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Swital M, Drouin J, Miranda S, Bakchine S, Botton J, Dray-Spira R. Use of multiple sclerosis disease-modifying therapies during pregnancy in France: Nationwide study between 2010 and 2021. Mult Scler 2024; 30:227-237. [PMID: 38281078 PMCID: PMC10851628 DOI: 10.1177/13524585231223395] [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: 08/21/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) frequently affects women of childbearing age and pregnant women. OBJECTIVE To assess the use of MS disease-modifying therapies (DMTs) during pregnancy in France over the last decade, marked by an increasing DMTs availability. METHODS All pregnancies ended from April 2010 to December 2021 in women with MS were identified based on the nationwide Mother-Child Register EPI-MERES, built from the French National Health Data System (Système National des Données de Santé (SNDS)). RESULTS Of a total of 20,567 pregnancies in women with MS, 7587 were exposed to DMT. The number of DMT-exposed pregnancies markedly increased from 1079 in 2010-2012 to 2413 in 2019-2021 (+124%), especially those exposed to glatiramer acetate, natalizumab, dimethyl fumarate, and anti-CD20. Among pregnancies of women on DMT 6 months before pregnancy, 78.0% underwent DMT discontinuation and 7.6% switched DMT, generally before (33.0% and 77.0%, respectively) or during the first trimester of pregnancy (58.3% and 17.8%, respectively). DMT discontinuation decreased from 84.0% in 2010-2012 to 72.4% in 2019-2021 and was less frequent among women aged ⩾35 years and those socioeconomically disadvantaged. CONCLUSION Despite MS therapeutic management adaptations to pregnancy, exposure during pregnancy to treatments whose safety profile has not yet been clearly established has increased sharply over the last decade.
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Affiliation(s)
- Morgane Swital
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
- French National Institute of Health and Medical Research (INSERM), Department of Social Epidemiology (ERES), Pierre Louis Institute for Epidemiology and Public Health (IPLESP), Paris, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
| | - Sara Miranda
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
| | - Serge Bakchine
- University of Reims Champagne Ardennes (URCA), Reims, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
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Pina Vegas L, Drouin J, Weill A, Dray-Spira R. Pregnancy outcomes in women with rheumatoid arthritis: an 11-year French nationwide study. RMD Open 2024; 10:e003762. [PMID: 38242551 PMCID: PMC10806509 DOI: 10.1136/rmdopen-2023-003762] [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: 09/25/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) can affect women of childbearing age. The management of patients with RA during pregnancy has evolved over the past decades, especially with the availability of new therapeutic molecules. OBJECTIVES To describe pregnancy in women with RA, to compare pregnancy outcomes with those of women in the general population and to compare pregnancy outcomes in women with active and inactive RA. METHODS Using the French National Health Data System, we identified all pregnancies ending between 2010 and 2020 in patients with and without RA. Characteristics were described. Active RA was defined by conventional synthetic/biological/targeted synthetic disease-modifying antirheumatic drug initiation, systemic or intra-articular corticosteroid administration and/or RA-related hospitalisation. Pregnancy outcomes were compared computing multivariable logistic marginal regression model using generalised estimating equation (GEE). RESULTS We included 11 792 RA and 10 413 681 non-RA pregnancies. Among RA pregnancies, 74.5% ended in live births and 0.4% in stillbirths. RA pregnancies resulted more frequently in preterm births (adjusted OR (ORa) 1.84; 95% CI 1.69 to 2.00) and very preterm births (ORa 1.43; 95% CI 1.20 to 1.71), low birth weight (ORa 1.65; 95% CI: 1.52 to 1.90), caesarean section (ORa 1.46; 95% CI 1.38 to 1.55) and pregnancy-related hospitalisation (ORa 1.30; 95% CI 1.22 to 1.39). Disease activity decreased during pregnancy. Active RA had higher rates of prematurity (ORa 2.02; 95% CI 1.71 to 2.38), small for gestational age (ORa 1.53; 95% CI 1.28 to 1.83) and caesarean section (ORa 1.25; 95% CI 1.11 to 1.40) than non-active RA. CONCLUSION Pregnancies in women with RA were associated with more adverse outcomes, especially if the disease was active. These findings should encourage physicians to closely monitor RA during this crucial period.
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Affiliation(s)
- Laura Pina Vegas
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
- Service de Rhumatologie, Hopital Henri Mondor, Créteil, France
| | - Jérôme Drouin
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
| | - Alain Weill
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
| | - Rosemary Dray-Spira
- Épidémiologie des produits de santé, ANSM-CNAM, EPI-PHARE, Saint-Denis, France
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Meyer A, Miranda S, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Safety of Vedolizumab and Ustekinumab Compared With Anti-TNF in Pregnant Women With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00010-7. [PMID: 38199301 DOI: 10.1016/j.cgh.2023.12.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND & AIMS Limited data are available on the consequences of prenatal exposure to vedolizumab and ustekinumab. We aimed to compare the safety of vedolizumab and ustekinumab with that of anti-tumor necrosis factor (TNF) in pregnant women with inflammatory bowel diseases (IBD). METHODS Using nationwide, comprehensive data of the EPI-MERES registry, we identified pregnancies in women with IBD in France, exposed to anti-TNF, vedolizumab, and ustekinumab between 2014 and 2021. We compared pregnancy outcomes and complications in the offspring according to treatment exposure during pregnancy. We applied a propensity score matching for maternal, IBD, and pregnancy characteristics. RESULTS Three hundred ninety-eight pregnancies exposed to vedolizumab were compared with 1592 pregnancies exposed to anti-TNF; 464 pregnancies exposed to ustekinumab were compared with 1856 pregnancies exposed to anti-TNF. Overall, compared with anti-TNF, neither vedolizumab nor ustekinumab was associated with increased risks of abortion, caesarean section, stillbirth, preterm birth, serious infections, malignancies, or congenital abnormality in children. Women exposed to ustekinumab had an increased risk of small for gestational age births. CONCLUSIONS Overall, the safety of vedolizumab and ustekinumab compared with anti-TNF use during pregnancy is reassuring. Further studies are needed to confirm these findings.
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Affiliation(s)
- Antoine Meyer
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France.
| | - Sara Miranda
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France
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Wang H, Molina JM, Dray-Spira R, Schmidt AJ, Hickson F, Vijver DVD, Jonas KJ. Response to "On the risk of using raw regional data on new HIV infections in France" by Tassi et al. J Int AIDS Soc 2024; 27:e26207. [PMID: 38193641 PMCID: PMC10775628 DOI: 10.1002/jia2.26207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/23/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
- Viroscience Department, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hôpital Saint-Louis, University of Paris Cité, Paris, France
| | - Rosemary Dray-Spira
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Axel J Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ford Hickson
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
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Marr K, Maguet C, Scarlett H, Dray-Spira R, Dubertret C, Gressier F, Sutter-Dallay AL, Melchior M, van der Waerden J. Social determinants in prenatal antidepressant use and continuation: Systematic review and meta-analysis. Acta Psychiatr Scand 2023. [PMID: 38145902 DOI: 10.1111/acps.13647] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Depression is one of the most common co-morbidities during pregnancy; with severe symptoms, antidepressants are sometimes recommended. Social determinants are often linked with antidepressant use in the general population, and it is not known if this is the case for pregnant populations. Our objective was to determine if social determinants are associated with prenatal antidepressant intake via a systematic review and meta-analysis. METHODS A systematic search of five databases was conducted to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (use/continuation) and one or more social determinants: education, race, immigration status, relationship, income, or employment. Eligible studies were included in random effects meta-analyses. RESULTS A total of 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83; 95% CI, 0.78 to 0.89; p < 0.00001; I2 = 53%). Meta-analyses of antidepressant use and education, race, and relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity. DISCUSSION While most social determinants in this review were not linked with prenatal antidepressant intake, lower maternal education level does seem to be associated with lower rates of prenatal antidepressant continuation. CONCLUSIONS Education appears to be linked with prenatal antidepressant intake. The low number of included studies precludes conclusive evidence for other social determinants.
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Affiliation(s)
- Ketevan Marr
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Charlotte Maguet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Honor Scarlett
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Rosemary Dray-Spira
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Caroline Dubertret
- AP-HP, Groupe Hospital-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
- Faculté de Médecine, Université de Paris, Paris, France
| | - Florence Gressier
- CESP, Inserm UMR1178, Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Anne-Laure Sutter-Dallay
- Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux University, Bordeaux, France
- University Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Maria Melchior
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
| | - Judith van der Waerden
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France
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Le Vu S, Bertrand M, Botton J, Jabagi MJ, Drouin J, Semenzato L, Weill A, Dray-Spira R, Zureik M. Risk of Guillain-Barré Syndrome Following COVID-19 Vaccines: A Nationwide Self-Controlled Case Series Study. Neurology 2023; 101:e2094-e2102. [PMID: 37788935 PMCID: PMC10663040 DOI: 10.1212/wnl.0000000000207847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Guillain-Barré syndrome (GBS) has been inconsistently associated with some coronavirus disease 2019 (COVID-19) vaccines. We aimed to quantify the risk of GBS according to the type of COVID-19 vaccine in a large population. METHODS Using the French National Health Data System linked to the COVID-19 vaccine database, we analyzed all individuals aged 12 years or older admitted for GBS from December 27, 2020, to May 20, 2022. We estimated the relative incidence (RI) of GBS within 1-42 days after vaccination up to the first booster dose compared with baseline periods using a self-controlled case series design. We then derived the number of cases attributable to the vaccination. Analyses were adjusted for the period and stratified by age group, sex, and for the presence of severe acute respiratory syndrome coronavirus 2 or common acute infections. RESULTS Of 58,530,770 people aged 12 years or older, 88.8% received at least 1 COVID-19 vaccine dose and 2,229 were hospitalized for GBS during the study period. Patients had a median age of 57 years, and 60% were male patients. The RI of GBS between 1-42 days was 2.5 (95% CI 1.8-3.6) for the first dose of ChAdOx1-S and 2.4 (95% CI 1.2-5.0) for the unique dose of Ad26.COV2.S vaccine. We estimated 6.5 attributable GBS cases per million persons having received a first dose of ChAdOx1-S and 5.7 cases per million for the Ad26.COV2.S vaccine. Except for the age group of 12-49 years after the second dose of the messenger RNA (mRNA)-1273 vaccine (RI 2.6, 95% CI 1.2-5.5), none of the RI estimates were found significantly increased for the mRNA vaccines. DISCUSSION In summary, we found increased risks of GBS after the first administration of ChAdOx1-S and Ad26.COV2.S vaccines. In this comprehensive assessment at the French population level, there was no statistically significant increase in the risk of GBS after the administration of mRNA vaccines. This is reassuring in the context of the ongoing and future use of mRNA-based booster vaccination.
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Affiliation(s)
- Stéphane Le Vu
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France.
| | - Marion Bertrand
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
| | - Jérémie Botton
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
| | - Marie-Joelle Jabagi
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
| | - Jérôme Drouin
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
| | - Laura Semenzato
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
| | - Alain Weill
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
| | - Rosemary Dray-Spira
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
| | - Mahmoud Zureik
- From the EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], French National Health Insurance [CNAM]) (S.L.V., M.B., J.B., M.-J.J., J.D., L.S., A.W., R.D.-S., M.Z.), Saint-Denis; Université Paris-Saclay (J.B.), Faculté de Pharmacie, Orsay; and University Paris-Saclay (M.Z.), UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, CESP, Montigny le Bretonneux, France
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Marcombes C, Penso L, Weill A, Dray-Spira R, Zureik M, Sbidian E. Persistence of second-line biologics in psoriasis after first-line biologic failure: a nationwide cohort study from the French health insurance database (SNDS). Br J Dermatol 2023; 189:561-568. [PMID: 37479503 DOI: 10.1093/bjd/ljad248] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/23/2023] [Accepted: 07/15/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Many biologics are available for psoriasis and have been compared in real-life studies based on their persistence (i.e. time between initiation and discontinuation). However, after first-line biologic failure, data are lacking on the choice of second-line biologic among the four available classes [tumour necrosis factor inhibitors (TNFi); interleukin (IL)-12/IL-23 inhibitor (IL-12/IL-23i); IL-17 inhibitors (IL-17i); and IL-23 inhibitors (IL-23i)]. OBJECTIVES To compare the long-term persistence of available second-line biologics in psoriasis according to prior exposure. METHODS This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to a hospital discharge database. Participants were adults with psoriasis, defined as having at least two prescriptions of a topical vitamin D derivative within a 2-year period, with initiation of a second-line biologic between 1 January 2015 and 31 December 2021. We included patients who initiated a second-line biologic directly after first-line discontinuation (i.e. without a 'washout' period). The end of follow-up was 30 June 2022. Discontinuation was defined as > 90 days without filling a prescription for the same treatment after the period covered by the previous prescription. Comparison of persistence by biologic class involved using propensity score-weighted Cox models (inverse probability treatment weighting) and adjustment of specific systemic nonbiologics (time-dependent variables). RESULTS We included 8693 patients [mean (SD) age 50 (14) years; 50.5% male]; 2824 (32.5%) started TNFi, 1561 (18.0%) IL-12/IL-23i, 2707 (31.1%) IL-17i and 1601 (18.4%) IL-23i. Overall, 1- and 3-year persistence rates were 60% and 30%, respectively. After weighting and adjustment, persistence was longer with IL-12/IL-23i [weighted hazard ratio (HRw) 0.68, 95% confidence interval (CI) 0.62-0.76)], IL-17i (HRw 0.70, 95% CI 0.64-0.78) and IL-23i (HRw 0.36, 95% CI 0.31-0.42) than TNFi, except after first-line IL-17i treatment, with no difference between IL-12/IL-23i, IL-17i and TNFi second-line persistence. Persistence was longer with IL-23i as a second-line treatment than IL-12/IL-23i (HRw 0.53, 95% CI 0.44-0.63) and IL-17i (HRw 0.51, 95% CI 0.44-0.60), regardless of first-line treatment, with no difference seen between IL-12/IL-23i and IL-17i (HRw 0.97, 95% CI 0.87-1.09). CONCLUSIONS This real-life study suggests the longer persistence of IL-23i than TNFi, IL-17i and IL-12/IL-23i as second-line treatment for psoriasis. Persistence rates for all biologics remained low at 3 years.
