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André E, Lemaitre F, Verdier MC, Haufroid V, Pereira JP, Hantson P. Transient Lactic Acidosis and Elevation of Transaminases after the Introduction of Remdesivir in a Patient with Acute Kidney Injury. Case Rep Crit Care 2024; 2024:6631866. [PMID: 38435396 PMCID: PMC10904205 DOI: 10.1155/2024/6631866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
A 56-year-old woman was transferred to the intensive care unit (ICU) two days after an allogeneic stem cell transplantation (ASCT) when she presented acute respiratory distress due to the relapse of a SARS-CoV-2 infection. Following that, she received two intravenous doses of 100 mg remdesivir. Subsequently, the patient developed multiple instances of diarrhea, progressing to oliguria and acute kidney injury, necessitating continuous venovenous hemofiltration (CVVH). Despite the absence of signs of hypoxemia or cardiocirculatory failure requiring vasopressor intervention, a progressive lactic acidosis emerged. Two days after the onset of lactic acidosis, a significant rise in aminotransferases and lactate dehydrogenase occurred, in the absence of encephalopathy and coagulation disorders. Remdesivir therapy had been interrupted upon the initial signs of lactic acidosis. Despite an improvement in liver function tests and lactic acidosis, the patient's condition deteriorated, ultimately leading to her demise on day 29 due to newly arising hematological complications.
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Affiliation(s)
- Elise André
- Department of Intensive Care, Cliniques Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, Environnement et travail)-UMR_S 1085, Rennes, France
- FHU SUPORT, Rennes F-35000, France
| | - Marie-Clémence Verdier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, Environnement et travail)-UMR_S 1085, Rennes, France
- FHU SUPORT, Rennes F-35000, France
| | - Vincent Haufroid
- Clinical Chemistry Department, Cliniques universitaires Saint-Luc, 1200 Brussels, Belgium
- Louvain Centre for Toxicology and Applied Pharmacology, UCLouvain, 1200 Brussels, Belgium
| | - João Pinto Pereira
- Department of Intensive Care, Cliniques Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
- Louvain Centre for Toxicology and Applied Pharmacology, UCLouvain, 1200 Brussels, Belgium
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Mascary JB, Bordeau V, Nicolas I, Verdier MC, Rocheteau P, Cattoir V. Intracellular activity and in vivo efficacy in a mouse model of septic arthritis of the novel pseudopeptide Pep16 against Staphylococcus aureus clinical isolates. JAC Antimicrob Resist 2024; 6:dlae025. [PMID: 38410249 PMCID: PMC10895697 DOI: 10.1093/jacamr/dlae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Objectives Assessing the therapeutic potential of a novel antimicrobial pseudopeptide, Pep16, both in vitro and in vivo for the treatment of septic arthritis caused by Staphylococcus aureus. Methods Seven clinical isolates of S. aureus (two MRSA and five MSSA) were studied. MICs of Pep16 and comparators (vancomycin, teicoplanin, daptomycin and levofloxacin) were determined through the broth microdilution method. The intracellular activity of Pep16 and levofloxacin was assessed in two models of infection using non-professional (osteoblasts MG-63) or professional (macrophages THP-1) phagocytic cells. A mouse model of septic arthritis was used to evaluate the in vivo efficacy of Pep16 and vancomycin. A preliminary pharmacokinetic (PK) analysis was performed by measuring plasma concentrations using LC-MS/MS following a single subcutaneous injection of Pep16 (10 mg/kg). Results MICs of Pep16 were consistently at 8 mg/L for all clinical isolates of S. aureus (2- to 32-fold higher to those of comparators) while MBC/MIC ratios confirmed its bactericidal activity. Both Pep16 and levofloxacin (when used at 2 × MIC) significantly reduced the bacterial load of all tested isolates (two MSSA and two MRSA) within both osteoblasts and macrophages. In MSSA-infected mice, Pep16 demonstrated a significant (∼10-fold) reduction on bacterial loads in knee joints. PK analysis following a single subcutaneous administration of Pep16 revealed a gradual increase in plasma concentrations, reaching a peak of 5.6 mg/L at 12 h. Conclusions Pep16 is a promising option for the treatment of septic arthritis due to S. aureus, particularly owing to its robust intracellular activity.
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Affiliation(s)
- Jean-Baptiste Mascary
- Inserm U1230 BRM (Bacterial RNAs and Medicine), Université de Rennes, Rennes, France
- SAS Olgram, Bréhan, France
| | - Valérie Bordeau
- Inserm U1230 BRM (Bacterial RNAs and Medicine), Université de Rennes, Rennes, France
| | | | | | | | - Vincent Cattoir
- CHU de Rennes, Service de Bactériologie-Hygiène hospitalière, 2 rue Henri Le Guilloux, 35033 Rennes, France
- CNR de la Résistance aux Antibiotiques (laboratoire associé 'Entérocoques'), CHU de Rennes, Rennes, France
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Luque-Paz D, Verdier MC, Lefèvre CR, Chauvin P, Goter T, Armange L, Bayeh B, Lalanne S, Tattevin P, Jouneau S. Pleural penetration of amoxicillin and metronidazole during pleural infection: An ambispective cohort study. Int J Antimicrob Agents 2023; 62:107004. [PMID: 37839716 DOI: 10.1016/j.ijantimicag.2023.107004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/06/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES The pharmacokinetics of antibiotics in pleural fluid during pleural infections has been poorly described. This study aimed to explore amoxicillin and metronidazole diffusion into the pleural space. METHODS This was an ambispective, single-centre study that included patients with complicated parapneumonic effusion or pleural empyema managed with repeated therapeutic thoracentesis as first-line treatment between 2014 and 2022. Pleural steady-state or trough concentrations of amoxicillin and metronidazole were measured, with a lower limit of quantification of 5 mg/L. RESULTS Seventy paired blood and pleural samples were analysed from 40 patients. The median (interquartile range) patient age was 55 years (45-67 years) and 88% were male. The median patient weight was 65.8 kg (57.3-82 kg) and median plasma albumin concentration was 29.7 g/L (23.7-33.9 g/L). Median creatinine clearance was 106 mL/min (95-117 mL/min). Median amoxicillin pleural concentrations in patients treated with oral, bolus and continuous intravenous administrations (6 g/day) were, respectively, 5.2 (<5-6.4), 9.4 (8-13.1) and 10.8 (7.1-13.1) mg/L. Pleural concentrations were <5 mg/L in 5/11 samples (45%) with oral treatment and 6/59 (10%) with intravenous treatment. Median metronidazole pleural concentrations were 18.4 (15.7-22.8) mg/L, with all patients being treated orally (1.5 g/day). CONCLUSIONS Oral metronidazole (1.5 g/day) and intravenous amoxicillin (6 g/day) achieved therapeutic targets in pleural fluid in most cases, but oral amoxicillin did not.
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Affiliation(s)
- David Luque-Paz
- Department of Respiratory Diseases, Rennes University Hospital, Rennes, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR 1230, Rennes, France.
| | - Marie-Clémence Verdier
- Clinical Pharmacology Department, CHU Rennes, Rennes, France; University of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Charles R Lefèvre
- Biochemistry Laboratory, Pontchaillou Hospital CHU Rennes, Rennes, France
| | - Pierre Chauvin
- Department of Respiratory Diseases, Rennes University Hospital, Rennes, France
| | - Thomas Goter
- Department of Respiratory Diseases, Rennes University Hospital, Rennes, France
| | - Lucas Armange
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | | | | | - Pierre Tattevin
- Department of Respiratory Diseases, Rennes University Hospital, Rennes, France; University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR 1230, Rennes, France
| | - Stéphane Jouneau
- Department of Respiratory Diseases, Rennes University Hospital, Rennes, France; University of Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
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Boglione-Kerrien C, Zerrouki S, Le Bot A, Camus C, Marchand T, Bellissant E, Tron C, Verdier MC, Gangneux JP, Lemaitre F. Can we predict the influence of inflammation on voriconazole exposure? An overview. J Antimicrob Chemother 2023; 78:2630-2636. [PMID: 37796931 DOI: 10.1093/jac/dkad293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Voriconazole is a triazole antifungal indicated for invasive fungal infections that exhibits a high degree of inter-individual and intra-individual pharmacokinetic variability. Voriconazole pharmacokinetics is non-linear, making dosage adjustments more difficult. Therapeutic drug monitoring is recommended by measurement of minimum plasma concentrations. Several factors are responsible for the high pharmacokinetic variability of voriconazole: age, feeding (which decreases absorption), liver function, genetic polymorphism of the CYP2C19 gene, drug interactions and inflammation. Invasive fungal infections are indeed very frequently associated with inflammation, which engenders a risk of voriconazole overexposure. Many studies have reviewed this topic in both the adult and paediatric populations, but few studies have focused on the specific point of the prediction, to evaluate the influence of inflammation on voriconazole pharmacokinetics. Predicting the impact of inflammation on voriconazole pharmacokinetics could help optimize antifungal therapy and improve patient management. This review summarizes the existing data on the influence of inflammation on voriconazole pharmacokinetics in adult populations. We also evaluate the role of C-reactive protein, the impact of inflammation on patient metabolic phenotypes, and the tools that can be used to predict the effect of inflammation on voriconazole pharmacokinetics.
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Affiliation(s)
- Christelle Boglione-Kerrien
- Rennes University Hospital, Department of Biological Pharmacology, 2, rue Henri le Guilloux, F-35000 Rennes, France
| | - Selim Zerrouki
- Rennes University Hospital, Department of Biochemistry, Rennes, France
| | - Audrey Le Bot
- Rennes University Hospital, Department of Infectious Diseases, Rennes, France
| | - Christophe Camus
- Rennes University Hospital, Department of Intensive Care Medicine, Rennes, France
| | - Tony Marchand
- Rennes University Hospital, Department of Clinical Haematology, Rennes, France
| | - Eric Bellissant
- Rennes University Hospital, Department of Biological Pharmacology, 2, rue Henri le Guilloux, F-35000 Rennes, France
- INSERM, CIC-P 1414 Clinical Investigation Centre, Rennes, France
- Rennes University Hospital, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) -UMR_S 1085, F-35000 Rennes, France
| | - Camille Tron
- Rennes University Hospital, Department of Biological Pharmacology, 2, rue Henri le Guilloux, F-35000 Rennes, France
- INSERM, CIC-P 1414 Clinical Investigation Centre, Rennes, France
- Rennes University Hospital, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) -UMR_S 1085, F-35000 Rennes, France
| | - Marie-Clémence Verdier
- Rennes University Hospital, Department of Biological Pharmacology, 2, rue Henri le Guilloux, F-35000 Rennes, France
- INSERM, CIC-P 1414 Clinical Investigation Centre, Rennes, France
- Rennes University Hospital, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) -UMR_S 1085, F-35000 Rennes, France
| | - Jean-Pierre Gangneux
- Rennes University Hospital, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) -UMR_S 1085, F-35000 Rennes, France
- Rennes University Hospital, Department of Parasitology and Mycology, National Reference Centre for Mycoses and Antifungals (LA Asp-C) and European Excellence Centre in Medical Mycology (ECMM EC), Rennes, France
| | - Florian Lemaitre
- Rennes University Hospital, Department of Biological Pharmacology, 2, rue Henri le Guilloux, F-35000 Rennes, France
- INSERM, CIC-P 1414 Clinical Investigation Centre, Rennes, France
- Rennes University Hospital, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) -UMR_S 1085, F-35000 Rennes, France
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Couette A, Tron C, Golbin L, Franck B, Houssel-Debry P, Frouget T, Morin MP, Brenier H, Rayar M, Verdier MC, Vigneau C, Chemouny J, Lemaitre F. Area under the curve of tacrolimus using microsampling devices: towards precision medicine in solid organ transplantation? Eur J Clin Pharmacol 2023; 79:1549-1556. [PMID: 37725122 DOI: 10.1007/s00228-023-03566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Therapeutic drug monitoring of tacrolimus using trough concentration (Cmin) is mandatory to ensure drug efficacy and safety in solid organ transplantation. However, Cmin is just a proxy for the area under the curve of drug concentrations (AUC) which is the best pharmacokinetic parameter for exposure evaluation. Some studies suggest that patients may present discrepancies between these two parameters. AUC is now easily available through mini-invasive microsampling approach. The aim of this study is to evaluate the relationship between AUC and Cmin in patients benefiting from a complete pharmacokinetic profile using a microsampling approach. METHODS Fifty-one transplant recipients benefited from a complete pharmacokinetic profile using a microsampling approach, and their 24-h AUC were calculated using the trapezoidal method. The correlation with Cmin was then explored. In parallel, we estimated AUC using the sole Cmin and regression equations according to the post-transplantation days and the galenic form. RESULTS Weak correlations were found between 24-h AUC observed and the corresponding Cmin (R2 = 0.60) and between AUC observed and expected using the sole Cmin (R2 = 0.62). Therapeutic drug monitoring of tacrolimus using Cmin leads to over- or under-estimate drug exposure in 40.3% of patients. CONCLUSION Tacrolimus Cmin appears to be an imperfect reflection of drug exposure. Evaluating AUC using a microsampling approach offers a mini-invasive strategy to monitor tacrolimus treatment in transplant recipients.
