A Veyradier

Publications (7)29.5 Total impact

• Article: [Human immunodeficiency virus-associated thrombotic microangiopathies].

  L Gilardin, S Malak, Y Schoindre, L Galicier, A Veyradier, P Coppo
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  ABSTRACT: Human immunodeficiency virus (HIV) infection represents a risk factor for thrombotic microangiopathy. HIV-associated thrombotic microangiopathies encompass two entities with distinct pathophysiology, clinical presentation, treatment and prognosis. Thrombotic thrombocytopenic purpura associated with human immunodeficiency virus is typically characterized by a sudden onset in a patient with a moderate immune deficiency and a few events of opportunistic diseases, and a profound acquired deficiency in the von Willebrand factor cleaving protease ADAMTS13. This diagnosis requires a well-codified management including daily therapeutic plasma exchanges, a highly active antiretroviral therapy and eventually immunomodulatory drugs. The prognosis is good with a response rate and an overall survival comparable to that of HIV-negative thrombotic thrombocytopenic purpura. On the opposite, HIV-associated thrombotic microangiopathy with a progressive onset that occurs in profoundly immunocompromised patients with past history of multiple opportunistic diseases usually have a detectable ADAMTS13 activity and a worse prognosis. Usual treatment is poorly efficient. Forthcoming studies should assess the role of immunomodulatory drugs such as rituximab in the setting of HIV-associated thrombotic microangiopathy, and identify possible risk factors associated with the occurrence of these diseases.
  La Revue de Médecine Interne 01/2012; 33(5):259-64. · 0.61 Impact Factor
• Article: Efficacy and safety of first-line rituximab in severe, acquired thrombotic thrombocytopenic purpura with a suboptimal response to plasma exchange. Experience of the French Thrombotic Microangiopathies Reference Center.

  Antoine Froissart, Marc Buffet, Agnès Veyradier, Pascale Poullin, François Provôt, Sandrine Malot, Michael Schwarzinger, Lionel Galicier, Philippe Vanhille, Jean-Paul Vernant, [......], Eric Mariotte, Eric Rondeau, Jean-Paul Mira, Alain Wynckel, Karine Clabault, Gabriel Choukroun, Claire Presne, Jacques Pourrat, Mohamed Hamidou, Paul Coppo
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  ABSTRACT: To assess the efficacy and safety of rituximab in adults responding poorly to standard treatment for severe autoimmune thrombotic thrombocytopenic purpura. Open-label prospective study. Outcomes in the survivors were compared to those of 53 historical survivors who were given therapeutic plasma exchange alone or with vincristine. Hospitals belonging to the Reference Network for Thrombotic Microangiopathies in France. Twenty-two adults with either no response or a disease exacerbation when treated with intensive therapeutic plasma exchange. Add-on rituximab therapy, four infusions over 15 days. One patient died despite two rituximab infusions. In the rituximab-treated patients, the time to a durable remission was significantly shortened (p = .03), although the plasma volume required to achieve a durable remission was not significantly different compared to the controls. Platelet count recovery occurred within 35 days in all 21 survivors, compared to only 78% of the historical controls (p < .02). Of the rituximab-treated patients, none had a relapse within the first year but three relapsed later on. In patients treated with rituximab, a rapid and profound peripheral B-cell depletion was produced, lasting for 9 months and correlating with higher a disintegrin and metalloproteinase with thrombospondin-13 activity and lower anti-a disintegrin and metalloproteinase with thrombospondin-13 antibody titers. These differences were no longer significant after 12 months. No severe side effects occurred. Adults with severe thrombocytopenic purpura who responded poorly to therapeutic plasma exchange and who were treated with rituximab had shorter overall treatment duration and reduced 1-yr relapses than historical controls.
  Critical care medicine 09/2011; 40(1):104-11. · 6.37 Impact Factor
• Article: HLA-DRB1*11: a strong risk factor for acquired severe ADAMTS13 deficiency-related idiopathic thrombotic thrombocytopenic purpura in Caucasians.

  P Coppo, M Busson, A Veyradier, A Wynckel, P Poullin, E Azoulay, L Galicier, P Loiseau
  Journal of Thrombosis and Haemostasis 02/2010; 8(4):856-9. · 5.73 Impact Factor
• Article: Human immunodeficiency virus-associated thrombotic microangiopathies: clinical characteristics and outcome according to ADAMTS13 activity.

