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Le Marois M, Doudka N, Tzavara E, Delaunay L, Quaranta S, Blin O, Belzeaux R, Guilhaumou R. Simultaneous Quantification of Psychotropic Drugs in Human Plasma and Breast Milk and Its Application in Therapeutic Drug Monitoring and Peripartum Treatment Optimization. Ther Drug Monit 2024; 46:227-236. [PMID: 37684719 DOI: 10.1097/ftd.0000000000001136] [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] [Received: 03/28/2023] [Accepted: 06/07/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Therapeutic drug monitoring is recommended for several psychotropic drugs, particularly in sensitive situations such as the peripartum period. This study aimed to develop an ultra-high-performance liquid chromatography-tandem spectrometry method for the simultaneous quantification of 14 psychotropic drugs in human plasma and 4 in breast milk. METHODS The samples were precipitated with methanol containing the stable isotope-labeled analogs. Chromatographic separation was performed using a Phenomenex Luna Omega Polar C18 column. Detection was performed using a triple-quadrupole mass spectrometer equipped with an electrospray ionization interface. The method was fully validated in plasma according to the European Guidelines on Bioanalytical Method Validation and partially validated in breast milk by determining the intraday precision and accuracy, linearity, lower limit of quantification, and matrix effect. RESULTS The correlation coefficients of the calibration curves were greater than 0.99. Coefficients of variation ranged from 3.05% to 14.66% and 0.62%-14.90% for internal standard-normalized matrix effect, 1.4%-14.1% and 2.1%-10.4% for intraday precision, and 3.2%-13.9% and 4.1%-9.6% for interday precision, in plasma and milk, respectively. The relative error in accuracy did not exceed ±15% for any analyte. The method was successfully applied clinically to measure the concentrations of psychotropic drugs in 952 plasma samples, among which 43% of the concentrations were out of the therapeutic range, and 13 breast milk samples, with calculated relative infant doses ranging from 0.32% to 8.18%. CONCLUSIONS To the best of the authors' knowledge, this is the first routine technique validated for the quantification of psychotropic drugs in both plasma and breast milk, allowing for treatment optimization and prevention of adherence issues, including those in breastfeeding patients.
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Affiliation(s)
- Marguerite Le Marois
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille Cedex 5 13385, France
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Marseille 13385, France
- Aix Marseille Univ, CNRS, Inst Neurosci Timone, Marseille, France
| | - Natalia Doudka
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille Cedex 5 13385, France
| | - Eleni Tzavara
- Pôle de Psychiatrie, Hôpital Sainte-Marguerite, AP-HM, Marseille, France
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, Paris 75006, France
- Fondation FondaMental, Créteil, France
| | - Laurence Delaunay
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille Cedex 5 13385, France
| | - Sylvie Quaranta
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de la Timone, Marseille Cedex 5 13385, France; and
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille Cedex 5 13385, France
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Marseille 13385, France
| | - Raoul Belzeaux
- Aix Marseille Univ, CNRS, Inst Neurosci Timone, Marseille, France
- Fondation FondaMental, Créteil, France
- Pôle Universitaire de Psychiatrie, CHU de Montpellier, Montpellier, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille Cedex 5 13385, France
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Marseille 13385, France
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Lacroix C, Pietri T, Montero V, Soeiro T, Rouby F, Blin O, Guilhaumou R, Micallef J. Antibiotic-induced neurological adverse drug reactions. Therapie 2024; 79:181-188. [PMID: 37957055 DOI: 10.1016/j.therap.2023.09.008] [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: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 11/15/2023]
Abstract
Antibiotics are drugs widely used all around the world. Central nervous system adverse drug reactions (CNS ADRs) are mostly under-suspected with antibiotics. Nevertheless, these ADRs could lead to severe complications such as encephalopathy. To illustrate the clinical patterns of these off-target ADRs, we here present data from pharmacovigilance system, through different populations and points of view (worldwide, French population, vulnerable population and individual). These data could help clinicians to better know about CNS ADRs with antibiotics, to better identify risk factors and vulnerable patients and to highlight the importance to set up the right diagnostic explorations in the best timing to avoid complications. Clinicians should request a pharmacological opinion from pharmacologist (biologists and pharmacovigilance clinicians) in front of vulnerable population before or during antibiotics. Pharmacovigilance advice could help clinicians in the diagnosis and the management of an ADR. Therapeutic drug monitoring is particularly contributive to adjust doses of antibiotics administered in vulnerable patients. Pharmacovigilance advice and TDM are essential to perform personalized medicine, and contribute to the proper use of drugs.
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Affiliation(s)
- Clémence Lacroix
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France.
| | - Tessa Pietri
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France
| | - Vincent Montero
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France
| | - Thomas Soeiro
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France
| | - Frank Rouby
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France
| | - Olivier Blin
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France
| | - Romain Guilhaumou
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France
| | - Joëlle Micallef
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, service de pharmacologie clinique et pharmacosurveillance (CEIP-Addictovigilance PACA-Corse ; centre régional de pharmacovigilance Marseille Provence Corse ; Laboratoire de Pharmacologie Biologique ; Pharmacoépidémiologie), 13009 Marseille, France
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Ragonnet G, Guilhaumou R, Hanafia O, Néant N, Denante S, Vanel N, Honoré S, Michel F. Continuous infusion of beta-lactam antibiotics in pediatric intensive care unit: A monocenter before/after implementation study. Anaesth Crit Care Pain Med 2024; 43:101354. [PMID: 38360404 DOI: 10.1016/j.accpm.2024.101354] [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: 09/16/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
CONTEXT Beta-lactam continuous infusion (CI) is currently recommended in adult intensive care units to achieve target concentrations. In pediatric intensive care (PICU), few studies suggest the value of Beta-lactam CI to achieve target concentration. Our objective was to analyze the impact of Beta-lactam CI protocolization on the achievement of target concentration in PICU patients. MATERIAL AND METHODS We conducted a single-center retrospective study in patients with beta-lactam treatment for more than 2 days and at least one sample for therapeutic drug monitoring (TDM). From January 2018 to February 2022 (period 1, P1), BL were administered as an intermittent infusion with TDM upon request. From February to September 2022 (period 2, P2), Beta-lactam CI with TDM at day one was protocolized. The primary endpoint concerned achieving fT>4× Minimum Inhibitory Concentration = 100%. RESULTS In P1, 214 assays involved 103 patients; in P2, 199 assays involved 72 patients. Target concentration achievement was more frequent in P2 (P2 = 73.7% vs. P1 = 29.1%; p < 0.001). At day 5/6 after Beta-lactam initiation, c-reactive protein concentrations were P1 = 84.9 ± 79.2 mg/L; P2 = 53.7±49.8 mg/L (p < 0.05). In the multivariable logistic regression model: P2, BSA, and albumin were positively associated with target achievement; urea, and male sex were negatively associated with target achievement. The daily average cost of beta-lactam vial consumption per child was: P1 = 5.04 ± 2.6 € vs. P2 = 3.21 ± 2.7 € (p-value < 0.001). The daily average reconstitution time of Beta-lactam syringes per child was: P1 = 23.5 ± 8.7 min, P2 = 13.9 ± 9.2 min (p-value < 0.001). CONCLUSION Protocolization of Beta-lactam continuous infusion was associated with more frequent target concentration achievements in PICU. This implementation could be cost-effective and nurse time-saving.
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Affiliation(s)
- Gwendoline Ragonnet
- Pharmacie à Usage Intérieur Centre Hospitalo-Universitaire Timone, 13385 Marseille Cedex 5, France.
| | - Romain Guilhaumou
- Aix Marseille Univ, APHM, Institut des Neurosciences des Systèmes, Inserm UMR 11600, Service de Pharmacologie Clinique et PharmaSurveillance, 13385 Marseille Cedex 5, France
| | - Omar Hanafia
- Pharmacie à Usage Intérieur Centre Hospitalo-Universitaire Timone, 13385 Marseille Cedex 5, France
| | - Nadège Néant
- Laboratoire de Pharmacocinétique et Toxicologie, 13385 Marseille Cedex 5, France
| | - Solène Denante
- Réanimation Pédiatrique Centre Hospitalo-universitaire Timone, 13385 Marseille Cedex 5, France
| | - Noémie Vanel
- Réanimation Pédiatrique Centre Hospitalo-universitaire Timone, 13385 Marseille Cedex 5, France
| | - Stéphane Honoré
- Pharmacie à Usage Intérieur Centre Hospitalo-Universitaire Timone, 13385 Marseille Cedex 5, France; Aix Marseille Univ, EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Observatoire des Médicaments, Dispositifs Médicaux et Innovations Thérapeutiques (OMéDIT PACA Corse), Marseille, France
| | - Fabrice Michel
- Réanimation Pédiatrique Centre Hospitalo-universitaire Timone, 13385 Marseille Cedex 5, France
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Couderc S, Djerada Z, Rivals F, Lemaire-Hurtel AS, Lelong-Boulouard V, Lelièvre B, Abbara C, Lafay C, Abe E, Libert F, Pressiat C, Montange D, Imbert L, Tonini J, Lenski M, Guilhaumou R, Mathieu O. Questionnaire about therapeutic drug monitoring (TDM) of psychotropics for a panel of French psychiatrists. Therapie 2024:S0040-5957(24)00008-8. [PMID: 38355346 DOI: 10.1016/j.therap.2024.01.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Sylvain Couderc
- Department of Pharmacology and Toxicology, University Hospital, 87000 Limoges, France.
| | - Zoubir Djerada
- Department of Pharmacology and Toxicology, University Hospital, 51092 Reims, France
| | - Florence Rivals
- Department of Pharmacology and Toxicology, University Hospital, 87000 Limoges, France
| | | | | | - Bénédicte Lelièvre
- Department of Pharmacology and Toxicology, University Hospital, 49100 Angers, France
| | - Chadi Abbara
- Department of Pharmacology and Toxicology, University Hospital, 49100 Angers, France
| | - Claire Lafay
- Department of Pharmacology and Toxicology, University Hospital, 86000 Poitiers, France
| | - Emuri Abe
- Department of Pharmacology and Toxicology, University Hospital, Raymond Poincare Hospital, AP-HP, 92380 Garches, France
| | - Frédéric Libert
- Department of Pharmacology, University Hospital, 63000 Clermont-Ferrand, France
| | - Claire Pressiat
- Department of Pharmacology, University Hospital, Henri-Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Damien Montange
- Department of Pharmacology and Toxicology, University Hospital, 25030 Besançon, France
| | - Laurent Imbert
- Department of Pharmacology and Toxicology, University Hospital, 76000 Rouen, France
| | - Julia Tonini
- Department of Pharmacology and Toxicology, University Hospital, 38000 Grenoble, France
| | - Marie Lenski
- Department of Toxicology, University hospital, 59045 Lille, France
| | - Romain Guilhaumou
- Department of Pharmacology, University Hospital, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Olivier Mathieu
- Department of Pharmacology and Toxicology, University Hospital, 34090 Montpellier, France
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Lemaitre F, Florentin V, Blin O, Bayle A, Benito S, Chauny JV, Galaup A, Korchagina D, Lang M, Le Tourneau C, Pelloux H, Picard N, Guilhaumou R. Can precision medicine be integrated into routine therapeutic decisions at the bedside of patients? Therapie 2024; 79:13-22. [PMID: 38065821 DOI: 10.1016/j.therap.2023.11.007] [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: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 02/27/2024]
Abstract
Therapeutic strategies are shifting from a "one-size-fits-all" population-based approach to a stratified approach targeting groups with similar characteristics, or even individuals, tailoring treatments to the unique characteristics of each patient. Since such strategies rely on increasingly complex knowledge and healthcare technologies, along with an understanding of the tools of precision medicine, the appropriate dissemination and use of these strategies involves a number of challenges for the medical community. Having evaluation methodologies that have been jointly designed with the institutional, industrial, academic stakeholders, and also patients, like streamlining the processes and externally validating performances, could enhance the relevance of the "evaluation" aspect of precision medicine. Creating a network of expert precision-medicine centers and ensuring that precision-medicine procedures are reimbursed by social security would guarantee fair and sustainable access. Finally, training healthcare professionals, creating interfaces between precision-medicine expert centers and primary care professionals as well as patients, and integrating individual patient data into medical records are all key drivers that will enable information from precision-medicine to be made available and guarantee the proper use of these approaches.
