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Puppo C, Préau M, Bernaud C, Grégoire A, Biron C, Coutherut J, Raffi F, Bonnet B. La construction identitaire et les pratiques de prévention des PrEPeurs face à la stigmatisation : une étude qualitative. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Puppo C, Préau M, Bonnet B, Bernaud C, Malet M, Henry C, Gorre R, Lanier S, Coutherut J, Biron C. Étude qualitative par focus groups de la qualité de vie sexuelle et la satisfaction des personnes suivies pour PrEP. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bonnet B, Bernaud C, Gregoire A, Secher S, Raffi F. La PreP : un relais organisé possible vers la médecine de ville. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.400] [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: 11/17/2022]
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4
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Sinnaeve PR, Fahrni G, Schelfaut D, Spirito AS, Mueller CH, Frenoux JM, Hmissi A, Bernaud C, Moccetti T, Atar SA, Valgimigli MV. 5232Inhibition of platelet aggregation after subcutaneous administration of a single-dose of selatogrel, a novel P2Y12 antagonist, in acute myocardial infarction: a randomised open-label phase 2 study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/14/2022] Open
Abstract
Abstract
Background
Oral P2Y12 receptor antagonists exhibit a delayed onset of platelet inhibition in patients experiencing acute myocardial infarction (AMI). Selatogrel is a potent, reversible, and highly selective P2Y12 receptor antagonist with a rapid onset and offset of action when administered subcutaneously.
Purpose
To assess inhibition of platelet aggregation (IPA) after subcutaneous (s.c.) single-dose administration of selatogrel in patients with AMI receiving standard concomitant therapy.
Methods
Male and postmenopausal female adults (≤85 years) presenting with type 1 AMI (ST-elevation MI [STEMI] or non-STEMI [NSTEMI]) and onset of AMI symptoms >30 min to <6 h were randomised (1:1) to receive a single s.c. dose of either 8 mg or 16 mg selatogrel. Blood samples were collected at baseline and at 15, 30, and 60 min post-dose and evaluated for ADP-induced platelet aggregation (expressed as P2Y12 reaction units [PRU]) using VerifyNow. The primary endpoint was the response to treatment (defined by PRU <100) at 30 min post-dose. Safety was assessed up to 48 h post-dose.
Results
Forty-seven patients (median age 69 y; 72% male; 62% STEMI; 94% Killip class 1) received 8 mg (N=24) or 16 mg (N=23) selatogrel. Study-treatment concomitant medications included acetylsalicylic acid (98%), P2Y12 inhibitors (96%), heparins (94%), statins (94%), nitrates (68%) and morphine (38%). Oral ticagrelor (92%) with corresponding loading doses was only administered after selatogrel. The proportion of patients meeting the primary endpoint (responders) 30 min post-dose was 91% (95% CI: 72, 99) and 95% (95% CI: 77, 100) with 8 and 16 mg, respectively (p<0.001 for both doses). Response rates were independent from STEMI/NSTEMI diagnosis, age and sex. A response was observed as early as 15 min (8 mg: 75% of patients [95% CI: 53, 90]; 16 mg: 91% of patients [95% CI: 72, 99]), and sustained up to 60 min post-dose (8 mg: 75% of patients [95% CI: 53, 90]; 16 mg: 96% of patients [95% CI: 78, 100]). Platelet reactivity was decreased following selatogrel administration (Figure; interquartile range [box], min and max [whiskers], median and mean [horizontal line and symbol, respectively, within the box]). Overall, 43% of patients had ≥1 treatment-emergent adverse event (TEAE), which were mainly of mild/moderate intensity. Ventricular tachycardia ([VT] 8 mg: 5/24; 16 mg: 3/23) was the most frequent TEAE. Treatment-emergent serious AEs of VT were reported in two patients receiving 8 mg (one patient also experienced ventricular fibrillation) and one patient receiving 16 mg selatogrel. Post-procedural haemorrhage (mild) occurred in one patient: bleeding at radial access after percutaneous coronary intervention (∼1 h after selatogrel 8 mg).
Conclusion
Single-dose administration of s.c. selatogrel (8 mg and 16 mg) induced a rapid IPA response in patients with AMI at 30 min (as early as 15 min and maintained at 60 min post-dose) and was well-tolerated with no major bleeding events.
Acknowledgement/Funding
Fully funded by Idorsia Pharmaceuticals Ltd
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Affiliation(s)
- P R Sinnaeve
- University Hospitals (UZ) Leuven, Campus Gasthuisberg, Department of Cardiology, Leuven, Belgium
| | - G Fahrni
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | | | - A S Spirito
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - C H Mueller
- University Hospital Basel, Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J.-M Frenoux
- Idorsia Pharmaceuticals Ltd, Therapeutic Area Units, Allschwil, Switzerland
| | - A Hmissi
- Idorsia Pharmaceuticals Ltd, Biometry, Allschwil, Switzerland
| | - C Bernaud
- Idorsia Pharmaceuticals Ltd, Therapeutic Area Units, Allschwil, Switzerland
| | - T Moccetti
- Cardiocentro Ticino, Lugano, Switzerland
| | - S A Atar
- Azrieli Faculty of Medicine, Department of Cardiology, Safed, Israel
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Storey RF, Gurbel PA, James S, Ten Berg JM, Tanguay JF, Bernaud C, Frenoux JM, Hmissi A, Van Der Harst P, Van't Hof AWJ, Dangas GD, Kunadian V, Gorog DA, Trenk D, Angiolillo DJ. 2349Selatogrel, a novel P2Y12 inhibitor for emergency use, achieves rapid, consistent and sustained platelet inhibition following single-dose subcutaneous administration in stable CAD patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the setting of AMI, rapid platelet inhibition is desirable but the onset of pharmacodynamic (PD) effect of oral platelet P2Y12 inhibitors is delayed, sometimes for hours. Subcutaneous (s.c) administration of a rapidly-acting P2Y12 inhibitor would overcome many of the limitations of available therapies. Patients with stable CAD were investigated initially.
