Rituximab in The Management of Pediatric Steroid-Resistant Nephrotic Syndrome: A Systematic Review.
Identifieur interne : 000319 ( Main/Exploration ); précédent : 000318; suivant : 000320Rituximab in The Management of Pediatric Steroid-Resistant Nephrotic Syndrome: A Systematic Review.
Auteurs : Manel Jellouli [Tunisie] ; Rim Charfi [Tunisie] ; Bayen Maalej [Tunisie] ; Abdelmajid Mahfoud [Tunisie] ; Sameh Trabelsi [Tunisie] ; Tahar Gargah [Tunisie]Source :
- The Journal of pediatrics [ 1097-6833 ] ; 2018.
Descripteurs français
- KwdFr :
- Enfant (MeSH), Enfant d'âge préscolaire (MeSH), Facteurs immunologiques (effets indésirables), Facteurs immunologiques (usage thérapeutique), Glucocorticoïdes (usage thérapeutique), Humains (MeSH), Induction de rémission (MeSH), Rein (anatomopathologie), Rituximab (effets indésirables), Rituximab (usage thérapeutique), Résistance aux substances (effets des médicaments et des substances chimiques), Résultat thérapeutique (MeSH), Syndrome néphrotique (traitement médicamenteux).
- MESH :
- anatomopathologie : Rein.
- effets des médicaments et des substances chimiques : Résistance aux substances.
- effets indésirables : Facteurs immunologiques, Rituximab.
- traitement médicamenteux : Syndrome néphrotique.
- usage thérapeutique : Facteurs immunologiques, Glucocorticoïdes, Rituximab.
- Enfant, Enfant d'âge préscolaire, Humains, Induction de rémission, Résultat thérapeutique.
English descriptors
- KwdEn :
- Child (MeSH), Child, Preschool (MeSH), Drug Resistance (drug effects), Glucocorticoids (therapeutic use), Humans (MeSH), Immunologic Factors (adverse effects), Immunologic Factors (therapeutic use), Kidney (pathology), Nephrotic Syndrome (drug therapy), Remission Induction (MeSH), Rituximab (adverse effects), Rituximab (therapeutic use), Treatment Outcome (MeSH).
- MESH :
- chemical , adverse effects : Immunologic Factors, Rituximab.
- chemical , therapeutic use : Glucocorticoids, Immunologic Factors, Rituximab.
- drug effects : Drug Resistance.
- drug therapy : Nephrotic Syndrome.
- pathology : Kidney.
- Child, Child, Preschool, Humans, Remission Induction, Treatment Outcome.
Abstract
OBJECTIVES
To evaluate the efficacy and safety of rituximab in children with steroid-resistant nephrotic syndrome.
STUDY DESIGN
A systematic review evaluating the efficacy and safety of rituximab in children with steroid-resistant nephrotic syndrome was performed. Data from studies, performed before April 2017 were collected, from MEDLINE, Cochrane Library, Scopus, and Web of Science. Study eligibility criteria included clinical trials and observational studies with a minimal sample size of 5 patients, regarding treatment with rituximab in children with steroid-resistant nephrotic syndrome. Independent extraction of articles by 2 investigators using predefined data fields was performed.
RESULTS
We included 7 case series and 1 open-label randomized controlled trial. Among them, 3 studies were multicenter. A total of 226 patients were included. Mean age at onset was 5.6 ± 1.1 years. Mean number of rituximab administrations was 3.1 ± 1.1 infusions per patient. Remission was observed in 89 patients (46.4%). Remission was seen in 40.8% patients with initial steroid-resistant nephrotic syndrome and 52.8% patients with late steroid-resistant nephrotic syndrome. Good initial response to rituximab therapy was observed in 63.2% patients with minimal change nephrotic syndrome, 39.2% patients with focal and segmental glomerulosclerosis, 1 patient had diffuse mesangial hypercellularity, and 1 patient had IgM nephropathy. Sustained remission ranged from 18% to 93.7%. Five serious adverse events were observed.
CONCLUSIONS
Rituximab exhibited a satisfactory profile regarding efficacy and safety indicating that this agent is a promising therapy for steroid-resistant nephrotic syndrome and should be further investigated by randomized clinical trials.
