{"id":15630,"date":"2021-12-14T07:00:20","date_gmt":"2021-12-14T06:00:20","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=15630"},"modified":"2024-12-11T22:07:36","modified_gmt":"2024-12-11T21:07:36","slug":"interet-du-mycophenolate-mofetil-en-association-a-la-cortisone-dans-le-pti-en-1ere-ligne","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/interet-du-mycophenolate-mofetil-en-association-a-la-cortisone-dans-le-pti-en-1ere-ligne\/","title":{"rendered":"Int\u00e9r\u00eat du mycoph\u00e9nolate mof\u00e9til en association \u00e0 la cortisone dans le PTI en 1re ligne"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:calc( 1240px + 0px );margin-left: calc(-0px \/ 2 );margin-right: calc(-0px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0px;--awb-margin-bottom-large:0px;--awb-spacing-left-large:0px;--awb-width-medium:100%;--awb-spacing-right-medium:0px;--awb-spacing-left-medium:0px;--awb-width-small:100%;--awb-spacing-right-small:0px;--awb-spacing-left-small:0px;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>R\u00e9f. : HematoStat.net ; 2 (4) : R33<\/p>\n<p><strong> <\/strong><\/p>\n<p><em>Bradbury CA et al. Mycophenolate Mofetil for First-Line Treatment of Immune Thrombocytopenia. <\/em><em>N Engl J Med. 2 sept 2021;385(10):885<\/em><em>\u2011<\/em><em>95.<\/em><\/p>\n<p><em> <\/em><\/p>\n<p><strong>R\u00e9sum\u00e9 de l&#8217;article<\/strong><\/p>\n<p>La corticoth\u00e9rapie est le traitement recommand\u00e9 en premi\u00e8re ligne dans le purpura thrombop\u00e9nique immunologique (PTI). L\u2019essai randomis\u00e9 contr\u00f4l\u00e9 FLIGHT proposait d\u2019inclure des patients (&gt; 16 ans) atteints de PTI en 1<sup>re <\/sup>ligne ; ils recevaient de la cortisone en monoth\u00e9rapie ou en association au mycoph\u00e9nolate mofetil (MMF). Les patients trait\u00e9s par MMF (n=59) pr\u00e9sentaient un taux d\u2019\u00e9chec de 22 % (13\/59) contre 44 % pour le groupe corticoth\u00e9rapie (n=61) seule (HR : 0,41 [0,21-0,80]; p=0,008).<\/p>\n<p><strong>Dans nos pratiques<\/strong><\/p>\n<p>Traitement de r\u00e9f\u00e9rence depuis plusieurs d\u00e9cennies, la corticoth\u00e9rapie ne permet d\u2019obtenir qu\u2019environ 20% de r\u00e9ponses durables. Ajouter du MMF r\u00e9duit le risque d\u2019\u00e9chec et permet d\u2019obtenir un compte plaquettaire sup\u00e9rieur. Cette bith\u00e9rapie retentit sur la qualit\u00e9 de vie. Une option th\u00e9rapeutique \u00e0 r\u00e9server probablement \u00e0 certaines situations sp\u00e9cifiques (anticoagulation curative avec n\u00e9cessit\u00e9 d\u2019avoir des plaquettes &gt; 50 G\/L ?).<\/p>\n<p><strong>Le regard du statisticien<\/strong><\/p>\n<p>Afin d\u2019\u00e9tudier l\u2019apport du MMF, un essai contr\u00f4l\u00e9 randomis\u00e9 a \u00e9t\u00e9 effectu\u00e9 pour \u00e9tudier l\u2019\u00e9chec du traitement comme \u00e9v\u00e9nement principal. Malgr\u00e9 la r\u00e9partition al\u00e9atoire des patients, certaines variables comme l\u2019\u00e2ge, le sexe ratio et l\u2019IMC \u00e9taient d\u00e9s\u00e9quilibr\u00e9s entre les deux groupes de traitement semble-t-il (il n\u2019y avait pas de <i>p-values<\/i> dans la table descriptive comparative pour le v\u00e9rifier). Cela a donc n\u00e9cessit\u00e9 de faire une analyse de sensibilit\u00e9 (= multivari\u00e9e) afin d\u2019ajuster l\u2019effet du traitement incluant MMF et d\u2019aboutir \u00e0 ce r\u00e9sultat de HR=0.40 [0.20-0.78] sur la population enti\u00e8re. Il aurait \u00e9t\u00e9 pr\u00e9f\u00e9rable d\u2019utiliser un mod\u00e8le avec risques comp\u00e9titifs mais vu qu\u2019il n\u2019y a eu qu\u2019un seul \u00e9v\u00e9nement de d\u00e9c\u00e8s, un mod\u00e8le de Cox est appropri\u00e9 dans le cas pr\u00e9sent. L\u2019\u00e9volution de la qualit\u00e9 de vie la premi\u00e8re ann\u00e9e a \u00e9t\u00e9 \u00e9valu\u00e9e par un calcul d\u2019AUC ce qui est assez original, la lecture \u00e9tant claire : si l\u2019AUC est n\u00e9gative significativement (0 exclu de l\u2019intervalle de confiance), on a donc une am\u00e9lioration nette.<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":16,"featured_media":14595,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[36],"tags":[201,202,180,203,87],"ppma_author":[456],"class_list":["post-15630","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","tag-analyse-multivariee","tag-corticotherapie-pti","tag-modele-de-cox","tag-mycophenolate-mofetil","tag-risques-competitifs","author-alexis-genthon"],"aioseo_notices":[],"authors":[{"term_id":456,"user_id":16,"is_guest":0,"slug":"alexis-genthon","display_name":"Alexis GENTHON","avatar_url":{"url":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png","url2x":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png"},"first_name":"","last_name":"","user_url":"","description":"H\u00e9matologue.\r\nCorrespondance : H\u00f4pital Saint-Antoine \r\nService h\u00e9matologie clinique\r\n184 rue du Faubourg Saint-Antoine 75012 Paris."}],"_links":{"self":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/15630","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/comments?post=15630"}],"version-history":[{"count":2,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/15630\/revisions"}],"predecessor-version":[{"id":18311,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/15630\/revisions\/18311"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/media?parent=15630"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=15630"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=15630"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=15630"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}