Pub Date : 2024-05-01DOI: 10.1016/j.therap.2023.07.002
Simon Verdez , Marc Bardou , Yannis Duffourd , Maxime Luu , Christel Thauvin-Robinet , Laurence Faivre , Nicolas Picard
Although French genomic medicine is reaching a turning point in its history and the implementation of genome sequencing in routine is being implemented as part of the France Genomic Medicine 2025 Plan (FGMP), many questions about secondary data management remain to be addressed. In particular, the use of pharmacogenetic (PGx) information that can be extracted from genome data is a concern. We sought to analyze the opinion of French health professionals on their desire to have access to this information. For this purpose, we created a 22-item questionnaire on the experiences, attitudes, expectations, and knowledge of French physicians and pharmacists about PGx. We collected the responses in different groups and determined a knowledge score with the last 3 questions of the questionnaire. Then, we built a prediction model for this score and determined which factors may influence it. Half of the responders were physicians (158/311) and the other half were pharmacists (153/311), and the majority of them worked in a hospital (265/311). Almost two third (62.7%, 195/311) of the responders thought that pharmacogenetic data should be communicated with genomic results for the primary indication within the framework of FGMP, and 89.1% (277/311) of them that PGx tests could be an interesting tool to optimize patients’ drug therapy in the future. Only 11.2% (35/311) of the responders reached the maximum knowledge score, while 25.4% (76/311) had already prescribed or recommended a PGx test. This study identified a need for training for French physicians and pharmacists in PGx, particularly given the interest of health professionals in it.
{"title":"Experience and expectations of pharmacogenetic tests in France","authors":"Simon Verdez , Marc Bardou , Yannis Duffourd , Maxime Luu , Christel Thauvin-Robinet , Laurence Faivre , Nicolas Picard","doi":"10.1016/j.therap.2023.07.002","DOIUrl":"10.1016/j.therap.2023.07.002","url":null,"abstract":"<div><p>Although French genomic medicine is reaching a turning point in its history and the implementation of genome sequencing in routine is being implemented as part of the France Genomic Medicine 2025 Plan (FGMP), many questions about secondary data management remain to be addressed. In particular, the use of pharmacogenetic<span> (PGx) information that can be extracted from genome data is a concern. We sought to analyze the opinion of French health professionals on their desire to have access to this information. For this purpose, we created a 22-item questionnaire on the experiences, attitudes, expectations, and knowledge of French physicians and pharmacists about PGx. We collected the responses in different groups and determined a knowledge score with the last 3 questions of the questionnaire. Then, we built a prediction model for this score and determined which factors may influence it. Half of the responders were physicians (158/311) and the other half were pharmacists (153/311), and the majority of them worked in a hospital (265/311). Almost two third (62.7%, 195/311) of the responders thought that pharmacogenetic data should be communicated with genomic results for the primary indication within the framework of FGMP, and 89.1% (277/311) of them that PGx tests could be an interesting tool to optimize patients’ drug therapy in the future. Only 11.2% (35/311) of the responders reached the maximum knowledge score, while 25.4% (76/311) had already prescribed or recommended a PGx test. This study identified a need for training for French physicians and pharmacists in PGx, particularly given the interest of health professionals in it.</span></p></div>","PeriodicalId":23147,"journal":{"name":"Therapie","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9891999","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}
Pub Date : 2024-05-01DOI: 10.1016/j.therap.2023.03.007
Yasmine Salem Mahjoubi , Imen Aouinti , Ons Charfi , Ahmed Zaiem , Widd Kaabi , Ghozlane Lakhoua , Riadh Daghfous , Sihem El Aidli
{"title":"Neurotoxicity following atezolizumab in a patient with tolerated rechallenge","authors":"Yasmine Salem Mahjoubi , Imen Aouinti , Ons Charfi , Ahmed Zaiem , Widd Kaabi , Ghozlane Lakhoua , Riadh Daghfous , Sihem El Aidli","doi":"10.1016/j.therap.2023.03.007","DOIUrl":"10.1016/j.therap.2023.03.007","url":null,"abstract":"","PeriodicalId":23147,"journal":{"name":"Therapie","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41149417","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}
Immune-mediated necrotizing myopathy (IMNM) is a form of statin myopathy characterized by the presence of antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti HMGCR).