DOI: 10.1016/j.jpeds.2018.01.008
PubMed: 29680473
Affiliations:
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Electronic address: maneljellouli@yahoo.fr.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Department of Pediatric Nephrology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis</wicri:regionArea><placeName><settlement type="city">Tunis</settlement><region nuts="2">Gouvernorat de Tunis</region></placeName></affiliation></author><author><name sortKey="Charfi, Rim" sort="Charfi, Rim" uniqKey="Charfi R" first="Rim" last="Charfi">Rim Charfi</name><affiliation wicri:level="3"><nlm:affiliation>Department of Clinical Pharmacology, National Center of Pharmacovigilance, Faculty of Medicine of Tunis, Clinical and Experimental Pharmacology Laboratory LR16SP02, Tunis El Manar University, Tunis, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Department of Clinical Pharmacology, National Center of Pharmacovigilance, Faculty of Medicine of Tunis, Clinical and Experimental Pharmacology Laboratory LR16SP02, Tunis El Manar University, Tunis</wicri:regionArea><placeName><settlement type="city">Tunis</settlement><region nuts="2">Gouvernorat de Tunis</region></placeName></affiliation></author><author><name sortKey="Maalej, Bayen" sort="Maalej, Bayen" uniqKey="Maalej B" first="Bayen" last="Maalej">Bayen Maalej</name><affiliation wicri:level="1"><nlm:affiliation>Department of Pediatrics, Pediatric Emergency and Intensive Care, Hedi Chaker Hospital, Sfax, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Department of Pediatrics, Pediatric Emergency and Intensive Care, Hedi Chaker Hospital, Sfax</wicri:regionArea><wicri:noRegion>Sfax</wicri:noRegion></affiliation></author><author><name sortKey="Mahfoud, Abdelmajid" sort="Mahfoud, Abdelmajid" uniqKey="Mahfoud A" first="Abdelmajid" last="Mahfoud">Abdelmajid Mahfoud</name><affiliation wicri:level="1"><nlm:affiliation>Department of Pediatrics, Pediatric Emergency and Intensive Care, Hedi Chaker Hospital, Sfax, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Department of Pediatrics, Pediatric Emergency and Intensive Care, Hedi Chaker Hospital, Sfax</wicri:regionArea><wicri:noRegion>Sfax</wicri:noRegion></affiliation></author><author><name sortKey="Trabelsi, Sameh" sort="Trabelsi, Sameh" uniqKey="Trabelsi S" first="Sameh" last="Trabelsi">Sameh Trabelsi</name><affiliation wicri:level="3"><nlm:affiliation>Department of Clinical Pharmacology, National Center of Pharmacovigilance, Faculty of Medicine of Tunis, Clinical and Experimental Pharmacology Laboratory LR16SP02, Tunis El Manar University, Tunis, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Department of Clinical Pharmacology, National Center of Pharmacovigilance, Faculty of Medicine of Tunis, Clinical and Experimental Pharmacology Laboratory LR16SP02, Tunis El Manar University, Tunis</wicri:regionArea><placeName><settlement type="city">Tunis</settlement><region nuts="2">Gouvernorat de Tunis</region></placeName></affiliation></author><author><name sortKey="Gargah, Tahar" sort="Gargah, Tahar" uniqKey="Gargah T" first="Tahar" last="Gargah">Tahar Gargah</name><affiliation wicri:level="3"><nlm:affiliation>Department of Pediatric Nephrology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Department of Pediatric Nephrology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis</wicri:regionArea><placeName><settlement type="city">Tunis</settlement><region nuts="2">Gouvernorat de Tunis</region></placeName></affiliation></author></analytic><series><title level="j">The Journal of pediatrics</title><idno type="eISSN">1097-6833</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Child (MeSH)</term><term>Child, Preschool (MeSH)</term><term>Drug Resistance (drug effects)</term><term>Glucocorticoids (therapeutic use)</term><term>Humans (MeSH)</term><term>Immunologic Factors (adverse effects)</term><term>Immunologic Factors (therapeutic use)</term><term>Kidney (pathology)</term><term>Nephrotic Syndrome (drug therapy)</term><term>Remission Induction (MeSH)</term><term>Rituximab (adverse effects)</term><term>Rituximab (therapeutic use)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Enfant (MeSH)</term><term>Enfant d'âge préscolaire (MeSH)</term><term>Facteurs immunologiques (effets indésirables)</term><term>Facteurs immunologiques (usage thérapeutique)</term><term>Glucocorticoïdes (usage thérapeutique)</term><term>Humains (MeSH)</term><term>Induction de rémission (MeSH)</term><term>Rein (anatomopathologie)</term><term>Rituximab (effets indésirables)</term><term>Rituximab (usage thérapeutique)</term><term>Résistance aux substances (effets des médicaments et des substances chimiques)</term><term>Résultat thérapeutique (MeSH)</term><term>Syndrome néphrotique (traitement médicamenteux)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Immunologic Factors</term><term>Rituximab</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Glucocorticoids</term><term>Immunologic Factors</term><term>Rituximab</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Rein</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Drug Resistance</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Nephrotic