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Affiliation(s)
- Aurélien Couette
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France
| | - Camille Tron
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France
- INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
- FHU SUPORT, Rennes, F-35000, France
| | - Léonard Golbin
- FHU SUPORT, Rennes, F-35000, France
- Department of Nephrology, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
| | - Bénédicte Franck
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France
- INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
- FHU SUPORT, Rennes, F-35000, France
| | - Pauline Houssel-Debry
- Liver Disease Unit, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
| | - Thierry Frouget
- Department of Nephrology, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
| | - Marie-Pascale Morin
- Department of Nephrology, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
| | - Henri Brenier
- Department of Nephrology, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
| | - Michel Rayar
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France
- INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
- Liver Disease Unit, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
| | - Marie-Clémence Verdier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France
- INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
- FHU SUPORT, Rennes, F-35000, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France
- FHU SUPORT, Rennes, F-35000, France
- Department of Nephrology, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
| | - Jonathan Chemouny
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France
- INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
- FHU SUPORT, Rennes, F-35000, France
| | - Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR S 1085, F-35000 Rennes, France.
- INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France.
- FHU SUPORT, Rennes, F-35000, France.
- Pharmacology Department, Hôpital Pontchaillou, CHU de Rennes, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France.
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Lalanne S, Cattoir V, Guerin F, Verdier MC, Revest M. Differential response to antibiotic therapy in staphylococcal infective endocarditis: contribution of an ex vivo model. J Antimicrob Chemother 2023:7185844. [PMID: 37248684 DOI: 10.1093/jac/dkad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Staphylococcal infective endocarditis (IE) remains a hard-to-treat infection with high mortality. Both the evaluation of new innovative therapies and research on alternative models mimicking human IE are therefore urgently needed to improve the prognosis of patients with diagnosed IE. Dalbavancin is a novel anti-staphylococcal lipoglycopeptide but there are limited data supporting its efficacy on biofilm infections. This antibiotic could be an alternative to current therapies for the medical treatment of IE but it needs to be further evaluated. METHODS Here we developed an original ex vivo model of Staphylococcus aureus IE on human heart valves and assessed biofilm formation on them. After validating the model, the efficacy of two antistaphylococcal antibiotics, vancomycin and dalbavancin, was compared by measuring and visualizing their respective ability to inhibit and eradicate late-formed biofilm. RESULTS Determination of the minimum biofilm inhibitory (MbIC) and eradicating (MbEC) concentrations in our ex vivo model identified dalbavancin as a promising drug with much lower MbIC and MBEC than vancomycin (respectively <0.01 versus 28 mg/L and 0.03 versus 32 mg/L). CONCLUSIONS These data highlight a strong bactericidal effect of dalbavancin, particularly on an infected heart valve compared with vancomycin. Dalbavancin could be a realistic alternative treatment for the management of staphylococcal IE.
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Affiliation(s)
- Sébastien Lalanne
- Department of Pharmacology, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S 1085, 2 avenue du Professeur Léon Bernard, F-35000 Rennes, France
- Univ Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_S 1230, 2 avenue du Professeur Léon Bernard, F-35000 Rennes, France
| | - Vincent Cattoir
- Univ Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_S 1230, 2 avenue du Professeur Léon Bernard, F-35000 Rennes, France
- Department of Bacteriology, Univ Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
| | - François Guerin
- Department of Bacteriology, Univ Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
| | - Marie-Clémence Verdier
- Department of Pharmacology, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S 1085, 2 avenue du Professeur Léon Bernard, F-35000 Rennes, France
| | - Matthieu Revest
- Univ Rennes, CHU Rennes, Infectious Diseases and Intensive Care Unit, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
- Univ Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_S 1230, 2 avenue du Professeur Léon Bernard, F-35000 Rennes, France
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Dorel M, Albert R, Bot AL, Caillault L, Lalanne S, Tattevin P, Verdier MC, Lemaignen A, Revest M. Amoxicillin therapeutic drug monitoring for endocarditis: a comparative study (EI-STAB). Int J Antimicrob Agents 2023; 62:106821. [PMID: 37088439 DOI: 10.1016/j.ijantimicag.2023.106821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION International guidelines recommend high doses of beta-lactams for most infective endocarditis (IE). Therapeutic drug monitoring (TDM) is increasingly used to adjust the dose based on plasma concentrations, although no comparative study supports these practices. We aimed to evaluate the benefit of amoxicillin TDM during IE. METHODS An observational retrospective cohort study of all adults treated with high-dose amoxicillin for enterococcal or streptococcal IE was conducted in two referral centers. We compared patients with, or without TDM. The primary outcome was mean daily amoxicillin dose. RESULTS We enrolled 206 streptococcal (n=140, 68%) or enterococcal (n=66, 32%) IE, on native valve (n=129, 63%) or prosthetic valve (n=77, 37%). There were 154 men (75%), mean age was 70 ± 14 years, valvular surgery was performed in 81/206 (39%) patients, and in-hospital mortality was 8% (17/206). All patients in the TDM group and the vast majority of them in the other group received amoxicillin as continuous infusion. Amoxicillin TDM was performed for 114 patients (55.3%), with a mean of 4.7 +/- 2.3 measures per patient, a mean plasma steady-state concentration of 41.2 +/- 19 mg/L, most (82/114, 72%) being within the therapeutic target (20-80 mg/L). Mean amoxicillin dose was lower in patients with TDM (10.0 +/- 3.3 g/day vs 11.3 +/- 2.0 g/day in patients without TDM, P=0.003). CONCLUSION Amoxicillin TDM was associated with a reduction in daily doses, with no impact on adverse events and prognosis. Individualized treatment of IE through TDM may contribute to decreased use of antibiotics.
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Affiliation(s)
- Marie Dorel
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France
| | - Robin Albert
- Infectious Diseases and Tropical Medicine Unit, CHRU de Tours, Tours, France
| | - Audrey Le Bot
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France
| | - Leila Caillault
- Internal Medicine Unit, CHU Rennes, 35033 Rennes Cedex, France
| | - Sébastien Lalanne
- Univ Rennes, Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France; University of Rennes, Inserm, BRM, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, F-3500 Rennes, France
| | - Marie-Clémence Verdier
- Univ Rennes, Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France
| | - Adrien Lemaignen
- Infectious Diseases and Tropical Medicine Unit, CHRU de Tours, Tours, France; University of Tours, Tours, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, CHU Rennes, 35033 Rennes Cedex, France; Inserm, CIC 1414, CHU Rennes, 35033 Rennes Cedex, France; University of Rennes, Inserm, BRM, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, F-3500 Rennes, France.
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Coste G, Chabanne C, Tron C, Lelong B, Verdier MC, Roussel M, Le Gall F, Turlin B, Desille-Dugast M, Flécher E, Laviolle B, Lemaitre F. Blood, Cellular, and Tissular Calcineurin Inhibitors Pharmacokinetic-Pharmacodynamic Relationship in Heart Transplant Recipients: The INTRACAR Study. Ther Drug Monit 2023; 45:229-235. [PMID: 36006706 DOI: 10.1097/ftd.0000000000001025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND After heart transplantation, calcineurin inhibitors (CNI) (cyclosporin A and tacrolimus) are key immunosuppressive drugs to prevent graft rejection. Whole-blood concentration (C blood )-guided therapeutic drug monitoring (TDM) is systematically performed to improve graft outcomes. However, some patients will still experience graft rejection and/or adverse events despite CNI C blood within the therapeutic range. Other pharmacokinetic parameters, such as the intragraft, or intracellular concentration at the CNI site of action could refine their TDM. Nonetheless, these remain to be explored. The objective of the INTRACAR study was to describe the relationship between whole blood, intragraft, and intracellular CNI concentrations as well as their efficacy in heart transplant recipients (HTR). METHODS In a cohort of HTR, protocol endomyocardial biopsies (EMB) were collected to assess rejection by anatomopathological analysis. Part of the EMB was used to measure the intragraft concentrations of CNI (C EMB ). C blood and the concentration inside peripheral blood mononuclear cells, (C PBMC ), a cellular fraction enriched with lymphocytes, were also monitored. Concentrations in the 3 matrices were compared between patients with and without biopsy-proven acute rejection (BPAR). RESULTS Thirty-four HTR were included, representing nearly 100 pharmacokinetic (PK) samples for each CNI. C blood , C EMB , and C PBMC correlated for both CNI. BPAR was observed in 74 biopsies (39.6%) from 26 patients (76.5%), all except one was of low grade. None of the PK parameters (C blood , C EMB , C PBMC , C EMB/blood , and C PBMC/blood ) was associated with BPAR. CONCLUSIONS In this cohort of well-immunosuppressed patients, no association was observed for any of the PK parameters, including C blood , with the occurrence of BPAR. However, a trend was noticed for the C EMB and C EMB/blood of cyclosporin A. Further studies in higher-risk patients may help optimize the use of C EMB and C PBMC for CNI TDM in HTR.
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Affiliation(s)
- Gwendal Coste
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR S 1085, EHESP, Inserm, CHU Rennes
- INSERM, Centre d'Investigation Clinique
- Laboratoire de pharmacologie biologique, Centre Hospitalier Universitaire de Rennes
| | - Céline Chabanne
- Service de chirurgie cardio-thoracique et vasculaire, Centre Hospitalier Universitaire de Rennes
| | - Camille Tron
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR S 1085, EHESP, Inserm, CHU Rennes
- INSERM, Centre d'Investigation Clinique
- Laboratoire de pharmacologie biologique, Centre Hospitalier Universitaire de Rennes
| | - Bernard Lelong
- Service de chirurgie cardio-thoracique et vasculaire, Centre Hospitalier Universitaire de Rennes
| | - Marie-Clémence Verdier
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR S 1085, EHESP, Inserm, CHU Rennes
- INSERM, Centre d'Investigation Clinique
- Laboratoire de pharmacologie biologique, Centre Hospitalier Universitaire de Rennes
| | - Mikael Roussel
- Laboratoire d'hématologie, Centre Hospitalier Universitaire de Rennes
- Université de Rennes, Établissement Français du Sang (EFS) de Bretagne, Inserm, MICMAC-UMR_S1236
| | - François Le Gall
- Laboratoire d'anatomie et cytologie pathologiques, Centre Hospitalier Universitaire de Rennes
| | - Bruno Turlin
- Laboratoire d'anatomie et cytologie pathologiques, Centre Hospitalier Universitaire de Rennes
- Centre de Ressources Biologiques (CRB) Santé de Rennes BB-0033-00056, Centre Hospitalier Universitaire de Rennes
| | - Mireille Desille-Dugast
- Centre de Ressources Biologiques (CRB) Santé de Rennes BB-0033-00056, Centre Hospitalier Universitaire de Rennes
| | - Erwan Flécher
- INSERM, Centre d'Investigation Clinique
- Service de chirurgie cardio-thoracique et vasculaire, Centre Hospitalier Universitaire de Rennes
- Laboratoire Traitement du Signal et de l'Image (LTSI) unité mixte 1099 INSERM; and
- FHU SUPORT, Rennes, France
| | - Bruno Laviolle
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR S 1085, EHESP, Inserm, CHU Rennes
- INSERM, Centre d'Investigation Clinique
- Laboratoire de pharmacologie biologique, Centre Hospitalier Universitaire de Rennes
- FHU SUPORT, Rennes, France
| | - Florian Lemaitre
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR S 1085, EHESP, Inserm, CHU Rennes
- INSERM, Centre d'Investigation Clinique
- Laboratoire de pharmacologie biologique, Centre Hospitalier Universitaire de Rennes
- FHU SUPORT, Rennes, France
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9
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Lalanne S, Bouzillé G, Tron C, Revest M, Polard E, Bellissant E, Verdier MC, Lemaitre F. Amoxicillin-Induced Neurotoxicity: Contribution of a Healthcare Data Warehouse to the Determination of a Toxic Concentration Threshold. Antibiotics (Basel) 2023; 12:antibiotics12040680. [PMID: 37107042 PMCID: PMC10135267 DOI: 10.3390/antibiotics12040680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Amoxicillin (AMX)-induced neurotoxicity is well described and may be associated with AMX overexposure. No neurotoxic concentration threshold has been determined thus far. A better knowledge of maximum tolerable AMX concentrations is of importance to improve the safety of high doses of AMX. Methods: We conducted a retrospective study using the local hospital data warehouse EhOP® to generate a specific query related to AMX neurotoxicity symptomatology. All patient medical reports containing a mention of neurotoxicity clinical symptoms coupled with AMX plasma concentration measurements were explored. Patients were classified into two groups according to the imputability of AMX in the onset of their neurotoxicity, on the basis of chronological and semiological criteria. A receiver-operating characteristic curve was performed to identify an AMX neurotoxic steady-state concentration (Css) threshold. Results: The query identified 101 patients among 2054 patients benefiting from AMX TDM. Patients received a median daily dose of 9 g AMX, with a median creatinine clearance of 51 mL/min. A total of 17 of the 101 patients exhibited neurotoxicity attributed to AMX. The mean Css was higher for patients with neurotoxicity attributed to AMX (118 ± 62 mg/L) than those without 74 ± 48 mg/L (p = 0.002). A threshold AMX concentration of 109.7 mg/L predicted the occurrence of neurotoxicity. Conclusions: This study identified, for the first time, an AMX Css threshold of 109.7 mg/L associated with an excess risk of neurotoxicity. This approach needs to be confirmed by a prospective study with systematic neurological evaluation and TDM.