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Affiliation(s)
- Florian Lemaitre
- Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), UMR S 1085, CHU de Rennes, université Rennes, 35000 Rennes, France.
| | - Virginie Florentin
- Direction médecine personnalisée, Roche SAS, 92600 Boulogne-Billancourt, France
| | - Olivier Blin
- Inserm 1106, service de pharmacologie clinique et pharmacosurveilleance, en delegation Tafalgie Therapeutics, UMR, Aix-Marseille université, AP-HM, 13385 Marseille, France
| | - Arnaud Bayle
- Bureau biostatistique et epidémiologie, Gustave-Roussy, université Paris-Saclay, 94800 Villejuif, France; Inserm, CESP U1018 Oncostat, labelisé Ligue contre le cancer, université Paris-Saclay, 94800 Villejuif, France
| | | | - Jean-Vannak Chauny
- Direction accès au marché & affaires publiques, Amgen, 92100 Boulogne-Billancourt, France
| | | | | | | | - Christophe Le Tourneau
- Institut Curie, Paris, France; Inserm U900, Saint-Cloud, France; Université Paris-Saclay, 75005 Paris, France
| | - Hervé Pelloux
- Parasitology-Mycology laboratory, University Grenoble-Alpes, University Hospital Grenoble-Alpes, 38043 Grenoble, France
| | - Nicolas Picard
- Service de pharmacologie, toxicologie et pharmacovigilance, centre de biologie et de recherche en santé (CBRS), CHU de Limoges, 87042 Limoges, France
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Lemaitre F, Florentin V, Blin O, Bayle A, Benito S, Chauny JV, Galaup A, Korchagina D, Lang M, Le Tourneau C, Pelloux H, Picard N, Guilhaumou R. Comment faire entrer la médecine de précision dans la décision thérapeutique de routine au lit du malade ? Therapie 2024; 79:1-11. [PMID: 38129247 DOI: 10.1016/j.therap.2023.10.014] [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: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Florian Lemaitre
- Inserm, EHESP, Institut de recherche en santé, environnement et travail (Irset) - UMR S 1085, université de Rennes, CHU de Rennes, 35000 Rennes, France.
| | - Virginie Florentin
- Direction médecine personnalisée, Roche SAS, 92600 Boulogne-Billancourt, France
| | - Olivier Blin
- Inserm 1106, service de pharmacologie clinique et pharmacosurveilleance, en delegation Tafalgie Therapeutics, UMR, Aix-Marseille université, AP-HM, 13385 Marseille, France
| | - Arnaud Bayle
- Bureau biostatistique et epidémiologie, Gustave-Roussy, université Paris-Saclay, 94800 Villejuif, France; Inserm, CESP U1018 Oncostat, labelisé Ligue contre le cancer, université Paris-Saclay, 94800 Villejuif, France
| | | | - Jean-Vannak Chauny
- Direction accès au marché & affaires publiques, Amgen, 92100 Boulogne-Billancourt, France
| | | | | | | | - Christophe Le Tourneau
- Institut Curie, 75000 Paris, France; Inserm U900, 92210 Saint-Cloud, France; Université Paris-Saclay, 75005 Paris, France
| | - Hervé Pelloux
- Parasitology-Mycology laboratory, University Grenoble-Alpes, University Hospital Grenoble-Alpes, 38043 Grenoble, France
| | - Nicolas Picard
- Service de pharmacologie, toxicologie et pharmacovigilance, centre de biologie et de recherche en santé (CBRS), CHU de Limoges, 87042 Limoges, France
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Lacroix C, Guilhaumou R, Micallef J, Bruneteau G, Desnuelle C, Blin O. Cannabis for the treatment of amyotrophic lateral sclerosis: What is the patients' view? Rev Neurol (Paris) 2023; 179:967-974. [PMID: 37460332 DOI: 10.1016/j.neurol.2023.03.018] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/19/2022] [Accepted: 03/13/2023] [Indexed: 11/12/2023]
Abstract
Cannabis may have therapeutic benefits to relieve symptoms of amyotrophic lateral sclerosis (ALS) thanks to its pleiotropic pharmacological activity. This study is the first to present a large questionnaire-based survey about the "real-life" situation regarding cannabis use in the medical context in ALS patients in France. There were 129 respondents and 28 reported the use of cannabis (21.7%) to relieve symptoms of ALS. Participants mostly reported the use of cannabidiol (CBD) oil and cannabis weed and declared benefits both on motor (rigidity, cramps, fasciculations) and non-motor (sleep quality, pain, emotional state, quality of life, depression) symptoms and only eight reported minor adverse reactions (drowsiness, euphoria and dry mouth). Even if cannabis is mostly used outside medical pathways and could expose patients to complications (street and uncontrolled drugs, drug-drug interactions, adverse effects…), most of the participants reported "rational" consumption (legal cannabinoids, with only few combustion and adverse reactions). Despite some limitations, this study highlights the need for further research on the potential benefits of cannabis use for the management of ALS motor and non-motor symptoms. Indeed, there is an urgent need and call for and from patients to know more about cannabis and secure its use in a medical context.
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Affiliation(s)
- C Lacroix
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France.
| | - R Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France
| | - J Micallef
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France
| | - G Bruneteau
- Paris ALS expert center, Assistance publique-Hôpitaux de Paris, Sorbonne université, Pitié-Salpêtrière Hospital, 75013 Paris, France; Brain Institute, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - C Desnuelle
- Departement of Neurology, Charity Association ARSLA, Emeritus Professor University Côte d'Azur, Côte d'Azur, France
| | - O Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, Aix-Marseille University, University Hospital Federation DHUNE, 13005 Marseille, France
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8
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Guilhaumou R, Chevrier C, Setti JL, Jouve E, Marsot A, Julian N, Blin O, Simeone P, Lagier D, Mokart D, Bruder N, Garnier M, Velly L. β-Lactam Pharmacokinetic/Pharmacodynamic Target Attainment in Intensive Care Unit Patients: A Prospective, Observational, Cohort Study. Antibiotics (Basel) 2023; 12:1289. [PMID: 37627709 PMCID: PMC10451857 DOI: 10.3390/antibiotics12081289] [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: 07/12/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The aims of this study were to describe pharmacokinetic/pharmacodynamic target attainment in intensive care unit (ICU) patients treated with continuously infused ß-lactam antibiotics, their associated covariates, and the impact of dosage adjustment. METHODS This prospective, observational, cohort study was performed in three ICUs. Four ß-lactams were continuously infused, and therapeutic drug monitoring (TDM) was performed at days 1, 4, and 7. The primary pharmacokinetic/pharmacodynamic target was an unbound ß-lactam plasma concentration four times above the bacteria's minimal inhibitory concentration during the whole dosing interval. The demographic and clinical covariates associated with target attainment were evaluated. RESULTS A total of 170 patients were included (426 blood samples). The percentages of empirical ß-lactam underdosing at D1 were 66% for cefepime, 43% for cefotaxime, 47% for ceftazidime, and 14% for meropenem. Indexed creatinine clearance was independently associated with treatment underdose if increased (adjusted odds ratio per unit, 1.01; 95% CI, 1.00 to 1.01; p = 0.014) or overdose if decreased (adjusted odds ratio per unit, 0.95; 95% CI, 0.94 to 0.97; p < 0.001). Pharmacokinetic/pharmacodynamic target attainment was significantly increased after ß-lactam dosage adjustment between day 1 and day 4 vs. no adjustment (53.1% vs. 26.2%; p = 0.018). CONCLUSIONS This study increases our knowledge on the optimization of ß-lactam therapy in ICU patients. A large inter- and intra-patient variability in plasmatic concentrations was observed, leading to inadequate exposure. A combined indexed creatinine clearance and TDM approach enables adequate dosing for better pharmacokinetic/pharmacodynamic target attainment.
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Affiliation(s)
- Romain Guilhaumou
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Constance Chevrier
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Jean Loup Setti
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Elisabeth Jouve
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Amélie Marsot
- Faculté de Pharmacie, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Nathan Julian
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Olivier Blin
- Department of Clinical Pharmacology and Pharmacosurveillance, La Timone University Hospital; 13005 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13005 Marseille, France
| | - Pierre Simeone
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- Inst Neurosci Timone, INT, CNRS, Aix Marseille University, UMR7289, 13005 Marseille, France
| | - David Lagier
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- C2VN, Inserm 1263, Inra 1260, Aix Marseille Université, 13005 Marseille, France
| | - Djamel Mokart
- Department of Anaesthesiology and Critical Care Medicine, Institut Paoli-Calmette, 13009 Marseille, France
| | - Nicolas Bruder
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
| | - Marc Garnier
- Sorbonne University, GRC29, APHP, DMU DREAM, Rive Droite, Site Tenon, 75020 Paris, France
- Département d’Anesthésie-Réanimation et Médecine Périopératoire, CHU de Clermont-Ferrand, University Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Lionel Velly
- University Hospital Timone, Department of Anaesthesiology and Critical Care Medicine, APHM, Aix Marseille University, 13005 Marseille, France; (J.L.S.); (P.S.); (D.L.)
- Inst Neurosci Timone, INT, CNRS, Aix Marseille University, UMR7289, 13005 Marseille, France
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9
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Lacroix C, Guilhaumou R, Micallef J, Blin O. Cannabidiol and pharmacokinetics drug-drug interactions: Pharmacological toolbox. Therapie 2023:S0040-5957(23)00080-X. [PMID: 37296021 DOI: 10.1016/j.therap.2023.05.003] [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: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Cannabidiol (CBD) is one of the most important components of the Cannabis sativa plant with delta9-tetrahydrocannabinol (THC). CBD is used both for medical and recreational purposes. It can be of pharmaceutical grade (Epidyolex®), and also self-service purchased in pharmacy, CBD shops and on the internet (non-pharmaceutical). CBD is almost as widespread as it is poorly understood from a pharmacological point of view and particularly in terms of drug interactions. Drug-drug interactions could lead to clinical complications, and we here gather data currently available on pharmacokinetics (PK) drug-drug interactions with CBD through a narrative review. This review shows that several PK drug-drug interactions exist with different class of medications and aims to help clinicians to better know about CBD for their practice as this product is increasingly used.
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Affiliation(s)
- Clémence Lacroix
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France.
| | - Romain Guilhaumou
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Joëlle Micallef
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Olivier Blin
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
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10
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Becam J, Martin E, Pouradier G, Doudka N, Solas C, Guilhaumou R, Fabresse N. Transdermal Nicotine Poisoning: A Rare Case Report of Occupational Exposure. Toxics 2023; 11:toxics11050464. [PMID: 37235278 DOI: 10.3390/toxics11050464] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
We report a case of accidental nicotine intoxication following transdermal exposure in a 22-year-old man with no medical history, who worked in a company manufacturing e-liquids for electronic cigarettes. He accidentally spilled 300 mL of pure nicotine solution (>99%) on his right leg without wearing protective clothing or a mask. Less than a minute later, he experienced dizziness, nausea, and headaches, followed by painful burning sensations in the affected area. He immediately removed his pants and washed his leg thoroughly with water. He presented to the emergency department two hours later, where he exhibited a respiratory rate of 25 cpm, a heart rate of 70 bpm, headaches, abdominal pain, pallor, and vomiting. He recovered without specific treatment five hours post-intoxication. Plasma levels of nicotine, cotinine, and hydroxycotinine were measured five hours after exposure using liquid chromatography-mass spectrometry. The concentrations found were 447 ng/mL for nicotine, 1254 ng/mL for cotinine, and 197 ng/mL for hydroxycotinine. Nicotine is an alkaloid that can be highly toxic, with doses of 30-60 mg being potentially fatal. Transdermal intoxication is rare, with very few cases reported in the literature. This case highlights the risk of acute intoxication through cutaneous exposure to nicotine-containing liquid products and the need for protective clothing when handling such products in a professional context.
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Affiliation(s)
- Jenny Becam
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
| | - Edouard Martin
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France
| | - Gildas Pouradier
- Intensive Care Unit, Laveran Military Teaching Hospital, 34 Boulevard Laveran, 13384 Marseille, France
| | - Natalia Doudka
- Department of Clinical Pharmacology and Pharmacovigilance, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
| | - Caroline Solas
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
| | - Romain Guilhaumou
- Department of Clinical Pharmacology and Pharmacovigilance, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
- Institut de Neurosciences des Systèmes, Aix Marseille University, INSERM UMR 1106, 13385 Marseille, France
| | - Nicolas Fabresse
- Laboratory of Pharmacokinetics and Toxicology, La Timone University Hospital, 264 Rue Saint Pierre, CEDEX 5, 13385 Marseille, France
- Economic and Social Sciences of Health and Medical Information Processing, Aix Marseille University, INSERM UMR 1252, IRD, SESSTIM, 13385 Marseille, France
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11
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El-Haffaf I, Guilhaumou R, Velly L, Marsot A. Impact of piperacillin unbound fraction variability on dosing recommendations in critically ill patients. Br J Clin Pharmacol 2023; 89:1502-1508. [PMID: 36445340 DOI: 10.1111/bcp.15619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/03/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
A common approach to assess the efficacy of piperacillin is to first measure the total concentration and afterwards apply a theoretical unbound fraction of 70% to obtain the unbound concentration. However, hypoalbuminemia is a common phenomenon in critically ill patients, resulting in variations in unbound fraction, therefore we aimed to simulate the impact of piperacillin unbound fraction fluctuations on the predictive performance of a population pharmacokinetic model and on the dosing recommendations of piperacillin. Unbound factors of 70%, 75%, 80% and 85% were applied to total concentrations of piperacillin administered by continuous infusion from an external dataset. A validated model was used for assessment of predictive performance and to estimate patient clearance. Dosing simulations were performed to evaluate target attainment. Variation in unbound fractions caused minimal impact on piperacillin clearance and target attainment but seemed to influence model validity.
