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Comment faciliter la diffusion des tests de pharmacogénétique ? 如何促进药物遗传学测试的传播?
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2025-01-01 DOI: 10.1016/j.therap.2024.11.007
Céline Verstuyft , Dominique Dewolf , Olivier Blin , Virginie Florentin , Laurent Mesnard , Boris Chaumette , Estelle Ayme-Dietrich , Laure Raymond , Marie Lang , Antonin Lamazière , Béatrice Allard , Laurence Samelson , Liliane Lamezec , Marie-Anne Loriot , Antoine Le Bozec , Nicolas Picard
La médecine des 4 P (personnalisée, préventive, prédictive, participative) connaît un essor remarquable, et la pharmacogénétique en est un élément incontournable. Cependant, plusieurs obstacles freinent son déploiement. Cette table ronde a réuni un groupe d’experts qui ont dressé un état des lieux, tout en réfléchissant aux moyens de faciliter la prescription de ces tests et la diffusion des résultats à l’échelle nationale. Les experts se sont penchés sur les modalités de prescription et de communication des données de pharmacogénétique dans le contexte actuel, mais aussi dans les prochaines années avec l’arrivée de logiciels d’intelligence artificielle. Les questions relatives au remboursement des tests, toujours d’actualité, ont également été discutées, car il s’agit d’un levier pour permettre à tous les patients d’accéder à ces tests. De nombreuses recommandations ont été formulées sur ces différents points, visant à faciliter la maîtrise de la prescription par les professionnels de santé, tout en garantissant la conservation et l’utilisation des résultats tout au long de la vie du patient. Enfin, il a été recommandé de mieux informer les patients et de renforcer l’implication des professionnels de santé ainsi que des industriels dans cette démarche, en insistant sur la formation et l’engagement nécessaires pour assurer son succès.
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引用次数: 0
Données de santé : l’accès régionalisé est un défi prioritaire pour construire un patrimoine national des données de santé sécurisé, transparent et innovant 卫生数据:区域化访问是建立安全、透明和创新的国家卫生数据遗产的一项优先挑战。
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2025-01-01 DOI: 10.1016/j.therap.2024.12.007
Daniel Szeftel , Vianney Jouhet , Gilles Duluc , Cécile Charle-Maachi , Thomas Sejourné , Jérôme Fabiano , Hélène Guimiot , Aurore Gaignon , Caroline Germain , Quentin Demanet , Emmanuel Merieux , Thomas Rapp
La France est engagée dans une transition juridique et organisationnelle depuis de nombreuses années. Elle doit adapter son cadre national avec les nécessités juridiques de protection des données personnelles, avec les ambitions européennes et la concurrence internationale. Depuis la loi Informatique et Libertés de 1978 et jusqu’à la loi de 2019 sur la transformation du système de santé, les réformes ont renforcé les exigences en matière de protection des données personnelles, tout en ouvrant la voie à des usages innovants. Les récents règlements européens, comme l’AI Act (2024) et l’Espace européen des données de santé (2024), visent à renforcer cette dynamique, en assurant un cadre sécurisé, transparent et compétitif pour le partage et l’utilisation des données de santé. Comment garantir une véritable efficacité dans la réutilisation des données issues du soin tout en respectant les droits fondamentaux des citoyens ? Comment concilier des ambitions nationales et européennes avec les réalités techniques et organisationnelles du système de santé, dans les équipes cliniques et de recherche, et au plus près des patients et des usagers dans nos territoires ? Ces questions sont essentielles car l’accès et l’usage des données de santé sont perçus comme des leviers majeurs pour améliorer la qualité des soins, soutenir l’innovation et renforcer la compétitivité du système de santé français. L’étude d’impact de la réforme de 2019 souligne que la transformation du système de santé devra reposer sur une meilleure prise en compte des besoins des patients et des professionnels, en favorisant les initiatives territoriales. Dans ce contexte, la France fait face à une priorité : instaurer une coordination renforcée entre les niveaux national et local, tout en préservant la confiance des usagers. Cette confiance si précieuse doit permettre d’assurer cette transition pour atteindre les objectifs nationaux et européens en matière de valorisation scientifique et économique des données.
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引用次数: 0
Ethics and clinical research: How can the Ethics Committees (CPPs) and Committees for Research Ethics (CER) evolve? 伦理与临床研究:伦理委员会(CPPs)和研究伦理委员会(CER)如何发展?