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Affiliation(s)
- Clarisse Marcombes
- EpiDermE, Paris Est Créteil University, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Laetitia Penso
- EpiDermE, Paris Est Créteil University, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
| | - Emilie Sbidian
- EpiDermE, Paris Est Créteil University, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint Denis, France
- Inserm, Centre d'investigation clinique 1430, Hôpital Henri Mondor, Creteil, France
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, Créteil, France
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Tran A, Zureik M, Sibiude J, Drouin J, Miranda S, Weill A, Dray-Spira R, Duval X, Tubiana S. Prevalence and associated factors of antibiotic exposure during pregnancy in a large French population-based study during the 2010-19 period. J Antimicrob Chemother 2023; 78:2535-2543. [PMID: 37624919 DOI: 10.1093/jac/dkad266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Although bacterial infections are frequent during pregnancy, the prescription of antibiotics to pregnant women represents a challenge for physicians, driven by the benefit-risk balance. OBJECTIVES To assess the extent of prenatal antibiotic exposure and its associated factors. METHODS This study included pregnancies in the National Mother-Child EPI-MERES Register 2010-19 (built from the French Healthcare Data System) regardless of outcome. Antibiotic exposure was defined as having at least one antibiotic prescription filled during pregnancy. The prevalence of pregnancies exposed to antibiotics was estimated. Univariable Poisson regression with generalized estimating equations was used to compare the number of antibiotic prescriptions filled during pregnancy and the period after pregnancy with the period 1 year before pregnancy. Multivariable Poisson regression was used to investigate factors associated with antibiotic exposure during pregnancy. RESULTS Among 9 769 764 pregnancies, 3 501 294 (35.8%) were exposed to antibiotics and amoxicillin was the most common. Compared with a similar period 1 year before pregnancy, the number of filled antibiotic prescriptions was lower during pregnancy [incidence rate ratio (IRR) 0.903 (95% CI 0.902-0.905)] and during the period 1 year after pregnancy [IRR 0.880 (95% CI 0.879-0.881)]. Region of residence, deprivation index, smoking-related conditions and chronic diseases (especially chronic respiratory diseases) were associated with antibiotic exposure during pregnancy. CONCLUSIONS Antibiotic prescriptions are filled less frequently during pregnancy than during the preceding year. This may be due to a more relevant benefit-risk assessment. Pregnant women living with social deprivation, those with smoking-related conditions and those with chronic diseases are more likely to fill antibiotic prescriptions.
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Affiliation(s)
- Anh Tran
- Paris Cité University, IAME, INSERM, Paris, France
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM] and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM] and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Jeanne Sibiude
- Paris Cité University, IAME, INSERM, Paris, France
- Gynaecology-Obstetrics Department, Louis Mourier Hospital, AP-HP, Colombes, France
| | - Jérôme Drouin
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM] and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Sara Miranda
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM] and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Alain Weill
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM] and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM] and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Xavier Duval
- Paris Cité University, IAME, INSERM, Paris, France
- Clinical Investigation Center, INSERM CIC 1425, Bichat Hospital, AP-HP, Paris, France
| | - Sarah Tubiana
- Paris Cité University, IAME, INSERM, Paris, France
- Clinical Investigation Center, INSERM CIC 1425, Bichat Hospital, AP-HP, Paris, France
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9
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Semenzato L, Botton J, Le Vu S, Jabagi MJ, Cuenot F, Drouin J, Dray-Spira R, Weill A, Zureik M. Protection of COVID-19 Vaccination Against Hospitalization During the Era of Omicron BA.4 and BA.5 Predominance: A Nationwide Case-Control Study Based on the French National Health Data System. Open Forum Infect Dis 2023; 10:ofad460. [PMID: 37808897 PMCID: PMC10551849 DOI: 10.1093/ofid/ofad460] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Background Knowing the duration of effectiveness of coronavirus disease 2019 (COVID-19) booster doses is essential to providing decision-makers with scientific arguments about the frequency of subsequent injections. We estimated the level of protection against COVID-19-related hospitalizations (Omicron BA.4-BA.5) over time after vaccination, accounting for breakthrough infections. Methods In this nationwide case-control study, all cases of hospitalizations for COVID-19 identified in the comprehensive French National Health Data System between June 1, 2022, and October 15, 2022, were matched with up to 10 controls by year of birth, sex, department, and an individual COVID-19 hospitalization risk score. Conditional logistic regressions were used to estimate the level of protection against COVID-19-related hospitalizations conferred by primary and booster vaccination, accounting for history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Results A total of 38 839 cases were matched to 377 653 controls; 19.2% and 9.9% were unvaccinated, respectively, while 68.2% and 77.7% had received ≥1 booster dose. Protection provided by primary vaccination reached 45% (95% CI, 42%-47%). The incremental effectiveness of booster doses ranged from 69% (95% CI, 67%-71%; ≤2 months) to 22% (95% CI, 19%-25%; ≥6 months). Specifically, the second booster provided an additional protection compared with the first ranging from 61% (95% CI, 59%-64%; ≤2 months) to 7% (95% CI, 2%-13%; ≥4 months). Previous SARS-CoV-2 infection conferred a strong, long-lasting protection (51% ≥20 months). There was no incremental effectiveness of a second booster among individuals infected since the first booster. Conclusions In the era of Omicron BA.4 and BA.5 predominance, primary vaccination still conferred protection against COVID-19 hospitalization, while booster doses provided an additional time-limited protection. The second booster had no additional protection in case of infection since the first booster.
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Affiliation(s)
- Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Stéphane Le Vu
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
| | - Marie-Joëlle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
| | - François Cuenot
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
- Paris-Saclay University, UVSQ, Paris-Sud University, Inserm, Anti-infective Evasion and Pharmacoepidemiology Unit/Team, CESP, Montigny le Bretonneux, France
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Abstract
Importance Proton pump inhibitor (PPI) use may lead to infections through alteration of the microbiota or direct action on the immune system. However, only a few studies were conducted in children, with conflicting results. Objective To assess the associations between PPI use and serious infections in children, overall and by infection site and pathogen. Design, Setting, and Participants This nationwide cohort study was based on the Mother-Child EPI-MERES Register built from the French Health Data System (SNDS). We included all children born between January 1, 2010, and December 31, 2018, who received a treatment for gastroesophageal reflux disease or other gastric acid-related disorders, namely PPIs, histamine 2 receptor antagonists, or antacids/alginate. The index date was defined as the first date any of these medications was dispensed. Children were followed up until admission to the hospital for serious infection, loss of follow-up, death, or December 31, 2019. Exposure PPI exposure over time. Main Outcomes and Measures Associations between serious infections and PPI use were estimated by adjusted hazard ratios (aHRs) and 95% CIs using Cox models. PPI use was introduced as time-varying. A 30-day lag was applied to minimize reverse causality. Models were adjusted for sociodemographic data, pregnancy characteristics, child comorbidities, and health care utilization. Results The study population comprised 1 262 424 children (median [IQR] follow-up, 3.8 [1.8-6.2] years), including 606 645 who received PPI (323 852 male [53.4%]; median [IQR] age at index date, 88 [44-282] days) and 655 779 who did not receive PPI (342 454 male [52.2%]; median [IQR] age, 82 [44-172] days). PPI exposure was associated with an increased risk of serious infections overall (aHR, 1.34; 95% CI, 1.32-1.36). Increased risks were also observed for infections in the digestive tract (aHR, 1.52; 95% CI, 1.48-1.55); ear, nose, and throat sphere (aHR, 1.47; 95% CI, 1.41-1.52); lower respiratory tract (aHR, 1.22; 95% CI, 1.19-1.25); kidneys or urinary tract (aHR, 1.20; 95% CI, 1.15-1.25); and nervous system (aHR, 1.31; 95% CI, 1.11-1.54) and for both bacterial (aHR, 1.56; 95% CI, 1.50-1.63) and viral infections (aHR, 1.30; 95% CI, 1.28-1.33). Conclusions and Relevance In this study, PPI use was associated with increased risks of serious infections in young children. Proton pump inhibitors should not be used without a clear indication in this population.
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Affiliation(s)
- Marion Lassalle
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Rosemary Dray-Spira
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France
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11
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Roland N, Drouin J, Desplas D, Duranteau L, Cuenot F, Dray-Spira R, Weill A, Zureik M. Impact of coronavirus disease 2019 on contraception use in France. Therapie 2023; 78:593-603. [PMID: 36732137 PMCID: PMC9851715 DOI: 10.1016/j.therap.2023.01.002] [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: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/21/2023]
Abstract
To limit the spread of the coronavirus disease 2019 (COVID 19), sanitary restrictions have been established since March 2020 in France. These restrictions and the waves of contamination may have had consequences on the use of health products in general, and on the use of contraceptives in particular. We aimed to assess the impact of COVID 19 pandemic from March 16th 2020 to April 30th 2021 in France on reimbursed contraceptives. We analyzed data from the French national health insurance database (SNDS) by extracting all oral contraception (OC), emergency contraception (EC), levonorgestrel-intrauterine system (LNG-IUS), copper-intrauterine device (C-IUD) and contraceptive implant dispensations in 2018, 2019, 2020 and to April 30th 2021. We computed the expected use of contraceptives in 2020 and 2021 without pandemic and its associated sanitary restrictions, by taking the annual trend into account. We assessed the evolution of dispensations by type of contraceptive and by age-groups (≤25 years old, between 25 and 35 and >35 years old) between observed and expected dispensations. After 15 months of pandemic, a decrease of all reimbursed contraceptives dispensations had been estimated, compared with what was expected: -2.0% for OC, -5.0% for EC, -9.5% for LNG-IUS, -8.6% for C-IUD, -16.4% for implant. Women under 25 years old were the most impacted by the decrease. This national study showed that the impact of the COVID 19 crisis was global on all reimbursed contraceptives, with different levels of impact depending on the type of contraceptive, the age-group and the severity of the restriction. OC dispensing decreased marginally compared with expectations. The decrease in long-acting contraceptives dispensing was more pronounced, especially for the implant. These results call for continued monitoring of contraceptive use over the long term and for prioritizing access to sexual health services during crises, especially among the youngest women who were most affected in this study.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France; University of Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 78180 Montigny le Bretonneux, France.
| | - Jérôme Drouin
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - David Desplas
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynaecology Unit and Reference Center for Rare, Diseases of Genital Development, AP.HP University of Paris Saclay, Bicêtre Hospital, 94270 Le Kremlin Bicêtre, France
| | - François Cuenot
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Alain Weill
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Mahmoud Zureik
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France; University of Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 78180 Montigny le Bretonneux, France
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12
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Meyer A, Rios P, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Maternal Exposure to Anti-TNF or Thiopurines for IBD Does Not Increase Risk of Early-life Malignancy in Children. Clin Gastroenterol Hepatol 2023; 21:2679-2681.e5. [PMID: 36064096 DOI: 10.1016/j.cgh.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Antoine Meyer
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris Saclay, Le Kremlin Bicêtre, France.
| | - Paula Rios
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France
| | - Jérôme Drouin
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France
| | - Alain Weill
- EPIPHARE, Épidémiologie des Produits de Santé, Saint-Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris Saclay, Le Kremlin Bicêtre, France
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13
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Zureik M, Cuenot F, Weill A, Dray-Spira R. Contribution of real-life studies in France during the COVID-19 pandemic and for the national pharmaco-epidemiological surveillance of COVID-19 vaccines. Therapie 2023; 78:553-557. [PMID: 36739224 PMCID: PMC9851737 DOI: 10.1016/j.therap.2022.12.013] [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: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 01/21/2023]
Abstract
During the COVID-19 pandemic, EPI-PHARE, a scientific group in pharmaco-epidemiology created by the French National Agency for the Safety of Medicines and Health Products (ANSM) and the French National Health Insurance (Cnam), has reoriented its work program to enlighten health authorities in this health crisis. By exploiting massive and complex data of the French Health Data System (SNDS) from the beginning of the first lockdown in France in March 2020, we were able to publish numerous results on the use, benefits and risks of medicines, on the risk factors of COVID-19 before and after vaccination, and on the benefits and risks of COVID-19 vaccines. Our results were widely taken into account by the French health authorities and allowed them to take informed decision in this pandemic situation in order to ensure the health of the population.