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Affiliation(s)
- Sébastien Lalanne
- Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche Ensanté, Environnement et Travail) UMR_S 1085, University of Rennes, 35000 Rennes, France
- Correspondence:
| | - Guillaume Bouzillé
- CHU Rennes, Inserm, LTSI—UMR 1099, University of Rennes, 35000 Rennes, France
| | - Camille Tron
- Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche Ensanté, Environnement et Travail) UMR_S 1085, University of Rennes, 35000 Rennes, France
| | - Matthieu Revest
- CHU Rennes, Infectious Diseases and Intensive Care Unit, 2 Rue Henri Le Guilloux, University of Rennes, 35033 Rennes, France
| | - Elisabeth Polard
- Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche Ensanté, Environnement et Travail) UMR_S 1085, University of Rennes, 35000 Rennes, France
| | - Eric Bellissant
- Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche Ensanté, Environnement et Travail) UMR_S 1085, University of Rennes, 35000 Rennes, France
| | - Marie-Clémence Verdier
- Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche Ensanté, Environnement et Travail) UMR_S 1085, University of Rennes, 35000 Rennes, France
| | - Florian Lemaitre
- Department of Pharmacology, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche Ensanté, Environnement et Travail) UMR_S 1085, University of Rennes, 35000 Rennes, France
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10
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Manczak B, Verdier MC, Dewulf JP, Lemaitre F, Haufroid V, Hantson P. Lactic acidosis after allogeneic haematopoietic stem cell transplantation potentially related to letermovir. Br J Clin Pharmacol 2023; 89:1686-1689. [PMID: 36748282 DOI: 10.1111/bcp.15686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
A 53-year-old woman with a history of acute myeloid leukaemia received a second allogeneic haematopoietic stem cell transplant and was prescribed, among other medications, acyclovir and letermovir (480-mg daily oral dose) for prophylaxis of, respectively, herpes simplex and cytomegalovirus infection. The patient was admitted in the intensive care unit for dyspnoea and oliguria. Laboratory investigations revealed acute kidney injury but also a severe and progressive lactic acidosis. Liver function tests were within normal range. The combination of lactic acidosis, hypoglycaemia and acylcarnitine profile in plasma raised the suspicion of mitochondrial toxicity. Letermovir therapy was interrupted, and determination of plasma letermovir pharmacokinetics revealed a prolonged terminal half-life (38.7 h) that was not significantly influenced by continuous venovenous haemofiltration. Exploration for genetic polymorphisms revealed that the patient was SLCO1B1*5/*15 (c.521T>C homozygous carrier and c.388A>G heterozygous carrier) with a predicted nonfunctional organic anion transporting polypeptide 1B1 protein. The relationship between letermovir accumulation and development of lactic acidosis requires further observations.
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Affiliation(s)
- Bérénice Manczak
- Department of Intensive Care, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marie-Clémence Verdier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Rennes, France.,FHU SUPORT, Rennes, France
| | - Joseph P Dewulf
- Clinical Chemistry Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Rennes, France.,FHU SUPORT, Rennes, France
| | - Vincent Haufroid
- Clinical Chemistry Department, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Louvain Centre for Toxicology and Applied Pharmacology, UCLouvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Louvain Centre for Toxicology and Applied Pharmacology, UCLouvain, Brussels, Belgium
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11
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Boglione-Kerrien C, Morcet J, Scailteux LM, Bénézit F, Camus C, Mear JB, Gangneux JP, Bellissant E, Tron C, Verdier MC, Lemaitre F. Contribution of voriconazole N-oxide plasma concentration measurements to voriconazole therapeutic drug monitoring in patients with invasive fungal infection. Mycoses 2023; 66:396-404. [PMID: 36698317 DOI: 10.1111/myc.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Voriconazole (VRC), a widely used triazole antifungal, exhibits significant inter- and intra-individual pharmacokinetic variability. The main metabolite voriconazole N-oxide (NOX) can provide information on the patient's drug metabolism capacity. OBJECTIVES Our objectives were to implement routine measurement of NOX concentrations and to describe the metabolic ratio (MR), and the contribution of the MR to VRC therapeutic drug monitoring (TDM) by proposing a suggested dosage-adjustment algorithm. PATIENTS AND METHODS Sixty-one patients treated with VRC were prospectively included in the study, and VRC and NOX levels were assayed by LC-MS/MS. A mixed logistic model on repeated measures was implemented to analyse risk factors for the patient's concentration to be outside the therapeutic range. RESULTS Based on 225 measurements, the median and interquartile range were 2.4 μg/ml (1.2; 4.2), 2.1 μg/ml (1.5; 3.0) and 1.0 (0.6; 1.9) for VRC, NOX and the MR, respectively. VRC Cmin <2 μg/ml were associated with a higher MR during the previous visit. MR values >1.15 and <0.48 were determined to be the best predictors for having a VRC Cmin lower than 2 μg/ml and above 5.5 μg/ml, respectively, at the next visit. CONCLUSIONS Measurement of NOX resulted useful for TDM of patients treated with VRC. The MR using NOX informed interpretation and clinical decision-making and is very interesting for complex patients. VRC phenotyping based on the MR is now performed routinely in our institution. A dosing algorithm has been suggested from these results.
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Affiliation(s)
| | - Jeff Morcet
- Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Lucie-Marie Scailteux
- Department of Clinical Pharmacology, Rennes University Hospital, Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes, France
| | - François Bénézit
- Department of Infectious Diseases, Rennes University Hospital, Rennes, France
| | - Christophe Camus
- Department of Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Jean-Baptiste Mear
- Department of Clinical Haematology, Rennes University Hospital, Rennes, France
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Eric Bellissant
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Camille Tron
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Marie-Clémence Verdier
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Florian Lemaitre
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
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12
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Pontis A, Delavenne X, Verdier MC, Hodin S, Andriamaharo A, Gueret P, Nedelec-Gac F, Bachelot-Loza C, Gaussem P, Gouin-Thibault I. Impact of age on in vitro metabolism of clopidogrel: a potential explanation for high on-treatment platelet reactivity in the elderly? Res Pract Thromb Haemost 2023; 7:100014. [PMID: 36891520 PMCID: PMC9986101 DOI: 10.1016/j.rpth.2022.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/07/2022] [Indexed: 01/08/2023] Open
Abstract
Background High on-treatment platelet reactivity has been reported in 30% of patients on clopidogrel and 50% in elderly patients; however, little is known about the mechanisms of this biological resistance. One hypothesis is an age-related impaired hepatic metabolism of the prodrug clopidogrel, leading to a lower formation of its active metabolite (clopidogrel-AM). Objectives To compare the levels of clopidogrel-AM formed in vitro using "old" and "young" human liver microsomes (HLMs) and their consequences on platelet functions. Methods We developed an in vitro model using "old" (73.6 ± 2.3 years) and "young" (51.2 ± 8.5 years) HLMs, added to platelet-rich plasma from 21 healthy donors with or without clopidogrel (50 μM) and incubated at 37 °C for 30 (T30) and 45 minutes (T45). Clopidogrel-AM was quantified by liquid chromatography-mass spectrometry/mass spectrometry method. Platelet aggregation was performed by light transmission aggregometry. Results The generation of clopidogrel-AM increased over time and reached concentrations comparable with those reported in treated patients. At T30, mean clopidogrel-AM concentrations were significantly higher with "young" (8.56 μg/L; 95% CI, 5.87-11.24) than with "old" HLMs (7.64 μg/L; 95% CI, 5.14-10.14; P = .002); and at T45, 11.40 μg/L; 95% CI (7.57-15.22) vs 10.63 μg/L, 95% CI (7.10-14.15), P = .02 (n = 21). Despite a significant inhibition of platelet aggregation, no significant difference was found in light transmission aggregometry (adenosine diphosphate, 10 μM) after clopidogrel metabolism by "old" or "young" HLMs, probably because of low sensitivity of the method to small variations of clopidogrel-AM. Conclusion In this original model combining metabolic and functional approaches, less clopidogrel-AM was produced with HLMs from older patients. This provides support for a decreased CYP450 activity that may contribute to high on-treatment platelet reactivity in elderly patients.
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Affiliation(s)
- Adeline Pontis
- Laboratoire d'Hématologie, Pontchaillou University Hospital, Rennes, France
- INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, Rennes, France
| | - Xavier Delavenne
- Laboratoire de Pharmacologie Toxicologie, Saint-Etienne University Hospital, Saint-Etienne, France
- INSERM, UMR_S1059, Université de Lyon, Saint-Etienne, France
| | - Marie-Clémence Verdier
- INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, Rennes, France
- Laboratoire de Pharmacologie Clinique, Pontchaillou University Hospital, Rennes, France
| | - Sophie Hodin
- Laboratoire de Pharmacologie Toxicologie, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Annie Andriamaharo
- Laboratoire de Pharmacologie Clinique, Pontchaillou University Hospital, Rennes, France
| | - Pierre Gueret
- Laboratoire d'Hématologie, Pontchaillou University Hospital, Rennes, France
| | | | | | - Pascale Gaussem
- Université de Paris Cité, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Service d'Hématologie Biologique, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Isabelle Gouin-Thibault
- Laboratoire d'Hématologie, Pontchaillou University Hospital, Rennes, France
- INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, Rennes, France
- Correspondence Isabelle Gouin-Thibault, Laboratoire d'Hématologie, Pontchaillou University Hospital, INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, 35000, Rennes, France.
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13
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Lalanne S, Guérin F, Flécher E, Cattoir V, Nesseler N, Revest M, Verdier MC. Diffusion of amoxicillin into heart valves from infective endocarditis patients. J Antimicrob Chemother 2022; 78:232-237. [PMID: 36378501 DOI: 10.1093/jac/dkac379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Amoxicillin is the drug of choice in the management of streptococcal and enterococcal infective endocarditis (IE) but little is known regarding amoxicillin diffusion into infected heart valves. Herein, we assessed amoxicillin valvular distribution and related pharmacokinetic/pharmacodynamic (PK/PD) target attainment in IE patients undergoing heart valve surgery. PATIENTS AND METHODS In this 2-year prospective study, patients with IE treated by continuous infusion of amoxicillin and undergoing a surgical valve replacement were included. Both amoxicillin plasma and tissue concentrations were measured the day of surgery. Amoxicillin concentration in plasma and crushed heart valves were measured by a validated liquid chromatography method coupled with ultra-violet and tandem mass spectrometry, respectively. MIC and MBC of amoxicillin were determined for all available isolates. The rate of achievement of PK/PD efficacy parameters were assessed. RESULTS Twenty-two heart valves were removed from 20 patients. Bacterial aetiology was streptococcal (n = 17) and enterococcal (n = 3). Amoxicillin mean daily dose was 12 ± 3 g/24 h, mean plasma concentration was 29 ± 21 mg/L (n = 15), mean tissue concentration was 23 ± 15 mg/L (n = 22). Median diffusion rate was 62%. Patients reached a plasma concentration target >4XCMI (n = 13). Tissue concentrations were bactericidal for all streptococcal IE but not for enterococcal IE. CONCLUSIONS Amoxicillin intravalvular measurements in IE treated patients showed significant penetration into the infectious site. These data are reassuring that in situ bactericidal concentrations can be largely achieved in the management of streptococcal IE and support the need for combination antibiotic therapy for enterococcal IE.