Purpose
To characterise the inhibition of platelet aggregation and pharmacokinetics (PK) of a single dose of selatogrel, a novel s.c P2Y12 inhibitor, in patients with stable CAD.
Methods
Patients with stable CAD receiving oral antiplatelet therapy (aspirin and/or oral P2Y12 inhibitor) were randomized to 1 of 8 groups based on treatment (selatogrel or matching placebo), dose (8 mg or 16 mg) and s.c injection site (thigh or abdomen). Venous blood samples were collected into PPACK anticoagulant tubes. Platelet reactivity was assessed by VerifyNow PRU (P2Y12 reaction units) test before and 15 min, 30 min and 1, 2, 4, 8 and 24 h after injection. Light-transmittance aggregometry (LTA; ADP 20 uM) was also performed. PK samples were collected up to 24 h post-dose. Adverse events occurring within 30 days were recorded. Responders were defined as having PRU <100 at 30 min after injection and lasting ≥3 h.
Results
345 patients (mean age 65 y; 20% female; 31% diabetes) received selatogrel 8 mg (n=114), selatogrel 16 mg (n=115) or placebo (n=116). 97% were on background therapy with aspirin (or its derivative carbasalate) and 35% with oral P2Y12 inhibitor (clopidogrel 23%, prasugrel 4%, ticagrelor 8%). 89% of subjects were responders to selatogrel 8 mg, 90% to selatogrel 16 mg and 16% to placebo (P<0.0001). At 15 min post-dose, PRU values (mean±SD) were 10±25 with selatogrel 8 mg, 5±10 with selatogrel 16 mg and 163±73 with placebo (Figure). PRU levels were maintained at 2 and 4 h for both doses and gradually returned to pre-dose levels by 24 h post-dose (Figure). LTA results were consistent with the VerifyNow results. PD responses were similar for thigh and abdomen injection sites. Selatogrel was well tolerated: mild dyspnoea (or moderate dyspnoea, n=1, with 16 mg) occurred in 5% and 9% with selatogrel 8 mg and 16 mg, respectively, vs 0% with placebo; dizziness occurred in 4% and 4% vs 1%, respectively, without significant haemodynamic or ECG changes. Bleeding events occurred in 9.6% and 4.3% with selatogrel 8 mg and 16 mg, respectively, vs 6.9% with placebo. Pharmacokinetic data will be presented.
Conclusions
Selatogrel has a rapid PD effect following s.c injection in patients with stable CAD, within 15 min in most patients. The consistent and high levels of P2Y12 inhibition with a single 8 mg or 16 mg dose are sustained for over 4 hours, following which platelet reactivity progressively recovers over 24 h. Selatogrel was well tolerated, with mostly mild, transient dyspnoea observed in <10% patients. These data support further studies of selatogrel for emergency treatment of AMI patients.
Acknowledgement/Funding
Fully funded by Idorsia Pharmaceuticals Ltd
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Affiliation(s)
- R F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
| | - P A Gurbel
- Inova Heart and Vascular Institute, Virginia, United States of America
| | - S James
- Uppsala University, Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | - J M Ten Berg
- St Antonius Hospital, Department of Cardiologie, Nieuwegein, Netherlands (The)
| | - J.-F Tanguay
- Institut de Cardiologie de Montréal, Université de Montréal, Department of Medicine, Montreal, Canada
| | - C Bernaud
- Idorsia Pharmaceuticals Ltd, Therapeutic Area Units, Allschwil, Switzerland
| | - J.-M Frenoux
- Idorsia Pharmaceuticals Ltd, Therapeutic Area Units, Allschwil, Switzerland
| | - A Hmissi
- Idorsia Pharmaceuticals Ltd, Biometry, Allschwil, Switzerland
| | - P Van Der Harst
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - A W J Van't Hof
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - G D Dangas
- Mount Sinai Hospital, Division of Cardiology, New York, United States of America
| | - V Kunadian
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - D A Gorog
- University of Hertfordshire, Hertfordshire, United Kingdom
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
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Malet M, Henry C, Gorre R, Lescop K, Lanier S, Gouraud M, Bernaud C, Patoureau M, Biron C, Bonnet B. Rôle clé de l’entretien infirmier en santé sexuelle dans la prise en charge des « Prepeurs ». Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bernaud C, Sécher S, Michau C, Perre P, Fialaire P, Vatan R, Raffi F, Allavena C, Hitoto H. HIV-infected patients aged above 75years. Med Mal Infect 2019; 50:43-48. [PMID: 31088755 DOI: 10.1016/j.medmal.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/06/2017] [Revised: 02/28/2018] [Accepted: 04/01/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little data is available on HIV-infected patients aged over 75years. METHODS A descriptive study of HIV-infected patients aged over 75years was conducted in six hospitals of the Pays de la Loire region, France. Socio-demographic, immuno-virological, and therapeutic characteristics were collected via an electronic medical record software (Nadis®). To assess frailty, a simplified geriatric assessment was conducted during an HIV routine visit. RESULTS Among the 3965 patients followed in the six centers, 65 (1.6%) were aged over 75years. From January to May 2016, 51 patients were included in the study: median age 78.7years, male patients 74.5%, homosexual transmission 41.2%, living at home 98% and single in 54.5% of cases, median duration of HIV infection 18.8years, median CD4 nadir 181 cells/mm3; CDC stage C 36.4%. All patients were on antiretroviral therapy and 98% of them had an HIV RNA<50c/mL; 82% of patients had at least one comorbidity and 58% at least two comorbidities. Eleven of 51 patients (21.6%) were diagnosed as at risk of frailty and 2/51 (3.9%) were considered frail. Cognitive disorders were diagnosed in 60.8%, depression in 35.3%, malnutrition in 25.5%, and vitamin D deficiency in 45.9%. CONCLUSIONS HIV-infected patients aged above 75years are well-managed, but the prevalence of geriatric comorbidities is high.