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2025-01-01 DOI: 10.1016/j.therap.2024.11.006
Driss Berdaï , Aurélie Guérin , David Pérol , Cécile Girault , Mathieu Molimard , Philippe Amiel , Hélène Beaussier , Pierre-Henri Bertoye , Catherine Cornu , Dominique Deplanque , Didier Dreyfuss , Luc Duchossoy , Cécile Fouret , Thibaud Haaser , Anne Le Louarn , Soraya Rifai , Jean-Pierre Thierry
In line with the spirit of the Giens workshops, this article reports on the recommended evolution of the Ethics Committees (CPPs) and the Committees for Research Ethics (CER) in France. These committees play a crucial role in the ethical evaluation of clinical research projects, a process that has become more complex, particularly in view of recent legislative, regulatory and methodological developments. This reflection highlights the current challenges faced by the CPPs, including the increasing workload, the complexity of the issues to be addressed and the need for better use of their resources. To address this, several recommendations are proposed. These include improving support to sponsors prior to submission, simplifying administrative tasks for CPP members and improving IT tools. The article also highlights the need for continuous evaluation of the activities of the CPPs to contribute to the quality and consistency of their opinions, as well as the importance of making this activity more attractive to qualified professionals, by offering them adequate compensation and professional recognition. For the benefit of all involved in health research, there is a strong desire to develop a single document management system accessible to all and inclusive of relevant information and document templates. Regarding the CERs, which currently operate without a legal framework, the proposition is that their development should take place under conditions of compliance with essential principles of collegiality, transparency and appropriate management of conflict of interest. Finally, it appeared necessary that the National Commission for Research Involving the Human Person (CNRIPH) be given adequate resources to carry out its tasks effectively, including the coordination of the CPPs and the development of appropriate training programs for their members. These recommendations aim to improve the operating conditions of the CPPs and CERs, ensuring the ethics of the research undertaken, as well as the quality of their results.
根据Giens研讨会的精神,本文报告了法国伦理委员会(CPPs)和研究伦理委员会(CER)的建议演变。这些委员会在临床研究项目的伦理评估中发挥关键作用,这一过程已变得更加复杂,特别是考虑到最近立法、监管和方法的发展。这一反思突出了方案协调会目前面临的挑战,包括工作量不断增加、待处理问题的复杂性以及需要更好地利用其资源。为了解决这个问题,提出了几项建议。这些措施包括改进提交前对赞助商的支持,简化CPP成员的管理任务以及改进IT工具。这篇文章还强调,需要持续评估cpp的活动,以促进其意见的质量和一致性,以及通过向合格的专业人员提供足够的报酬和专业认可,使这一活动对他们更具吸引力的重要性。为了所有参与卫生研究的人的利益,人们强烈希望开发一个所有人都可以使用的单一文件管理系统,并包括相关信息和文件模板。关于目前没有法律框架的核证审查制度,我们的主张是,它们的发展应在遵守合议、透明度和适当管理利益冲突等基本原则的条件下进行。最后,似乎有必要向涉及人的研究国家委员会(CNRIPH)提供足够的资源,以有效地执行其任务,包括协调cpp和为其成员制定适当的培训方案。这些建议旨在改善cpp和cer的操作条件,确保所进行研究的道德规范及其结果的质量。
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引用次数: 0
How can the reform of the activity-based payment system (T2A) help in financing innovative health products? 基于活动的支付系统(T2A)的改革如何有助于创新卫生产品的融资?
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2025-01-01 DOI: 10.1016/j.therap.2024.10.063
Xavier Armoiry , Nejma Saidani , Martine Aoustin , Dorothée Camus , Auriane Cano-Chancel , Sophie Carlier , Albane Degrassat-Théas , Anne-Aurélie Epis de Fleurian , Anne Grumblat , Aurélie Lavorel , Mégane Lesaignoux , Tess Martin , Adrien Michaud , Jonathan Morizot , Nathalie Préaubert , Valery-Pierre Riche , Isabelle Durand Zaleski
In France, the short-stay activities of public and private sector healthcare facilities have been financed since 2004 by activity-based pricing (T2A). The principle is to allow for payment determined primarily by the nature and volume of activities. T2A has enabled a major transformation compared to the old financing system, chiefly for public sector facilities that used to operate under a general allocation, and convergence between payment methods in the public and private sectors. However, official reports and public pronouncements by many hospital healthcare stakeholders have also highlighted the limits of this method of financing, leading to several reform projects. With that in mind, round table 3 of the Giens Workshops, including experts from academia and/or hospitals, institutions, and industry, questioned the impact of the new T2A reforms on access to innovative health care products in hospitals. After scoping out the issue and drawing up observations, the round table proposed six general recommendations that would be avenues for improving access to innovative health care products for hospital service users.
在法国,自2004年以来,公共和私营部门保健设施的短期住院活动一直采用基于活动的定价方式(T2A)。其原则是允许主要由活动的性质和数量决定的付款。与旧的融资体系相比,T2A实现了重大转变,主要是针对过去在一般拨款下运作的公共部门设施,以及公共和私营部门支付方式的融合。然而,许多医院医疗保健利益相关者的官方报告和公开声明也强调了这种融资方式的局限性,导致了几个改革项目。考虑到这一点,包括来自学术界和(或)医院、机构和产业界的专家在内的Giens讲习班圆桌会议3对T2A新改革对医院获得创新医疗保健产品的影响提出了质疑。在确定问题范围并提出意见之后,圆桌会议提出了六项一般性建议,这些建议将成为改善医院服务使用者获得创新保健产品的途径。
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引用次数: 0
Health data: Regionalised access is a priority challenge for building a secure, transparent and innovative national health data repository 卫生数据:区域获取是建立安全、透明和创新的国家卫生数据存储库的一项优先挑战。
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2025-01-01 DOI: 10.1016/j.therap.2024.12.008
Daniel Szeftel , Vianney Jouhet , Gilles Duluc , Cécile Charle-Maachi , Thomas Sejourné , Jérôme Fabiano , Hélène Guimiot , Aurore Gaignon , Caroline Germain , Quentin Demanet , Emmanuel Merieux , Thomas Rapp
France has been engaged in a legal and organisational transition for many years. It has had to adapt its national framework to the legal requirements of personal data protection, European ambitions and international competition. From the Data Protection Act of 1978 to the Healthcare System Transformation Act of 2019, reforms have strengthened requirements in terms of personal data protection, while opening the way to innovative uses. Recent European regulations, such as the AI Act (2024) and the European Health Data Area (2024), aim to reinforce this dynamic, ensuring a secure, transparent and competitive framework for the sharing and use of health data. How can we ensure that the re-use of healthcare data is truly effective, while respecting the fundamental rights of citizens? How can we reconcile national and European ambitions with the technical and organisational realities of the healthcare system, in clinical and research teams, and as close as possible to patients and users in our territories? These questions are essential, because access to and use of health data are seen as major levers for improving the quality of care, supporting innovation and boosting the competitiveness of the French healthcare system. The impact study on the 2019 reform stresses that the transformation of the healthcare system will have to be based on taking better account of the needs of patients and professionals by encouraging local initiatives. In this context, France faces a priority to establish greater coordination between the national and local levels, while preserving the trust of users. This precious trust is essential if we are to make the transition to achieving national and European objectives for the scientific and economic use of data.
多年来,法国一直在进行法律和组织上的过渡。它不得不调整其国家框架,以适应个人数据保护的法律要求、欧洲的雄心和国际竞争。从1978年的《数据保护法》到2019年的《医疗体系转型法案》,改革加强了对个人数据保护的要求,同时为创新使用开辟了道路。最近的欧洲法规,如《人工智能法》(2024年)和《欧洲卫生数据区》(2024年),旨在加强这一动态,确保共享和使用卫生数据的安全、透明和有竞争力的框架。我们如何确保医疗数据的再利用真正有效,同时尊重公民的基本权利?我们如何使国家和欧洲的雄心与医疗保健系统、临床和研究团队的技术和组织现实,以及尽可能接近我们领土上的患者和用户协调起来?这些问题至关重要,因为卫生数据的获取和使用被视为提高医疗质量、支持创新和提高法国卫生保健系统竞争力的主要杠杆。对2019年改革的影响研究强调,医疗体系的转型必须建立在鼓励地方举措、更好地考虑患者和专业人员需求的基础上。在这方面,法国面临的一个优先事项是在国家和地方各级之间建立更大的协调,同时保持用户的信任。如果我们要过渡到实现国家和欧洲在科学和经济使用数据方面的目标,这种宝贵的信任是必不可少的。
{"title":"Health data: Regionalised access is a priority challenge for building a secure, transparent and innovative national health data repository","authors":"Daniel Szeftel ,&nbsp;Vianney Jouhet ,&nbsp;Gilles Duluc ,&nbsp;Cécile Charle-Maachi ,&nbsp;Thomas Sejourné ,&nbsp;Jérôme Fabiano ,&nbsp;Hélène Guimiot ,&nbsp;Aurore Gaignon ,&nbsp;Caroline Germain ,&nbsp;Quentin Demanet ,&nbsp;Emmanuel Merieux ,&nbsp;Thomas Rapp","doi":"10.1016/j.therap.2024.12.008","DOIUrl":"10.1016/j.therap.2024.12.008","url":null,"abstract":"<div><div>France has been engaged in a legal and organisational transition for many years. It has had to adapt its national framework to the legal requirements of personal data protection, European ambitions and international