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Affiliation(s)
- Sébastien Lalanne
- Department of Pharmacology, University of Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France.,INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
| | - François Guérin
- Department of Bacteriology, University of Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
| | - Erwan Flécher
- Department of Thoracic and Cardiovascular Surgery, University of Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
| | - Vincent Cattoir
- Department of Bacteriology, University of Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France.,University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_S 1230, 2 Avenue du Professeur Léon Bernard, F-35000 Rennes, France
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, University of Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, University of Rennes, CHU Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France.,University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_S 1230, 2 Avenue du Professeur Léon Bernard, F-35000 Rennes, France
| | - Marie-Clémence Verdier
- Department of Pharmacology, University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) UMR_S 1085, 2 Avenue du Professeur Léon Bernard, F-35000 Rennes, France.,INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000, 2 Rue Henri Le Guilloux, 35033 Rennes cedex, Rennes, France
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14
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Duval X, Franck B, Revest M, Tron C, Chemouny JM, Lalanne S, Houot R, Verdier MC, Lemaitre F. Comparison of different equations for renal function evaluation as proxies for antibiotic drug clearance: the examples of amoxicillin and cloxacillin. Clin Biochem 2022; 109-110:86-89. [PMID: 36108718 DOI: 10.1016/j.clinbiochem.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
Abstract
The most appropriate renal function estimation equation to predict drug clearance is a matter of debate. In this study, we compare the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease Epidemiology collaboration (CKD-EPI) and the Cockroft-Gault (CG) equations to predict amoxicillin and cloxacillin clearance among hospitalized patients receiving high doses of these antibiotic treatments. This study aimed to compare different equations used to predict amoxicillin and cloxacillin clearance among hospitalized patients receiving amoxicillin or cloxacillin treatments outside the intensive care unit. Data from 128 patients contributing 268 plasma samples was analyzed, and correlations between the equations and the amoxicillin and cloxacillin antibiotic clearance rates were calculated. We found a correlation between antibiotic clearance and all the renal function estimation equations, CG being the best, with a R2 of 0.35 for amoxicillin and 0.29 for cloxacillin (compared to 0.26 and 0.21 for MDRD and 0.12 and 0.24 for CKD-EPI). CG should be preferentially used as a proxy for amoxicillin and cloxacillin drug clearance, but the use of completely different tools such as therapeutic drug monitoring could help individualize antibiotic dosage.
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Affiliation(s)
- Xavier Duval
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Bénédicte Franck
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Matthieu Revest
- Unité Inserm U1230, Université de Rennes 1, Rennes, France; Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
| | - Camille Tron
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Jonathan M Chemouny
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Sébastien Lalanne
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Roch Houot
- Department of Hematology, University Hospital of Rennes, Rennes, France; INSERM, U1236, Rennes, France
| | - Marie-Clémence Verdier
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Florian Lemaitre
- Irset (Institut de Recherche en Santé, Environnement et Travail)- UMR S 1085, EHESP, Inserm, CHU Rennes, Université Rennes 1, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
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15
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Tron C, Bouvet R, Verdier MC, Lamoureux F, Hennart B, Dubourg C, Bellissant E, Galibert MD. A Robust and Fast/Multiplex Pharmacogenetics Assay to Simultaneously Analyze 17 Clinically Relevant Genetic Polymorphisms in CYP3A4, CYP3A5, CYP1A2, CYP2C9, CYP2C19, CYP2D6, ABCB1, and VKORC1 Genes. Pharmaceuticals (Basel) 2022; 15:ph15050637. [PMID: 35631462 PMCID: PMC9145594 DOI: 10.3390/ph15050637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
In the field of pharmacogenetics, the trend is to analyze a panel of several actionable genetic polymorphisms. It may require the use of high-throughput sequencing which demands expensive reagents/instruments and specific skills to interpret results. As an alternative, the aim of this work was to validate an easy, fast, and inexpensive multiplex pharmacogenetics assay to simultaneously genotype a panel of 17 clinically actionable variants involved in drug pharmacokinetics/pharmacodynamics. We designed primers to perform a multiplex PCR assay using a single mix. Primers were labeled by two fluorescent dye markers to discriminate alleles, while the size of the PCR fragments analyzed by electrophoresis allowed identifying amplicon. Polymorphisms of interest were CYP3A4*22, CYP3A5*3, CYP1A2*1F, CYP2C9*2-*3, CYP2C19*2-*3-*17, VKORC1-1639G > A, ABCB1 rs1045642-rs1128503-rs2229109-rs2032582, and CYP2D6*3-*4-*6-*9. The assay was repeatable and a minimum quantity of 10 ng of DNA/ sample was needed to obtain accurate results. The method was applied to a validation cohort of 121 samples and genotyping results were consistent with those obtained with reference methods. The assay was fast and cost-effective with results being available within one working-day. This robust assay can easily be implemented in laboratories as an alternative to cumbersome simplex assays or expensive multiplex approaches. Together it should widespread access to pharmacogenetics in clinical routine practice.
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Affiliation(s)
- Camille Tron
- Pharmacology Department, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Univ Rennes, F-35000 Rennes, France; (M.-C.V.); (E.B.)
- Correspondence: ; Tel.: +33-2-99-28-42-80
| | - Régis Bouvet
- Department of Molecular Genetics and Genomics, Rennes Hospital University, F-35000 Rennes, France; (R.B.); (C.D.); (M.-D.G.)
| | - Marie-Clémence Verdier
- Pharmacology Department, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Univ Rennes, F-35000 Rennes, France; (M.-C.V.); (E.B.)
| | | | - Benjamin Hennart
- CHU Lille, Service de Toxicologie et Génopathies, F-59000 Lille, France;
| | - Christèle Dubourg
- Department of Molecular Genetics and Genomics, Rennes Hospital University, F-35000 Rennes, France; (R.B.); (C.D.); (M.-D.G.)
- CNRS, IGDR (Institut de Génétique et Développement de Rennes)-UMR 6290, Univ Rennes, F-35000 Rennes, France
| | - Eric Bellissant
- Pharmacology Department, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Univ Rennes, F-35000 Rennes, France; (M.-C.V.); (E.B.)
| | - Marie-Dominique Galibert
- Department of Molecular Genetics and Genomics, Rennes Hospital University, F-35000 Rennes, France; (R.B.); (C.D.); (M.-D.G.)
- CNRS, IGDR (Institut de Génétique et Développement de Rennes)-UMR 6290, Univ Rennes, F-35000 Rennes, France
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16
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Duval X, Lemaitre F, Pertuisel S, Probert J, Gandemer V, Verdier MC, Tron C. The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report. BMC Infect Dis 2021; 21:1143. [PMID: 34749667 PMCID: PMC8573890 DOI: 10.1186/s12879-021-06828-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022] Open
Abstract
Background Ganciclovir pharmacokinetics is characterized by a high variability in drug exposure. Usually, monitoring of ganciclovir exposure is performed by measuring trough concentration. However, due to the specificity of pediatric pharmacokinetics, trough concentration measurements may not be a relevant surrogate of ganciclovir exposure. Area under the curve of concentration (AUC) may be a more appropriate biomarker. Case presentation We report the case of 3.6-year-old boy with Emberger syndrome with a cytomegalovirus reactivation occurring after allogenic hematopoietic stem cell transplantation. After a few days of treatment with intravenous ganciclovir, sub-therapeutic trough ganciclovir concentrations were measured (< 0.5 µg/mL) and viral load still increased. Ganciclovir dosage was increased by two-fold to deal with this treatment failure. Trough concentrations remained sub-therapeutic. The patient had hematologic disorder therefore it was decided to estimate ganciclovir AUC to assess more accurately drug exposure before any further dosage modification. AUC0–12 h was measured at 51 μg h/mL, which was within the therapeutic range (40–60 μg h/mL). Afterward, viral load decreased and became undetectable. Conclusions This case report highlights that monitoring ganciclovir exposure based on AUC should be performed to tailor drug dosage in order to improve treatment efficacy and safety in pediatric patients.
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Affiliation(s)
- Xavier Duval
- Laboratory of Clinical Pharmacology, University Hospital of Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
| | - Florian Lemaitre
- Laboratory of Clinical Pharmacology, University Hospital of Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France.,Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, 35000, Rennes, France
| | - Sophie Pertuisel
- Department of Paediatric Hemato-Oncology, University Hospital of Rennes, 35000, Rennes, France
| | - Jamie Probert
- Department of Paediatric Hemato-Oncology, University Hospital of Rennes, 35000, Rennes, France
| | - Virginie Gandemer
- Department of Paediatric Hemato-Oncology, University Hospital of Rennes, 35000, Rennes, France
| | - Marie-Clémence Verdier
- Laboratory of Clinical Pharmacology, University Hospital of Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France.,Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, 35000, Rennes, France
| | - Camille Tron
- Laboratory of Clinical Pharmacology, University Hospital of Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France. .,Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, University of Rennes, 35000, Rennes, France.
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17
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Lemaitre F, Fily F, Foulquier JB, Revest M, Jullien V, Petitcollin A, Tattevin P, Tron C, Polard JL, Verdier MC, Comets E, Huten D, Arvieux C, Bellissant E, Laviolle B. Development of a dosing-adjustment tool for fluoroquinolones in osteoarticular infections: The Fluo-pop study. Biomed Pharmacother 2021; 142:112053. [PMID: 34435591 DOI: 10.1016/j.biopha.2021.112053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022] Open
Abstract
Fluoroquinolones efficacy depend on both the drug exposure and the level of drug resistance of the bacteria responsible for the infection. Specifically for the Staphylococcus species, which is the microorganism mainly involved in osteoarticular infections (OAI), in-vitro data reported that an AUC/MIC ratio above 115 h maximizes drug efficacy. However, data on OAI patients are lacking and a simple approach to access AUCs is still a clinical issue. We conducted a prospective, single-center study in 30 OAI patients hospitalized in the Rennes University Hospital to model ofloxacin pharmacokinetics and to define a limited sampling strategy (LSS) suitable for ofloxacin and levofloxacin treatments. Modeling was conducted with the Monolix software. The final model was externally validated using levofloxacin data. Monte-Carlo simulations were used to evaluate the probability of target attainment (PTA) of different dosing regimens. Two hundred and ninety-seven (297) ofloxacin concentrations were available for the pharmacokinetic modeling. Ofloxacin pharmacokinetics was best described using a bicompartmental model with a first order elimination, and a transit compartment model absorption. CKD-EPI and sex explained half of ofloxacin pharmacokinetic variability. For LSS, the 0, 1 h and 3 h sampling scheme resulted in the best approach both for BID and TID dosages (R2 adjusted = 91.1% and 95.0%, outliers = 4.8% and 5.0%, respectively). PTA allows choosing the best drug and dosage according to various hypotheses. A simple 3-sample protocol (pre-dose, 1 h after intake and 3 h after intake) to estimate ofloxacin and levofloxacin AUC allows optimal drug dosage for the treatment of osteoarticular infections.
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Affiliation(s)
- Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France.
| | - Fabien Fily
- Epicentre, 55 rue Crozatier, 75012, Paris, France; Infectious Diseases Unit, Broussais Hospital, Saint Malo, France
| | - Jean-Baptiste Foulquier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France
| | - Matthieu Revest
- INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR, France
| | - Vincent Jullien
- University Paris 13, groupe hospitalier Paris Seine-Saint-Denis, Assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Molecular Mycology Unit-CNRS UMR 2000, Pasteur Institute, 75015 Paris, France
| | | | - Pierre Tattevin
- INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR, France
| | - Camille Tron
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France
| | - Jean-Louis Polard
- Department of Orthopaedic Surgery and Traumatology, Pontchaillou University Hospital, 2 Avenue Henri Le Guilloux, 35203 Rennes, France
| | - Marie-Clémence Verdier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France
| | - Emmanuelle Comets
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France
| | - Denis Huten
- Department of Orthopaedic Surgery and Traumatology, Pontchaillou University Hospital, 2 Avenue Henri Le Guilloux, 35203 Rennes, France
| | - Cédric Arvieux
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR, France; Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France
| | - Eric Bellissant
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France
| | - Bruno Laviolle
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique, CIC 1414, F-35000 Rennes, France
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18
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Tron C, Belleguic C, Piau C, Brinchault G, Deneuville E, Ricordel C, Kayal S, Bellissant E, Verdier MC, Lemaitre F. Determination of amoxicillin and cotrimoxazole concentrations in sputum of patients with cystic fibrosis. Biomed Chromatogr 2021; 35:e5208. [PMID: 34212399 DOI: 10.1002/bmc.5208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/09/2022]
Abstract
In the management of cystic fibrosis, treatments against Staphylococcus aureus and Haemophilus influenzae such as amoxicillin or cotrimoxazole have to be prescribed and the antibiotherapy's efficacy may be linked to the concentration that reaches the infected site. As cystic fibrosis patients present disturbed pharmacokinetics parameters, drug monitoring would be relevant to assess the lung distribution of antibiotics and to optimize dosing regimens. In this context, the aim of the study was to develop and validate HPLC-based methods for the determination of both antibiotics in bronchial sputum from cystic fibrosis patients, in order to assess the distribution of the drugs into the lungs. Plasma proteins were precipitated by acetonitrile and amoxicillin concentrations in sputum were determined by HPLC coupled with tandem-mass spectrometry. Following liquid extraction with ethyl acetate, cotrimoxazole was quantified by HPLC using ultraviolet detection. Both methods were rapid, specific, accurate and reproducible. The method was applied to patient samples. In three treated patients, concentrations of amoxicillin in sputum were similar and below the lower limit of quantification (0.1 μg/g) and in six patients, sputum concentrations up to 11.1 and 6.4 μg/g were measured for sulfamethoxazole and trimethoprim, respectively.