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Affiliation(s)
- C Bernaud
- Hôtel-Dieu university hospital, infectious and tropical disease department, 44000 Nantes, France.
| | - S Sécher
- Hôtel-Dieu university hospital, infectious and tropical disease department, 44000 Nantes, France; COREVIH Pays de la Loire, Nantes university hospital, 44000 Nantes, France
| | - C Michau
- Saint-Nazaire hospital, internal medicine department, Saint-Nazaire, 44600 Saint-Nazaire, France
| | - P Perre
- Departmental hospital, post-emergency department medicine unit, 85000 La Roche-sur-Yon, France
| | - P Fialaire
- Angers hospital, infectious and tropical disease department, 49000 Angers, France
| | - R Vatan
- Laval hospital, internal medicine department, 53000 Laval, France
| | - F Raffi
- Hôtel-Dieu university hospital, infectious and tropical disease department, 44000 Nantes, France
| | - C Allavena
- Hôtel-Dieu university hospital, infectious and tropical disease department, 44000 Nantes, France
| | - H Hitoto
- Le Mans hospital, infectious and tropical disease department, 72000 Le Mans, France
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Bonnet B, Hall N, Besnier M, Bernaud C, Gorre R, Henry C, Malet M, Coutherut J, Biron C, Raffi F. PrEP : intérêt d’une approche globale en santé sexuelle au sein d’une unité spécifique de prévention. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Allavena C, Rodallec A, Leplat A, Hall N, Luco C, Le Guen L, Bernaud C, Bouchez S, André-Garnier E, Boutoille D, Ferré V, Raffi F. Interest of proviral HIV-1 DNA genotypic resistance testing in virologically suppressed patients candidate for maintenance therapy. J Virol Methods 2017; 251:106-110. [PMID: 29042218 DOI: 10.1016/j.jviromet.2017.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 05/17/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 01/08/2023]
Abstract
Switch of antiretroviral therapy in virologically suppressed HIV-infected patients is frequent, to prevent toxicities, for simplification or convenience reasons. Pretherapeutic genotypic resistance testing on RNA can be lacking in some patients, which could enhance the risk of virologic failure, if resistance-associated mutations of the new regimen are not taken into account. Proviral DNA resistance testing in 69 virologically suppressed patients on antiretroviral treatment with no history of virological failure were pair-wised compared with pre-ART plasma RNA resistance testing. The median time between plasma (RNA testing) and whole blood (proviral DNA testing) was 47 months (IQR 29-63). A stop codon was evidenced in 23% (16/69) of proviral DNA sequences; these strains were considered as defective, non-replicative, and not taken into consideration. Within the non defective strains, concordance rate between plasma RNA and non-defective proviral DNA was high both on protease (194/220 concordant resistance-associated mutations=88%) and reverse transcriptase (28/37 concordant resistance-associated mutations=76%) genes. This study supports that proviral DNA testing might be an informative tool before switching antiretrovirals in virologically suppressed patients with no history of virological failure, but the interpretation should be restricted to non-defective viruses.
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Affiliation(s)
- C Allavena
- Infectious Diseases Department, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France.
| | - A Rodallec
- Virology, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
| | - A Leplat
- Virology, CHU Hotel Dieu, University Hospital, Nantes, France
| | - N Hall
- Infectious Diseases Department, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
| | - C Luco
- Virology, CHU Hotel Dieu, University Hospital, Nantes, France
| | - L Le Guen
- Virology, CHU Hotel Dieu, University Hospital, Nantes, France
| | - C Bernaud
- Infectious Diseases Department, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
| | - S Bouchez
- Infectious Diseases Department, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
| | - E André-Garnier
- Virology, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
| | - D Boutoille
- Infectious Diseases Department, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
| | - V Ferré
- Virology, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
| | - F Raffi
- Infectious Diseases Department, CHU Hotel Dieu, University Hospital, Nantes, France; UIC 1413, INSERM, Nantes, France
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Delamarre-Damier F, Henni S, Veyrac G, Ruellan A, Joyau C, Bernaud C, Allavena C. FRENCH NURSING HOMES: IS THERE PLACE FOR THE AGING HIV POPULATION? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F. Delamarre-Damier
- Geriatric Department University Hospital, Nantes, France,
- French Nursing Home Research Organization (AGREE), Chateau Thébault, France,
| | - S. Henni
- University Hospital Center of Angers, Angers, France,
- French Nursing Home Research Organization (AGREE), Chateau Thébault, France,
| | - G. Veyrac
- Department of Clinical Pharmacology, Institute of Biology, University Hospital, Nantes, France,
- French Nursing Home Research Organization (AGREE), Chateau Thébault, France,
| | - A. Ruellan
- Department of Clinical Pharmacology, Institute of Biology, University Hospital, Nantes, France,
| | - C. Joyau
- Department of Clinical Pharmacology, Institute of Biology, University Hospital, Nantes, France,
- French Nursing Home Research Organization (AGREE), Chateau Thébault, France,
| | - C. Bernaud
- Department of tropical and infectious diseases, University Hospital, Nantes, France
| | - C. Allavena
- Department of tropical and infectious diseases, University Hospital, Nantes, France
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Ruellan A, Joyau C, Veyrac G, Allavena C, Bernaud C, Delamarre-Damier F, Jolliet P. POLYPHARMACY AND ANTIRETROVIRAL THERAPY IN THE AGING HIV-INFECTED POPULATION: A NEW CHALLENGE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A. Ruellan
- Department of Clinical Pharmacology, Institute of Biology, University Hospital, Nantes, France,
| | - C. Joyau
- Department of Clinical Pharmacology, Institute of Biology, University Hospital, Nantes, France,
- French Nursing Home Research Organization (AGREE), Chateau Thebault, France,
| | - G. Veyrac
- Department of Clinical Pharmacology, Institute of Biology, University Hospital, Nantes, France,
- French Nursing Home Research Organization (AGREE), Chateau Thebault, France,
| | - C. Allavena
- Department of tropical and infectious diseases, University Hospital, Nantes, France,
| | - C. Bernaud
- Department of tropical and infectious diseases, University Hospital, Nantes, France,
| | - F. Delamarre-Damier
- Geriatric Department University Hospital, Nantes, France,
- French Nursing Home Research Organization (AGREE), Chateau Thebault, France,
| | - P. Jolliet
- Department of Clinical Pharmacology, Institute of Biology, University Hospital, Nantes, France,
- EA4275 «Biostatistics, Pharmacoepidemiology and Subjective Health Measures», Medicine University, Nantes, France
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Pradat P, Pugliese P, Poizot-Martin I, Valantin MA, Cuzin L, Reynes J, Billaud E, Huleux T, Bani-Sadr F, Rey D, Frésard A, Jacomet C, Duvivier C, Cheret A, Hustache-Mathieu L, Hoen B, Cabié A, Cotte L, Chidiac C, Ferry T, Ader F, Biron F, Boibieux A, Miailhes P, Perpoint T, Schlienger I, Lippmann J, Braun E, Koffi J, Longuet C, Guéripel V, Augustin-Normand C, Brochier C, Degroodt S, Pugliese P, Ceppi C, Cua E, Cottalorda J, Courjon J, Dellamonica P, Demonchy E, De Monte A, Durant J, Etienne C, Ferrando S, Fuzibet J, Garraffo R, Joulie A, Risso K, Mondain V, Naqvi A, Oran N, Perbost I, Pillet S, Prouvost-Keller B, Wehrlen-Pugliese S, Rosenthal E, Sausse S, Rio V, Roger P, Brégigeon S, Faucher O, Obry-Roguet V, Orticoni M, Soavi M, Geneau de Lamarlière P, Laroche H, Ressiot E, Carta M, Ducassou M, Jacquet I, Gallie S, Galinier A, Ritleng A, Ivanova A, Blanco-Betancourt C, Lions C, Debreux C, Obry-Roguet V, Poizot-Martin I, Agher R, Katlama C, Valantin M, Duvivier C, Lortholary O, Lanternier F, Charlier C, Rouzaud C, Aguilar C, Henry B, Lebeaux D, Cessot G, Gergely A, Consigny P, Touam F, Louisin C, Alvarez M, Biezunski N, Cuzin L, Debard A, Delobel P, Delpierre C, Fourcade C, Marchou B, Martin-Blondel G, Porte M, Mularczyk M, Garipuy D, Saune K, Lepain I, Marcel M, Puntis E, Atoui N, Casanova M, Faucherre V, Jacquet J, Le Moing V, Makinson A, Merle De Boever C, Montoya-Ferrer A, Psomas C, Reynes J, Raffi F, Allavena C, Billaud E, Biron C, Bonnet B, Bouchez S, Boutoille D, Brunet C, Jovelin T, Hall N, Bernaud C, Morineau P, Reliquet V, Aubry O, Point P, Besnier M, Larmet L, Hüe H, Pineau S, André-Garnier E, Rodallec A, Choisy P, Vandame S, Huleux T, Ajana F, Alcaraz I, Baclet V, Huleux T, Melliez H, Viget N, Valette M, Aissi E, Allienne C, Meybeck A, Riff B, Bani-Sadr F, Rouger C, Berger J, N'Guyen Y, Lambert D, Kmiec I, Hentzien M, Lebrun D, Migault C, Rey D, Batard M, Bernard-Henry C, Cheneau C, de Mautort E, Fischer P, Partisani M, Priester M, Lucht F, Frésard A, Botelho-Nevers E, Gagneux-Brunon A, Cazorla C, Guglielminotti C, Daoud F, Lutz M, Jacomet C, Laurichesse H, Lesens O, Vidal M, Mrozek N, Corbin V, Aumeran C, Baud O, Casanova S, Coban D, Hustache-Mathieu L, Thiebaut-Drobacheff M, Foltzer A, Gendrin V, Bozon F, Chirouze C, Abel S, Cabié A, Césaire R, Santos GD, Fagour L, Najioullah F, Ouka M, Pierre-François S, Pircher M, Rozé B, Hoen B, Ouissa R, Lamaury I. Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients - "En route for eradication"? J Infect 2017; 75:234-241. [PMID: 28579302 DOI: 10.1016/j.jinf.2017.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/10/2016] [Revised: 03/17/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients. METHODS All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection. RESULTS Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR. CONCLUSIONS HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.
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Affiliation(s)
- Pierre Pradat
- Center for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet, Nice, France
| | - Isabelle Poizot-Martin
- Immuno-hematology Clinic, Assistance Publique - Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, France; Aix-Marseille University, Inserm U912 (SESSTIM), Marseille, France
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Lise Cuzin
- CHU Toulouse, COREVIH, Toulouse, France; Université de Toulouse III, Toulouse, France; INSERM, UMR, 1027, Toulouse, France
| | - Jacques Reynes
- Department of Infectious Diseases, UMI 233 INSERM U1175, CHU de Montpellier, Montpellier, France
| | - Eric Billaud
- Department of Infectious Diseases, Hotel Dieu Hospital, Nantes, France
| | - Thomas Huleux
- Department of Infectious Diseases and Travel Diseases, Centre Hospitalier Gustave-Dron, Tourcoing, France
| | - Firouze Bani-Sadr
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, CHU, Reims, France; Université de Reims Champagne-Ardenne, Faculté de médecine, EA-4684/SFR CAP-SANTE, Reims, France
| | - David Rey
- HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg, France
| | - Anne Frésard
- Department of Infectious Diseases, CHU, Saint-Etienne, France
| | - Christine Jacomet
- Department of Infectious Diseases, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Claudine Duvivier
- Department of Infectious Diseases, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France
| | - Antoine Cheret
- Department of Internal Medicine, CHU, Bicètre, France; Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France
| | | | - Bruno Hoen
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, and Service de Maladies Infectieuses et Tropicales, Dermatologie et Médecine Interne, and Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - André Cabié
- Department of Infectious Diseases, CHU de Martinique, Fort-de-France, France; Université des Antilles EA4537 and INSERM CIC1424, Fort-de-France, France
| | - Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, Lyon, France.
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Cuzin L, Katlama C, Cotte L, Pugliese P, Cheret A, Bernaud C, Rey D, Poizot-Martin I, Chirouze C, Bani-Sadr F, Cabié A. Ageing with HIV: do comorbidities and polymedication drive treatment optimization? HIV Med 2016; 18:395-401. [PMID: 28858437 DOI: 10.1111/hiv.12441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of the study was to describe the ageing HIV-infected population (> 50 years old) and their current antiretroviral therapy (ART), comorbidities and coprescriptions in France in 2013 and to compare them to the younger population. METHODS A retrospective analysis of a prospectively collected database was performed. The characteristics of patients receiving ART as well as their current ART and their numbers of comorbidities and comedications at the censoring date (1 July 2013) were compared between patients ageing with HIV infection, patients who seroconverted while ageing, and younger patients. RESULTS We compared 10 318 ageing patients [median age 56 years; 25% interquartile range (IQR) 53-62 years] with 13 302 younger patients (median age 42 years; 25% IQR 36-47 years). The ageing patients were more frequently male than the younger patients (77 vs. 65%). Among the ageing patients, 7025 were diagnosed with HIV infection before 2000 and represented a distinct group, the 'experienced ageing' group, by comparison with the 'recently diagnosed ageing' group. Triple therapy containing a boosted protease inhibitor was used in 28.2% of the patients (vs. 39% and 36% of the younger and "recently diagnosed ageing" groups, respectively); a nonnucleoside reverse transcriptase inhibitor in 27% (vs. 33% and 38%, respectively), an integrase strand transfer inhibitor (INSTI) in 9% (vs. 7% and 9%, respectively), and another regimen (fewer or more than three drugs) in 35.8% (vs. 21% and 16.5%, respectively). "Experienced ageing" patients typically had one or more comorbidities (62.1%) and were receiving at least one comedication (71%). Central nervous system (CNS) agents (prescribed in 44.6% of the "experienced ageing" patients) and antilipidaemics (in 44.2%) were the most frequently prescribed comedications. INSTIs were used in 23% of the population and were used significantly more often in patients with comorbidities and coprescriptions. For all comparisons, P < 0.0001. CONCLUSIONS In ageing HIV-infected patients, especially those with a long history of HIV infection, comorbidities and coprescriptions are highly prevalent.
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Affiliation(s)
- L Cuzin
- INSERM, UMR 1027, Toulouse, France.,Toulouse III University, Toulouse, France.,COREVIH, CHU Toulouse, Toulouse, France
| | - C Katlama
- UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Univ, Paris, France.,Infectious Diseases Department, Pitié Salpêtrière, AP-HP, Paris, France
| | - L Cotte
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France.,INSERM U1052, Lyon, France
| | - P Pugliese
- Infectious Diseases Department, CHU Archet, Nice, France
| | - A Cheret
- EA 3620, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France.,Infectious Diseases Department, Tourcoing General Hospital, Tourcoing, France.,Internal Medicine Unit, Bicêtre Hospital, AP-HP, Paris, France
| | - C Bernaud
- Infectious Diseases Department, CHU Hotel Dieu, Nantes, France
| | - D Rey
- Le Trait d'Union, HIV care Center, CHU Strasbourg, Strasbourg, France
| | - I Poizot-Martin
- Immuno-Hematology Clinic, APHM Hôpital Sainte-Marguerite, Aix-Marseille Univ, Marseille, France.,Inserm U912 (SESSTIM), Marseille, France
| | - C Chirouze
- UMR CNRS 6249 Chrono-Environnement, Franche-Comté University, Besançon, France.,Infectious Diseases Department, Besançon University Hospital, Besançon, France
| | - F Bani-Sadr
- EA-4684/SFR CAP-SANTE, Reims Champagne-Ardenne University, Reims, France.,Tropical and Infectious Diseases, Hôpital Robert Debré, CHU Reims, Reims, France
| | - A Cabié
- Infectious Diseases Department, Université Antilles, Guyane, EA 4537.,Franch West Indies University, Fort de France, France
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14
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Brion N, Demarez JP, Belorgey C, Amiel P, Berger F, Bernaud C, Best N, Brindel I, Chapuis F, Couderc M, Duplantier SC, De Crémiers F, Deneulin A, Diebolt V, Spriet TD, Brentano CF, Genève J, Guérin C, Jaillon AG, Hansel S, Hilaly S, Lechat P, Lemaire F, Loeb F, Loeb G, Mijonnet A, Bailly JM, Nourissier C, Oréfice C, Laurent Vo JM, Plétan Y, Roche T, Sassano P, Sibenaler C, Gay BW. Committee for the Protection of Persons. Therapie 2005. [DOI: 10.2515/therapie:2005046] [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: 11/20/2022]
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15
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Fouchard M, Zannad F, Autret-Leca E, Bader JP, Bellet M, Bergmann JF, Bernard-Harlaud M, Bernaud C, Bordet R, Bouvenot G, Brun-Strang C, Castaigne A, Dumarcet N, Eschwège E, Gallard M, Giri I, Hamelin B, Jeanblanc A, Jolliet P, Kolsky H, Lagarde D, Lapeyre G, Lassale C, Lehner JP, Lelouët H, Malbezin M, Paulmier-Bigot S, Pigeon M, Ravoire S, Ricordeau P, Rouveix B, Soletti J, Tardieu S, Thomas JL, Thuillez C. The Results of Major Clinical Trials. Therapie 2004. [DOI: 10.2515/therapie:2004061] [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: 11/20/2022]
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16
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Diévart F, Pasquié JL, Bernaud C, Grolleau-Raoux R. [Validation of the therapeutic role of amlodipine in 31,946 French hypertensive patients]. Ann Cardiol Angeiol (Paris) 2000; 49:423-30. [PMID: 12555497] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Amlodipine, a dihydropyridine calcium channel blocker (CCB), with a long duration of action, has been the subject of numerous controlled studies which showed its effectiveness and good tolerance in arterial hypertension in once-daily doses. We report the results of a large, multicentric, French, prospective phase IV study which evaluated the effectiveness and tolerance of amlodipine administered at a rate of 5 to 10 mg in only one daily dose. We also assess the evolution of the quality of life after 12 weeks of treatment among 31,946 hypertensive patients followed up to the ambulatory stage by general practitioners. The response rate--defined as the patients having had a reduction of 10 mmHg or more diastolic blood pressure--was 88%. The blood pressure standardization--defined by a diastolic blood pressure lower than 90 mmHg--was achieved for 70% of the patients. Amlodipine was administered in stand-alone therapy in 78% of the cases. The occurrence of an undesirable event was noted in the course of treatment in 12% of the patients and justified interruption of the treatment for 3.7% of the total population. The index average of quality of life was improved by the end of the 12-week treatment. This study carried out on a significant number of hypertensive patients (n = 31,946) under real prescription conditions confirms the efficacy and good tolerance of amlodipine, as has already been demonstrated in the preliminary developmental studies.
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Affiliation(s)
- F Diévart
- Clinique Villette, 18, rue Parmentier, 59240 Dunkerque, France
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17
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Hanon O, Giacomino A, Troy S, Bernaud C, Girerd X, Weber S. [Efficacy of and tolerance to prolonged release prazosin in patients with hypertension and non-insulin dependent diabetes]. Ann Cardiol Angeiol (Paris) 2000; 49:390-6. [PMID: 12555491] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
UNLABELLED The treatment of hypertension represents one of the major elements of the cardiovascular prognosis in type II diabetes. Among antihypertensive drugs, alpha blockers may be interesting because of the absence of unfavourable effects on plasma glucose and lipid levels. OBJECTIVE The aim of this study was to evaluate the effectiveness and the safety of prazosin osmotic tablet treatment in non-insulin-dependent diabetic patients with mild to moderate arterial hypertension. METHODS After an initial 4-week-single-blind placebo period, 81 hypertensive subjects (162 +/- 11/96 +/- 5 mmHg) with type II diabetes were included in the study to receive prazosin osmotic tablet (o.t) open-label therapy at the dose of 2.5 mg/day for 12 weeks. After 4 weeks of treatment the dosage of prazosin o.t was increased to 5 mg/day if the diastolic blood pressure remained > or = 90 mmHg. RESULTS Both supine and standing systolic and diastolic blood pressures were significantly decreased (P < 0.001) with prazosin therapy from 162 +/- 10/96 +/- 5 mmHg in supine and 160 +/- 12/95 +/- 6 mmHg in the upright position, to 149 +/- 15/86 +/- 9 mmHg and 148 +/- 16/86 +/- 9 mmHg respectively at the end of the 12-week-treatment period. There were no significant changes in the glycemic parameters (glycemia, haemoglobin A1c) during the prazosin therapy compared with baseline values. A significant decrease of triglycerides (P = 0.005), total cholesterol (P < 0.001) and LDL cholesterol (P = 0.03) levels was observed during prazosin therapy compared with the baseline measurements, whereas HDL cholesterol remained stable. Only 6% of the patients reported adverse events in relation with the study drug during the active treatment period. CONCLUSION This study showed a significant decrease of the blood pressure in hypertensive subjects with type II diabetes after prazosin o.t treatment, without any change of glycemic parameters. Moreover, there was a favourable evolution of the lipidic parameters during the study characterised by a significant decrease of triglycerides and total and LDL cholesterol.
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Affiliation(s)
- O Hanon
- Service de médecine interne, hôpital Broussais, 96, rue Didot, 75014 Paris, France.