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Affiliation(s)
- Ibrahim El-Haffaf
- Faculty of Pharmacy, Université de Montréal, Pavillon Jean-Coutu, Montreal, Québec, Canada.,Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Institut de neurosciences des systèmes, Inserm UMR 1106, Aix Marseille Université, Marseille, France
| | - Lionel Velly
- Service d'anesthésie-réanimation, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille et Institut de neurosciences de la Timone, CNRS, Aix Marseille Université, Marseille, France
| | - Amélie Marsot
- Faculty of Pharmacy, Université de Montréal, Pavillon Jean-Coutu, Montreal, Québec, Canada.,Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada.,Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
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12
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Jumpertz M, Guilhaumou R, Million M, Parola P, Lagier JC, Brouqui P, Cassir N. Subcutaneously administered antibiotics: a review. J Antimicrob Chemother 2022; 78:1-7. [PMID: 36374566 DOI: 10.1093/jac/dkac383] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subcutaneous (SC) administration of antibiotics represents an attractive alternative to the intravenous (IV) route. METHODS We performed a systematic electronic search of PubMed and the Cochrane Library for all articles published prior to April 2022, using the key terms and MeSH terms 'subcutaneous', 'antibiotic' and the international non-proprietary name of antibiotics. RESULTS A total of 30 studies were selected including data on the efficacy and tolerability of antibiotics, and seven studies that were conducted in healthy subjects, for relevant information regarding the safety and tolerability of antibiotics. Comparative studies have shown that efficacy is similar for the SC and IV routes for ceftriaxone, teicoplanin and ertapenem. The SC use of other antibiotics such as ampicillin, ceftazidime, cefepime, piperacillin/tazobactam, metronidazole and fosfomycin has also been described. These results have largely been corroborated by pharmacokinetic/pharmacodynamic analyses, especially for time-dependent antibiotics. Complications of SC treatment are rarely severe, with no reports of bacteraemia or other invasive infection related to this route of administration. Therapeutic drug monitoring has been proposed to adapt the dose and avoid toxicity. DISCUSSION The rationale for using SC administration of ceftriaxone, ertapenem and teicoplanin is strong in patients with non-severe infections. It is already commonly practised in some countries, particularly in France. Other antibiotics could be administered subcutaneously, but further studies are needed to validate their use in clinical practice. Further research is needed to safely generalize and optimize this route of administration whenever possible. This would reduce the risk of catheter-related infections and their complications, together with the length of hospital stay.
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Affiliation(s)
- Marie Jumpertz
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France
| | - Matthieu Million
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Parola
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Jean-Christophe Lagier
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Brouqui
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Nadim Cassir
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
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13
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Alarcan H, Cannet P, Camus V, Fond G, Zendjidjian X, Guilhaumou R, Quaranta S. Correlation between assessment of cytochrome P450 1A2 activity and enzyme activity scores, and their relation to clozapine exposure. Br J Clin Pharmacol 2022; 89:1665-1671. [PMID: 36507652 DOI: 10.1111/bcp.15636] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS Cytochrome P450 1A2 (CYP1A2) is involved in the metabolism of antipsychotic drugs such as clozapine and olanzapine. Personalization of these treatments requires an accurate estimation of CYP1A2 activity. In this study, we aimed (1) to evaluate the correlation between activity score (AS), covariate-corrected activity score (CCS) and the phenotype of CYP1A2 using a caffeine test probe and (2) to investigate their relationship with dose-adjusted clozapine concentrations in a subgroup of the cohort. METHODS A multicentric, retrospective and observational study was carried out in the French university hospitals of Marseille and Tours. CYP1A2 activity was calculated by the paraxanthine/caffeine (17X/137X) ratio determined 4 h after an oral intake of 100 mg caffeine. AS was calculated according to the CYP1A2*1F alleles. CCS was calculated according to the CYP1A2*1F alleles, smoking status and the presence of concomitant inhibitors. RESULTS As expected, among the 89 patients included, the 17X/137X ratio was significantly higher in patients who smoked. We found a significant but modest correlation between the 17X/137X ratio and CCS (R2 = 0.3, P = 1.74 × 10-8 ) but none between the 17X/137X ratio and AS (R2 = -0.007, P = 0.52). AS was not correlated with dose-adjusted clozapine levels, contrary to CCS (R2 = 0.19, P = 0.016) and especially the 17X/137X ratio (R2 = 0.42, P = 1.7 × 10-5 ). CONCLUSIONS Correlation with clozapine concentrations showed the advantage of the 17X/137X ratio over the CCS in clozapine dose optimization. CYP1A2 activity, especially when determined by the caffeine probe, may be used to personalize clozapine dosing for patients experiencing treatment failure.
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Affiliation(s)
- Hugo Alarcan
- CHRU de Tours, 2 boulevard Tonnellé, Tours, France.,UMR 1253 iBrain, Université de Tours, Inserm, 10 boulevard Tonnellé, Tours, France
| | | | - Vincent Camus
- CHRU de Tours, 2 boulevard Tonnellé, Tours, France.,UMR 1253 iBrain, Université de Tours, Inserm, 10 boulevard Tonnellé, Tours, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Xavier Zendjidjian
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone; Aix Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR, Marseille, France
| | - Sylvie Quaranta
- Service de Pharmacocinétique et Toxicologie, Hôpital de la Timone/Service de Biologie Moléculaire, Hôpital Conception; Laboratoire de Biologie Médicale, Assistance Publique, Hôpitaux de Marseille, Marseille, France
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14
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Lereclus A, Korchia T, Riff C, Dayan F, Blin O, Benito S, Guilhaumou R. Towards Precision Dosing of Clozapine in Schizophrenia: External Evaluation of Population Pharmacokinetic Models and Bayesian Forecasting. Ther Drug Monit 2022; 44:674-682. [PMID: 35385439 DOI: 10.1097/ftd.0000000000000987] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapeutic drug monitoring and treatment optimization of clozapine are recommended, owing to its narrow therapeutic range and pharmacokinetic (PK) variability. This study aims to assess the clinical applicability of published population PK models by testing their predictive performance in an external data set and to determine the effectiveness of Bayesian forecasting (BF) for clozapine treatment optimization. METHODS Available models of clozapine were identified, and their predictive performance was determined using an external data set (53 patients, 151 samples). The median prediction error (PE) and median absolute PE were used to assess bias and inaccuracy. The potential factors influencing model predictability were also investigated. The final concentration was reestimated for all patients using covariates or previously observed concentrations. RESULTS The 7 included models presented limited predictive performance. Only 1 model met the acceptability criteria (median PE ≤ ±20% and median absolute PE ≤30%). There was no difference between the data used for building the models (therapeutic drug monitoring or PK study) or the number of compartments in the models. A tendency for higher inaccuracy at low concentrations during treatment initiation was observed. Heterogeneities were observed in the predictive performances between the subpopulations, especially in terms of smoking status and sex. For the models included, BF significantly improved their predictive performance. CONCLUSIONS Our study showed that upon external evaluation, clozapine models provide limited predictive performance, especially in subpopulations such as nonsmokers. From the perspective of model-informed prediction dosing, model predictability should be improved using updating or metamodeling methods. Moreover, BF substantially improved model predictability and could be used for clozapine treatment optimization.
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Affiliation(s)
- Aurélie Lereclus
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Marseille, France
- EXACTCURE, Nice, France
| | - Théo Korchia
- Département de Psychiatrie, Sainte Marguerite University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France; and
| | - Camille Riff
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, France
| | | | - Olivier Blin
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Marseille, France
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, France
| | | | - Romain Guilhaumou
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Marseille, France
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, France
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15
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Zalta A, Trébuchon A, Lagarde S, Lacroix C, Velly L, Jamon A, Blin O, Guilhaumou R. WE-140. Optimizing the monitoring of beta-lactam antibiotics in intensive care patients: A Neurophysio-Pharmacological study. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.184] [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] [Indexed: 11/03/2022]
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16
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Lacroix C, Alleman-Brimault I, Zalta A, Rouby F, Cassé-Perrot C, Jouve E, Attolini L, Guilhaumou R, Micallef J, Blin O. What Do We Know About Medical Cannabis in Neurological Disorders and What Are the Next Steps? Front Pharmacol 2022; 13:883987. [PMID: 35571129 PMCID: PMC9091192 DOI: 10.3389/fphar.2022.883987] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Medical use of cannabis has been receiving growing attention over the last few decades in modern medicine. As we know that the endocannabinoid system is largely involved in neurological disorders, we focused on the scientific rationale of medical cannabis in three neurological disorders: amyotrophic lateral sclerosis, Parkinson’s disease, and Alzheimer’s disease through pharmacological plausibility, clinical studies, and patients’ view. Clinical studies (randomized controlled trials, open-label studies, cohorts, and case reports) exploring medical cannabis in these disorders show different results depending on the methods and outcomes. Some show benefits on motor symptoms and others on non-motor symptoms and quality of life. Concerning patients’ view, several web surveys were collected, highlighting the real use of cannabis to relieve symptoms of neurological disorders, mostly outside a medical pathway. This anarchic use keeps questioning particularly in terms of risks: consumption of street cannabis, drug–drug interactions with usual medical treatment, consideration of medical history, and adverse reactions (psychiatric, respiratory, cardiovascular disorders, etc.), underlining the importance of a medical supervision. To date, most scientific data support the therapeutic potential of cannabis in neurological disorders. As far as patients and patients’ associations are calling for it, there is an urgent need to manage clinical studies to provide stronger evidence and secure medical cannabis use.
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Affiliation(s)
- Clémence Lacroix
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Isabelle Alleman-Brimault
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Arnaud Zalta
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Frank Rouby
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Catherine Cassé-Perrot
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Elisabeth Jouve
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Laurence Attolini
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Romain Guilhaumou
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Joëlle Micallef
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Olivier Blin
- APHM, INSERM, Inst Neurosci Syst, UMR 1106, Aix Marseille Univ, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
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17
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Alarcan H, Guilhaumou R, Quaranta S. Traitements psychiatriques et pharmacogénétique. Actualités Pharmaceutiques 2022. [DOI: 10.1016/j.actpha.2022.03.008] [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] [Indexed: 10/17/2022]
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18
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Pastol J, Le Marois M, Guilhaumou R, Blin O, Belzeaux R. Measuring drug concentrations in breast milk to improve therapeutic monitoring and patient adherence in bipolar disorder: A case report. Aust N Z J Psychiatry 2022; 56:96. [PMID: 33938286 DOI: 10.1177/00048674211010340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julia Pastol
- Pôle de psychiatrie, Hôpital Sainte-Marguerite, AP-HM, Marseille, France.,Fondation Fondamental, Créteil, France
| | - Marguerite Le Marois
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Marseille, France.,Aix Marseille Université, CNRS, Institut de Neurosciences de la Timone (INT) - UMR7289, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Marseille, France
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Marseille, France
| | - Raoul Belzeaux
- Pôle de psychiatrie, Hôpital Sainte-Marguerite, AP-HM, Marseille, France.,Fondation Fondamental, Créteil, France.,Aix Marseille Université, CNRS, Institut de Neurosciences de la Timone (INT) - UMR7289, Marseille, France
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19
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Doudka N, Giocanti M, Basso M, Ugdonne R, Barthelemy K, Lacarelle B, Blin O, Solas C, Guilhaumou R. Development and Validation of a Simple and Rapid Ultrahigh-Performance Liquid Chromatography Tandem Spectrometry Method for the Quantification of Hydroxychloroquine in Plasma and Blood Samples in the Emergency Context of SARS-CoV-2 Pandemic. Ther Drug Monit 2021; 43:570-576. [PMID: 33165216 PMCID: PMC8277042 DOI: 10.1097/ftd.0000000000000836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/01/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
ABSTRACT Therapeutic drug monitoring of hydroxychloroquine (HCQ) has been recommended to optimize the treatment of patients with COVID-19. The authors describe an ultrahigh-performance liquid chromatography tandem spectrometry method developed in a context of emergency, to analyze HCQ in both human plasma and blood samples. After adding the labeled internal standard and simple protein precipitation, plasma samples were analyzed using a C18 column. Blood samples required evaporation before analysis. The total chromatographic run time was 4 minutes (including 1.5 minutes of column equilibration). The assay was linear over the calibration range (r2 > 0.99) and up to 1.50 mcg/mL for the plasma samples (5.00 mcg/mL for the blood matrix). The limit of quantification was 0.0150 mcg/mL for plasma samples (0.05 mcg/mL blood matrix) with accuracy and precision ranging from 91.1% to 112% and from 0.750% to 11.1%, respectively. Intraday and interday precision and accuracy values were within 15.0%. No significant matrix effect was observed in the plasma or blood samples. This method was successfully applied to patients treated for COVID-19 infection. A simple and rapid ultrahigh-performance liquid chromatography tandem spectrometry method adapted to HCQ therapeutic drug monitoring in the context of SARS-CoV-2 infection was successfully developed and validated.