competition. From the Data Protection Act of 1978 to the Healthcare System Transformation Act of 2019, reforms have strengthened requirements in terms of personal data protection, while opening the way to innovative uses. Recent European regulations, such as the AI Act (2024) and the European Health Data Area (2024), aim to reinforce this dynamic, ensuring a secure, transparent and competitive framework for the sharing and use of health data. How can we ensure that the re-use of healthcare data is truly effective, while respecting the fundamental rights of citizens? How can we reconcile national and European ambitions with the technical and organisational realities of the healthcare system, in clinical and research teams, and as close as possible to patients and users in our territories? These questions are essential, because access to and use of health data are seen as major levers for improving the quality of care, supporting innovation and boosting the competitiveness of the French healthcare system. The impact study on the 2019 reform stresses that the transformation of the healthcare system will have to be based on taking better account of the needs of patients and professionals by encouraging local initiatives. In this context, France faces a priority to establish greater coordination between the national and local levels, while preserving the trust of users. This precious trust is essential if we are to make the transition to achieving national and European objectives for the scientific and economic use of data.</div></div>","PeriodicalId":23147,"journal":{"name":"Therapie","volume":"80 1","pages":"Pages 125-134"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lactic acidosis with metformin accumulation in the intensive care units of the Nord Pas de Calais region: A known serious adverse event that can be better prevented. 乳酸酸中毒与二甲双胍积累在北加来海峡地区的重症监护病房:一个已知的严重不良事件,可以更好地预防。
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-27 DOI: 10.1016/j.therap.2024.12.009
Sophie Gautier, Julie Truong-Minh, Johana Béné, Johanna Temime, Maxime Granier, Benjamin Hennart, Sandrine Bergeron, Emmanuelle Jaillette

Objective: Metformin-associated lactic acidosis (MALA) is a rare but serious adverse drug reaction (ADR). The aim of the study was to identify clinical situations associated with the onset of MALA in patients hospitalised in the Nord Pas de Calais regional intensive care units (ICUs), and to assess its preventability.

Material and methods: We included all cases of MALA, identified by metformin accumulation >2.3mg/dL and lactate >2.2mmol/L, reported by the regional ICU physicians to the Regional Centre of Pharmacovigilance and registered in the French Pharmacovigilance Database between 1 January 2017 and 30 December 2018.

Results: One hundred and ninety-eight (198) cases of MALA were included. 38 patients died in direct association with MALA (19.2%). There was a correlation between metformin plasma accumulation and acute renal failure and with the severity of MALA (P<0.0001). All patients presented an acute intercurrent event favouring MALA, dehydration for 87 (43.9%) patients, severe infection for 65 (32.8%) patients. For 172 patients (86.7%), the prescription was not adapted to the intercurrent medical situation as recommended. Seventy (40.5%) patients consulted their general practitioner for the acute intercurrent event, 1 temporarily stopped metformin and 34.3% had been referred directly to hospital. The remaining 65.7% presented to the hospital around 4 days later due to worsening symptoms. MALA was identified as preventable in 160 patients (80.8%).

Conclusions: MALA in ICUs often follow acute dehydration or infection, and these high-risk situations must be signals to prevent this serious ADR. Specific education programmes for physicians and patients could also reduce this risk.