Objectives
The aim of this study was to investigate the relationship between the different statins and the risk of IMNM.
Methods
A two-time approach was used. First, we performed a descriptive analysis of the French national pharmacovigilance database (FNPV) for the period from 1985 to december2020. To identify relevant cases, we used Medical Dictionary for Regulatory Activities (MedDRA) preferred terms (PTs) related to IMNM. We performed a quantitative and qualitative review of individual case safety reports (ICSRs) recorded in the french vigilance spontaneous reporting system. In a second time, we performed a comparative analysis with the World Health Organization global individual case safety reports database (Vigibase). The association between IMNM and statins exposure was assessed by calculating the reporting odds ratio (ROR) and its 95% confidence interval.
Results
After analysis, a total of 25 ICSRs were related to IMNM in the FNPV. The suspected statins were atorvastatin (n = 21), simvastatin (n = 2), pravastatin (n = 1) and rosuvastatin (n = 1). In Vigibase, 567 notifications were identified. A significant ROR value was found for atorvastatin, pitavastatin, simvastatin, pravastatin and rosuvastatin.
Conclusion
Atorvastatin presents the highest risk of IMNM. Our data suggest that the occurrence of IMNM is a class effect.
{"title":"Statins and immune-mediated necrotizing myopathy: Variability in the risk","authors":"Thierry Trenque , Jed Hadjoudj , Agathe Trenque , Federica Tralongo , Salomé Martin , Brahim Azzouz","doi":"10.1016/j.therap.2023.07.005","DOIUrl":"10.1016/j.therap.2023.07.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Immune-mediated necrotizing myopathy<span> (IMNM) is a form of statin<span> myopathy characterized by the presence of antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti HMGCR).</span></span></p></div><div><h3>Objectives</h3><p>The aim of this study was to investigate the relationship between the different statins and the risk of IMNM.</p></div><div><h3>Methods</h3><p>A two-time approach was used. First, we performed a descriptive analysis of the French national pharmacovigilance database (FNPV) for the period from 1985 to december2020. To identify relevant cases, we used Medical Dictionary for Regulatory Activities (MedDRA) preferred terms (PTs) related to IMNM. We performed a quantitative and qualitative review of individual case safety reports (ICSRs) recorded in the french vigilance spontaneous reporting system. In a second time, we performed a comparative analysis with the World Health Organization global individual case safety reports database (Vigibase). The association between IMNM and statins exposure was assessed by calculating the reporting odds ratio (ROR) and its 95% confidence interval.</p></div><div><h3>Results</h3><p><span>After analysis, a total of 25 ICSRs were related to IMNM in the FNPV. The suspected statins were atorvastatin (</span><em>n</em> <!-->=<!--> <span>21), simvastatin (</span><em>n</em> <!-->=<!--> <span>2), pravastatin (</span><em>n</em> <!-->=<!--> <span>1) and rosuvastatin (</span><em>n</em> <!-->=<!--> <span>1). In Vigibase, 567 notifications were identified. A significant ROR value was found for atorvastatin, pitavastatin, simvastatin, pravastatin and rosuvastatin.</span></p></div><div><h3>Conclusion</h3><p>Atorvastatin presents the highest risk of IMNM. Our data suggest that the occurrence of IMNM is a class effect.</p></div>","PeriodicalId":23147,"journal":{"name":"Therapie","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10448768","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}
La diffusion et le remboursement de stratégies ou produits de santé relèvent de la décision des pouvoirs publics et des autorités sanitaires. Dans un contexte de ressources collectives limitées et de contrainte budgétaire forte, la prise de décision quant aux produits de santé innovants et coûteux intègre non seulement des données d’efficacité, de sécurité mais aussi d’efficience. En France, plusieurs dispositifs existent et permettent la production de données médico-économiques éclairant sur l’efficience. Ils sont une opportunité de développement, de structuration et de financement de l’évaluation médico-économique. Toutefois, la multiplicité des sources de financement et les spécificités de chacune compliquent leur lisibilité. L’objectif de cet article est d’en dresser un panorama, tout en soulignant les avantages et les limites de certains d’entre eux. Il en ressort une nécessaire fluidification des interactions entre les industriels, les pouvoirs publics et les structures d’évaluation médico-économique des établissements de santé. L’enjeu est de pouvoir faire appel au dispositif le plus adapté pour produire les données pertinentes au moment le plus opportun.