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Affiliation(s)
- Natalia Doudka
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Aix-Marseille University, The Institut de Neurosciences des Systèmes
| | - Madeleine Giocanti
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de la Timone, Clinical and Pharmacological Unit, Timone Hospital, Laboratory of Pharmacokinetic and Toxicology; and
| | - Manon Basso
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de la Timone, Clinical and Pharmacological Unit, Timone Hospital, Laboratory of Pharmacokinetic and Toxicology; and
| | - Renée Ugdonne
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de la Timone, Clinical and Pharmacological Unit, Timone Hospital, Laboratory of Pharmacokinetic and Toxicology; and
| | - Karine Barthelemy
- Aix-Marseille Univ, Unité des Virus Emergents (UVE) IRD 190, Aix-Marseille University, Unité des Virus Emergents (UVE) IRD 190, Marseille, France
| | - Bruno Lacarelle
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de la Timone, Clinical and Pharmacological Unit, Timone Hospital, Laboratory of Pharmacokinetic and Toxicology; and
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Aix-Marseille University, The Institut de Neurosciences des Systèmes
| | - Caroline Solas
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de la Timone, Clinical and Pharmacological Unit, Timone Hospital, Laboratory of Pharmacokinetic and Toxicology; and
- Aix-Marseille Univ, Unité des Virus Emergents (UVE) IRD 190, Aix-Marseille University, Unité des Virus Emergents (UVE) IRD 190, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Aix-Marseille University, The Institut de Neurosciences des Systèmes
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20
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Le Turnier P, El Helali N, Guilhaumou R, Pilmis B, Revest M, Velly LJ, Leroy AG, Duval X, Lemaitre F, Gregoire M. CSF concentration of cefotaxime in adult patients with pneumococcal meningitis: a multicentre retrospective study. J Antimicrob Chemother 2021; 76:2352-2355. [PMID: 34120184 DOI: 10.1093/jac/dkab191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pneumococcal meningitis is a devastating disease that requires adequate meningeal antibiotic penetration to limit the mortality. Despite a large usage in this indication, data about CSF concentration of cefotaxime during pneumococcal meningitis in adults are scarce. Therefore, we aimed to describe the CSF concentration obtained after high-dose cefotaxime administration in adult patients treated for Streptococcus pneumoniae meningitis. PATIENTS AND METHODS In this multicentre, observational, retrospective study, cases of adult patients with S. pneumoniae meningitis hospitalized between January 2013 and October 2019 for whom cefotaxime concentration was measured in CSF were reviewed. RESULTS Cefotaxime concentration was analysed in 44 CSF samples collected among 31 patients. Median (IQR) age was 61 years (52-69). Dexamethasone was administered in 27 subjects. Median (IQR) cefotaxime daily dosage was 15 g (12-19), corresponding to 200 mg/kg (150-280). CSF samples were collected approximately 5 days after cefotaxime initiation. Median (IQR, range) cefotaxime CSF concentration was 10.3 mg/L (4.8-19.3, 1.2-43.4). Median (range) MIC for Streptococcus pneumoniae was 0.25 mg/L (0.008-1) (n = 22). The median (IQR, range) CSF/MIC ratio was 38 (12-146, 4-1844). Twenty-five CSF concentrations (81%) were above 10 times the MIC. Cefotaxime was discontinued in two patients for toxicity. In-hospital mortality rate was 29%. CONCLUSIONS Adult patients with pneumococcal meningitis treated with a high dose of cefotaxime (200 mg/kg/day) had elevated CSF concentrations with satisfying pharmacokinetics/pharmacodynamics parameters and tolerability profile. This study brings reassuring pharmacological data regarding the use of high-dose cefotaxime monotherapy for treating pneumococcal meningitis with susceptible strains to cefotaxime.
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Affiliation(s)
- Paul Le Turnier
- Department of Infectious Diseases, Nantes University Hospital, Nantes, France.,INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Najoua El Helali
- Plateforme de Dosages des Anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Romain Guilhaumou
- Aix Marseille Univ, Department of Clinical Pharmacology and Pharmacovigilance CIC-CPCET, University Hospital Timone, Marseille, France.,Institut de neurosciences des systèmes, Inserm UMR 1106, Marseille, France
| | - Benoit Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.,Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France.,University of Rennes, Centre d'Investigation Clinique 1414, INSERM, Bacterial Regulatory RNAS and Medicine, Unité Mixte de Recherche 1230, Rennes, France
| | - Lionel J Velly
- Aix Marseille Univ, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France.,CNRS, INT, Inst Neurosci Timone, UMR7289, Marseille, France
| | - Anne-Gaëlle Leroy
- Department of Microbiology, Nantes University Hospital, Nantes, France
| | - Xavier Duval
- Paris University, IAME, INSERM, Paris, France.,Inserm Clinical Investigation Centre 1425, Paris, France.,Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France.,UMR_S 1085, F- INSERM, Centre d'Investigation Clinique, CIC 1414, Rennes, France
| | - Matthieu Gregoire
- Clinical Pharmacology Laboratory Department Nantes University Hospital, Nantes, France.,UMR INSERM 1235, The enteric nervous system in gut and brain disorders, University of Nantes, Nantes, France
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21
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Lacroix C, Bera-Jonville AP, Montastruc F, Velly L, Micallef J, Guilhaumou R. Serious Neurological Adverse Events of Ceftriaxone. Antibiotics (Basel) 2021; 10:540. [PMID: 34066591 PMCID: PMC8148437 DOI: 10.3390/antibiotics10050540] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 03/30/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022] Open
Abstract
We described ceftriaxone-induced CNS adverse events through the largest case series of Adverse Drug Reactions (ADRs) reports, from 1995 to 2017, using the French Pharmacovigilance Database. In total, 152 cases of serious CNS ADRs were analyzed; 112 patients were hospitalized or had a prolonged hospitalization (73.7%), 12 dead (7.9%) and 16 exhibited life-threatening ADRs (10.5%). The median age was 74.5 years, mainly women (55.3%), with a median creatinine clearance of 35 mL/min. Patients mainly exhibited convulsions, status epilepticus, myoclonia (n = 75, 49.3%), encephalopathy (n = 45, 29.6%), confused state (n = 34, 22.4%) and hallucinations (n = 16, 10.5%). The median time of onset was 4 days, and the median duration was 4.5 days. The mean daily dose was 1.7 g mainly through an intravenous route (n = 106, 69.7%), and three patients received doses above maximal dose of Summary of Product Characteristics. Ceftriaxone plasma concentrations were recorded for 19 patients (12.5%), and 8 were above the toxicity threshold. Electroencephalograms (EEG) performed for 32.9% of the patients (n = 50) were abnormal for 74% (n = 37). We described the world's biggest case series of ceftriaxone-induced serious CNS ADRs. Explorations (plasma concentrations, EEG) are contributive to confirm the ceftriaxone toxicity-induced. Clinicians may be cautious with the use of ceftriaxone, especially in the older age or renal impairment population.
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Affiliation(s)
- Clémence Lacroix
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France; (C.L.); (J.M.)
| | - Annie-Pierre Bera-Jonville
- Centre Régional de Pharmacovigilance et d’Information sur le Médicament Centre-Val-de-Loire, Service de Pharmacosurveillance, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France;
| | - François Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, 31000 Toulouse, France;
- Unité Clinique de Pharmacologie Psychiatrique, Faculté de Médecine, Centre Hospitalier Universitaire, 31000 Toulouse, France
| | - Lionel Velly
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille Université, 13005 Marseille, France;
- CNRS, INT, Institut Neurosci Timone, UMR 7289, Aix Marseille Université, 13005 Marseille, France
| | - Joëlle Micallef
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France; (C.L.); (J.M.)
| | - Romain Guilhaumou
- Laboratoire de Pharmacologie Clinique, Service de Pharmacologie Clinique, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France
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22
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Lacroix C, Soeiro T, Le Marois M, Guilhaumou R, Cassé-Perrot C, Jouve E, Röhl C, Belzeaux R, Micallef J, Blin O. Innovative approaches in CNS clinical drug development: Quantitative systems pharmacology. Therapie 2020; 76:111-119. [PMID: 33358366 DOI: 10.1016/j.therap.2020.12.007] [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: 06/15/2020] [Accepted: 07/19/2020] [Indexed: 11/26/2022]
Abstract
Clinical trials involving brain disorders are notoriously difficult to set up and run. Innovative ways to develop effective prevention and treatment strategies for central nervous system (CNS) diseases are urgently needed. New approaches that are likely to renew or at least modify the paradigms used so far have been recently proposed. Quantitative systems pharmacology (QSP) uses mathematical computerized models to characterize biological systems, disease processes and CNS drug pharmacology. Integrated experimental medicine should increase the probability and predictability of success while controlling clinical trials costs. Finally, the societal perspective and patient empowerment also offer additional approaches to demonstrate the benefit of a new drug in the CNS field.
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Affiliation(s)
- Clémence Lacroix
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Thomas Soeiro
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Marguerite Le Marois
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Romain Guilhaumou
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Catherine Cassé-Perrot
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Elisabeth Jouve
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Claas Röhl
- Obmann NF Kinder/Obmann NF Patients United/Obmann EUPATI Austria, 1230 Wien, Austria
| | - Raoul Belzeaux
- Aix Marseille Univ, APHM, CNRS, Inst Neurosci Timone, University Hospital Federation DHUNE, Service de Psychiatrie, 13005 Marseille, France
| | - Joëlle Micallef
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France
| | - Olivier Blin
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital Federation DHUNE, Service de Pharmacologie Clinique et Pharmacovigilance, 13005 Marseille, France.
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23
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Chavant A, Gautier-Veyret E, Chhun S, Guilhaumou R, Stanke-Labesque F. [Pharmacokinetic changes related to acute infection. Examples from the SARS-CoV-2 pandemic]. Therapie 2020; 76:319-333. [PMID: 33129512 PMCID: PMC7833468 DOI: 10.1016/j.therap.2020.10.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023]
Abstract
The knowledge of factors of pharmacokinetic variability is important in order to personalize pharmacological treatment, particularly for drugs with a narrow therapeutic range for which pharmacological therapeutic monitoring is recommended. Inflammation is a protective response against acute infections and injuries that contributes to intra- and inter-individual variability in drug exposure by modulating the activity of enzymes involved in drug metabolism, and by altering the binding of drugs to plasma proteins. The understanding of the impact of inflammation on drug metabolism and the related clinical consequences allow to better take into consideration the effect of inflammation on the variability of drug exposure. We first summarized the molecular mechanisms by which inflammation contributes to the inhibition of drug metabolism enzymes. We then presented an updated overview of the consequences of the outcome of acute infectious event on pharmacokinetic exposure of drugs with a narrow therapeutic range and that are substrates of cytochrome P450, and the related clinical consequences. Finally, in the context of the COVID-19 pandemic, we reported examples of drug overexposures in COVID- 19 infected patients.
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Affiliation(s)
- Anaëlle Chavant
- Laboratoire de pharmacologie-pharmacogénétique-toxicologie, pôle de biologie et pathologie, CHU Grenoble Alpes, 38700 La Tronche, France
| | - Elodie Gautier-Veyret
- Laboratoire de pharmacologie-pharmacogénétique-toxicologie, pôle de biologie et pathologie, CHU Grenoble Alpes, 38700 La Tronche, France; University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38043 Grenoble, France
| | - Stéphanie Chhun
- UFR de médecine Paris centre, 75015 Paris, France; Institut Necker-Enfants Malades (INEM), Inserm U1151-CNRS UMR 8253, 75015 Paris, France; Laboratoire d'immunologie biologique, département médico universitaire BioPhyGen, hôpital universitaire Necker-enfants malades, AP-HP, 75015 Paris, France
| | - Romain Guilhaumou
- Unité de pharmacologie clinique et pharmacovigilance AP-HM, 13354 Marseille, France; Aix Marseille Univ, Inserm, INS Inst Neurosci Syst, 13354 Marseille, France
| | - Françoise Stanke-Labesque
- Laboratoire de pharmacologie-pharmacogénétique-toxicologie, pôle de biologie et pathologie, CHU Grenoble Alpes, 38700 La Tronche, France; University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38043 Grenoble, France.
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24
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Venisse N, Peytavin G, Bouchet S, Gagnieu MC, Garraffo R, Guilhaumou R, Solas C. Concerns about pharmacokinetic (PK) and pharmacokinetic-pharmacodynamic (PK-PD) studies in the new therapeutic area of COVID-19 infection. Antiviral Res 2020; 181:104866. [PMID: 32659293 PMCID: PMC7351053 DOI: 10.1016/j.antiviral.2020.104866] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 06/09/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 01/07/2023]
Abstract
In the context of the COVID-19 pandemic, several drugs have been repurposed as potential candidates for the treatment of COVID-19 infection. While preliminary choices were essentially based on in vitro potency, clinical translation into effective therapies may be challenging due to unfavorable in vivo pharmacokinetic properties at the doses chosen for this new indication of COVID-19 infection. However, available pharmacokinetic and pharmacokinetic-pharmacodynamic studies suffer from severe limitations leading to unreliable conclusions, especially in term of dosing optimization. In this paper we propose to highlight these limitations and to identify some of the major requirements that need to be addressed in designing PK and PK-PD studies in this era of COVID. A special attention should be paid to pre-analytical and analytical requirements and to the proper collection of covariates affecting dose-exposure relationships (co-medications, use of specific organ support techniques and other clinical and para-clinical data). We also promote the development of population PK and PK-PD models specifically dedicated to COVID-19 patients since those previously developed for other diseases (SEL, malaria, HIV) and clinical situations (steady-state, non-ICU patients) are not representative of severe patients. Therefore, implementation of well-designed PK and PD studies targeted to COVID-19 patients is urgently needed. For that purpose we call for multi-institutional collaborative work and involvement of clinical pharmacologists in multidisciplinary research consortia.
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Affiliation(s)
- Nicolas Venisse
- INSERM CIC1402, University Hospital of Poitiers, University of Poitiers, 86021, Poitiers Cedex, France,Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Milétrie, 86021, Poitiers Cedex, France,Corresponding author. Laboratoire de Toxicologie et Pharmacocinétique, et CIC INSERM 1402, Centre Hospitalier Universitaire de Poitiers 2, rue de la Milétrie, 86021, Poitiers, France
| | - Gilles Peytavin
- AP-HP, Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department and IAME, INSERM, UMRS1137, Université de Paris, 75018, Paris, 7, France
| | - Stephane Bouchet
- Laboratoire de Pharmaco-Toxicologie, Service de Pharmacologie Médicale, CHU De Bordeaux, INSERM U1219, F-33076, Bordeaux Cedex, France
| | - Marie-Claude Gagnieu
- Hospices Civils de Lyon, GHS-Centre de Biologie Sud, Pierre Bénite, Lyon, France
| | - Rodolphe Garraffo
- Pharmacologie et Toxicologie Médicales, CHU et Faculté de Médecine de Nice, Université Côte D'Azur, Nice, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, APHM, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Université D'Aix-Marseille, 13005, Marseille, France
| | - Caroline Solas
- Aix-Marseille Univ, APHM, Unité des Virus Emergents (UVE) IRD 190, INSERM 1207, Laboratoire de Pharmacocinétique et Toxicologie, Hôpital La Timone, 13005, Marseille, France,Corresponding author. Laboratoire de Pharmacocinétique et de Toxicologie, APHM et Unité des Virus Émergents - (UVE) Aix-Marseille Université - IRD_190 - Inserm_1207 EFS - IRBA Hôpital de La Timone 264 rue Saint-Pierre 13005, Marseille, France
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25
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Lopez A, Duclos G, Pastene B, Bezulier K, Guilhaumou R, Solas C, Zieleskiewicz L, Leone M. Effects of Hydroxychloroquine on Covid-19 in Intensive Care Unit Patients: Preliminary Results. Int J Antimicrob Agents 2020; 56:106136. [PMID: 32777263 PMCID: PMC7413851 DOI: 10.1016/j.ijantimicag.2020.106136] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/29/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/19/2022]
Abstract
Usefulness of antivirals and hydroxychloroquine in Covid-19 patients in the Intensive care unit (ICU) is not evidence-based. No association between hydroxychloroquine plasma concentration, viral load evolution, and clinical outcome for Covid-19. These results indicate that administration of hydroxychloroquine in critically ill patients would not be useful.