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Affiliation(s)
- Camille Tron
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
| | - Chantal Belleguic
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Caroline Piau
- Bacteriology-Hygiene Unit, Rennes university hospital, Rennes, France
| | - Graziella Brinchault
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Eric Deneuville
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Charles Ricordel
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, Rennes, France
| | - Samer Kayal
- Bacteriology-Hygiene Unit, Rennes university hospital, Rennes, France
| | - Eric Bellissant
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
| | - Marie-Clémence Verdier
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
| | - Florian Lemaitre
- Université Rennes, CHU Rennes, Inserm, EHESP, Institut de recherche en santé, environnement et travail - UM_SR, Rennes, France
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19
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Lemaitre F, Locher C, Verdier MC, Naudet F. Clinical trials during pandemics and beyond: time for a more efficient pharmacological strategy. J Antimicrob Chemother 2021; 76:2234-2236. [PMID: 34075390 PMCID: PMC8195206 DOI: 10.1093/jac/dkab190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, clinical trials on antiviral or symptomatic drugs have been conducted very rapidly even for drugs with a poor pharmacological rationale for efficacy on SARS-CoV-2. Despite lacking basic pharmacological information, most of these clinical trials were also extremely redundant. Applying simple rules, (such as identifying a mechanistic rationale, confirming the ability to reach exposure targets at therapeutic dosage and ensuring tests show drug efficacy in appropriate in vitro and animal models before entering clinical trials) might have saved considerable amounts of time and money, and might have avoided useless research. Moreover, combining these simple rules with the implementation of a relevant policy at both an international and a national level, by limiting studies with a poor methodological/scientific approach and aggregating studies with similar design into single clinical trials, is potentially a far more-efficient strategy.
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Affiliation(s)
- Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Cliniqu1e de Rennes)], F- 35000, Rennes, France
| | - Clara Locher
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Cliniqu1e de Rennes)], F- 35000, Rennes, France
| | - Marie-Clémence Verdier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Cliniqu1e de Rennes)], F- 35000, Rennes, France
| | - Florian Naudet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Cliniqu1e de Rennes)], F- 35000, Rennes, France
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20
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Tron C, Ferrand-Sorre MJ, Querzerho-Raguideau J, Chemouny JM, Houssel-Debry P, Verdier MC, Bellissant E, Lemaitre F. Volumetric absorptive microsampling for the quantification of tacrolimus in capillary blood by high performance liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1165:122521. [PMID: 33486216 DOI: 10.1016/j.jchromb.2020.122521] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
Volumetric absorptive microsampling (VAMS) is an innovative alternative strategy to venipuncture for monitoring tacrolimus levels in transplant recipients. In this study, we aimed to validate a new high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method for quantifying tacrolimus in blood collected by VAMS. Tacrolimus was extracted from dried blood tips in an original process involving sonication, protein precipitation and salting out. The assay was validated in accordance with EMA and IATDMCT guidelines. For clinical validation, the tacrolimus concentrations measured in liquid venous whole blood (with the reference method) were compared with those measured in capillary whole blood collected simultaneously with VAMS by a nurse. The assay was then used to monitor tacrolimus exposure in transplant recipients. The method was linear, sensitive and fast. Within-day and between-day precisions and overall bias were within ±15%. No significant hematocrit effect was observed. The matrix effect was negligible and recovery exceeded 80% for every concentration and hematocrit levels. Tacrolimus was stable in blood collected by VAMS for 1 week at room temperature, 48 h at 60 °C and 4 °C and 1 month at -80 °C. Clinical validation (n = 42 paired samples) demonstrated a strong correlation between the two methods (r = 0.97 Pearson correlation). Bland-Altman analysis revealed that more than 90% of the differences between VAMS and liquid blood paired concentrations were within the ±20% acceptable range. The method had a satisfactory analytical performance and fulfilled clinical requirements. This minimally invasive VAMS-based assay appears reliable for the determination of tacrolimus levels in blood from transplanted patients.
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Affiliation(s)
- Camille Tron
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France.
| | - Marie-José Ferrand-Sorre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France
| | - Julie Querzerho-Raguideau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France
| | - Jonathan M Chemouny
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France
| | - Pauline Houssel-Debry
- Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France; Department of Liver Diseases, Rennes University Hospital, Rennes, France
| | - Marie-Clémence Verdier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France
| | - Eric Bellissant
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France
| | - Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France
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21
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Bouvet R, Verdier MC, El Baroudi Y, Galibert MD, David V, Schutz S, Tron C. PharmFrag: An Easy and Fast Multiplex Pharmacogenetics Assay to Simultaneously Analyze 9 Genetic Polymorphisms Involved in Response Variability of Anticancer Drugs. Int J Mol Sci 2020; 21:ijms21249650. [PMID: 33348915 PMCID: PMC7766892 DOI: 10.3390/ijms21249650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Regarding several cytotoxic agents, it was evidenced that genetic polymorphisms in genes encoding enzymes involved in their metabolism are associated with higher risk of toxicity. Genotyping these genes before treatment is a valuable strategy to prevent side effects and to predict individual response to drug therapy. This pharmacogenetic approach is recommended for chemotherapies such as thiopurines (azathioprine, 6-mercaptopurine, thioguanine), irinotecan, and fluoropyrimidines (capecitabine and 5-fluorouracil). In this study, we aimed at developing and validating a fast, cost-effective, and easily implementable multiplex genotyping method suitable for analyzing a panel of nine variants involved in the pharmacogenetics of widely prescribed anticancer drugs. We designed a multiplex-specific PCR assay where fragments were labeled by two different fluorescent dye markers (HEX/FAM) identifiable by fragment analysis. These two labels were used to discriminate bi-allelic variants, while the size of the fragment allowed the identification of a particular polymorphism location. Variants of interest were TPMT (rs1800462, rs1142345, rs1800460), NUDT15 (rs116855232), DPYD (rs55886062, rs3918290, rs67376798, rs75017182), and UGT1A1 (rs8175347). The assay was repeatable, and genotypes could be determined when DNA sample amounts ranged from 25 to 100 ng. Primers and dye remained stable in a ready-to-use mixture solution after five freeze–thaw cycles. Accuracy was evidenced by the consistency of 187 genotyping results obtained with our multiplex assay and a reference method. The developed method is fast and cost-effective in simultaneously identifying nine variants involved in the pharmacological response of anticancer drugs. This assay can be easily implemented in laboratories for widespread access to pharmacogenetics in clinical practice.
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Affiliation(s)
- Régis Bouvet
- Department of Molecular Genetics and Genomics, Rennes University Hospital, 35000 Rennes, France; (R.B.); (Y.E.B.); (M.-D.G.); (V.D.); (S.S.)
| | - Marie-Clémence Verdier
- IRSET (Institut de Recherche en Santé, Environnement et Travail), University of Rennes, CHU Rennes, EHESP, UMR_S 1085, 35000 Rennes, France;
- Inserm, Centre D’investigation Clinique 1414, Rennes University Hospital, 35000 Rennes, France
- Pharmacology Department, Rennes University Hospital, 35000 Rennes, France
| | - Yahya El Baroudi
- Department of Molecular Genetics and Genomics, Rennes University Hospital, 35000 Rennes, France; (R.B.); (Y.E.B.); (M.-D.G.); (V.D.); (S.S.)
| | - Marie-Dominique Galibert
- Department of Molecular Genetics and Genomics, Rennes University Hospital, 35000 Rennes, France; (R.B.); (Y.E.B.); (M.-D.G.); (V.D.); (S.S.)
| | - Véronique David
- Department of Molecular Genetics and Genomics, Rennes University Hospital, 35000 Rennes, France; (R.B.); (Y.E.B.); (M.-D.G.); (V.D.); (S.S.)
| | - Sacha Schutz
- Department of Molecular Genetics and Genomics, Rennes University Hospital, 35000 Rennes, France; (R.B.); (Y.E.B.); (M.-D.G.); (V.D.); (S.S.)
- Genetic Laboratory Department, Brest University Hospital, 29200 Brest, France
| | - Camille Tron
- IRSET (Institut de Recherche en Santé, Environnement et Travail), University of Rennes, CHU Rennes, EHESP, UMR_S 1085, 35000 Rennes, France;
- Inserm, Centre D’investigation Clinique 1414, Rennes University Hospital, 35000 Rennes, France
- Pharmacology Department, Rennes University Hospital, 35000 Rennes, France
- Correspondence: ; Tel.: +33-(0)-299-284280; Fax: +33-(0)-299-284184
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Tron C, Coste G, Lalanne S, Bernard A, Jan YG, Ferrand-Sorre MJ, Verdier MC, Bellissant E, Lemaitre F. A simple and fast liquid chromatography tandem mass spectrometry method to determine cyclosporine A concentrations in endomyocardial biopsies. J Pharm Biomed Anal 2020; 193:113664. [PMID: 33160221 DOI: 10.1016/j.jpba.2020.113664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022]
Abstract
Measuring cyclosporine A (CsA), an immunosuppressive drug used to prevent heart transplant rejection, concentrations in myocardial biopsies might be more informative than its measurement in whole blood. Therefore, a fast, accurate and reproductive method to determine CsA concentration in this complex matrix is needed. We report the validation of a liquid chromatography tandem mass spectrometry method to measure CsA concentration in heart parenchyma, applicable to everyday practice. The method was found to be precise, accurate, reproducible, specific of CsA, and without any matrix effect or carry-over. The lower limit of quantification was 50 pg of CsA in myocardium. The method was linear up to 2000 pg of CsA in myocardium. Samples were found stable for one year at - 80 °C. At last, 40 drugs which could be prescribed to heart transplant recipients were tested with the method and showed no interference with CsA signal. The method was suitable to quantify CsA in endomyocardial biopsies from heart transplanted patients. This method allows designing clinical studies aiming at exploring the relationship between CsA intra-graft concentrations and outcome.
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Affiliation(s)
- Camille Tron
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France.
| | - Gwendal Coste
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Sébastien Lalanne
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Aurélie Bernard
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Yann-Gaël Jan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Marie-José Ferrand-Sorre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Marie-Clémence Verdier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Eric Bellissant
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
| | - Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; INSERM, Centre d'Investigation Clinique 1414, F-35000 Rennes, France
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23
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Crémieux AC, Dinh A, Nordmann P, Mouton W, Tattevin P, Ghout I, Jayol A, Aimer O, Gatin L, Verdier MC, Saleh-Mghir A, Laurent F. Efficacy of colistin alone and in various combinations for the treatment of experimental osteomyelitis due to carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother 2020; 74:2666-2675. [PMID: 31263884 DOI: 10.1093/jac/dkz257] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES In a new experimental model of carbapenemase-producing Klebsiella pneumoniae osteomyelitis we evaluated the efficacy of colistin alone and in various combinations and examined the emergence of colistin-resistant strains and cross-resistance to host defence peptides (HDPs). METHODS KPC-99YC is a clinical strain with intermediate susceptibility to meropenem (MIC = 4 mg/L) and full susceptibility to gentamicin, colistin and tigecycline (MICs = 1 mg/L) and fosfomycin (MIC = 32 mg/L). Time-kill curves were performed at 4× MIC. Osteomyelitis was induced in rabbits by tibial injection of 2 × 108 cfu. Treatment started 14 days later for 7 days in seven groups: (i) control; (ii) colistin; (iii) colistin + gentamicin; (iv) colistin + tigecycline; (v) colistin + meropenem; (vi) colistin + meropenem + gentamicin; and (vii) colistin + fosfomycin. RESULTS In vitro, colistin was rapidly bactericidal, but regrowth occurred after 9 h. Combinations of colistin with meropenem or fosfomycin were synergistic, whereas combination with tigecycline was antagonistic. In vivo, colistin alone was not effective. Combinations of colistin with meropenem or fosfomycin were bactericidal (P < 0.001) and the addition of gentamicin enhanced the efficacy of colistin + meropenem (P = 0.025). Tigecycline reduced the efficacy of colistin (P = 0.007). Colistin-resistant strains emerged in all groups except colistin + fosfomycin and two strains showed cross-resistance to HDP LL-37. CONCLUSIONS In this model, combinations of colistin plus meropenem, with or without gentamicin, or colistin plus fosfomycin were the only effective therapies. The combination of colistin and tigecycline should be administered with caution, as it may be antagonistic in vitro and in vivo.