Diffusion and reimbursement of healthcare strategies, drugs or medical devices are based on decisions made by public authorities and health authorities. In a situation of restricted resources and strict budget restrictions, decisions on innovative and costly health products must take into account not only efficacy and safety data, but also efficiency data. In France, generate health economics data to inform on efficiency can be obtain by different processes, resulting in an opportunity to develop, structure and finance health economic evaluation. However, the diversity of sources of funding and the specific requirements of each process make them difficult to understand. The aim of this article is to provide an overview of these sources, while highlighting their advantages and limitations. It also points the need to facilitate interaction between manufacturers, public authorities and the health economic evaluation organisations of health care institutions. The issue is to be able to mobilize the most appropriate system to produce relevant data at the most appropriate time.
{"title":"Les dispositifs de soutien à l’innovation et la structuration de l’évaluation médico-économique en France","authors":"Fanny Monmousseau , Claire Cavalin , Valéry-Pierre Riche","doi":"10.1016/j.therap.2023.09.003","DOIUrl":"10.1016/j.therap.2023.09.003","url":null,"abstract":"<div><p>La diffusion et le remboursement de stratégies ou produits de santé relèvent de la décision des pouvoirs publics et des autorités sanitaires. Dans un contexte de ressources collectives limitées et de contrainte budgétaire forte, la prise de décision quant aux produits de santé innovants et coûteux intègre non seulement des données d’efficacité, de sécurité mais aussi d’efficience. En France, plusieurs dispositifs existent et permettent la production de données médico-économiques éclairant sur l’efficience. Ils sont une opportunité de développement, de structuration et de financement de l’évaluation médico-économique. Toutefois, la multiplicité des sources de financement et les spécificités de chacune compliquent leur lisibilité. L’objectif de cet article est d’en dresser un panorama, tout en soulignant les avantages et les limites de certains d’entre eux. Il en ressort une nécessaire fluidification des interactions entre les industriels, les pouvoirs publics et les structures d’évaluation médico-économique des établissements de santé. L’enjeu est de pouvoir faire appel au dispositif le plus adapté pour produire les données pertinentes au moment le plus opportun.</p></div><div><p>Diffusion and reimbursement of healthcare strategies, drugs or medical devices are based on decisions made by public authorities and health authorities. In a situation of restricted resources and strict budget restrictions, decisions on innovative and costly health products must take into account not only efficacy and safety data, but also efficiency data. In France, generate health economics data to inform on efficiency can be obtain by different processes, resulting in an opportunity to develop, structure and finance health economic evaluation. However, the diversity of sources of funding and the specific requirements of each process make them difficult to understand. The aim of this article is to provide an overview of these sources, while highlighting their advantages and limitations. It also points the need to facilitate interaction between manufacturers, public authorities and the health economic evaluation organisations of health care institutions. The issue is to be able to mobilize the most appropriate system to produce relevant data at the most appropriate time.</p></div>","PeriodicalId":23147,"journal":{"name":"Therapie","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213867","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}
Cannabidiol (CBD) is one of the most important components of the Cannabis sativa plant with delta9-tetrahydrocannabinol (THC). CBD is used both for medical and recreational purposes. It can be of pharmaceutical grade (Epidyolex®), and also self-service purchased in pharmacy, CBD shops and on the internet (non-pharmaceutical). CBD is almost as widespread as it is poorly understood from a pharmacological point of view and particularly in terms of drug interactions. Drug-drug interactions could lead to clinical complications, and we here gather data currently available on pharmacokinetics (PK) drug-drug interactions with CBD through a narrative review. This review shows that several PK drug-drug interactions exist with different class of medications and aims to help clinicians to better know about CBD for their practice as this product is increasingly used.
