{"id":1890,"date":"2010-10-01T01:00:00","date_gmt":"2010-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/les-retombees-pratiques-de-cesame\/"},"modified":"2018-10-20T18:39:55","modified_gmt":"2018-10-20T16:39:55","slug":"les-retombees-pratiques-de-cesame","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/les-retombees-pratiques-de-cesame\/","title":{"rendered":"Les retomb\u00e9es pratiques de CESAME"},"content":{"rendered":"<p><strong>2010<\/strong><\/p>\n<p><em>Laurent Beaugerie, h\u00f4pital Saint-Antoine, Paris.<\/em><\/p>\n<p><strong>Gastroent\u00e9rologie <\/strong>&#8211; \u00a02010-09-02 &#8211;\u00a0CF &#8211;<\/p>\n<p>________________________________<\/p>\n<p>CESAME a atteint son objectif scientifique principal qui \u00e9tait de confirmer et de pr\u00e9ciser l\u2019ampleur du sur-risque de lymphomes chez les patients ayant une MICI et recevant des thiopurines. Apr\u00e8s ajustement sur tous les autres facteurs, le risque est ainsi multipli\u00e9 par 5.1  Mais l\u2019\u00e9tude est all\u00e9e tr\u00e8s au-del\u00e0 sur l\u2019identification des populations \u00e0 risque et sur la caract\u00e9risation des lymphomes associ\u00e9s aux MICI ou \u00e0 l\u2019immunosuppression.  Principalement, les jeunes hommes (&lt;35 ans) s\u00e9ron\u00e9gatifs pour l\u2019EBV ont un risque non n\u00e9gligeable en croisant EBV sous thiopurines de d\u00e9velopper une lymphoprolif\u00e9ration fatale dans les suites imm\u00e9diates de la mononucl\u00e9ose infectieuse comme dans le syndrome de lymphoprolif\u00e9ration li\u00e9e au chromosome X ou syndrome de Purtilo. Il convient donc de tester la s\u00e9rologie EBV chez les hommes jeunes avant mise sous thiopurines, et discuter un traitement de fond alternatif  (monoth\u00e9rapie par anti-TNF) en cas de n\u00e9gativit\u00e9. CESAME a aussi confirm\u00e9 que les l\u00e9sions inflammatoires chroniques intestinales peuvent faire le lit de lymphomes intestinaux au m\u00eame titre que des ad\u00e9nocarcinomes, comme cela avait \u00e9t\u00e9 sugg\u00e9r\u00e9 dans une s\u00e9rie de la Mayo Clinic possiblement entach\u00e9e de biais de recrutement.2<br \/>\nIl existait en France une grande inconnue sur l\u2019ampleur du risque ce cancer colo-rectal (CCR) au cours des MICI, sachant que des \u00e9tudes r\u00e9centes scandinaves sugg\u00e9raient que ce sur-risque avait disparu avec le temps et l\u2019\u00e9volution des traitements. En fait, CESAME d\u00e9montre avec une grande puissance statistique que le risque de CCR reste doubl\u00e9 au cours des MICI en France en 2004-2007. N\u00e9anmoins, nous montrons aussi que ce sur-risque est cantonn\u00e9 aux MICI coliques anciennes et \u00e9tendues : il convient donc de combattre ce risque sur ce terrain par la surveillance endoscopique et la ch\u00e9mopr\u00e9vention. Une \u00e9tude de pratiqu\u00e9e nich\u00e9e dans les centres universitaires franciliens participant \u00e0 CESAME a montr\u00e9 que pr\u00e8s de la moiti\u00e9 des malades n\u2019\u00e9taient pas du tout d\u00e9pist\u00e9s, ce qui doit nous inciter \u00e0 am\u00e9liorer l\u2019information et la motivation des patients et des gastro-ent\u00e9rologues sur ce point.  En termes de ch\u00e9mopr\u00e9vention, nous avons pu, a \u00e0 travers une \u00e9tude cas-t\u00e9moins nich\u00e9e dans CESAME, \u00e9valuer comparativement l\u2019effet protecteur des 5-ASA et des thiopurines, apr\u00e8s ajustement sur les autres facteurs de risque et sur la propension \u00e0 recevoir les traitements. Chez les patients \u00e0 haut risque, et surtout dans la RCH, nous confirmons clairement l\u2019effet protecteur des 5-ASA, qui diminuent, comme dans la m\u00e9ta-analyse de Velayos et al., le risque de CCR de moiti\u00e9. L\u2019effet protecteur des thiopurines, sugg\u00e9r\u00e9 dans la partie prospective de CESAME,3 n\u2019atteint pas tout \u00e0 fait dans l\u2019\u00e9tude cas-t\u00e9moins le seuil de significativit\u00e9 statistique.   En pratique donc, l\u2019int\u00e9r\u00eat de la ch\u00e9mopr\u00e9vention par les 5-ASA est incontestable chez les patients ayant une RCH ancienne et \u00e9tendue, et l\u2019association \u00e0 un  traitement fond par les thiopurines, si ce dernier est  n\u00e9cessaire par ailleurs, est vraisemblablement encore plus favorable.<br \/>\nEn vrac, CESAME confirme par une \u00e9tude nich\u00e9e que les grossesses men\u00e9es sous thiopurines  ne sont pas \u00e0 risque particulier de malformations. Enfin, l\u2019\u00e9tude des cancers de la peau en cours confirme le sur-risque li\u00e9 aux thiopurines r\u00e9cemment publi\u00e9,4 et montre que plusieurs cancers surviennent bien avant l\u2019\u00e2ge habituel, renfor\u00e7ant d\u2019un point de vue pratique l\u2019int\u00e9r\u00eat majeur de convaincre les patients sous thiopurines de se prot\u00e9ger convenablement du soleil et de montrer leur peau r\u00e9guli\u00e8rement aux m\u00e9decins.<\/p>\n<p>R\u00e9f\u00e9rences<\/p>\n<p>1.\tBeaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 2009; 374:1617-25.<br \/>\n2.\tDayharsh GA, Loftus EV, Jr., Sandborn WJ, et al. Epstein-Barr virus-positive lymphoma in patients with inflammatory bowel disease treated with azathioprine or 6-mercaptopurine. Gastroenterology 2002; 122:72-7.<br \/>\n3.\tVelayos FS, Terdiman JP, Walsh JM. Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and metaanalysis of observational studies. Am J Gastroenterol 2005; 100:1345-53.<br \/>\n4.\tLong MD, Herfarth HH, Pipkin CA, Porter CQ, Sandler RS, Kappelman MD. Increased risk for non-melanoma skin cancer in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2010; 8:268-74.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2010 Laurent Beaugerie, h\u00f4pital Saint-Antoine, Paris. Gastroent\u00e9rologie &#8211; \u00a02010-09-02 &#8211;\u00a0CF &#8211; ________________________________ CESAME a atteint son objectif scientifique principal qui \u00e9tait de confirmer et de pr\u00e9ciser l\u2019ampleur du sur-risque de lymphomes chez les patients ayant une MICI et recevant des thiopurines. Apr\u00e8s ajustement sur tous les autres facteurs, le risque est ainsi multipli\u00e9 par 5.1 [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[21],"class_list":["post-1890","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-21"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Les retomb\u00e9es pratiques de CESAME - Abstracts des congr\u00e8s de l&#039;ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/les-retombees-pratiques-de-cesame\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Les retomb\u00e9es pratiques de CESAME - 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