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Affiliation(s)
- Mahmoud Zureik
- EPI-PHARE, Epidemiology of Health Products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), Saint-Denis cedex, France; University of Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-Infective Evasion and Pharmaco-epidemiology, CESP (Center for Research in Epidemiology and Population Health), 78180 Montigny le Bretonneux, France.
| | - François Cuenot
- EPI-PHARE, Epidemiology of Health Products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), Saint-Denis cedex, France
| | - Alain Weill
- EPI-PHARE, Epidemiology of Health Products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), Saint-Denis cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE, Epidemiology of Health Products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), Saint-Denis cedex, France
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14
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Billioti de Gage S, Jourdain H, Desplas D, Dray-Spira R. Roll-out and effectiveness of HIV pre-exposure prophylaxis in France: An overview. Therapie 2023; 78:585-591. [PMID: 36894453 DOI: 10.1016/j.therap.2023.02.010] [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: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Oral HIV pre-exposure prophylaxis (PrEP) has been available and fully reimbursed for people at high risk of sexually acquired HIV infection in France since January 2016. OBJECTIVE To evaluate the roll-out of PrEP use in France and its real-life effectiveness. The main results of two previously published studies were presented at the second e-congress of the EPI-PHARE scientific interest group on pharmacoepidemiology and public decision support held in June 2022, and are reported in this article. METHODS Two studies were carried out using the French National Health Data System (SNDS) covering 99% of the French population. A first study aimed to evaluate the roll-out of PrEP use in France from its implementation until June 2021, globally over the entire study period, including an assessment of the impact of the coronavirus disease 2019 (COVID-19) pandemic that started in February 2020 in France. A second study using a nested case-control design was conducted in a cohort of men at high risk of HIV acquisition included between January 2016 and June 2020 to assess the effectiveness of PrEP in the real world. RESULTS As of 30 June 2021, a total of 42 159 people had initiated PrEP in France. Initiations increased steadily until February 2020, then slowed down sharply from the start of the COVID-19 pandemic and resumed from the first half of 2021. PrEP users were overwhelmingly men (98%), with an average age of 36 years, living in a large urban area (74%), and of whom a minority (7%) were socioeconomically disadvantaged. Throughout the study period, the level of PrEP maintenance from one semester to the next was high (80-90%). However, for 20% of PrEP initiators, no prescription renewals were recorded during the first six months, suggesting a substantial proportion of early treatment discontinuation. A minority (21%) of PrEP renewal prescriptions were made by private practitioners. Among 46 706 men at high risk of HIV infection, 256 patients identified with HIV infection were matched with 1213 controls. PrEP was used by 29% of cases and 49% of controls. Overall, PrEP effectiveness reached 60% (95% confidence interval 46% to 71%), and was increased in people with high PrEP use (93% (84% to 97%)), or after excluding periods of treatment discontinuation (86% (79% to 92%)). PrEP effectiveness was significantly reduced in people under 30 years of age (26% (-21% to 54%)) and in socioeconomically disadvantaged people (-64% (-392% to 45%)), for whom low PrEP uptake rates or high PrEP discontinuation rates were frequently observed. CONCLUSION PrEP roll-out has been strongly impacted by the COVID-19 pandemic in France. Although it has been substantial among men who have sex with men, additional measures are needed to expand access to PrEP to all other population groups that could benefit from it. Promoting adherence to PrEP (especially among young people and the socioeconomically disadvantaged) will be essential to ensure a higher level of PrEP effectiveness, which has been shown to be lower in real-life settings than in clinical trials.
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Affiliation(s)
- Sophie Billioti de Gage
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France.
| | - Hugo Jourdain
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| | - David Desplas
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
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15
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Wang H, Molina JM, Dray-Spira R, Schmidt AJ, Hickson F, van de Vijver D, Jonas KJ. Spatio-temporal changes in pre-exposure prophylaxis uptake among MSM in mainland France between 2016 and 2021: a Bayesian small area approach with MSM population estimation. J Int AIDS Soc 2023; 26:e26089. [PMID: 37221971 PMCID: PMC10206410 DOI: 10.1002/jia2.26089] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION In France, oral pre-exposure prophylaxis (PrEP) for HIV prevention has been publicly available since 2016, mainly targeting at men who have sex with men (MSM). Reliable and robust estimations of the actual PrEP uptake among MSM on a localized level can provide additional insights to identify and better reach marginalized MSM within current HIV prevention service provision. This study used national pharmaco-epidemiology surveillance data and regional MSM population estimations to model the spatio-temporal distribution of PrEP uptake among MSM in France 2016-2021 to identify marginalized MSM at risk for HIV and increase their PrEP uptake. METHODS We first applied Bayesian spatial analyses with survey-surveillance-based HIV incidence data as a spatial proxy to estimate the size of (1) regional HIV-negative MSM populations and (2) MSM who could be eligible for PrEP use according to French PrEP guidelines. We then applied Bayesian spatio-temporal ecological regression modelling to estimate the regional prevalence and relative probability of the overall- and new-PrEP uptake from 2016 to 2021 across France. RESULTS HIV-negative and PrEP-eligible MSM populations vary regionally across France. Île-de-France was estimated to have the highest MSM density compared to other French regions. According to the final spatio-temporal model, the relative probability of overall PrEP uptake was heterogeneous across France but remained stable over time. Urban areas have higher-than-average probabilities of PrEP uptake. The prevalence of PrEP use increased steadily (ranging from 8.8% [95% credible interval 8.5%;9.0%] in Nouvelle-Aquitaine to 38.2% [36.5%;39.9%] in Centre-Val-de-Loire in 2021). CONCLUSIONS Our results show that using Bayesian spatial analysis as a novel methodology to estimate the localized HIV-negative MSM population is feasible and applicable. Spatio-temporal models showed that despite the increasing prevalence of PrEP use in all regions, geographical disparities and inequalities of PrEP uptake continued to exist over time. We identified regions that would benefit from greater tailoring and delivery efforts. Based on our findings, public health policies and HIV prevention strategies could be adjusted to better combat HIV infections and to accelerate ending the HIV epidemic.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
- Viroscience Department, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hôpital Saint-Louis, University of Paris Cité, Paris, France
| | - Rosemary Dray-Spira
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Axel J Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ford Hickson
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
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Laanani M, Weill A, Jollant F, Zureik M, Dray-Spira R. Suicidal risk associated with finasteride versus dutasteride among men treated for benign prostatic hyperplasia: nationwide cohort study. Sci Rep 2023; 13:5308. [PMID: 37002313 PMCID: PMC10066399 DOI: 10.1038/s41598-023-32356-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Finasteride, a 5α-reductase inhibitor used in benign prostatic hyperplasia and androgenetic alopecia, has been associated with an increased suicidal risk, whereas it is unclear whether such risk is similar to that for another 5α-reductase inhibitor, dutasteride. We aimed to assess the risk of suicidal behaviours with finasteride relative to dutasteride. A nationwide cohort study was conducted using the French National Health Data System (SNDS). Men aged 50 years or older initiating finasteride 5 mg or dutasteride 0.5 mg in France between 01-01-2012 and 30-06-2016 were included and followed until outcome (suicide death identified from death certificate or self-harm hospitalisation), treatment discontinuation or switch, death, or 31-12-2016. Self-harm by violent means or resulting in admission to an intensive care unit were also examined. Cox proportional hazards models controlled for age and psychiatric and non-psychiatric conditions by inverse probability of treatment weighting (IPTW). Analyses were stratified according to psychiatric history. The study compared 69,786 finasteride new users to 217,577 dutasteride new users (median age: 72.0 years [Q1-Q3 = 64.5-80.2] vs. 71.1 [Q1-Q3 = 65.0-79.2]). During follow-up, 18 suicide deaths (0.57/1000 person-years) and 34 self-harm hospitalisations (1.08/1000) occurred among finasteride users versus 47 deaths (0.43/1000) and 87 hospitalisations (0.79/1000) among dutasteride users. Overall, finasteride was not associated with an increased risk of any suicidal outcome (IPTW-adjusted Hazard Ratio = 1.21 [95% Confidence Interval .87-1.67]), suicide death or self-harm hospitalisation. However, among individuals with a history of mood disorders, finasteride was associated with an increased risk of any suicidal outcome (25 versus 46 events; HR = 1.64 [95% CI 1.00-2.68]), suicide death (8 versus 10 events; HR = 2.71 [95% CI 1.07-6.91]), self-harm by violent means (6 versus 6 events; HR = 3.11 [95% CI 1.01-9.61]), and self-harm with admission to an intensive care unit (7 versus 5 events; HR = 3.97 [95% CI 1.26-12.5]). None of these risks was significantly increased among individuals without a psychiatric history. These findings do not support an increased risk of suicide with finasteride used in the treatment of benign prostatic hyperplasia. However, an increased risk cannot be excluded among men with a history of mood disorder, but this result based on a limited number of events should be interpreted with caution.
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Affiliation(s)
- Moussa Laanani
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France.
- French National Health Insurance (CNAM), Paris, France.
| | - Alain Weill
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
| | - Fabrice Jollant
- Université Paris-Saclay & CHU Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- Nîmes University Hospital (CHU), Nîmes, France
- Department of psychiatry, McGill Group for Suicide Studies, McGill University, Montréal, Canada
- Moods Team, INSERM UMR-1018, CESP, Le Kremlin-Bicêtre, France
| | - Mahmoud Zureik
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
| | - Rosemary Dray-Spira
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
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Jabagi MJ, Bertrand M, Botton J, Le Vu S, Weill A, Dray-Spira R, Zureik M. Stroke, Myocardial Infarction, and Pulmonary Embolism after Bivalent Booster. N Engl J Med 2023; 388:1431-1432. [PMID: 36988584 PMCID: PMC10074551 DOI: 10.1056/nejmc2302134] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 03/30/2023]
Affiliation(s)
| | | | - Jérémie Botton
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
| | - Stéphane Le Vu
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
| | | | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
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18
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Roland N, Baricault B, Weill A, Bouillon K, Dray-Spira R, Duranteau L, Zureik M. Utilisation d'anxiolytiques, d'hypnotiques et d'antidépresseurs dans les deux ans après la délivrance d'un Système Intra-Utérin à 52 mg de lévonorgestrel comparativement à celle d'un sytème contenant 19,5 mg de lévonorgestrel en France : une étude nationale de cohorte appariée. Rev Epidemiol Sante Publique 2023. [DOI: 10.1016/j.respe.2023.101429] [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: 02/26/2023] Open
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19
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Semenzato L, Botton J, Baricault B, Bouillon K, Vu SL, Jabagi MJ, Drouin J, Dray-Spira R, Weill A, Zureik M. Design cas témoins apparié sur score de risque : un outil méthodologique original pour une étude de l'efficacité vaccinale et des conséquences médicales de l'hospitalisation pour COVID-19 en France. Rev Epidemiol Sante Publique 2023. [PMCID: PMC9950199 DOI: 10.1016/j.respe.2023.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Introduction L’étude de l'efficacité vaccinale d'une part, et des conséquences médicales du COVID-19 d'autre part, nécessitent généralement la mise en place de deux designs spécifiques. La construction d'un cas témoins apparié sur un score de risque d'hospitalisation pour COVID-19 est un design original visant à répondre à ces deux objectifs. Méthodes A partir des données du Système national des données de santé (SNDS), nous avons construit pour les 67 millions de résidents, un score individuel de risque d'hospitalisation pour COVID-19 à partir d'un modèle de Cox prenant en compte l’âge, le genre, la région, l'indice de défavorisation, 50 facteurs de risque médicaux, et la prise d'immunosuppresseurs ou de corticoïdes. Ce score a été discrétisé en 20 classes de même effectif, basées sur la répartition de ce score chez les cas d'hospitalisation pour COVID-19 survenus entre le 01/06/2022 et le 15/10/2022. Chaque cas d'hospitalisation a ensuite été apparié sur l'année de naissance, le genre, le département et sa tranche de score de risque, à 1-10 témoins non hospitalisés pour COVID-19. Le schéma vaccinal (base SI-VAC) et les résultats des tests (SI-DEP), ont été chainés. Résultats La quasi-totalité des 39 059 cas a pu être appariée à ≥1 individu non hospitalisé comparables en termes de facteurs médicaux: respectivement 24 % versus 25 % de diabète, 19 % de maladies respiratoires chroniques, 65% d'hypertension artérielle et 1 % de cancer du poumon dans les deux groupes, etc. L'administration d'une dose additionnelle de vaccin (3e ou 4e dose) comparativement à des patients vaccinés ne bénéficiant pas de cette dose additionnelle, non récemment infectés, permettait de réduire de 50 % le risque d'hospitalisation sur une durée de 4 mois. Discussion/Conclusion L'appariement sur le score de risque a permis de prendre en compte un grand nombre de facteurs de confusion. A partir de ce design original, nous avons pu étudier l'efficacité vaccinale et nous étudierons lors d'un suivi longitudinal les conséquences médicales de l'hospitalisation pour COVID-19 dans un contexte de prédominance du sous-lignage BA5 du variant Omicron. Mots-clés Covid-19 ; Score de risque ; Vaccination ; Efficacité ; SNDS Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
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Affiliation(s)
- L. Semenzato
- EpiPhare, Saint-Denis, France,Auteur correspondant
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20
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Roland N, Baricault B, Dray-Spira R, Weill A, Duranteau L, Zureik M. Profiles of copper intrauterine devices and levonorgestrel intrauterine systems users in France in 2019: A national observational population-based study. Int J Gynaecol Obstet 2023; 160:594-603. [PMID: 36066002 PMCID: PMC10087463 DOI: 10.1002/ijgo.14438] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the user profiles of copper intrauterine devices (Cu-IUD) and levonorgestrel intrauterine systems (LNG-IUS) in France in 2019 and the rates of continuation 1 year later. METHODS A population-based study was conducted of all French women aged 13-49 years for whom an IUD was dispensed in 2019. Information was collected from the French National Health Data System about their characteristics at the time of dispensation and indicators of continued use 1 year later. Associations between these characteristics and the type of IUD were analyzed using multivariate regressions. RESULTS A total of 477 705 Cu-IUDs and 355 242 LNG-IUSs (mean age 32.5 ± 7.3 and 36.4 ± 7.7 years, respectively) were dispensed in 2019. After adjustment, having a LNG-IUS rather than a Cu-IUD was associated with being aged 35-44 years compared to 25-35 years (odds ratio [OR35-44 ] 2.03, 95% confidence interval [CI] 2.01-2.05), having a prescription by a gynecologist rather than a general practitioner (OR35-44 1.09, 95% CI 1.08-1.11), and having a gynecological history (OR35-44 2.28, 95% CI 2.20-2.36). The continuation rates 1 year after dispensation were 86.4% for Cu-IUD versus 85.7% for LNG-IUS. A Cu-IUD dispensation rather than a LNG-IUS one was associated with a higher chance of continued use 1 year later. CONCLUSION Two different patterns of use of Cu-IUDs and LNG-IUSs in France are highlighted.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis Cedex, France.,University Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, Center for Research in Epidemiology and Population Health (CESP), Montigny le Bretonneux, France
| | - Bérangère Baricault
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis Cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis Cedex, France
| | - Alain Weill
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis Cedex, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynaecology Unit and Reference Center for Rare Diseases of Genital Development, APHP Paris Saclay University, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Mahmoud Zureik
- EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), Saint-Denis Cedex, France.,University Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, Center for Research in Epidemiology and Population Health (CESP), Montigny le Bretonneux, France
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21
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Roland N, Baricault B, Weill A, Bouillon K, Dray-Spira R, Duranteau L, Zureik M. Association Between Doses of Levonorgestrel Intrauterine Systems and Subsequent Use of Psychotropic Drugs in France. JAMA 2023; 329:257-259. [PMID: 36548007 PMCID: PMC9857179 DOI: 10.1001/jama.2022.21471] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/24/2022]
Abstract
This matched-cohort study uses data from the French National Health Insurance database to assess whether a 19.5-mg levonorgestrel intrauterine system, vs a 52-mg system, is associated with increased use of antidepressant, hypnotic, and anxiolytic medications.