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Affiliation(s)
- Anne-Claude Crémieux
- St Louis Hospital, Paris 7 University, Paris, France.,UMR 1173, Versailles Saint-Quentin University, Versailles, France
| | - Aurélien Dinh
- UMR 1173, Versailles Saint-Quentin University, Versailles, France.,Raymond Poincaré University Hospital, Garches, France
| | - Patrice Nordmann
- Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science and Medicine, INSERM European Unit (IAME, France), Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
| | - William Mouton
- Team 'Staphylococcal pathogenesis', International Centre for Infectiology Research, INSERM U1111 - CNRS UMR5308 - ENS Lyon - Lyon 1 University, Lyon, France.,Institute for Infectious Agents, Department of Bacteriology - CNR des staphylocoques, Croix-Rousse Hospital, North Biology Centre, Hospices Civils de Lyon, Lyon, France
| | - Pierre Tattevin
- Pontchaillou University Hospital, Rennes, France.,INSERM U1230, Rennes 1 University, IFR140, F-35033, Rennes, France
| | - Idir Ghout
- AP-HP, Ambroise Paré University Hospital, Boulogne, France
| | - Aurelie Jayol
- Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science and Medicine, INSERM European Unit (IAME, France), Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
| | - Omar Aimer
- Department of Pharmacy, Raymond-Poincaré University Hospital, Garches, France
| | - Laure Gatin
- UMR 1173, Versailles Saint-Quentin University, Versailles, France
| | - Marie-Clémence Verdier
- Pontchaillou University Hospital, Rennes, France.,INSERM U1230, Rennes 1 University, IFR140, F-35033, Rennes, France
| | - Azzam Saleh-Mghir
- UMR 1173, Versailles Saint-Quentin University, Versailles, France.,Raymond Poincaré University Hospital, Garches, France
| | - Frédéric Laurent
- Team 'Staphylococcal pathogenesis', International Centre for Infectiology Research, INSERM U1111 - CNRS UMR5308 - ENS Lyon - Lyon 1 University, Lyon, France.,Institute for Infectious Agents, Department of Bacteriology - CNR des staphylocoques, Croix-Rousse Hospital, North Biology Centre, Hospices Civils de Lyon, Lyon, France
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24
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Painvin B, Guillot P, Verdier MC, Gacouin A, Maamar A. Hydroxychloroquine pharmacokinetic in COVID-19 critically ill patients: an observational cohort study. Intensive Care Med 2020; 46:1772-1773. [PMID: 32514594 PMCID: PMC7276495 DOI: 10.1007/s00134-020-06142-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Benoit Painvin
- Service de Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
| | - Pauline Guillot
- Service de Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Marie-Clémence Verdier
- Laboratoire de Pharmacologie Biologique, Centre Hospitalier Universitaire Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.,Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Arnaud Gacouin
- Service de Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.,Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Adel Maamar
- Service de Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.,Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
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25
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Tron C, Woillard JB, Houssel-Debry P, David V, Jezequel C, Rayar M, Balakirouchenane D, Blanchet B, Debord J, Petitcollin A, Roussel M, Verdier MC, Bellissant E, Lemaitre F. Pharmacogenetic-Whole blood and intracellular pharmacokinetic-Pharmacodynamic (PG-PK2-PD) relationship of tacrolimus in liver transplant recipients. PLoS One 2020; 15:e0230195. [PMID: 32163483 PMCID: PMC7067455 DOI: 10.1371/journal.pone.0230195] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/24/2020] [Indexed: 12/21/2022] Open
Abstract
Tacrolimus (TAC) is the cornerstone of immunosuppressive therapy in liver transplantation. This study aimed at elucidating the interplay between pharmacogenetic determinants of TAC whole blood and intracellular exposures as well as the pharmacokinetic-pharmacodynamic relationship of TAC in both compartments. Complete pharmacokinetic profiles (Predose, and 20 min, 40 min, 1h, 2h, 3h, 4h, 6h, 8h, 12h post drug intake) of twice daily TAC in whole blood and peripheral blood mononuclear cells (PBMC) were collected in 32 liver transplanted patients in the first ten days post transplantation. A non-parametric population pharmacokinetic model was applied to explore TAC pharmacokinetics in blood and PBMC. Concurrently, calcineurin activity was measured in PBMC. Influence of donor and recipient genetic polymorphisms of ABCB1, CYP3A4 and CYP3A5 on TAC exposure was assessed. Recipient ABCB1 polymorphisms 1199G>A could influence TAC whole blood and intracellular exposure (p<0.05). No association was found between CYP3A4 or CYP3A5 genotypes and TAC whole blood or intracellular concentrations. Finally, intra-PBMC calcineurin activity appeared incompletely inhibited by TAC and less than 50% of patients were expected to achieve intracellular IC50 concentration (100 pg/millions of cells) at therapeutic whole blood concentration (i.e.: 4–10 ng/mL). Together, these data suggest that personalized medicine regarding TAC therapy might be optimized by ABCB1 pharmacogenetic biomarkers and by monitoring intracellular concentration whereas the relationship between intracellular TAC exposure and pharmacodynamics biomarkers more specific than calcineurin activity should be further investigated.
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Affiliation(s)
- Camille Tron
- Rennes 1 University, Rennes University Hospital, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)—UMR_S 1085, Rennes, France
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France
- * E-mail:
| | - Jean-Baptiste Woillard
- Department of Pharmacology and Toxicology, Limoges University Hospital, Limoges, France
- INSERM, UMR 1248, Limoges, France
- Limoges University, Limoges, France
| | - Pauline Houssel-Debry
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France
- Hepato-Biliary and Digestive Surgery Unit, Rennes University Hospital, Rennes, France
| | - Véronique David
- Department of Molecular Genetics and Genomics, Rennes University Hospital, Rennes, France
- CNRS, UMR6290, IGDR, Rennes, France
| | - Caroline Jezequel
- Hepato-Biliary and Digestive Surgery Unit, Rennes University Hospital, Rennes, France
| | - Michel Rayar
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France
- Hepato-Biliary and Digestive Surgery Unit, Rennes University Hospital, Rennes, France
| | - David Balakirouchenane
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pharmacokinetics and Pharmacochemistry Department, Cochin Hospital, Paris, France
| | - Benoit Blanchet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pharmacokinetics and Pharmacochemistry Department, Cochin Hospital, Paris, France
- CNRS, UMR8638, Faculty of Pharmacy, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Jean Debord
- Department of Pharmacology and Toxicology, Limoges University Hospital, Limoges, France
- INSERM, UMR 1248, Limoges, France
| | | | - Mickaël Roussel
- Haematology Laboratory, Rennes University Hospital, Rennes, France
| | - Marie-Clémence Verdier
- Rennes 1 University, Rennes University Hospital, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)—UMR_S 1085, Rennes, France
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France
| | - Eric Bellissant
- Rennes 1 University, Rennes University Hospital, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)—UMR_S 1085, Rennes, France
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France
| | - Florian Lemaitre
- Rennes 1 University, Rennes University Hospital, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)—UMR_S 1085, Rennes, France
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France
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26
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Lalanne S, Le Vée M, Lemaitre F, Le Corre P, Verdier MC, Fardel O. Differential interactions of the β-lactam cloxacillin with human renal organic anion transporters (OATs). Fundam Clin Pharmacol 2020; 34:476-483. [PMID: 32100322 DOI: 10.1111/fcp.12541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 01/17/2023]
Abstract
The β-lactam penicillin antibiotic cloxacillin (CLX) presents wide inter-individual pharmacokinetics variability. To better understand its molecular basis, the precise identification of the detoxifying actors involved in CLX disposition and elimination would be useful, notably with respect to renal secretion known to play a notable role in CLX elimination. The present study was consequently designed to analyze the interactions of CLX with the solute carrier transporters organic anion transporter (OAT) 1 and OAT3, implicated in tubular secretion through mediating drug entry at the basolateral pole of renal proximal cells. CLX was first shown to block OAT1 and OAT3 activity in cultured OAT-overexpressing HEK293 cells. Half maximal inhibitory concentration (IC50 ) value for OAT3 (13 µm) was however much lower than that for OAT1 (560 µm); clinical inhibition of OAT activity and drug-drug interactions may consequently be predicted for OAT3, but not OAT1. OAT3, unlike OAT1, was next shown to mediate CLX uptake in OAT-overexpressing HEK293 cells. Kinetic parameters for this OAT3-mediated transport of CLX (Km = 10.7 µm) were consistent with a possible in vivo saturation of this process for high CLX plasma concentrations. OAT3 is consequently likely to play a pivotal role in renal CLX secretion and consequently in total renal CLX elimination, owing to the low plasma unbound fraction of the antibiotic. OAT3 genetic polymorphisms as well as co-administered drugs inhibiting in vivo OAT3 activity may therefore be considered as potential sources of CLX pharmacokinetics variability.
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Affiliation(s)
- Sébastien Lalanne
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Univ Rennes, CHU Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Marc Le Vée
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Florian Lemaitre
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Univ Rennes, CHU Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Pascal Le Corre
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, CHU Rennes, Univ Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Marie-Clémence Verdier
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Univ Rennes, CHU Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
| | - Olivier Fardel
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, CHU Rennes, Univ Rennes, 2 avenue du Professeur Léon Bernard, F-35000, Rennes, France
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27
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Gatin L, Mghir AS, Mouton W, Laurent F, Ghout I, Rioux-Leclercq N, Tattevin P, Verdier MC, Cremieux AC. Colistin-containing cement spacer for treatment of experimental carbapenemase-producing Klebsiella pneumoniae prosthetic joint infection. Int J Antimicrob Agents 2019; 54:456-462. [PMID: 31319190 DOI: 10.1016/j.ijantimicag.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/29/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) are emerging multidrug-resistant bacteria responsible for invasive infections, including prosthetic joint infections (PJIs). Local administration of colistin may provide bactericidal concentrations in situ. This study evaluated the efficacy of a colistin-impregnated cement spacer, alone and in combination with systemic antibiotics, in a rabbit model of CPE-PJI. Elution of 3 MIU of colistimethate sodium (CMS) in 40 g of poly(methyl methacrylate) cement was studied in vitro. In vivo, 5 × 108 CFU of KPC-producing Klebsiella pneumoniae (colistin and meropenem MICs of 1 mg/L and 4 mg/L, respectively) were injected close to a prosthetic knee. Surgical debridement and prosthesis removal were performed 7 days later, and rabbits were assigned to six treatment groups (11-13 rabbits each): drug-free spacer; colistin-loaded spacer; colistin intramuscular (i.m.); colistin i.m. + colistin spacer; colistin i.m. + meropenem subcutaneous (s.c.); and colistin i.m. + meropenem s.c. + colistin spacer. Systemic treatment was administered at doses targeting pharmacokinetics in humans, and rabbits were euthanised 7 days later to evaluate bacterial counts in infected bones. In vitro, CMS elution was low (<0.1% at 24 h) but reached a local concentration of ≥20 mg/L (>20 × MIC). In vivo, combinations of local and systemic colistin, with or without meropenem, were the only regimens superior to the control group (P ≤ 0.05) in terms of viable bacterial counts and the proportion of rabbits with sterile bone, with no emergence of colistin-resistant strains. Colistin-loaded cement spacer in combination with systemic antibiotics were the most effective regimens in this CPE-PJI model.