{"title":"Cannabidiol and pharmacokinetics drug-drug interactions: Pharmacological toolbox","authors":"Clémence Lacroix , Romain Guilhaumou , Joëlle Micallef , Olivier Blin","doi":"10.1016/j.therap.2023.05.003","DOIUrl":"10.1016/j.therap.2023.05.003","url":null,"abstract":"<div><p><span>Cannabidiol (CBD) is one of the most important components of the </span><em>Cannabis sativa</em><span> plant with delta9-tetrahydrocannabinol (THC). CBD is used both for medical and recreational purposes. It can be of pharmaceutical grade (Epidyolex®), and also self-service purchased in pharmacy, CBD shops and on the internet (non-pharmaceutical). CBD is almost as widespread as it is poorly understood from a pharmacological point of view and particularly in terms of drug interactions. Drug-drug interactions could lead to clinical complications, and we here gather data currently available on pharmacokinetics (PK) drug-drug interactions with CBD through a narrative review. This review shows that several PK drug-drug interactions exist with different class of medications and aims to help clinicians to better know about CBD for their practice as this product is increasingly used.</span></p></div>","PeriodicalId":23147,"journal":{"name":"Therapie","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9592999","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}
Pub Date : 2024-05-01DOI: 10.1016/j.therap.2023.06.004
Elisabeth Frauger , Nathalie Fouilhé , Clémence Lacroix , Amélie Daveluy , Reynald Le Boisselier , Célian Bertin , Bruno Revol , Louise Carton , Cécile Chevalier , Céline Eiden , Valérie Gibaja , Aurélie Aquizerate , Leila Chaouachi , Emilie Bouquet , Anne Roussin , Michel Mallaret , Joëlle Micallef
Introduction
Une surveillance renforcée a été mise en place par le réseau français d’addictovigilance à la suite du premier confinement lié au coronavirus disease 2019 (COVID-19), en raison du risque d’augmentation des surdoses, notamment avec la méthadone. Dans ce contexte, une étude a été mise en place pour décrire les surdoses liées à la méthadone en 2020 au regard de l’année 2019.
Méthodes
Les surdoses liées à la méthadone ont été analysées selon deux sources : le dispositif DRAMES (décès avec analyses toxicologiques) et la base nationale de pharmacovigilance (BNPV) pour les surdoses non fatales.
Résultats
D’après les données DRAMES, la méthadone est toujours la première substance impliquée dans les décès en 2020 avec une augmentation des décès : en nombre (n = 230 en 2020 versus n = 178 en 2019), en proportion (41 % versus 35 %) et en nombre de décès pour 1000 sujets exposés (3,4 versus 2,8). D’après la BNPV, le nombre de surdoses a augmenté en 2020 par rapport à 2019 (98 versus 79 ; soit multiplié par 1,2) en particulier durant certaines périodes cibles : premier confinement, déconfinement/période estivale et deuxième confinement. En 2020, le nombre le plus important de surdoses a été observé en avril (n = 15) et mai (n = 15). Les surdoses sont survenues chez des consommateurs de méthadone dans le cadre d’un protocole de soins ou en dehors (sujets naïfs/consommateurs occasionnels ayant obtenu la méthadone via le marché de rue ou l’entourage). Les surdoses résultent de différents facteurs : surconsommation, polyconsommation avec d’autres dépresseurs ou cocaïne, injection, consommation à des fins sédatives, récréatives ou intoxication médicamenteuse volontaire.