Syndrome</term></keywords><keywords scheme="MESH" qualifier="effets des médicaments et des substances chimiques" xml:lang="fr"><term>Résistance aux substances</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Facteurs immunologiques</term><term>Rituximab</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Kidney</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Syndrome néphrotique</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Facteurs immunologiques</term><term>Glucocorticoïdes</term><term>Rituximab</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Child</term><term>Child, Preschool</term><term>Humans</term><term>Remission Induction</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Humains</term><term>Induction de rémission</term><term>Résultat thérapeutique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To evaluate the efficacy and safety of rituximab in children with steroid-resistant nephrotic syndrome.</p></div><div type="abstract" xml:lang="en"><p><b>STUDY DESIGN</b></p><p>A systematic review evaluating the efficacy and safety of rituximab in children with steroid-resistant nephrotic syndrome was performed. Data from studies, performed before April 2017 were collected, from MEDLINE, Cochrane Library, Scopus, and Web of Science. Study eligibility criteria included clinical trials and observational studies with a minimal sample size of 5 patients, regarding treatment with rituximab in children with steroid-resistant nephrotic syndrome. Independent extraction of articles by 2 investigators using predefined data fields was performed.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>We included 7 case series and 1 open-label randomized controlled trial. Among them, 3 studies were multicenter. A total of 226 patients were included. Mean age at onset was 5.6 ± 1.1 years. Mean number of rituximab administrations was 3.1 ± 1.1 infusions per patient. Remission was observed in 89 patients (46.4%). Remission was seen in 40.8% patients with initial steroid-resistant nephrotic syndrome and 52.8% patients with late steroid-resistant nephrotic syndrome. Good initial response to rituximab therapy was observed in 63.2% patients with minimal change nephrotic syndrome, 39.2% patients with focal and segmental glomerulosclerosis, 1 patient had diffuse mesangial hypercellularity, and 1 patient had IgM nephropathy. Sustained remission ranged from 18% to 93.7%. Five serious adverse events were observed.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Rituximab exhibited a satisfactory profile regarding efficacy and safety indicating that this agent is a promising therapy for steroid-resistant nephrotic syndrome and should be further investigated by randomized clinical trials.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29680473</PMID><DateCompleted><Year>2019</Year><Month>02</Month><Day>26</Day></DateCompleted><DateRevised><Year>2019</Year><Month>04</Month><Day>19</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1097-6833</ISSN><JournalIssue CitedMedium="Internet"><Volume>197</Volume><PubDate><Year>2018</Year><Month>06</Month></PubDate></JournalIssue><Title>The Journal of pediatrics</Title><ISOAbbreviation>J Pediatr</ISOAbbreviation></Journal><ArticleTitle>Rituximab in The Management of Pediatric Steroid-Resistant Nephrotic Syndrome: A Systematic Review.</ArticleTitle><Pagination><MedlinePgn>191-197.e1</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0022-3476(18)30008-8</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jpeds.2018.01.008</ELocationID><Abstract><AbstractText Label="OBJECTIVES">To evaluate the efficacy and safety of rituximab in children with steroid-resistant nephrotic syndrome.</AbstractText><AbstractText Label="STUDY DESIGN">A systematic review evaluating the efficacy and safety of rituximab in children with steroid-resistant nephrotic syndrome was performed. Data from studies, performed before April 2017 were collected, from MEDLINE, Cochrane Library, Scopus, and Web of Science. Study eligibility criteria included clinical trials and observational studies with a minimal sample size of 5 patients, regarding treatment with rituximab in children with steroid-resistant nephrotic syndrome. Independent extraction of articles by 2 investigators using predefined data fields was performed.</AbstractText><AbstractText Label="RESULTS">We included 7 case series and 1 open-label randomized controlled trial. Among them, 3 studies were multicenter. A total of 226 patients were included. Mean age at onset was 5.6 ± 1.1 years. Mean number of rituximab administrations was 3.1 ± 1.1 infusions per patient. Remission was observed in 89 patients (46.4%). Remission was seen in 40.8% patients with initial steroid-resistant nephrotic syndrome and 52.8% patients with late steroid-resistant nephrotic syndrome. Good initial response to rituximab therapy was observed in 63.2% patients with minimal change nephrotic syndrome, 39.2% patients with focal and segmental glomerulosclerosis, 1 patient had diffuse mesangial hypercellularity, and 1 patient had IgM nephropathy. Sustained remission ranged from 18% to 93.7%. Five serious adverse events were observed.