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Affiliation(s)
- L Gatin
- UMR U1173 Université Versailles St-Quentin, Versailles, France; Service d'Orthopédie et traumatologie, Hôpital Raymond Poincaré, Garches, France
| | - A Saleh Mghir
- UMR U1173 Université Versailles St-Quentin, Versailles, France
| | - W Mouton
- Laboratoire de Bactériologie, Hôpital de la Croix Rousse, Centre National de Référence des Staphylocoques Unité Inserm 851, Faculté de Médecine Lyon Est, Lyon, France
| | - F Laurent
- Laboratoire de Bactériologie, Hôpital de la Croix Rousse, Centre National de Référence des Staphylocoques Unité Inserm 851, Faculté de Médecine Lyon Est, Lyon, France
| | - I Ghout
- URC Paris-Ouest, Laboratoire de Biostatistiques, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - N Rioux-Leclercq
- Service d'Anatomopathologie, Hôpital Pontchaillou, CHU de Rennes, Rennes, France
| | - P Tattevin
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, CHU de Rennes, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France.
| | - M C Verdier
- Laboratoire de Pharmacologie Biologique, Hôpital Pontchaillou, CHU de Rennes, Rennes, France
| | - A C Cremieux
- UMR U1173 Université Versailles St-Quentin, Versailles, France; Service des maladies infectieuses Hôpital Saint Louis AP-HP, Université Paris 7, Paris, France
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Fily F, Jolivet-Gougeon A, Polard E, Gicquel T, Dupont M, Verdier MC, Arvieux C. Moxifloxacin-rifampicin combination for the treatment of non-staphylococcal Gram-positive orthopedic implant-related infections. Med Mal Infect 2019; 49:540-544. [PMID: 31277834 DOI: 10.1016/j.medmal.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/07/2018] [Accepted: 06/19/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We aimed to describe the effectiveness and safety of the moxifloxacin-rifampicin combination in non-staphylococcal Gram-positive orthopedic implant-related infections. METHODS Patients treated with the moxifloxacin-rifampicin combination for an implant-related infection from November 2014 to November 2016 were retrospectively identified from the database of the referral centers for bone and joint infections in Western France. RESULTS Twenty-three cases of infection due to Streptococcus spp. (n=12), Cutibacteriumacnes (n=6), and Enterococcus faecalis (n=5) were included. Ten patients with hip prosthesis were included. Infection was polymicrobial in 11 cases. According to the MIC, moxifloxacin was 1.5 to 11.7 times as active as levofloxacin against non-staphylococcal Gram-positive bacteria. We reported an 81.8% success rate, and no severe adverse effect. CONCLUSION The moxifloxacin-rifampicin combination is a valuable alternative for the treatment of non-staphylococcal Gram-positive implant-related infections because of the good activity of moxifloxacin against these bacteria and the potential activity on the biofilm.
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Affiliation(s)
- F Fily
- Unité des maladies infectieuses, hôpital Broussais, 1, rue de la Marne, 35400 Saint-Malo, France; Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France.
| | - A Jolivet-Gougeon
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Laboratoire de microbiologie, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - E Polard
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service de pharmacologie clinique et biologique et centre de pharmacovigilance, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - T Gicquel
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - M Dupont
- Unité des maladies infectieuses, hôpital Broussais, 1, rue de la Marne, 35400 Saint-Malo, France
| | - M C Verdier
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service de pharmacologie clinique et biologique et centre de pharmacovigilance, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - C Arvieux
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service des maladies infectieuses et réanimation médicale, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
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Boglione-Kerrien C, Verdier MC, Gautier-Veyret E, Hennart B, Belaz S, Revest M, Lemaitre F. Using unusual drug-drug interactions to maximize voriconazole treatment efficacy. Med Mal Infect 2019; 49:555-557. [PMID: 31178201 DOI: 10.1016/j.medmal.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/10/2018] [Accepted: 05/17/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Christelle Boglione-Kerrien
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, 35033 Rennes, France.
| | - Marie-Clémence Verdier
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, 35033 Rennes, France
| | - Elodie Gautier-Veyret
- Inserm, HP2, université Grenoble-Alpes, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - Benjamin Hennart
- Department of Pharmacology and Toxicology, Lille University Hospital, 59000 Lille, France
| | - Sorya Belaz
- Department of Mycology-Parasitology, Rennes University Hospital, 35033 Rennes, France
| | - Matthieu Revest
- Department of Infectious Diseases and Intensive Care Unit, Rennes University Hospital, 35033 Rennes, France
| | - Florian Lemaitre
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, 35033 Rennes, France
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Lemaitre F, Tron C, Jezequel C, Verdier MC, Rayar M. Intrapatient variability in solid organ transplantation: Should we make the first move earlier? Am J Transplant 2019; 19:610. [PMID: 30188607 DOI: 10.1111/ajt.15107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Florian Lemaitre
- Service de Pharmacologie Clinique et épidémiologique, Centre hospitalier Universitaire Pontchaillou, Rennes, France.,INSERM, Centre d'Investigation Clinique, Rennes, France.,Faculté de médecine, Université Rennes 1, Rennes, France
| | - Camille Tron
- Service de Pharmacologie Clinique et épidémiologique, Centre hospitalier Universitaire Pontchaillou, Rennes, France.,INSERM, Centre d'Investigation Clinique, Rennes, France.,Faculté de médecine, Université Rennes 1, Rennes, France
| | - Caroline Jezequel
- Service des maladies du foie, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | - Marie-Clémence Verdier
- Service de Pharmacologie Clinique et épidémiologique, Centre hospitalier Universitaire Pontchaillou, Rennes, France.,INSERM, Centre d'Investigation Clinique, Rennes, France.,Faculté de médecine, Université Rennes 1, Rennes, France
| | - Michel Rayar
- INSERM, Centre d'Investigation Clinique, Rennes, France.,Service des maladies du foie, Centre hospitalier Universitaire Pontchaillou, Rennes, France
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Lemaitre F, Lorcy N, Tron C, Golbin L, Petitcollin A, Verdier MC, Vigneau C, Bellissant E. Tacrolimus overexposure in kidney transplant recipients during the first post-operative week: caution is required in older patients. Fundam Clin Pharmacol 2018; 33:347-354. [PMID: 30431672 DOI: 10.1111/fcp.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/22/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
In liver transplantation, tacrolimus trough concentrations (Cmin) above 20 ng/mL during the first days led to worse outcome at 1 year but data in the kidney transplant (KT) era are scarce. The aim of this study was to evaluate the impact of tacrolimus overexposure during the first week post-transplantation on the kidney function (KF) of KT recipients. In this retrospective study, 105 KT recipients were attributed to overexposure group (OG) or normal group according to their Cmin during the first week of treatment. KF was evaluated by comparing the rate of delayed graft function (DGF) and by collecting plasma creatinine from day 1, 2, 3, 4, 5, 6, 7, 14, 21, 28 and at 1 year. Risk factors for developing DGF were also investigated using a multivariate model. DGF was more frequent in OG (43% of patients; P = 0.027) which has higher plasma creatinine on day 7, 14, and 21. OG patients were older with more extended criteria donor's grafts. In the multivariate analysis, only cold ischemia time (CIT) remained associated with DGF (OR = 1.003), while TAC overexposure did not reach significance (P = 0.06; OR = 3.9). In this study, we confirmed the predominant role of CIT as a risk factor for the onset of DGF in kidney transplantation. 43% of KT recipients were overexposed with more DGF, especially older patients.
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Affiliation(s)
- Florian Lemaitre
- Department of Clinical and Biological Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du Professeur Léon Bernard, 35000, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Center, 2, rue Henri Le Guilloux, 35000, Rennes, France
| | - Nolwen Lorcy
- Division of Nephrology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France
| | - Camille Tron
- Department of Clinical and Biological Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du Professeur Léon Bernard, 35000, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Center, 2, rue Henri Le Guilloux, 35000, Rennes, France
| | - Léonard Golbin
- Division of Nephrology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France
| | - Antoine Petitcollin
- Department of Clinical and Biological Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du Professeur Léon Bernard, 35000, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Center, 2, rue Henri Le Guilloux, 35000, Rennes, France
| | - Marie-Clémence Verdier
- Department of Clinical and Biological Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du Professeur Léon Bernard, 35000, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Center, 2, rue Henri Le Guilloux, 35000, Rennes, France
| | - Cécile Vigneau
- Division of Nephrology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France.,Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR 1085, 9 avenue du Professeur Léon Bernard, 35000, Rennes, France
| | - Eric Bellissant
- Department of Clinical and Biological Pharmacology, Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, 2, rue Henri Le Guilloux, 35000, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du Professeur Léon Bernard, 35000, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Center, 2, rue Henri Le Guilloux, 35000, Rennes, France
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Tron C, Lemaitre F, Verstuyft C, Petitcollin A, Verdier MC, Bellissant E. Pharmacogenetics of Membrane Transporters of Tacrolimus in Solid Organ Transplantation. Clin Pharmacokinet 2018; 58:593-613. [DOI: 10.1007/s40262-018-0717-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Tron C, Allard M, Petitcollin A, Ferrand-Sorre MJ, Verdier MC, Querzerho-Raguideau J, Blanchet B, Le Priol J, Roussel M, Deugnier Y, Bellissant E, Lemaitre F. Tacrolimus diffusion across the peripheral mononuclear blood cell membrane: impact of drug transporters. Fundam Clin Pharmacol 2018; 33:113-121. [PMID: 30203853 DOI: 10.1111/fcp.12412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/05/2018] [Accepted: 09/06/2018] [Indexed: 01/17/2023]
Abstract
Measuring tacrolimus (TAC) concentration in peripheral blood mononuclear cells (PBMCs) could better reflect the drug effect on its target (calcineurin (CaN) in lymphocytes) than whole blood concentrations. Mechanisms influencing TAC diffusion into PBMC are not well characterized. This work aimed at describing, ex vivo, TAC diffusion kinetics into PBMC and investigating the contribution of membrane transporters to regulate TAC intracellular concentration as well as the impact on CaN activity. PBMCs were incubated with TAC for 5 min to 4 h and under several experimental conditions: 37 °C (physiological conditions), 4 °C (inhibition of influx and efflux active transport), 37 °C + transporter inhibitors (verapamil, carvedilol, and probenecid and bromosulfophthalein, respectively, inhibitors of P-gp, OAT, and OATP). TAC concentration and CaN activity were measured in PBMC using liquid chromatography coupled with mass spectrometry. TAC intra-PBMC concentration was maximal after 1 h of incubation. Mean TAC PMBC concentrations were significantly lower in samples incubated at 4 °C compared to the 37 °C groups. Addition of verapamil slightly increased TAC accumulation in PBMC while other inhibitors had no effect. A significant correlation was found between TAC intra-PBMC concentration and the level of inhibition of CaN. Using an ex vivo cellular model, these results suggest that P-gp is involved in the drug efflux from PBMC while influx active transporters likely to regulate TAC intra-PBMC disposition remain to be identified. TAC concentration in PBMC is correlated with its pharmacodynamic effect. Then, TAC intra-PBMC concentration appears to be a promising biomarker to refine TAC therapeutic drug monitoring.
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Affiliation(s)
- Camille Tron
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology, Drug Information Centre, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du professeur Léon Bernard - CS 34317, 35043, Rennes, France.,Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Marie Allard
- Pharmacokinetics and pharmacochemistry Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Antoine Petitcollin
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology, Drug Information Centre, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du professeur Léon Bernard - CS 34317, 35043, Rennes, France.,Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Marie-José Ferrand-Sorre
- Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du professeur Léon Bernard - CS 34317, 35043, Rennes, France.,Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Marie-Clémence Verdier
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology, Drug Information Centre, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du professeur Léon Bernard - CS 34317, 35043, Rennes, France.,Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Julie Querzerho-Raguideau
- Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du professeur Léon Bernard - CS 34317, 35043, Rennes, France.,Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Benoit Blanchet
- Pharmacokinetics and pharmacochemistry Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Faculty of Pharmacy, UMR8638 CNRS, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Jérôme Le Priol
- Haematology Laboratory, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Mickael Roussel
- Haematology Laboratory, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Yves Deugnier
- Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France.,Liver diseases department, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Eric Bellissant
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology, Drug Information Centre, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du professeur Léon Bernard - CS 34317, 35043, Rennes, France.,Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Florian Lemaitre
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology, Drug Information Centre, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.,Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, 2 avenue du professeur Léon Bernard - CS 34317, 35043, Rennes, France.,Inserm, CIC-P 1414, Clinical Investigation Centre, 2 rue Henri Le Guilloux, 35033, Rennes, France
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Petitcollin A, Leuret O, Tron C, Lemaitre F, Verdier MC, Paintaud G, Bouguen G, Willot S, Bellissant E, Ternant D. Modeling Immunization To Infliximab in Children With Crohn's Disease Using Population Pharmacokinetics: A Pilot Study. Inflamm Bowel Dis 2018; 24:1745-1754. [PMID: 29788058 DOI: 10.1093/ibd/izy129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Antidrug antibodies (ADAs) dramatically increase infliximab clearance and are responsible for underexposure to the drug, leading to treatment failure. This pilot study aimed at developing a population pharmacokinetic model to detect and describe an early increase in infliximab clearance due to ADA. METHODS Twenty children with Crohn's disease (CD) were followed for 1 year or until treatment failure. Infliximab trough concentration, ADA, C-reactive protein (CRP), and Paediatric Crohn's Disease Activity Index (PCDAI) were recorded at each visit. A time-varying clearance population pharmacokinetic model was built to detect and describe an increase in infliximab clearance, independent from ADA testing. Factors associated with clearance variation and the relationships between infliximab concentrations, clearance variation, and clinical response were investigated. RESULTS The model detected important increases in clearance in 4 patients. These patients had suboptimal early response, with higher mean PCDAI (P = 0.0086) and CRP (P = 0.028) compared with other patients. Two of them had detectable ADA. Clearance increase as described by the model and lower infliximab trough concentration at week 2 were associated with poorer outcomes in a multivariate Cox model (P = 0.001 and P = 0.0048, respectively). CONCLUSIONS Being able to detect an increase in infliximab clearance, this model could allow the early detection of immunization to infliximab and therefore could help with dose adjustment in patients with CD. Moreover, the results suggest that clearance variations could be used as a predictive marker of clinical response. These findings need to be confirmed in a larger cohort, however, and predictive factors of clearance increase have to be investigated.
