PubMed Health⌕ Search

Biomedical subjects

Bernard Combe

Publications and source records attributed to Bernard Combe.

29 records · Page 2Linked to original sources
PubMed2004

Inefficacy of infliximab in primary Sjögren's syndrome: results of the randomized, controlled Trial of Remicade in Primary Sjögren's Syndrome (TRIPSS).

OBJECTIVE: There is no effective treatment for patients with primary Sjögren's syndrome (SS). Since tumor necrosis factor alpha (TNF alpha) could be a key element in the pathogenesis of primary SS, we conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the effect of infliximab in primary SS. METHODS: A total of 103 patients with primary SS were randomly assigned to receive infliximab infusions (5 mg/kg) or placebo at weeks 0, 2, and 6 and were followed up for 22 weeks. All patients fulfilled the new American-European Consensus Group criteria for SS and had active disease as assessed by values >50 mm on 2 of 3 visual analog scales (VAS) (0-100 mm) that evaluated joint pain, fatigue, and buccal, ocular, skin, vaginal, or bronchial dryness. A favorable overall response was defined as the patient having > or =30% improvement between weeks 0 and 10 in the values on 2 of the 3 VAS. Secondary end points were values on each VAS separately, the number of tender and swollen joints, the basal salivary flow rate, results of the Schirmer test for lacrimal gland function, the focus score on labial salivary gland biopsy, the level of C-reactive protein, and the erythrocyte sedimentation rate evaluated at weeks 0, 10, and 22, as well as quality of life evaluated by use of the generic Short Form 36 questionnaire administered at weeks 0, 10, and 22. RESULTS: At week 10, 26.5% of patients receiving placebo and 27.8% of patients treated with infliximab had a favorable overall response (P = 0.89), and at week 22, 20.4% of the placebo group and 16.7% of the infliximab group had a favorable response (P = 0.62). In addition, the 2 groups did not differ in any of the secondary end points over the 22 weeks of the trial. Severe adverse events reported in the infliximab group did not differ from those observed in previous studies. CONCLUSION: This randomized, double-blind, placebo-controlled study of an anti-TNF agent did not show any evidence of efficacy of infliximab in primary SS.

Aged↗
PubMed2004

Should patients with recent-onset polyarthritis receive aggressive treatment?

The diagnostic and therapeutic management of rheumatoid arthritis has benefited considerably in recent years not only from the introduction of new treatments (including new disease-modifying antirheumatic drugs, new combinations of these drugs, and TNF inhibitors), but also from the development of new concepts. Important new concepts include the use of novel diagnostic approaches, very early management within the first 3-6 months of symptom onset, periodic assessments of clinical disease activity based on objective clinical criteria and radiographic progression, and earlier use of aggressive treatments. The goal is to induce a clinical remission, thereby preventing radiographic deterioration. These concepts are firmly supported by sound scientific data. At present, patients at risk for progression to severe rheumatoid arthritis must be identified early on, and disease activity and progression must be monitored closely. This should enable patients with highly progressive disease to receive aggressive treatment (e.g., a combination of disease-modifying antirheumatic drugs or biological therapy) very early on with the goal of minimizing joint destruction and subsequent functional impairments.

Antirheumatic Agents↗
PubMed2003

[What treatments can reduce the digestive complications of NSAIDs].

OBJECTIVE: The aim is to compile a systematic review of literature data on the efficacy of GI protective agents in the prevention of upper GI lesions in a subject receiving long-term therapy with an NSAID. METHOD: We have selected solely experimental studies which have received a very high score in terms of methodology, whether in internal validity or clinical significance. Thus, 35 randomized, controlled studies have been reviewed. RESULTS: Only one large long-term study examined the prevention of serious GI risks and misoprostol (800 micrograms/day) showed that it was capable of reducing the incidence of ulcer complications (perforations and bleeding) by 40% compared to placebo. No such data are available for PPI and H2-receptor antagonists (H2-RA). In summary Controlled endoscopic study results for patients with joint diseases receiving NSAID therapy for a period greater than 3 weeks demonstrated that misoprostol, PPI and H2-RA at double-dose are effective in reducing the risk both of gastric and duodenal ulcer. The standard doses of H2-RA are not effective in reducing the risk of gastric ulcer. There are very few studies comparing two gastro-intestinal protective agents and they seem to indicate that misoprostol and proton pump inhibitors are comparable in reducing the risk of gastric ulcer and are better than standard doses of H2-RA and that omeprazol is better than misoprostol at reducing the risk of duodenal ulcer. Tolerability of PPI and H2-RA are appreciably better than misoprostol which induces intestinal disorders.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

[Prescription of NSAIDs in patients treatment with platelet inhibitors or anticoagulants].