目的:二甲双胍相关性乳酸性酸中毒(MALA)是一种罕见但严重的药物不良反应(ADR)。该研究的目的是确定在北加来海峡地区重症监护病房(icu)住院的患者中与MALA发病相关的临床情况,并评估其可预防性。材料和方法:我们纳入了2017年1月1日至2018年12月30日期间由地区ICU医生向区域药物警戒中心报告并在法国药物警戒数据库中登记的所有MALA病例,这些病例由二甲双胍积累>2.3mg/dL和乳酸>2.2mmol/L确定。结果:共纳入198例MALA。与MALA直接相关的死亡38例(19.2%)。二甲双胍血浆积存与急性肾功能衰竭及MALA严重程度存在相关性(p)结论:icu患者MALA常伴发急性脱水或感染,这些高危情况必须作为预防严重不良反应的信号。针对医生和患者的特殊教育项目也可以降低这种风险。
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引用次数: 0
Adalimumab-induced myoclonus: A potential adverse drug reaction? 阿达木单抗诱导的肌阵挛:潜在的药物不良反应?
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-17 DOI: 10.1016/j.therap.2024.12.006
Yasmine Salem Mahjoubi, Israa Dahmani, Fatma Zgolli, Widd Kaabi, Sarrah Kastalli, Imen Aouintin, Sihem El Aidli
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引用次数: 0
Shaping the future of pharmacoepidemiology in France: Recommendations from the SFPT Pharmacoepidemiology Working Group. 塑造法国药物流行病学的未来:SFPT药物流行病学工作组的建议。
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-14 DOI: 10.1016/j.therap.2024.12.005
Thomas Soeiro, Marion Allouchery, Johana Bene, Julien Bezin, Charles Dolladille, Jean-Luc Faillie, Lamiae Grimaldi, Florentia Kaguelidou, Charles Khouri, Margaux Lafaurie, Bérenger Largeau, François Montastruc, Lucas Morin, Lucie-Marie Scailteux, Antoine Pariente

The drug authorization process is shifting towards a policy aimed at shortening time-to-market. While this policy facilitates early access to new treatments, it can also result in potentially insufficient knowledge of both efficacy and safety at the time of marketing. The latter is particularly true for long-term outcomes or in specific populations (e.g., children and the elderly). Yet, French pharmacoepidemiology is currently not designed to address these challenges, despite recognized expertise. In this context, we aim: (i) to define a strategy for strengthening pharmacoepidemiology in France; and (ii) to identify the associated human, technical, and financial requirements to ensure its success. In this paper, we present the French Pharmacoepidemiology Initiative (https://frenchpharmacoepi.org/), i.e. a network of independent academic teams to complement existing institutions. It will provide coordinated expertise and a workforce to meet national and regional needs for pharmacoepidemiological monitoring and drug-related decision-making. Leveraging the existing expertise of university hospital pharmacoepidemiology units would enable rapid operational deployment to inform the decisions and policies of national regulatory agencies.

药物授权程序正在转向旨在缩短上市时间的政策。虽然这一政策有助于尽早获得新疗法,但也可能导致在上市时对疗效和安全性的了解可能不足。对于长期结果或特定人群(如儿童和老年人)而言,后者尤其如此。然而,尽管有公认的专业知识,法国的药物流行病学目前还没有设计来应对这些挑战。在此背景下,我们的目标是:(i)确定加强法国药物流行病学的战略;(ii)确定相关的人力、技术和财务需求,以确保其成功。在本文中,我们介绍了法国药物流行病学倡议(https://frenchpharmacoepi.org/),即一个独立学术团队网络,以补充现有机构。它将提供协调一致的专门知识和工作人员,以满足国家和区域在药物流行病学监测和药物相关决策方面的需要。利用大学医院药物流行病学单位的现有专业知识,将能够快速开展业务部署,为国家监管机构的决策和政策提供信息。
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引用次数: 0
Lactulose induced maculo-papular eruption with positive rechallenge: Unusual reaction to this medication. 乳果糖诱导的斑疹丘疹阳性再挑战:对这种药物的不寻常反应。
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-11 DOI: 10.1016/j.therap.2024.12.004
Imen Bouaziz, Rim Atheymen, Khadija Sellami, Rym Sahnoun, Kamilia Ksouda, Emna Bahloul, Hanen Affes, Serria Hammami, Hamida Turki, Khaled Zghal
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引用次数: 0
Polyintoxication with cenobamate, perampanel, and carbamazepine: A complex case report. 多中毒与辛奥巴酸,perampanel和卡马西平:一个复杂的病例报告。
IF 2.2 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-05 DOI: 10.1016/j.therap.2024.12.001
Alexandre Destere, Alexandre O Gérard, Diane Merino, Elliot Ewig, Fanny Rocher, Nouha Ben Othmann, Benjamin Hennart, Jean Dellamonica, Hervé Hyvernat, Milou-Daniel Drici
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引用次数: 0
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Therapie
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