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Affiliation(s)
- Antoine Petitcollin
- Pharmacoepidemiology and Drug Information Center, Department of Clinical and Biological Pharmacology and Pharmacovigilance, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,CIC-P 1414 Clinical Investigation Center, Inserm, Rennes, France
| | - Oriane Leuret
- Paediatric Medicine Unit, Tours University Hospital, Tours, France
| | - Camille Tron
- Pharmacoepidemiology and Drug Information Center, Department of Clinical and Biological Pharmacology and Pharmacovigilance, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,CIC-P 1414 Clinical Investigation Center, Inserm, Rennes, France
| | - Florian Lemaitre
- Pharmacoepidemiology and Drug Information Center, Department of Clinical and Biological Pharmacology and Pharmacovigilance, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,CIC-P 1414 Clinical Investigation Center, Inserm, Rennes, France
| | - Marie-Clémence Verdier
- Pharmacoepidemiology and Drug Information Center, Department of Clinical and Biological Pharmacology and Pharmacovigilance, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,CIC-P 1414 Clinical Investigation Center, Inserm, Rennes, France
| | - Gilles Paintaud
- Laboratory of Pharmacology-Toxicology, CNRS, GICC UMR 7292, Tours University Hospital, François-Rabelais University of Tours, Tours, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Rennes University Hospital, Rennes, France.,CIC-P 1414 Clinical Investigation Center, Inserm U991, Rennes, France
| | - Stéphanie Willot
- Paediatric Medicine Unit, Tours University Hospital, Tours, France
| | - Eric Bellissant
- Pharmacoepidemiology and Drug Information Center, Department of Clinical and Biological Pharmacology and Pharmacovigilance, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,CIC-P 1414 Clinical Investigation Center, Inserm, Rennes, France
| | - David Ternant
- Laboratory of Pharmacology-Toxicology, CNRS, GICC UMR 7292, Tours University Hospital, François-Rabelais University of Tours, Tours, France
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Tron C, Petitcollin A, Verdier MC, Rayar M, Beaurepaire JM, Boudjema K, Bellissant E, Lemaitre F. Tacrolimus: Does direct glucuronidation matter? An analytical and pharmacological perspective. Pharmacol Res 2017; 124:164-166. [DOI: 10.1016/j.phrs.2017.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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Gatin L, Saleh-Mghir A, Laurent F, Verdier MC, Ghout I, Tattevin P, Crémieux AC. Efficacy of Colistin-Loaded Cement Spacer in Carbapenem-Resistant Klebsiella pneumoniae Experimental Prosthetic Joint Infection. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laure Gatin
- UMR 1173 Université Versailles St-Quentin, Service d'Orthopédie et Traumatologie, Hôpital Raymond Poincaré, Garches, France
| | | | - Frederic Laurent
- Laboratory of Bacteriology, Regional Reference Center for Bji, Hospices Civils de Lyon, Lyon, France; INSERM U1111 - International Center for Research in Infectiology - Claude Bernard Lyon 1 University, Lyon, France
| | | | - Idir Ghout
- URC Paris-Ouest Laboratoire de Bio statistiques, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | | | - Anne-Claude Crémieux
- Hôpital R. Poincaré, UMR 1173, University of Versailles St Quentin, Garches, France
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Tattevin P, Saleh-Mghir A, Dinh A, Gatin L, Mouton W, Ghout I, Ropers J, Verdier MC, Laurent F, Nordmann P, Crémieux AC. Efficacy of Colistin Alone and in Various Combinations for the Treatment of Carbapenemase-Producing Klebsiella pneumoniae Experimental Osteomyelitis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Laure Gatin
- Garches University Hospital, Garches, France
| | | | - Idir Ghout
- URC Paris-Ouest Laboratoire de Bio statistiques, Hôpital Ambroise Paré, Boulogne-Billancourt, France
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Tron C, Rayar M, Petitcollin A, Beaurepaire JM, Cusumano C, Verdier MC, Houssel-Debry P, Camus C, Boudjema K, Bellissant E, Lemaitre F. A high performance liquid chromatography tandem mass spectrometry for the quantification of tacrolimus in human bile in liver transplant recipients. J Chromatogr A 2016; 1475:55-63. [DOI: 10.1016/j.chroma.2016.10.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/09/2023]
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Tron C, Leven C, Fillâtre P, Maillard N, Nesseler N, Tattevin P, Flecher E, Bellissant E, Verdier MC, Lemaitre F. Should we fear tubing adsorption of antibacterial drugs in extracorporeal membrane oxygenation? An answer for cephalosporins and carbapenems. Clin Exp Pharmacol Physiol 2016; 43:281-3. [PMID: 26667301 DOI: 10.1111/1440-1681.12527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Camille Tron
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, Rennes, France. .,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.
| | - Cyril Leven
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France
| | - Pierre Fillâtre
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France
| | | | - Nicolas Nesseler
- Surgical Intensive Care Unit Department, Rennes University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Erwan Flecher
- Thoracic and Cardio-Vascular Surgery Department, Rennes University Hospital, Rennes, France.,Inserm 1099, CIC-IT, Clinical Investigation Centre, Rennes, France
| | - Eric Bellissant
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Marie-Clémence Verdier
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Florian Lemaitre
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes University Hospital, Rennes, France.,Laboratory of Experimental and Clinical Pharmacology, Faculty of Medicine, Rennes 1 University, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
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Lemaitre F, Blanchet B, Latournerie M, Antignac M, Houssel-Debry P, Verdier MC, Dermu M, Camus C, Le Priol J, Roussel M, Zheng Y, Fillatre P, Curis E, Bellissant E, Boudjema K, Fernandez C. Pharmacokinetics and pharmacodynamics of tacrolimus in liver transplant recipients: inside the white blood cells. Clin Biochem 2015; 48:406-11. [DOI: 10.1016/j.clinbiochem.2014.12.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
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Lemaitre F, Antignac M, Verdier MC, Bellissant E, Fernandez C. Opportunity to monitor immunosuppressive drugs in peripheral blood mononuclear cells: Where are we and where are we going? Pharmacol Res 2013; 74:109-12. [DOI: 10.1016/j.phrs.2013.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/21/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
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Lemaitre F, Barbaz M, Scailteux LM, Uhel F, Tadié JM, Verdier MC, Bellissant E. A Case-report of Unpredictable and Massive Voriconazole Intoxication in a Patient with Extensive CYP2C19 and CYP2C9 Polymorphisms. Drug Metab Pharmacokinet 2013; 28:439-41. [DOI: 10.2133/dmpk.dmpk-13-nt-007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Ethosuximide is a minor antiepileptic drug, available in France since 1965, indicated in the epilepsy absence, whose interest was reassessed from recent clinical trials, showing that it was the first choice, in term of risk benefit relationship, in this indication. It is a chiral molecule that presents a high bioavailability, a lack of protein binding, hepatic metabolism and urinary excretion. Its elimination half-life is long, between 40 and 60 h in adults, 30 and 40 h in children. The therapeutic range is established at 40-100 mg/L (283-708 µmol/L), but the upper limit is probably underestimated. The clinical studies of relation exposure effects, although ancient (from the 1970s) and realized with methodologies that do not meet current criteria, show concentration-efficacy and -toxicity relationship and the risk of drug interactions is proven. It is a drug preponderantly prescribed in children, a vulnerable population with physiological change with age. To benefit at best of its effectiveness, it is necessary to have relatively high plasma concentrations. Despite these arguments and due to the lack of studies providing a sufficient level of evidence, the recommendation can only be "potentially useful", assessment probably underestimated.
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Abstract
Lacosamide is a third generation antiepileptic drug, available in France since 2008. It is indicated in combination therapy for the treatment of inadequately controlled focal seizures, from the age of 16. The bioavailability of lacosamide is 100% and is unaffected by food intake; protein binding is low; it is metabolized by CYP2C19 into inactive O-desmethyl lacosamide. It does not inhibit or induce cytochromes; the elimination is renal with a half-life of approximately 13 h. The relationship between dose and plasma concentration is established, but there does not appear to be any clear relationship between concentration and efficacy. However, the main side effects are concentration dependent. The potential for drug-drug interaction of lacosamide is low and variability between individuals is minimal. Accordingly, the level of evidence for the therapeutic drug monitoring has been estimated at "probably of no use".
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Abstract
Stiripentol is a third generation antiepileptic, marketed since 2007 under the name of Diacomit(®). It is indicated, always in combination, in the treatment of severe myoclonic epilepsy in infancy or Dravet syndrome. Its pharmacokinetics is not linear. It is a potent inhibitor of CYP3A4, 1A2 and 2C19 and increases the plasma concentrations of many other antiepileptic drugs. Without this being considered as a validated therapeutic range, the trough plasma concentrations at steady-state, corresponding to the usual doses are between 10 and 15 mg/L. The concentration-efficacy relationship is not established, but there is some evidence for a concentration-related toxicity. However, because of its non-linear kinetics, stiripentol should be a good candidate for therapeutic drug monitoring (TDM). Nonetheless, the current level of evidence for the advantage of TDM is "remains to be estimated".
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Bentué-Ferrer D, Verdier MC, Tribut O. Suivi thérapeutique pharmacologique de la primidone et du phénobarbital. Therapie 2012; 67:381-90. [DOI: 10.2515/therapie/2012036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 04/17/2012] [Indexed: 11/20/2022]
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Verdier MC, Tribut O, Tattevin P, Michelet C, Bentué-Ferrer D. Assessment of interindividual variability of plasma concentrations after administrazion of high doses of intravenous amoxicillin or cloxacillin in critically ill patients. J Chemother 2012; 23:277-81. [PMID: 22005059 DOI: 10.1179/joc.2011.23.5.277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of the present retrospective observational clinical study was to assess the interindividual pharmacokinetic variability of plasma concentrations of amoxicillin or cloxacillin administered in high doses intravenously in critically ill patients, related to renal function or administration method.Four hundred and two plasma concentrations were measured at steady-state with a high performance liquid chromatography technique in 162 patients treated with 100 - 300 mg/kg/day of intravenous amoxicillin or cloxacillin.For both drugs and administration methods, plasma concentrations were significantly higher for patients with creatinine clearance below 60 ml/min, even though doses were adapted for renal impairment. the correlations calculated between plasma concentrations and creatinine level, creatinine clearance or doses were all low. There were fewer outlying drug concentrations in patients receiving continuous rather than intermittent regimens.Our results are in favor of adapting dosages of these beta-lactam antibiotics based on plasma concentrations, especially in cases of renal impairment.
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Affiliation(s)
- M C Verdier
- Biological Pharmocology Laboratory, Pontchaillou University Hospital, Rennes, France
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Dailly E, Verdier MC, Deslandes G, Bouquié R, Tribut O, Bentué-Ferrer D. Niveau de preuve du suivi thérapeutique pharmacologique de la ceftriaxone. Therapie 2012; 67:145-9. [DOI: 10.2515/therapie/2012018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 10/20/2011] [Indexed: 11/20/2022]
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Bentué-Ferrer D, Tribut O, Verdier MC. Suivi thérapeutique pharmacologique du rufinamide. Therapie 2012; 67:161-5. [DOI: 10.2515/therapie/2012013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 10/20/2011] [Indexed: 11/20/2022]
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Verdier MC, Bentué-Ferrer D, Tribut O. Suivi thérapeutique pharmacologique de la quinine. Therapie 2011; 66:507-16. [DOI: 10.2515/therapie/2011071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 06/10/2011] [Indexed: 01/21/2023]
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