PLATELET INHIBITION: Conventional NSAIDs and aspirin have platelet-inhibiting properties via platelet cyclo-oxygenase-1 (Cox-1) isoenzyme inhibition. Among the NSAIDs which induce reversible inhibition of Cox-1, naproxen seems to have a potent platelet-inhibiting action associated with a decrease in cardiovascular clinical events in secondary prevention. Flurbiprofen is indicated in the secondary prevention after myocardial infarction. Conversely, no conventional NSAID is indicated and none have demonstrated efficacy in primary prevention. GI BLEEDING: The platelet-inhibiting action of conventional NSAIDs and aspirin is a key factor in explaining the increased risk of bleeding reported with these medicinal products. Digestive system bleeding is the main risk. Few data are available regarding bleeding other than gastro-intestinal. COX-2 SPECIFIC INHIBITION PROPERTIES: Conversely, Cox-2 specific inhibitors have no platelet-inhibiting properties: the pharmacological profile of Cox-2 SI is therefore different from that of conventional NSAIDs. These medicinal products are anti-inflammatory, analgesic, platelet-inhibiting agents which are not harmful to the GI mucosa and which probably induce less bronchospasms. In patients with cardiovascular risks, Cox-2 SI can and should be used in combination with platelet-inhibiting agents, in particular aspirin, because they do not alter the aspirin effect on platelets, contrary to what is observed with conventional NSAIDs. PRESCRIPTION WITH ANTI-COAGULANTS: The concomitant prescription of conventional NSAIDs with anti-coagulants is not recommended because, in addition to the possible potentiation of oral anti-coagulants, NSAIDs increase the risk of serious bleeding adverse events due to their irritative effect on the GI mucosa and their platelet-inhibiting effect. This risk might be lower with Cox-2 specific inhibitors.

Administration, Oral↗
PubMed2003

The 5-yr HAQ-disability is related to the first year's changes in the narrowing, rather than erosion score in patients with recent-onset rheumatoid arthritis.

OBJECTIVE: To evaluate the predictive validity of radiological change on 5-yr disability in rheumatoid arthritis (RA). METHODS: The study was designed to be multicentre, prospective, longitudinal, with a 5-yr follow-up. Participants were RA patients (ACR criteria), with a disease duration of <1 yr at entry. Radiographs of the hands and feet in posteroanterior view at baseline and after 12 months of follow-up (van der Heijde's modification of Sharp method) were used for structural evaluation. Disability was evaluated with Health Assessment Questionnaire (HAQ) at yr 5. Analyses consisted of (i) correlation existing between the changes in the radiological scores during the first year and the HAQ value at yr 5 and (ii) determination of the optimal cut-off in the changes in the radiological scoring system, by ROC curve analysis, in which variable to be explained was disability status at yr 5, defined by HAQ value of at least 1. RESULTS: Due to missing data and/or lost to follow-up, 135 patients (out of the 191 recruited patients) were included in the analyses (mean change in the radiological score = 4.9 +/- 8.7 points, mean HAQ at yr 5 = 0.62 +/- 0.68). There was a statistically significant correlation between the HAQ-disability status at yr 5 and the changes observed in the radiological total damage and narrowing scores during the first year (r = 0.18, P = 0.046 and r = 0.25, P = 0.006, respectively). Conversely, the short-term changes in the erosion score were not correlated with subsequent HAQ-disability (r = 0.084, P = 0.36). A change of at least 2 points in the total X-ray score was considered as optimal (sensitivity, specificity, positive and negative predictive values of 66.7, 53.9, 32.8 and 82.8%, respectively). CONCLUSION: This work shows that early changes in joint damage in patients with recent-onset RA are related to subsequent HAQ-disability. This relationship is due to changes in narrowing, rather than in erosion score, suggesting that the joint narrowing score might be of great importance in the follow-up of RA patients and in the reports of scientific results. The weak performance of the thresholds established using predictive validity for subsequent HAQ-disability compromise their use at the individual level.