Discussion/Conclusion
L’ensemble de ces données montre une augmentation de la morbi-mortalité liée à la méthadone pendant l’épidémie de COVID-19 en 2020. Ce phénomène a été également constaté dans d’autres pays.
Introduction
Due to the risk of overdoses increase especially with methadone, a reinforced monitoring has been set up by the French Addictovigilance Network following the first lockdown related to coronavirus disease 2019 (COVID-19). In this context, we managed a specific study to analyze overdoses related to methadone in 2020 compared to 2019.
Material and methods
We analyzed methadone-related overdoses which occurred in 2019 and 2020 from two sources: DRAMES program (deaths with toxicological analysis) and the French pharmacovigilance database (BNPV) (overdoses that did not lead to death).
Results
Data from DRAMES program in 2020 show methadone as the first drug involved in deaths as well as an increase in deaths: in number (n = 230 versus n = 178), in proportion
{"title":"Augmentation des surdoses et décès en lien avec la consommation de méthadone durant la crise sanitaire liée au COVID-19 en 2020","authors":"Elisabeth Frauger , Nathalie Fouilhé , Clémence Lacroix , Amélie Daveluy , Reynald Le Boisselier , Célian Bertin , Bruno Revol , Louise Carton , Cécile Chevalier , Céline Eiden , Valérie Gibaja , Aurélie Aquizerate , Leila Chaouachi , Emilie Bouquet , Anne Roussin , Michel Mallaret , Joëlle Micallef","doi":"10.1016/j.therap.2023.06.004","DOIUrl":"10.1016/j.therap.2023.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Une surveillance renforcée a été mise en place par le réseau français d’addictovigilance à la suite du premier confinement lié au <em>coronavirus disease 2019</em> (COVID-19), en raison du risque d’augmentation des surdoses, notamment avec la méthadone. Dans ce contexte, une étude a été mise en place pour décrire les surdoses liées à la méthadone en 2020 au regard de l’année 2019.</p></div><div><h3>Méthodes</h3><p>Les surdoses liées à la méthadone ont été analysées selon deux sources : le dispositif DRAMES (décès avec analyses toxicologiques) et la base nationale de pharmacovigilance (BNPV) pour les surdoses non fatales.</p></div><div><h3>Résultats</h3><p>D’après les données DRAMES, la méthadone est toujours la première substance impliquée dans les décès en 2020 avec une augmentation des décès : en nombre (<em>n</em> <!-->=<!--> <!-->230 en 2020 versus <em>n</em> <!-->=<!--> <!-->178 en 2019), en proportion (41 % versus 35 %) et en nombre de décès pour 1000 sujets exposés (3,4 versus 2,8). D’après la BNPV, le nombre de surdoses a augmenté en 2020 par rapport à 2019 (98 versus 79 ; soit multiplié par 1,2) en particulier durant certaines périodes cibles : premier confinement, déconfinement/période estivale et deuxième confinement. En 2020, le nombre le plus important de surdoses a été observé en avril (<em>n</em> <!-->=<!--> <!-->15) et mai (<em>n</em> <!-->=<!--> <!-->15). Les surdoses sont survenues chez des consommateurs de méthadone dans le cadre d’un protocole de soins ou en dehors (sujets naïfs/consommateurs occasionnels ayant obtenu la méthadone via le marché de rue ou l’entourage). Les surdoses résultent de différents facteurs : surconsommation, polyconsommation avec d’autres dépresseurs ou cocaïne, injection, consommation à des fins sédatives, récréatives ou intoxication médicamenteuse volontaire.</p></div><div><h3>Discussion/Conclusion</h3><p>L’ensemble de ces données montre une augmentation de la morbi-mortalité liée à la méthadone pendant l’épidémie de COVID-19 en 2020. Ce phénomène a été également constaté dans d’autres pays.</p></div><div><h3>Introduction</h3><p>Due to the risk of overdoses increase especially with methadone, a reinforced monitoring has been set up by the French Addictovigilance Network following the first lockdown related to coronavirus disease 2019 (COVID-19). In this context, we managed a specific study to analyze overdoses related to methadone in 2020 compared to 2019.</p></div><div><h3>Material and methods</h3><p>We analyzed methadone-related overdoses which occurred in 2019 and 2020 from two sources: DRAMES program (deaths with toxicological analysis) and the French pharmacovigilance database (BNPV) (overdoses that did not lead to death).</p></div><div><h3>Results</h3><p>Data from DRAMES program in 2020 show methadone as the first drug involved in deaths as well as an increase in deaths: in number (<em>n</em> <!-->=<!--> <!-->230 versus <em>n</em> <!-->=<!--> <!-->178), in proportion","PeriodicalId":23147,"journal":{"name":"Therapie","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10266982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9735398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.therap.2023.07.006
Aurélie Lacroix , Victor Puybaret , Pierre Villéger , Juliette Zattoni-Leroy , Sylvain Cantaloube , Catherine Chevalier , Philippe Nubukpo
Objectives
Opioid use disorder is a public health problem worldwide with a treatment gap partially due to sociocultural representation and stigma. Taking the opportunity of an authorization to a subcutaneous (SC) injectable solution of buprenorphine, the first and only injectable treatment for opioid dependence available in France, we investigate potential obstacles to its implementation in France.
Methods
This study aimed to define the factors predicting the acceptance of a new SC form of opiate substitution treatment (OST) by comparing the social representations using an adapted version of the Explanatory Model Interview Catalogue (EMIC) and the internalized stigma of intravenous drug injection using the Internalized Stigma of Mental Illness Inventory (ISMI) between participants receiving OST likely to accept the SC form or not. We also observed whether the fear of an opiate withdrawal syndrome could influence this choice.
Results
Fifty OST patients were included, 54% of them accepted a new SC form of OST. Perceived causes of drug injection measured with EMIC were significantly lower among participants who would not accept the new SC form. No significant difference was found regarding the total score of the adapted ISMI or its items. The fear of opiate withdrawal syndrome did not seem to be statistically related to acceptance of a long-acting SC OST in either group. The most discriminating combination of factors in predicting patient acceptance of such treatment was related to the perceived causes of drug injection associated with a severe Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5) diagnosis, and a lower alcohol consumption.
Conclusions
We observed significant differences in social representations but not in internalized stigma between the two groups. Moreover, the predictive factors linked to the acceptance of a new SC form of OST suggest a multifactorial combination of elements that will have to be tested in a larger and prospective study delivering long-acting high-dose buprenorphine.