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Affiliation(s)
| | | | | | | | | | - Lise Duranteau
- Department of Medical Gynecology, Le Kremlin Bicêtre Hospital, Paris, France
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22
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Pina Vegas L, Drouin J, Dray-Spira R, Weill A. Prevalence, mortality, and treatment of patients with rheumatoid arthritis: A cohort study of the French National Health Data System, 2010-2019. Joint Bone Spine 2023; 90:105460. [PMID: 36113771 DOI: 10.1016/j.jbspin.2022.105460] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic inflammatory disease mostly affecting the joints. Data on the prevalence of RA differ widely, depending on the study and country. Our objectives were to estimate the prevalence of RA in France and the mortality rate, characterise the causes of death, and identify prescribed treatments. METHODS This nationwide cohort study was based on data of the French National Health Data System (SNDS) which covers 99% of the French population. All patients identified with RA based on specific ICD-10 codes (M05 and M06, except M06.1) between 2010 and 2019 were included. RESULTS We identified 385,919 RA cases between 2010 and 2019, 318,243 of which were followed in 2019 (65.8±16.8 years, 72% women). The overall crude prevalence rate in 2019 was 0.47%: 0.66% for women and 0.28% for men. The crude annual mortality rate was 3.1%. The overall standardised mortality ratio (SMR) of RA patients relative to the French general population decreased over time, reaching 1.21 in 2019. Cause-specific mortality was increased in RA patients for cardiovascular (SMR 1.40, 95% confidence interval 1.36-1.43), respiratory system (1.80, 1.73-1.87), digestive system (1.73, 1.59-1.88), and urogenital system (1.73, 1.59-1.88) diseases and infections (1.91, 1.76-2.06). We found no excess mortality due to tumours. The prevalence of treatment with conventional synthetic and biological/targeted synthetic disease-modifying antirheumatic drugs for RA in 2019 was 41.9% (n=133,477) and 18.7% (n=59,409), respectively. CONCLUSION Our results may provide a better understanding of RA and its care in France.
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Affiliation(s)
- Laura Pina Vegas
- GIS EPI-PHARE, épidémiologie des produits de santé, CNAM-ANSM, Saint-Denis, France; Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France.
| | - Jérôme Drouin
- GIS EPI-PHARE, épidémiologie des produits de santé, CNAM-ANSM, Saint-Denis, France
| | - Rosemary Dray-Spira
- GIS EPI-PHARE, épidémiologie des produits de santé, CNAM-ANSM, Saint-Denis, France
| | - Alain Weill
- GIS EPI-PHARE, épidémiologie des produits de santé, CNAM-ANSM, Saint-Denis, France
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23
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Semenzato L, Botton J, Drouin J, Barricault B, Bertrand M, Jabagi MJ, Bouillon K, Vu SL, Dray-Spira R, Weill A, Zureik M. Caractéristiques sociodémographiques et médicales associées au risque d’échec d'un schéma vaccinal deux doses contre la COVID-19 en France. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634433 DOI: 10.1016/j.respe.2022.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Contexte Bien qu'il ait été démontré une efficacité majeure des vaccins contre la COVID-19 pour prévenir les formes sévères de la maladie, il se pose la question d'une meilleure compréhension des facteurs de risque d'échec des vaccins. Objectif Identifier les caractéristiques sociodémographiques et médicales associées au risque d'hospitalisation et/ou de décès hospitalier pour COVID-19 en France après un schéma vaccinal complet. Méthodes L'étude porte sur les données de la base nationale de vaccination COVID-19 VAC-SI couplées au Système national des données de santé (SNDS). L'ensemble des personnes présentant un schéma vaccinal complet en France au 31 juillet 2021 de deux injections vaccinales par mRNA BNT162b2 (Pfizer©), mRNA-1273 (Moderna©), ou ChAdOx1 nCoV-19 (Astrazeneca©), ou d'une unique injection lors d'un diagnostic d'infection préalable au SARS-COV-2, ont été incluses et suivies jusqu'au 31 août 2021. Des modèles de Cox ont été utilisés pour estimer les Hasards Ratios ajustés (HRa) d'hospitalisation et de décès hospitalier pour COVID-19 associés à l'âge, au sexe, à l'indice de défavorisation sociale, aux comorbidités et à la prise de traitements immunosuppresseurs ou de corticoïdes oraux 14 jours après un schéma vaccinal complet. Résultats Un total de 28 031 641 personnes avec un schéma vaccinal complet ont été incluses et suivies pendant en moyenne 80 jours (médiane de 67 jours, IQR 48-105). Au cours de ce suivi, 5 345 (19 pour 100 000) ont été hospitalisées et 996 (4 pour 100 000) sont décédées à l'hôpital pour COVID-19. Dans cette population de sujets vaccinés, les risques respectifs d'hospitalisation et de décès hospitalier pour COVID-19 étaient associés à l'âge (85-89 ans versus 45-54 ans : HRa 4,0 [3,5- 4,7] et HRa 38 [19-75]), au genre masculin (HRa 1,6 [1,5-1,7] et HRa 2,0 [1,7-2,3]) et au niveau de défavorisation sociale (communes les plus défavorisées vs les plus favorisées : HRa 1,3 [1,2-1,4] et HRa 1,5 [1,2-1,9]). Les 47 affections chroniques testées étaient positivement associées à des risques accrus à l'exception de la dyslipidémie. Les associations les plus fortes étaient retrouvées pour la transplantation rénale (HRa 32 [28-37] et 34 [24-47]), la transplantation du poumon (HRa 14 [8,1-23] et 11 [1,5-88]), l'insuffisance rénale en dialyse (HRa 7,0 [5,9-8,2] et HRa 8,6 [6,3-12]), la trisomie 21 (HRa 3,9 [2,1- 7,3] et 45 [16-127]), le retard mental (HRa 3,6 [2,5-5,0] et 3,1 [1,0-10]) et le cancer actif du poumon (HRa 3,5 [2,7-4,4] et 6,5 [4,2-10]). Les risques étaient également augmentés chez les personnes vaccinées traitées par immunosuppresseurs (HRa 3,3 [2,8-3,8] et 2,4 [1,7-3,5]) ou corticoïdes oraux (HRa 2,8 [2,5-3,1] et 4,1 [3,3-5,1]). Moins de 10 % des personnes hospitalisées et 2 % des personnes décédées à l'hôpital ne présentaient aucune comorbidité. Après ajustement, les risques d'hospitalisation et de décès hospitalier augmentaient fortement avec le nombre de comorbidités, atteignant chez les personnes présentant au moins 5 comorbidités des risques multipliés par 10 (HRa 10 [9,0- 11]) et 18 (HRa 18 [11- 27]) respectivement. Conclusion Bien que la vaccination ait très fortement réduit la fréquence des formes sévères de COVID-19, un risque résiduel persistait en particulier dans les populations âgées, immunodéprimées et/ou polypathologiques. Des mesures de prévention complémentaires (gestes barrières) restent nécessaires pour réduire le risque résiduel de formes sévères de COVID-19. Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
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Affiliation(s)
- L. Semenzato
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France,Auteur correspondant
| | - J. Botton
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - J. Drouin
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - B. Barricault
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - M. Bertrand
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - M-J. Jabagi
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - K. Bouillon
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - S. Le Vu
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - R. Dray-Spira
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - A. Weill
- EPI-PHARE, épidémiologie des produits de santé (ANSM, Cnam) – EPI-PHARE (French National Agency for Medicines and Health Products Safety, ANSM; and French National Health Insurance, CNAM), France
| | - M. Zureik
- Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), France
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Vu SL, Bertrand M, Jabagi MJ, Botton J, Drouin J, Baricault B, Weill A, Dray-Spira R, Zureik M. 8Association entre les vaccins COVID-19 à ARN messager et la survenue de myocardite et péricardite chez les personnes de 12 à 50 ans en France. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634427 DOI: 10.1016/j.respe.2022.09.067] [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: 11/06/2022] Open
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Meyer A, Neumann A, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Benefits and Risks Associated With Continuation of Anti-Tumor Necrosis Factor After 24 Weeks of Pregnancy in Women With Inflammatory Bowel Disease : A Nationwide Emulation Trial. Ann Intern Med 2022; 175:1374-1382. [PMID: 36162111 DOI: 10.7326/m22-0819] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Continuation of biologics for inflammatory disorders during pregnancy is still a difficult decision. Many women with inflammatory bowel diseases (IBDs) stop anti-tumor necrosis factor (anti-TNF) treatment after 24 weeks. OBJECTIVE To evaluate the benefits and risks of anti-TNF continuation after 24 weeks of pregnancy for mothers with IBD and their offspring. DESIGN Target trial emulation between 2010 and 2020. SETTING Nationwide population-based study using the Système National des Données de Santé. PATIENTS All pregnancies with birth exposed to anti-TNF between conception and 24 weeks of pregnancy in women with IBD. INTERVENTION Continuation of anti-TNF after 24 weeks of pregnancy. MEASUREMENTS Occurrence of maternal IBD relapse up to 6 months after pregnancy, adverse pregnancy outcomes, and serious infections in the offspring during the first 5 years of life was compared according to anti-TNF continuation after 24 weeks of pregnancy using inverse probability-weighted marginal models. RESULTS A total of 5293 pregnancies were included; among them, anti-TNF treatment was discontinued before 24 weeks for 2890 and continued beyond 24 weeks for 2403. Continuation of anti-TNF was associated with decreased frequencies of maternal IBD relapse (35.8% vs. 39.0%; adjusted risk ratio [aRR], 0.93 [95% CI, 0.86 to 0.99]) and prematurity (7.6% vs. 8.9%; aRR, 0.82 [CI, 0.68 to 0.99]). No difference according to anti-TNF continuation was found regarding stillbirths (0.4% vs. 0.2%; aRR, 2.16 [CI, 0.64 to 7.81]), small weight for gestational age births (13.1% vs. 12.9%; aRR, 1.01 [CI, 0.88 to 1.17]), and serious infections in the offspring (54.2 vs. 50.2 per 1000 person-years; adjusted hazard ratio, 1.08 [CI, 0.94 to 1.25]). LIMITATION Algorithms rather than clinical data were used to identify patients with IBD, pregnancies, and serious infections. CONCLUSION Continuation of anti-TNF after 24 weeks of pregnancy appears beneficial regarding IBD activity and prematurity, while not affecting neonatal outcomes and serious infections in the offspring. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Antoine Meyer
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, and Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France (A.M.)
| | - Anke Neumann
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
| | - Jérôme Drouin
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
| | - Alain Weill
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre & Université Paris-Saclay, Le Kremlin Bicêtre, France (F.C.)
| | - Rosemary Dray-Spira
- EPI-PHARE, Épidémiologie des produits de santé, Saint-Denis, France (A.N., J.D., A.W., R.D.)
