{"id":16041,"date":"2022-03-28T20:21:17","date_gmt":"2022-03-28T18:21:17","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=16041"},"modified":"2024-12-11T15:08:39","modified_gmt":"2024-12-11T14:08:39","slug":"pti-corticoresistant-un-traitement-atra-ctif","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/pti-corticoresistant-un-traitement-atra-ctif\/","title":{"rendered":"PTI corticor\u00e9sistant : un traitement ATRA-ctif ?"},"content":{"rendered":"
R\u00e9f. : HematoStat.net ; 3 (1) : R49<\/span><\/div>\n


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Wu Y-J, Liu H, Zeng Q-Z, Liu Y, Wang J-W, Wang W-S, et al. All-trans retinoic acid plus low-dose rituximab vs low-dose rituximab in corticosteroid-resistant or relapsed ITP. <\/span>Blood. 20 janv 2022;139(3):333\u201142.<\/i><\/div>\n
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R\u00e9sum\u00e9<\/h3>\n
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Cette \u00e9tude randomis\u00e9e (2:1) multicentrique a inclus des patients adultes atteints de purpura thrombop\u00e9nique immunologique (PTI) corticor\u00e9sistants. Au total, 112 patients recevaient du rituximab faible dose (R-fd, 100 mg\/semaine, 6 semaines) et de l\u2019ATRA tandis que 56 patients n\u2019\u00e9taient trait\u00e9s que par R-fd. Les taux de r\u00e9ponse globaux \u00e9taient de 80 % et 61 %, en faveur du bras exp\u00e9rimental. Le traitement \u00e9tait bien tol\u00e9r\u00e9 (x\u00e9rose cutan\u00e9e, c\u00e9phal\u00e9es).<\/div>\n
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Dans nos pratiques<\/h3>\n

Bien que pr\u00e9sentant un certain nombre de limites (patients tr\u00e8s majoritairement recrut\u00e9s dans le m\u00eame centre, sch\u00e9ma du rituximab, seuil plaquettaire retenu pour la r\u00e9ponse) cette \u00e9tude illustre une nouvelle fois l\u2019int\u00e9r\u00eat des associations dans le PTI. Parmi les candidats potentiels, l\u2019ATRA administr\u00e9 par voie orale et (relativement) bien tol\u00e9r\u00e9 tient la corde.<\/p>\n

Critique m\u00e9thodologique<\/h3>\n

Cet essai ne pr\u00e9cise pas en premier lieu si l\u2019on se place dans une phase 2 ou 3 (ou 2\/3). Le crit\u00e8re primaire est la r\u00e9ponse au traitement durant la 1\u00e8re ann\u00e9e, et non pas \u00e0 un instant pr\u00e9cis (1 mois, 3 mois ?). Du coup il aurait \u00e9t\u00e9 plus judicieux de faire une courbe de Kaplan-Meier sur la survenue de r\u00e9ponse durant cette ann\u00e9e de suivi. Ici le taux de r\u00e9ponse et le d\u00e9lai de r\u00e9ponse \u00e9taient 2 informations s\u00e9par\u00e9es. La seule courbe pr\u00e9sente s\u2019agit de la survie sans rechute des patients r\u00e9pondeurs mais 1) elle ne tient pas compte du moment d\u2019obtention de la r\u00e9ponse et 2) le r\u00e9sultat semble curieusement tr\u00e8s significatif alors que les courbes ne se distinguent pas tant que \u00e7a. Sans oublier qu\u2019il est indiqu\u00e9 dans le texte que des donn\u00e9es manquantes subsistent\u2026
\n\u00c0 noter que cet essai a \u00e9t\u00e9 perturb\u00e9 par l\u2019\u00e9pid\u00e9mie de Covid-19. Globalement le niveau de preuve reste moyen malgr\u00e9 les bonnes intentions.<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":16,"featured_media":16042,"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":[],"ppma_author":[456],"class_list":["post-16041","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","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\/16041","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=16041"}],"version-history":[{"count":1,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16041\/revisions"}],"predecessor-version":[{"id":18219,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16041\/revisions\/18219"}],"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=16041"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=16041"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=16041"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=16041"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}