</AbstractText><AbstractText Label="CONCLUSIONS">Rituximab exhibited a satisfactory profile regarding efficacy and safety indicating that this agent is a promising therapy for steroid-resistant nephrotic syndrome and should be further investigated by randomized clinical trials.</AbstractText><CopyrightInformation>Copyright © 2018 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Jellouli</LastName><ForeName>Manel</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Pediatric Nephrology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia. Electronic address: maneljellouli@yahoo.fr.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Charfi</LastName><ForeName>Rim</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Clinical Pharmacology, National Center of Pharmacovigilance, Faculty of Medicine of Tunis, Clinical and Experimental Pharmacology Laboratory LR16SP02, Tunis El Manar University, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Maalej</LastName><ForeName>Bayen</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Pediatric Emergency and Intensive Care, Hedi Chaker Hospital, Sfax, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mahfoud</LastName><ForeName>Abdelmajid</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Pediatric Emergency and Intensive Care, Hedi Chaker Hospital, Sfax, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Trabelsi</LastName><ForeName>Sameh</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Clinical Pharmacology, National Center of Pharmacovigilance, Faculty of Medicine of Tunis, Clinical and Experimental Pharmacology Laboratory LR16SP02, Tunis El Manar University, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gargah</LastName><ForeName>Tahar</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Pediatric Nephrology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D000078182">Systematic Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>04</Month><Day>18</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Pediatr</MedlineTA><NlmUniqueID>0375410</NlmUniqueID><ISSNLinking>0022-3476</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D005938">Glucocorticoids</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007155">Immunologic Factors</NameOfSubstance></Chemical><Chemical><RegistryNumber>4F4X42SYQ6</RegistryNumber><NameOfSubstance UI="D000069283">Rituximab</NameOfSubstance></Chemical></ChemicalList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D002648" MajorTopicYN="N">Child</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002675" MajorTopicYN="N">Child, Preschool</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004351" MajorTopicYN="N">Drug Resistance</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005938" MajorTopicYN="N">Glucocorticoids</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007155" MajorTopicYN="N">Immunologic Factors</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007668" MajorTopicYN="N">Kidney</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009404" MajorTopicYN="N">Nephrotic Syndrome</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012074" MajorTopicYN="N">Remission Induction</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000069283" MajorTopicYN="N">Rituximab</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">children</Keyword><Keyword MajorTopicYN="Y">relapse</Keyword><Keyword MajorTopicYN="Y">remission</Keyword><Keyword MajorTopicYN="Y">rituximab</Keyword><Keyword MajorTopicYN="Y">steroid-resistant nephrotic syndrome</Keyword><Keyword MajorTopicYN="Y">systematic review</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>09</Month><Day>25</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>12</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2018</Year><Month>01</Month><Day>02</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>4</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>2</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>4</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29680473</ArticleId><ArticleId IdType="pii">S0022-3476(18)30008-8</ArticleId><ArticleId IdType="doi">10.1016/j.jpeds.2018.01.008</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Tunisie</li></country><region><li>Gouvernorat de Tunis</li></region><settlement><li>Tunis</li></settlement></list><tree><country name="Tunisie"><region name="Gouvernorat de Tunis"><name sortKey="Jellouli, Manel" sort="Jellouli, Manel" uniqKey="Jellouli M" first="Manel" last="Jellouli">Manel Jellouli</name></region><name sortKey="Charfi, Rim" sort="Charfi, Rim" uniqKey="Charfi R" first="Rim" last="Charfi">Rim Charfi</name><name sortKey="Gargah, Tahar" sort="Gargah, Tahar" uniqKey="Gargah T" first="Tahar" last="Gargah">Tahar Gargah</name><name sortKey="Maalej, Bayen" sort="Maalej, Bayen" uniqKey="Maalej B" first="Bayen" last="Maalej">Bayen Maalej</name><name sortKey="Mahfoud, Abdelmajid" sort="Mahfoud, Abdelmajid" uniqKey="Mahfoud A" first="Abdelmajid" last="Mahfoud">Abdelmajid Mahfoud</name><name sortKey="Trabelsi, Sameh" sort="Trabelsi, Sameh" uniqKey="Trabelsi S" first="Sameh" last="Trabelsi">Sameh Trabelsi</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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