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Botton J, Jabagi MJ, Bertrand M, Baricault B, Drouin J, Le Vu S, Weill A, Farrington P, Zureik M, Dray-Spira R. Risk for Myocardial Infarction, Stroke, and Pulmonary Embolism Following COVID-19 Vaccines in Adults Younger Than 75 Years in France. Ann Intern Med 2022; 175:1250-1257. [PMID: 35994748 PMCID: PMC9425709 DOI: 10.7326/m22-0988] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The BNT162b2 (Pfizer-BioNTech) vaccine has been shown to be safe with regard to risk for severe cardiovascular events (such as myocardial infarction [MI], pulmonary embolism [PE], and stroke) in persons aged 75 years or older. Less is known about the safety of other COVID-19 vaccines or outcomes in younger populations. OBJECTIVE To assess short-term risk for severe cardiovascular events (excluding myocarditis and pericarditis) after COVID-19 vaccination in France's 46.5 million adults younger than 75 years. DESIGN Self-controlled case series method adapted to event-dependent exposure and high event-related mortality. SETTING France, 27 December 2020 to 20 July 2021. PATIENTS All adults younger than 75 years hospitalized for PE, acute MI, hemorrhagic stroke, or ischemic stroke (n = 73 325 total events). MEASUREMENTS Linkage between the French National Health Data System and COVID-19 vaccine databases enabled identification of hospitalizations for cardiovascular events (MI, PE, or stroke) and receipt of a first or second dose of the Pfizer-BioNTech, mRNA-1273 (Moderna), Ad26.COV2.S (Janssen), or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine. The relative incidence (RI) of each cardiovascular event was estimated in the 3 weeks after vaccination compared with other periods, with adjustment for temporality (7-day periods). RESULTS No association was found between the Pfizer-BioNTech or Moderna vaccine and severe cardiovascular events. The first dose of the Oxford-AstraZeneca vaccine was associated with acute MI and PE in the second week after vaccination (RI, 1.29 [95% CI, 1.11 to 1.51] and 1.41 [CI, 1.13 to 1.75], respectively). An association with MI in the second week after a single dose of the Janssen vaccine could not be ruled out (RI, 1.75 [CI, 1.16 to 2.62]). LIMITATIONS It was not possible to ascertain the relative timing of injection and cardiovascular events on the day of vaccination. Outpatient deaths related to cardiovascular events were not included. CONCLUSION In persons aged 18 to 74 years, adenoviral-based vaccines may be associated with increased incidence of MI and PE. No association between mRNA-based vaccines and the cardiovascular events studied was observed. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France, and Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, France (J.B.)
| | - Marie Joelle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France (M.J.J., M.B., B.B., J.D., S.L.V., A.W., R.D.)
| | - Marion Bertrand
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France (M.J.J., M.B., B.B., J.D., S.L.V., A.W., R.D.)
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France (M.J.J., M.B., B.B., J.D., S.L.V., A.W., R.D.)
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France (M.J.J., M.B., B.B., J.D., S.L.V., A.W., R.D.)
| | - Stéphane Le Vu
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France (M.J.J., M.B., B.B., J.D., S.L.V., A.W., R.D.)
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France (M.J.J., M.B., B.B., J.D., S.L.V., A.W., R.D.)
| | - Paddy Farrington
- School of Mathematics and Statistics, The Open University, Milton Keynes, United Kingdom (P.F.)
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France, and University Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective evasion and pharmacoepidemiology, CESP, Montigny le Bretonneux, France (M.Z.)
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products - ANSM, French National Health Insurance - CNAM), Saint-Denis, France (M.J.J., M.B., B.B., J.D., S.L.V., A.W., R.D.)
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Semenzato L, Botton J, Drouin J, Baricault B, Bertrand M, Jabagi MJ, Cuenot F, Vu SL, Dray-Spira R, Weill A, Zureik M. Characteristics associated with the residual risk of severe COVID-19 after a complete vaccination schedule: A cohort study of 28 million people in France. Lancet Reg Health Eur 2022; 19:100441. [PMID: 35789881 PMCID: PMC9243470 DOI: 10.1016/j.lanepe.2022.100441] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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Affiliation(s)
- Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Marion Bertrand
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Marie-Joëlle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - François Cuenot
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Stéphane Le Vu
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
- University Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-infective evasion and Pharmacoepidemiology Unit/Team, CESP, 78180, Montigny le Bretonneux, France
- Corresponding author.
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Bouillon K, Baricault B, Semenzato L, Botton J, Bertrand M, Drouin J, Dray-Spira R, Weill A, Zureik M. Association of Statins for Primary Prevention of Cardiovascular Diseases With Hospitalization for COVID-19: A Nationwide Matched Population-Based Cohort Study. J Am Heart Assoc 2022; 11:e023357. [PMID: 35699173 PMCID: PMC9238639 DOI: 10.1161/jaha.121.023357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is little evidence on the relationship between statin use and the risk of hospitalization attributable to COVID‐19. Methods and Results The French National Healthcare Data System database was used to conduct a matched‐cohort study. For each adult aged ≥40 years receiving statins for the primary prevention of cardiovascular diseases, one nonuser was randomly selected and matched for year of birth, sex, residence area, and comorbidities. The association between statin use and hospitalization for COVID‐19 was examined using conditional Cox proportional hazards models, adjusted for baseline characteristics, comorbidities, and long‐term medications. Its association with in‐hospital death from COVID‐19 was also explored. All participants were followed up from February 15, 2020, to June 15, 2020. The matching procedure generated 2 058 249 adults in the statin group and 2 058 249 in the control group, composed of 46.6% of men with a mean age of 68.7 years. Statin users had a 16% lower risk of hospitalization for COVID‐19 than nonusers (adjusted hazard ratio [HR], 0.84; 95% CI, 0.81–0.88). All types of statins were significantly associated with a lower risk of hospitalization, with the adjusted HR ranging from 0.75 for fluvastatin to 0.89 for atorvastatin. Low‐ and moderate‐intensity statins also showed a lower risk compared with nonusers (HR, 0.78 [95% CI, 0.71–0.86] and HR, 0.84 [95% CI, 0.80–0.89], respectively), whereas high‐intensity statins did not (HR, 1.01; 95% CI, 0.86–1.18). We found similar results with in‐hospital death from COVID‐19. Conclusions Our findings support that the use of statins for primary prevention is associated with lower risks of hospitalization for COVID‐19 and of in‐hospital death from COVID‐19.
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Affiliation(s)
- Kim Bouillon
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France.,Faculty of Pharmacy Paris-Saclay University Châtenay-Malabry France
| | - Marion Bertrand
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products Saint-Denis France.,Paris-Saclay University UVSQ CESP-Inserm, Anti-infective evasion and pharmacoepidemiology Montigny le Bretonneux France
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Meyer A, Taine M, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Serious Infections in Children Born to Mothers With Inflammatory Bowel Disease With In Utero Exposure to Thiopurines and Anti-Tumor Necrosis Factor. Clin Gastroenterol Hepatol 2022; 20:1269-1281.e9. [PMID: 34298191 DOI: 10.1016/j.cgh.2021.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We aimed to compare the risk of serious infections in children with in utero exposure to thiopurines and/or anti-tumor necrosis factor (TNF) born to mothers with inflammatory bowel disease (IBD). METHODS Using the French national health database, which covers 99% of the French population (around 66,000,000 people), we identified live births among women with IBD in France between 2010 and 2018. The risks of serious infections in children during the first 5 years of life were compared according to treatment exposures during pregnancy using propensity score-weighted marginal Cox models. RESULTS A total of 26,561 children were included: 3392 were exposed to thiopurine monotherapy, 3399 to anti-TNF monotherapy, 816 to combination therapy, and 18,954 were not exposed to any of these drugs. The risks of serious infections during the first year of life among children exposed to thiopurine monotherapy (adjusted hazard ratio [aHR], 0.94; 95% confidence interval [CI], 0.83-1.07) and anti-TNF monotherapy (aHR, 1.10; 95% CI, 0.95-1.27) were similar to those of unexposed children; a higher risk was observed in children exposed to combination therapy (aHR, 1.36; 95% CI, 1.04-1.79). The highest increased risks were observed for nervous system infections and viral infections. The risk of serious infections during the second to fifth years of life was not associated with IBD treatments. CONCLUSIONS In children born to mothers with IBD, in utero exposure to thiopurine and anti-TNF monotherapies do not increase the risk of serious infections during the first 5 years of life. Combination therapy is associated with an increased risk of serious infections during the first year of life.
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Affiliation(s)
- Antoine Meyer
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France & Université Paris Sud, Le Kremlin Bicêtre, France.
| | - Marion Taine
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
| | - Jérôme Drouin
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
| | - Alain Weill
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France & Université Paris Sud, Le Kremlin Bicêtre, France
| | - Rosemary Dray-Spira
- EPIPHARE, Épidémiologie des Produits de Santé, ANSM-CNAM, Saint Denis, France
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Jourdain H, de Gage SB, Desplas D, Dray-Spira R. Real-world effectiveness of pre-exposure prophylaxis in men at high risk of HIV infection in France: a nested case-control study. The Lancet Public Health 2022; 7:e529-e536. [DOI: 10.1016/s2468-2667(22)00106-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 12/20/2022] Open
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Botton J, Semenzato L, Dupouy J, Dray-Spira R, Weill A, Saint-Lary O, Zureik M. No association of low-dose aspirin with severe COVID-19 in France: A cohort of 31.1 million people without cardiovascular disease. Res Pract Thromb Haemost 2022; 6:e12743. [PMID: 35755854 PMCID: PMC9204394 DOI: 10.1002/rth2.12743] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Aspirin at low doses has been reported to be a potential drug candidate to treat or prevent severe coronavirus disease 2019 (COVID‐19). Objectives We aimed to explore whether low‐dose aspirin used for primary cardiovascular prevention was associated with a lower risk of severe COVID‐19. Method A large cohort of patients without known cardiovascular comorbidities was constructed from the entire French population registered in national health care databases. In total, 31.1 million patients aged ≥40 years, including 1.5 million reimbursed for low‐dose aspirin at least at three time points during the 6 months before the epidemic, were followed until hospitalization with a COVID‐19 diagnosis or intubation/death for hospitalized patients. Results Cox models adjusted for age and sex showed a positive association between low‐dose aspirin and the risk of hospitalization (hazard ratio [HR], 1.33; 95% confidence interval (CI), 1.29‐1.37]) or death/intubation (HR, 1.40 [95% CI, 1.33‐1.47]). In fully adjusted models, associations were close to null (HR, 1.03 [95% CI, 1.00‐1.06] and 1.04 [95% CI, 0.98‐1.10], respectively). Conclusion There was no evidence for an effect of low‐dose aspirin for primary cardiovascular prevention in reducing severe COVID‐19.
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Affiliation(s)
- Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products French National Agency for the Safety of Medicines and Health Products French National Health Insurance Saint-Denis France
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products French National Agency for the Safety of Medicines and Health Products French National Health Insurance Saint-Denis France
| | - Julie Dupouy
- MSPU de Pins Justaret University Paul Sabatier Toulouse III UMR 1295 Inserm Univ. Paul Sabatier F-31000 Toulouse France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products French National Agency for the Safety of Medicines and Health Products French National Health Insurance Saint-Denis France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products French National Agency for the Safety of Medicines and Health Products French National Health Insurance Saint-Denis France
| | - Olivier Saint-Lary
- University Paris-Saclay UVSQ Univ. Paris-Sud Inserm Primary Care and Prevention CESP Villejuif France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products French National Agency for the Safety of Medicines and Health Products French National Health Insurance Saint-Denis France.,University Paris-Saclay UVSQ Univ. Paris-Sud Inserm Primary Care and Prevention CESP Villejuif France
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Taine M, Offredo L, Weill A, Dray-Spira R, Zureik M, Chalumeau M. Pediatric Outpatient Prescriptions in Countries With Advanced Economies in the 21st Century: A Systematic Review. JAMA Netw Open 2022; 5:e225964. [PMID: 35467734 PMCID: PMC9039774 DOI: 10.1001/jamanetworkopen.2022.5964] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE An international comparison of pediatric outpatient prescriptions (POPs) is pivotal to investigate inadequate practices at the national scale and guide corrective actions. OBJECTIVE To compare annual POP prevalence among Organisation for Economic Co-operation and Development (OECD) member countries. EVIDENCE REVIEW Two independent reviewers systematically searched PubMed, Embase, and institutes of public health or drug agency websites for studies published since 2000 and reporting POP prevalence (expressed as number of patients aged <20 years with ≥1 POP per 1000 pediatric patients per year) in OECD member countries or large geographic areas within them. Risk of bias was assessed for exhaustiveness and representativeness. Prevalence ratios (PRs) were used to compare the highest and lowest POP prevalence among countries overall, by levels of Anatomical Therapeutic Chemical (ATC) classification for the overall pediatric population, and by age group (ie, ages <5-6 vs ≥5-6 years), stratifying on prescription-only drug (POD) status. FINDINGS Among 11 studies performed on 3 regional and 8 national medicoadministrative databases in 11 countries, 35 552 550 pediatric patients were included. The overall risk of bias was low (10 studies were representative [90.9%], and the prevalence denominator included nonusers of health care for 9 studies [81.8%]). Prevalence of 1 or more POP per year ranged from 480 to 857 pediatric patients per 1000 in Sweden and France, respectively (PR, 1.8 [95% CI, 1.8-1.8]). Overall, among 8 studies reporting ATC level 1 drugs, Denmark had the lowest POP prevalence (eg, systemic hormonal preparations: 9 pediatric patients per 1000 per year) and France the highest (eg, systemic hormonal preparation: 216 pediatric patients per 1000 per year). Among 8 studies reporting ATC level 2 drugs for PODs, the PR between France and Denmark was 108.2 (95% CI, 108.2-108.2) for systemic corticosteroids and 2.1 (95% CI, 2.1-2.1) for drugs for obstructive airway disease. The PR for antibiotics was 3.4 (95% CI, 3.4-3.4) between New Zealand and Sweden. For pediatric patients aged 5 to 6 years or older, the PR for sex hormones was 2.1 (95% CI, 2.1-2.1) between Denmark and France. Among 7 studies reporting ATC level 5 drugs, the prevalence of the 10 most prevalent PODs was less than 100 pediatric patients per 1000 per year in Scandinavian countries and the Netherlands and less than 300 pediatric patients per 1000 per year in France and New Zealand. CONCLUSIONS AND RELEVANCE This study found large between-country variations in POPs, which may suggest substantial inappropriate prescriptions. The findings may suggest guidance for educational campaigns and regulatory decisions in some OECD member countries.