Adult↗
PubMed2003

Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy.

OBJECTIVE: Because anti-tumor necrosis factor alpha (anti-TNF) has emerged as a highly effective treatment for numerous inflammatory arthritides, which are a common cause of AA amyloidosis, we retrospectively evaluated the safety and efficacy of anti-TNF in a nationwide study. METHODS: The rheumatology departments of all French teaching hospitals were contacted by mail to obtain the files of patients with histologically proven secondary AA amyloidosis and renal involvement who were treated with anti-TNF. Efficacy was assessed as a sustained decrease in 24-hour proteinuria and a stable/improved glomerular filtration rate (GFR). RESULTS: Among the 15 patients studied, the 24-hour proteinuria was 4.5 +/- 3.6 gm (mean +/- SD), creatininemia was 178.4 +/- 74.9 micromoles/liter, and GFR was 46 +/- 23 ml/minute before starting anti-TNF. Ten patients received infliximab, 4 received etanercept, and 1 received both types of treatment. The mean followup was 10.4 months. No severe adverse events were recorded; one episode of herpes zoster in the first branch of the trigeminal nerve occurred after one infusion of infliximab. Amyloidosis progressed in 7 patients and was stabilized in 5 patients. Three patients (receiving infliximab alone, infliximab plus methotrexate [MTX], or etanercept plus MTX) experienced rapid, dramatic, and sustained decreases in proteinuria (>or=80%), with the GFR increasing 15-78%. CONCLUSION: Anti-TNF was well-tolerated and safe in the 15 patients with AA amyloidosis and renal involvement. The pathogenic role of TNF in AA amyloidosis, the sustained proteinuria decrease in 3 patients, and the stabilization of renal parameters in 5 other patients make anti-TNF a promising candidate to treat AA amyloidosis secondary to inflammatory arthritides.

Adult↗
PubMed2003

Naturalistic survey on nonsteroidal antiinflammatory treatment in patients with musculoskeletal pain.

OBJECTIVE AND METHODS: To evaluate patients' opinions about the gastrointestinal safety and areas for improvement of conventional nonsteroidal antiinflammatory drug (NSAID) therapy for musculoskeletal pain, the Louis Harris Institute conducted a survey in 401 patients selected in France using a quota sampling method. RESULTS: Three hundred and five patients (76%) described their pain as incapacitating. Nearly, one-third of the patients (125/401, 31%) reported gastrointestinal side effects, which prompted endoscopy in 24 (24/125, 20%) and gastroprotective drug treatment (usually by a proton pump inhibitor) in 100 (100/125, 82%). NSAID discontinuation or dosage reduction because of gastrointestinal side effects occurred in 55 patients (55/125, 45%), at the cost of symptom exacerbation, including worse pain, in over half the cases. Among the 401 patients, 304 (76%) wanted more effective NSAIDs and 174 (43%) wanted better gastrointestinal tolerability. CONCLUSION: Under everyday conditions, the use and effectiveness of conventional NSAID therapy are limited by gastrointestinal side effects. Furthermore, patients want NSAIDs with better risk/benefit ratios to control musculoskeletal pain.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

Polymorphism of HLA-DMA and DMB alleles in patients with systemic lupus erythematosus.

OBJECTIVE: To evaluate the contribution of HLA-DM alleles to susceptibility to systemic lupus erythematosus (SLE) in a Caucasian population. METHODS: HLA-DMA and DMB alleles were studied in 73 patients with SLE, 147 randomly selected controls, and 86 HLA-DRB1 genotype matched controls by oligotyping of polymerase chain reaction amplified genomic DNA with sequence-specific oligonucleotide probes. RESULTS: There was a significant presence of HLA-DMA*0103, DMA*0104, and DMB*0102 in the SLE patients compared with the randomly selected controls. After stratification of patients and matched controls according to DRB1 genotypes, only HLA-DMA*0104 was increased in SLE patients negative for the SLE susceptibility HLA-DR alleles. For the patients and controls positive for HLA-DR allele-susceptibility for SLE, HLA-DMA*0103, DMA*0104, DMB*0102, and DMB*0103 alleles tended to be more frequent, but without reaching statistical significance. No correlation was found between HLA-DM phenotype frequencies and any clinical or biological manifestations of SLE. CONCLUSION: This is the first study evaluating the influence of HLA-DM in a Caucasian SLE population. Our results suggest that HLA-DMA*0104 may represent a novel allele of susceptibility to SLE.

