 deaths, tolerance of both drugs was considered acceptable in terms of WG severity before treatment and previous treatment lines. CONCLUSIONS: Our observations demonstrate the usefulness of infliximab and/or rituximab to obtain remission of refractory WG with a trend at M12 favouring rituximab. During long-term follow-up, rituximab was better able at obtaining and maintaining remission.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antibodies, Monoclonal/therapeutic use , Granulomatosis with Polyangiitis/drug therapy , Immunosuppressive Agents/therapeutic use , Adult , Aged , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Murine-Derived/adverse effects , Chi-Square Distribution , Drug Resistance , Drug Substitution , Female , France , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/mortality , Humans , Immunosuppressive Agents/adverse effects , Infliximab , Kaplan-Meier Estimate , Male , Middle Aged , Patient Selection , Prospective Studies , Recurrence , Remission Induction , Risk Assessment , Risk Factors , Rituximab , Severity of Illness Index , Time Factors , Treatment Outcome , Young AdultSubject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Aortic Aneurysm/etiology , Behcet Syndrome/complications , Behcet Syndrome/drug therapy , Polychondritis, Relapsing/complications , Polychondritis, Relapsing/drug therapy , Adult , Antirheumatic Agents/therapeutic use , Comorbidity , Female , Humans , Infliximab/therapeutic use , Receptors, Interleukin-6/immunology , Treatment Failure , Treatment OutcomeABSTRACT
Tolerability of the combination of zidovudine-lamivudine and lopinavir-ritonavir as postexposure prophylaxis (PEP) for human immunodeficiency virus infection was prospectively assessed. A total of 121 patients were enrolled in the study; 23 patients discontinued PEP prematurely for reasons other than adverse events. Of the other 98 patients, 58 (59%) experienced adverse effects, which led to premature PEP discontinuation in 20 cases (20%).