  S Malak, M Wolf, G A Millot, E Mariotte, A Veyradier, J-L Meynard, J-M Korach, S Malot, A Bussel, E Azoulay, E Boulanger, L Galicier, E Devaux, V Eschwège, S Gallien, C Adrie, B Schlemmer, E Rondeau, P Coppo
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  ABSTRACT: Human immunodeficiency virus (HIV) infection is a risk factor for thrombotic microangiopathy (TMA). We sought whether a severe deficiency in ADAMTS13, the enzyme specifically involved in the cleavage of von Willebrand factor, was associated with specific presenting features and outcome in HIV-associated TMA. In this prospective, multicentre, case-control study, 29 patients of 236 in the French Network on TMA had an HIV-associated TMA. Seventeen patients with severe ADAMTS13 deficiency (ADAMTS13 <5% HIV(+) group) were compared to 12 patients with a detectable ADAMTS13 activity (ADAMTS13 >or=5% HIV(+) group). HIV(+) patients were also compared to 62 patients with idiopathic TMA, either with (45 patients, ADAMTS13 <5% idiopathic group) or without (17 patients, ADAMTS13 >or=5% idiopathic group) severe ADAMTS13 deficiency. ADAMTS13 <5% HIV(+) patients had less AIDS-related complications than ADAMTS13 >or=5% HIV(+) patients (23.5% versus 91.6%, respectively, P = 0.0005) and their median CD4(+) T cell count was higher (P = 0.05). TMA-associated death rate was higher in ADAMTS13 >or=5% HIV(+) patients than in ADAMTS13 <5% HIV(+) patients (50% versus 11.7%, respectively, P = 0.04). In ADAMTS13 <5% patients, TMA-associated death rate was comparable between HIV(+) and idiopathic patients (15.5% in idiopathic patients, P-value was non-significant). By contrast, TMA-associated death rate in ADAMTS13 >or=5% HIV(+) patients was higher than in idiopathic patients (11.7% in idiopathic patients, P = 0.04). In conclusion, HIV-associated TMA with severe ADAMTS13 deficiency have less AIDS-related complications and a higher CD4(+) T cell count. TMA prognosis is better and comparable to this of idiopathic forms.
  Scandinavian Journal of Immunology 09/2008; 68(3):337-44. · 2.23 Impact Factor
• Article: Rituximab as preventive therapy of a clinical relapse in TTP with ADAMTS13 inhibitor.

  N Schleinitz, M Ebbo, K Mazodier, P Poullin, E Bernit, V Veit, A Veyradier, F Fakhouri, G Kaplanski, J-R Harle
  American Journal of Hematology 06/2007; 82(5):417-8. · 4.67 Impact Factor
• Article: Prognostic value of inhibitory anti-ADAMTS13 antibodies in adult-acquired thrombotic thrombocytopenic purpura.

  P Coppo, M Wolf, A Veyradier, A Bussel, S Malot, G A Millot, C Daubin, D Bordessoule, F Pène, J P Mira, F Heshmati, E Maury, B Guidet, E Boulanger, L Galicier, N Parquet, J P Vernant, E Rondeau, E Azoulay, B Schlemmer
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  ABSTRACT: In order to assess the prognostic value of inhibitory anti-ADAMTS13 antibodies in thrombotic thrombocytopenic purpura (TTP), we performed a multicentre prospective study of 33 adult patients with idiopathic acquired TTP. Patients were treated with high-dose plasma infusion and therapeutic plasma exchange. Patients without (group 1, n = 12) and with (group 2, n = 21) detectable inhibitory anti-ADAMTS13 antibodies were compared for clinical presentation, treatment and outcome. Both groups were comparable for clinical presentation. All patients in group 1 achieved a sustained complete remission within a median of 7 d [95% confidence interval (CI), 4-18], which required a median plasma volume of 235 ml/kg (range, 131-1251). In group 2, 17 patients achieved a durable complete remission within a median of 23 d (95% CI, 11-32) (P = 0.001). Median plasma volume was 718 ml/kg (range, 219-3107) (P = 0.02). In group 2, there was a trend for more episodes of flare-up than in group 1 (13 vs. 3, respectively, P = 0.07). Four patients, all from group 2, died (P = not significant). The relapse rate was comparable between both groups. We suggest that TTP with detectable inhibitory anti-ADAMTS13 antibodies displays a worse prognosis, relative to a delayed platelet count recovery, a higher plasma volume requirement to achieve complete remission, and a trend for more frequent episodes of flare-up.
  British Journal of Haematology 02/2006; 132(1):66-74. · 4.94 Impact Factor
• Article: Prognostic value of inhibitory anti‐ADAMTS13 antibodies in adult‐acquired thrombotic thrombocytopenic purpura

  P. Coppo, M. Wolf, A. Veyradier, A. Bussel, S. Malot, G. A. Millot, C. Daubin, D. Bordessoule, F. Pène, J. P. Mira, [......], E. Maury, B. Guidet, E. Boulanger, L. Galicier, N. Parquet, J. P. Vernant, E. Rondeau, E. Azoulay, B. Schlemmer, the Réseau d'Etude des Microangiopathies Thrombotiques de l'Adulte
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  ABSTRACT: In order to assess the prognostic value of inhibitory anti-ADAMTS13 antibodies in thrombotic thrombocytopenic purpura (TTP), we performed a multicentre prospective study of 33 adult patients with idiopathic acquired TTP. Patients were treated with high-dose plasma infusion and therapeutic plasma exchange. Patients without (group 1, n = 12) and with (group 2, n = 21) detectable inhibitory anti-ADAMTS13 antibodies were compared for clinical presentation, treatment and outcome. Both groups were comparable for clinical presentation. All patients in group 1 achieved a sustained complete remission within a median of 7 d [95% confidence interval (CI), 4–18], which required a median plasma volume of 235 ml/kg (range, 131–1251). In group 2, 17 patients achieved a durable complete remission within a median of 23 d (95% CI, 11–32) (P = 0·001). Median plasma volume was 718 ml/kg (range, 219–3107) (P = 0·02). In group 2, there was a trend for more episodes of flare-up than in group 1 (13 vs. 3, respectively, P = 0·07). Four patients, all from group 2, died (P = not significant). The relapse rate was comparable between both groups. We suggest that TTP with detectable inhibitory anti-ADAMTS13 antibodies displays a worse prognosis, relative to a delayed platelet count recovery, a higher plasma volume requirement to achieve complete remission, and a trend for more frequent episodes of flare-up.
  British Journal of Haematology 12/2005; 132(1):66 - 74. · 4.94 Impact Factor