Adolescent↗
PubMed2003

Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis.

OBJECTIVE: To determine prognostic factors of disability in early rheumatoid arthritis (RA) and to investigate the radiological and functional course of the disease. METHODS: A total of 191 patients with early RA (diagnosed for less than one year) according to American College of Rheumatology criteria were followed prospectively for 5 years. At baseline and at endpoint, Stanford Health Assessment Questionnaire (HAQ) scores and radiological scores (Sharp's score modified by van der Heijde) were performed. Correlations between numerous baseline data and HAQ score at endpoint were analyzed, using nonparametric tests. A multilinear regression model was performed to select independent prognostic factors of HAQ disability. RESULTS: During the 5-year followup, mean HAQ decreased from 1.3 (+/- 0.7) to 0.6 (+/- 0.6). There were 98 (65.3%) patients with a score > 1 point at baseline, but only 46 (27.4%) after 3 years and 34 (21.8%) after 5 years. Moreover, 90% of the patients had an improvement of the disability score. Final HAQ disability was associated with baseline values of HAQ score, Pain, Ritchie index, tender joint count, Disease Activity Score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and erosion. Multivariate analysis selected baseline HAQ score, Ritchie index, ESR, CRP, and presence of erosion as independent prognostic factors of HAQ disability. The probability cutoff in the logistic model was selected to minimize the sum of false positive and false negative values: negative predictive value = 92.71%, positive predictive value = 46.15%, p = 0.408. Sex, age, IgM and IgA rheumatoid factors, other tested autoantibodies, and HLA class II genes did not contribute significantly to prediction of the disability after 5 years. At baseline, mean scores were 3.6 units (+/- 7.7) for total radiological score, 1.7 (+/- 4.5) for erosion score, and 1.9 (+/- 3.7) for joint space narrowing score. After 5 years, they were 17.9 +/- 22.3, 6.9 +/- 9.5, and 11.0 +/- 15.4, respectively. No erosion was present at the start in 58.0% of patients, compared to 24.2% and 22.4% at 3 and 5 years. Global radiographic progression concerned 87 patients (55.8%) during the 5 years. CONCLUSION: During the first 5 years of RA, radiological damage increased progressively in half of the patients, whereas HAQ disability improved in most of them during the same period of time and could be predicted by baseline values of HAQ score, Ritchie index, ESR, CRP, and presence (or absence) of erosion.

Adult↗
PubMed2002

Treatment of chronic knee synovitis with arthroscopic synovectomy: longterm results.

OBJECTIVE: We examined the longterm results of arthroscopic synovectomy in chronic knee synovitis of rheumatoid arthritis (RA). METHODS: Forty-one knees of 38 patients (30 women, 8 men), mean age of 42.7 +/- 15.3 years, were evaluated clinically and radiographically at a mean 8.9 years (range 5.0-12.3) after arthroscopic synovectomy. Arthroscopic synovectomies were always performed with a shaver by the same physician after failure of at least one radioactive or chemical synovectomy. Radiographs were blindly read by 2 examiners. RESULTS: At the final evaluation, the clinical results (pain, range of motion, recurrent effusion) were good in 29 cases (70.7%) and poor in 12 cases (knee arthroplasty was required in 11 cases). Radiographs highlighted significant progression of joint damage (more than one Larsen score grade) in 16 knees (39.0%). No radiographically detectable change was observed in 12 cases (29.3%), and 11 knees (26.8%) had a change of only one Larsen score grade. There was a close correlation between the Larsen score at final examination and both Larsen score and arthroscopic score for cartilage damage at baseline. Only 4 knees (22%) with grade 0 or I on preoperative radiographs had significant progression of joint damage, compared to 12 knees (57%) with Larsen scores of 2 or 3 at baseline. CONCLUSION: These data suggest that arthroscopic synovectomy is a useful alternative treatment for chronic knee synovitis in RA after failure of radiation or chemosynovectomy, and that less severely damaged joints deteriorate less rapidly after synovectomy.

Adolescent↗