During the Covid-19 pandemic, many intensive care unit (ICU) patients received hydroxychloroquine. The primary objective of this study was to assess the effects of hydroxychloroquine according to its plasma concentration in ICU patients. A single-center retrospective study was performed from March to April 2020 in an ICU of a university hospital. All patients admitted to the ICU with confirmed Covid-19 pneumonia and treated with hydroxychloroquine were included. The study compared 17 patients in whom the hydroxychloroquine plasma concentration was in the therapeutic target (on-target) and 12 patients in whom the plasma concentration was below the target (off-target). The follow-up of patients was 15 days. No association was found between hydroxychloroquine plasma concentration and viral load evolution (P = 0.77). There was no significant difference between the two groups for duration of mechanical ventilation, length of ICU stay, in-hospital mortality, and 15-days mortality. These findings indicate that hydroxychloroquine administration for Covid-19 patients hospitalized in ICU is not associated with improved outcomes. Larger multicenter studies are needed to confirm these results.
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Affiliation(s)
- Alexandre Lopez
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, 13015, France.
| | - Gary Duclos
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, 13015, France
| | - Bruno Pastene
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, 13015, France
| | - Karine Bezulier
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, 13015, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, APHM, Institut de neurosciences des systèmes, Inserm UMR 1106, Université d'Aix-Marseille, France
| | - Caroline Solas
- Aix-Marseille University, APHM, UMR "Emergence des Pathologies Virales" Inserm 1207 IRD 190, Laboratoire de Pharmacocinétique et Toxicologie, Hôpital La Timone, 13005 Marseille, France
| | - Laurent Zieleskiewicz
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, 13015, France; Center for Cardiovascular and Nutrition Research (C2VN) Aix Marseille Université, INSERM, INRA, Marseille, 13005, France
| | - Marc Leone
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, 13015, France
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Giaime P, Guenoun M, Pedinielli N, Narbonne H, Bergounioux JP, Solas C, Guilhaumou R, Sampol J, Ollier J, Sichez H, Serveaux M, Brunner F, Bataille S. Hydroxychloroquine and azithromycin tolerance in haemodialysis patients during COVID-19 infection. Nephrol Dial Transplant 2020; 35:1346-1353. [PMID: 32844224 PMCID: PMC7499716 DOI: 10.1093/ndt/gfaa191] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/08/2020] [Accepted: 06/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Haemodialysis patients are at risk of developing severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: coronavirus disease 2019 (COVID-19). In March 2020, hydroxychloroquine (HCQ) and azithromycin (AZI) were proposed as potential treatments of COVID-19, but with warnings concerning their possible toxicity. No data are available regarding the toxicity of this treatment in haemodialysis patients. METHODS We report the use of HCQ and AZI in a cohort of COVID-19 haemodialysis patients with focus on safety concerns. RESULTS Twenty-one patients received 200 mg HCQ thrice daily during 10 days, and AZI 500 mg on Day 1, and 250 mg on the four following days. HCQ plasma concentrations were within the recommended range (0.1-1.0 µg/mL) in all patients except one, in which maximum concentration was 1.1 µg/mL. HCQ concentration raised until the third day and remained stable thereafter. No cardiac event occurred in spite of progressive lengthening of corrected QT interval (QTc) during the treatment. One patient experienced a long QTc syndrome (QTc >500 ms) without any arrhythmia episode, although HCQ concentration was in the target range. Five (23.8%) patients experienced hypoglycaemia, a well-known HCQ side-effect. SARS-CoV-2 RNA remained detectable in nasopharyngeal swabs for a long time in haemodialysis patients (mean time 21 days). CONCLUSIONS HCQ and AZI are safe in haemodialysis patients at these doses but can lead to long QTc syndrome and hypoglycaemia. HCQ concentrations were not correlated with side effects. We recommend monitoring of the QTc length throughout treatment, as well as glycaemia. SARS-CoV-2 could persist for longer in haemodialysis patients than in the general population.
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Affiliation(s)
- Philippe Giaime
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Association pour le Traitement des Urémiques en Provence, Marseille, France
| | - Maxime Guenoun
- Department of Cardiology, Clinique Bouchard, Marseille, France
| | - Nathalie Pedinielli
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Association pour le Traitement des Urémiques en Provence, Marseille, France
| | - Hervé Narbonne
- Department of Endocrinology, Clinique Bouchard, Marseille, France
| | | | - Caroline Solas
- Aix-Marseille Université, APHM, Unité des Virus Emergents (UVE) IRD 190, INSERM 1207, Laboratoire de Pharmacocinétique et Toxicologie, Hôpital La Timone, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, APHM, Institut de Neurosciences des Systèmes, Inserm UMR 1106, Université d'Aix-Marseille, Marseille, France
| | - Jérôme Sampol
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Association pour le Traitement des Urémiques en Provence, Marseille, France
| | - Jacques Ollier
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Association pour le Traitement des Urémiques en Provence, Marseille, France
| | - Hélène Sichez
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Association pour le Traitement des Urémiques en Provence, Marseille, France
| | - Marianne Serveaux
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Association pour le Traitement des Urémiques en Provence, Marseille, France
| | - Flora Brunner
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Association pour le Traitement des Urémiques en Provence, Marseille, France
| | - Stanislas Bataille
- Phocean Nephrology Institute, Clinique Bouchard, Marseille, France
- Aix Marseille Université, INSERM, INRAE, C2VN, Marseille, France
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Marsot A, Hraiech S, Cassir N, Daviet F, Parzy G, Blin O, Papazian L, Guilhaumou R. Aminoglycosides in critically ill patients: which dosing regimens for which pathogens? Int J Antimicrob Agents 2020; 56:106124. [PMID: 32739478 DOI: 10.1016/j.ijantimicag.2020.106124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/30/2019] [Revised: 06/17/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022]
Abstract
Modifications of antibiotic pharmacokinetic parameters have been reported in critically ill patients, resulting in a risk of treatment failure. We aimed to determine optimised amikacin (AMK), gentamicin (GEN) and tobramycin (TOB) intravenous dosing regimens in this patient population. Patients admitted to the medical ICU and treated with AMK, GEN or TOB were included. Analyses were performed using a parametric population approach. Monte Carlo simulations were performed and the probability of target attainment (PTA) was calculated using Cmax/MIC ≥ 8 and trough concentrations as targets. A total of 117 critically ill hospitalised patients were studied. Median values (interindividual variability, ɷ2) of clearance were 3.51 (0.539), 3.53 (0.297), 2.70 (0.339) and 5.07 (0.339) L/h for AMK, GEN, TOB, and TOB in cystic fibrosis (CF), respectively. Median values (ɷ2) of central volume of distribution were 30.2 (0.215), 20.0 (0.109) and 25.6 (0.177) L for AMK, GEN and TOB, respectively. Simulations showed that doses should be adjusted to actual body weight and creatinine clearance (CLCR) for AMK and GEN, and according to CLCR and presence of CF for TOB. In conclusion, our recommendations for treating Pseudomonas aeruginosa infections in this population include using initial doses of 35 mg/kg for AMK or 10 mg/kg for TOB (CF and non-CF patients). GEN demonstrated the best rates of target attainment against Staphylococcus aureus infections with a dose of 5 mg/kg. As high aminoglycoside doses are required in this population, efficacy and safety targets are conflicting and therapeutic drug monitoring remains an important tool to manage this issue.
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Affiliation(s)
- A Marsot
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.
| | - S Hraiech
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - N Cassir
- Aix-Marseille Université, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - F Daviet
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - G Parzy
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - O Blin
- IHU Méditerranée Infection, Marseille, France
| | - L Papazian
- Service de Médecine Intensive-Réanimation, APHM, Hôpital Nord, Marseille, France; CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - R Guilhaumou
- Aix-Marseille Univ., APHM, INSERM, CIC CPCET Service de Pharmacologie Clinique et Pharmacovigilance, INS Inst Neurosci Syst, Marseille, France
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Stanke-Labesque F, Gautier-Veyret E, Chhun S, Guilhaumou R. Inflammation is a major regulator of drug metabolizing enzymes and transporters: Consequences for the personalization of drug treatment. Pharmacol Ther 2020; 215:107627. [PMID: 32659304 PMCID: PMC7351663 DOI: 10.1016/j.pharmthera.2020.107627] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [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: 03/03/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022]
Abstract
Inflammation is an evolutionary process that allows survival against acute infection or injury. Inflammation is also a pathophysiological condition shared by numerous chronic diseases. In addition, inflammation modulates important drug-metabolizing enzymes and transporters (DMETs), thus contributing to intra- and interindividual variability of drug exposure. A better knowledge of the impact of inflammation on drug metabolism and its related clinical consequences would help to personalize drug treatment. Here, we summarize the kinetics of inflammatory mediators and the underlying transcriptional and post-transcriptional mechanisms by which they contribute to the inhibition of important DMETs. We also present an updated overview of the effect of inflammation on the pharmacokinetic parameters of most of the drugs that are DMET substrates, for which therapeutic drug monitoring is recommended. Furthermore, we provide opinions on how to integrate the inflammatory status into pharmacogenetics, therapeutic drug monitoring, and population pharmacokinetic strategies to improve the personalization of drug treatment for each patient.
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Affiliation(s)
- Françoise Stanke-Labesque
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble 38000, France; Laboratory of Pharmacology-Pharmacogenetics-Toxicology, Pôle de Biologie et Pathologie, CHU Grenoble Alpes, France.
| | - Elodie Gautier-Veyret
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble 38000, France; Laboratory of Pharmacology-Pharmacogenetics-Toxicology, Pôle de Biologie et Pathologie, CHU Grenoble Alpes, France
| | - Stephanie Chhun
- Faculty of Medicine, Paris University, Paris, France; Institut Necker-Enfants Malades (INEM), INSERM U1151-CNRS UMR 8253, Paris, France; AP-HP, Paris Centre, Laboratory of Immunology, Necker-Enfants Malades Hospital, Paris, France
| | - Romain Guilhaumou
- Clinical Pharmacology and Pharmacovigilance Unit, AP-HM, Marseille, France; Aix Marseille Univ, INSERM, INS Inst Neurosci Syst, Marseille, France
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Roustit M, Guilhaumou R, Molimard M, Drici MD, Laporte S, Montastruc JL. Chloroquine and hydroxychloroquine in the management of COVID-19: Much kerfuffle but little evidence. Therapie 2020; 75:363-370. [PMID: 32473812 PMCID: PMC7244425 DOI: 10.1016/j.therap.2020.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/18/2020] [Indexed: 12/27/2022]
Abstract
Chloroquine and hydroxychloroquine are drugs that have shown in vitro activity on the replication of certain coronaviruses. In the context of the SARS-Cov-2 epidemic, the virus responsible for the novel coronavirus disease (COVID-19), these two drugs have been proposed as possible treatments. The results of the first clinical studies evaluating the effect of hydroxychloroquine do not support any efficacy of this drug in patients with COVID-19, due to major methodological weaknesses. Yet, these preliminary studies have aroused considerable media interest, raising fears of massive and uncontrolled use. In the absence of evidence of clinical benefits, the main risk is of exposing patients unnecessarily to the well-known adverse effects of hydroxychloroquine, with a possibly increased risk in the specific setting of COVID-19. In addition, widespread use outside of any recommendation risks compromising the completion of good quality clinical trials. The chloroquine hype, fueled by low-quality studies and media announcements, has yielded to the implementation of more than 150 studies worldwide. This represents a waste of resources and a loss of opportunity for other drugs to be properly evaluated. In the context of emergency, rigorous trials are more than ever needed in order to have, as soon as possible, reliable data on drugs that are possibly effective against the disease. Meanwhile, serious adverse drug reactions have been reported in patients with COVID-19 receiving hydroxychloroquine, justifying to limit its prescription, and to perform suitable cardiac and therapeutic drug monitoring.