{"title":"Predictive factors for acceptance of a long-acting opiate substitution treatment studied through social representations and internalized stigma","authors":"Aurélie Lacroix , Victor Puybaret , Pierre Villéger , Juliette Zattoni-Leroy , Sylvain Cantaloube , Catherine Chevalier , Philippe Nubukpo","doi":"10.1016/j.therap.2023.07.006","DOIUrl":"10.1016/j.therap.2023.07.006","url":null,"abstract":"<div><h3>Objectives</h3><p>Opioid use disorder is a public health problem worldwide with a treatment gap partially due to sociocultural representation and stigma. Taking the opportunity of an authorization to a subcutaneous (SC) injectable solution of buprenorphine<span>, the first and only injectable treatment for opioid dependence available in France, we investigate potential obstacles to its implementation in France.</span></p></div><div><h3>Methods</h3><p>This study aimed to define the factors predicting the acceptance of a new SC form of opiate substitution treatment (OST) by comparing the social representations using an adapted version of the Explanatory Model Interview Catalogue (EMIC) and the internalized stigma of intravenous drug injection using the Internalized Stigma of Mental Illness Inventory (ISMI) between participants receiving OST likely to accept the SC form or not. We also observed whether the fear of an opiate withdrawal syndrome could influence this choice.</p></div><div><h3>Results</h3><p>Fifty OST patients were included, 54% of them accepted a new SC form of OST. Perceived causes of drug injection measured with EMIC were significantly lower among participants who would not accept the new SC form. No significant difference was found regarding the total score of the adapted ISMI or its items. The fear of opiate withdrawal syndrome did not seem to be statistically related to acceptance of a long-acting SC OST in either group. The most discriminating combination of factors in predicting patient acceptance of such treatment was related to the perceived causes of drug injection associated with a severe Diagnostic and Statistical Manual of Mental Disorders 5th version (DSM-5) diagnosis, and a lower alcohol consumption.</p></div><div><h3>Conclusions</h3><p>We observed significant differences in social representations but not in internalized stigma between the two groups. Moreover, the predictive factors linked to the acceptance of a new SC form of OST suggest a multifactorial combination of elements that will have to be tested in a larger and prospective study delivering long-acting high-dose buprenorphine.</p></div>","PeriodicalId":23147,"journal":{"name":"Therapie","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073290","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}
Pub Date : 2024-05-01DOI: 10.1016/j.therap.2023.07.004
Julien Gouju , Charles Jourdan , Samuel Legeay
Contexte
Entre 1975 et 2014, le nombre de personnes souffrant d’obésité a triplé, jusqu’à atteindre 17 % de la population adulte en France et plus de 35 % aux États-Unis. L’obésité se définit par un indice de masse corporelle (IMC) > 30 kg/m2 et se caractérise par une accumulation importante de tissu adipeux responsable de l’augmentation du poids. Cette accumulation entraîne des changements physiologiques capables de modifier la pharmacocinétique des médicaments pouvant conduire à l’administration de doses inappropriées. Pour cette raison, certains des ajustements posologiques significatifs sont nécessaires chez le patient obèse. Cependant, les données sur ces adaptations sont peu accessibles et parfois complexes à mettre en œuvre en pratique.
Objectif
Proposer un nouvel outil en ligne permettant de calculer un ajustement de la dose d’un médicament à administrer à un patient obèse.
Méthodes
(i) réalisation d’une recherche bibliographique extensive selon la méthodologie PRISMA ; et (ii) développement d’un outil en ligne proposant une dose ajustée pour les patients obèses.
Résultats
Dans un premier temps, 49 revues de la littérature ont été évaluées concernant l’adaptation de la posologie des médicaments chez les patients obèses puis, dans un deuxième temps, 319 articles ont été sélectionnés. Parmi ces 319 articles, 204 ont été inclus dans la base de données afin de fournir des informations d’adaptation de posologie pour 84 molécules et modalités d’administration incluant des antibiotiques, des antifongiques, des anticoagulants ou encore des cytotoxiques. Cette base de données a été rendue accessible à travers le développement d’un calculateur utilisable sur le site internet Adapt’Obese. Ainsi, grâce au sexe, à la taille et au poids du patient obèse, l’outil propose au praticien une adaptation personnalisée du médicament à administrer au patient obèse.
Perspectives
D’autres principes actifs seront ajoutés prochainement, et des améliorations des fonctionnalités sont envisagées dans le but d’adapter les posologies chez le patient obèse, comme cela peut être réalisé chez les patients insuffisants rénaux.
Background
Between 1975 and 2014, the number of people suffering from obesity tripled, reaching 17% of the adult population in France and more than 35% in the United States. Obesity is defined by a Body Mass Index (BMI) > 30 kg/m2 and characterized by a significant accumulation of adipose tissue responsible for the increase in weight. This accumulation leads to physiological changes capable of modifying the pharmacokinetics of drugs, which can lead to the administration of inappropriate doses. For this reason, some significant dosage adjustments are necessary for obese patients. However, data on these adaptations are not easil
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