Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumathoid arthritis (OPTION study): a double blind, placebo controlled, randomized trial.

IL-6 is involved in the pathogenesis of rheumatoid arthritis via its broad effects on immune and inflammatory responses. Our aim was to assess the therapeutic effects of blocking IL-6 by inhibition of the Il-6 receptor with tocilizumab in patients with rheumatoid arthritis. In this double-blind, randomised, placebo-controlled parallel group phase III study, 623 patients were randomly assigned to receive tocilizumab 8 mg/kg (n=205), tocilizumab 4mg/kg (214) or placebo (204) intravenously every 4 week, with methotrexate at stable pre-study doses. The primary endpoint was the proportion of patients with 20% improvement according to ACR criteria at week 24. At 24 weeks, ACR 20 responses were seen in more patients receiving tocilizumab than in those receiving placebo. Tocilizumab could be an effective therapeutic approach in patients with moderate to severe active rheumatoid arthritis

Association between sarcopenia and frailty in elderly patients with chronic kidney disease

Abstract Background Frailty and sarcopenia are prevalent in chronic kidney disease (CKD) populations and could increase the risk for adverse health outcomes. Few studies assess the correlation between frailty, sarcopenia and CKD in non‐dialysis patients. Therefore, this study aimed to determine frailty‐associated factors in elderly CKD stage I–IV patients, expected to early identify and intervene in the frailty of elderly CKD patients. Methods A total of 774 elderly CKD I–IV patients (>60 years of age) recruited from 29 clinical centers in China between March 2017 and September 2019 were included in this study. We established a Frailty Index (FI) model to evaluate frailty risk and verified the distributional property of FI in the study population. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia 2019. Multinomial logistic regression analysis was used to assess the associated factors for frailty. Results Seven hundred seventy‐four patients (median age 67 years, 66.0% males) were included in this analysis, with a median estimated glomerular filtration rate of 52.8 mL/min/1.73 m2. The prevalence of sarcopenia was 30.6%. The FI exhibited a right‐skewed distribution. The age‐related slope of FI was 1.4% per year on a logarithmic scale (r2 = 0.706, 95% CI 0.9, 1.8, P < 0.001). The upper limit of FI was around 0.43. The FI was related to mortality (HR = 1.06, 95% CI 1.00, 1.12, P = 0.041). Multivariate multinomial logistic regression analysis showed that sarcopenia, advanced age, CKD stage II–IV, low level of serum albumin and increased waist–hip ratio were significantly associated with high FI status, while advanced age and CKD stage III–IV were significantly associated with for median FI status. Moreover, the results from the subgroup were consistent with the leading results. Conclusions Sarcopenia was independently associated with an increased risk for frailty in elderly CKD I‐IV patients. Patients with sarcopenia, advanced age, high CKD stage, high waist–hip ratio and low serum albumin level should be assessed for frailty

Commande numerique integree pour moteur a courant continu

Contient en annexe la these de PP. Parisy, 'Axe numerique integre a courant continu' soutenue le 20 octobre 1986 a l'Institut national polytechnique de GrenobleSIGLEAvailable at INIST (FR), Document Supply Service, under shelf-number : AR 14175 (1); AR 14175 (2) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc