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Laviolle B, Degon PF, Gillet-Giraud C, Thiveaud D, Lechat P, Boïko-Alaux V, Fougerou C, Jolly C, Petit A, Rémy-Jouet I, Yven R, Bouret L, Marrauld L, Vaslet MP, Delay V, Gavory AL, Olle F, Langevin J, Forteau L. How can the environmental sustainability of healthcare products be taken into account throughout their life cycle? Therapie 2024; 79:61-74. [PMID: 38102030 DOI: 10.1016/j.therap.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023]
Abstract
Healthcare product procurement accounts for around 50% of the French healthcare system's greenhouse gas emissions. This lesson learned from the publication of the Shift Project's work in November 2021 has been a catalyst within the healthcare system, accelerating the consideration and implementation of actions aimed at reducing the environmental impact of the healthcare system, before, during and after care. In addition to their carbon footprint, healthcare products have a wide range of environmental impacts, including on water, air and soil, throughout their entire life cycle. We have chosen to divide this life cycle into four main stages: from research and development to production, distribution and market access, use and finally end-of-life management. Analysis of the regulatory framework at each stage and of existing initiatives described in the literature or by those in the field have structured and fuelled our thinking. We found that existing regulations focus exclusively on the health risk, with little or no consideration of the environmental risk, which is in itself a health risk. Furthermore, the implementation of certain structuring actions during the first 3 stages of the life cycle would make it possible to simplify or even eliminate the major problem of waste management associated with the end-of-life of healthcare products. With this in mind, we have produced 9 recommendations to ensure that the environmental impact of healthcare products is better taken into account throughout their life cycle.
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Affiliation(s)
- Bruno Laviolle
- CHU Rennes, Univ Rennes, Inserm, UMR_S 1085 (IRSET), CIC Inserm 1414, 35000 Rennes, France.
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Laviolle B, Degon PF, Gillet-Giraud C, Thiveaud D, Lechat P, Boïko-Alaux V, Fougerou C, Jolly C, Petit A, Rémy-Jouet I, Yven R, Bouret L, Marrauld L, Vaslet MP, Delay V, Gavory AL, Olle F, Langevin J, Forteau L. Comment prendre en compte la dimension éco-responsable des produits de santé tout au long de leur cycle de vie? Therapie 2024; 79:47-60. [PMID: 37993369 DOI: 10.1016/j.therap.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Bruno Laviolle
- CHU de Rennes, université de Rennes, Inserm, UMR_S 1085 (IRSET), CIC Inserm 1414, 35000 Rennes, France.
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Lechat P, Kir F, Marquet P, Woillard JB. Within-subject pharmacokinetic variability has a strong influence on individual exposure ratios in bioequivalence studies, hence on drug formulation interchangeability. Eur J Clin Pharmacol 2023; 79:1565-1578. [PMID: 37737912 DOI: 10.1007/s00228-023-03565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Bioequivalence between a reference and a generic drug is based on the hypothesis that a ± 20% change in blood exposure (or ± 10% for drugs with narrow therapeutic index, NTI) following the generic/reference switch will not have any therapeutic consequences. However, the individual exposure ratio between generic and reference can be higher than 1.20 (or 1.10). This study aims to analyse the different parameters influencing the individual exposure ratio, hence the conditions for reference/generic interchangeability. METHODS Bioequivalence studies with a double cross-over design for a virtual drug were simulated using 100 random sets of 12, 24, 48 or 100 pairs of areas under the curve (AUC), varying the generic/reference AUC geometric mean ratios between 0.80 and 1.25 and the within-subject exposure variance of the reference and the generic formulations. RESULTS The proportion of subjects with an exposure generic/reference ratio outside the ± 10% or ± 20% acceptance intervals increases when (1) the reference within-subject variance increases; (2) the ratio of the generic within-subject variance on the reference within-subject variance increases; and (3) the generic/reference mean AUC ratio diverges from 1.0. When only considering replicated administrations of the reference, the individual exposure ratio increases with the within-subject variance, yielding values outside the usually accepted individual exposure ratio range of 0.5 to 2 for drugs with narrow therapeutic index as soon as the within-subject variance standard deviation is ≥ 0.25 (equivalent to within-patient CV% > 25%). CONCLUSIONS Interchangeability between reference and generic formulations, especially for drugs with narrow therapeutic index can only be assumed if, the within-subject variance of generic is less or equal to the within-subject variance of reference or, if this is not the case, if the distribution of the generic/generic individual exposure ratios is included within the therapeutic margins of the reference drug.
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Affiliation(s)
- Philippe Lechat
- Paris-cité University, Paris, France.
- Pharmacology and Toxicology Department, Georges Pompidou European Hospital, Drug Evaluation unit, Agence Générale des équipements et des produits de santé (AGEPS), 7 rue du fer à moulin, 75005 Paris, Assistance Publique des Hôpitaux de Paris, France.
| | - Fatma Kir
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Lokman Hekim University, Ankara, Turkey
| | - Pierre Marquet
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
| | - Jean-Baptiste Woillard
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
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Lechat P. Discussion à propos de la communication: «Potentiel Impact thérapeutique de la substitution en cours de traitement d’un princeps par un générique: limites de la bioéquivalence moyenne pour les médicaments à marge thérapeutique étroite». Bulletin de l'Académie Nationale de Médecine 2023. [DOI: 10.1016/j.banm.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Lechat P. Potentiel Impact thérapeutique de la substitution en cours de traitement d’un princeps par un générique : limites de la bioéquivalence moyenne pour les médicaments à marge thérapeutique étroite. Bulletin de l'Académie Nationale de Médecine 2023. [DOI: 10.1016/j.banm.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Deplanque D, Fetro C, Ferry A, Lechat P, Beghyn T, Bernard C, Bernasconi A, Bienayme H, Cougoule C, Del Bano J, Demiot C, Lebrun-Vignes B. Repositionnement des médicaments : de la découverte d’un effet pharmacologique utile à la mise à disposition du traitement pour le patient. Therapie 2023; 78:1-9. [PMID: 36564262 DOI: 10.1016/j.therap.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Dominique Deplanque
- Université Lille, Inserm, CHU Lille, centre d'investigation clinique (CIC) 1403, 59000 Lille, France.
| | | | | | - Philippe Lechat
- Université Paris-cité, service de pharmacologie et toxicologie, hôpital européen Georges-Pompidou, 75015 Paris, France; Agence générale des équipements et des produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, 75005 Paris, France
| | - Terence Beghyn
- APTEEUS SAS, campus Institut Pasteur, 59000 Lille, France
| | - Claude Bernard
- Agence générale des équipements et des produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, 75005 Paris, France
| | | | | | - Céline Cougoule
- Institut de pharmacologie et de biologie structurale (IPBS), université de Toulouse, CNRS, université Toulouse III - Paul-Sabatier (UPS), 31400 Toulouse, France
| | - Joanie Del Bano
- Aix-Marseille université, AP-HM, Inserm, DHUNE, Inst Neurosci Syst, service de pharmacologie clinique et pharmacovigilance, Thelonius Mind, 13000 Marseille, France
| | - Claire Demiot
- UR 20218-NeurIT, faculties of medicine and pharmacy, university of Limoges, 87025 Limoges, France
| | - Bénédicte Lebrun-Vignes
- Service de pharmacologie et centre régional de pharmacovigilance, hôpital Pitié-Salpêtrière, groupe hospitalier, AP-HP, Sorbonne université, 75013 Paris, France
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Deplanque D, Fetro C, Ferry A, Lechat P, Beghyn T, Bernard C, Bernasconi A, Bienayme H, Cougoule C, Del Bano J, Demiot C, Lebrun-Vignes B. Drug repurposing: From the discovery of a useful pharmacological effect to making the treatment available to the patient. Therapie 2023; 78:10-18. [PMID: 36528417 DOI: 10.1016/j.therap.2022.11.009] [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: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/07/2022]
Abstract
The repurposing of a medicine already on the market to a new indication could be an opportunity to respond rapidly to a therapeutic need not yet covered, particularly in the context of rare and neglected diseases, or health emergencies. However, at each stage, difficulties may arise that will prevent the repurposed drug from being provided to patients. Beyond fortuity or a systematic strategy to detect a useful pharmacological effect, the implementation of the preclinical and clinical stages is sometimes complicated by the difficulty of accessing the molecule and its pharmaceutical data. Furthermore, relevant clinical results will not always be sufficient to ensure that a marketing authorisation is obtained or that patients receive satisfactory care. In addition to describing these various obstacles, the round table provided an opportunity to put forward recommendations for overcoming them, in particular the creation of a public-private partnership structure with sufficient funding to be able to offer individualised support for projects up to and including the marketing application.
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Affiliation(s)
- Dominique Deplanque
- Université Lille, Inserm, CHU Lille, centre d'investigation clinique (CIC) 1403, 59000 Lille, France.
| | | | | | - Philippe Lechat
- Université Paris-cité, service de pharmacologie et toxicologie, hôpital européen Georges-Pompidou, 75015 Paris, France; Agence générale des équipements et des produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, 75005 Paris, France
| | - Terence Beghyn
- APTEEUS SAS, campus Institut Pasteur, 59000 Lille, France
| | - Claude Bernard
- Agence générale des équipements et des produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, 75005 Paris, France
| | | | | | - Céline Cougoule
- Institut de pharmacologie et de biologie structurale (IPBS), université de Toulouse, CNRS, université Toulouse III - Paul-Sabatier (UPS), 31400 Toulouse, France
| | - Joanie Del Bano
- Aix-Marseille université, AP-HM, Inserm, DHUNE, Inst Neurosci Syst, service de pharmacologie clinique et pharmacovigilance, Thelonius Mind, 13000 Marseille, France
| | - Claire Demiot
- UR 20218-NeurIT, faculties of medicine and pharmacy, university of Limoges, 87025 Limoges, France
| | - Bénédicte Lebrun-Vignes
- Service de pharmacologie et centre régional de pharmacovigilance, hôpital Pitié-Salpêtrière, groupe hospitalier, AP-HP, Sorbonne université, 75013 Paris, France
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Lechat P. Interchangeability between Generic and Reference Products: Limits of Average Bioequivalence Methodology. Eur J Drug Metab Pharmacokinet 2022; 47:777-787. [PMID: 35986193 DOI: 10.1007/s13318-022-00785-6] [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] [Accepted: 06/29/2022] [Indexed: 01/22/2023]
Abstract
Marketing authorisation of generic drugs is based on a demonstration of the "average" bioequivalence (ABE), with acceptance limits of 0.8-1.25 for the 90% confidence interval (CI) of the ratio (generic versus reference) of geometric means of exposure (whole blood, serum or plasma drug concentration). However, when interchangeability of reference by one generic is considered during treatment of a given patient, such methodology cannot guarantee the lack of therapeutic impact especially for drugs with narrow therapeutic index. This review article describes the basis and limits of ABE methodology, and the adaptations that have been proposed by regulatory agencies. For highly variable drugs, given their large therapeutic margin, regulatory agencies even allow widening of the bioequivalence acceptance limits. For drugs with a narrow therapeutic index, the average bioequivalence methodology has been amended differently by regulatory agencies. The European Medicine Agency only requires the narrowing of the ABE acceptance limits to the 0.9-1.10 range. The US Food and Drug Administration (FDA) has proposed to narrow the ABE acceptance limits according to the reference within-subject variance. The FDA requires a fully replicate cross-over study (with four periods) which allows one to compare the within-subject variance between generic and reference drug, and to detect any subject-by-formulation interaction. Indeed, any within-subject variance difference or subject by formulation interaction is an obstacle to interchangeability at the individual level. These amendments for the ABE do not fundamentally change the fact that individual ratios of exposure (generic/reference) will vary to a larger extent than the ratio of their means. For these reasons, since true individual bioequivalence studies cannot be performed for practical reasons and statistical issues, one can suggest that, in addition to the usual average bioequivalence criteria, the limits of the 95% confidence interval of the individual generic/reference exposure ratios could be used to allow interchangeability during treatment (at least for narrow therapeutic index drugs). Limit values of such CI for interchangeability acceptance should be scaled to the therapeutic margin of the reference drug. Regulatory agencies could conduct calculations based on real datasets of bioequivalence studies to determine if such criteria could be acceptable to allow interchangeability.
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Affiliation(s)
- Philippe Lechat
- Emeritus Professor, Paris-City University, Paris, France. .,Georges Pompidou European Hospital, Pharmacology department and Medicine Evaluation Unit, Agence Générale des Equipements et des Produits de Santé (AGEPS), Assistance Publique des Hôpitaux de Paris, Paris, France.
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Deplanque D, Cviklinski S, Bardou M, Ader F, Blanchard H, Barthélémy P, David I, D'Ortenzio E, Espérou H, Launay O, Lazarevic M, Lechat P, Lethiec F, Levy Y, Pérol D, Rage V, Roustit M, Thabut G. Health crisis: What opportunities for clinical drug research? Therapie 2022; 77:59-67. [PMID: 34973823 PMCID: PMC8673948 DOI: 10.1016/j.therap.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic led to the deployment of an unprecedented academic and industrial research effort, the sometimes redundant nature of which is regrettable, as is the lack of both national and international management. However, it must be noted that during this crisis, regulatory procedures were adapted and certain obstacles in the organisation of clinical research were partly removed to contribute to the deployment of trials as close as possible to patients and to facilitate monitoring and control procedures. The digitisation of certain processes and the decentralisation of certain activities were implemented under the cover of a mobilisation of the authorities and all institutional, academic and industrial players. While in the UK, the optimisation of resources through a single platform trial has made it possible to demonstrate or invalidate the efficacy of many treatments, in France the health crisis has highlighted the fragility of the organisation of clinical research, in particular a lack of coordination and funding, difficulties in implementing studies and a certain reluctance to share data. However, the crisis has also revealed the adaptability of the various stakeholders and has led to the improvement of several processes useful for the deployment of therapeutic innovation. Let us hope that the lessons learned during this crisis will allow for greater efficiency in the event of a new pandemic and, above all, that the progress made will continue to apply to all future clinical research activities.
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Affiliation(s)
- Dominique Deplanque
- Inserm, CIC 1403 - centre d'investigation clinique, University Lille, CHU de Lille, 59000 Lille, France.
| | - Stanislas Cviklinski
- Roche SAS - Direction des opérations cliniques, 92100 Boulogne-Billancourt, France
| | - Marc Bardou
- Cellule interministérielle recherche, direction générale de la santé, ministère des Solidarités et de la Santé, 75350 Paris 07 SP, France
| | - Florence Ader
- Département des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | | | | | - Isabelle David
- Sanofi Clinical Study Unit, 91385 Chilly-Mazarin, France
| | - Eric D'Ortenzio
- Inserm ANRS - Maladies infectieuses émergentes, université de Paris - Inserm Infection, Antimicrobien, Modélisation, Evolution (IAME), AP-HP Hôpital Bichat, service de maladies infectieuses et tropicales, Paris, France
| | - Hélène Espérou
- Inserm, pôle de recherche clinique, institut de santé publique, 75013 Paris, France
| | - Odile Launay
- Inserm CIC 1417, F-CRIN, COVIREIVAC, AP-HP, hôpital Cochin, 75014 Paris, France
| | | | | | | | - Yves Levy
- Inserm U955, Team 16, faculté de médecine, Vaccine Research Institute, université Paris-Est Créteil, 94000 Créteil, France
| | - David Pérol
- Direction de la recherche clinique et de l'innovation, centre Léon-Bérard, 69008 Lyon, France
| | - Virginie Rage
- Laboratoire de droit et économie de la santé, faculté de pharmacie, 34093 Montpellier, France
| | - Matthieu Roustit
- Inserm CIC1406, University Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France
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Deplanque D, Cviklinski S, Bardou M, Ader F, Blanchard H, Barthélemy P, David I, D'Ortenzio E, Espérou H, Launay O, Lazarevic M, Lechat P, Lethiec F, Levy Y, Pérol D, Rage V, Roustit M, Thabut G. Crise sanitaire : quelles opportunités pour la recherche clinique sur le médicament ? Therapie 2021; 77:49-57. [PMID: 34924206 PMCID: PMC8648377 DOI: 10.1016/j.therap.2021.11.010] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022]
Abstract
La pandémie de coronavirus disease-19 (COVID-19) a conduit au déploiement d’un effort de recherche académique et industriel sans précédent dont on peut regretter le caractère parfois redondant ainsi que le manque de pilotage tant national qu’international. Pourtant, force est de constater qu’à l’occasion de cette crise, les procédures réglementaires ont été adaptées de même que certains freins dans l’organisation de la recherche clinique ont pu être en partie levés pour contribuer au déploiement d’essais au plus près des patients et faciliter les modalités de suivi et de contrôle. La digitalisation de certains processus et la décentralisation de certaines activités ont pu être mises en œuvre sous couvert d’une mobilisation des autorités et de l’ensemble des acteurs institutionnels, académiques ou industriels. Si outre-manche, l’optimisation des ressources, au travers d’un essai de plateforme unique, a permis de montrer ou d’infirmer l’efficacité de nombreux traitements, en France la crise sanitaire a mis en lumière la fragilité de l’organisation de la recherche clinique, notamment un déficit de coordination et de financement, des difficultés dans la mise en œuvre des études ou encore une certaine frilosité concernant le partage des données. Cependant, la crise a aussi révélé les capacités d’adaptation des différents acteurs et permis l’amélioration de plusieurs processus utiles au déploiement de l’innovation thérapeutique. Gageons que les leçons tirées à l’occasion de cette crise permettront une meilleure efficacité en cas de nouvelle pandémie et surtout que les progrès obtenus continueront de s’appliquer à l’ensemble des activités de recherche clinique futures.
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Affiliation(s)
- Dominique Deplanque
- University Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, 59000 Lille, France.
| | - Stanislas Cviklinski
- Roche SAS - Direction des opérations cliniques, 92100 Boulogne-Billancourt, France
| | - Marc Bardou
- Cellule interministérielle recherche, direction générale de la santé, ministère des Solidarités et de la Santé, 75350 Paris 07 SP, France
| | - Florence Ader
- Département des maladies infectieuses et tropicales, hôpital de la Croix-Rousse, Hospices civils de Lyon, 69004 Lyon, France
| | | | | | - Isabelle David
- Sanofi Clinical Study Unit, 91385 Chilly-Mazarin, France
| | - Eric D'Ortenzio
- Université de Paris, Inserm CIC 1417, Assistance publique - Hôpitaux de Paris, hôpital Cochin, 75014 Paris, France
| | - Hélène Espérou
- Pôle de recherche clinique, institut de santé publique, INSERM, 75013 Paris, France
| | - Odile Launay
- Inserm CIC 1417, F-CRIN, COVIREIVAC, Assistance publique - hôpitaux de Paris, hôpital Cochin, 75014 Paris, France
| | | | - Philippe Lechat
- Université de Paris, Assistance publique - hôpitaux de Paris, AGEPS, 75005 Paris, France
| | | | - Yves Levy
- Vaccine Research Institute, université Paris-Est Créteil, faculté de médecine, INSERM U955, Team 16, 94000 Créteil, France
| | - David Pérol
- Direction de la recherche clinique et de l'innovation, centre Léon Bérard, 69008 Lyon, France
| | - Virginie Rage
- Faculté de pharmacie, laboratoire de droit et économie de la santé, 34093 Montpellier, France
| | - Matthieu Roustit
- University Grenoble Alpes, CHU de Grenoble, Inserm CIC1406, 38000 Grenoble, France
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Affiliation(s)
- Philippe Lechat
- Professeur émérite, Université de Paris, 75005 Paris, France.
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Lechat P. Inefficacité et dangerosité potentielle de l’hydroxychloroquine pour traiter une infection par le coronavirus Sars-Cov2. Archives des Maladies du Coeur et des Vaisseaux - Pratique 2020; 2020:25-27. [PMID: 32837201 PMCID: PMC7386302 DOI: 10.1016/j.amcp.2020.07.007] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Dhainaut JF, Blin O, Herry F, Benito S, Bilbault P, Cauterman M, Favrel-Feuillade F, Fazi-Leblanc S, Germain C, Goehrs C, Grosskopf C, Labarthe B, Lechat P, Malciu C, Marquet P, Miceli-Richard C, Peyret O, Rattenbach R, de Saint-Exupéry E. Health research and innovation: Can we optimize the interface between startups/pharmaceutical companies and academic health care institutions or not? Therapie 2020; 75:113-123. [DOI: 10.1016/j.therap.2019.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 01/23/2023]
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Dhainaut JF, Blin O, Herry F, Benito S, Bilbault P, Cauterman M, Favrel-Feuillade F, Fazi-Leblanc S, Germain C, Goehrs C, Grosskopf C, Labarthe B, Lechat P, Malciu C, Marquet P, Miceli-Richard C, Peyret O, Rattenbach R, de Saint-Éxupéry E. Recherche et innovation en santé : comment optimiser l’interface entre les startups/industries et les établissements de santé académiques ou non ? Therapie 2020; 75:101-111. [DOI: 10.1016/j.therap.2019.11.006] [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] [Received: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
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Sallah K, Gault N, Van Gysel D, Luquiens G, Lechat P. Élaboration d’un référentiel mettant en lien des champs textuels d’indications thérapeutiques avec des libellés diagnostiques, en vue de la détection de prescriptions hors AMM dans les dossiers médicaux. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.060] [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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Townsend A, de Trogoff H, Szwarcensztein K, Bourhis J, Bourguignon S, Dervaux B, Dubois S, Durand-Zaleski I, Epis de Fleurian AA, Favrel-Feuillade F, Lechat P, Maugendre P, Mezerette B, Polton D, Pourrat X. Experimentation to favor innovation: Promoting the success of Article 51 transformation projects. Therapie 2019; 74:51-57. [DOI: 10.1016/j.therap.2018.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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Townsend A, de Trogoff H, Szwarcensztein K, Bourhis J, Bourguignon S, Dervaux B, Dubois S, Durand-Zaleski I, Epis de Fleurian AA, Favrel-Feuillade F, Lechat P, Maugendre P, Mezerette B, Polton D, Pourrat X. Expérimentations en faveur de l’innovation : réussir un projet de transformation de type article 51. Therapie 2019; 74:43-49. [DOI: 10.1016/j.therap.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 11/15/2022]
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Nataf P, Guettier C, Hadjiisky P, Lechat P, Regan M, Gouezo R, Gerota J, Pavie A, Cabrol C, Gandjbakhch I. Evaluation of Cryopreserved Arteries as Alternative Small Vessel Prostheses. Int J Artif Organs 2018. [DOI: 10.1177/039139889501800404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biologic or synthetic grafts have had limited success in small vessel applications. Studies were initiated to assess the potential use of cryopreserved (CP) arteries as coronary artery bypass conduits. Sheep carotid arteries (internal diameter: 4 mm; length: 10 cm) were cryopreserved in a nutrient media containing 10% DMSO and were stored in a nitrogen vapor at -150°C. After thawing, histological, enzyme-histochemical and functional studies showed slight histological alterations, preservation of enzymal activities and an abolition of the contractile response. In a sheep model, arterial substitution of a 10 cm segment of carotid artery was realised by implantation of fresh autografts (n=4); fresh allografts (n=9) and CP allografts (n=9). After 3 months, all autografts were patent with slight histological alterations. Fresh and CP allografts showed similar modifications: patency rate was 7/9 in both groups. Intimal thickening with cell proliferation was seen in fresh (3/7) and CP (4/8) arteries; loss of smooth muscle medial cells was constant. Adventitia was always involved by a marked inflammatory reaction. One characteristic of CP allografts was the frequent presence of large dystrophic calcifications. In conclusion, morphologic and functional arterial changes occurred after freezing and thawing. In spite of vascular rejection, the patency rate of allografts after 3 months of implantation in arterial circulation remained high and does not seem influenced by cryopreservation.
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Affiliation(s)
- P. Nataf
- Centre de Recherche sur les Techniques Chirurgicales, Association Claude Bernard, Paris
| | - C. Guettier
- Department of Pathology, J Verdier Hospital, Bondy
| | - P. Hadjiisky
- Centre de Recherche sur les Maladies Cardio-vasculaires, Association Claude Bernard, Paris
| | - P. Lechat
- Centre de Recherche sur les Maladies Cardio-vasculaires, Association Claude Bernard, Paris
| | - M. Regan
- Centre de Recherche sur les Techniques Chirurgicales, Association Claude Bernard, Paris
| | - R. Gouezo
- Banque de Tissus de I'Hôpital Saint Louis, Paris - France
| | - J. Gerota
- Banque de Tissus de I'Hôpital Saint Louis, Paris - France
| | - A. Pavie
- Centre de Recherche sur les Techniques Chirurgicales, Association Claude Bernard, Paris
| | - C. Cabrol
- Centre de Recherche sur les Techniques Chirurgicales, Association Claude Bernard, Paris
| | - I. Gandjbakhch
- Centre de Recherche sur les Techniques Chirurgicales, Association Claude Bernard, Paris
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Berdaï D, Thomas-Delecourt F, Szwarcensztein K, d’Andon A, Collignon C, Comet D, Déal C, Dervaux B, Gaudin AF, Lamarque-Garnier V, Lechat P, Marque S, Maugendre P, Méchin H, Moore N, Nachbaur G, Robain M, Roussel C, Tanti A, Thiessard F. Requests for post-registration studies (PRS), patients follow-up in actual practice: Changes in the role of databases. Therapie 2018. [DOI: 10.1016/j.therap.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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20
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Lechat P, Ravoire S. L’application smartphone/site Internet DocaMED sur les médicaments et leurs indications thérapeutiques. Therapie 2017; 72:503-504. [DOI: 10.1016/j.therap.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 11/29/2022]
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21
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Martelli N, Puc C, Szwarcensztein K, Beuscart R, Coulonjou H, Degrassat-Théas A, Dutot C, Epis de Fleurian AA, Favrel-Feuillade F, Hounliasso I, Lechat P, Luigi E, Mairot L, Nguyen T, Piazza L, Roussel C, Vienney C. Hospital-based health technology assessment in France: A focus on medical devices. Therapie 2017; 72:115-123. [PMID: 28189333 DOI: 10.1016/j.therap.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 11/25/2022]
Abstract
Hospital-based health technology assessment (HTA) guides decisions as to whether new healthcare products should be made available within hospital structures. Its extension to medical devices (MDs) makes it possible to analyse several relevant aspects of these healthcare products in addition to their clinical value, and such evaluations are of interest to national health authorities, other healthcare establishments and industry. The aim of this work was to formulate several recommendations for a blueprint for hospital-based HTA for MDs in France. Five themes based on the work of the European Adopting hospital-based HTA in the EU (AdHopHTA) project were defined. Each member of the roundtable was then allocated a documentation task based on their experience of the theme concerned, and a literature review was carried out. An inventory of hospital-based HTA was performed and six recommendations aiming to strengthen and improve this approach were put forward: (1) encouragement of the spread of the hospital-based HTA culture and participation in communications and the promotion of this approach to hospital decision-makers; (2) adaptation of hospital-based HTA to the needs of decision-makers, taking into account the financial timetable and strategic objectives of the healthcare establishment; (3) harmonisation of the dossiers requested from industry between healthcare establishments, based on a common core; (4) promotion of the sharing of hospital-based HTA data under certain conditions, with data dissociable from the HTA report and the use of a validated methodology for the literature review; (5) creation of a composite indicator reflecting data production effort and the sharing of HTA activities, to be taken into account in the distribution of funds allocated for teaching, research and innovation missions considered of general interest; (6) the transmission of information directly from local to national level by pioneering centres. This work highlights the major issues at stake in hospital-based HTA and the need to valorise such activities in France.
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Affiliation(s)
- Nicolas Martelli
- Service de pharmacie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - Cyril Puc
- Medtronic, 92100 Boulogne-Billancourt, France
| | | | | | | | - Hélène Coulonjou
- Ministère des Affaires sociales et de la Santé, direction générale de l'offre de soins, 75007 Paris, France
| | | | | | | | | | - Iliona Hounliasso
- Service de pharmacie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Philippe Lechat
- Département de la recherche clinique et du développement, AP-HP, 75475 Paris, France
| | | | | | - Thao Nguyen
- Johnson et Johnson, 92130 Issy-les-Moulineaux, France
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Janus N, Cavagna F, Beauvais F, Garenaux M, Livet D, Bergmann J, Pol S, Sicard J, Monchecourt F, Hanon O, Lechat P, Deray G. Adaptation posologique et fonction rénale chez la personne âgée en officine. Résultat de l’étude IPOP. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.127] [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: 11/25/2022]
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23
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Girault D, Trouvin JH, Blachier-Poisson C, Gary F, Laloye D, Bergmann JF, Casadevall N, Delval C, De Sahb Berkovitch R, Fagon JY, Gersberg M, Lassale C, Lechat P, Le Jeunne C, Montastruc JL, Prugnaud JL, Ratignier-Carbonneil C, Rey-Coquais C. Biosimilars: from Technical to Pharmacoeconomic Considerations. Therapie 2016; 70:47-55. [PMID: 27393396 DOI: 10.2515/therapie/2015003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 11/20/2022]
Abstract
A biosimilar is a biological medicinal product claimed to be similar to a reference biological medicinal product. Its development plan includes studies comparing it with the reference product in order to confirm its similarity in terms of quality, preclinical safety, clinical efficacy, and clinical safety, including immunogenicity. Biosimilars differ from generics both in their molecular complexity and in the specific requirements that apply to them. Since patents on many biological medicinal products will expire within the next 5 years in major therapeutic areas such as oncology, rheumatology and gastroenterology and as those products are so costly to the French national health insurance system, the availability of biosimilars would have a considerable economic impact. The round table has issued a number of recommendations intended to ensure that the upcoming arrival of biosimilars on the market is a success, in which prescribing physicians would have a central role in informing and reassuring patients, an efficient monitoring of the patients treated with biologicals would be set up and time to market for biosimilars would be speeded up.
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Chatellier G, Varlet V, Blachier-Poisson C, Beslay N, Behier JM, Braunstein D, Caralp M, Congard-Chassol B, Diaz I, Fournier L, Josseran A, Lechat P, Lefevre C, von Lennep F, Levesque K, Maugendre P, Marchand G, Mennecier D, Moore N, Ravoire S, Riou C. « Big data » et « open data » : quel accès pour la recherche ? Therapie 2016. [DOI: 10.1016/j.therap.2016.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bocquet F, Fusier I, Cordonnier A, Lechat P, Paubel P. Budget Impact Analysis of Implementing Tenders Between The Branded Infliximab And Its Biosimilars In The Public Hospitals of Paris. Value in Health 2015. [PMID: 0 DOI: 10.1016/j.jval.2015.09.2275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Lechat P. [Pharmacological Basis for Therapeutics. Pharmacological Analysis of Summary of Product Characteristics (SPC) for Physicians]. Therapie 2015; 70:403-14. [PMID: 26109291 DOI: 10.2515/therapie/2015025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/13/2015] [Indexed: 11/20/2022]
Abstract
The summary of product characteristics, the SPC, is the major annex document of Marketing Authorisation (MA) dossier for a medicine. This document is the reference document for health care professionnals since it contains all necessary and opposable information for its therapeutic use. The SPC is initially submitted by the MA applicant and deeply revised in details by regulatory authorities, the national agencies for national MA, and the European Medicine Agency (EMA) for the european centralized procedures. The SPC presents with 12 sections each one being divided into several paragraphs. Sections 1-3 present the name, dosage, qualitative and quantitative composition, the pharmaceutical form of the medicine. Section 4 contains all the clinical particulars: Therapeutic indications, posology and methods of administration, contra-indications, special warnings and precautions for use, interactions, impact on fertility, contraception, pregnancy, lactation, effects on ability to drive and use machines, undesirable effects and risk associated with overdose. Section 5 describes pharmacological properties (pharmacodynamics and pharmacokinetics) and preclinical safety data. Section 6 describes the pharmaceutical particulars: excipients, incompatibilities, shelf live, nature and content of container, special precautions for disposal. Sections 7-10 are administrative ones (date of MA, MA holder), sections 11 and 12 are specific to radiopharmaceuticals (dosimetry and modalities of preparation). SPC is available free of charge on national regulatory agency websites and on EMA website. Sections of SPC finally have to be considered as the pharmacological basis of therapeutic use for each medicine.
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Krum H, van Veldhuisen DJ, Funck-Brentano C, Vanoli E, Silke B, Erdmann E, Follath F, Ponikowski P, Goulder M, Meyer W, Lechat P, Willenheimer R. Effect on mode of death of heart failure treatment started with bisoprolol followed by Enalapril, compared to the opposite order: results of the randomized CIBIS III trial. Cardiovasc Ther 2015; 29:89-98. [PMID: 20528880 DOI: 10.1111/j.1755-5922.2010.00185.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Mode of death in chronic heart failure (CHF) may be of relevance to choice of therapy for this condition. Sudden death is particularly common in patients with early and/or mild/moderate CHF. β-Blockade may provide better protection against sudden death than ACE inhibition (ACEI) in this setting. METHODS We randomized 1010 patients with mild or moderate, stable CHF and left ventricular ejection fraction ≤35%, without ACEI, β-blocker or angiotensin-receptor-blocker therapy, to either bisoprolol (n = 505) or enalapril (n = 505) for 6 months, followed by their combination for 6-24 months. The two strategies were blindly compared regarding adjudicated mode of death, including sudden death and progressive pump failure death. RESULTS During the monotherapy phase, 8 of 23 deaths in the bisoprolol-first group were sudden, compared to 16 of 32 in the enalapril-first group: hazard ratio (HR) for sudden death 0.50; 95% confidence interval (CI) 0.21-1.16; P= 0.107. At 1 year, 16 of 42 versus 29 of 60 deaths were sudden: HR 0.54; 95% CI 0.29-1.00; P= 0.049. At study end, 29 of 65 versus 34 of 73 deaths were sudden: HR 0.84; 95% CI 0.51-1.38; P= 0.487. Comparable figures for pump failure death were: monotherapy, 7 of 23 deaths versus 2 of 32: HR 3.43; 95% CI 0.71-16.53; P= 0.124, at 1 year, 13 of 42 versus 5 of 60: HR 2.57; 95% CI 0.92-7.20; P= 0.073, at study end, 17 of 65 versus 7 of 73: HR 2.39; 95% CI 0.99-5.75; P= 0.053. There were no significant between-group differences in any other fatal events. CONCLUSION Initiating therapy with bisoprolol compared to enalapril decreased the risk of sudden death during the first year in this mild systolic CHF cohort. This was somewhat offset by an increase in pump failure deaths in the bisoprolol-first cohort.
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Affiliation(s)
- Henry Krum
- Departments of Epidemiology and Preventive Medicine and Medicine, Monash University, Alfred Hospital, Melbourne, Australia Thoraxcenter, Department of Cardiology, University Hospital Groningen, The Netherlands UPMC - AP-HP - INSERM CIC9304, Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France Department of Cardiology, University of Pavia and Policlinico di Monza, Italy Department of Pharmacology & Therapeutics, Trinity Centre, St James' Hospital, Dublin, Ireland Medizinische Klinik III, University of Cologne, Germany Medicine A, University Hospital Zürich, Switzerland Department of Heart Diseases, Medical University, Wroclaw, Poland Worldwide Clinical Trials, Nottingham, UK Merck KGaA, Darmstadt, Germany Service de Pharmacologie, Hopital Pitié-Salpetriere, Paris, France Lund University and Heart Health Group, Malmö, Sweden
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Girault D, Trouvin JH, Blachier-Poisson C, Gary F, Laloye D, Bergmann JF, Casadevall N, Delval C, De Sahb Berkovitch R, Fagon JY, Gersberg M, Lassale C, Lechat P, Le Jeunne C, Montastruc JL, Prugnaud JL, Ratignier-Carbonneil C, Rey-Coquais C. [Not Available]. Therapie 2015; 70:37-46. [PMID: 27393395 DOI: 10.2515/therapie/2014233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/15/2014] [Indexed: 11/20/2022]
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Molimard M, Bernaud C, Lechat P, Bejan-Angoulvant T, Benattia C, Benkritly A, Braunstein D, Cabut S, David N, Fourrier-Réglat A, Gallet B, Gersberg M, Goni S, Jolliet P, Lamarque-Garnier V, Le Jeunne C, Leurs I, Liard F, Malbezin M, Micallef J, Nguon M. Information and communication on risks related to medications and proper use of medications for healthcare professionals and the general public: precautionary principle, risk management, communication during and in the absence of crisis situations. Therapie 2014; 69:355-66. [PMID: 25099666 DOI: 10.2515/therapie/2014045] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
Abstract
Recent drug crises have highlighted the complexity, benefits and risks of medication communication. The difficulty of this communication is due to the diversity of the sources of information and the target audience, the credibility of spokespersons, the difficulty to communicate on scientific uncertainties and the precautionary principle, which is influenced by variable perceptions and tolerances of the risk. Globally, there is a lack of training in risk management with a tendency of modern society to refuse even the slightest risk. Communication on medications is subject to regulatory or legal requirements, often uses tools and messages that are not adapted to the target audience and is often based on a poor knowledge of communication techniques. In order to improve this situation, the available information must be coordinated by reinforcing the unique medication information website and by coordinating communication between authorities by means of a single spokesperson. A particular effort must be made in the field of training in the proper use and risk of medications for both the general population and patients but also for healthcare professionals, by setting up a unified academic on-line teaching platform for continuing medical education on medications and their proper use.
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Affiliation(s)
- Mathieu Molimard
- CHU et Université de Bordeaux, Département de pharmacologie, Bordeaux, France
| | - Corine Bernaud
- Laboratoire AstraZeneca France, Direction médicaleRueil-Malmaison, France
| | - Philippe Lechat
- AP-HP, Département de la recherche clinique et du développement, Hôpital Saint Louis, Paris, France
| | | | | | | | | | | | | | | | | | | | | | - Sylvia Goni
- Laboratoire Lundbeck, Issy les Moulineaux, France
| | | | | | | | - Irina Leurs
- Laboratoire Norgine, Rueil Malmaison, France
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Molimard M, Bernaud C, Lechat P, Bejan-Angoulvant T, Benattia C, Benkritly A, Braunstein D, Cabut S, David N, Fourrier-Réglat A, Gallet B, Gersberg M, Goni S, Jolliet P, Lamarque-Garnier V, Le Jeunne C, Leurs I, Liard F, Malbezin M, Micallef J, Nguon M. Information et communication sur les risques liés au médicament et son bon usage auprès des professionnels de santé et du public : principe de précaution, gestion du risque, communication pendant et en dehors des situations de crise. Therapie 2014; 69:355-60. [DOI: 10.2515/therapie/2014044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
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31
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Schoindre Y, Jallouli M, Tanguy ML, Ghillani P, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z, Souberbielle JC, Costedoat-Chalumeau N. Lower vitamin D levels are associated with higher systemic lupus erythematosus activity, but not predictive of disease flare-up. Lupus Sci Med 2014; 1:e000027. [PMID: 25379192 PMCID: PMC4213833 DOI: 10.1136/lupus-2014-000027] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/03/2014] [Accepted: 05/08/2014] [Indexed: 01/11/2023]
Abstract
Objectives Growing evidence suggests that vitamin D plays a key role in the pathogenesis and progression of autoimmune diseases, including systemic lupus erythematosus (SLE). Recent studies have found an association between lower serum 25-hydroxyvitamin D (25(OH)D) levels and higher SLE activity. We studied the relationship between 25(OH)D levels and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and we assessed for the first time the role of vitamin D in predicting SLE flare-ups. Methods Serum 25(OH)D levels were measured in 170 patients with SLE who were prospectively followed up for 6 months (Plaquenil LUpus Systemic study, ClinicalTrials.gov number NCT00413361). Results The mean SLEDAI score was 2.03±2.43 and 12.3% patients had active disease (SLEDAI ≥6). The mean 25(OH)D level was 20.6±9.8 ng/mL. Deficiency (25(OH)D <10 ng/mL) was observed in 27 (15.9%), insufficiency (10≤25(OH)D<30) in 112 (65.9%) and optimal vitamin D status (25(OH)D≥30) in 31 (18.2%) patients. In multivariate analysis, female gender (p=0.018), absence of defined antiphospholipid syndrome (p=0.002) and higher creatinine clearance (p=0.004) were predictive of lower 25(OH)D levels. In multivariate analysis, lower 25(OH)D levels were associated with high SLE activity (p=0.02). Relapse-free survival rate was not statistically different according to the vitamin D status during the 6-month follow-up (p=0.22). Conclusions We found a low vitamin D status in the majority of patients with SLE, and a modest association between lower 25(OH)D levels and high disease activity. There was no association between baseline 25(OH)D levels and relapse-free survival rate.
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Affiliation(s)
- Yoland Schoindre
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne 1, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Moez Jallouli
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Marie-Laure Tanguy
- AP-HP, Hôpital Pitié-Salpêtrière, Unité de recherche clinique, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Pascale Ghillani
- AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire d'Immunochimie, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Lionel Galicier
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Saint-Louis, Service d'Immunologie Clinique, 1 avenue Claude Vellefaux , Paris , France
| | - Olivier Aumaître
- Université de Clermont-Ferrand , Clermont-Ferrand , France ; CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de Médecine Interne , Clermont-Ferrand, Cedex , France
| | - Camille Francès
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Tenon, Service de Dermatologie Allergologie , Paris , France
| | - Véronique Le Guern
- Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Cochin, Service de Médecine Interne , Paris , France
| | - Frédéric Lioté
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Lariboisière, Service de Rhumatologie , Paris , France
| | - Amar Smail
- CHU Amiens, Hôpital Nord, Service de Médecine Interne, Place Victor Pauchet , Amiens , France
| | - Nicolas Limal
- AP-HP, Hôpital Henri Mondor, Service de Médecine Interne , Créteil , France
| | - Laurent Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Médecine Interne , Lyon , France
| | - Hélène Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Médecine Interne , Lyon , France
| | - Du Le Thi Huong
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Bouchra Asli
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Saint-Louis, Service d'Immunologie Clinique, 1 avenue Claude Vellefaux , Paris , France
| | - Jean-Emmanuel Kahn
- Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Foch, Service de Médecine Interne , Suresnes, Cedex , France
| | - Laurent Sailler
- Université Paul-Sabatier , Toulouse , France ; CHU Toulouse, Hôpital Purpan, Service de Médecine Interne, Place Dr Baylac , Toulouse , France
| | - Félix Ackermann
- Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Foch, Service de Médecine Interne , Suresnes, Cedex , France
| | - Thomas Papo
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Bichat Claude-Bernard, Service de Médecine Interne , Paris , France
| | - Karim Sacré
- Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Bichat Claude-Bernard, Service de Médecine Interne , Paris , France
| | - Olivier Fain
- Université Paris Nord , Sorbonne Paris Cité , France ; AP-HP, Hôpital Jean-Verdier, Service de Médecine Interne , Bondy , France
| | - Jérôme Stirnemann
- Université Paris Nord , Sorbonne Paris Cité , France ; AP-HP, Hôpital Jean-Verdier, Service de Médecine Interne , Bondy , France
| | - Patrice Cacoub
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Gaëlle Leroux
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne 1, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Judith Cohen-Bittan
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Sébastien Hulot
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Pharmacologie , Paris, Cedex , France
| | - Philippe Lechat
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Pharmacologie , Paris, Cedex , France
| | - Lucile Musset
- AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire d'Immunochimie, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Charles Piette
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Zahir Amoura
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
| | - Jean-Claude Souberbielle
- Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Necker-Enfants Malades, Laboratoire de Physiologie , Paris , France
| | - Nathalie Costedoat-Chalumeau
- UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France
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Damman K, Voors AA, Hillege HL, Navis G, Lechat P, van Veldhuisen DJ, Dargie HJ. Congestion in chronic systolic heart failure is related to renal dysfunction and increased mortality. Eur J Heart Fail 2014; 12:974-82. [DOI: 10.1093/eurjhf/hfq118] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kevin Damman
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - Adriaan A. Voors
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - Hans L. Hillege
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
- Department of Epidemiology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - Gerjan Navis
- Department of Nephrology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - Philippe Lechat
- Clinical Pharmacology Department; La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris; Paris France
| | - Dirk J. van Veldhuisen
- Department of Cardiology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
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Alla F, Rosilio M, Funck-Brentano C, Barthélémy P, Brisset S, Cellier D, Chassany O, Demarez JP, Diebolt V, Francillon A, Gambotti L, Hannachi H, Lechat P, Lemaire F, Lièvre M, Misse C, Nguon M, Pariente A, Rosenheim M, Weisslinger-Darmon N. How can the quality of medical data in pharmacovigilance, pharmacoepidemiology and clinical studies be guaranteed? Therapie 2013; 68:209-23. [PMID: 23981258 DOI: 10.2515/therapie/2013040] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/20/2022]
Abstract
The development of medicinal products is subject to quality standards aimed at guaranteeing that database contents accurately reflect the source documents. Paradoxically, these standards hardly address the quality of the source data itself. The objective of this work was to propose recommendations to improve data quality in three fields (pharmacovigilance, pharmacoepidemiology and clinical studies). The analysis was focused on the data and on the critical stages presenting critical quality problems, for which the current guidelines are insufficiently detailed, unsuitable and/or poorly applied. Finally, recommendations have been proposed, mainly focused on the origin of the data and its transcription.
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Alla F, Rosilio M, Funck-Brentano C, Barthélémy P, Brisset S, Cellier D, Chassany O, Demarez JP, Diebolt V, Francillon A, Gambotti L, Hannachi H, Lechat P, Lemaire F, Lièvre M, Misse C, Nguon M, Pariente A, Rosenheim M, Weisslinger-Darmon N. Comment garantir des données médicales de qualité dans les études cliniques, pharmaco-épidémiologiques et en pharmacovigilance ? Therapie 2013; 68:209-16. [DOI: 10.2515/therapie/2013035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/20/2022]
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35
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Lechat P, Eugène M, Komajda M. Mécanismes de la contractilité cardiaque. Med Sci (Paris) 2013. [DOI: 10.4267/10608/3441] [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: 11/30/2022] Open
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36
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Costedoat-Chalumeau N, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Tanguy ML, Hulot JS, Lechat P, Musset L, Amoura Z, Piette JC. Hydroxychloroquine in systemic lupus erythematosus: results of a French multicentre controlled trial (PLUS Study). Ann Rheum Dis 2012; 72:1786-92. [DOI: 10.1136/annrheumdis-2012-202322] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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37
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Paintaud G, Diviné M, Lechat P. Monoclonal Antibodies for Therapeutic Use: Specific Characteristics of Clinical Development, Evaluation by the Agencies, and Long-term Monitoring of Safety. Therapie 2012; 67:329-37. [PMID: 23110833 DOI: 10.2515/therapie/2012046] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/04/2012] [Indexed: 11/20/2022]
Abstract
Monoclonal antibodies (MoAb) are very different from other drugs. The Round Table aimed to determine whether the specific characteristics of MoAb have repercussions on their clinical development, evaluation by the health authorities, and long-term monitoring. As regards the structure-activity relationship of MoAb, classification according to mechanism of action (neutralising or agonist MoAb, cytolytic MoAb) is more relevant than to their degree of humanisation. Recommendations on their clinical development would be useful since the early phases give rise to a number of problems and are insufficiently codified. The pharmacokinetic profile is very different from that of other drugs. The concentration-effect relationship is difficult to study since the biomarkers may be apparently disconnected from the therapeutic effect. The methodology for evaluation of MoAb by the agencies, and postmarketing surveillance do not differ from the procedures used for other drugs; however, MoAb bring together a number of specific characteristics as compared with other drugs.
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Affiliation(s)
- Gilles Paintaud
- François Rabelais University Tours; CNRS UMR 7292; CHRU of Tours, Pharmacology-Toxicology Laboratory, Tours, France
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Paintaud G, Diviné M, Lechat P, Bagot M, Boucot I, d’Andon A, Grudé F, Lecomte T, Liu-Leage S, Olive D, Piedbois P, Pigeon M, Pinquier JL, Prost JF, Thibault G, Vitzling C. Anticorps monoclonaux à usage thérapeutique : spécificités du développement clinique, évaluation par les agences, suivi de la tolérance à long terme. Therapie 2012; 67:319-27. [DOI: 10.2515/therapie/2012043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/04/2012] [Indexed: 11/20/2022]
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39
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Houeto P, Carton A, Guerbet M, Mauclaire AC, Gatignol C, Lechat P, Masset D. Assessment of the health risks related to the presence of drug residues in water for human consumption: Application to carbamazepine. Regul Toxicol Pharmacol 2012; 62:41-8. [DOI: 10.1016/j.yrtph.2011.11.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 11/05/2011] [Accepted: 11/23/2011] [Indexed: 11/16/2022]
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Bamberger M, Moore N, Lechat P. How to improve the clinical development paradigm and its division into phases I, II and III. Therapie 2011; 66:331-4, 327-30. [PMID: 21851796 DOI: 10.2515/therapie/2011046] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 05/19/2011] [Indexed: 11/20/2022]
Abstract
Based on the observation that over the last 30 years the cost of development has risen regularly as the number of new chemical entities reaching the market has fallen, how can "savings" be made in terms of clinical development, the objective being more rapid access to a drug for medical needs that are not covered? Several instruments exist to enable innovative products to be made available more quickly: temporary use authorisations, which are not concerned by this work (ATUs), conditional marketing authorisations (MAs) and MAs under exceptional circumstances. These aspects have been taken up in the European medicines agency (EMA)'s "Road Map", which states "A key issue for Regulators will be if a more "staggered" approval should be envisaged, characterised by a better defined/more restricted population of good responders, followed by a broadening of the population post-authorisation when more "real life" data are available. In addition, maximising the value of information generated in the post-authorisation phase should be developed through the use of cohorts and other prospectively collected use data, especially in the case of conditional marketing authorisations." The rules of procedure of the Transparency Commission for their part provide for the notion of preliminary examination: in order to prepare as best as possible the examination of dossiers of products assumed to be innovative and to limit delays, the office can undertake a preliminary study as soon as the dossier has been filed at the Committee for medicinal products for human use (CHMP). It may, at this time, request the firm to provide further information and may call on external experts. The implementation of this preliminary study does not exonerate the firm of the obligation of filing a complete dossier. The post inscription studies requested by the Transparency Commission (ISPEP - public health benefit and post-marketing studies) are usually requested in the case of hesitations regarding the level of improvement of the medical benefit (ASMR) [level II/III or IV/V]. Such requests mainly concern uncertainties regarding the transposability, the patient profile or correct usage in real life. Among the studies whose results were provided, in 15 cases the results were in line with expectations, in 6 cases they resulted in downward re-evaluations and the final 3 cases were inconclusive. The final recommendations of the round table were: Defining the medical need that is not covered by working in consultation (Industry and Health Authorities); Providing a Complementary Investigations Plan (PIC) after the MA at a very early stage to reinforce the early MA, and/or HTA (health technology assessment) preparation and monitoring (possible constraining actions); Enhanced use of modelling techniques and their transposability; "Intussusception" of phases to optimise the development of a complete dossier; Early "scientific opinions" (EMA, French Health Products Safety Agency [Afssaps], French Health Authority [HAS]); Raising the awareness of the authorities, industry, doctors and patients with regard to controlled observational studies; Developing the use of public data bases.