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18
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Consoli SM, Troy S, Bernaud C. [The quality of life of hypertensive patients treated with prazosin (sustained-release) or enalapril: a randomized controlled trial over 24 weeks]. Therapie 2000; 55:259-67. [PMID: 10967698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The importance of the criterion of Quality of Life (QOL) for compliance with antihypertensive drugs led us to study the QOL of 51 hypertensives receiving 2.5 mg of the new formulation of prazosin (sustained release), compared with 49 subjects treated by a converting enzyme inhibitor (enalapril 10 mg), in a double-blind randomized trial. QOL, assessed by means of a 22 item self-administered questionnaire, improved significantly with prazosin, during the 24 weeks of the trial. In the intention to treat analysis, the global score of QOL increased from 46.3 +/- 8.4 to 51.6 +/- 8.9 (p < 0.0001); the covariance analysis showed that the improvement was obtained as early as the 8th week. A similar favourable evolution was observed for anxiety, retardation and anhedonia components, computed from the same questionnaire. No significant difference in QOL evolution was found between prazosin and enalapril. Both treatments proved equivalent in respect of efficacy on blood-pressure values, and tolerance, estimated through the number of dropouts or side-effects. These results confirm the benefit to QOL of hypertensive patients of the new formulation of prazosin.
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Affiliation(s)
- S M Consoli
- Unité Médico-Psychologique, Hôpital Broussais, Paris, France
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19
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Mounier-Vehier C, Bernaud C, Carré A, Lequeuche B, Hotton JM, Charpentier JC. Compliance and antihypertensive efficacy of amlodipine compared with nifedipine slow-release. Am J Hypertens 1998; 11:478-86. [PMID: 9607387 DOI: 10.1016/s0895-7061(97)00485-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Poor compliance is a principal cause of treatment failure in hypertensive patients. Once-daily dosing improves compliance, but 24-h antihypertensive activity should be provided. The compliance, efficacy, and safety of amlodipine and nifedipine slow-release (SR) were compared in patients with mild-to-moderate essential hypertension recruited among 24 centers in France. After a 2-week washout period, 103 patients were randomized to 12 weeks of 5 to 10 amlodipine mg once daily (n = 55) or 20 mg nifedipine SR twice daily (n = 48). Compliance was calculated by electronic drug monitoring. Efficacy was measured by ambulatory and casual BP recordings. Patients receiving amlodipine demonstrated better compliance than patients receiving nifedipine SR with respect to compliance index (the total number of doses taken divided by the total number of doses prescribed, expressed as a percentage; 98.3% v 87%; P < .0001), days on which the correct number of doses were taken (92.5% v 74.8%; P < .0001), and prescribed doses taken on schedule (88.7% v 71.6%; P < .0001). Absolute and relative therapeutic coverage were higher in patients receiving amlodipine than nifedipine SR (P < .0001). Mean SBP and DBP decreased equally in both groups, although amlodipine offered better BP control compared with nifedipine SR at specific times of day. Fewer patients had high nocturnal SBP with amlodipine (39.3%) than nifedipine SR (71.4%; P = .042). Adverse events and treatment withdrawals occurred less frequently in amlodipine-treated patients than in nifedipine SR-treated patients. Amlodipine (5 to 10 mg) once daily provides improved compliance, better 24-h BP control, and fewer adverse events than 20 mg nifedipine SR twice daily in patients with mild-to-moderate hypertension.
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Affiliation(s)
- C Mounier-Vehier
- Department of Internal Medicine and Hypertension, Cardiology Hospital, Lille, France
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20
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Rocha P, Pathé M, Bernaud C, Zannier D, Baron B, Marchand X, Hotton JM, Kahn JC. Acute hemodynamic effects of amlodipine 15 days after a myocardial infarction in normotensive patients treated with atenolol. Cardiovasc Drugs Ther 1997; 11:139-47. [PMID: 9140691 DOI: 10.1023/a:1007732830753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The acute hemodynamic effects of 20 mg iv amlodipine were evaluated in a placebo-controlled study in 16 normotensive patients 15 +/- 1 days after an acute myocardial infarction by covariance analysis. Atenolol was given orally for at least 1 week before the study to maintain the heart rate between 50 and 60 beats/min. All patients were given two doses of 10 mg of amlodipine, or 10 ml of a placebo twice, in i.v. infusion lasting 2 minutes each. Hemodynamic data were collected during the control period and 15 minutes after each of the two amlodipine or placebo infusions. At the time of the last measurements, 15 minutes after the second amlodipine or placebo infusion, the plasma amlodipine level was 31 +/- 16 micrograms/l and the plasma atenolol level was 773 +/- 564 mu/l in the amlodipine group versus 795 +/- 916 micrograms/l in the placebo group. There were no chronotropic, dromotropic, or inotropic effects. The main hemodynamic effect was a fall in systemic vascular resistance (1548 +/- 591 dynes.sec.cm-5 to 1176 +/- 526 dynes.sec.cm-5, p = 0.045) with decreases in aortic pressure and in the left ventricular stroke work index. The left ventricular ejection fraction was 51 +/- 12% in the placebo group and 56 +/- 15% in the amlodipine group (ns) during the control period, and did not change after infusion of placebo or amlodipine. Left ventricular compliance seemed to be enhanced by amlodipine, because the end-diastolic left ventricular volume index rose from 82 +/- 11 ml/m2 to 87 +/- 11 ml/m2 (p = 0.026) 15 minutes after the beginning of the second infusion of 10 mg of amlodipine, without any change in end-diastolic left ventricular pressure. Intravenous infusion of 20 mg of amlodipine is well tolerated 15 days after acute myocardial infarction in normotensive patients without deeply depressed left ventricular systolic function and chronically treated with atenolol. The main hemodynamic effects observed are potentially useful for such patients.