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Affiliation(s)
- Marion Taine
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medecines and Health Products, French National Health Insurance, Saint Denis, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université de Paris, National Institute of Health and Medical Research, F-75004, Paris, France
| | - Lucile Offredo
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medecines and Health Products, French National Health Insurance, Saint Denis, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université de Paris, National Institute of Health and Medical Research, F-75004, Paris, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medecines and Health Products, French National Health Insurance, Saint Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medecines and Health Products, French National Health Insurance, Saint Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medecines and Health Products, French National Health Insurance, Saint Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université de Paris, National Institute of Health and Medical Research, F-75004, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
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Roland N, Duranteau L, Cuenot F, Dray-Spira R, Weill A, Zureik M. Impact de l’épidémie COVID-19 sur l'utilisation des contraceptifs en France en 2020 et jusqu'en avril 2021. Rev Epidemiol Sante Publique 2022. [PMCID: PMC8907811 DOI: 10.1016/j.respe.2022.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Des difficultés d'accès aux services de santé sexuelle ont été rapportées dans le monde entier pendant l’épidémie de COVID-19. En France, les trois confinements ainsi que les couvre-feux ont pu modifier l'accès aux contraceptifs et leur utilisation. Méthodes Nous avons mené une étude observationnelle nationale grâce aux données de remboursement du Système national des données de santé (SNDS), qui couvre 99,5 % de la population française. Nous avons extrait le nombre de délivrances de contraception orale (CO, progestatifs et contraception oestroprogestative remboursée), de contraception d'urgence (CU), de dispositifs intra-utérins en cuivre (DIU-C) et hormonaux (DIU-H) et d'implants contraceptifs en 2018, 2019, 2020 et au premier quadrimestre de 2021. Nous avons calculé les nombres attendus de consommation de chacune de ces contraceptions en 2020 et 2021, en se basant sur les utilisations de 2018 et 2019, et en tenant compte des jours fériés et des tendances annuelles de consommations. Nous avons comparé les chiffres observés et attendus par contraceptif et par âge d'utilisatrices (âge ≤ 25 ans, entre 25 et 35 ans, > à 35 ans). Résultats L'usage des contraceptifs a diminué de façon globale par rapport à l'attendu après 15 mois de pandémie : -2,0 % pour la CO, -5,0 % pour la CU, -9,5 % pour les DIU-H, -8,6 % pour les DIU-C, et -16,4 % pour l'implant. La baisse d'utilisation a concerné majoritairement les femmes âgées de moins de 25 ans. Un phénomène de stockage de la CO a été observé au début des deux premiers confinements. Discussion/Conclusion Il existe une différence d'impact selon les contraceptifs, les degrés de restriction et les âges des consommatrices. La baisse d'utilisation des contraceptifs peut être expliquée partiellement par la baisse des interactions sociales notamment chez les plus jeunes. Même si les chiffres d'interruption volontaire de grossesse sont stables en 2020, l'accès à la contraception doit être une priorité de santé publique pour limiter l'impact de la pandémie sur le taux de grossesses non désirées
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Rolland N, Barricault B, Dray-Spira R, Weill A, Duranteau L, Zureik M. Utilisation des dispositifs intra-utérins en 2019 et taux de continuation un an après en France : une étude nationale observationnelle en vie réelle. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.096] [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: 11/28/2022] Open
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Abstract
This comparative effectiveness research study examines the effectiveness of full vaccination with Ad26.COV2.S vs BNT162b2 against COVID-19–related hospitalization.
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Affiliation(s)
- Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, Saint-Denis, France
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, Saint-Denis, France
| | - Marie-Joëlle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, Saint-Denis, France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, Saint-Denis, France
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Lassalle M, Le Tri T, Afchain P, Camus M, Kirchgesner J, Zureik M, Dray-Spira R. Use of Proton Pump Inhibitors and Risk of Pancreatic Cancer: A Nationwide Case-Control Study Based on the French National Health Data System (SNDS). Cancer Epidemiol Biomarkers Prev 2022; 31:662-669. [PMID: 34937794 PMCID: PMC9381101 DOI: 10.1158/1055-9965.epi-21-0786] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/15/2021] [Accepted: 12/13/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Only a few studies investigated the association between proton pump inhibitor (PPI) use and pancreatic cancer, with inconsistent results. Moreover, these studies had a number of methodologic limitations. Our objective was to assess this association in a nationwide case-control study. METHODS We used the French National Health Data System (SNDS), covering 99% of the French population since 2006. Incident cases of pancreatic cancer, identified between 2014 and 2018, were matched with up to four controls on year of birth, sex, frequency of hospitalization within 8 years prior to index date, and department of residence. Associations between PPIs and pancreatic cancer were estimated using conditional logistic regression models adjusted for sociodemographic characteristics, risk factors of pancreatic cancer (including diabetes mellitus, tobacco-related diseases, and morbid obesity), and other comorbidities. RESULTS A total of 23,321 cases of pancreatic cancer (mean age, 69.8 years; 51.7% males) and 75,937 matched controls were included. Overall, 77.8% of cases and 75.5% of controls were PPI ever users. Ever (vs. never) PPI use was associated with an increased risk of pancreatic cancer [adjusted OR (aOR) = 1.05, 95% confidence interval (CI), 1.01-1.09]. A dose-response relationship was observed [1-30 cumulative defined daily dose (cDDD): aOR = 0.92, 95% CI, 0.87-0.97; 31-180 cDDD: aOR = 1.05, 95% CI, 1.00-1.11; 181-1,080 cDDD: aOR = 1.18, 95% CI, 1.12-1.24; >1,080 cDDD: aOR = 1.17, 95% CI, 1.10-1.23]. CONCLUSIONS On the basis of these findings, a slight increase in the risk of pancreatic cancer associated with high cumulative doses of PPIs cannot be excluded. IMPACT Given the overuse of PPIs, efforts should be continued to limit treatments to appropriate indications and durations.
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Affiliation(s)
- Marion Lassalle
- EPIPHARE, Epidemiology of Health Products [French National Agency for the Safety of Medicines and Health Products (ANSM), and French National Health Insurance (CNAM)], Saint-Denis, France
| | - Thien Le Tri
- EPIPHARE, Epidemiology of Health Products [French National Agency for the Safety of Medicines and Health Products (ANSM), and French National Health Insurance (CNAM)], Saint-Denis, France
| | - Pauline Afchain
- Medical Oncology Department, APHP, Hôpital Saint Antoine, Paris, France
| | - Marine Camus
- Sorbonne University, Centre de Recherche Saint Antoine, UMRS-938, Paris, France
- Digestive Endoscopy Department, APHP, Hôpital Saint Antoine, Paris, France
| | - Julien Kirchgesner
- Sorbonne University, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
- Department of Gastroenterology, APHP, Hôpital Saint-Antoine, Paris, France
| | - Mahmoud Zureik
- EPIPHARE, Epidemiology of Health Products [French National Agency for the Safety of Medicines and Health Products (ANSM), and French National Health Insurance (CNAM)], Saint-Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Rosemary Dray-Spira
- EPIPHARE, Epidemiology of Health Products [French National Agency for the Safety of Medicines and Health Products (ANSM), and French National Health Insurance (CNAM)], Saint-Denis, France
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Ghebremichael-Weldeselassie Y, Jabagi MJ, Botton J, Bertrand M, Baricault B, Drouin J, Weill A, Zureik M, Dray-Spira R, Farrington P. A modified self-controlled case series method for event-dependent exposures and high event-related mortality, with application to COVID-19 vaccine safety. Stat Med 2022; 41:1735-1750. [PMID: 35092037 PMCID: PMC9303905 DOI: 10.1002/sim.9325] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 09/16/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 01/14/2023]
Abstract
We propose a modified self‐controlled case series (SCCS) method to handle both event‐dependent exposures and high event‐related mortality. This development is motivated by an epidemiological study undertaken in France to quantify potential risks of cardiovascular events associated with COVID‐19 vaccines. Event‐dependence of vaccinations, and high event‐related mortality, are likely to arise in other SCCS studies of COVID‐19 vaccine safety. Using this case study and simulations to broaden its scope, we explore these features and the biases they may generate, implement the modified SCCS model, illustrate some of the properties of this model, and develop a new test for presence of a dose effect. The model we propose has wider application, notably when the event of interest is death.
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Affiliation(s)
| | - Marie Joëlle Jabagi
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France
| | - Jérémie Botton
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France.,Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, France
| | - Marion Bertrand
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France
| | - Bérangère Baricault
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France
| | - Alain Weill
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France.,Anti-infective Evasion and Pharmacoepidemiology, Centre for Epidemiology and Population Health (CESP), Montigny-le-Bretonneux, France
| | - Rosemary Dray-Spira
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France
| | - Paddy Farrington
- School of Mathematics and Statistics, The Open University, Milton Keynes, UK
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38
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Jabagi MJ, Botton J, Bertrand M, Weill A, Farrington P, Zureik M, Dray-Spira R. Myocardial Infarction, Stroke, and Pulmonary Embolism After BNT162b2 mRNA COVID-19 Vaccine in People Aged 75 Years or Older. JAMA 2022; 327:80-82. [PMID: 34807248 PMCID: PMC8609457 DOI: 10.1001/jama.2021.21699] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [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: 12/24/2022]
Abstract
This population-based study evaluates the short-term risk of severe cardiovascular events among French residents aged 75 years or older after receipt of the BNT162b2 mRNA COVID-19 vaccination.
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Affiliation(s)
- Marie Joelle Jabagi
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Jérémie Botton
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Marion Bertrand
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Paddy Farrington
- School of Mathematics and Statistics, the Open University, Milton Keynes, United Kingdom
| | - Mahmoud Zureik
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
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39
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Bouillon K, Baricault B, Botton J, Jabagi MJ, Bertrand M, Semenzato L, Le Vu S, Drouin J, Dray-Spira R, Weill A, Zureik M. Effectiveness of BNT162b2, mRNA-1273, and ChAdOx1-S vaccines against severe covid-19 outcomes in a nationwide mass vaccination setting: cohort study. BMJ Med 2022; 1:e000104. [PMID: 36936561 PMCID: PMC9978755 DOI: 10.1136/bmjmed-2021-000104] [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: 12/23/2021] [Accepted: 05/11/2022] [Indexed: 11/07/2022]
Abstract
Objective To estimate the effectiveness of the three covid-19 vaccines by Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), and Oxford-AstraZeneca (ChAdOx1-S) in people after receiving two doses. Design Cohort study. Setting Nationwide, population based data in France, from the French National Health Data System (Système National des Données de Santé), between 27 December 2020 and 30 April 2021. Participants Adults aged ≥50 years receiving a first dose of BNT162b2, mRNA-1273, or ChAdOx1-S were randomly selected (1:1) and matched on the date of vaccination with one unvaccinated control. Individuals were matched on year of birth, sex, region of residence, and residence in a nursing home (for individuals aged ≥75 years). All individuals were followed up until 20 August 2021. Main outcome measures Primary outcome measure was vaccine effectiveness estimated at least 14 days after the second dose against covid-19 related hospital admission using Cox proportional hazards models adjusted for baseline characteristics and comorbidities. Vaccine effectiveness against covid-19 related death in hospital was also investigated. Results 11 256 832 vaccinated individuals were included in the study (63.6% (n=7 161 658) with the BNT162b2 vaccine, 7.6% (n=856 599) with the mRNA-1273 vaccine, and 28.8% (n=3 238 575) with the ChAdOx1-S vaccine), along with 11 256 832 matched unvaccinated controls. During follow-up (up to 20 August 2021), 43 158 covid-19 related hospital admissions and 7957 covid-19 related deaths in hospital were registered. Compared with unvaccinated controls, vaccine effectiveness of two doses against covid-19 related hospital admission was 91% (95% confidence interval 91% to 92%), 95% (93% to 96%), and 91% (89% to 94%) for the BNT162b2, mRNA-1273, and ChAdOx1-S vaccines, respectively. Similar results were observed for vaccine effectiveness of two doses against covid-19 related deaths in hospital (BNT162b2, 91% (90% to 93%); mRNA-1273, 96% (92% to 98%); and ChAdOx1 nCoV-19, 88% (68% to 95%)). At 5-6 months after receiving the second dose of vaccine, effectiveness remained high at 94% (92% to 95%) for the BNT162b2 vaccine and 98% (93% to 100%) for the mRNA-1273 vaccine. Vaccine effectiveness of ChAdOx1-S estimated at 3-4 months was 90% (63% to 97%). All three vaccines remained effective at the time of circulation of the delta variant of SARS-CoV-2 between 1 July and 20 August 2021 (effectiveness between 89% and 95%). Conclusions These findings provide evidence indicating that two doses of ChAdOx1-S is as effective as two doses of mRNA vaccines in France against the alpha and delta variants of SARS-CoV-2. The effectiveness of ChAdOx1-S should be further examined with a longer follow-up and in the light of the circulation of new SARS-CoV-2 variants of concern.