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Gallanagh S, Castagno D, Wilson B, Erdmann E, Zannad F, Remme WJ, Lopez-Sendon JL, Lechat P, Follath F, Höglund C, Mareev V, Sadowski Z, Seabra-Gomes RJ, Dargie HJ, McMurray JJV. Evaluation of the functional status questionnaire in heart failure: a sub-study of the second cardiac insufficiency bisoprolol survival study (CIBIS-II). Cardiovasc Drugs Ther 2011; 25:77-85. [PMID: 21287410 DOI: 10.1007/s10557-011-6284-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS We evaluated a generic quality of life (QoL) Functional Status Questionnaire (FSQ), in patients with chronic heart failure (CHF). The FSQ assesses the 3 main dimensions of QoL: physical functioning, mental health and social role. It also includes 6 single item questions about: work status, frequency of social interactions, satisfaction with sexual relationships, days in bed, days with restricted activity and overall satisfaction with health status. The FSQ was compared to the Minnesota Living with Heart Failure questionnaire (MLwHF). METHODS AND RESULTS The FSQ was evaluated in a substudy (n = 340) of the second Cardiac Insufficiency Bisoprolol Survival study (CIBIS-II), a placebo-controlled mortality trial. 265 patients (75%) patients completed both questionnaires at 6 months of follow-up. Both questionnaires indicated substantially impaired QoL. The FSQ demonstrated high internal consistency (Cronbach's α > 0.7 for all items except "social activity" = 0.66) and construct and concurrent validity. After 6 months, the only item on either questionnaire to show a difference between the placebo- and bisoprolol-treatment groups was the single item FSQ question about "days in bed" (p = 0.018 in favour of bisoprolol). CONCLUSIONS The FSQ performed well in this study, provided additional information to the MLwHF questionnaire and allowed interesting comparisons with other chronic medical conditions. The FSQ may be a useful general QoL instrument for studies in CHF.
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Affiliation(s)
- Siobhan Gallanagh
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
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Bamberger M, Moore N, Lechat P, Azizi M, Blin P, Bouhassira M, Cellier D, Demarez JP, Duval X, Gueyffier F, Le Jeunne C, Libersa C, Mahlberg-Gaudin F, Maison P, Marquet P, Molimard M, Moser A, Pavlovic M, Piedbois P, Regnier O, Reynier JC, Rey-Quinio C, Rossignol P, Spriet A, Vignal F. Comment faire évoluer le paradigme du développement clinique et son découpage en phases I, II, III. Therapie 2011; 66:327-30. [DOI: 10.2515/therapie/2011043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/10/2011] [Indexed: 11/20/2022]
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Berdaï D, Hotton JM, Lechat P. Comparators (medicinal and non medicinal) for marketing authorization, for public health, for payers and at the European level. Therapie 2010; 65:329-34. [PMID: 20854755 DOI: 10.2515/therapie/2010035] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 06/08/2010] [Indexed: 11/20/2022]
Abstract
Drug evaluation is based on comparison. Thus, the choice of the comparator for any new treatment becomes a key issue, especially when there are great differences in medical practice and of use conditions of the comparators depending on the geographical zones and their evolution with time. The choice of the comparators must satisfy sometimes different expectations from the registration authorities and for insurance coverage. The universal comparator that allows answering all the clinical assessment questions does not exist. Placebo, when it can be used, remains a reference for the MA (marketing authorisation) application, but does not exclude the use of the reference drug available on the market and prescribed under optimal efficacy conditions. The reference treatment is sometimes a difficult choice due to the absence of validated therapeutic recommendations or if the recommendations vary depending on the countries. The expansion and international harmonization of prescription guidelines (clinical practice guidelines) would reinforce the robustness and efficiency of clinical research efforts with respect to the relevance of the comparison to reference treatments. This principle also applies to the use of a non-drug comparator when it has been recognized as the reference comparator in the treatment of the pathology in question. In as much as possible, the search for a consensus must also aim at defining in the clinical development recommendations significant thresholds for the size of evaluated effects. Optimization of the information made available after clinical trials could also be helped by the development of use of methodologies that allow assessing superiority on secondary criteria during a non-inferiority study on the main criterion. Finally, the development of early scientific consultations by the Haute Autorité de Santé (HAS, French Health Authority) would contribute to adapt phase III clinical trials better to questions concerning the assessment of the clinical added value of the medicinal products evaluated.
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Hammoud HA, Aymard G, Lechat P, Boccheciampe N, Riou B, Aubrun F. Relationships between plasma concentrations of morphine, morphine-3-glucuronide, morphine-6-glucuronide, and intravenous morphine titration outcomes in the postoperative period. Fundam Clin Pharmacol 2010; 25:518-27. [DOI: 10.1111/j.1472-8206.2010.00867.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Berdaï D, Hotton JM, Lechat P, Barna A, Becquemont L, Bergman JF, Bernaud C, Boucot I, Cheiney I, Cucherat M, d’Andon A, d’Enfert J, Francillon A, Frauger E, Girault D, Harlin JM, Joseph A, Lassale C, Mahlberg-Gaudin F, Moreau-Defarges T, Pavlovic M, Ravoire S, Rochaix L, Vicaut E. Les comparateurs (médicamenteux et non médicamenteux) pour l’autorisation de mise sur le marché, pour la santé publique, pour les payeurs et au niveau européen. Therapie 2010; 65:323-8. [DOI: 10.2515/therapie/2010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 06/08/2010] [Indexed: 11/20/2022]
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46
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47
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Costedoat-Chalumeau N, Galicier L, Francès C, Aumaitre O, Lioté F, Le Guern V, Limal N, Smail A, Ninet J, Perard L, Le Huong Thi D, Asli B, Grandpeix C, Sailler L, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Jallouli M, Leroux G, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Étude des facteurs associés à une concentration basse d’hydroxychloroquine chez 523 patients inclus dans l’étude Plaquénil Lupus Systémique (PLUS, étude française multicentrique). Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.410] [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: 11/30/2022]
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48
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Costedoat-Chalumeaum N, Galicier L, Aumaitre O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Grandpeix C, Pourrat J, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Cohen J, Jallouli M, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Données épidémiologiques d’une cohorte française multicentrique de 569 patients lupiques. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.407] [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: 10/19/2022]
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49
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Costedoat-Chalumeau N, Jallouli M, Galicier L, Aumaître O, Francès C, Le Guern V, Liote F, Smail A, Limal N, Pérard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Grandpeix C, Pourrat J, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Cohen J, Tanguy ML, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Description des patients lupiques inclus dans l’étude PLUS (Plaquénil Lupus Systémique, étude française multicentrique) en fonction de leur origine ethnique. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.406] [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: 10/19/2022]
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50
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Castagno D, Jhund PS, McMurray JJ, Lewsey JD, Erdmann E, Zannad F, Remme WJ, Lopez-Sendon JL, Lechat P, Follath F, Höglund C, Mareev V, Sadowski Z, Seabra-Gomes RJ, Dargie HJ. Improved survival with bisoprolol in patients with heart failure and renal impairment: an analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial. Eur J Heart Fail 2010; 12:607-16. [DOI: 10.1093/eurjhf/hfq038] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Davide Castagno
- Cardiology Unit, Department of Internal Medicine; University of Turin; Turin Italy
- BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine; University of Glasgow; Glasgow G12 8TA UK
| | - Pardeep S. Jhund
- BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine; University of Glasgow; Glasgow G12 8TA UK
| | - John J.V. McMurray
- BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine; University of Glasgow; Glasgow G12 8TA UK
| | - James D. Lewsey
- Department of Public Health, Faculty of Medicine; University of Glasgow; Glasgow UK
| | - Erland Erdmann
- Department III of Internal Medicine; University of Cologne; Cologne Germany
| | - Faiez Zannad
- Inserm, CIC9501, U961, CHU and University of Nancy; Nancy France
| | - Willem J. Remme
- Sticares Cardiovascular Research Institute; Rhoon Netherlands
| | | | - Philippe Lechat
- Pharmacology Department; Pitié-Salpêtrière Hospital, APHP, UPMC; Paris
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