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Affiliation(s)
- M Roustit
- Pharmacologie clinique, Université Grenoble Alpes, CHU de Grenoble, 38043 Grenoble, France.
| | - R Guilhaumou
- Aix Marseille Université, hôpital de la Timone, institut de neuroscience des systèmes, 13005 Marseille, France
| | - M Molimard
- Service de pharmacologie médicale, University Bordeaux, Inserm U1219, 33076 Bordeaux, France
| | - M-D Drici
- Pharmacovigilance - Department of Pharmacology, Pasteur Hospital, 06001 Nice, France
| | - S Laporte
- Université Jean Monnet, Université de Lyon, et unité de recherche clinique, innovation, pharmacologie, CHU Saint-Etienne, 42055 Saint-Étienne, France
| | - J-L Montastruc
- Service de pharmacologie médicale et clinque, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, CIC INSERM 1436, faculté de Médecine, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
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30
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Wang YL, Guilhaumou R, Blin O, Velly L, Marsot A. External evaluation of population pharmacokinetic models for continuous administration of meropenem in critically ill adult patients. Eur J Clin Pharmacol 2020; 76:1281-1289. [PMID: 32495084 DOI: 10.1007/s00228-020-02922-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/27/2020] [Accepted: 05/29/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Beta-lactams (BL), the most commonly prescribed class of antibiotics, are recommended as the first-line therapy for multiple indications in infectious disease guidelines. Meropenem (MERO) is frequently used in intensive care units (ICU) to treat bacterial infections with or without sepsis. The pharmacokinetics of MERO display a large variability in patients admitted to ICUs due to altered pathophysiology. The aim of this study was to perform an external evaluation of published population pharmacokinetic models of MERO in order to test their predictive performance in a cohort of ICU adult patients. METHODS A literature search in PubMed/Medline database was made following the PRISMA statement. External evaluation was performed using NONMEM software, and the bias and inaccuracy values were calculated. RESULTS An external validation dataset from the Timone Hospital in Marseille, France, included 84 concentration samples from 27 patients. Four models of MERO were identified according to the inclusion criteria of the study. None of the models presented acceptable values of bias and inaccuracy. CONCLUSION While performing external evaluations on some populations may confirm a model's suitability to diverse groups of patients, there is still some variability that cannot be explained nor solved by the procedure. This brings to light the difficulty to develop only one model for ICU patients and the need to develop one specific model to each population of critically ill patients.
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Affiliation(s)
- Y L Wang
- Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculté de Pharmacie, Université de Montréal, Pavillon Jean-Coutu, 2940 chemin de Polytechnique, Montréal, QC, H3T 1J4, Canada.,Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - R Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Pharmacologie intégrée et interface clinique et industrielle, Institut de Neuroscience des systèmes, CNRS 7289, Aix Marseille Université, 13385, Marseille, France
| | - O Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Pharmacologie intégrée et interface clinique et industrielle, Institut de Neuroscience des systèmes, CNRS 7289, Aix Marseille Université, 13385, Marseille, France
| | - L Velly
- Service d'Anesthésie-Réanimation, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Amélie Marsot
- Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculté de Pharmacie, Université de Montréal, Pavillon Jean-Coutu, 2940 chemin de Polytechnique, Montréal, QC, H3T 1J4, Canada. .,Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada. .,Centre de Recherche, CHU Sainte Justine, Montréal, QC, Canada.
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31
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Marsot A, Ménard A, Dupouey J, Allanioux L, Blin O, Guilhaumou R. Evaluation of current dosing guidance for oral rifampicin treatment in adult patients with osteoarticular infections. Br J Clin Pharmacol 2020; 86:2319-2324. [PMID: 32330996 DOI: 10.1111/bcp.14319] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/23/2023] Open
Abstract
For management of osteoarticular infections, rifampicin appears to be the key antibiotic. We aimed to evaluate the actual rifampicin dosing regimens using a population pharmacokinetic model of rifampicin in patients with osteoarticular infections. A Monte Carlo simulation study was performed to simulate steady-state plasma concentrations for 1000 randomly sampled subjects using a total daily dose between 600 and 1200 mg (600 and 900 mg once daily, 450 and 600 mg twice daily, or 300 mg 3 times daily). When rifampicin was administered with fusidic acid, the pharmacokinetic/pharmacodynamic (PK/PD) target (area under the curve/minimum inhibitory concentration ≥952) was achieved with all tested dosing regimen, except 600 mg once daily for Staphylococcus epidermidis infections. Without coadministration of fusidic acid, none of tested dosing regimens achieved this PK/PD target. Most recommended drug-dosing regimens allow attaining the fixed area under the curve/minimum inhibitory concentration target for Staphylococcus aureus and coagulase-negative staphylococcal osteoarticular infections. In future studies, PK/PD target for osteoarticular infections in human should also be confirmed.
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Affiliation(s)
- Amélie Marsot
- Laboratoire de Suivi Thérapeutique Pharmacologique et Pharmacocinétique, Faculté de Pharmacie, Université de Montréal, Montréal, Canada, QC
| | - Amélie Ménard
- Pôle des Maladies Infectieuses et Tropicales, Fondation IHU Méditerranée Infection, APHM, Marseille, France
| | - Julien Dupouey
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, France.,Aix Marseille Université, Pharmacologie intégrée et interface clinique et industrielle, Institut de Neuroscience des systèmes, CNRS, 7289, Marseille, France
| | - Laurent Allanioux
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, France
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, France.,Aix Marseille Université, Pharmacologie intégrée et interface clinique et industrielle, Institut de Neuroscience des systèmes, CNRS, 7289, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, France.,Aix Marseille Université, Pharmacologie intégrée et interface clinique et industrielle, Institut de Neuroscience des systèmes, CNRS, 7289, Marseille, France
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Lefeuvre S, Bois-Maublanc J, Guilhaumou R. [Practical information for therapeutic drug monitoring of vancomycine]. Therapie 2019; 75:506-509. [PMID: 31653523 DOI: 10.1016/j.therap.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/24/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Sandrine Lefeuvre
- Laboratoire de biochimie-pharmacologie-toxicologie, CHR La Source, 14, avenue de l'Hôpital, 45067 Orléans, France.
| | - Julie Bois-Maublanc
- Laboratoire de biochimie-pharmacologie-toxicologie, CHR La Source, 14, avenue de l'Hôpital, 45067 Orléans, France
| | - Romain Guilhaumou
- Service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, CHU de Marseille, 13000 Marseille, France
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Francon D, Riff C, Blin O, Cohen M, Guilhaumou R. Prolonged continuous wound infiltration with a local anaesthetic after total mastectomy: pharmacokinetics and preliminary results on postoperative pain. Anaesth Crit Care Pain Med 2019; 38:385-386. [DOI: 10.1016/j.accpm.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
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Gaillard-Bigot F, Zendjidjian XY, Kheloufi F, Casse-Perrot C, Guilhaumou R, Micallef J, Fakra E, Azorin JM, Blin O. Quantitative System Pharmacology (QSP): An Integrative Framework for paradigm change in the treatment of the first-episode schizophrenia. Encephale 2019; 44:S34-S38. [PMID: 30935485 DOI: 10.1016/s0013-7006(19)30077-6] [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] [Indexed: 12/18/2022]
Abstract
Despite the lack of progress in the curative treatment of mental illness, especially schizophrenia, the accumulation of neuroscience data over the past decade suggests the re-conceptualization of schizophrenia. With the advent of new biomarkers and cognitive tools, new neuroscience technologies such as functional dynamic connectivity and the identification of subtle clinical features; it is now possible to detect early stages at risk or prodromes of a first psychotic episode. Current concepts reconceptualizes schizophrenia as a neurodevelopmental disorder at early onset, with polygenic risk and only symptomatic treatment for positive symptoms at this time. The use of such technologies in the future suggests new diagnostic and therapeutic options. Next steps include new pharmacological perspectives and potential contributions of new technologies such as quantitative system pharmacology brain computational modeling approach.
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Affiliation(s)
- F Gaillard-Bigot
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - X-Y Zendjidjian
- Pôle psychiatrie centre, hôpital de la Conception, assistance publique des hôpitaux de Marseille, Marseille, France
| | - F Kheloufi
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - C Casse-Perrot
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - R Guilhaumou
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - J Micallef
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France
| | - E Fakra
- Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France, Inserm U1059, University of Lyon, Saint-Etienne F-42023, France
| | - J-M Azorin
- Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France
| | - O Blin
- Service de pharmacologie clinique et pharmacovigilance, CIC CPCET, assistance publique des hôpitaux de Marseille, Institut de neurosciences des systèmes, Inserm UMR 1106, université d'Aix-Marseille, France.
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Guilhaumou R, Benaboud S, Bennis Y, Dahyot-Fizelier C, Dailly E, Gandia P, Goutelle S, Lefeuvre S, Mongardon N, Roger C, Scala-Bertola J, Lemaitre F, Garnier M. Optimization of the treatment with beta-lactam antibiotics in critically ill patients-guidelines from the French Society of Pharmacology and Therapeutics (Société Française de Pharmacologie et Thérapeutique-SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation-SFAR). Crit Care 2019; 23:104. [PMID: 30925922 PMCID: PMC6441232 DOI: 10.1186/s13054-019-2378-9] [Citation(s) in RCA: 271] [Impact Index Per Article: 54.2] [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: 11/21/2018] [Accepted: 02/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Beta-lactam antibiotics (βLA) are the most commonly used antibiotics in the intensive care unit (ICU). ICU patients present many pathophysiological features that cause pharmacokinetic (PK) and pharmacodynamic (PD) specificities, leading to the risk of underdosage. The French Society of Pharmacology and Therapeutics (SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) have joined forces to provide guidelines on the optimization of beta-lactam treatment in ICU patients. METHODS A consensus committee of 18 experts from the two societies had the mission of producing these guidelines. The entire process was conducted independently of any industry funding. A list of questions formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes) was drawn-up by the experts. Then, two bibliographic experts analysed the literature published since January 2000 using predefined keywords according to PRISMA recommendations. The quality of the data identified from the literature was assessed using the GRADE® methodology. Due to the lack of powerful studies having used mortality as main judgement criteria, it was decided, before drafting the recommendations, to formulate only "optional" recommendations. RESULTS After two rounds of rating and one amendment, a strong agreement was reached by the SFPT-SFAR guideline panel for 21 optional recommendations and a recapitulative algorithm for care covering four areas: (i) pharmacokinetic variability, (ii) PK-PD relationship, (iii) administration modalities, and (iv) therapeutic drug monitoring (TDM). The most important recommendations regarding βLA administration in ICU patients concerned (i) the consideration of the many sources of PK variability in this population; (ii) the definition of free plasma concentration between four and eight times the Minimal Inhibitory Concentration (MIC) of the causative bacteria for 100% of the dosing interval as PK-PD target to maximize bacteriological and clinical responses; (iii) the use of continuous or prolonged administration of βLA in the most severe patients, in case of high MIC bacteria and in case of lower respiratory tract infection to improve clinical cure; and (iv) the use of TDM to improve PK-PD target achievement. CONCLUSIONS The experts strongly suggest the use of personalized dosing, continuous or prolonged infusion and therapeutic drug monitoring when administering βLA in critically ill patients.
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Affiliation(s)
- Romain Guilhaumou
- AP-HM Hôpital de la Timone, Service de Pharmacologie Clinique et Pharmacovigilance, 264 rue Saint Pierre, 13005 Marseille, France
| | - Sihem Benaboud
- AP-HP Hôpital Cochin, Service de Pharmacologie, 27 rue du Faubourg St-Jacques, 75679 Paris Cedex 14, France
| | - Youssef Bennis
- CHU d’Amiens Picardie, Service de Pharmacologie Clinique, UPJV EA7517, Avenue Laennec, 80054 Amiens Cedex 1, France
| | - Claire Dahyot-Fizelier
- CHU de Poitiers, Département d’Anesthésie Réanimation, 2 Rue de la Milétrie, 86021 Poitiers, France
| | - Eric Dailly
- CHU de Nantes, Département de Pharmacologie Clinique, 5 allée de l’île gloriette, 44093 Nantes Cedex 01, France
| | - Peggy Gandia
- CHU de Toulouse, Laboratoire de Pharmacocinétique et Toxicologie Clinique, Institut Fédératif de Biologie, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - Sylvain Goutelle
- CHU de Lyon, Service de Pharmacie, Groupement Hospitalier Nord, Hôpital Pierre Garraud, 136 rue du Commandant Charcot, 69322 Lyon cedex 05, France
| | - Sandrine Lefeuvre
- CHR d’Orléans, Laboratoire de Biochimie, 14 Avenue de l’Hôpital, 45067 Orléans, France
| | - Nicolas Mongardon
- AP-HP Hôpital Henri Mondor, Département d’Anesthésie-Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Claire Roger
- CHU de Nîmes, Département d’anesthésie, réanimation, douleur et médicine d’urgence, Place du Pr Robert Debré, 30029 Nîmes cedex 9, France
| | - Julien Scala-Bertola
- CHRU de Nancy, Département de pharmacologie clinique et de toxicologie, 29 rue Lionnois, 54000 Nancy, France
| | - Florian Lemaitre
- CHU Pontchaillou, Service de Pharmacologie Clinique et épidémiologique, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Marc Garnier
- AP-HP Hôpital Tenon, Département d’Anesthésie et Réanimation, 4 rue de la Chine, 75020 Paris, France
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Sautet P, Mékidèche T, Guilhaumou R, Abdel MP, Argenson JN, Parratte S, Ollivier M. Vancomycin elution kinetics from porous tantalum metal. J Orthop Res 2019; 37:308-312. [PMID: 30325073 DOI: 10.1002/jor.24160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/03/2018] [Indexed: 02/04/2023]
Abstract
Revisions TKAs are being completed with uncemented constructs more frequently. We hypothesized that tantalum cones could be an efficient carrier of antibiotics in uncemented procedures. We aimed to compare the release of vancomycin between (i) tantalum and smooth stainless cylinders; (ii) different concentrations of vancomycin; and (iii) different durations of bathing. Specifically designed tantalum cylinders were bathed in a vancomycin solution with various durations of baths. We investigated rinses between each interval as well as the dose of vancomycin. Vancomycin concentrations were determined in each group by fluorescence polarization immunoassay at different intervals (1 h, days 1, 2, 3, 5). At 1 h, the mean vancomycin concentration for the 1-hour soaking group was 3,172 μg/ml, whereas mean concentration for the smooth stainless steel group was 39.37 μg/ml (p < 0.001). The rinsing group showed a significantly lower concentration at 1 h and 1 day (p < 0.05). The 2-gram vancomycin group showed no difference at days 1, 2, and 3 compared to the 1-hour group. The 5, 15, and 30-minute bathing groups showed significantly lower vancomycin concentrations at all-time points. All vancomycin concentrations at day 3 were superior to the minimal inhibitory concentration of Staphyloccocus aureus. The mean concentration of vancomycin depends on the material, duration of bathing, the rinsing effect, and the drug dose. Our in-vitro study is the first to show that porous tantalum cylinders allow antibiotic carriage and progressive release. If appearing in vivo, in a similar extent, this intrinsic property might be useful to prevent and/or treat peri-prosthetic joint infection. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:308-312, 2019.
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Affiliation(s)
- Pierre Sautet
- Institute of Movement and Locomotion, Saint-Marguerite Hospital, Boulevard Sainte-Marguerite, 13009 Marseille, France.,Aix-Marseille University, CNRS, ISM, Institute Movement Science, Marseille, France
| | - Thibaut Mékidèche
- Department of Clinical Pharmacology, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Romain Guilhaumou
- Department of Clinical Pharmacology, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jean-Noël Argenson
- Institute of Movement and Locomotion, Saint-Marguerite Hospital, Boulevard Sainte-Marguerite, 13009 Marseille, France.,Aix-Marseille University, CNRS, ISM, Institute Movement Science, Marseille, France
| | - Sébastien Parratte
- Institute of Movement and Locomotion, Saint-Marguerite Hospital, Boulevard Sainte-Marguerite, 13009 Marseille, France.,Aix-Marseille University, CNRS, ISM, Institute Movement Science, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Saint-Marguerite Hospital, Boulevard Sainte-Marguerite, 13009 Marseille, France.,Aix-Marseille University, CNRS, ISM, Institute Movement Science, Marseille, France
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Lemaitre F, Goirand F, Launay M, Chatelut E, Boyer JC, Evrard A, Paludetto MN, Guilhaumou R, Ciccolini J, Schmitt A. [5-fluorouracil therapeutic drug monitoring: Update and recommendations of the STP-PT group of the SFPT and the GPCO-Unicancer]. Bull Cancer 2018; 105:790-803. [PMID: 30103904 DOI: 10.1016/j.bulcan.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/04/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
Despite being 60-years old now, 5-FU remains the backbone of numerous regimen to treat a variety of solid tumors such as breast, head-and-neck and digestive cancers either in neo-adjuvant, adjuvant or metastatic settings. Standard 5-FU usually claims 15-40% of severe toxicities and up to 1% of toxic-death. Numerous studies show a stiff relationship between 5-FU exposure and toxicity or efficacy. In addition, 5-FU pharmacokinetics is highly variable between patients. Indeed, 80% of the 5-FU dose is catabolized in the liver by dihydropyrimidine dehydrogenase (DPD) into inactive compounds. It is now well established that DPD deficiency could lead to severe toxicities and, thus, require dose reduction in deficient patients. However, despite dosage adaptation based on DPD status, some patients may still experience under- or over-exposure, leading to inefficacy or major toxicity. The "Suivi thérapeutique pharmacologique et personnalisation des traitements" (STP-PT) group of the "Société française de pharmacologie et de thérapeutique" (SFPT) and the "Groupe de pharmacologie clinique oncologique" (GPCO)-Unicancer, based on the latest and most up-to-date literature data, recommend the implementation of 5-FU Therapeutic Drug Monitoring in order to ensure an adequate 5-FU exposure.
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Affiliation(s)
- Florian Lemaitre
- Université Rennes 1, CHU de Rennes, centre d'investigation clinique Inserm 1414, service de pharmacologie clinique, laboratoire de pharmacologie expérimentale et clinique, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Françoise Goirand
- Centre hospitalo-universitaire de Dijon-Bourgogne, 5, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Manon Launay
- Hôpital européen Georges-Pompidou, laboratoire de pharmacologie et de toxicologie, service de pharmacologie, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - Etienne Chatelut
- Institut Claudius-Regaud et centre de recherches en cancérologie de Toulouse, IUCT - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Jean-Christophe Boyer
- CHU de Nîmes Carémeau, laboratoire de biochimie et biologie moléculaire, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Alexandre Evrard
- CHU de Nîmes Carémeau, laboratoire de biochimie et biologie moléculaire, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Marie-Noelle Paludetto
- Institut Claudius-Regaud et centre de recherches en cancérologie de Toulouse, IUCT - Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Romain Guilhaumou
- AP-HM, CHU Timone, service de pharmacologie clinique et pharmacovigilance, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Joseph Ciccolini
- AP-HM, CHU Timone, SMARTc CRCM UMR Inserm U1068, laboratoire de pharmacocinétique clinique, 265, rue St-Pierre, 13385 Marseille, France
| | - Antonin Schmitt
- Centre Georges-François-Leclerc, service pharmacie, 1, rue Pr.-Marion, 21000 Dijon, France.
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Marsot A, Gallais F, Galambrun C, Coze C, Blin O, Andre N, Guilhaumou R. Vancomycin in Pediatric Patients with Solid or Hematological Malignant Disease: Predictive Performance of a Population Pharmacokinetic Model and New Optimized Dosing Regimens. Paediatr Drugs 2018; 20:375-381. [PMID: 29736878 DOI: 10.1007/s40272-018-0295-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The application of population pharmacokinetic models and Bayesian methods offers the potential to develop individualized therapeutic approaches. OBJECTIVES The current study presents an external evaluation of a vancomycin pharmacokinetic model in a pediatric cancer population and proposes an easy-to-use chart for clinicians for a priori vancomycin schedule adaptation to achieve target concentration. METHODS External evaluation of a population pharmacokinetic model of vancomycin administered via continuous infusion was realized in a new retrospective dataset of pediatric patients with cancer. The published population pharmacokinetic model was implemented in NONMEM 7.3 with the structural and variance parameter values set equal to estimates previously reported. Predictive performance was assessed by quantifying bias and accuracy of model prediction. Normalized prediction distribution errors were also evaluated. Dosage simulations were performed according to the target concentration. RESULTS A total of 77 patients were included in this study, representing 146 vancomycin courses and 289 concentrations. The model adequately predicted vancomycin concentrations (median prediction error % of - 9.4%, median |PE|% of 24.1%). Based on simulation results, vancomycin dosage (mg/kg) should be adapted for each child on the basis of body weight and cyclosporine coadministration. CONCLUSION The model previously proposed by Guilhaumou et al. in pediatric patients with solid or hematological malignant disease was externally validated. Simulations have enabled the description of new dosage schedules and creation of a chart to help clinicians adapt vancomycin dosage.
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Affiliation(s)
- Amélie Marsot
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 5, France.
- Aix Marseille Université, Pharmacologie Intégrée Interface Clinique et Industriel, Institut des Neurosciences Timone-CNRS 7289, 13385, Marseille, France.
| | - F Gallais
- Aix Marseille Université, Pharmacologie Intégrée Interface Clinique et Industriel, Institut des Neurosciences Timone-CNRS 7289, 13385, Marseille, France
| | - C Galambrun
- Service d'Hématologie et Oncologie Pédiatrique, Hôpital de la Timone, Marseille, France
| | - C Coze
- Service d'Hématologie et Oncologie Pédiatrique, Hôpital de la Timone, Marseille, France
| | - O Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 5, France
- Aix Marseille Université, Pharmacologie Intégrée Interface Clinique et Industriel, Institut des Neurosciences Timone-CNRS 7289, 13385, Marseille, France
| | - N Andre
- Service d'Hématologie et Oncologie Pédiatrique, Hôpital de la Timone, Marseille, France
- INSERM, UMR 911, Centre de Recherche en Oncologie biologique et en Oncopharmacologie, Aix-Marseille University, Marseille, France
| | - R Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 5, France
- Aix Marseille Université, Pharmacologie Intégrée Interface Clinique et Industriel, Institut des Neurosciences Timone-CNRS 7289, 13385, Marseille, France
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Riff C, Bourgoin A, Marsot A, Allanioux L, Leone M, Blin O, Guilhaumou R. Population pharmacokinetic model for tumescent lidocaine in women undergoing breast cancer surgery. Eur J Clin Pharmacol 2018; 74:1309-1315. [PMID: 29909577 DOI: 10.1007/s00228-018-2503-8] [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: 03/07/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Tumescent lidocaine anesthesia (TLA) is an opportunity to perform mastectomy for breast cancer without general anesthesia in elderly women. Few reports are available on the pharmacokinetics of lidocaine in a context of TLA during a unilateral mastectomy. The aim of this study was to describe lidocaine pharmacokinetics in elderly women undergoing breast cancer surgery after TLA and to explore the risk of the toxicity of this technique. METHODS A prospective study was conducted to examine the pharmacokinetics of lidocaine in women undergoing TLA. TLA consists of an intradermal lidocaine instillation (20 mL, 1% [200 mg]) followed by a tumescent lidocaine infiltration (100 mL of 1% lidocaine [1000 mg] and 0.5 mg epinephrine to 1 L Ringer's lactate) via an infusion pump. A population pharmacokinetic (popPK) analysis was performed using the nonlinear mixed effects model (NONMEM). RESULTS The analysis included 116 observations from 17 women with a median (range) age of 83.4 (60.5-90.0). The median tumescent lidocaine dose was 800 mg (range 375-1000 mg) infused over 48.0 ± 11.0 min. A one-compartment disposition model with first order absorption, two input compartments, and a central elimination best described the pharmacokinetics of lidocaine. The estimates (between subject variability; relative standard error, %) of apparent volume, apparent clearance, tumescent absorption rate, and instillation absorption rate were 195.0 (46.3; 14.5%) L, 24.7 (48.9; 13.3%) L h-1, 0.28 (39.6; 13.8%) h-1, and 2.56 (135.3; 44.9%) h-1, respectively. CONCLUSIONS This is the first popPK model developed to describe kinetic profiles of TLA. These findings confirm the slow diffusion of lidocaine from the tumescent deposit.
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Affiliation(s)
- Camille Riff
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, AP-HM, 13385, Marseille, France. .,Pharmacologie Intégrée et Interface Clinique Industrielle, Institut des Neurosciences Timone - AMU-CNRS 7289, Aix-Marseille Université, 13385, Marseille, France.
| | - Aurélie Bourgoin
- Aix Marseille Université, Service d'Anesthésie-Réanimation, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, APHM, Marseille, France
| | - Amelie Marsot
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, AP-HM, 13385, Marseille, France.,Pharmacologie Intégrée et Interface Clinique Industrielle, Institut des Neurosciences Timone - AMU-CNRS 7289, Aix-Marseille Université, 13385, Marseille, France
| | - Laurent Allanioux
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, AP-HM, 13385, Marseille, France
| | - Marc Leone
- Aix Marseille Université, Service d'Anesthésie-Réanimation, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, APHM, Marseille, France
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, AP-HM, 13385, Marseille, France.,Pharmacologie Intégrée et Interface Clinique Industrielle, Institut des Neurosciences Timone - AMU-CNRS 7289, Aix-Marseille Université, 13385, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, AP-HM, 13385, Marseille, France
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Riff C, Diaz A, Blin O, Leone M, Guilhaumou R, Bourgoin A. Tumescent local anaesthesia for breast cancer surgery in elderly women: about 6 cases. Anaesth Crit Care Pain Med 2018; 38:387-389. [PMID: 29864551 DOI: 10.1016/j.accpm.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 10/14/2022]
Affiliation(s)
- C Riff
- Department of clinical pharmacology et Pharmacovigilance, AP-HM, 13385 Marseille, France; Integrated pharmacology and industrial clinical platform, Institut des Neurosciences Timone-AMU-CNRS 7289, Aix-Marseille Université, 13385 Marseille, France.