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Affiliation(s)
- Kim Bouillon
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Châtenay-Malabry, France
| | - Marie-Joëlle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Marion Bertrand
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Stéphane Le Vu
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, Saint-Denis, France
- CESP-Inserm, Anti-infective evasion and pharmacoepidemiology, Paris-Saclay University, UVSQ, Montigny le Bretonneux, France
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40
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Roland N, Drouin J, Desplas D, Duranteau L, Cuenot F, Dray-Spira R, Weill A, Zureik M. Impact of Coronavirus Disease 2019 (COVID-19) On Contraception Use in 2020 and up until the end of April 2021 in France. Contraception 2021; 108:50-55. [PMID: 34971603 PMCID: PMC8714238 DOI: 10.1016/j.contraception.2021.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
Objectives To assess the impact of the COVID-19 pandemic on the use of reimbursed contraceptives in France after 15 months of the pandemic, according to age-group and updating previous data only pertaining to the first lockdown (2 months). Study design We conducted a national register-based study by extracting all reimbursements of oral contraceptives (OC), emergency contraception (EC), intrauterine devices (IUD), and implants from the French National Health Insurance database (SNDS), which includes and covers 99.5% of the French population, in 2018, 2019, 2020 and from January 1, 2021 to April30, 2021. We calculated the expected use of contraceptives in 2020 and 2021 in the absence of the pandemic, based on 2018 and 2019 usage and taking annual trends into account. We assessed the difference between observed and expected dispensing rates by contraceptive type and by age-group (≤18 years old, 18< age ≤25, 25< age ≤35, >35). Results Dispensing of all contraceptives decreased compared to expect dispensing numbers: −2.0% for OC, −5.3% for EC, −9.5% for LNG-IUS, −8.6% for C-IUD, and −16.4% for implant. This decrease in the dispensing of contraceptives was observed in all age-groups, but mainly concerned women under the age of 18 years (−22% for OC, −10% for EC, −37.2% for LNG-IUS, −36.4% for C-IUD, −26.4% for implant) and those aged 18 to 25 (−5.1% for OC, −11.9% for EC, −18.1% for LNG-IUS, −15.9% for C-IUD, −17.6% for implants). Conclusions Our study showed that the dispensing of contraceptives in France was markedly impacted by the COVID-19 pandemic. Prescriptions for long-acting contraceptive use and women under the age of 25 years were the most substantially impacted. Ensuring access to contraceptive methods during health emergencies must be a public health policy priority. Implications The COVID-19 pandemic strongly impacted the dispensing of contraceptives in France with varying degrees of decreased dispensing according to the type of contraceptive, the age-group and the level of pandemic-related restrictions. The impact of these restrictions on unintended pregnancy at the population level remains undetermined.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France; University of Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 2 Avenue de la Source de la Bièvre 78180, Montigny le Bretonneux, France.
| | - Jérôme Drouin
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - David Desplas
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynaecology Unit and Reference Center for Rare, Diseases of Genital Development, AP.HP University of Paris Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - François Cuenot
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Alain Weill
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Mahmoud Zureik
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France; University of Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 2 Avenue de la Source de la Bièvre 78180, Montigny le Bretonneux, France
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41
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Botton J, Dray-Spira R, Baricault B, Drouin J, Bertrand M, Jabagi MJ, Weill A, Zureik M. Reduced risk of severe COVID-19 in more than 1.4 million elderly people aged 75 years and older vaccinated with mRNA-based vaccines. Vaccine 2021; 40:414-417. [PMID: 34924220 PMCID: PMC8664658 DOI: 10.1016/j.vaccine.2021.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022]
Abstract
Randomized clinical trials have shown mRNA-based vaccines to be 92–95% effective to prevent COVID-19 in adults. We aimed to estimate the impact of vaccination on the risk of severe COVID-19 (requiring hospitalization) in elderly people. Each 1,422,461 vaccinated subject aged 75 or older was matched to two unvaccinated subjects of same age, sex, administrative region, and type of residence. They were followed from date of first injection between 27 December 2020 and 24 February 2021 to 20 March 2021 for COVID-19 hospitalization. Mean age was 82.4 years (SD, 5.7) and median follow-up was 38 days [IQR, 17–54]. Adjusted Hazard Ratio for COVID-19 hospitalization from day 7 after the second dose was estimated at 0.14 (95% confidence interval, 0.11–0.17), i.e. an estimated 86% risk reduction in people aged 75 and older, highlighting the major impact of mRNA vaccination on reducing the risk of COVID-19 among elderly people.
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Affiliation(s)
- Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France; Faculté de Pharmacie, Université Paris-Saclay, 92296 Châtenay-Malabry, France.
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France
| | - Marion Bertrand
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France
| | - Marie-Joëlle Jabagi
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products of the French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, France; University Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective evasion and Pharmacoepidemiology, CESP, 78180 Montigny le Bretonneux, France
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42
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Taine M, Offredo L, Dray-Spira R, Weill A, Chalumeau M, Zureik M. Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study: Paediatric outpatient prescriptions in France, 2010 to 2019. Lancet Reg Health Eur 2021; 7:100129. [PMID: 34557839 PMCID: PMC8454786 DOI: 10.1016/j.lanepe.2021.100129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Paediatric outpatient prescription (POP) monitoring is pivotal to identify inadequate prescriptions and optimize drug use. We aimed at describing recent trends in POPs in France. Methods All reimbursed dispensations of outpatient prescribed drugs (excluding vaccines) were prospectively collected for the paediatric population (<18 years old) in the French national health database in 2010-2011 and 2018-2019 (mean 117,356,938/year). POP prevalence (proportion of children receiving ≥1 drug prescriptions/year) was calculated by age groups and compared by prevalence rate ratios (PRRs). Given the large sample size, 95% confidence intervals of POP prevalences and PRRs did not differ from estimates. Findings Among the 14,510,023 children resident in France in 2018-2019, mean POP prevalence was 857‰ children. Most prescribed therapeutic classes were analgesics (643‰), antibiotics (405‰), nasal corticosteroids (328‰), nonsteroidal anti-inflammatory drugs (NSAIDs) (244‰), antihistamines (246‰) and systemic corticosteroids (210‰). POPs decreased with age from 976‰ for infants to 782‰ for adolescents. Children <6 years old were notably more exposed to inhaled corticosteroids (PRR=3.06), non-penicillin beta-lactam antibacterial agents (PRR=3.05) and systemic corticosteroids (PRR=2.11) than older ones. The POP prevalence was slightly higher (PRR=1.04) during 2018-2019 than 2010-2011, with marked increases for anti-emetics (PRR=1.84), vitamin D (PRR=1.49), proton pump inhibitors (PRR=1.42), systemic contraceptives (PRR=1.24) and nasal corticosteroids (PRR=1.21) and decreases for propulsive/prokinetic agents (PRR=0.09), NSAIDs (PRR=0.73) and systemic antibiotics (PRR=0.88). Interpretation POP remained highly prevalent in France throughout the 2010s, especially for children <6 years old, with only a few improvements for selected therapeutic classes. These findings should prompt clinical guidance campaigns and/or regulatory policies. Funding Internal funding.
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Affiliation(s)
- Marion Taine
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, U1153 Inserm, Université de Paris, F-75004 Paris, France.,EPI-PHARE (French National Agency for Medicines and Health Products Safety -ANSM- and French National Health Insurance -CNAM-), Saint-Denis, France
| | - Lucile Offredo
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, U1153 Inserm, Université de Paris, F-75004 Paris, France.,EPI-PHARE (French National Agency for Medicines and Health Products Safety -ANSM- and French National Health Insurance -CNAM-), Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE (French National Agency for Medicines and Health Products Safety -ANSM- and French National Health Insurance -CNAM-), Saint-Denis, France
| | - Alain Weill
- EPI-PHARE (French National Agency for Medicines and Health Products Safety -ANSM- and French National Health Insurance -CNAM-), Saint-Denis, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, U1153 Inserm, Université de Paris, F-75004 Paris, France.,Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades Hospital, AP-HP, Université de Paris, Paris, France
| | - Mahmoud Zureik
- EPI-PHARE (French National Agency for Medicines and Health Products Safety -ANSM- and French National Health Insurance -CNAM-), Saint-Denis, France.,Université Paris-Saclay, Université Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm, Anti-infective evasion and pharmacoepidemiology, CESP, 78180, Montigny-le-Bretonneux, France
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43
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Semenzato L, Botton J, Drouin J, Cuenot F, Dray-Spira R, Weill A, Zureik M. Chronic diseases, health conditions and risk of COVID-19-related hospitalization and in-hospital mortality during the first wave of the epidemic in France: a cohort study of 66 million people. Lancet Reg Health Eur 2021; 8:100158. [PMID: 34308411 PMCID: PMC8282330 DOI: 10.1016/j.lanepe.2021.100158] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND From the beginning of the COVID-19 pandemic, age (most importantly), male gender and various comorbidities were found to be associated with severe forms of COVID-19. However, there was little information provided for an entire country such as France, which was severely affected throughout the epidemic. METHODS In France, the SNDS, comprising all health insurance reimbursements and benefits, and the PMSI, comprising hospital data, can be used to estimate the risk associated with about fifty diseases or health conditions for hospitalization primarily related to COVID-19 and COVID-19-related deaths. A cohort was constituted comprising all people alive on February 15, 2020. Data were censored at 15 June 2020 for COVID-19-related hospitalization and at 15 July 2020 for death for patients still hospitalized for COVID-19 on 15 June 2020. Cox proportional hazards models were used to estimate hazard ratios (HR) for the associations between each comorbidity (n=47) and the risk of COVID-19-related hospitalization or death. These associations were determined with adjustment for age and gender, and then in models including all variables (adjusted hazard ratios [aHR]). FINDINGS In a population of 66,050,090 people, 87,809 people (134 per 100,000) were hospitalized for COVID-19 between February 15, 2020 and June 15, 2020 and a subgroup of 15,661 people (24 per 100,000) died in hospital.A much higher risk was observed with increasing age, reaching a risk of hospitalization for COVID-19 more than five fold higher and a risk of COVID-19-related in-hospital mortality more than 100-fold higher in people aged 85 years and older (absolute risks of 750 and 268 per 100,000, respectively) compared to people aged 40 to 44 years.Men were at higher risk of COVID-19-related hospitalization aHR 1.38 [1.36-1.40]) and COVID-19-related in-hospital mortality (aHR 2.08 [2.01-2.16]) compared to women. Positive associations between social deprivation index and risk of COVID-19 were also observed. Almost all chronic health conditions were positively associated with an increased risk of COVID-19-related hospitalization and in-hospital mortality, with the exception of dyslipidaemia, which was negatively associated. The strongest associations for both COVID-19-related hospitalization and in-hospital mortality were observed in people with Down syndrome (7.0 [6.1-8.1] and 22.9 [17.1-30.7], respectively), mental retardation (3.8 [3.5-4.2] and 7.3 [6.1-8.8], respectively), kidney transplantation (4.6 [4.2-5.0] and 7.1 [6.0-8.4], respectively), lung transplantation (3.5 [2.4-5.3] and 6.2 [2.8-14.0], respectively) end-stage renal disease on dialysis (4.2 [3.9-4.4] and 4.7 [4.2-5.2], respectively) and active lung cancer (2.6 [2.4-2.8] and 4.0 [3.5-4.6], respectively). INTERPRETATION This national cohort study confirms the associations with most diseases and health conditions in France and provides data on less frequent health conditions, which could be useful particularly to target priority populations during present and future vaccination campaigns. FUNDING None.
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Affiliation(s)
- Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
| | - François Cuenot
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
- University Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective evasion and pharmacoepidemiology, CESP, 78180, Montigny le Bretonneux, France
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Meyer A, Drouin J, Weill A, Carbonnel F, Dray-Spira R. Comparative study of pregnancy outcomes in women with inflammatory bowel disease treated with thiopurines and/or anti-TNF: a French nationwide study 2010-2018. Aliment Pharmacol Ther 2021; 54:302-311. [PMID: 34162011 DOI: 10.1111/apt.16448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data about thiopurines or anti-TNF use during pregnancy in women with inflammatory bowel diseases (IBD) are reassuring. However, many studies are based upon small sample sizes. AIMS To assess IBD medication safety during pregnancy. METHODS Using the French national health database, which covers more than 99% of the French population, around 65 000 000 people, we identified pregnancies ending with a birth in IBD patients in France between 2010 and 2018. Pregnancy outcomes (vital status at birth, birth term, and weight for gestational age) were compared according to treatment exposure during pregnancy using propensity score-weighted marginal logistic regression models. RESULTS 27 729 pregnancies were included: 3554 were exposed to thiopurines monotherapy, 3525 to anti-TNF monotherapy, 839 to combination therapy, and 19 811 unexposed. Pregnancies exposed to thiopurines monotherapy compared to unexposed pregnancies more frequently resulted in stillbirths (1.0% vs 0.5%, aOR 2.04; 95%CI: 1.18-3.55), preterm birth (12.3% vs 7.1%, aOR 1.76; 95%CI: 1.55-2.00), large for gestational age (10.6% vs 8.4%, aOR 1.32; 95%CI: 1.13-1.53) and less frequently in small for gestational age (9.6% vs 11.1%, aOR 0.79; 95%CI: 0.67-0.92). By contrast, pregnancies exposed to anti-TNF monotherapy were not different from unexposed pregnancies as regards to these outcomes. Compared to unexposed pregnancies, those exposed to combination therapy more frequently resulted in preterm births (aOR 1.55; 95%CI: 1.15-2.11) and larger for gestational age (aOR 1.61; 95%CI: 1.13-2.29) but did not differ as regards to stillbirths. CONCLUSIONS Pregnancies exposed to thiopurines more frequently resulted in stillbirths, preterm births and large for gestational age compared to pregnancies exposed to anti-TNF or unexposed pregnancies. By contrast, pregnancies exposed to anti-TNF monotherapy were not associated with these outcomes.
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Affiliation(s)
- Antoine Meyer
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Denis, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Jérôme Drouin
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Denis, France
| | - Alain Weill
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris-Saclay, Le Kremlin Bicêtre, France
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Penso L, Dray-Spira R, Weill A, Zureik M, Sbidian E. Psoriasis-related treatment exposure and hospitalization or in-hospital mortality due to COVID-19 during the first and second wave of the pandemic: cohort study of 1 326 312 patients in France. Br J Dermatol 2021; 186:59-68. [PMID: 34310699 PMCID: PMC8444811 DOI: 10.1111/bjd.20659] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
Background Data on treatment exposures for psoriasis and poor COVID‐19 outcomes are limited. Objectives To assess the risk of hospitalization or in‐hospital mortality due to COVID‐19 by treatment exposure in patients with psoriasis. Methods All adults with psoriasis registered in the French national health‐insurance (Système National des Données de Santé, SNDS) database between 2008 and 2019 were eligible. Two study periods were considered: 15 February to 30 June 2020 and 1 October 2020 to 31 January 2021, the first and second waves of the COVID‐19 pandemic in France, respectively. Patients were classified according to their baseline treatment: biologics, nonbiologics, topicals or no treatment. The primary endpoint was hospitalization for COVID‐19 using Cox models with inverse probability of treatment weighting. The secondary endpoint was in‐hospital mortality due to COVID‐19. Results We identified 1 326 312 patients with psoriasis (mean age 59 years; males, 48%). During the first study period, 3871 patients were hospitalized for COVID‐19 and 759 (20%) died; during the second period 3603 were hospitalized for COVID‐19 and 686 (19%) died. In the propensity score‐weighted Cox models, risk of hospitalization for COVID‐19 was associated with exposure to topicals or nonbiologics [hazard ratio (95% confidence interval): 1·11 (1·04–1·20) and 1·27 (1·09–1·48), respectively] during the first period, and with all exposure types, during the second period. None of the exposure types was associated with in‐hospital mortality due to COVID‐19. Conclusions Systemic treatments for psoriasis (including biologics) were not associated with increased risk of in‐hospital mortality due to COVID‐19. These results support maintaining systemic treatment for psoriasis during the pandemic. Whatis already known about this topic? Almost all chronic diseases have emerged as risk factors for hospitalization for COVID‐19 and poor COVID‐19 outcomes. Multimorbidity is frequent in psoriasis. In France, psoriasis was found to be associated with increased risk of hospitalization for COVID‐19 but not in‐hospital mortality due to COVID‐19. Biologics are associated with an increased risk of infection. Few data have been published on the course of COVID‐19 in patients with psoriasis receiving biologics.
Whatdoes this study add? Systemic treatments for psoriasis (including nonbiologics and biologics) were not associated with an increased risk of in‐hospital mortality due to COVID‐19. Our results did not support a prophylactic effect of long‐term use of biologics on risk of hospitalization for COVID‐19 or in‐hospital mortality. These results provide evidence supporting the continuity of care for psoriasis and maintaining systemic treatment for psoriasis during the pandemic.
Linked Comment: S. Cazzaniga and L. Naldi. Br J Dermatol 2022; 186:7–8. Plain language summary available online
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Affiliation(s)
- L Penso
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Univ Paris-Est Creteil, EpiDermE, Créteil, F-94010, France
| | - R Dray-Spira
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France
| | - A Weill
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Caisse Nationale d'assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - M Zureik
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,INSERM, Echappement aux anti-infectieux et Pharmacoépidémiologie, CESP, UVSQ, Montigny le Bretonneux, F-78180, France
| | - E Sbidian
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Univ Paris-Est Creteil, EpiDermE, Créteil, F-94010, France.,AP-HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, Créteil, F-94010, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, F-94010, France
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Penso L, Dray-Spira R, Weill A, Pina Vegas L, Zureik M, Sbidian E. Association Between Biologics Use and Risk of Serious Infection in Patients With Psoriasis. JAMA Dermatol 2021; 157:1056-1065. [PMID: 34287624 DOI: 10.1001/jamadermatol.2021.2599] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Biologics and targeted therapies, such as apremilast, are efficient treatments to manage moderate to severe psoriasis. More information about the risk of serious infection is needed for the newest treatment options in a real-world setting. Objective To assess the risk of serious infection among biologics and apremilast used to treat psoriasis, with etanercept as the comparator. Design, Setting, and Participants This nationwide cohort study from France involved data from the National Health Data System covering approximately 99% of the French population. All adults with psoriasis, defined as receiving at least 2 prescriptions of a topical vitamin D derivative within a 2-year period, registered in the database between January 1, 2008, and May 31, 2019, were eligible. The study population included those who were new users of biologic agents or apremilast (ie, without any prescriptions of a biologic or apremilast during the previous year). Patients with HIV infection or a history of cancer, transplant, or serious infection were excluded. End of follow-up was January 31, 2020. Main Outcome Measures The primary end point was a serious infection in a time-to-event analysis using propensity score-weighted Cox proportional hazards regression models, estimating weighted hazard ratios (wHRs) and 95% CIs. Results A total of 44 239 new users of biologic treatment were identified (mean [SD] age, 48.4 [13.8] years; 22 866 [51.7%] men; median follow-up, 12 months [interquartile range, 7-24 months]). A total of 29 618 (66.9%) were prescribed a tumor necrosis factor inhibitor first, 6658 (15.0%) an interleukin (IL) 12/23 inhibitor, 4093 (9.3%) an IL-17 inhibitor, 526 (1.2%) an IL-23 inhibitor, and 3344 (7.6%) apremilast. The total number of serious infections was 1656, and the overall crude incidence rate was 25.0 (95% CI, 23.8-26.2) per 1000 person-years. The most frequent serious infections were gastrointestinal infections (645 patients [38.9%]). After adjusting for time-dependent covariables, risk of serious infections was higher for new users of adalimumab (wHR, 1.22; 95% CI, 1.07-1.38) or infliximab (wHR, 1.79; 95% CI 1.49-2.16) vs etanercept, whereas ustekinumab was associated with a lower risk of having a serious infection (wHR, 0.79; 95% CI, 0.67-0.94). Risk of serious infections was not increased for new users of IL-17 and the IL-23 inhibitor guselkumab or apremilast vs etanercept. Risk of serious infections was increased with concomitant nonsteroidal anti-inflammatory drugs or systemic corticosteroids. Conclusions and Relevance In this cohort study of individuals with moderate to severe psoriasis, risk of serious infections was increased in new users of infliximab and adalimumab vs etanercept, whereas ustekinumab users had lower risk of having a serious infection but not new users of IL-17 and IL-23 inhibitors or apremilast. Other observational studies are needed to confirm results for the most recent drugs.
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Affiliation(s)
- Laetitia Penso
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France
| | - Rosemary Dray-Spira
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Alain Weill
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Laura Pina Vegas
- Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France.,Département de Rhumatologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, Créteil, France
| | - Mahmoud Zureik
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,INSERM, Echappement aux anti-infectieux et Pharmacoépidémiologie, Centre de recherche en épidémiologie et santé des populations, Université de Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Emilie Sbidian
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France.,Département de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, Université Paris-Est Creteil, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
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Penso L, Bergqvist C, Meyer A, Herlemont P, Weill A, Zureik M, Dray-Spira R, Sbidian E. Risk of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis initiating interleukin 17 inhibitors: a nationwide population-based study using the French national health data system. Arthritis Rheumatol 2021; 74:244-252. [PMID: 34279061 DOI: 10.1002/art.41923] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/21/2021] [Revised: 05/14/2021] [Accepted: 07/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate whether IL17-inhibitors (IL17i) initiation in real life is associated with a higher risk of inflammatory bowel disease (IBD) in patients with psoriasis (PsO), psoriatic arthritis and ankylosing spondylitis (PsA/AS). METHODS This nationwide cohort study involved the French national health data system database. All adults with PsO and PsA/AS who were new-users of IL17i during 2016-2019 were included. Two non-exposed PsO and PsA/AS population were included: new-users of (1) apremilast and (2) etanercept. End of follow-up was September 30, 2019. The primary end-point was an occurrence of IBD in a time-to-event analysis with propensity score-weighted Cox and Fine-Gray models. RESULTS A total of 16,793 IL17i new-users (mean age 48.4±13 years; 46% men); 20,556 apremilast new-users (mean age 52.5±14.6 years; 53% men); and 10,245 etanercept new-users (mean age 46.3±15 years; 44% men) were included. Previous systemic treatements were closer between IL17i and etanercept compared with apremilast. IBD occurred in 132 cases: 72 (0.43%) in IL17i new-users, 11 (0.05%) in apremilast new-users and 49 (0.48%) in etanercept new-users. Most IBD cases occurred after 6 months of exposure (82%, 55% and 76% respectively). After propensity score weighting, the risk of IBD was significantly greater with IL17i than apremilast (HRw 3.8, 95%CI 2.1-6.8). No difference was observed between IL17i and etanercept new-users (HRw 0.8, 95%CI 0.5-1.2). CONCLUSION Compared with patients initiating etanercept that displayed the same severity of the underlying disease, IL17i new-users did not present a higher risk of IBD. These results need to be confirmed in other large databases.
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Affiliation(s)
- Laëtitia Penso
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,EpiDermE, Université Paris Est Créteil, F-94010, Créteil, France
| | - Christina Bergqvist
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, F-94010, Créteil, France
| | - Antoine Meyer
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,Department of Gastroenterology and Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris Sud, France
| | - Philippe Herlemont
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,University Paris-Saclay, UVSQ, Univ. Paris-Sud, Anti-infective evasion and pharmacoepidemiology, CESP, 78180, Montigny le Bretonneux, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance
| | - Emilie Sbidian
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,EpiDermE, Université Paris Est Créteil, F-94010, Créteil, France.,Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, F-94010, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, F-94010, Créteil, France
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Meyer A, Semenzato L, Zureik M, Weill A, Carbonnel F, Dray-Spira R. Risk of severe COVID-19 in patients treated with IBD medications: a French nationwide study. Aliment Pharmacol Ther 2021; 54:160-166. [PMID: 34110040 DOI: 10.1111/apt.16410] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/22/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, the SECURE-IBD study, based on a physician-reported registry, suggested that thiopurines, either alone or combined with anti-TNF, may increase risk of severe COVID-19. AIMS To compare the risk of severe COVID-19 according to IBD medications in a large and unselected population. METHODS Using the French national health data system, the risks of hospitalisation and of death or mechanical ventilation for COVID-19 from 15 February 2020 to 31 August 2020 in IBD patients were compared according to IBD treatment (immunomodulators and biologics), using multivariable Cox models adjusted for socio-demographic characteristics, budesonide/corticosteroids and aminosalicylates use, and comorbidities. RESULTS Among 268 185 IBD patients, 600 were hospitalised for COVID-19 and 111 of them died or were mechanically ventilated (including 78 deaths). In multivariable analysis, the risk of hospitalisation for COVID-19 did not differ according to IBD treatment category, with adjusted Hazard Ratios (aHR, unexposed patients used as reference) of 0.94 (95%CI: 0.66-1.35) for immunomodulator monotherapy, 1.05 (0.80-1.38) for anti-TNF monotherapy, 0.80 (0.38-1.69) for anti-TNF combination therapy, 1.06 (0.55-2.05) for vedolizumab and 1.25 (0.64-2.43) for ustekinumab. Similarly, the risk of death or mechanical ventilation for COVID-19 did not differ according to IBD treatment. CONCLUSIONS Immunomodulators and biologics prescribed in patients with IBD do not appear to increase the severity of COVID-19 infection.
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Affiliation(s)
- Antoine Meyer
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Saint Denis, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Laura Semenzato
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Saint Denis, France
| | - Mahmoud Zureik
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Saint Denis, France.,Université Versailles Saint-Quentin en Yvelines, Montigny le Bretonneux, France
| | - Alain Weill
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Saint Denis, France
| | - Franck Carbonnel
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Rosemary Dray-Spira
- EPIPHARE, Épidémiologie des produits de santé, ANSM-CNAM, Saint Denis, France
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Penso L, Dray-Spira R, Weill A, Zureik M, Sbidian E. Drop in biological initiation for patients with psoriasis during the COVID-19 pandemic. Br J Dermatol 2021; 185:671-673. [PMID: 33894022 PMCID: PMC8250964 DOI: 10.1111/bjd.20406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- L Penso
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Université Paris-Est Creteil, EpiDermE, Créteil, F-94010, France
| | - R Dray-Spira
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France
| | - A Weill
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Caisse Nationale d'assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - M Zureik
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,INSERM, Echappement aux anti-infectieux et Pharmacoépidémiologie, CESP, UVSQ, Montigny le Bretonneux, F-78180, France
| | - E Sbidian
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Université Paris-Est Creteil, EpiDermE, Créteil, F-94010, France.,AP-HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, Créteil, F-94010, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, F-94010, France
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Billioti de Gage S, Drouin J, Desplas D, Cuenot F, Dray-Spira R, Weill A, Zureik M. Intravitreal Anti-Vascular Endothelial Growth Factor Use in France During the Coronavirus Disease 2019 Pandemic. JAMA Ophthalmol 2021; 139:240-242. [PMID: 33331873 PMCID: PMC7747036 DOI: 10.1001/jamaophthalmol.2020.5594] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Sophie Billioti de Gage
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Jérôme Drouin
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - David Desplas
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - François Cuenot
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Alain Weill
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
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