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Affiliation(s)
- P Rocha
- Hôpital Intercommunal de Poissy, Orsay, France
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21
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Marchand X, Tibi T, Bernaud C, Morand P. [Evaluation of amlodipine in stable effort angina. Comparison with diltiazem in terms of efficacy, tolerability and maintenance of the anti-ischemic action 24 hours after the last dose]. Ann Cardiol Angeiol (Paris) 1996; 45:74-82. [PMID: 8734139] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
83 patients were enrolled in a multicentre, randomized, open study to assess the efficacy of amlodipine in stable effort angina. Preselected patients were submitted to a one-week placebo wash-out period during which only nitrates or molsidomine were authorized. Patients were then randomized to receive either 5 mg of amlodipine as a morning dose, or 180 mg of diltiazem in three divided doses. After two weeks, the dosage was able to be increased (according to clinical efficacy) to 10 mg of amlodipine as a single dose or 240 mg of diltiazem in four divided doses. The antianginal efficacy of these two treatments was essentially evaluated in terms of the results of stress tests (ST) conducted at the end of the second week and fourth week of active treatment: and 24 hours after the last dose of the drug. The results of 63 patients who scrupulously complied with the protocol showed that amlodipine and diltiazem corrected or improved the ST parameters (time to onset and amplitude of ST depression, duration of ST, work performed). The anti-ischaemic action of amlodipine was maintained for at least 24 hours after the last dose and therefore provides better security (by covering the entire 24-hour period) and better compliance (by tolerating a dose omission of several hours).
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Abstract
PURPOSE Cardiac disorders, cardiac arrest and ventricular fibrillation in the most severe cases, have been observed after the administration of dantrolene to patients treated by verapamil for coronary artery disease. This study was designed to examine the interaction of dantrolene with amlodipine, a dihydropyridine. METHODS In 12 anaesthetized, open-chest pigs, the effects of the interaction have been studied on heart rate, atrioventricular conduction, monophasic action potential duration, intraventricular conduction time, left ventricular dP/dt max and mean blood pressure. The study was performed with normal coronary circulation and ischaemia of a large area of the left ventricule, obtained by complete occlusion of the left anterior descending coronary artery near its origin, under pacing at a constant high rate, 180 beats.min-1. The drugs were injected iv, amlodipine 0.4 mg.kg-1 first and dantrolene 3.0 mg.kg-1 20 min later in six animals and the order was reversed in the other animals. RESULTS Sinus rate and atrioventricular conduction were not affected by amlodipine, but were slowed by dantrolene added (145 +/- 9 to 131 +/- 7 beats.min-1, P < 0.01 and 150 +/- 15 to 180 +/- 20 msec, P < 0.01). In contrast, amlodipine or amlodipine plus dantrolene did not change MAP duration or conduction time in the normal heart. Similarly, they did not alter the maximal variations due to ischaemia, but delayed them, while prolonging the time to onset of fibrillation (111 +/- 8 to 343 +/- 33 sec. P < 0.001 with amlodipine alone, 289 +/- 11 to 323 +/- 16 sec, P < 0.05 with dantrolene). Left ventricular dP/dt max was lowered from 1670 +/- 86 to 1532 +/- 50 mmHg.sec-1 (P < 0.001) and mean blood pressure from 79 +/- 4 to 70 +/- 3 mmHg (P < 0.01) by amlodipine, but dantrolene did not enhance and even counteracted these effects. Finally, potassium plasma concentration did not increase above 5.1 +/- 0.2 mmol.L-1 under the dual influence of amlodipine and dantrolene. CONCLUSION In usual clinical doses, dantrolene may be safely administered concurrently with amlodipine.
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Affiliation(s)
- M Freysz
- Department of Anesthesiology and Intensive Care, General Hospital, Dijon
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Toupance O, Lavaud S, Canivet E, Bernaud C, Hotton JM, Chanard J. Antihypertensive effect of amlodipine and lack of interference with cyclosporine metabolism in renal transplant recipients. Hypertension 1994; 24:297-300. [PMID: 8082935 DOI: 10.1161/01.hyp.24.3.297] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The catabolism of various calcium channel blockers through cytochrome P-450 is heterogeneous and may be modified by concomitant use of cyclosporin A. In an open study we investigated the antihypertensive effect and clinical tolerance of the dihydropyridine amlodipine and its effects on cyclosporine kinetics in stable hypertensive renal transplant recipients not taking corticosteroids. Ten adult hypertensive patients grafted for 21.4 +/- 8.9 months and well stabilized with normal renal function were included in the study. Renal artery stenosis was ruled out by normal Doppler echography. After 2 weeks of placebo, amlodipine was started at a daily dose of 5 mg. The dose was then adjusted to 10 mg if necessary. Blood and urine chemistries and whole-blood cyclosporine trough levels were measured weekly. Cyclosporine kinetics were determined on a hourly basis before amlodipine administration and after 4 weeks of treatment. Normal blood pressure was obtained with the use of 5 mg/d amlodipine in 7 patients and 10 mg/d in 3, diastolic blood pressure decreasing from 98.7 +/- 3.8 to 81.3 +/- 9.1 mm Hg (P = .0007). Heart rate slightly increased by 10% (P < .02). The drug was well tolerated, and only minor ankle edema was found in 3 patients. Cyclosporine doses were not modified and cyclosporine levels remained unchanged throughout the study. Cyclosporine kinetic parameters were not significantly different at the beginning and end of the study. Bioequivalence was demonstrated indicating that cyclosporine biotransformation was not altered by the concomitant administration of amlodipine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- O Toupance
- Nephrology Service, University Hospital, Reims, France
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