| | - A Diaz
- Department of anaesthesia and intensive care, Aix Marseille University, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, APHM, 13015 Marseille, France
| | - O Blin
- Department of clinical pharmacology et Pharmacovigilance, AP-HM, 13385 Marseille, France; Integrated pharmacology and industrial clinical platform, Institut des Neurosciences Timone-AMU-CNRS 7289, Aix-Marseille Université, 13385 Marseille, France
| | - M Leone
- Department of anaesthesia and intensive care, Aix Marseille University, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, APHM, 13015 Marseille, France
| | - R Guilhaumou
- Department of clinical pharmacology et Pharmacovigilance, AP-HM, 13385 Marseille, France
| | - A Bourgoin
- Department of anaesthesia and intensive care, Aix Marseille University, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, APHM, 13015 Marseille, France
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Riff C, Guilhaumou R, Marsot A, Beaussier M, Cohen M, Blin O, Francon D. Ropivacaine Wound Infiltration for Pain Management After Breast Cancer Mastectomy: A Population Pharmacokinetic Analysis. Clin Pharmacol Drug Dev 2018; 7:811-819. [DOI: 10.1002/cpdd.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/31/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Camille Riff
- Service de Pharmacologie Clinique et Pharmacovigilance; AP-HM; Pharmacologie intégrée et interface clinique industrielle; Institut des Neurosciences Timone - AMU-CNRS 7289; Aix-Marseille Université; Marseille France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance; AP-HM; Pharmacologie intégrée et interface clinique industrielle; Institut des Neurosciences Timone - AMU-CNRS 7289; Aix-Marseille Université; Marseille France
| | - Amelie Marsot
- Service de Pharmacologie Clinique et Pharmacovigilance; AP-HM; Pharmacologie intégrée et interface clinique industrielle; Institut des Neurosciences Timone - AMU-CNRS 7289; Aix-Marseille Université; Marseille France
| | - Marc Beaussier
- Département Anesthésie; Institut Mutualiste Montsouris; Paris France
| | - Monique Cohen
- Département Chirurgie Oncologique; Institut Paoli-Calmettes; Marseille France
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance; AP-HM; Pharmacologie intégrée et interface clinique industrielle; Institut des Neurosciences Timone - AMU-CNRS 7289; Aix-Marseille Université; Marseille France
| | - Daniel Francon
- Institut Paoli-Calmettes; Département Anesthésie - Réanimation; Marseille France
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Toullec L, Dupouey J, Vigne C, Marsot A, Allanioux L, Blin O, Leone M, Guilhaumou R. Analytical interference during cefepime therapeutic drug monitoring in intensive care patient: About a case report. Therapie 2017; 72:587-592. [DOI: 10.1016/j.therap.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/07/2017] [Indexed: 11/16/2022]
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Marsot A, Guilhaumou R, Azulay JP, Blin O. Levodopa in Parkinson’s Disease: A Review of Population Pharmacokinetics/Pharmacodynamics Analysis. J Pharm Pharm Sci 2017; 20:226-238. [DOI: 10.18433/j30h04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease. Although levodopa remains the single effective agent in the management of Parkinson’s disease, the accurate determination of this optimal dosage is complicated by marked between-subject and between-occasion variability in this population. This review presents a synthesis of the population pharmacokinetic and pharmacodynamic models of levodopa described in Parkinson’s disease. Methods:A literature search was conducted from the PubMed database, from their inception through April 2016, using the following terms: levodopa, pharmacokinetic(s), pharmacodynamic(s) population, model(ling) and nonlinear mixed effect. Articles were excluded if they were not pertinent. References of all selected articles were also evaluated. Results: A total of 12 articles were finally retained. The following covariates were selected as interindividual variability factors: body weight, age, sex, creatinine clearance and levodopa dose. The clinical response versus effect site concentration relationship was described with different sigmoidal Emax models. Different pharmacodynamic effects were described: UPDRS, Tapping, Dyskinesia, CURSΣ and treatment response scale. Discussion: This review allows us to realize interpretation of a patient’s clinical picture and confirmed the appropriateness of the pharmacokinetic-pharmacodynamic modeling for levodopa. External evaluation of previous published models should be also continued to evaluate these previous studies. New pharmacokinetic and/or pharmacodynamic population modelling studies could be consider to improve future models and decrease variability, to better understand the evolution of patients with Parkinson’s disease treated by levodopa. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.
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Satori D, Setti J, Marsot A, Triglia T, Bruder N, Blin O, Velly L, Guilhaumou R. Suivi thérapeutique pharmacologique des beta-lactamines administrées en perfusion continue en réanimation. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marsot A, Michel F, Chasseloup E, Paut O, Guilhaumou R, Blin O. Phenobarbital in intensive care unit pediatric population: predictive performances of population pharmacokinetic model. Fundam Clin Pharmacol 2017; 31:558-566. [PMID: 28407406 DOI: 10.1111/fcp.12291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/18/2016] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 11/30/2022]
Abstract
An external evaluation of phenobarbital population pharmacokinetic model described by Marsot et al. was performed in pediatric intensive care unit. Model evaluation is an important issue for dose adjustment. This external evaluation should allow confirming the proposed dosage adaptation and extending these recommendations to the entire intensive care pediatric population. External evaluation of phenobarbital published population pharmacokinetic model of Marsot et al. was realized in a new retrospective dataset of 35 patients hospitalized in a pediatric intensive care unit. The published population pharmacokinetic model was implemented in nonmem 7.3. Predictive performance was assessed by quantifying bias and inaccuracy of model prediction. Normalized prediction distribution errors (NPDE) and visual predictive check (VPC) were also evaluated. A total of 35 infants were studied with a mean age of 33.5 weeks (range: 12 days-16 years) and a mean weight of 12.6 kg (range: 2.7-70.0 kg). The model predicted the observed phenobarbital concentrations with a reasonable bias and inaccuracy. The median prediction error was 3.03% (95% CI: -8.52 to 58.12%), and the median absolute prediction error was 26.20% (95% CI: 13.07-75.59%). No trends in NPDE and VPC were observed. The model previously proposed by Marsot et al. in neonates hospitalized in intensive care unit was externally validated for IV infusion administration. The model-based dosing regimen was extended in all pediatric intensive care unit to optimize treatment. Due to inter- and intravariability in pharmacokinetic model, this dosing regimen should be combined with therapeutic drug monitoring.
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Affiliation(s)
- Amélie Marsot
- Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie Intégrée et Interface Clinique Industrielle, Institut des Neurosciences Timone - AMU-CNRS 7289, Aix-Marseille Université, AP-HM, Hopital Timone - Bâtiment F, 264 rue Saint Pierre, Marseille, 13385, France
| | - Fabrice Michel
- Service de Réanimation Pédiatrique, AP-HM, Hopital Timone, 264 rue saint pierre Marseille, 13385, France
| | - Estelle Chasseloup
- Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie Intégrée et Interface Clinique Industrielle, Institut des Neurosciences Timone - AMU-CNRS 7289, Aix-Marseille Université, AP-HM, Hopital Timone - Bâtiment F, 264 rue Saint Pierre, Marseille, 13385, France
| | - Olivier Paut
- Service de Réanimation Pédiatrique, AP-HM, Hopital Timone, 264 rue saint pierre Marseille, 13385, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie Intégrée et Interface Clinique Industrielle, Institut des Neurosciences Timone - AMU-CNRS 7289, Aix-Marseille Université, AP-HM, Hopital Timone - Bâtiment F, 264 rue Saint Pierre, Marseille, 13385, France
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Pharmacologie Intégrée et Interface Clinique Industrielle, Institut des Neurosciences Timone - AMU-CNRS 7289, Aix-Marseille Université, AP-HM, Hopital Timone - Bâtiment F, 264 rue Saint Pierre, Marseille, 13385, France
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Chouraqui L, Schmitt C, Bosdure E, Torrents R, Boulamery A, Guilhaumou R, Simon N, De Haro L. Intoxication aiguë à l’isoniazide chez un nourrisson de 21 mois. Toxicologie Analytique et Clinique 2017. [DOI: 10.1016/j.toxac.2017.03.052] [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] [Indexed: 11/26/2022]
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Marsot A, Boucherie Q, Kheloufi F, Riff C, Braunstein D, Dupouey J, Guilhaumou R, Zendjidjian X, Bonin-Guillaume S, Fakra E, Guye M, Jirsa V, Azorin JM, Belzeaux R, Adida M, Micallef J, Blin O. [What can we expect from clinical trials in psychiatry?]. Encephale 2017; 42:S2-S6. [PMID: 28236988 DOI: 10.1016/s0013-7006(17)30046-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clinical trials in psychiatry allow to build the regulatory dossiers for market authorization but also to document the mechanism of action of new drugs, to build pharmacodynamics models, evaluate the treatment effects, propose prognosis, efficacy or tolerability biomarkers and altogether to assess the impact of drugs for patient, caregiver and society. However, clinical trials have shown some limitations. Number of recent dossiers failed to convince the regulators. The clinical and biological heterogeneity of psychiatric disorders, the pharmacokinetic and pharmacodynamics properties of the compounds, the lack of translatable biomarkers possibly explain these difficulties. Several breakthrough options are now available: quantitative system pharmacology analysis of drug effects variability, pharmacometry and pharmacoepidemiology, Big Data analysis, brain modelling. In addition to more classical approaches, these opportunities lead to a paradigm change for clinical trials in psychiatry.
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Affiliation(s)
- A Marsot
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - Q Boucherie
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - F Kheloufi
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - C Riff
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - D Braunstein
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - J Dupouey
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - R Guilhaumou
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - X Zendjidjian
- Service de Psychiatrie, Hôpital de la Conception, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - S Bonin-Guillaume
- Département de Gériatrie, Hôpital Sainte-Marguerite, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - E Fakra
- Service de Psychiatrie Adultes, CHU Saint-Étienne, 5 Chemin de la Marendière, 42055 Saint-Étienne cedex 2, France
| | - M Guye
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, 13385 Marseille, France ; APHM, Hôpitaux de la Timone, Pôle d'imagerie Médicale, CEMEREM, 13005 Marseille, France
| | - V Jirsa
- Aix-Marseille Université, Institut de Neurosciences des Systèmes, 13385 Marseille, France ; INSERM, UMR_S 1106, 13385 Marseille, France
| | - J-M Azorin
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille, France
| | - R Belzeaux
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille, France
| | - M Adida
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille, France
| | - J Micallef
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France
| | - O Blin
- Pharmacologie Clinique et Pharmacovigilance, AP-HM, Piici, UMR 7298, Aix-Marseille Université-CNRS, Marseille, France.
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Marsot A, Ménard A, Dupouey J, Muziotti C, Guilhaumou R, Blin O. Population pharmacokinetics of rifampicin in adult patients with osteoarticular infections: interaction with fusidic acid. Br J Clin Pharmacol 2017; 83:1039-1047. [PMID: 27813241 DOI: 10.1111/bcp.13178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/13/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 01/01/2023] Open
Abstract
AIMS Rifampicin represents the key antibiotic for the management of osteoarticular infections. An important pharmacokinetic variability has already been described, particularly for absorption and metabolism. All previous pharmacokinetic studies have been focused only on patients treated for tuberculosis. The objective of the present study was to describe a population pharmacokinetic model of rifampicin in patients with staphylococcal osteoarticular infections, which has not been investigated to date. METHOD Rifampicin concentrations were collected retrospectively from 62 patients treated with oral rifampicin 300 mg three times daily. Plasma concentration-time data were analysed using NONMEM to estimate population pharmacokinetic parameters. Demographic data, infection characteristics and antibiotics taken in addition to rifampicin antibiotics were investigated as covariates. RESULTS A one-compartment model, coupled to a transit absorption model, best described the rifampicin data. Fusidic acid coadministration was identified as a covariate in rifampicin pharmacokinetic parameters. The apparent clearance and apparent central volume of distribution mean values [95% confidence interval (CI)] were 5.1 1 h-1 (1.2, 8.2 1 h-1 )/23.8 l (8.9, 38.7 l) and 13.7 1 h-1 (10.6, 18.0 1 h-1 )/61.1 1 (40.8, 129.0 1) for patients with and without administration of fusidic acid, respectively. Interindividual variability (95% CI) in the apparent clearance and apparent central volume of distribution were 72.9% (49.5, 86.0%) and 59.1% (5.5, 105.4%), respectively. Residual variability was 2.3 mg l-1 (1.6, 2.6 mg l-1 ). CONCLUSION We developed the first population pharmacokinetic model of rifampicin in patients with osteoarticular infections. Our model demonstrated that fusidic acid affects rifampicin pharmacokinetics, leading to potential high drug exposure. This finding suggests that fusidic acid dosing regimens should be reconsidered.
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Affiliation(s)
- Amélie Marsot
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, 264 rue saint pierre, 13385, Marseille, France.,Aix Marseille Université, Pharmacologie intégrée et interface clinique et industrielle, Institut des Neurosciences Timone - CNRS 7289, 27 boulevard jean moulin, Marseille, 13385, France
| | - Amelie Ménard
- Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses, Fondation IHU Méditerranée Infection, Centre Hospitalo-Universitaire Conception, 147, Boulevard Baille, 13385, Marseille cedex 05, France
| | - Julien Dupouey
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, 264 rue saint pierre, 13385, Marseille, France.,Aix Marseille Université, Pharmacologie intégrée et interface clinique et industrielle, Institut des Neurosciences Timone - CNRS 7289, 27 boulevard jean moulin, Marseille, 13385, France
| | - Cedric Muziotti
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, 264 rue saint pierre, 13385, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, 264 rue saint pierre, 13385, Marseille, France.,Aix Marseille Université, Pharmacologie intégrée et interface clinique et industrielle, Institut des Neurosciences Timone - CNRS 7289, 27 boulevard jean moulin, Marseille, 13385, France
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, Hôpital de la Timone, Marseille, 264 rue saint pierre, 13385, Marseille, France.,Aix Marseille Université, Pharmacologie intégrée et interface clinique et industrielle, Institut des Neurosciences Timone - CNRS 7289, 27 boulevard jean moulin, Marseille, 13385, France
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Dupouey J, Doudka N, Belo S, Blin O, Guilhaumou R. Simultaneous determination of four antiepileptic drugs in human plasma samples using an ultra-high-performance liquid chromatography tandem mass spectrometry method and its application in therapeutic drug monitoring. Biomed Chromatogr 2016; 30:2053-2060. [DOI: 10.1002/bmc.3789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/17/2016] [Accepted: 07/08/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Julien Dupouey
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
| | - Natalia Doudka
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
| | - Séphora Belo
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
| | - Olivier Blin
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
| | - Romain Guilhaumou
- Service de Pharmacologie clinique et Pharmacovigilance; Hôpital de la Timone; 264 rue Saint Pierre 13385 Marseille Cedex 5 France
- Pharmacologie intégrée et Interface clinique et industriel, Institut des Neurosciences Timone - CNRS 7289; Aix Marseille Université; Marseille 13385 France
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Marsot A, Guilhaumou R, Riff C, Blin O. Amikacin in Critically Ill Patients: A Review of Population Pharmacokinetic Studies. Clin Pharmacokinet 2016; 56:127-138. [DOI: 10.1007/s40262-016-0428-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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